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Discussion

To llg

Now I am curious. You have a PhD but choose to work in the hospital. Any reasons that you would like to share? How was teaching? Was it worth going for your PhD? Was this even the reason for pursuing PhD? I know, alot of questions, I'm just wondering. Thanks.:)

Featured Replies

  • Experts

OK. I'll bite. Since the question was asked of me in a public forum, I will answer it publically. I'm sorry this post is so long, but it's not an easy question to answer.

After graduating with my BSN in 1977, I worked as a NICU staff nurse for 2 years, then got my MSN in Perinatal Nursing (with a minor in Nursing Administration and some extra coursework in Nursing Education.) Then I worked as a NICU CNS for 10 years. For 2 of those years, I had a joint appointment with a school of nursing, teaching a Master's level course in neonatal nursing and supervising some graduate student clinicals.

After 10 years as a CNS (with a fairly strong staff development component to my role much of the time), I felt I was ready to move on. The projects I wanted to do required more education and I needed to learn more. Also, I knew that in order to rightfully claim "fully equal status" to physicians, I would need a fully equal education -- that meant a doctorate. Finally, I was always somewhat bookish and always wanted a PhD. So, I did it. I quit my job in my mid-thirties and went back to school for another 5 years as a PhD student, graduating in 1996.

The "ivy-covered halls" image always appealed to me, but like many nurses in my generation, that just didn't work out for me. When I was getting to graduate with my PhD, schools were only hiring nurse practitioners for their faculties. They were trying to expand these programs and were not interested in those of use who had specialized in what I will call "traditional nursing care roles." In fact, I was scheduled to serve on a panel at a very major conference with other PhD students from UCSF and the Univ. of Washington to discuss how so many of us getting ready to graduate could not even get interviews. (I think of that when I hear about them whining about the faculty shortage. They chased us away back in the 1990's.)

Besides the nurse practitioner issue, there was another problem. My clinical specialty, neonatal (both low risk and high risk) is only a minor part of the undergraduate curriculum. So, I am not well-suited to teach undergraduate clinical rotations. Actually, I would call myself "unqualified" as I have never worked adult med/surg and have minimal peds and maternity experience. Clinically, I am a baby person and my other areas of genuine expertise are in the roles of Master's-prepared nurses -- CNS, staff development, etc.

Now ... Here is the stickler. When you are a brand new faculty member, you usually come into system as the junior member of the team, regardless of your clinical background/qualifications. They want you to teach the courses that no one else wants to teach -- undergraduate clinicals. But how can I teach undergraduate clinicals when I have never worked in those fields? And the courses that I was (and still am) most qualified to teach -- undergraduate and Master's level courses in research, leadership, advanced role issues, and theory are almost always given to the long-time faculty members because they have the nicest hours and are considered the "plum" teaching assignments -- even though those faculty members may have minimal experience actually working in those roles as opposed to my many years of experience.

In short, there is no established process for people who have risen in their careers in hospitals to "cross over" to academic teaching roles (with a few exceptions, such as post-doc fellowships and luck). If you are at the beginning of your career and happen to have chosen a general field that fits well with undergraduate clinicals, then it is a lot easier. If you are in a sub-specialty and have risen to become an expert in it (I had published, served on a national committee, etc. in neonatal) ... then it is harder because you have been farther removed from the generalist world of the beginner-level undergraduate. Does that make sense? Am I explaining this semi-clearly?

I got lucky. A university offered me a position teaching in their undergraduate mother/baby rotation. They promised me that I would be paired with a maternity instructor for the first few weeks to give me a chance to develop some maternity skills before having a group by myself. I would give all the baby lectures ... and have clinical groups that would include the special care nursing, the mother-baby unit, and labor and delivery. I was told that since the students would be paired with a nurse in L and D, my lack of experience there would be no problem.

Well ... after moving across the country to take advantage of that great opportunity, I learned on my first day of work that they decided not to give me the orientation they promised me. Instead, I would have to take a clinical group to an adult med/surg unit for the first rotation! Then, I would do the perinatal rotations listed above, but with no orientation to OB. The feedback from the students and the nurses on the floor was actually pretty positive that semester, considering. I coped. But after the first semester, I learned that the person I had replaced had decided to return and that my contract would not be renewed the following year. They really wanted a generalist who could teach everything, not a baby specialist. (Then why had they hired me?) I had moved across the country and invested a year of my life for essentially nothing -- nothing but a lot of stress and a feeling of having been betrayed by some very prominent nursing leaders at that university.

I landed on my feet -- back as a NICU CNS at a children's hospital in a much nicer city. In a few years, the Vice President for Nursing offered me a unique position as the liaison with all the local schools of nursing, the coordinator of the summer nurse extern program, and with the opportunity to work on a lot of special projects of my own choosing. I make more money then most faculty members, set my own hours (0900-1800 most days), and have a whole lot of autonomy. With the extern program, I work only with students who are really motivated in peds. ... and with the staff development that I continue to do sometimes, those courses are taught at a level appropriate for people who have already graduated.

In the end, I have done OK and I am satisfied with my job. Sometimes, I still wish for the "ivy-covered-halls" fantasy ... but I have come to see that, for most of us, that is just a fantasy. The reality of teaching is often a lot different than the fantasy. Only a few get the fantasy. I'm making the best of my "2nd choice" for a career.

Do I regret going for my PhD? Never for a moment. I loved doing it and I would not feel complete without it. It added so much to my perspective of nursing and to life and scholarship in general. It's like when Dorothy landed in the Land of Oz and everything after that was in color instead of black and white. There is a whole other level that most nurses never see and that is a shame.

llg

  • Author

Thank you llg for taking the time to explain your background. It opens my eyes to alot of things. The reason I asked you for more info on the PhD is because I was curious why a person would spend all that time and money for a degree that will not produce a very high paying position in academia (or will it?). I am getting ready to start a community health nursing/education MSN program in the fall. I too have no med/surg. experience but a concentrated experience in geriatrics/homehealth/Assisted Living/QA. I don't know if there will be a place for me as a faculty member. Is my experience one of the broad nursing areas that can be utilized in an instructor role? I do know that I have a bunch of opportunities presently in my specialization that could take me far, so I am not afraid of not having a job. But will there be a future for me as a full time faculty and do I eventually want to go for my PhD? I can't answer that right now so I will take it one step at a time. Thanks again, I enjoyed reading your response.

  • Experts

With a specialty in geriatrics, I can't imagine that you will have the same problem that I did. Geriatrics is a big part of undergraduate programs as is the whole more general field of community health.

I think your attitude of taking it one step at a time is the best one to have. You never know where life will take you. You just have to adapt and go with it. I didn't get my PhD for a specific job, but rather for the internal sense of self-fulfillment. It gave me that and opened up a few doors -- one of which I have taken full advantage of. I'm happy with my education and have no regrets in having gotten it.

I wish you all the best.

llg

  • Experts

llg - just curious if you considered teaching an online course? I am finishing a BSN through University of Phoenix online and our teachers are very good and clinically competent. The instructor I had for Family Nursing was a peds/NICU RN with a PhD. I'm starting the MSN program with UofP June 3rd and want to be an educator, but not in a school - rather in the hospital. Thanks so much for your information.

  • Experts

Yes, in fact I have given serious consideration to applying for a job with the UofP -- and may give it a try. I even went to their web page for perspective faculty last year. I found the web page very intimidating and didn't pursue it ... but it has been in the back of my mind.

Thanks for the suggestion.

llg

  • Experts

llg - the one thing that all the instructors (I've taken 14 classes for the BSN completion) have in common is that they are so clinically competent. They all are practicing RNs. I work in the ER of a large, teaching institute and see many students (LPN, ADN, BSN, MSN) with their instructors. One of the instructors asked me to help her set up an IV line and show the students how to do it because "its been a long time since I've done it." To me, as a student paying big bucks for this experience, I want someone clinically competent. Good luck...

I read the original post and was going to respond to it, but since it was written directly to you, I felt it was inappropriate. I am a nurse educator and working on a Med-Surg floor right now and did so as an agency nurse in the summer. For some reason, it is difficult for many staff nurses to understand why someone with an advanced degree would work as a staff nurse. For me, I really miss the bedside when I am away from it too long and I also want to keep current as an educator and RN. Things change so fast and I don't like feeling lost or unprepared when I am in clinical, so I find it necessary to stay active in practice. I have realized that I want to return to ICU because the current reality of Med-Surg is unmanageable. Having six patients and responsibility for your LPN's six patients is manageable....but, having eight of your own with a lot of movement including transfers, discharges and admissions just does not allow me to provide the care I want to deliver. I won't allow my patients not to be repositioned, have their teeth brushed or oral care provided...we have CNA's, but being new and not a Charge Nurse, I find it easier to do most of it myself and I do...plus, I like connecting to patients and the outcome better when I do it as well. When someone has been in a hospital for five days and has no toothbrush, one knows that such basic care is not being provided. When patients respond to the basic care that I do deliver, I find it sad that others don't think it is important. I had some of my preceptors tell me that there is no way I could do all of that direct care and get done on time...I would have to agree with them as I have had to work over the past two eves. But, it isn't like it was in 1982, when we stayed over for two hours charting every nite....and we were dumb enough to do so off of the clock too.

When I have admitted patients, they act like I am doing something wrong by taking a detailed history...many have responded that the other times they were admitted that the nurse just gave them the form to complete on their own. I have never heard of this type of assessment gathering, but they do go home on time. It makes me wonder how they can be satisfied with the work that they do when they go home. Perhaps this is how they cope with staying on a Med-Surg floor in today's nursing world.

In large cities, there are MSN and PhD-prepared nurses who work in the hospitals. But, in areas of the country that are not so progressive, I have been the only one over the past four years. When I began working at this hospital, the nurses were introduced to me by their name and degrees. The baccalaureate nurses have RN, BSN on their ID tags....mine says RN. I learned long ago that it only causes problems to have advanced degrees on an ID tag...if in the role of staff nurse. When I have taught, my MSN is proudly worn. But, I have not worked one day in a clinical environment without my two school pins and certification pin...if someone wants to study them, that is up to them.

I have applied for an online PhD in Education program and waiting for acceptance. I am a life-long learner and learning is exciting, motivating and satisfying to me and I also find that it is contagious if shared. On Monday, I will turn my grades in for this baccalaureate program and will continue to work in practice and try not to take an eternity to finish this degree. Practice allows me that flexibility and time. llg...I, too have considered teaching online on a part time basis because I know I will miss having that connection with students. I would be honored to be a faculty member with you.

Barbara

Thanks for sharing your story llg. I enjoyed reading your post. I am currently working on MSN degree at UoP. The instructors for the nursing courses I've taken have all been PhD trained and I must say, they do a good job with the online environment. I did not think I would be able to learn theory and research at MSN level without losing my sanity in the process. But I have learned it! And it wasn't as bad as what I expected, although schoolwork consumes an enormous amount of my time. I am finishing up research now, getting ready to start my 6th class next month. Advanced Community Nursing. Teaching online seems like a great job and really interests me but I doubt I will be able to afford to pursue PhD after I finish MSN next year.

I would encourage you to re-visit the page you mentioned in your post. There seems to be a large number of nurses now pursuing advanced degrees online and I would bet $ there is a job there for you! Good luck.

Cheryl

llg,

I knew a bit of your story but not much in depth as this post.

Thanks for sharing.

Hi Laura,

You have nothing but my total admiration. In spite of where your studies have or haven't brought you, I read your story in awe. You need to know that you're an inspiration to nursing.

Leslie

Dear llg,

Thanks for sharing your experiences regarding the road to faculty positions. I will be finishing my MSN this year and have been doing small independent workshops on leadership for nurses. My concern is that I don't know how to move into a faculty position for leadership education when there are very few courses on this subject offered within any curriculum.

So your perpective on the politics that surround trying to obtain this kind of faculty position is extremely useful to me.

I will probably continue trying to develop my programs and work independently while working agency to pay my bills. I know that I will also need to move into a PhD program but the thought of more nursing theory has put a damper on any thought of obtaining a PhD in nursing. I am looking at PhD in Organizational Management programs with the primary focus being leadership.

Who know where this will lead.....as you and others responding to your post have said, we need to be lifetime learners and you never know where our learning will lead us.

Thanks!:)

For me, I really miss the bedside when I am away from it too long and I also want to keep current as an educator and RN. Things change so fast and I don't like feeling lost or unprepared when I am in clinical, so I find it necessary to stay active in practice. I have realized that I want to return to ICU because the current reality of Med-Surg is unmanageable. Having six patients and responsibility for your LPN's six patients is manageable....but, having eight of your own with a lot of movement including transfers, discharges and admissions just does not allow me to provide the care I want to deliver. I won't allow my patients not to be repositioned, have their teeth brushed or oral care provided...we have CNA's, but being new and not a Charge Nurse, I find it easier to do most of it myself and I do...plus, I like connecting to patients and the outcome better when I do it as well. When someone has been in a hospital for five days and has no toothbrush, one knows that such basic care is not being provided. When patients respond to the basic care that I do deliver, I find it sad that others don't think it is important. I had some of my preceptors tell me that there is no way I could do all of that direct care and get done on time...I would have to agree with them as I have had to work over the past two eves. But, it isn't like it was in 1982, when we stayed over for two hours charting every nite....and we were dumb enough to do so off of the clock too.

Barbara

I have often wondered what happened to this VERY BASIC nursing care when I've opened patients' mouths to intubate and had to literally use Magill forceps to remove unidentifiable particles before I could find the cords! I've even given oral care (dilute H2O2 and a lap sponge did wonders) during surgery. I worked as a nurse technician (essentially a nurses' aide but in a BSN program) in school. I, too, remember those nights staying over to chart. Worked 16h shifts Sat & Sun. I remember trying to not laugh aloud when we were told in class that 'every patient's chart should have an initial assessment documented within 30 min.' Yeah, right. I was opening charts at 2230 and had been there since 0630!! I like to believe the 22 year old with breast cancer appreciated having her legs shaved while we gabbed about 'stuff'. Hard to do that from behind the nurse's station, or now, from behind a computer. Anyway, we're from the same era (early 80's).

Back to the orginal subject: A heartfelt thanks to all of you teaching the upcoming generation of nurses. Most people have no clue how much time and effort goes into teaching didactics and clinical. The students make it worthwhile.

PG

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