Challenges to research productivity of doctoral program nursing faculty

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Accepted ManuscriptChallenges to Research Productivity of Doctoral Program Nursing FacultySuzanne C. Smeltzer, EdD, RN, FAAN Nancy C. Sharts-Hopko, PhD, RN, FAANMary Ann Cantrell, PhD, RN Mary Ann Heverly, PhD Nancy J. Wise, MSN, RNAmanda Jenkinson, MSN, RN Serah Nthenge, MSN, RNPII: S0029-6554(14)00090-6DOI: 10.1016/j.outlook.2014.04.007Reference: YMNO 933To appear in: Nursing OutlookReceived Date: 24 May 2013Revised Date: 16 February 2014Accepted Date: 9 April 2014Please cite this article as: Smeltzer SC, Sharts-Hopko NC, Cantrell MA, Heverly MA, Wise NJ,Jenkinson A, , Nthenge S, Challenges to Research Productivity of Doctoral Program Nursing Faculty,Nursing Outlook (2014), doi: 10.1016/j.outlook.2014.04.007.This is a PDF file of an unedited manuscript that has been accepted for publication. As a service toour customers we are providing this early version of the manuscript. The manuscript will undergocopyediting, typesetting, and review of the resulting proof before it is published in its final form. Pleasenote that during the production process errors may be discovered which could affect the content, and alllegal disclaimers that apply to the journal pertain.MANUSCRIPTACCEPTEDACCEPTED MANUSCRIPTResearch Productivity Doctoral Faculty 1 Challenges to Research Productivity of Doctoral Program Nursing Faculty Suzanne C. Smeltzer, EdD, RN, FAAN (Corresponding Author) Professor and Director, Center for Nursing Research Villanova University College of Nursing Villanova PA 19085-1690 610-519-6282 Nancy C. Sharts-Hopko, PhD, RN, FAAN Professor and Director, PhD Program Villanova University College of Nursing Mary Ann Cantrell, PhD, RN Professor Villanova University College of Nursing Mary Ann Heverly, PhD Adjunct Associate Professor Villanova University College of Nursing MANUSCRIPTACCEPTEDACCEPTED MANUSCRIPTResearch Productivity Doctoral Faculty 2 Nancy J. Wise, MSN, RN PhD Student Villanova University Amanda Jenkinson, MSN, RN PhD Student Villanova University Serah Nthenge, MSN, RN PhD Student Villanova University MANUSCRIPTACCEPTEDACCEPTED MANUSCRIPTResearch Productivity Doctoral Faculty 3 Abstract The Institute of Medicine (IOM), responding to a national health care crisis and related nursing labor force concerns, has called for an increase in the proportion of registered nurses with baccalaureate or higher degrees to 80% and a doubling of the number of nurses with doctorates by 2020. Simultaneously, large numbers of senior faculty are starting to retire, while the movement of doctorally-prepared nurses into academia is insufficient to replace them. Issues associated with the efforts of nursing programs to increase their capacity to respond to the IOMs recommendations, particularly the effect on scholarly productivity among nursing faculty in doctoral programs, are examined in this paper. Creative strategies for promoting scholarly productivity among doctoral program faculty are identified. MANUSCRIPTACCEPTEDACCEPTED MANUSCRIPTResearch Productivity Doctoral Faculty 4 Introduction In response to the widely acknowledged crisis in health care in the United States (US) and related nursing labor force concerns, the Institute of Medicine (IOM) called for an increase in the proportion of nurses with a baccalaureate nursing (BSN) degree to 80 percent and a doubling of the number of nurses with doctorates by 2020 (IOM, 2010). The subsequent implementation of the Affordable Care Act (ACA) has increased the demand for advanced practice nurses (APNs), including nurse practitioners (NPs), because it is refocusing the US health care delivery system on primary and preventive services (Naylor & Kurtzman, 2010; Health Policy Brief, 2013). Moreover, the ACA is enabling millions more Americans to access non-emergency services amidst an already existing shortage of primary care providers (US Department of Health & Human Services, 2014). Both of these trends clearly increase the demand for nursing faculty who are prepared for the faculty role to staff new and expanding educational programs that will prepare more nurses at all levels to address these urgent societal needs. The purpose of this paper is to explore the known challenges of doctoral nursing faculty to contribute to nursing science and evidence-based practice through research and scholarship> At the same time, doctoral nursing faculty are required to balance the demands associated with teaching and mentoring growing numbers of doctoral students, foster the development of new faculty colleagues, provide leadership to the profession, and in some cases, continue clinical practice to maintain advanced practice credentials. Nursing Faculty Shortage Prior to the IOM (2010) report that recommended major changes in the preparation and deployment of nurses, a shortage of nurses and of nursing faculty was well-documented MANUSCRIPTACCEPTEDACCEPTED MANUSCRIPTResearch Productivity Doctoral Faculty 5 (National Research Council, 2005; Yordy, 2006). The US Bureau of Labor Statistics (2013a) indicates that from now until 2022, the registered nurse labor force will need to be 22% greater than it is currently, while the advanced practice nurse labor force will need to increase by 31% (US Bureau of Labor Statistics, 2013b). Concurrent with these growing labor force needs, the nursing faculty shortage, which resulted in almost 75,000 potential baccalaureate and graduate student nurses being turned away in 2011 because of insufficient faculty to teach them, has increased in recent years (American Association of Colleges of Nursing, 2012; National League for Nursing, 2008, 2010). To be eligible for employment, faculty members in baccalaureate and higher-degree nursing programs need to be prepared at the doctoral level and need to be productive in research and scholarship to retain their positions (Hinshaw, 2001). The American Association of Colleges of Nursing (AACN) recently reported a 7.7% national nurse faculty vacancy rate, with over 91% of the positions requiring a doctoral degree (AACN, 2012). Schools of nursing typically have a lower percentage of faculty with doctoral degrees than other disciplines. Recent AACN data indicate that in 2012, there were 620 graduates from 131 research-focused doctoral programs, and in 2013 there were 2443 graduates from 241 Doctor of Nursing Practice (DNP) programs (AACN, 2014; Fang, 2013). Fewer than 40% of research-focused doctoral (PhD) program graduates assume roles in academic institutions, while the rest accept research positions in clinical settings, industry and health advocacy organizations, leadership positions in health care systems, and health administration positions in government agencies (National Advisory Council on Nurse Education and Practice, 2010). Over 30% of DNP graduates currently accept positions in schools of nursing without preparation for the faculty role; many enter academia as DNPs with no prior experience in nursing education (National Advisory Council on Nursing Education and Practice, 2010). MANUSCRIPTACCEPTEDACCEPTED MANUSCRIPTResearch Productivity Doctoral Faculty 6 Doctorally-prepared nurse faculty have shorter careers than academics in other disciplines. They tend to earn their terminal degrees in midlife and retire earlier than faculty from other fields (Berlin & Sechrist, 2002). The number of nursing faculty with doctorates who are younger than 45 years of age has been decreasing (Berlin & Sechrist, 2002), thus increasing the average age of nursing faculty. The retirement of faculty members in the post-World War II Baby Boom generation will deplete the numbers of faculty with doctorates, increase the teaching roles of those who remain, and diminish the time they have available for research and scholarship (Hinshaw, 2001; Brady, 2010). Those teaching in PhD programs are ideally seasoned faculty who are highly productive in research and scholarship; they also tend to be leaders in their institutions who are expected to shoulder increasing administrative and institutional service demands. To summarize briefly, the demands on doctorally-prepared nursing faculty to educate a growing nursing labor force, including registered nurses, advanced practice nurses, as well as those with doctorates, are increasing concurrently with the retirement of large numbers of senior nursing faculty. Needs of New Faculty Nurses often move into faculty positions upon completion of a graduate degree, the focus of which is most often clinical practice or research. As is true in most academic disciplines, new faculty typically lack formal preparation for the faculty role. They need to learn to effectively prepare classes and design effective clinical practica, actively engage their students, evaluate learning, and participate more broadly in the processes of their schools within the context of an academic culture that differs markedly from the world of health care delivery. In order to be retained by their institution, faculty may at the same time be expected to quickly institute a MANUSCRIPTACCEPTEDACCEPTED MANUSCRIPTResearch Productivity Doctoral Faculty 7 program of research that may require acquiring external funding as well as the generation of a stream of peer-reviewed publications. With the retirement of growing numbers of senior faculty and the need to prepare growing numbers of doctoral graduates, new faculty will have to assume responsibilities for the education of doctoral students early in their careers. Senior faculty who remain will need to devote increased time to mentoring larger numbers of new faculty in their faculty roles, in the development of their programs of research, and in the mentorship of doctoral students (Dreher, Smith & Cornelius, 2012). Increased Emphasis on Advanced Practice and the Emergence of the DNP Nursing programs are responding to societal need by expanding their preparation of nurses for advanced practice, particularly nurse practitioners (NPs). Faculty who teach in these programs must, in additional to the traditional tripartite role of nursing faculty (Hinshaw, 2001), actively engage in clinical practice so that they maintain their own advanced practice credentials. For example, the DNP was conceived as a way to prepare clinical leaders who would have parity with other health professionals. To date the AACN does not promote the preparation of DNP graduates for teaching roles, yet over 30% of DNP graduates teach in schools of nursing and increasingly they are needed to teach in DNP programs as these programs grow in size and number. The AACN (2006) identified the need for a culture of inquiry and practice scholarship in programs that prepare DNPs. DNP program faculty are expected to be actively engaged in practice and expected to develop and implement programs of scholarship that range from knowledge development through original research to the translation of research into clinical practice. They may be expected to obtain extramural grants for support of practice innovations, MANUSCRIPTACCEPTEDACCEPTED MANUSCRIPTResearch Productivity Doctoral Faculty 8 publish in peer-reviewed journals, present scholarly papers, engage in peer-review, provide leadership in professional organizations, engage in health policy activities, and develop and disseminate clinical practice improvement products (AACN, 2006). Some DNP faculty are being asked to meet the same requirements as PhD faculty for retention and promotion (Nicholas & Dyer, 2012). Evidence about DNPs success in faculty roles is not yet available. In terms of the faculty of the future, another challenge is that compared to PhD programs, DNP programs now graduate approximately four times as many graduates annually. Given the lack of emphasis in DNP programs on teaching and research, there is concern about who will encourage BSN and MSN students to consider advanced study in teaching and research as well as who will teach these areas of content in the future. Currently some faculty prepared with research doctorates are engaged in teaching DNP students, or both DNP and PhD students. Mentorship of DNP students differs from mentorship of PhD students due to the typically shorter length of the DNP program, creating additional challenges for doctoral faculty (Dreher et al., 2012; Author, in review). The Robert Wood Johnson Foundation Evaluating Innovations in Nursing Education Program has made public data for the July 2009-June 2010 year that provides some insight into PhD and DNP productivity, though the survey only included people specifically in nursing faculty roles (National Survey of Nurse Faculty, 2009). During that year, 20% of faculty had published one or more peer-reviewed articles while 80% published none. Among faculty prepared as DNPs, 33% published one or more peer reviewed articles during the year, compared to 63.4% of faculty prepared as PhDs. During that time period 29% of nursing faculty prepared one or more grant proposals, while 71% prepared none. Among faculty prepared as DNPs, 40.7% reported submission of one or more grant proposals, while among faculty holding a PhD, MANUSCRIPTACCEPTEDACCEPTED MANUSCRIPTResearch Productivity Doctoral Faculty 9 66.5% prepared a grant proposal. To contrast the national data with data from top research institutions in nursing, the Chronicle of Higher Education most recently reported 2007 Faculty Scholarly Productivity Index data for ten top-ranked research institutions in nursing. The range of percentages of faculty with a journal publication was 72-95%, and the range of journal publications per faculty was 2.5-7.23. The range of percentage of faculty getting a new grant was 12-41%, and the range of new grants per faculty was .15-.59% (The Chronicle, 2013). Faculty Retention Issues Faculty members, particularly those under age 45, are increasingly likely to leave academia because of opportunities in other sectors (Berlin & Sechrist, 2002; National Advisory Council on Nurse Education and Practice, 2010). The Healthcare Research and Services Administrations (HRSA) National Advisory Council on Nurse Education and Practice studied issues associated with nurse faculty recruitment and retention in 2009-2010. Barriers that the council identified included the existence of many alternative career choices for doctorally- prepared nurses, job dissatisfaction with the faculty role, non-competitive salaries, competition among health professions for a diverse workforce, and lack of outreach to pre-college and college students suggesting that they consider teaching careers. Strategies that were shared by HRSA with the U.S. Congress included the need to address the salary issue and provide increased funds for the forgiveness of academic loans, and greater use of mentoring for the retention and development of new faculty. The council recommended that institutions be supported to address work environment factors that promote dissatisfaction (National Advisory Council on Nurse Education and Practice, 2010). Funding Issues MANUSCRIPTACCEPTEDACCEPTED MANUSCRIPTResearch Productivity Doctoral Faculty 10 The pressure exerted by the recent economic recession on higher education in the U.S. provides a context for the consideration of doctoral education in nursing (AAUP, 2012). A trend toward full-time faculty carrying reduced course or student loads so that they can engage in programs of research, preferably funded with overhead for their institutions, has led to greater use of adjunct and contingent faculty at the same time that student expenses have increased at a far greater rate than the consumer price index (Taylor, 2010). During the recession, state contributions to the budgets of academic institutions, particularly public institutions, declined and endowments shrank (Mumper, Gladiex, King, & Corrigan, 2011). Faculty in public institutions experienced pay cuts, loss of tenure lines, and furloughs as well as increased teaching loads due to layoffs of adjunct and contingent faculty, while elsewhere pay increases flattened for several years, all issues that have implications for the recruitment and retention of nurse faculty. It is expected that the federal budget for domestic programs will continue to be lower than it was several years ago, leading to reduced support for academic and research enterprises (American Association for the Advancement of Science, 2013). The percentage of tenure-track and tenured faculty has steadily decreased over the past several decades and this trend is expected to continue (AAUP, 2010). Thus in general, across higher education in the US, the standing faculty has shrunk. In 2013, 9.2% of National Institutes for Health grants were funded and the percentage within the National Institute for Nursing Research was 9.1%, or 53 recipients (NIH, 2013). In recent years funding opportunities from other government entities such as HRSA and the new Patient Centered Outcomes Research Institute (PCORI) as well as corporate and private foundations have increased in importance for scholars in many disciplines. It may be detrimental to faculty motivation and success in granstmanship as well as the ongoing development of MANUSCRIPTACCEPTEDACCEPTED MANUSCRIPTResearch Productivity Doctoral Faculty 11 nursing science to continue to emphasize the traditional benchmark of funding success, an NIH grant. Moreover, significant progress can be made on a research trajectory by chunking, or attaining smaller grants for specific aspects of an overall project. Lack of Incentives for the Doctoral Faculty Role Traditionally the academic lifestyle, relative autonomy, and flexible schedule that faculty enjoyed attracted doctorally-prepared nurses to faculty roles. Additional benefits included the opportunity to shape the profession, steward the discipline, and maintain an acceptable work-life balance. In contrast there are also disincentives. As the National Advisory Council on Nurse Education and Practice (2010) documented, disincentives to pursuit of advanced education are significant and include the length of time and the expense associated with completion of masters and doctoral degrees. Dreher et al. (2012) found that the greatest priorities related to job satisfaction among a national sample of doctoral nursing faculty was salary, followed by internal resources for scholarship, teaching load, climate for intellectual discourse, and quality of students. In addition, the significant amount of time required to submit research grants coupled with low success rates, the increasing expectation of post-doctoral study which pays far less than a clinical position, increasing workloads, and pressure associated with tenure and promotion are identified as disincentives (Dreher et al.). In a recent study of over 3000 nurse faculty members, 58% of faculty teaching in doctoral programs reported that they were satisfied with their workload, compared to 70% of faculty in non-doctoral programs (National Survey of Nurse Faculty, 2011). The doctoral program faculty represented 8% of the participants in the study (National Survey of Nurse Faculty, 2011). Nursings Scientific Mission MANUSCRIPTACCEPTEDACCEPTED MANUSCRIPTResearch Productivity Doctoral Faculty 12 Over a decade ago, Hinshaw (2001) warned that the development of the scientific base of nursing may be hampered by the nursing and nursing faculty shortages as well as the paucity of nursing faculty engaged in research because of the need for them to teach across all programs in schools of nursing. She pointed out that the expectations of faculty in terms of research and scholarship, including granstmanship, will persist despite increased teaching responsibilities and administrative and service demands. Despite these competing demands, nurses with doctoral degrees are needed to conduct rigorous research and to increase the scientific base of nursing practice in order to participate authoritatively in changing the U.S. health care system (Broome, 2012). Doctorally-prepared faculty are called upon to evaluate nursing interventions to prevent illness and disability, enhance health promotion, improve quality of life through symptom management, increase patient safety and reduce medical errors, improve the quality of hospital-based care as well as patient satisfaction with care, prepare patients and their families to manage complex care at home, and improve palliative and end-of-life care (IOM, 2010; NRC, 2005). Additionally, the strategic plan of the National Institute of Nursing Research (2011) has specified development of the next generation of nurse scientists as a key component of its mission. At the same time, the science of nursing education must develop to identify new evidence-based pedagogies for the efficient and effective preparation of nurses at all levels to function interprofessionally in a decentralized health care system (Broome, 2009, 2012; NLN, 2013). However, in 2009 a national survey of doctoral nurse faculty revealed that 59% of the 367 respondents did not believe there would be enough nursing faculty qualified to teach in PhD programs in the next five years (Dreher et al., 2012). Given the current trend favoring DNP over PhD enrollment and annual graduation, this does not appear to be a likely problem for DNP education. MANUSCRIPTACCEPTEDACCEPTED MANUSCRIPTResearch Productivity Doctoral Faculty 13 Institutions that offer research-focused doctoral programs fall across a spectrum ranging from research-intensive institutions in which the teaching effort of doctoral faculty is well-integrated into their programs of research and in which faculty are mentors, to more teaching-focused institutions in which faculty may or may not engage in their own research, and if they do, it is distinct from their teaching effort. Many institutions fall between the two extremes. Kim, McKenna, and Ketefian (2006) as well as the AACN (2010) have identified quality indicators for research-focused doctoral programs. While these provide guidance for the ongoing development of all PhD programs, at the same time the current training capacity of research-intensive institutions is insufficient to fulfill the national need. A concern when considering the quality of doctoral education is the ability of doctoral faculty in sub-optimally resourced institutions to maintain a program of research through which to mentor doctoral students. Nurse scientists recognize the mandate that complex problems be studied using interprofessional approaches. Given the need to maximize our research capacity, it is important that faculty who are engaged in scholarship ask themselves whether they are full-partners in projects that address seminal issues of concern to our discipline or if they are functioning as technical support to scholars in other disciplines. Nursing versus Other Disciplines Work-life balance is a concern for new and tenured nursing faculty (Poronsky, Doering, Mkandawire-Valhmu, & Rice, 2012). A national study of faculty in higher education revealed that work-life balance has a direct and powerful effect on level of satisfaction of faculty (Rosser, 2004). Although faculty are less likely to leave tenured positions because of poor work-life balance, an unsatisfactory work-life balance among new faculty may lead to their departure from academe. The findings of this study indicated that the socialization of doctoral students for MANUSCRIPTACCEPTEDACCEPTED MANUSCRIPTResearch Productivity Doctoral Faculty 14 academic careers that may be almost exclusively focused on research may conflict with the reality of the expectations associated with the faculty role and may affect their intention to remain in their faculty positions or academic institutions. An issue that should be of concern to the nursing profession is that female faculty members are generally less satisfied than their male counterparts in higher education with their advising and course workload, the quality of their benefits, job security, and salary levels (Collaborative on Academic Careers in Higher Education [COACHE], 2007). Lack of mentoring of new faculty further decreases their satisfaction with work-life balance and increases the likelihood of their leaving academe. Strategies identified as important for new faculty include administrative and technical support, access to graduate assistants, financial and administrative support for professional development, and protection from overwhelming committee work (Rosser, 2004). Creative Strategies to Consider As noted by Broome (2012), doctorally-prepared faculty need to be leaders. She identified several fundamental strategies to accomplish this goal, each of which is in need of further study. Broome posed the following questions for the discipline to ponder: 1. What approaches to development of doctorally-prepared nurses for leadership roles are most effective while at the same time judicious with regard to institutional resources? 2. What strategies for promoting junior faculty members network of interdisciplinary contacts are most productive in terms of their scholarship? 3. How can peer support be harnessed to promote team teaching, research, and practice in ways that effectively move the group toward tenure and promotion? MANUSCRIPTACCEPTEDACCEPTED MANUSCRIPTResearch Productivity Doctoral Faculty 15 Some creative strategies to address the challenges for doctoral nurse faculty to maintain active programs of scholarship include: Conducting studies among national samples of PhD and DNP faculty to ascertain what benefits, barriers, and successful strategies they use to maintain a high level of scholarship activities while serving as doctoral program faculty; Responding to the IOM recommendation for studies that advance the professions teaching mission; Finding efficient and effective approaches for graduate education, clinical experiences, and overall pedagogy; Examining doctoral programs from the perspective of enhanced preparation for the diverse roles that PhDs and DNPs fulfill, particularly the role of educator; Examining the career aspirations of doctorally-prepared nurses and exploring the reasons few doctorally-prepared teachers want to teach and conduct research; Identifying strategies to incentivize MSNs to pursue doctoral studies and academic roles; Creating innovative strategies in order to ensure the most effective use of doctorally- prepared faculty given their relative scarcity in the discipline of nursing; Revising tenure and promotion policies to acknowledge significant funding other than NIH grants as well as substantial funding efforts; Embracing those opportunities for interprofessional research in which the nurse scientists are peers addressing concerns that are central to our discipline; MANUSCRIPTACCEPTEDACCEPTED MANUSCRIPTResearch Productivity Doctoral Faculty 16 Deciding, in a shortage of doctorally-prepared nurse faculty and an increased demand for production of doctorally-prepared nurses, how to provide research immersion opportunities for nurses; Examining existing practice-teaching models within and outside the discipline (e.g. medical school practice models) to determine how doctorally-prepared advanced practice nurses can maintain an active practice and meet their scholarship demands; and Creating mentorship and career development programs that foster retention of new doctorally-prepared nurse faculty. Conclusion In conclusion, it is evident that a large gap exists in the academic environment in terms of nursing faculty preparation and longevity, scholarly productivity, and production of doctoral graduates sufficient to meet IOM recommendations. To close this gap, a body of evidence must be developed and exploited to guide current and emerging leaders in building disciplinary strength. Nurses entering academia will quickly become doctoral faculty. They need adequate ongoing preparation, mentorship, and support for the fulfillment of their multiple roles, for the development of an externally funded program of research supported by a team, for the development of the ability to focus and see the larger context, institutional, disciplinary, as well as national, in which they work, for engagement outside of self, and for achievement of work-life balance. Senior faculty need administrative support to assist them and their school leadership in examining their optimal use of time to fulfill their teaching, research and service obligations. Nursing faculty can contribute to closure of this gap now by encouraging MSNs to return to school to pursue a program of study that will support a role in an academic setting and by MANUSCRIPTACCEPTEDACCEPTED MANUSCRIPTResearch Productivity Doctoral Faculty 17 recruiting gifted students into academia, and most importantly, by sharing their enthusiasm and passion for their craft. MANUSCRIPTACCEPTEDACCEPTED MANUSCRIPTResearch Productivity Doctoral Faculty 18 References American Association for the Advancement of Science (2013). AAAS analysis shows uncertain future for federal r&d spending. Accessed February 14, 2014. American Association of Colleges of Nursing (2006). The essentials of doctoral education for advanced nursing practice. Washington, DC: Author. 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Support for this work was provided to Dr. Suzanne Smeltzer and the Villanova University College of Nursing in the form of a grant from the Robert Wood Johnson Foundations Evaluating Innovations in Nursing Education National Program Office