- Email: [email protected]
Conflicts Within the Discipline of Nursing: Is There a Looming Paradigm War?
Journal of Professional Nursing xxx (xxxx) xxx–xxx
Contents lists available at ScienceDirect
Journal of Professional Nursing journal homepage: www.elsevier.com/locate/jpnu
Conflicts Within the Discipline of Nursing: Is There a Looming Paradigm War? Maureen E. Groera, , John M. Clochesyb ⁎
a b
University of South Florida College of Nursing, United States of America University of Miami School of Nursing and Health Studies, United States of America
ARTICLE INFO
ABSTRACT
Keywords: Kuhn Paradigm Discipline Conflicts Doctorates Faculty
This paper presents a view of the current sources of potential conflicts in the academic discipline of nursing. It suggests that these conflicts could lead, in the Kuhnian sense, to a paradigm war. The differing paradigms underlying the education and traditions of the PhD prepared nurse scientist/researcher/scholar and the DNP prepared nurse practitioner are a challenge for the discipline. DNP programs are swelling and faculty are needed to teach in these programs, and their position with regard to the usual rank and tenure structures of academe are not yet clear. Concern arises when the tenured PhD nurse scientist faculty numbers drop as the DNP faculty numbers increase. The body of nursing science is threatened as fewer students enter PhD programs and faculty retire. The DNP faculty paradigm does not provide for the rigor and preparation need to carry forward the disciplinary scientific knowledge mission. Rather than a fruitless war between the two paradigms, ways are suggested to fully embrace the differences as important to nursing, and to increase the number of PhD prepared nurse scientists.
Philosophical background Thomas Kuhn provided a view of scientific change through a sociological perspective in his influential book, first published in 1962, The Structure of Scientific Revolutions. Kuhn's basic idea was that science has historically changed through a series of revolutions. In his view, one research tradition (or paradigm) supplants the previous one and is incommensurable with the previous paradigm. A paradigm is a set of assumptions about entities in the world, how these entities interact, and assumptions about methods for construction and testing theories about these entities (Laudan, 1978). As anomalies arise within the paradigm, the community of scholars within the research tradition tends to ignore or discount anomalies and continue doing “normal science” (Kuhn, 2012). The nature of the work within the paradigm was referred to by Kuhn as “puzzle solving” or “mopping up”. In a way, the scientists within the paradigm were blind to any other way of thinking and studying nature. A breakaway group within the paradigm begins to see the problems to solve and the approaches used to be incompatible with the way the paradigm directs them. They suggest that the paradigm is no longer useful, and a new incommensurable paradigm arises, and a paradigm “war” arises. The new paradigm, or world view, which emerges after a period of time does not enfold the old paradigm and Kuhn described this as a scientific revolution. His book gives many ⁎
historical examples of these revolutions. When a new or competing paradigm emerges, it survives and grows because it can solve puzzles that could not be solved in the old paradigm. This revolutionary view has been challenged as being vague, superficial and not accounting for the more likely gradual effects of anomalies on normal science (Fuller, 2001). Nevertheless, the idea that paradigms help to solve problems and can compete with each other is of relevance to the discipline of nursing. The academic nursing science paradigm For nursing science, we have a research tradition (paradigm) founded initially on many other disciplinary theories and perspectives, or on nursing theories that were largely impractical guides for research. Nurses prepared in other disciplines brought approaches to knowledge generation to bear as the discipline split from the profession, moving education and research into the university. This is similar to Snow's reflection on the nature of two cultures, in nursing's case scientific inquiry (discipline) and clinical practice (profession) (Snow, 1959). Academically derived nursing science emerges from both theoretical, qualitative, phenomenological and empirical research and scholarship and is developing its own particular and evolving paradigm about humans, health care and health. This disciplinary paradigm is somewhat
Corresponding author at: USF College of Nursing, 12910 Bruce B. Downs Blvd., Tampa, FL 33612, United States of America. E-mail address: [email protected] (M.E. Groer).
https://doi.org/10.1016/j.profnurs.2019.06.014 Received 26 November 2018; Received in revised form 21 June 2019; Accepted 27 June 2019 8755-7223/ © 2019 Elsevier Inc. All rights reserved.
Please cite this article as: Maureen E. Groer and John M. Clochesy, Journal of Professional Nursing, https://doi.org/10.1016/j.profnurs.2019.06.014
Journal of Professional Nursing xxx (xxxx) xxx–xxx
M.E. Groer and J.M. Clochesy
fluid and emerging as nursing is, comparatively, a very new academic discipline and the paradigm's genesis is emerging from the science and understandings generated by the academic discipline of nursing within the universities across the world. Some would argue that nursing is a practice discipline unique from most other academic disciplines, as the knowledge generated by nurse scientists must be developed and disseminated, but also translatable into practice. But nursing must be considered as building a body of disciplinary knowledge about phenomenon of importance not only to nursing but also to other disciplines. Translation of that knowledge may take many years of work. Knowledge generated about both health and illness is of interest to many disciplines. Health care requires that the knowledge we generate as nurse scientists be broadly applicable in the 21st century.
the tenure track and tenured faculty. Grants related to practice/ teaching scholarship are not available in the same way as scientific grants are available to the tenured faculty and do not generally hold the same valence. What can this faculty contribute to nursing science, when, in fact, the majority of their time is spent in the scholarship of teaching? Salient to this question is a recent AACN Position statement addressed the defining of scholarship for academic nursing (https:// www.aacnnursing.org/News-Information/Position-Statements-WhitePapers/Defining-Scholarship-Nursing). Scholarship is defined as scholarship of discovery, scholarship of practice and scholarship of teaching. There are clear delineations of the forms these separate categories take. Scholarship of discovery includes empirical work and, importantly, implementation science. The latter requires the rigor of science, and the preparation appropriate to carry out this work, and that is the domain of the PhD prepared scientist. The DNP prepared scholar advances the scholarship of practice by implementing evidence-based practices. The major role of the DNP prepared nurse could be translation of the science into practice, but this is not an easy role, when their practice arena becomes the university. And the great concern for nursing as an academic discipline, housed within universities and colleges, is that the pipeline of new PhDs to assume ranked and tenured faculty roles and continue to build the emerging science of nursing is shrinking. At the national level, the average number of PhD nursing students is less than one quarter of the DNP student enrollment. This is beginning to translate into more DNP than PhD prepared graduates applying to universities for academic positions.
Threats to the current paradigm It is the thesis of this paper that nursing's current paradigm is threatened by a new paradigm that supports DNP doctoral preparation in nursing. We do not argue about the need for and utility of new doctoral prepared nurses, particularly nurse practitioners, but rather what this preparation could do to the educational enterprise that supports the discipline. There are two major underpinning concerns. The first is the shrinking pipeline of PhD prepared nurse scientists and the looming retirement of many academic nurse scientists. Nursing scientists generate the knowledge that supports the scientific paradigm of the discipline. This knowledge can, of course, emerge from clinical trials research, laboratory research, phenomenological studies and other forms of scholarship, but they consist of studies that are conceived of, and carried out by, PhD prepared nurse scientists. The second threat is related to the concerns, goals, and outcomes of the academic community, as the number of Ph.D. faculty continue to be reduced in proportion to the DNP prepared faculty, who are needed to teach the growing numbers of DNP students. Nursing has determined that there is a need for both the PhD preparation for the nurse scientist and the professional doctorate (Doctor of Nursing Practice) for the advanced practitioner. This decision has led to significant changes in the academic environment as entry into DNP program explodes while PhD enrollment is dropping. The National Institute for Nursing Research (NINR) in collaboration with the American Association of Colleges of Nursing (AACN) recently held an invitational discussion, Sustaining the Science, the PhD pipeline in Nursing (https://www.aacnnursing.org/ Portals/42/News/Surveys-Data/PhD-Pipeline.pdf). They noted a 9.6% decline in PhD enrollment in Nursing programs that began in 2014. Of concern, the number of PhD faculty is also declining and the average age of this group is 56 years old. From 2017 to 2018, the number of students enrolled in DNP programs increased from 29,093 to 32,678. During that same period, the number of DNP graduates increased from 6090 to 7039 (http://www. aacnnursing.org/News-Information/Fact-Sheets/DNP-Fact-Sheet). DNP graduates are prepared for advanced nursing practice. The issue at hand is that many of the expert practitioner graduates of DNP programs are migrating into academic positions. Faculty are needed in order to provide the swelling DNP student body with the practice-based knowledge that is needed for advanced clinical work. The DNP education does not prepare an individual for scholarly endeavors typically associated with university rank, including competing for extramural research funds. Yet, DNP prepared faculty are generally ranked.
Is a paradigm war looming? A paradigm war occurs when a new paradigm threatens to supplant the old paradigm and people immersed in either have to take a contradictory stance. The potential for a paradigm war in nursing exists if the membership and structure of the academy significantly changes when a new paradigm of science emerges that is incommensurable with the old paradigm. As the number of DNP prepared faculty increases, a certain tension and conflict has begun to emerge. There are fundamental underlying beliefs, values, goals and principles in the worldviews (i.e.; paradigms) of both DNP and PhD prepared faculty, but these paradigms may produce conflict. There is a lack of understanding about roles of DNP faculty, confusion about research, collaboration, supports and resources needed, and personal characteristics and attitudes that differ between the two faculty types (Staffileno, Murphy, & Carlson, 2017). It is possible that ranked, tenured faculty may soon be outnumbered by DNP prepared non-tenured faculty in nursing academic units where the DNP program is offered. The reasons for this change in faculty composition are manifold. A recent study reported that one third of the current 2015 nursing faculty will retire between 2016 and 2025 (Fang & Kesten, 2017). Some see the DNP prepared nurse as a major solution to the faculty numbers as the shortage grows (Tyczkowski & Reilly, 2017). DNP prepared individuals will need to accept the significantly lower salaries offered in the academic compared to the clinical world (Kelly, 2010). Furthermore, the paradigm of the DNP graduate is one of devotion to practice excellence, not to discovery or teaching and the education does not produce a natural socialization into the scholarship intrinsic to the academy (Ketefian & Redman, 2015). Yet 55% of DNP students expressed their career aspiration to be a faculty position, even in the face of lower salaries (Loomis, Willard, & Cohen, 2006). So, the numbers of DNP faculty will likely rise as the number of PhD prepared faculty drops. Decisions at all levels within academy will be influenced by new and different perspectives if faculty composition changes dramatically. This could have a direct effect on nursing science and scholarly thinking. This is the new paradigm that is potentially threatening the old paradigm. Faculty contributions to nursing science knowledge generation could be thwarted as the numbers of truly academically prepared PhD faculty researchers and scientists fall, and the mission and vision of schools
Potential paradigmatic conflicts As ranked faculty in non-tenure tracks within collegiate programs they are expected to produce scholarly works for promotion or job retention. The scholarship is expected to be related to the practice arena, but if the faculty member is in a fulltime position, he or she may lack the resources and time to carry out scholarship related to practice. Teaching loads are generally higher for these individuals, compared to 2
Journal of Professional Nursing xxx (xxxx) xxx–xxx
M.E. Groer and J.M. Clochesy
Where will the academic faculty of the future come from if students don't ever get introduced to nursing science? We have a responsibility to the discipline to educate undergraduate students about both pathways to the doctoral degree. New ways to prepare scholars for the academy are needed. Collaboration between program, students and faculty may address some of the confusion early in the educational programs (Eaton, Gordon, & Doorenbos, 2017). As there is now a large number of DNP graduates, it may be useful to develop DNP to PhD tracks to better equip those entering the academy with the knowledge and skills expected. Another possibility is to develop integrated PhDDNP programs. We must share our excitement and fulfillment as nurse scientists, highlight nursing science to our undergraduates, and provide many opportunities for students to understand research and the joys of a research career. And we need to seek resources to support the future nurse scientists through their development and early career. Otherwise the growth of nursing science will be threatened and the years of science development in the discipline lost.
could potentially move towards a professional perspective rather than that of an academic discipline. Our view that the paradigm for nursing science should continue to embrace the current historical rank and tenure system may be viewed by some as elitist and they would argue that a system based on only the scholarship of discovery is an outdated system. Without demeaning other kinds of scholarly work, we endorse that scientific discovery developed through rigorous scholarly work by truly academic PhD prepared nurse scientists must be held to the same standards as other academic disciplines and tenure, at least in part, assures that. This is not incommensurable with the emerging DNP education and function. The time line for the existence of nursing as a discipline is short; we have only been in the academy as a full-fledged member for 3 or 4 decades. The Ph.D. in nursing was a rare offering in universities until the 70s. We are an extremely young discipline and we have struggled to achieve recognition and respect in the academy. But we now face a “tipping point”. We will continue to grow the DNP, which will supplant the master's degree. We must acknowledge that this preparation does not build nursing science in the empirical sense. This does not mean that we must undergo paradigm shift. Warring with the DNP is not the answer. We need to acknowledge the need for rigorous development of science to support the DNP in practice, without the need for DNPs to actually engage in research. We must find ways to collaborate with each other for the betterment of our educational enterprises and for patients' health. Empiricism and scholarship as the scientific basis for new knowledge generation by nursing remains the goal of the discipline, but the need for translation of the science into practice and scientific approaches to study the implementation are recent imperatives that require PhD/DNP collaboration to be successful. But we also need to stand firm in the academy to clarify and preserve traditions about rank and tenure. Otherwise the growth of nursing science will be threatened and the years of science development in the discipline will be thwarted
References Eaton, L. H., Gordon, D. B., & Doorenbos, A. Z. (2017). Innovation in learning: PhD and DNP student collaborations. Journal of Nursing Education, 56(9), 556–559. https:// doi.org/10.3928/01484834-20170817-08. Fang, D., & Kesten, K. (2017). Retirements and succession of nursing faculty in 20162025. Nursing Outlook, 65(5), 633–642. https://doi.org/10.1016/j.outlook.2017.03. 003. Fuller, S. (2001). Thomas Kuhn: Philosophical history for our times. Chicago: University of Chicago Press. Kelly, K. (2010). Is the DNP the answer to the nursing faculty shortage? Not likely!. Nursing Forum, 45(4), 266–270. https://doi.org/10.1111/j.1744-6198.2010.00197.x. Ketefian, S., & Redman, R. W. (2015). A critical examination of developments in nursing doctoral education in the United States. Revista Latino-Americana de Enfermagem, 23(3), 363–371. https://doi.org/10.1590/0104-1169.0797.2566. Kuhn, T. (2012). The structure of scientific revolution (4th ed.). Chicago: University of Chicago. Laudan, L. (1978). Progress and its problems (1st ed.). Berkeley, CA: University of California press. Loomis, J. A., Willard, B., & Cohen, J. (2006). Difficult professional choices: Deciding between the PhD and the DNP in nursing. Online Journal of Issues in Nursing, 12(1), 6. Snow, C. P. (1959). The two cultures and the scientific revolution. New York: The Syndics of the Cambridge University Press. Staffileno, B. A., Murphy, M. P., & Carlson, E. (2017). Determinants for effective collaboration among DNP- and PhD-prepared faculty. Nursing Outlook, 65(1), 94–102. https://doi.org/10.1016/j.outlook.2016.08.003. Tyczkowski, B. L., & Reilly, J. (2017). DNP-prepared nurse leaders: Part of the solution to the growing faculty shortage. Journal of Nursing Administration, 47(7–8), 359–360. https://doi.org/10.1097/nna.0000000000000494.
Preserving the paradigms We must work to capture the imagination, fervor, and ambition of our young nursing students, so that they will build the ranks of the PhD prepared faculty, as the currently aging sector is lost. Many times, students are really not sure about their career directions when thinking about graduate school, and the DNP program may seem attractive for a variety of reasons. The AACN invited discussion in August of 2018 made a series of important recommendations for students, academic institutions, and resources (https://www.aacnnursing.org/Portals/42/ News/Surveys-Data/PhD-Pipeline.pdf). A major thrust that was recommended was to identify and excite nurses with a proclivity towards research, with peer connections and mentoring, and to find ways to highlight and make more visible the importance of nursing science. Many schools no longer offer nursing research as a graduate course, but rather a course in evidence-based practice as an equivalent course.
Web references http://www.aacnnursing.org/News-Information/Fact-Sheets/DNP-Fact-Sheet. https://www.aacnnursing.org/News-Information/Position-Statements-White-Papers/ Defining-Scholarship-Nursing. https://www.aacnnursing.org/Portals/42/News/Surveys-Data/PhD-Pipeline.pdf. https://www.aacnnursing.org/Portals/42/News/Surveys-Data/PhD-Pipeline.pdf.
3
Contents lists available at ScienceDirect
Journal of Professional Nursing journal homepage: www.elsevier.com/locate/jpnu
Conflicts Within the Discipline of Nursing: Is There a Looming Paradigm War? Maureen E. Groera, , John M. Clochesyb ⁎
a b
University of South Florida College of Nursing, United States of America University of Miami School of Nursing and Health Studies, United States of America
ARTICLE INFO
ABSTRACT
Keywords: Kuhn Paradigm Discipline Conflicts Doctorates Faculty
This paper presents a view of the current sources of potential conflicts in the academic discipline of nursing. It suggests that these conflicts could lead, in the Kuhnian sense, to a paradigm war. The differing paradigms underlying the education and traditions of the PhD prepared nurse scientist/researcher/scholar and the DNP prepared nurse practitioner are a challenge for the discipline. DNP programs are swelling and faculty are needed to teach in these programs, and their position with regard to the usual rank and tenure structures of academe are not yet clear. Concern arises when the tenured PhD nurse scientist faculty numbers drop as the DNP faculty numbers increase. The body of nursing science is threatened as fewer students enter PhD programs and faculty retire. The DNP faculty paradigm does not provide for the rigor and preparation need to carry forward the disciplinary scientific knowledge mission. Rather than a fruitless war between the two paradigms, ways are suggested to fully embrace the differences as important to nursing, and to increase the number of PhD prepared nurse scientists.
Philosophical background Thomas Kuhn provided a view of scientific change through a sociological perspective in his influential book, first published in 1962, The Structure of Scientific Revolutions. Kuhn's basic idea was that science has historically changed through a series of revolutions. In his view, one research tradition (or paradigm) supplants the previous one and is incommensurable with the previous paradigm. A paradigm is a set of assumptions about entities in the world, how these entities interact, and assumptions about methods for construction and testing theories about these entities (Laudan, 1978). As anomalies arise within the paradigm, the community of scholars within the research tradition tends to ignore or discount anomalies and continue doing “normal science” (Kuhn, 2012). The nature of the work within the paradigm was referred to by Kuhn as “puzzle solving” or “mopping up”. In a way, the scientists within the paradigm were blind to any other way of thinking and studying nature. A breakaway group within the paradigm begins to see the problems to solve and the approaches used to be incompatible with the way the paradigm directs them. They suggest that the paradigm is no longer useful, and a new incommensurable paradigm arises, and a paradigm “war” arises. The new paradigm, or world view, which emerges after a period of time does not enfold the old paradigm and Kuhn described this as a scientific revolution. His book gives many ⁎
historical examples of these revolutions. When a new or competing paradigm emerges, it survives and grows because it can solve puzzles that could not be solved in the old paradigm. This revolutionary view has been challenged as being vague, superficial and not accounting for the more likely gradual effects of anomalies on normal science (Fuller, 2001). Nevertheless, the idea that paradigms help to solve problems and can compete with each other is of relevance to the discipline of nursing. The academic nursing science paradigm For nursing science, we have a research tradition (paradigm) founded initially on many other disciplinary theories and perspectives, or on nursing theories that were largely impractical guides for research. Nurses prepared in other disciplines brought approaches to knowledge generation to bear as the discipline split from the profession, moving education and research into the university. This is similar to Snow's reflection on the nature of two cultures, in nursing's case scientific inquiry (discipline) and clinical practice (profession) (Snow, 1959). Academically derived nursing science emerges from both theoretical, qualitative, phenomenological and empirical research and scholarship and is developing its own particular and evolving paradigm about humans, health care and health. This disciplinary paradigm is somewhat
Corresponding author at: USF College of Nursing, 12910 Bruce B. Downs Blvd., Tampa, FL 33612, United States of America. E-mail address: [email protected] (M.E. Groer).
https://doi.org/10.1016/j.profnurs.2019.06.014 Received 26 November 2018; Received in revised form 21 June 2019; Accepted 27 June 2019 8755-7223/ © 2019 Elsevier Inc. All rights reserved.
Please cite this article as: Maureen E. Groer and John M. Clochesy, Journal of Professional Nursing, https://doi.org/10.1016/j.profnurs.2019.06.014
Journal of Professional Nursing xxx (xxxx) xxx–xxx
M.E. Groer and J.M. Clochesy
fluid and emerging as nursing is, comparatively, a very new academic discipline and the paradigm's genesis is emerging from the science and understandings generated by the academic discipline of nursing within the universities across the world. Some would argue that nursing is a practice discipline unique from most other academic disciplines, as the knowledge generated by nurse scientists must be developed and disseminated, but also translatable into practice. But nursing must be considered as building a body of disciplinary knowledge about phenomenon of importance not only to nursing but also to other disciplines. Translation of that knowledge may take many years of work. Knowledge generated about both health and illness is of interest to many disciplines. Health care requires that the knowledge we generate as nurse scientists be broadly applicable in the 21st century.
the tenure track and tenured faculty. Grants related to practice/ teaching scholarship are not available in the same way as scientific grants are available to the tenured faculty and do not generally hold the same valence. What can this faculty contribute to nursing science, when, in fact, the majority of their time is spent in the scholarship of teaching? Salient to this question is a recent AACN Position statement addressed the defining of scholarship for academic nursing (https:// www.aacnnursing.org/News-Information/Position-Statements-WhitePapers/Defining-Scholarship-Nursing). Scholarship is defined as scholarship of discovery, scholarship of practice and scholarship of teaching. There are clear delineations of the forms these separate categories take. Scholarship of discovery includes empirical work and, importantly, implementation science. The latter requires the rigor of science, and the preparation appropriate to carry out this work, and that is the domain of the PhD prepared scientist. The DNP prepared scholar advances the scholarship of practice by implementing evidence-based practices. The major role of the DNP prepared nurse could be translation of the science into practice, but this is not an easy role, when their practice arena becomes the university. And the great concern for nursing as an academic discipline, housed within universities and colleges, is that the pipeline of new PhDs to assume ranked and tenured faculty roles and continue to build the emerging science of nursing is shrinking. At the national level, the average number of PhD nursing students is less than one quarter of the DNP student enrollment. This is beginning to translate into more DNP than PhD prepared graduates applying to universities for academic positions.
Threats to the current paradigm It is the thesis of this paper that nursing's current paradigm is threatened by a new paradigm that supports DNP doctoral preparation in nursing. We do not argue about the need for and utility of new doctoral prepared nurses, particularly nurse practitioners, but rather what this preparation could do to the educational enterprise that supports the discipline. There are two major underpinning concerns. The first is the shrinking pipeline of PhD prepared nurse scientists and the looming retirement of many academic nurse scientists. Nursing scientists generate the knowledge that supports the scientific paradigm of the discipline. This knowledge can, of course, emerge from clinical trials research, laboratory research, phenomenological studies and other forms of scholarship, but they consist of studies that are conceived of, and carried out by, PhD prepared nurse scientists. The second threat is related to the concerns, goals, and outcomes of the academic community, as the number of Ph.D. faculty continue to be reduced in proportion to the DNP prepared faculty, who are needed to teach the growing numbers of DNP students. Nursing has determined that there is a need for both the PhD preparation for the nurse scientist and the professional doctorate (Doctor of Nursing Practice) for the advanced practitioner. This decision has led to significant changes in the academic environment as entry into DNP program explodes while PhD enrollment is dropping. The National Institute for Nursing Research (NINR) in collaboration with the American Association of Colleges of Nursing (AACN) recently held an invitational discussion, Sustaining the Science, the PhD pipeline in Nursing (https://www.aacnnursing.org/ Portals/42/News/Surveys-Data/PhD-Pipeline.pdf). They noted a 9.6% decline in PhD enrollment in Nursing programs that began in 2014. Of concern, the number of PhD faculty is also declining and the average age of this group is 56 years old. From 2017 to 2018, the number of students enrolled in DNP programs increased from 29,093 to 32,678. During that same period, the number of DNP graduates increased from 6090 to 7039 (http://www. aacnnursing.org/News-Information/Fact-Sheets/DNP-Fact-Sheet). DNP graduates are prepared for advanced nursing practice. The issue at hand is that many of the expert practitioner graduates of DNP programs are migrating into academic positions. Faculty are needed in order to provide the swelling DNP student body with the practice-based knowledge that is needed for advanced clinical work. The DNP education does not prepare an individual for scholarly endeavors typically associated with university rank, including competing for extramural research funds. Yet, DNP prepared faculty are generally ranked.
Is a paradigm war looming? A paradigm war occurs when a new paradigm threatens to supplant the old paradigm and people immersed in either have to take a contradictory stance. The potential for a paradigm war in nursing exists if the membership and structure of the academy significantly changes when a new paradigm of science emerges that is incommensurable with the old paradigm. As the number of DNP prepared faculty increases, a certain tension and conflict has begun to emerge. There are fundamental underlying beliefs, values, goals and principles in the worldviews (i.e.; paradigms) of both DNP and PhD prepared faculty, but these paradigms may produce conflict. There is a lack of understanding about roles of DNP faculty, confusion about research, collaboration, supports and resources needed, and personal characteristics and attitudes that differ between the two faculty types (Staffileno, Murphy, & Carlson, 2017). It is possible that ranked, tenured faculty may soon be outnumbered by DNP prepared non-tenured faculty in nursing academic units where the DNP program is offered. The reasons for this change in faculty composition are manifold. A recent study reported that one third of the current 2015 nursing faculty will retire between 2016 and 2025 (Fang & Kesten, 2017). Some see the DNP prepared nurse as a major solution to the faculty numbers as the shortage grows (Tyczkowski & Reilly, 2017). DNP prepared individuals will need to accept the significantly lower salaries offered in the academic compared to the clinical world (Kelly, 2010). Furthermore, the paradigm of the DNP graduate is one of devotion to practice excellence, not to discovery or teaching and the education does not produce a natural socialization into the scholarship intrinsic to the academy (Ketefian & Redman, 2015). Yet 55% of DNP students expressed their career aspiration to be a faculty position, even in the face of lower salaries (Loomis, Willard, & Cohen, 2006). So, the numbers of DNP faculty will likely rise as the number of PhD prepared faculty drops. Decisions at all levels within academy will be influenced by new and different perspectives if faculty composition changes dramatically. This could have a direct effect on nursing science and scholarly thinking. This is the new paradigm that is potentially threatening the old paradigm. Faculty contributions to nursing science knowledge generation could be thwarted as the numbers of truly academically prepared PhD faculty researchers and scientists fall, and the mission and vision of schools
Potential paradigmatic conflicts As ranked faculty in non-tenure tracks within collegiate programs they are expected to produce scholarly works for promotion or job retention. The scholarship is expected to be related to the practice arena, but if the faculty member is in a fulltime position, he or she may lack the resources and time to carry out scholarship related to practice. Teaching loads are generally higher for these individuals, compared to 2
Journal of Professional Nursing xxx (xxxx) xxx–xxx
M.E. Groer and J.M. Clochesy
Where will the academic faculty of the future come from if students don't ever get introduced to nursing science? We have a responsibility to the discipline to educate undergraduate students about both pathways to the doctoral degree. New ways to prepare scholars for the academy are needed. Collaboration between program, students and faculty may address some of the confusion early in the educational programs (Eaton, Gordon, & Doorenbos, 2017). As there is now a large number of DNP graduates, it may be useful to develop DNP to PhD tracks to better equip those entering the academy with the knowledge and skills expected. Another possibility is to develop integrated PhDDNP programs. We must share our excitement and fulfillment as nurse scientists, highlight nursing science to our undergraduates, and provide many opportunities for students to understand research and the joys of a research career. And we need to seek resources to support the future nurse scientists through their development and early career. Otherwise the growth of nursing science will be threatened and the years of science development in the discipline lost.
could potentially move towards a professional perspective rather than that of an academic discipline. Our view that the paradigm for nursing science should continue to embrace the current historical rank and tenure system may be viewed by some as elitist and they would argue that a system based on only the scholarship of discovery is an outdated system. Without demeaning other kinds of scholarly work, we endorse that scientific discovery developed through rigorous scholarly work by truly academic PhD prepared nurse scientists must be held to the same standards as other academic disciplines and tenure, at least in part, assures that. This is not incommensurable with the emerging DNP education and function. The time line for the existence of nursing as a discipline is short; we have only been in the academy as a full-fledged member for 3 or 4 decades. The Ph.D. in nursing was a rare offering in universities until the 70s. We are an extremely young discipline and we have struggled to achieve recognition and respect in the academy. But we now face a “tipping point”. We will continue to grow the DNP, which will supplant the master's degree. We must acknowledge that this preparation does not build nursing science in the empirical sense. This does not mean that we must undergo paradigm shift. Warring with the DNP is not the answer. We need to acknowledge the need for rigorous development of science to support the DNP in practice, without the need for DNPs to actually engage in research. We must find ways to collaborate with each other for the betterment of our educational enterprises and for patients' health. Empiricism and scholarship as the scientific basis for new knowledge generation by nursing remains the goal of the discipline, but the need for translation of the science into practice and scientific approaches to study the implementation are recent imperatives that require PhD/DNP collaboration to be successful. But we also need to stand firm in the academy to clarify and preserve traditions about rank and tenure. Otherwise the growth of nursing science will be threatened and the years of science development in the discipline will be thwarted
References Eaton, L. H., Gordon, D. B., & Doorenbos, A. Z. (2017). Innovation in learning: PhD and DNP student collaborations. Journal of Nursing Education, 56(9), 556–559. https:// doi.org/10.3928/01484834-20170817-08. Fang, D., & Kesten, K. (2017). Retirements and succession of nursing faculty in 20162025. Nursing Outlook, 65(5), 633–642. https://doi.org/10.1016/j.outlook.2017.03. 003. Fuller, S. (2001). Thomas Kuhn: Philosophical history for our times. Chicago: University of Chicago Press. Kelly, K. (2010). Is the DNP the answer to the nursing faculty shortage? Not likely!. Nursing Forum, 45(4), 266–270. https://doi.org/10.1111/j.1744-6198.2010.00197.x. Ketefian, S., & Redman, R. W. (2015). A critical examination of developments in nursing doctoral education in the United States. Revista Latino-Americana de Enfermagem, 23(3), 363–371. https://doi.org/10.1590/0104-1169.0797.2566. Kuhn, T. (2012). The structure of scientific revolution (4th ed.). Chicago: University of Chicago. Laudan, L. (1978). Progress and its problems (1st ed.). Berkeley, CA: University of California press. Loomis, J. A., Willard, B., & Cohen, J. (2006). Difficult professional choices: Deciding between the PhD and the DNP in nursing. Online Journal of Issues in Nursing, 12(1), 6. Snow, C. P. (1959). The two cultures and the scientific revolution. New York: The Syndics of the Cambridge University Press. Staffileno, B. A., Murphy, M. P., & Carlson, E. (2017). Determinants for effective collaboration among DNP- and PhD-prepared faculty. Nursing Outlook, 65(1), 94–102. https://doi.org/10.1016/j.outlook.2016.08.003. Tyczkowski, B. L., & Reilly, J. (2017). DNP-prepared nurse leaders: Part of the solution to the growing faculty shortage. Journal of Nursing Administration, 47(7–8), 359–360. https://doi.org/10.1097/nna.0000000000000494.
Preserving the paradigms We must work to capture the imagination, fervor, and ambition of our young nursing students, so that they will build the ranks of the PhD prepared faculty, as the currently aging sector is lost. Many times, students are really not sure about their career directions when thinking about graduate school, and the DNP program may seem attractive for a variety of reasons. The AACN invited discussion in August of 2018 made a series of important recommendations for students, academic institutions, and resources (https://www.aacnnursing.org/Portals/42/ News/Surveys-Data/PhD-Pipeline.pdf). A major thrust that was recommended was to identify and excite nurses with a proclivity towards research, with peer connections and mentoring, and to find ways to highlight and make more visible the importance of nursing science. Many schools no longer offer nursing research as a graduate course, but rather a course in evidence-based practice as an equivalent course.
Web references http://www.aacnnursing.org/News-Information/Fact-Sheets/DNP-Fact-Sheet. https://www.aacnnursing.org/News-Information/Position-Statements-White-Papers/ Defining-Scholarship-Nursing. https://www.aacnnursing.org/Portals/42/News/Surveys-Data/PhD-Pipeline.pdf. https://www.aacnnursing.org/Portals/42/News/Surveys-Data/PhD-Pipeline.pdf.
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