Friends of Flo - Who Should Pursue A PhD in Nursing?

On this episode the Friends of Flo are talking with Sandra Daack-Hirsch about Nursing PhDs. When should you pursue a PhD compared to a DNP? Sandy is the Director, PhD Program for the University of Iowa's College of Nursing. If you have any questions for Sandy you can reach out to her here: sandra-daack-hirsch@uiowa.edu

Transcript

Narrator: 0:00

This episode of Friends of Flo is brought to you by NCLEX mastery. If you're a nursing student and you're about to take your NCLEX, you need to go to the app store right now and download NCLEX mastery.

Tess: 0:00

Welcome back folks it's Friends of Flo, Tess Judge-Ellis

Andrew: 0:18

I'm Andrew Whitters

Rebecca: 0:20

I'm Rebecca Porter

Tess: 0:21

and we actually have a Friend of Flo here with us today it's Dr. Sandy Daack-Hirsch. And so we have a really exciting time planned today where our goal is to really talk about Ph.D. education for nurses and Dr. Sandy Daack-Hirsch is the director of the Ph.D. program at the University of Iowa College of Nursing. So do we have anything else to clear up? I mean before we got on we talked a little bit about lice.

Rebecca: 0:51

Oh yeah

Tess: 0:52

Because Doug you see has lice in the family. So you know so we've been talking about that universal problem especially now that school starting, right? And so how much time you spend coming to your kids here out.

Rebecca: 1:03

My dog had fleas, is that the same?

Tess: 1:06

Your furry friend had fleas. Andrew, any comments on lice or what's been going on in your life.

Andrew: 1:13

We've not incurred lice events at my house yet and my dog has had fleas. And school did start today. So those cover the whole three subject gamut right there.

Tess: 1:24

That's right. I was walking in when I was driving over here I saw the little kid being walked to school by their parents.

Rebecca: 1:29

Do you remember when your kids started?

Tess: 1:31

Oh my gosh. Yeah, definitely.

Rebecca: 1:33

And Sandy when your kids started?

Sandy: 1:35

Oh yeah, yeah.

Rebecca: 1:36

What was it like?

Sandy: 1:37

I can tell you my oldest, the day that she her first day of school I can tell you what she was wearing. I can tell you that she and I sat on the back porch and watched a flock of yellow birds or Goldfinch and that these flowers and sat and talked about what the birds were eating and then I walked her to school and I cried(laugjs).

Tess: 2:00

Did she ever have lice?

Sandy: 2:01

God she had lice. I was telling you guys. So we were just I was home alone with her and her brother and saw that she had lice and I just freaked out, called my husband at work said you've got to come home, I can't do this by myself. And we had a shampoo and she has really thick long hair and we had to shampoo and comb her out like four or five times and then her brother find all the stuffed animals get all the bedding off and wash it and bag up everything. It was like a two day ordeal and you just feel totally dirty.

Tess: 2:35

I think you said the only other worse thing is when you get called and said your kid bit somebody.

Sandy: 2:41

Yeah, yeah. The two worst childhood faux pas.

Tess: 2:46

So it is worth talking about education and back for education and talking about Ph.D. So Sandy talk a little bit about your background in nursing and how you came into this current position.

Sandy: 2:59

OK so Tess you know my story well I didn't start out in life to be a nurse I actually was really interested in genetics and started as a biology major. I had really no idea that nurses could go to college most of the nurses that I knew worked at a hospital and had gone to a hospital based program called diploma programs. Don't know if you guys have talked about those but they were three year programs that were affiliated with hospitals. They trained the nurses who would work eventually at their hospital or their system of hospitals for the most part.

Tess: 3:31

My mom went to a diploma school.

Sandy: 3:32

Great programs are really very good programs solid nurses came out of...

Tess: 3:36

Totally solid, tut you know then my mom decided to get her bachelor's degree. Actually she's like why did I go to college and not get a degree. Right. And then she also recognized that you're basically staffing the units on evenings and nights after a certain amount of time.

Sandy: 3:51

Right. Right. It's very much based in the traditional way that nurses were educated. Right. In the hospital that they worked and so many those nurses them weren't paid they were apprenticed. And so finding a job that actually paid you was typically outside of the hospital system because the hospital used the nurses that they were educating to care for the patients. Oh probably what mid 1980s the diploma programs were phased out...

Tess: 4:19

Because 1965 was the American Nurses who made the big like everybody's all nurses should have a bachelor's degree. That was in 1965. But I don't know what entity actually said that.

Sandy: 4:32

I didn't realize it was early as 65'.

Tess: 4:34

It was 1965. That statement was made. And actually the only state in the union is North Dakota that requires their nurses to have a bachelor's degree

Rebecca: 4:43

I saw that in the report on the future of nursing that North Dakota. I chose a nursing school. I wanted to go to university. I refused to go to a hospital program and the two competitors for nursing in Calgary at that time were Foothills Hospital and University of Calgary and I was called down in jobs because you were one of those degree nurse who didn't know anything.

Tess: 5:15

We've gone through a lot of changes

Rebecca: 5:19

But back to Sandy

Sandy: 5:19

OK so...

Tess: 5:19

Shiny objects, shiny objects.

Sandy: 5:22

So I loved to genetics loved genetics so this is 1981 when I graduated from high school and we didn't really have you know advanced placement science or honors courses in high school at the time. But anything genetics I would do extra work in and I...so I'm a first generation college and I didn't really have you know a role model of oh find a college and what are you looking for in a college. But because I was such a nerdy science kid I joined this like, it was like a group of high school students and we took field trips around the state of Iowa where you know the different colleges and universities and the University of Iowa had as we know life sciences and biological sciences and health care discipline were really very well known for those things. So as a high school student I experienced that and thought OK that's where I'll go to college. I came here as a biology major like I said interested in genetics and genetic counseling. So after my freshman year of college I started looking into the genetic counseling program and they said oh you know that's a master's degree through the College of Nursing. And I thought, what? You know, what does nursing and genetics...

Rebecca: 6:38

When did it get taken away?

Sandy: 6:38

Oh that's a sad thing. We'll get to that. So I thought like I said I didn't even know that nurses could go to college and then I so quickly changed majors because I wanted to do this genetics thing. So...

Tess: 6:51

You changed to nursing then

Sandy: 7:46

I changed to nursing my after my sophomore year of college. Finished my nursing degree, got into pediatrics because that's where genetics was really happening at the time was pediatrics and O.B. Three and a half years on the floor and then right into the genetics clinic to coordinate the care for children and families who have neuromuscular disorders or muscular dystrophy. And I was, you know, it just struck me full face that, wow, genetics and nursing are just the perfect perfect union of what I wanted to do because you were offering genetic counseling as a portion or piece of the care that we were giving patients. But most of my time was spent care coordinating, facilitating these childrens education and their physical mobility issues in the school setting. Helping families during the dying process.

Tess: 7:51

This was their lived experience of illness with a genetic background

Sandy: 7:54

Exactly. it really was and I didn't understand that when I was getting my degree I thought it was just a means to an end, right? From there I went into a masters in the genetic program at the College of Nursing at the University of Iowa

Tess: 8:08

What year was that Sandy?

Sandy: 8:09

That was 1997 was when I finished my master's degree. And then I was working what I was doing. You know what I was studying. So it was just phenomenal. I got involved in a research lab where we were studying the genetics and environmental factors of cleft lip and cleft lip and palate.

Rebecca: 8:34

So what kind of lab was it?

Sandy: 8:34

It was a molecular genetics lab.

Rebecca: 8:36

So what was that like?

Sandy: 8:37

It was fascinating to be in you know in an environment that was interdisciplinary and things were happening quickly. We were like internationally known research facility for studying cleft lip and palate.

Rebecca: 8:53

So I'm really interested in this because I think nurses think that they have to get right into intensive care, critical care, or...

Tess: 9:01

E.R.

Rebecca: 9:01

and forget that we have to have a science background as well as the humanities. So what did you do in the lab were you....

Tess: 9:12

What did the nurse bring to the table?

Sandy: 9:14

So these are these are big large population-based studies and we had a big study in the state of Iowa, in the Philippines, and in Denmark and to do this kind of work it's human molecular biology, you have to recruit human participants and part of recruiting human participants is explaining the biology and risk factors for why does my baby have cleft cleft lip and palate. Why would I want to be part of this study? So you weren't just recruiting people into a study you were offering genetic counseling services and care coordination services and you know thinking of the family more holistically...

Tess: 9:53

No kidding you're not just an object for my research to my ends

Sandy: 9:56

Exactly, exactly

Tess: 9:57

Good for you.

Sandy: 9:59

So when we created database systems we were creating systems that always had things that would facilitate communication with the family. So as discoveries were made and as cause you know families are lifelong interested in what happened and will this happen again and what's happening with the research and how will this research you know affect the next generation or my children and grandchildren. So because you're I'm a nurse I can think about those things.

Tess: 10:31

You kept the patient at the center, you were the advocate for the patient in that setting and what they needed.

Sandy: 10:35

Exactly

Rebecca: 10:35

And really help keep the other scientists focused on the person.

Sandy: 10:40

Yes.

Rebecca: 10:40

That there's a reason we're doing this it's not just to get a grant.

Andrew: 10:44

Right, there something behind the data that we're looking at.

Sandy: 10:52

So this is an interdisciplinary lab. There's physicians, there's dentists, there's Ph.D. prepared scientists that are bench molecular scientists and you know for the most part samples appear on their bench and then they start to do whatever research they're going to do genetic research that they're going to do. So you're absolutely right that they were fascinated with the stories of who the people were that had given the samples to the lab and more than once I was able to take a young you know genetic scientist to the floor with me as I was talking to a family about the research we were doing and about recurrence risks and genetics and it really then helps them understand the value of the sample they had in front of them.

Tess: 11:37

The links to the person and they must like that too, the patient, the families really felt important. And that what they were doing mattered, for sure validated

Andrew: 11:46

Well this humanizes the science so it was really a great opportunity for them.

Rebecca: 11:51

I really think it's so important in clinical research that people aren't an object of research and not a means to an end, but are the end of themselves.

Sandy: 12:02

Right.

Rebecca: 12:03

And I think your work as a nurse in bringing that is just so vitally important.

Tess: 12:10

So when did you get your Ph.D. and talk about that a bit.

Rebecca: 12:15

When was it time to go and why did you do a Ph.D.?

Sandy: 12:19

So you know so I loved the science I thought the genetics and the nursing the piece of biological science and behavioral science and psychology and caring for patients it all just blended so well. While I was working in the lab, Jeff Murray the physician that I worked with and who was the P.I. the principal investigator on that project more than once said why don't you go back to school and get your Ph.D.. And I thought I've got a great job what I would why would I want to do that. And then I would meet some of the professors that I had while I was in school both undergraduate and graduate. I did them all here at the University of Iowa and Maredene.

Tess: 13:00

Talk about someone we have to have on the pod.

Rebecca: 13:05

She's the one that got me my application done. I'll have to tell you that story.

Sandy: 13:14

So I see her at the bus stop, this was like before, this is actually how I got you know decided to make the decision to go back to school. And she said so are you still working for that physician.

Everyone: 13:27

(laughter)

Sandy: 13:29

And you know Jeff is like he's just world famous you know. Yeah I'm still working for that position. Well how long are you going to do other people's research and not your own?

Tess: 13:43

Oh OK just put it to me Maradene.

Sandy: 13:47

So I didn't have an answer for you know I just wanted to crawl under a rock.

Tess: 13:51

Of course

Sandy: 13:52

And said OK I'll have my application in the next round. And so that's what I did. And I must have you know I was probably in my 40s at the time but always involved in research and I have to say that it was quite liberating to go back to school and be able to think about research. She's right now doing someone else's research, but ask the questions that I wanted to ask and conduct the studies that I wanted to conduct.

Rebecca: 14:21

That's how I felt about going doing your Ph.D. as well as that I've been doing research and I wanted my name first.

Sandy: 14:27

Yeah

Rebecca: 14:27

I mean it's an ego thing, but I also really hated the fact that people were lost and people's stories were lost and when I did a Ph.D. it was to be able to ask the questions that I wanted to ask and get trained or learned how to do that. And it was amazing. Yeah.

Sandy: 14:55

And there's lots of ways to be involved in research and I was telling Tess just the other day was talking to a student who's getting her DNP and in the course of getting her DNP she's looking at a project and she keeps asking questions that are research questions not project-like questions and so she started talking. She came to my office to talk about the Ph.D. and I said you know there are lots of ways that you can be involved in research. It's a team science, we need clinicians that you know really ground us and clinically based research questions and you can inform the way that we ask the question and which questions we're asking and if we're doing implementation science you know giving us clues as to how this might be implemented in the care environment. And I said so you can be a lively part of a team and have your DNP and still involved in research. However if you want to drive you're going to have to get your Ph.D. and she goes,"no, I don't want to be a passenger I want to drive." So I said, then you should think about getting a Ph.D.

Rebecca: 15:54

So what are the barriers, what were your barriers to doing a Ph.D.?

Sandy: 16:01

Boy you know I think most of the barriers are ones that we put up ourselves.

Rebecca: 16:07

I agree

Sandy: 16:07

You know we talk ourselves out, it's not the right time. I'm not smart enough, I don't know statistics.

Rebecca: 16:19

So mine was the GRE. That was my barrier. And I think I spent three years trying to relearn math for the GRE because I graduated from high school and I think God was invented then, think God was around when I graduated from high school. I hadn't done math. Hadn't done algebra or calculus which you have to do for that stupid GRE thing and I went to Maradean and she said"So why isn't your application here?" And I said,"well the GRE and I can't do math. I've been trying to study and it's not going to happen and I'm obviously not smart enough for this and well I don't know" And she said,"Oh for God's sake it's just a box to check off, go do it next week" she said"We just want to know" so there are parts of that GRE that a computer told me I wasn't doing well. But then the writing part I did really well. But once I got over that it was.

Tess: 17:31

Do you still require the GRE?

Sandy: 17:32

No we don't.

Rebecca: 17:33

Oh my god!

Sandy: 17:36

Just last year we took that requirement out.

Rebecca: 17:40

How come?

Tess: 17:41

Not fair! Not fair!

Sandy: 18:01

It's not a very good predictor of who's going to do well

Rebecca: 18:04

For my master's degree in Boston they had, Simmons College had a you could either do the GRE or you could get a B+ or an A on their gate keeper course.

Sandy: 18:19

You know it's a big deterrent. And if you want a diverse student body as well, because we all know that the GRE is really kind of biased towards students who are academically privileged. So it's a big detour for us in diversity and it just isn't a very good predictor of who's going to do well.

Rebecca: 18:42

When's the best time to...you know I did my Ph.D. when I was old. I was the oldest person I could've been the parent really of some of my classmates.

Sandy: 18:56

Yeah

Rebecca: 18:56

But I knew I wanted to do it, I had I had to do it for me because of the questions I had. And so for me it was late. But what about you?

Andrew: 19:12

Well define late for the audience. I mean what's your idea of late?

Rebecca: 19:14

My idea of late is it depends what you want to do with your Ph.D. If you want to go into academia you need to have I think seven or eight years after you complete your Ph.D. to being a post-doctoral fellowship and assistant professor...

Tess: 19:38

If you're at a research institution, a Tier 1 you know

Rebecca: 19:40

If that's what you're goal is. And that takes a long time and a lot of hard hard work and you have to really look at how that how that balances in, but there are other opportunities to use your Ph.D. way outside of academia, in entrepreneurial work. And it really depends who you are you

Tess: 20:11

How do you counsel students about that Sandy?

Sandy: 20:16

Yeah I was in my 40s. So if I have one regret it's that I didn't do it soon enough. But I do think that we're pressing on young people to get into a doctor whether it's being you know advanced degree early and there's a reason for that because of our faculty shortage and healthcare becoming more acute and the need for primary care providers and so we've really pushed that people make that decision earlier. I think experience is a good thing. I think that it helps inform the kinds of questions that you're going to ask and the type of scientists that you want to be. But I think, you know my mid 40s was probably too late for the reasons that Rebecca's talking about. You know you need to come sort of full circle when you get your Ph.D. So if you're going to go into academia or research, whether that's academic research or research at you know a hospital based program or with an institute or however you're going to do that research. It takes about five to eight years to really establish yourself as an investigator doing the preliminary studies or the based studies that you need to build your program of research. And then after that you become very more senior and independent and you can start to mentor and a Ph.D. degree is a more not an entrepreneur, but more apprenticeship type of degree. And we do a lot of teaching one on one and mentoring our students one on one by involving them in our research. And so you know to be able to do that you have had to gotten your feet under you right. And competence. And then to be able to not focus so much on yourself but on the students and others. And if you're in academia you know that full circle is to become a full professor and then to really think about the academy and mentoring and teaching students nursing students or whatever your discipline is from the very beginning like an undergraduate degree all the way through graduate school. So takes a while to be able to do those things. But there are other reasons to get your Ph.D. and you're just absolutely right. So consultation, business, and you know maybe then it's not such an urgency to get your Ph.D. in your 20s and 30s

Rebecca: 22:27

Right. I think you really need to have a reason why because there are times during your Doctoral work that you stop and think, why am I doing this?

Tess: 22:45

What's my passion?

Rebecca: 22:46

Why am I doing this? And I always thought when I die I wanted to have on my tombstone Ph.D. behind my name. To me that was important. But then I remember a good friend of mine I was a physician that I worked with in Vancouver who said, got Ph.D. died anyway.

Tess: 23:05

(laughs) Nice

Rebecca: 23:11

So I think it's really important to have a good reason why you're doing it. Because it's a financial investment as well.

Tess: 23:22

Hang on, you know we got to take a break now Rebecca

Rebecca: 23:24

Oh, we do?

Tess: 23:24

Yes we do

Rebecca: 23:25

Can we talk about funding and how do you do this.

Tess: 23:28

So we'll take a little break right now and we'll be back because we have Dr. Sandy Daack-Hirsch, director of the University of Iowa College of Nursing Ph.D. program

Narrator: 23:44

Here at NCLEX Mastery we love nurses and especially nursing students, but we need your feedback about this podcast. If you have ideas on topics or questions you want us to answer, shoot us a message, leave a comment, go to our Facebook page and just tell us what you think because we want to help you in the most specific way that you need that help. Thank you so much.

Tess: 24:00

So we are back with Dr. Daack-Hirsch talking about Ph.D. education specifically and when we broke Rebecca had questions about financing and how expensive it is and it does cost time and money and energy so the passion that needs to be there and so how do you counsel people and what resources are available for Ph.D. education? How long does it take typically and those sorts of questions that are kind of real functional to this?

Sandy: 24:26

So it's less expensive to get your Ph.D. than your DNP

Andrew: 24:33

Is it really?

Sandy: 24:33

Universally.

Tess: 24:36

Is it universal?

Sandy: 24:37

It is because clinical degrees are more expensive. It's more expensive to train clinicians because of the resources and technology and you know simulation. Your earning potential is higher for a DNP. So we'll be honest about that. That's true across the discipline when you do academic type medicine so the earning potential is higher. It's not that Ph.D. prepared nurses make a you know a bad salary but that's just that's just sort of the economics of educating people. So how long does it take? It takes about four to five years seven is sort of what we'd like to say is the max. That's universally for Ph.D. not just nursing Ph.D.

Rebecca: 25:29

Our history Ph.D.'s can take up to eight to ten years because they're learning. A friend of mine is a history professor and she had to learn Latin and French to do medieval history

Tess: 25:48

Sure her primary sources

Rebecca: 25:49

Right and go to primary sources and the research was years long. So I think for nursing maybe it is shorter.

Sandy: 26:00

So again universally we're trying to bring these down. I mean that's a long time to be in school for any discipline and so...

Andrew: 26:07

Is that a deterrent though frankly? I mean seven years is a long investment.

Sandy: 26:11

So for someI think it might be, but nursing is one of the disciplines that seems to think shorter is better. Other disciplines don't necessarily have that mentality. Now remember a Ph.D. when you get a Ph.D. in nursing you're not only getting a you're getting a Ph.D. in your discipline of nursing but you're not measured or compared to just other nurses with a Ph.D. You're measured and compared to all people who have Ph.D's because a Ph.D. is a universal terminal degree. So for example if I am a research scientist and I'm a nurse Ph.D. and I'm going to the National Institute of Health to get a grant I'm competing for that grant against other nurses whether Ph.D. but other scientists who have Ph.D's as well. So we have to be able to measure up to all people who are doing this similar type of science and to truncate the degree just for nurses means that we would be...

Rebecca: 27:16

You're crippling

Sandy: 27:17

Right. Right. But we're trying to get the Ph.D. more manageable. Ten years is a long time. So at the University of Iowa we typically say you know seven years is the goal is the maximum for students. Our last cohort of students the average time degree was 5.2 years.

Rebecca: 27:36

Mine was seven years.

Sandy: 27:38

Yeah. Yeah which is really phenomenal and that has to do with how we're collecting data now to an understanding that we are setting some people up for an entire program of research so they may be doing a sort of a homegrown...

Rebecca: 27:52

Which is what I was doing it was entirely, nobody had done this before

Sandy: 27:57

Exactly. Versus teaching you how to the research process and using data that's available and then you know you're applying your research

Rebecca: 28:06

I always thought that you were supposed to be finding your own data and not using secondary sources. I look at that as an ethical issue and when you're shortening if you don't know what it is to gather the data to answer your own question.

Sandy: 28:24

So that's a good point. So that's the apprentice piece that the Ph.D. that you know to get your dissertation. Secondary data is an excellent source of data we have so much data that we're putting aside and not. That's almost unethical as well. You've collected this data you've not used it to its maximum capability and so you've got a young bright Ph.D. student

Tess: 28:45

Can you talk about an example at some point Sandy where secondary data you know what does that mean?

Sandy: 28:50

Sure sure. So being part of a team and learning those other aspects of collecting primary data and you know an ethical review board so that you have your science reviewed by an ethics ethics board to say yeah go ahead. This is a good project you can you can do this. Is part of that team experience, but you don't necessarily have to have your research be that experience, but you expect that a student has that experience during their Ph.D. program

Tess: 29:17

Talk about secondary research then what is that exactly?

Sandy: 29:22

So think of all of the data that's collected in a hospital. So every time an artist goes to the site and collects temperature blood pressure and writes notes about how patient responded to a certain treatment. And all of that data is housed now in electronic medical record. And you know behind that is a database that's data that you didn't collect for a primary reason. Health care is a primary reason but not a primary reason in terms of research. Now I can ask a question and go to data that's already been collected and look for the answers in that data rather than collecting my own

Rebecca: 29:59

And I jump in and think, is it ethical to use data on people from people from whom you haven't asked permission to use that part of their being. I haven't donated my blood pressure reading for your research. So why are you using it? Why are you taking it? It's not yours it's mine.

Sandy: 30:23

Right. So now we're going to get into a whole we can do that.

Tess: 30:32

I want to cover financing and I also want to delve into nursing as a science and as a discipline and why we need Ph.D. and what is nursing science research and how is that furthered by you know why do we need pointy headed academics in the academy that study science of nursing and that tension between the care delivery that we do and training bad. Does that make sense? To go there just a little bit that indulges my...

Sandy: 31:03

So how do we finance Ph.D. education? We finance Ph.D. education. The students are research assistants and have the tuition paid for and then have a stipend and nursing students, Ph.D. students right training grants with their mentors and they can get funding from the National Institute of Health. We have generous donors who have established scholarships for nurses to be able to get their Ph.D.

Rebecca: 31:36

Being a teaching assistant is really valuable

Sandy: 31:40

Being a teaching assistant is very valuable. At the University of Iowa College of Nursing we don't have as many teaching assistant positions as we do research, but that has to do with organizational mandates not because we don't value teaching assistants and that experience. And then some nurses do work part time while they're there.

Tess: 32:03

I was going to say you can probably work a little bit part time depending on what else is on your plate.

Rebecca: 32:07

I think it depends on what your job is. When I was there was no way I could have worked part time. When I was going. Did you work?

Sandy: 32:16

I did. I worked part time.

Rebecca: 32:18

Oh, you're brilliant. I'm not that smart.

Tess: 32:21

So I think it's we talked about this. How do you think that the Ph.D. prepared person and just the science, how do you think that advances nursing as a profession to have pointy heads doing nursing research because sometimes I think that nurses feel out of touch with what nursing research is doing and what the academics or academy does for...

Andrew: 32:46

Especially at that level

Tess: 32:47

For sure for sure especially when you have people. I mean I can tell you many examples at the College of Nursing where particularly Janet Speck and Maradenes nursing research was working with nursing aides and nursing homes to do better care for. And that to me is really connecting the dots. But I'd like Sandy to talk

Rebecca: 33:07

And my example was when I was a nurse practitioner I called over to the College of Nursing to a professor who would be an expert in a problem my patient was having. And I was told that there was no connection and I said that that's what their research is on, surely you are an expert in as you know we don't come over there and I think that that's a real problem.

Tess: 33:36

Well now it's like we've gotten ourselves out of the hospital right? As we've moved on said nursing education needs to be in a brick and mortar not being, not being apprenticed in the in the diploma model that we deserve to have degrees and we move towards baccalaureate degrees. But now we want to get back into the hospital.

Rebecca: 33:56

Or in the community

Tess: 33:56

Or into the community and say we want to be there so and we haven't been there as much as we needed to.

Sandy: 34:03

So to talk about Ph.D. education you really have to think about the historical context of the discipline and how we grew up. And so I started the podcast with them talking about hospital based nursing programs and over time you know nursing programs moved into universities and you could get your BSN or you know college degree and so doing so that meant that the people who were teaching you were part of a greater college university structure. And if you were an English major or political science major you were learning from Ph.D. prepared professors, but nurses weren't Ph.D. prepared. They were trained as nurses and then moved into the university settings college settings and started teaching. Eventually, I think the discipline then grew into being parallel to other disciplines. There are professors also having Ph.D.. So the very first Ph.D. were really an education. So how do you teach nurses to be nurses, not what's the science of our discipline. And so we've always had a lot of tension between the art and science of nursing and is nursing a science. Our own identity crisis and then others telling us that we are or are not a science based discipline. Today we believe that we are science based discipline and our sciences are biologically and behaviorally based and a Ph.D. really looks at what it is we do as nurses how patients respond to the things that we do. Are they evidence based. And how do we become better practitioners and have it based in science. Again, behavioral and biological sciences rather than having other people tell us what to do. We want to be in charge of our own discipline...

Tess: 36:05

You're darn right we do

Rebecca: 36:07

I think that there's a way to combine the art and the science and that's what I was trying to do...

Andrew: 36:13

And that's how do we...so I'm envisioning someone else on this podcast, say a bedside RN or an LPN nurse that's listening to this. This is heady stuff we're talking about. So say if that person was here, let me just play devil's advocate for a moment and say, what if I was to ask the question,"Well, what does this nursing theory have to do with me giving my medications to my patient or making sure that they're clean

Tess: 36:46

Or safe

Andrew: 36:46

Like their activities of daily living is the most important thing that is on my priorities list for this patient today. So I'm just speaking as an advocate for the bedside nurse because these are ideas...

Tess: 37:06

Or nurse practitioner

Rebecca: 37:09

Getting to the question of how do I know what I know and why am I doing what I'm doing.

Andrew: 37:15

Sure

Rebecca: 37:16

And how do you get there?

Sandy: 37:17

So I, Andrew, so that was what got the discipline I think in a little bit of a quandary when we first started off as a Ph.D. because we were very much talking about theory, grand big theories that we have a really hard time bringing to the bedside. So nurse scientists don't really don't exist in that big grin...you know the big grin theory is a grand idea about how when what we do it doesn't really get at the clinical problems

Tess: 37:48

It's not granular

Sandy: 37:48

Right. So the clinical problems are we address with mid-level theory and theorizing. Do I need to use heparin every time I flush a lock or I want to disconnect a patient from the IV fluids but I want to keep that IV in because the heparin really burns and I've got a change the IV all the time and so you know that question for example came from bedside nurses and it's really expensive to use heparin over and over again. Might we just flush it was saline? So how do you know that heparin is better than saline? You have to apply a research process to be able to study that, collect data and say this is better than what you did you can now not do a practice that wasn't based in research or evidence base it's just what we always did, right? And I have no evidence that was nursing research that said you know what saline is just as good as heparin. And so now we can use, we've changed our practice to using saline instead of heparin.

Tess: 38:52

Stellar example. And that was somebody saying why are we doing this and listening to the patient and them saying...

Rebecca: 39:00

So how, Sandy, can you talk about why that is a Ph.D. question and not a DNP question.

Sandy: 39:05

Because again you just have to do it the way that you again collect the data and establish the evidence. So, you know, I observed it and of one it worked and of one. Does that mean it's going to work for everybody? We don't know. So you want to do a more systematic trial where you have a variety of patients in a variety of conditions in which you're using that sort of new intervention. A lot of our interventions are based on, I did it it worked and so I trained somebody else, they did it it worked. But we can't really apply it to a population or to the general population and say this is what we should teach in our nursing program

Rebecca: 39:48

So going through a scientific process

Sandy: 39:50

Going through a scientific process, yes. So these are clinical and basic science researchers that train nurses how to integrate biology and behavior in order to influence our practice. So our question should be clinically based or system based. So clinically based in patient problems or a system based in how do nurses deliver care.

Andrew: 40:16

Sure so one of the things that I think that we have in common across the whole scope of nursing practice from the Ph.D. the DNP to the diploma level is what you mentioned you touched on earlier was implementation. That's just one aspect of the nursing process. All right. I have a sort of a two part inquiry for you I'd love to have your thoughts on this. I have the privilege of working with a wide array of trained nurses from there are some diploma level nurses that are still out there. I work with a lot of LPN's that are in geriatric facilities as well as RN's. I do have DNP colleagues that are opening up. We're pushing the envelope of the private practice world which I think is awesome. It's a lot different than the big academic centers like the University of Iowa. I mean, not necessarily for the best or the worst, but it's just different in a very good way. But one of the questions I have for you is how do we standardize nursing education considering we have such a wide array of nurses and different types of education but yet we all use this nursing process. We all come from a general knowledge background. But we alluded to earlier was it one of the Dakota states? The standard is they have to have a four year degree. Where do you stand on this. I mean it's a loaded question but it's something that comes up in my practice every so often in a social way.

Tess: 42:12

Well sure because you can have mulitple different letters behind your name. So when a nurse is a nurse and so when can we standardize baccalaureate education as entry. Well you're never going to let go of the ADN. I'll tell you that right now.

Rebecca: 42:23

How come?

Tess: 42:24

How come? Well, I mean we can actually go into this another time, but I would say cost, but I would also say they produce an excellent product that stays in the community where they're from and that community colleges are invested in keeping nursing there because it helps with all the other educational components that they need biology and sciences and all that stuff.

Rebecca: 42:48

So is an RN an RN an RN an RN?

Tess: 42:48

And does it matter and how does that matter. And that may be a topic for another podcast actually.

Rebecca: 42:57

Cause I have friends who are my age.

Tess: 42:59

Yeah

Rebecca: 42:59

Who are diploma nurses and why should they at age x decide to go back and return to school to do what they've been doing for the last 30 years.

Tess: 43:13

Well and who's driving is who's wagging the tail. Do you know what I'm saying?

Andrew: 43:18

That is a valid question. And I'm not trying to be controversial when I say...

Rebecca: 43:22

Oh, I think we should be controversial

Tess: 43:24

Why does nursing do it? Why do we do it to ourselves?

Andrew: 43:27

We have done a lot to ourselves. Right. And so I'm interested here Sandy's opinion on this because you've been in academia, you've been in research. You have a great science background which I think frankly a lot of nurses including myself can identify with and I look at the 30000 foot view of nursing and I'm like, what the heck. Why have we done this to ourselves?

Sandy: 43:49

Right. I know. You know we're just so I mean you know the basic nursing degree you're BSN is just to me one of the most awesome degrees out there

Tess: 44:02

For sure

Sandy: 44:02

Because you do have this blend of science, sociology, humanities and you bring it together all together to be able to understand people in their illness and you know life trajectories as a holistic whole package not just the biology piece of them not just the behavioral piece of them.

Rebecca: 44:22

Right and it's a jumping point

Tess: 44:24

Plus you get out with an RN the most trusted and respected profession I mean in a four year degree. Hello. You could be an attorney. You could go to(whispers) medical school

Rebecca: 44:34

No, no, no, no

Sandy: 44:35

So I will say that I am a big proponent of entry into practice being a BSN, a huge proponent of that and...

Rebecca: 44:42

Why, do you think?

Sandy: 44:44

Because I think that's that experience of a...

Tess: 44:51

Broad based liberal arts degree

Sandy: 44:57

Yeah, liberal arts degree is an important degree because it's not just teaching you how to be a nurse. It's teaching you how to be a responsible citizen and problem solving.

Rebecca: 45:11

Wait a minute. That the evidence is there that nurses with a bachelor's degree, patients who are cared for have for every...what was the percentage increase that that guy quoted in the IOM on the future of nursing?

Sandy: 45:28

Yeah, don't remember

Rebecca: 45:29

That there is actual evidence that the more education a nurse has, the lower the probability of a bad outcome for their patients. So it improves the quality of care improves the safety of patient care. And while it's more expensive to hire Bachelor's of a BSN in a short term, in the long term hospital organizations are actually recovering costs...

Tess: 45:58

That's an interesting statistic. That's really interesting.

Rebecca: 46:04

Yeah, look at the Institute of Medicine education Appendix One...ACON

Andrew: 46:12

So there is a secondary inquiry I had we had mentioned BSN baccalaureate prepared nurses. So my question for you Sandy is at the bedside and we've talked about this in previous podcasts a little bit. There's an exodus of nurses leaving the bedside and I see that in my practice on a daily basis. Nurses who...they don't feel satisfied. Part of it is I don't think they feel appreciated.

Rebecca: 46:48

I would argue it's more of a stress and burnout and compassion fatigue.

Andrew: 46:51

OK, that's another very...

Tess: 46:53

Leadership. Moral leadership.

Andrew: 46:54

Your point is well noted. And so I do think that's a great point. And so...

Rebecca: 47:03

The research shows it.

Andrew: 47:06

Spoken like a true Ph.D. What do you think can be done at the bedside level to prevent an exodus of nurses because that is where the shortage is. That's where the needs are. And we need good people there to take care of people in the community.

Sandy: 47:27

What can be done? That's a big question.

Andrew: 47:28

Yes it is.

Sandy: 47:30

And you know this has been an issue forever. I mean when I was getting my BSN I remember you know we took a history class on nursing at the very end of that nursing program and they were talking about already what are you going to do next. And it was a master's in your nurse practitioner Ph.D. the assumption like that if you got your BSN that you would go you would go on and you kind of sat in the corner if you really wanted to stay at the bedside because you didn't want people to know that you didn't aspire to do more.

Andrew: 48:02

Right. And that is almost it's disappointing that we put that pressure on ourselves and on fellow nursing colleagues. I personally don't think it's right. And in fact if I can just add to that for a moment like one of the things that I have I I do and I make my rounds with all my patients I bring the nurse in right away, before I even see the patient. What are your concerns? Then after I see the patient. Hey these are my ideas, what do you think? And I make them a part of my care process. I make it a part of my care plan. And I make sure that I have their their investment too because I care about what they know and how they're seeing the patients because after all they are there.

Sandy: 48:42

Absolutely

Andrew: 48:42

At bedside far more than I am.

Rebecca: 48:46

We need to also remember that or think about the fact that as human beings we are restless. We want more. And there are other people who are quite content and are staying where they need to be. But what we need to do in nursing is give people permission and reinforce

Tess: 49:08

Empower

Rebecca: 49:08

Empower that when you are at the bedside. This is an extraordinarily important job and you are no less for staying at the bedside than for going to graduate school

Andrew: 49:21

Of course not

Rebecca: 49:22

And I think that's what you're saying...

Andrew: 49:22

And showing some appreciation I think can add to the satisfaction of a bedside nurse. And I have no data to prove that but...

Sandy: 49:35

I think you know if everyone would do that it would do a world of good right? That nurses, bedside nurses felt that they were part of the entire team. And I think we make big strides in that and then backwards big strides and backwards. You know. But we're caught in this sort of environment where the faculty nursing shortage is so great that people have put a lot of emphasis on making a decision earlier to get an advanced degree whether that be a DNP or a Ph.D. so that you can come back and teach in all sizes of colleges and program schools of nursing. So that's created some tension because you want to identify who those young people are who you feel would be successful in an advanced degree and get them thinking about it earlier so that they have time to develop as an advanced practice nurse or a Ph.D. prepared nurse. But in doing so we've not listened necessarily to the nurses at the bedside and people saying that I want to wait. Or you know I think making people feel bad that they want to take some time and do this and do it for a while. There's a new report that the American Association of Colleges of Nursing has put out and it's the advance health care transformation. It's called the MANAT report. And it really focuses on clinical partnerships. Nurse researchers and advanced practice nurses partnering with academic health centers. But more importantly focusing with health centers whether they be hospitals or community based programs so that your partner partnering with bedside boots on the ground first line nurses to identify clinical problems clinical clinically based problems what are the problems that are important to nursing to solve and including your practice partners bedside nurses in that research team and invest a good toread team in that project that an advanced practice nurse a DMP prepared nurse is doing because they're there the practice that you're going to hopefully affect is that delivery of care. So not removing it like it's something that's done in an ivory tower but it's something that's done in collaboration with people where they're practicing regardless of where they're practicing. So we need to get better at doing that and Manatt report really focuses on those partnerships.

Tess: 52:06

I'm going to swing into the DNP for just a few minutes that I think is one of the hardest things for students going forward for their doctoral and nursing practice doctor in nursing practice. And that's the idea of project manager instead of doer and that's probably one of the hugest things I have to talk to the students about, all of us in the DNP program, is no, no, no it's not your project to actually do the teaching that you identify, it's to get the resources of the people at the clinic that you're doing and implement this good idea that's evidence based, that focuses on a population and I think it's this mindset of nursing that we have to do all of it you know and so when you move into looking at populations it's more about almost being the nurse for the population instead. Am I making sense with this? I don't know.

Sandy: 53:02

Well we've I think for too long separated that you know research is done someplace other than where care is delivered and it's not. We have a lot of knowledge again that we've you know databased or catalogued or wrote about and now it's time to implement those things. We have to see if they work well they're seeing if they work in a more laboratory, sterile environment, but to see that they work in where they're actually need to work like at the point of care is a different type of science and that involves the people who are actually delivering the care not a surrogate who does it just for the study but for the people who do it on a daily basis. That's effectiveness. Efficacy is does this thing work in a sterile environment. Effectiveness is does this whatever I want to do work in real time, real point of care because there's lots of things that affect the way that you care for patients.

Rebecca: 53:53

There's so many variables

Sandy: 53:53

So many. And even in a system there are and so that involves the care practitioner whether that's a bedside nurse or advanced practice nurse. In this study in the research that you're doing and so you've got to be able to develop more dynamic teams of people who are doing search

Rebecca: 54:10

It really is a larger team.

Sandy: 54:12

Yes

Rebecca: 54:12

And that's where I see a marriage between a Ph.D. and a DNP...

Sandy: 54:17

Or a bedside nurse

Rebecca: 54:21

And a bedside nurse

Sandy: 54:21

Well public health nurse or school nurse.

Tess: 54:24

What I love is the discussion is like, you can build a team based on patient outcomes and a problem that you've identified that you have someone you want to call and talk to about it and say hey is there someone who'll listen to me talk about that and then you might call like the program or somebody who's got a DNP that's in academics that you know or you call someone a Ph.D. and they say, you know what, you've got questions why aren't you thinking about the next degree? So I love that and we love nursing because it's what you said Sandy it was this whole like why wouldn't you want to get a bachelor's degree in the lived experience of people with health that's well-rounded you know if that's your bent that's your bent.

Sandy: 55:07

So let me just put a plug in about you know Ph.D. prepared nurses. We're not going to have that until we start being excited about our nursing science in that wherever you're learning how to be a nurse BSN, ADN, wherever it is. That's exciting things and our students should...they're afraid of research or think that somebody else does research that they're not part of this process. But again these clinically driven questions come from the people who are practicing at the bedside or advance practice or wherever and to understand and embrace that as a nurse in your first degree is the first step into thinking, I could do this or I want to do this instead of making the scary thing that it's a hard grade and I'm not going to ever use this. We should be celebrating the fact that we do these things because nurse scientists discovered that this is what we should do or this is how we should approach those and we should all embrace and be excited about that research that's going on whether we do it or not. We should be living it when those findings are published. And you do that by embracing the research process even in your undergraduate

Tess: 56:13

Because it matters to people, to patients and to nurses who are taking care of patients like your research Rebecca on moral distress. Because it matters and it matters that's our profession.

Rebecca: 56:27

It's just so wide open and the opportunity is just wherever you choose to make it. Can I ask Sandy, can people contact you if they want to talk to you about when should I do a Ph.D. where do I apply? Which school do I apply to?

Sandy: 56:45

Of course

Tess: 56:50

And so Daack-Hirsch will you come back again and be another guest? You're officially a friend of the pod.

Rebecca: 56:59

Thanks Sandy!

Tess: 57:01

Thanks for having me.

Rebecca: 57:02

It's been great. All right so we always end with our...

Andrew: 57:07

Words of wisdom

Tess: 57:08

Signature statements. Keep your eye on the patient

Andrew: 57:10

Innovate, agitate, educate

Rebecca: 57:13

Be kind, be generous

Tess: 57:16

And keep your stick on the ice, Rebecca Yeah, keep your stick on the ice.

Sandy: 57:19

I think I said my last one about you know embracing research in the undergraduate. Wasn't there a pearl of wisdom in there?

Tess: 57:26

You're awesome.

Andrew: 57:27

Sounds good. See you guys.

Narrator: 57:42

Friends of Flo is brought to you by NCLEX Mastery go to the app store right now, download NCLEX mastery. And before you leave, if you could just share this with your nursing friends, tell them about us. Leave us feedback, go to our facebook page, tell us what you liked, tell us what you didn't love so much, be nice; but thank you so much. We really appreciate you.