Friday, March 20, 2009


Kim over at Emergiblog had a post recently discussing the relatively new phenomenon in nursing education of the "BS to PhD track." This course of study includes no masters, not even a courtesy masters: one goes straight from earning a BS in nursing to working on a PhD. Kim, a very popular blogger and long-time ED nurse who has gone back to school, took Diana J. Mason, PhD, RN, FAAN, the Editor-in Chief of the American Journal of Nursing to task for her position against this educational approach.

Interestingly, Dr. Mason replied in Kim's comments (I told you Kim was popular!) What she had to say ameliorated most of Kim's concerns, but it managed to make my blood boil.

Nursing is an odd profession/discipline in many ways. It developed from an apprenticeship model, not an academic model. Nursing education has evolved from hospital-based, physician-run programs that "grew their own" (and used the nursing students as menial laborers along the way), to being independent programs and schools within colleges and universities. Graduate programs are very new: the first masters in nursing wasn't available until 1956. The first doctoral level degrees specifically in nursing became available in, I believe, the 1970's.

From these two strands has developed a unique approach to graduate education. In most academic programs, individuals generally go directly from their undergraduate to their graduate education, often times straight through to their PhD. In nursing, the norm has been to get some kind of degree, whether it be diploma, AD, or BS, work for a number of years, then go back for a master's degree, and then, 10 or 20 years later, go back and get a PhD. Some of the accepted wisdom is that there is no way you can understand, never mind teach, nursing without a credible number of years "at the bedside."

Things started to shift in the past 10 years, with schools of nursing trying all kinds of new approaches, most notably "Direct Entry" for advanced clinical programs (aka Nurse Practitioner programs) for people who already had baccalaureate degrees and BS to PhD programs, moving individuals with a BS in Nursing directly into a PhD program.

There has been a great hue and cry against both these practices, because how can someone know anything about nursing, nursing practice, nursing culture, etc. without spending at least a decade doing it? And of course, by "doing it," the implication is that one is in a hospital and providing direct care, despite the fact that, according to the Bureau of Labor Statistics, only 59% of all nursing jobs are in the hospital (including managers, educators, and other non-bedside positions).

The bottom line for both Kim and Diana is that there is no way someone can graduate from a nursing undergraduate program, go directly for a PhD, and be either a competent instructor or a relevant researcher.

I beg to disagree. Furthermore, I'd say that there an awful lot of assertions being made based on assumptions without any empirical evidence.*

I am completing a BS to PhD program. Like a number of the BS to PhD students in my program, I come to nursing as an adult with a wealth of experience that can inform my practice. Just because I am learning a new skill set and knowledge base doesn't mean all my prior experience, education, and abilities are thrown out the window. There's a lot more to nursing than being able to place an IV or read and interpret a rhythm strip. There's interpersonal skills, time management skills, the ability to take in a great amount of information, sort, prioritize, act, respond...these skills are not the purview of nurses alone.

As to my lack of nursing experience, neither myself, nor any of my colleagues in my program have completed it without concurrently working as nurses, at least part-time. Frankly, I'm a little insulted by the implication that anyone smart enough to succeed in a PhD program wouldn't figure that they need to acquire clinical experience along the way. By the time I am finished with my PhD I will have been working as a nurse for 6 years.

As regarding clinically relevant research, I believe that the relevance of ones research is a lot more dependent on ones academic culture than one's work history. My program has always emphasized research which is clinically relevant in general and relevant to nursing in particular. I can't imagine being able to get funding, particularly in these tight money times, without meeting a need and filling a knowledge gap. Furthermore, I have already received feedback from professionals within the fields of end-of-life research, and nursing as well as patients and families that my research focus on family caregivers at end-of-life is filling a gap and a need. This feedback has included some very generous and prestigious funding

As for being a good educator, I am lucky that my program has excellent education offerings, developed under the leadership of highly respected experts on nursing education. I have already started to do some mentored teaching, and I've gotten good feedback from students and faculty about what I bring to teaching and the positive impact I have had in both the classroom and in curriculum development. I will go into my first faculty position a lot better prepared to develop curriculum and provide meaningful educational experiences than a lot of newly-minted PhDs with years of bedside experience. There is an expression "those who can't teach." The reality is that just because you are an expert in a field, doesn't mean you can teach the field's knowledge effectively.

I know I'm going to make a damn fine teacher and researcher. I know that my students will not be short changed by my not having worked a med-surg floor for 30 years. I know that the knowledge and understanding that I uncover in my research will be useful and relevant to practice, and will move the science forward.

*Some may say what follows is not empirical evidence but anecdotal. Well, as a constructivist, qualitative researcher, I would say it describes a particular reality from which guarded generalizations may be made.


Kim said...

What a great post! Thanks for trying to get to the bottom of this and offering a different perspective. There is a big tendency towards skepticism for higher education not just in the nursing field, and it is good to hear from someone who made the choice to go for it.

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