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Demystifying the doctorate

There are multiple pathways to gain a higher qualification, writes Mardi Chapman.

Fear and trepidation are normal responses when considering whether to add a PhD to the resumé but nurses should instead focus on the career development benefits and potential for improving future practice and patient outcomes.

Professor Debra Jackson, from the Faculty of Nursing, Midwifery and Health at the University of Technology Sydney, says PhDs are increasingly in demand and more accessible than ever.

Jackson says as well as having a real interest in their research topic, candidates needed good support. "The first generation of professors of nursing didn't have the opportunity to do PhDs in nursing and had to go elsewhere to faculties of education or sociology. Now we have our own doctoral programs but there are still not enough people going through them."

Additionally, most nurse PhD candidates are mid-career - often in their mid-40s, studying part-time and therefore completing their PhD with perhaps 10 years before retirement.
As a result, there is a looming international shortage of nurse academics with a doctorate.

However, Jackson says this anomaly, a transition period for the profession, provides both opportunities for nurses and incentives for alternatives to the classic Doctor of Philosophy.

"People are sometimes intimidated by a PhD and in particular, the thought of producing a 70,000-100,000 word thesis. Even for those people who have achieved autonomy in their professional life, a PhD can seem overwhelming."

She and her colleagues want nurses to be aware of other options - part of the reason for her paper, Demystifying PhDs, published recently in the journal Contemporary Nurse.

One pathway to a PhD that is well established in some European countries and increasingly popular in Australia is the PhD by publication.

This program can recognise a body of published work in leading journals by established researchers especially those with international standing. Candidates submit their published works along with a 10,000 word supporting statement.

Another version of the PhD by publication requires a series of shorter 5000 word papers on a consistent theme of independent research. Professional doctorates are also available which blend coursework and research components. "These are all equally rigorous options for qualifying for a PhD but some better suit different styles of learning and studying," Jackson says.

She says people come to a doctorate by various pathways. Young student nurses are now exposed to honours programs in nursing which can kick-start their early interest in research fresh from an undergraduate degree.

More experienced nurses, often in senior management or clinical nurse consultant roles, are more likely to be drawn to a PhD to extend and broaden their career opportunities.

"Some may want to move towards a teaching and research career while others want a more informed evidence base for their clinical practice. These nurses have often been studying non-stop and have a lot of qualifications such as a Master of Advanced Clinical Practice associated with so many years of developing their clinical expertise."

Jackson says mid-career nurses already have many of the skills to be successful in completing a doctorate.

"They already juggle high pressure jobs and the demands that come with senior positions. They understand deadlines, know how to access the nursing literature, are competent writers and they are disciplined."

She says there is also a lot of encouragement in the workplace for all forms of learning advancement and many employers will provide support such as study leave or by helping with data collection.

As nurses have become more skilled at applying for research grants, she says there are also more opportunities for taking up PhDs that are embedded in larger projects funded by agencies such as the Australian Research Council.

"I would certainly urge anyone who is considering a PhD to make contact with a university and talk it through. In the past a lot of nurse PhDs focused on nurse education but we see more research now on nursing practice, interventions and treatments."

Jackson says research that combines quantitative and qualitative components can be very valuable in developing a deeper understanding of the patient experience - taking the value of a PhD well beyond individual career shaping or academic pursuit.

"Nurses enjoy privileged access to people and share their most intimate moments. We are with them in severe health crises, during the loss of loved ones, and through changes to living with a disability."

"A PhD is not only a gift to yourself, but makes the patient experience so much more visible. It contributes to new knowledge, contemporary knowledge, and has the potential to generate changes in practice that will enhance the patient experience."

Turning misfortune to advantage

Clare Cole, PhD University of Ballarat

Clare Cole gives the impression of someone fast-tracking her nursing career: combining clinical practice, teaching and research in an effort to regain a few lost years between school and her Bachelor of Nursing.

Currently on maternity leave from the University of Ballarat, she is about 12 months into her PhD and juggles clinical shifts each month.

She is also lead author on a new Australian and New Zealand pocket companion for Jarvis's Physical Examination and Health Assessment and is delighted to have had an abstract accepted for a conference in the US next year.

It all bodes well for a productive academic career and the opportunity to make her mark in the profession. However, Cole admits that some aspects of her career were spectacularly unplanned. A serious back injury sustained on an orthopaedic ward in 2007 put her in rehabilitation and prompted a move towards teaching and research.

"If I hadn't had the back injury, I might have stayed in a clinical career as I like the adrenalin of working in areas such as trauma and emergency care," she says. "However, I really like teaching which developed out of preceptoring students on the ward. I looked around for entry-level academic positions and started a Master of Education Studies."

Cole's master's research focused on ethics in a day-surgery environment. Her doctorate investigates whether the notion of nurses as patient advocates is outdated in the contemporary healthcare system.

"Career-wise I needed to keep going to the next level. In a university setting, it's almost assumed that you either have a PhD or will be working towards one. I felt the timing was right. I enjoy learning and studying and a PhD is a once-in-a-lifetime experience."

While time is the major obstacle, Cole treats her PhD like a second job and has the support and enthusiasm to see it through. "I am exceptionally lucky with my principal and co-supervisors. I have a good working relationship with them and they provide wonderful guidance and good feedback."

She says their interest, backed up by the invitation to present at an international conference, helps keep her motivated. "It's a big pick-me-up to know that other people think it's worthwhile," she says.

"I think I have found a little gap in the literature that will potentially help me change how we teach students. We need to be contemporary in our thinking and I like to challenge the status quo."

Cole hopes there might also be the opportunity for a book on related ethical and legal issues but ultimately the research is not about her.

"I could be wrong but I feel that while some aspects of patient advocacy are still applicable, others need to be updated and individualised. It's about helping nursing to establish itself a little more and teaching nurses to be the best so we have top-notch care for our patients."

Mardi Chapman

A teacher with a passion for research

Julie Harris, PhD University of New England

Succeeding in postgraduate study is a combination of both sheer tenacity and strong supervision from teachers and peers for Julie Harris. "I believe part of why I got to where I am is because I'm self-driven and motivated to achieve my goals," she says.

"But on the flip side, I couldn't do what I do without the support of the people around me. My PhD supervisors have been terrific in recognising my achievements and providing support and guidance."

Under the supervision of Dr Penny Paliadelis and Dr Glenda Parmenter, Harris is currently completing her doctorate at the University of New England on the nurse's experience of applying the theory of medication administration to practice.

Harris opted to complete her doctorate at her alma mater having completed her studies at the rural NSW campus as an undergraduate. "I wanted to complete the cycle," she says.

"UNE has stayed with me for life. I started my undergraduate diploma in 1985 and have returned to finish my pathway with the PhD."

Although she now lives and works in Queensland, she says the distance doesn't present an obstacle. Instead, it's the quality of the professional relationships that matter most.
"In terms of accessing information, there is no reason for tertiary study to be located on campus. You can be anywhere in the world. It just depends on your level of commitment to the communication."

Harris began her nursing career as a registered nurse before moving into teaching, first as a nurse educator in the Barwon Health Service district, and then as a lecturer at the University of Southern Queensland's Fraser campus. As a medical education officer in the Fraser Coast in the late 1990s, Harris was also responsible for co-ordinating an education program for junior doctors in the aftermath of the Jayant Patel scandal.

As a result of her teaching appointment at USQ, she has been named as one of the nation's top 50 university lecturers and the USQ's top ranking lecturer for 2010.

"I see myself as a teacher with a passion for research. I believe that what I teach needs to be based in evidence and if I'm going to find the evidence then I need to do the research. But I am also a teacher who believes that I need to understand implicitly how what I teach can be applied to practice and, from that point of view, I have kept my nursing position at Fraser Coast Health Service."

To maintain her clinical skills, Harris continues to complete one shift a fortnight in the ED, ICU and surgical and medical pools.

"You have to know what you are talking about and you can only do that if you have the evidence to support best practice."

One the most significant challenges of working and completing her PhD is prioritising her time and managing her competing areas of interest.

"Sometimes I feel a little conflicted about where my energy needs to go; whether it's my PhD, my job, my family or whether it's my social life. Sometimes the pressure to split yourself in too many ways can be quite strong."

However, Harris says she's learning to master the art of "chunking down her time" as recently explained to her by Dr Yoni Luxford at UNE. "This means committing to your research while you are with it and not letting it bleed into the other areas of your life."

Harris says while a PhD is highly sought after in the tertiary sector, remuneration for postgraduate qualifications within the health industry is closely tied to the requirements of the job.
Queensland Health is currently exploring models that assist clinicians to gain postgraduate qualifications through, for example, the funding of professional development activities.

"Education and research collaboratives are being developed that will work between the health and the tertiary sectors to encourage those relationships and engagement of staff in graduate certificates and higher degrees like masters and PhDs," Harris said.

She is expecting to complete her PhD study on reducing medication errors by December 2013.

Linda Belardi

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