Any PhD's here?

llg, PhD, RN · Jun 14, 2009

Which leaves the hospital positions that llg mentioned. While I would prefer to avoid management roles, I could do something like staff development. But I wonder how many of those positions there are, and whether I really need to get a PhD to do something like that.
Of course, part of the problem is that I haven't worked as an RN yet so there's a lot that I'm just not familiar with. I had a long clinical on a tele unit and found it boring, but I might find other units more interesting.

Positions that focus on the types of things that I do used to be non-existent. Now, there are a few of them around. I think there will be a lot more in the future. As the whole "evidence-based" culture spreads and the desire for Magnet designation spreads, etc. more and more hospitals will NEED people on board who understand research, can apply it, and can conduct an ocassional research project themselves. Hospitals will need people who can lead and mentor the staff in these types of functions. While people prepared at the Master's level have fulfilled these functions in the past, nursing really has not excelled in this area. Most research, publishing, etc. had been done by the academics and not by the people who work in practice settings.

There has been a "theory-practice gap" in nursing for generations and we are now at a point where it is recognized that people in clinical practice environments need to be knowledgable about research processes, skilled at interpreting and applying the research and theoretical literature, and communicating their "experiential knowledge" to the world. Nurses in clinical practice environments need to elevate their level of partcipation in the scholarly dialog of the nursing discipline -- both as "receivers and appliers" of scholarly knowledge. We can't leave it all to those who work in schools of nursing -- and most Master's programs focus on clinical practice or education and tend to be weak in the areas of research and theory.

Hospitals are "joining" the evidence-based practice movement, establishing Research and Evidence-Based Practice Commttees, etc.. With DNP grads hitting the workforce, there will be even more people prepared to lead this advancement of practice -- this development of the scholarly aspect of practice. So, I believe we are in the early stages of transition into a new era for nurses in clinical practce environments -- and that there will be more employment opportunities for doctorally prepared nurses (DNP and PhD) in hospitals in the future.

To get those positions ... nurses will probably need (and SHOULD need) solid clinical experience as well as the doctoral degree. Credibilty is key and an "academic expert" will also need credibility in a clinical area in order to be accepted as an authority on practice. When working in a clinical practice setting, you always have to remember that the central focus of the enterprise is the delivery of high quality of care in a cost-efficient way. That always comes first. The scholarly goals always "play 2nd fiddle." The doctorally prepared nurse working for a hospital has to appreciate the importance of that and be willing to compromise and to partcipate in some of the more "mundane" and less scholarly aspect of running the institution.

Yes, I teach some orientation classes, proctor CPR testing sessions, serve as the "manager" for the extern program and see to it that their employment paperwork gets filed, etc. Sometimes, those less scholarly tasks get in the way of my personal scholarly goals. Often, the work I want to do most gets delayed or cancelled because the hospital has more pressing needs in its effort to deliver care. However, as someone who is very experienced in this sort of work, I recognize that these mundane tasks and hurdles that I must get over are the very things that keep me engaged in the practice arena and keep me "current" in what is happening in the actual practice world. Without that engagement in the actual business of practice, my scholarly work would become the "ivory tower" work of an academic who is detached from the real world -- thus undermining the whole point of clinical scholarship.

Don't get me wrong. I don't believe that all the work done in academia is detached, useless, or anything of the sort. I just believe that scholars who actually maintain a deep engagement in actual practice add something to nursing's knowledge base that cannot be added by someone who only works in academia. Nursing needs BOTH types of people and BOTH types of scholarly positions -- those who work in academia and focus on the university mission -- and also scholars who work in clinical practice settings who directly connect scholarship and practice.

Oh ... and by the way ... I don't get paid any more for my PhD. I am in a position that is funded as a Master's required position. While I would love a pay raise, I am OK with my current arrangement as my boss acknowledges the pay issue and "compensates" me by giving me more freedom and autonomy in my work. I appreciate that and make use of it to serve my needs in lieu of extra money. But I hope that as these types of roles become more common, a higher pay level will become the norm. At least I make more than I would have if I were working as a full time Assistant or Associate Professor on a 9 or 10 month contract. :-) And with my flexible work schedule, I can supplement my income by teaching a course or two per year at a local university. (I teach theory and research in a BSN completion program.) With all the online programs, it's realistic to think you can earn a little extra money that way -- or as an adjunct teaching an ocassional face-to-face classroom teaching for a local school.

Joe NightingMale, MSN, RN · Jun 15, 2009

Great post llg! I strongly agree about the need to close the theory-practice gap.

. When working in a clinical practice setting, you always have to remember that the central focus of the enterprise is the delivery of high quality of care in a cost-efficient way. That always comes first. The scholarly goals always "play 2nd fiddle." The doctorally prepared nurse working for a hospital has to appreciate the importance of that and be willing to compromise and to partcipate in some of the more "mundane" and less scholarly aspect of running the institution.

This could end up being a problem for me, as my research tends to focus on the more psychological aspects of the patient experience. Unless I could present this as a way to, say, improve Press-Ganey scores, I'd probably have to drop it.

Also not really thrilled with the medical model approach to disease either.

llg, PhD, RN · Jun 15, 2009

Great post llg! I strongly agree about the need to close the theory-practice gap.
This could end up being a problem for me, as my research tends to focus on the more psychological aspects of the patient experience. Unless I could present this as a way to, say, improve Press-Ganey scores, I'd probably have to drop it.
Also not really thrilled with the medical model approach to disease either.

There is no need to adopt the medical model in your practice. The real world of health care has room for lots of different approaches. And there is plenty of interest in the psychosocial aspects of care, too.

Actually, I find it interesting that you assume that only those working in academia would be interested in those things -- as if academia is not at all connected wth the real world. Yes, there is a theory/research - practice gap. But those of us in the practice world are not exactly practicing in the Dark Ages and kow-towing to the physicians.:chuckle

marachne · Jun 15, 2009

What I find most striking is that, as someone who is still in their basic RN education, you seem to have found fault with everything!

The large universities, with a focus on research and tenure-track positions: Research institutions are too limiting geographically, money's no good, don't like teaching. FYI not all academic institutions are high-powered ones -- I was recruited for U of Idaho Boise, and while it is not a tier one research institute, they made it clear that I would have support for my program of research, as well as be encouraged to continue my clinical practice (and/or work with in the community).
Don't want to get into management
Found a tele unit boring
Think that research w/i a hospital setting would be all "medical model" and not focus on psychosocial issues
(which is pretty absurd, since, 1) some of the research would/could be around issues r/t nursing such as burn out, learning styles, knowledge processing, or any of the multitude of holistic aspects of the nursing scope of practice)

I have to ask -- just what do you think nursing is about? What are you goals and aspirations for your nursing career?

Also, as I said, the VA system (which is all over the US) has a very strong nursing research presence, and not all of it is hospital based. For example, there is a center in Florida that looks at safety and falls -- I know of at least two nurse-researchers working there. With all the focus on TBI they are getting a lot of $$ and interest right now, and it is not only the physiological but also the psychosocial aspects of these conditions that are of paramount importance.

I would ask again -- what do you think you want to do? What is important, where are you willing to let go of?

No matter what, it sounds like the best thing would be for you to finish your undergrad program, go out and work some, get that clinical knowledge and experience under your belt -- see what the clinically relevant issues are and then see if a PhD would be a way to address those issues for you.

Joe NightingMale, MSN, RN · Jun 15, 2009

I have to ask -- just what do you think nursing is about? What are you goals and aspirations for your nursing career?
I would ask again -- what do you think you want to do? What is important, where are you willing to let go of?.

That is the $64,000 question.:wink2: I do have a pretty good idea about what is important to me and what my goals are. The problem is finding a position that addresses those goals. I'll have to spend some more time thinking about which of those goals are most important, and how the various roles address those goals.

What may be required is some sort of unique approach, or a combination of positions to address those concerns. For example, I could get a PhD and a university position while simultaneously continuing to perform some work in the hospital. Or I could go into a field that always interested me...like palliative care...but as an NP rather than an RN. Or I could specialize in an area like psych, playing more of a counseling role rather than an RN one.

All quite tricky. And something that I'll have to think about a bit more.

marachne · Jun 15, 2009

That is the $64,000 question.:wink2: I do have a pretty good idea about what is important to me and what my goals are. The problem is finding a position that addresses those goals. I'll have to spend some more time thinking about which of those goals are most important, and how the various roles address those goals.
What may be required is some sort of unique approach, or a combination of positions to address those concerns. For example, I could get a PhD and a university position while simultaneously continuing to perform some work in the hospital. Or I could go into a field that always interested me...like palliative care...but as an NP rather than an RN. Or I could specialize in an area like psych, playing more of a counseling role rather than an RN one.
All quite tricky. And something that I'll have to think about a bit more.

I guess I'd love to hear more specifics about what you are interested in...that is if you want any more feedback. From the the few hints you have offered, I will tell you this:

1) If you are interested in palliative care, then yes, to be effective you need to get an advance clinical degree (NP or DNP) What I would caution you about that, however is do NOT get an NP in palliative care -- I know of at least one person who did this and when she moved to another state her NP was not recognized and she had to work as a CNS (which is fine, but still -- you want to get a more generalist NP and then you can get specialized training either through a palliative care fellowship (I've done this) or other training. From what I can see, many, many palliative care programs employ APNs. Again, you want to look at things on a state-by-state basis in terms of what APNs can do. For example, in WA and OR, NPs can work independently and can prescribe most to all drugs. In Florida, they are very, very restricted in what they can do.

2) If you are interested in something like a psych/MH NP, there are lots of good programs out there. The caveat with this degree is that many programs will hire a PMHNP basically as an RN writer, and the opportunity to provide more of a clinical role may be limited. That said, this is one area that many universities insist that you maintain a practice as well as teach/research, so if you want to stay involved in clinical practice, it is very likely to happen. I personally think that a certain amount of involvement in the clinical setting is VITAL for both teaching and research in order to maintain relevance.

3) Don't forget that policy is also an important part of what nursing professionals w/terminal degrees can have an impact on, whether it is on an institutional level like llg does or on a larger societal level.

Academia has 3 legs: research, teaching and service. Usually the "service" arm is an implication that you need to serve on umpty-ump committees, but it can also be that you continue to serve the community through a clinical practice.

But I'll repeat what I said below, and also what I say to new PhD students -- while it's good to have an idea of what you want to do/study, it's also important that you leave yourself open to what you experience as part of your education and the people you meet along the way. I never had any intention of getting a PhD -- maybe an AP degree, but not this route, and yet, when presented w/the opportunity, and after great consideration, I realized that it was a good fit for me. Furthermore, while my focus had been on EOL care for patients, my vistas were opened and I moved to a focus on family caregivers. My visions was the family member caring for a terminally ill person at home. My focus further moved to FCG of people w/dementia, but my diss is actually on FCG of people in assisted living, a setting I knew little to nothing about until I was a research assistant on a study in that setting and saw the gaps in our knowledge the need for change in policy and practice. Will I stay in this setting? I don't know. My work in the VA system has made me aware of the needs around PTSD at EOL and that too pulls me.

It really is true, an RN is just the beginning to having a multitude of opportunities. Don't limit yourself by what you precieve to be the inherent limitiations of the profession.

Joe NightingMale, MSN, RN · Jun 16, 2009

Funny, we must be thinking alike.

I have considered doing palliative care as an NP, but as a more generalist NP rather than only palliative. I know almost everyone says FNP is best, but I think I'd like acute care better, and I think it might work better with palliative care. When I first considering becoming an RN I looked at oncology, pain managment, and hospice, all of which overlaps with palliative care.

Believe it or not, my alternate career to RN was counseling, so I've been thinking about the mental health NP as well. I do have some concerns...my inpatient psych clinical was my most disturbing, so I think I'd like to try and focus on people who aren't psychotic. I've also worried that hearing people talking all day would get tedious...then I remind myslelf that this would be counseling, not real life where everyone seems to want to talk my ear off :rolleyes:

You're right about keeping an open mind, as I've done clinicals I've changed my mind multiple times...CNS, CRNA, ANP, ICU...so who knows, I might change it again.