Josephine R. Granner, BSN, RN, PhD candidate at University of Michigan Nursing, said she is pursuing a PhD in nursing because she wants to effect change at a public level. Being PhD-prepared and conducting research would allow her to have that public health level of influence. But for Granner, learning about the options in PhD education and what to expect from a degree program was difficult and much less accessible than information about other nursing degree programs.
"My undergraduate institution had a class that taught us about higher education options for nurses, which was extremely helpful, but a lot of schools do not have formalized learning about higher education options," she said.
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Josephine R. Granner, RN[/caption] Granner, who coauthored the paper, "Barriers for BSN students to pursue a doctorate in nursing and recommendations to address them: A scoping review," published in Nursing Outlook, also did not know about funding options for pursuing a PhD in nursing. She applied for her current fellowship at the last minute because, initially, she didn't realize the importance of pursuing specific funding opportunities. Lack of information on programs and financial support options are just two of the barriers nurses can run into when deciding on whether to pursue a PhD or DNP (Doctor of Nursing Practice), which is a popular doctorate in nursing. In 2020 alone, 9,158 nurses graduated with the DNP compared to 759 who graduated with a PhD in nursing, according to the Campaign for Action. More than 64% of today's nursing workforce is prepared at the baccalaureate and higher-degree level, but only 1.2% have a DNP degree and 0.6% a PhD, according to American Association of Colleges of Nursing (AACN) statistics. The issue is that nursing needs a strong pipeline of nurse researchers and nursing faculty -- jobs often held by PhD-prepared nurses. "Nurse scientists play an indispensable role in developing new knowledge to advance the health of patients, families, and communities. Yet PhD nurse enrollment has significantly dropped, and many later-career nurse scientists are nearing retirement," according to authors of a 2019 paper published in the Journal of Nursing Scholarship. Today's PhD nurse pipeline is not sufficient to replace the PhD-prepared faculty that are retiring, according to Granner.
Jobs That Call for a Doctorate in Nursing
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Adejoke B. Ayoola, RN[/caption] Granner and coauthor Adejoke B. Ayoola, PhD, RN, FAAN, Chair and Professor of Nursing at Calvin University Department of Nursing, in Grand Rapids, Michigan, found a general lack of awareness and understanding among student nurses and working nurses about the PhD in nursing. Ayoola, who teaches the course to prepare students for graduate school at Calvin University and mentors PhD nurses, said she witnesses the lack of awareness and misunderstandings on a regular basis. Many nursing students, for example, believe a PhD degree will limit them to a career in the research lab and eliminate nurse-patient interactions. That is not the case, according to Ayoola. PhD nurses who do research conduct studies to strengthen nursing practice in an increasingly complex healthcare landscape. Often, they will gather study data, including post-intervention information, by interviewing and educating study subjects. In essence, PhD nurse are scientists, educators, and advocates who design and implement programs at universities, within hospitals and communities, and for school systems, as well as for national and local governments, agencies, corporations, and other employers. One of the most common roles for PhD-prepared nurses is as academic faculty charged with teaching, doing research, or a combination of the two. Educating future generations of nurses amid a faculty shortage is reason enough to encourage more nurses to pursue PhDs, according to Ayoola. PhD-prepared nurses can work in health administration, at hospitals, or hospital systems where they help design and implement nursing interventions, Ayoola said. "As a nurse scientist, you can inform clinical practice," Ayoola said. Once trained as a PhD nurse, or nurse scientist, nurses can work in health departments to study and design nurse-specific interventions to implement in communities. Nurse scientists who work in communities often focus on specific aspects of health care, including pandemic-related community care. Ayoola conducts community-based research aimed at improving maternal health. PhD-prepared nurses work as independent consultants who are hired by health departments, hospitals, for-profit and nonprofit corporations, and other employers to identify problems and improve care or care delivery.
"The Future of Nursing 2020-2030" focuses on health disparities, health equity, and dealing with diversity," said Ayoola. "For us to effectively do that, we need to be in the community in a setting where PhD-prepared nurses can work with agencies to design programs that will promote health. That is what nursing is all about. It is about health promotion."
What's Holding You Back?
The review identified other barriers, including limited future thoughts or plans. BSN students, according to Granner, might be so "in the weeds" with their BSN program that they find it hard to find time to think about the future. "A lot of people had family or work conflicts or just thought that it would take too much time and energy to get a PhD," Granner said. "Another huge barrier is people thought they needed clinical experience before they got their PhD [which they do not]. Lack of funding also is a big problem." The pandemic, which resulted in many degree programs being shifted online, might offer a silver lining by helping to make PhD education more accessible to busy nurses, Granner continued. Educating students about pursuing a doctorate in nursing should start early, according to a paper Ayoola authored in the September-October 2021 Journal of Professional Nursing "Strategies to promote and sustain baccalaureate students' interest in pursuing a PhD degree in nursing." Discussions about the benefits of a PhD education and its impact on the science of nursing and the future of the nursing profession early in the undergraduate nursing program is essential. Ayoola said courses like the one in which she teaches to undergraduate nursing students to introduce them to graduate school options is among the solutions to maintain a stream of graduate nurses. Mentorships are one of the most important solutions for fueling the doctorate in nursing pipeline, according to Granner. That's because individual level mentorship relationships are oftentimes what have been successful for empowering students who want to pursue a PhD, she said. Funding for PhD student fellowships is a key facilitator of PhD education. Granner and Ayoola, for example, write in their review that undergraduate faculty members need sufficient funding to launch research projects in which students can engage so that students are better informed about PhD careers during the informative, decision-making years. BSN students need to be made more aware of PhD funding options and how to pursue them, according to Granner.
"Applying for specific fellowships can increase your chances of being admitted to a program because you are bringing funding with you, and it reduces the burden of having to look for funding when you get there," said Granner.
Granner suggests that nurses interested in learning more about the doctorate in nursing options visit university websites. There are 135 PhD nursing programs in the U.S., according to AACN. "[University websites] have quite a lot of information about what the program will be like, what the curriculum is like, and some funding options," said Granner. "Another recommendation is to look at which professors at your undergraduate institution are PhD-prepared and reach out to them for what it might look like to go back to school," Learn more about earning a doctorate in nursing and other educational milestones in our Higher Education Guide. 
