Putting the PhD in Nursing

Nursing at Emory has come a long way since its first class graduated 90 years ago at what was then known as the Wesley Memorial Hospital Training School for Nurses. The neophytes, trained by doctors, were expected to give comfort to the sick - and that meant everything from changing bandages and bedpans to singing and sewing. Even today, the stereotype still lingers of women in crisp white uniforms and stiff hats, bustling down hospital corridors, bestowing acts of kindness and being helpful to physicians.

Assistant professor and nurse midwife
Joyce King is one of a growing cadre of
doctorally prepared nurses assuming
research roles at the Nell Hodgson
Woodruff School of Nursing. She holds
a PhD in physiology from Emory and
conducts basic science research on
glucose metabolism in fat cells. She
hopes her upcoming studies of insulin
resistance in fat cells in female
pregnant and nonpregnant rats will
increase our understanding of
gestational diabetes. King was the
only nurse among 36 scientists from
around the world studying cell and
molecular biology this summer at the
Marine Biological Laboratory in
Woods Hole, Massachusetts.

While perceptions fade slowly, nursing has changed dramatically. The caring attitude remains key, but the responsibilities of the men and women in nursing's ranks today have grown enormously. Advanced practice nurses are often called upon to do what primary care physicians did 20 years ago - including physical examinations, patient education, birthing, and in some states like New York, everything from making house calls and writing prescriptions to providing the full spectrum of care for chronically ill patients. Beyond the bedside, nurses have become managers of the clinical enterprise with far-reaching oversight. They have assumed increasingly pivotal research roles in such areas as measuring outcomes and managing clinical trials.

Those increasing demands have not gone unnoticed in education circles, especially in the Nell Hodgson Woodruff School of Nursing. In fact, Emory is taking two giant steps to ensure that its own nursing school will help set the agenda for nursing leadership in the next century.

By fall 1999, the nursing school's first PhD class - six to eight students - will begin doctoral work at Emory. A year later, the school will move into a new building that will better fit nursing's new agenda by providing additional space for interdisciplinary research.

The two moves will work hand in hand to create an intensive multi-disciplinary research environment, says Interim Dean Margaret Parsons. Both are part of Emory's plans to differentiate itself from other schools of nursing by managing enrollment to build a larger graduate program that addresses current trends in health care. Currently the school has 150 undergraduates and 250 graduate students.

The doctoral program will include a core curriculum that emphasizes outcomes measurement, ethical decision making, and policy issues. Doctoral students will benefit from the school's current research strength in such areas as women's health, cardiovascular disease, oncology, pain, and sleep.

Unanimous decision

Interim Dean
Puts Retirement
on Hold

Interim Dean Margaret Parsons
will lead the Nell Hodgson
Woodruff School of Nursing
over the coming months as the
school steps into a new era of
nursing education and seeks a
replacement for its former
dean. In June, Dean Dyanne
Affonso left the helm of the
school but plans to stay as a
faculty member. Dean Jim
Curran of the Rollins School
of Public Health is heading a
health sciences center-wide
search committee for a new
nursing dean.

Dean Parsons had just been
given a retirement party when
she was asked to stay until a
new dean is named. A popular,
well-regarded member of the
nursing faculty since 1976,
she was appointed associate
dean for academic affairs in
1994. She has received the
Emory Williams Teaching
Award and the School of
Nursing's Outstanding
Faculty and Outstanding
Undergraduate Faculty
awards, and was the
speaker at graduation
this year.

Nurses doing research? Absolutely.

Nursing education has shifted from an emphasis on how things are done to why. Such an analytical approach requires more doctorally prepared nursing faculty - a commodity in short supply and high demand in university, research, and clinical areas. Lack of a doctoral program has been a hindrance to recruiting senior research faculty to Emory's nursing school.

That barrier was pointed out last year during strategic planning for the Woodruff Health Sciences Center. Like the schools of medicine and public health, nursing took a close look at itself to determine what it needed to do to move into the nation's top-tier research schools within seven years. The conclusions were that space, a doctoral program, and research are inextricably linked and that all top-ranked academic health sciences centers and research centers in this country offer nursing PhDs.

"We have developed as far as we can as a master's granting school without a doctoral program," says Lynn Lotas, director of the Office of Research Affairs and co-chair of the nursing research strategic planning process. "For us to continue to recruit research faculty and build the research program, we had to have the doctoral program. It's the old chicken and egg dilemma. We know we should be a mature research institution to have a doctoral program, and we need to have a doctoral program to become a mature research institution. Our research program and our doctoral program have to develop together."

The doctoral program was approved unanimously this spring by the Executive Council of the Graduate School and the Academic Affairs Committee of the Board of Trustees. The School of Nursing will join 64 other doctoral programs across the nation, including three in Georgia.

When its new PhD program is in place, the nursing school hopes to increase the ranks of doctorally prepared faculty from 41% to more than 80% over the next five years. And it must increase its research funding levels by 600% to reach the mean funding level of top-tier schools.

Overwhelming? Not really. Nursing at Emory needs only an additional $1.5 million to reach its goal. Dedicated research space and a PhD program will greatly improve the School of Nursing's opportunities to make that leap.

The school already has a small, active core of researchers with a history of working with physicians, ethicists, theologians, public health professionals, and lawyers. Research covers topics ranging from the effects of low birth weight babies on parental decision making, to sleep disorders in dialysis patients, and the impact of cardioverter devices on quality of life.

Nurses are in an ideal position to analyze such issues, notes David Blake, vice president for academic health affairs. "They spend more time with patients than other caregivers. They know how to interview them, assess their situations, and become a confidant of patients very quickly."

The strategic plan also points out that nursing research is in its infancy, not just at Emory but nationwide. The oldest nursing doctoral programs have been around only for 25 years. In 1980, there were fewer than 1,000 nursing PhDs in the United States. Interest has accelerated in recent years, and the NIH developed a nursing research institute only a decade ago.

(continued below)

Research by nurses is assuming increased importance in the world of health care. Consider these examples from the Nell Hodgson Woodruff School of Nursing:
  • In working with dialysis patients over the past 15 years, nursing professor Kathy Parker observed that many had major problems sleeping. As a result, dialysis patients often suffer daytime sleepiness, irritability, depression, anxiety, and decreased motivation. The National Institute of Nursing has awarded Parker a three-year, $870,000 grant to study the physiologic effects of dialysis on sleep and develop interventions to enhance sleep quality in these patients.
  • Tanya Sudia-Robinson was principal investigator of a recent interdisciplinary project with the Emory Ethics Center, nursing faculty, and hospital staff. They followed families of babies in the neonatal intensive care unit at Grady Hospital and how those families made decisions involving their baby's care. Researchers found that the highly technical and specialized care in an NICU significantly alters how families function and that health care providers and parents both felt ownership of the baby. The study concludes that members of the health care team need to be more aware of how parental interpretation of information can adversely affect the communication process and their relationships with care providers. An offshoot of this project is a new required, graduate-level course on the interdisciplinary perspectives of health care ethics, co-taught by nursing, theology, the ethics center, and rehabilitation medicine faculty.
  • Assistant Professor Christi Deaton is part of a multidisciplinary group of physicians, nurses, health services researchers, economists, and biostatisticians who collaborate in cardiovascular research. In a pilot study funded by the American Nurses Foundation, Deaton and her colleagues found that patients with shorter lengths of stay after coronary bypass surgery were not at increased risk for readmission. Patients readmitted within the following three months had longer postoperative lengths of stay. Readmission rates were higher in women and patients with heart failure.
A closer look at nursing research

Why now?

While talk of a nursing PhD has been ongoing for almost two decades here, Emory has an advantage initiating a doctoral program now, says Dean Parsons. "Most doctoral programs were designed in the 1970s when health care was much less turbulent and transitional than it is today. We have a different view now of what's needed in a nursing doctoral program - one that addresses today's issues in a time of unprecedented upheaval and change.

"For example, nurses will contribute vital insight into complex ethical issues, such as who gets what care and how technology can be used sensitively and compassionately," she says. "The same is true of health-related outcomes issues."

The PhD program is expected to give Emory nursing a recruiting edge and will enrich the nursing curriculum at all levels. If the volume of calls the school received even before the PhD program was approved is any indication, Emory is well positioned to take the cream of the doctoral crop.

Besides attracting research faculty and PhD students, the school will continue to recruit nationally for mature, goal-directed undergraduates to look at issues such as policy implications of health care from a nursing perspective. More faculty conducting groundbreaking research and scholarship promises to be an additional enticement to potential students.

Already, many School of Nursing undergraduates at Emory are set apart from the average student, with many launching second careers: 33% of the undergraduates and 9% of graduate students have degrees in other fields, such as engineering, education, social work, even doctorates in the basic sciences. The average age for undergraduates is 27 and 34 for graduate students.

An ideal climate

Emory offers a particularly ideal environment for research on outcomes, ethics, and policy. Emory's rich array of resources - schools of medicine, theology, public health, law, and business; its ethics center; the Carter Center; and the Centers for Disease Control and Prevention - will offer doctoral aspirants a promising mix for collaboration.
In this Issue

From the Director  /  Letters

Yerkes: Link to the Past,
   Hope for the Future

Build It and They Will Come

Putting the PhD in Nursing

Moving Forward  /  Noteworthy

Facing Death and Dying


It will also prepare them for a marketplace that continues to change. Demand is strong today for critical care and operating room nurses, and it is growing in areas such as home health care, long-term care, midwifery, and advanced practice nursing.

While currently 80% of nursing PhDs teach and do research in academic settings, increasing numbers are going beyond the academic enterprise into leadership areas such as developing policy for corporate health care, school systems, pharmaceutical companies, and institutional health care.

The doctoral program and new building are a strong vote of confidence for the Nell Hodgson Woodruff School of Nursing - named for the late wife of Robert W. Woodruff. And, says Dean Parsons, the changes will go a long way toward filling a growing need for a new breed of nurse-scientists who can identify and evaluate innovative and cost-effective ways to deliver high-quality, affordable health care.

--Marlene Goldman


Copyright © Emory University, 1998. All Rights Reserved.
Send comments to the Editors.
Web version by Jaime Henriquez.