Healthcare in America has been in the spotlight for a number of months.
The picture portrayed in the media is of a giant "black box" into which
16% of our gross domestic product (GDP) goes and out of which comes
healthcare whose quality and quantity is under debate. Within that
black box is a complex mix of healthcare workers and their
organizations, hospitals, insurance companies, government agencies,
private agencies, big and small pharma, instrument corporations, citizen
groups, corporate executives, politicians, lobbyists, and scientists,
each with its own agenda and goals.
Of these components of healthcare, none is more attractive and respected
than the group committed to the "protection, promotion, and
optimization of health and abilities; prevention of illness and injury;
alleviation of suffering through the diagnosis and treatment of human
responses; and advocacy in healthcare for individuals" -- the nurses.
(The definition is from the American Nurses Association.) Holding a
special position in the nursing profession, a carefully chosen group
carries out research -- a career choice that merits consideration by
qualified young individuals seeking a research career in healthcare. A
nursing Ph.D. program is an excellent way to enter such a career.
I work as a physician-scientist at the University of Wisconsin (UW)
School of Medicine and Public Health, I have long been aware of the
increasingly important role nurse researchers and nurse Ph.D.'s play in
modern healthcare. Barbara J. Bowers, Associate Dean for Nursing
Research at UW-Madison, kindly gave me a generous amount of her time to
convey an in-depth view of the opportunities and challenges of nursing
Ph.D. programs and research careers in nursing. Much more information
nursing Ph.D. programs and research careers is available on these
institution's Web sites.
My discussion with Dr. Bowers made it clear that -- to paraphrase an old General Motors ad -- this is not your mother or grandmother's career in nursing. For starters, nursing is no longer a gender-specific profession. Nearly 15% of the entering class in nursing at the UW is men, a number that reflects the national average -- and that is increasing.
Let's look at how nursing education has changed in the last couple of decades. In decades past, great number of nurses entered the profession with an associate degree -- a technical degree conferred after 2 to 3 years in a community or technical college or hospital. With additional coursework, these nurses could earn a bachelor's degree. Those interested in a research career could later earn a master's degree, and eventually a Ph.D., most commonly in education, psychology, or sociology.
In present-day nursing education, many students begin with a 4-year Bachelor of Science in Nursing ( BS or BSN) program. These programs are often competitive; at UW-Madison, about 400 applications are received for 150 places. Those accepted generally have GPA sof 3.5 or higher. Nursing-bound high school students need courses in mathematics, science, social studies, humanities, foreign languages, and communication skills. Strong preparation in physical and social sciences is essential.
The curriculum of the nursing baccalaureate program at UW-Madison is representative of most programs. The first 2 years concentrate on general education and includes prerequisite courses in the sciences, humanities, and social studies. Applied skills are acquired during the junior and senior years via core lecture, laboratory, and clinical courses and elective courses that allow students to pursue individual interests.
UW-Madison offers an innovative option for top students interested in entering a research career in nursing: the early-entry Ph.D. program selects first year students who are invited to plan, in conjunction with the faculty advisory committee, an individualized program of study and research. The program includes early and intensive research training, clinical practice, and required and recommended coursework. Each student works closely with a senior faculty member whose research matches their own interests. This research is combined with graduate courses in the area they select and completion of the required and recommended undergraduate and graduate courses in nursing and related disciplines. Students completing the program receive 3 degrees: B.S., M.S., and Ph.D.
Research areas of current students in this program include the ethnocultural influences on pain and pain management, effects of global environmental change on human health, and symptom management for patients. Students publish their findings in major professional journals and present their work at research conferences.
More traditional post-baccalaureate Ph.D. nursing programs -- my university has one of those, too -- offer a strong emphasis on research training in nursing through an apprenticeship model. Students work closely with their nursing school preceptor and faculty committee to follow an individualized, research-driven program of study. The preceptor advises the student on the selection of courses and serves as a liaison to the major department and other departments in the graduate school.
Students in both programs receive financial support through graduate assistantships and traineeships. Stipends usually run about $30,000, plus tuition remission.
A major financial supporter of these programs is the National Institute of Nursing Research (NINR), part of the National Institutes of Health (NIH). NINR currently has fourteen "priority areas":
- Research related to low birth weights
- HIV infection care delivery
- Long-term care for older adults
- Management of pain and other symptoms associated with acute and chronic illness
- Nursing informatics to enhance patient care
- Health promotion for older children and adolescents
- Technology dependence across the lifespan
- Community-based nursing models
- Preventing HIV/AIDS in women
- Preventing diabetes, obesity, and hypertension
- Cognitive impairment
- Coping with chronic illness
- Families at risk for violence
- Behavioral factors relation to immunosuppression
This list illustrates the scope and importance of some of the key issues that are the focus of nursing research
At a time when job opportunities in general can be hard to come by, graduates of nursing Ph.D. programs are in demand in a variety of educational, clinical, and governmental settings. Ph.D. nurses have faculty appointments or positions as research scientists or research directors. Faculty positions usually start at the assistant professor level, on the tenure track, with annual salaries of about $70,000 to $80,000 a year.
What's unique about this type of research career, Bowers stresses, is its involvement with people -- living and working with them and dealing with the challenges their health problems present. It's a stable and rewarding career with a range extending from gerontology to health policy. Graduates entering into it can expect to remain engaged, satisfied, and see their research funded.
Are there special characteristics that identify people particularly well suited for a career in nursing research? Bowers cites an interest in finding more effective ways to solve complex care problems and a high level of curiosity. Physicians tend to be more interested in diagnoses and treatment while nurses are more focused on prevention of poor health outcomes by changing lifestyle and helping patients and their families live with diseases. Beyond this, the attributes she associates with students suited for a career in nursing research are commitment to improved health and more effective health care delivery, initiative, a desire to "push the envelope," and, above all, a feeling of excitement when carrying out research.
For those qualified individuals who want a "hands-on" career in dealing with people and their health problems, consider nursing research. Few other careers can match its challenges and rewards.