Proceedings of Doctoral Programs in Nursing: Consensus for Quality

SPEC]IAL F E A T U R E

Proceedings of Doctoral Programs in Nursing: Consensus for Quality

SPONSORED BY THE AMERICAN ASSOCIATION OF COLLEGES OF NURSING AND

THE DMSION OF NURSING, D E P ~ OF HEALTH AND HU~LAN SERVICES EDITED BY JOANN S. JAMANN, MSN, EDD

T/sh report of the Proceedings of the Conference, held August 13-15, 1984, is being distributed to all participating schools for faculty review.

FOREWORD

I AM PLEASED to tO the proceedings of the con- present you ference on doctoral preparation in nursing cosponsored by

the American Association of Colleges of Nursing (AACN) and the Division of Nursing, DHHS. The purposes of the conference were to reach consensus on issues of quality in doctoral programs in nursing, to define areas in which quality control is critical, to state criteria for assessing quality, and to identify resources and extra-university relationships crucial to the operation of such programs.

The American Association of Colleges of Nursing has as its major purpose the advancement of quality care through promotion of quality baccalaureate and graduate programs in nursing. All institutions with current and proposed doctoral programs in nursing are members of the AACN. Further, the AACN has evidenced its concerns about doctoral preparation in nursing through position statements and activities. It is fitting that the AACN cosponsor the conference with the Division of Nurs- ing, which has over the past years provided excellent support for the development of doctoral study in nursing through two national conferences, publications, and the Advanced Nurse Training and Research programs.

The conference participants considered some difficult questions about the future of doctoral programs in nursing. Their deliberations and discussions have resulted in consensus statements which we offer to you for your consideration and further input. It is our hope that these efforts will result in doctoral programs of higher quality that, in turn, will promote the advancement of quality care.

LINDA K. AMOS, RN, EDD, FAAN President, AACN

T HE DEVEIDPMENT of doctoral programs in nursing in this country has been both exciting and sobering. Exciting be-

cause these programs signal the arrival of the science of nut~ng

Received from the American Association of Colleges of Nursing, One Dupont Circle, N.W., Suite 530, Washington. D.C. 20036. Produced under Purchase Order UHRSA 84-499 (P), Division of Nursing, DHHS.

Address correspondence and reprint requests to the AACN.

9O

at a level which can sustain the theoretical and research-oriented work that is characteristic of this most advanced degree; sobering because development of these programs has created a number of difficulties with which we now must deal.

As doctoral programs have developed, individual faculties have successfully guided proposed curricula through collegial review, graduate school scrutiny, university approval, and often skepti- cal legislatures that have needed to be educated as to the potential benefits of doctoral level education for nurses. This has been possible because a slowly developing but certainly productive group of scholars has addressed the theoretical basis of nursing, and has begun to seriously test the knowledge upon which nursing rests. This has meant the development of nurses who have had the appropriate conceptual and research tools--nurses who could question and test, take apart and put together, expand and delimit that which is the growing science of nursing. Based on this body of knowledge, faculties have been successful in establishing some very sound programs-programs which are of unquestionable merit in their own right, as well as in comparison with doctoral programs in other disciplines.

At the same time, some doctoral programs have been developed that lack the quality we might wish. There is room, certainly, for programs with a variety of emphases, programs that provide alternative approaches to doctoral study, and programs that focus on preparation for one degree rather than another. Programs must not he developed for the wrong reason. For example, they should not be developed out of need for the program alone, no matter how pressing. Instead, they must be the natural outgrowth of more and better prepared faculty and of increased university and community learning resources, which together provide the rich environment needed to establish and successfully operate demanding educational programs.

It is the hope of the Division of Nursing and of the American Association of Colleges of Nursing, cosponsors of this conference, that the participants who have worked together to develop these indicators of quality for doctoral programs will also sub- scribe to them in their own institutions. For the participants, as well as for prospective students, employers of program graduates, and others who wish to make reasoned judgments of these programs, it is hoped that the indicators will prove to be of considerable value.

Jo ELEANOR ELLIO'IT, MA, RN, FAAN Director, Division o f Nursing DHHS

AACN/DHHS DOGTORAL PROGRAMS IN NURSING 91

PREFACE

T HE EVOLUTION of nursing as a science and a profession has been led by the development of doctoral education in nurs-

ing and for nurses. The first ~ 'o doctoral level programs for nurses were established in the 1940s. Shortly thereafter, in 1955, the Nurse Research Fellowship Program was established to combine knowledge of nursing and a basic science. The foundations for a science of nursing were initiated, and the cadre of nurses with doctoral preparation established, to lead the development of nursing science, practice, and education.

Within the past decade, there has been a rapid expansion of doctoral programs in nursing-from nine in 1974 to thirty in 1984. Although the growth may slow during the latter half of the 1980s because of national economic and higher education resources, a steady growth and development of doctoral education in nursing is predicted. The issues of need are no longer discussed.

In 1971, the Division of Nursing, U.S. Department of Health, Education, and Welfare, sponsored the conference, "Future Directions of Doctoral Education for Nurses" to explore current and future trends. The key conclusions of this conference, and many subsequent conferences, identified the need for diversity in doctoral level education in nursing. Diversi.ty in types of programs offered, in emphasis or focus of content, in fund-

ing mechanisms, and in research efforts was, and is, recognized as a strength in the development of the science and profession of nursing. Thus, the current conference, cosponsored by the Division of Nursing and American Association of Colleges of Nursing, was called to address the promotion and maintenance of quality in existing and developing doctoral programs in nursing.

This conference was structured to facilitate consensus build- ing at several stages. First, two addresses about quality in graduate education in general and in doctoral programs in nursing were delivered. The full group of participants then considered areas in which statements about quality control in nursing doctoral programs were essential. The bulk of conference time was spent in work groups, which developed statements about quality and brought them to the full group for further discussion and consensus. On the final morning of the conference, those items on which disagreement still existed were further discussed until consensus was reached.

These proceedings present reports of each of these activities toward consensus on indicators of quality in doctoral programs in nursing.

JOANN S. JA.',tANN, MSN, EDD Editor

92 JOURNAL OF PROFESSIONAL NURSING �9 MARCH-APRIL 1985

CONTENTS

Consensus Statements 92

The Nature of the Doctorate and Criteria for Quality 94

Issues in Doctoral Preparation in Nursing: Current Perspectives and Future Directions 101

Discussion: Areas in Which Quality Control is Essential 108

Reports of Work Groups

Faculty Qualifications 109

Program of Study If0

Educational Resources 112

Students 113

Research 115

Evaluation of the Program 116

Consensus Development and Recommendations 118

Consensus Statements

INDICATORS OF QUALITY IN DOCTORAL PROGRAMS IN NURSING

The purpose of doctoral education in nursing is the development of nursing knowledge. The primary emphasis of the doctor of philosophy program is research and creative scholarship. The professional degree emphasizes advanced clinical practice with the integration of research to improve nursing care (DNS). The following statement is the consensual foundation for the indicators of quality doctoral programs in nursing. (This report does not consider the ND degree.)

This report of the Proceedings of the Conference is being distributed to all participating schools for faculty review.

The following indicators apply to the doctor of philosophy degree in nursing (PhD) and to the doctor of nursing science degree (DNS).

Faculty

1. Members should be actively engaged in continuing research related to the program of study in which doctoral students participate.

2. Members should hold graduate school appointments, if appropriate, at the_ university.

3. Members should include a core of nurse

faculty members holding earned doctoral degrees in nursing.

4. Faculty research or knowledge development should take place in the context of the history and philosophy of science and lead to a better understanding of the phenomena of nursing.

5. Publication of research and scholarly activity that disseminates new knowledge and perspectives should be subject to peer review.

6. Faculty mentors should socialize the student into a career of stimulating and satis- fying excellence of inquiry and service.

Program of Study

1. The program of study is determined by the faculty's conceptualizations of the phenomena of nursing. The common elements in programs of study for the doctor of philosophy and the professional doctoral degree (DNS) include:

a. History, philosophy, and future directions of nursing science.

b. Comparative research designs, methods, and techniques of analysis appropriate to the level of study.

c. Theory construction.

d. Critical analysis of social, ethical, and political issues of importance to the discipline.

e. Data management, tools, and technology.

f. Student research opportunities.

�9 2. Core content can be provided in a variety of ways and should not be restricted to formal course work. Cognates are substantive courses that supplement the research area and assist in the development of a minor field of study. The balance between nursing and cognate fields depends upon the philosophy, purpose, and objectives of the program.

Resources

1. Students have the use of computer services, and new advanced technology, to meet the goals of the program.

AACN/DHHS DOCTORAL PROGRAMS IN NURSING 93

2. Library resources are sufficient to assure acquisition of materials for advanced nursing science development, and technology for rapid retrieval of information is in place.

3. Laboratories must support and be appropriate to the educational program.

4. Students have access to the clinical research center in universities, where one exists.

5. Access to clinical facilities appropriate to the program's goals and objectives is for- mally arranged.

6. Financial and political resources are sufficient to support both program and student needs.

Students

1. A pool of serious, qualified applicants is identified to support the need for the program.

2. Admission criteria consistent with those of the institution and rigorous enough to pre- sume student success in the program are established. Data on admission criteria and student performance are retained to establish a basis for success prediction.

3. Provision is made for review of the excep- tional applicant who does not meet the criteria.

4. Location of the program facilitates the enrollment of students appropriate to the program's goals.

5. Information on faculty expertise and resources is distributed to potential applicants.

6. Doctoral students in nursing are provided the same opportunities to apply for university-sponsored financial assistance that doctoral students in other disciplines enjoy.

7. The school has a clearly defined financial assistance program for doctoral students that would go into effect in the event that funds became available.

8. Students are made aware of sources of financial support, and assertive competition for funding is fostered and encouraged.

9. Part-time students have an established sup-

port system and are encouraged to achieve full-time status.

10. The socialization process is viewed as essential to the doctoral program, and program activities encourage socialization.

11. To achieve their research objectives, students should receive continuity of assistance from the faculty.

12. Students receive job counseling and place- ment assistance.

13. The sequence of requirements for progress in the program is clear, and evaluation milestones, such as qualifying and comprehensive examinations, admission to candidacy, and the final defense, are set forth.

Research

1. The university and school of nursing consider research a priority and have adequate funding for it.

2. The school of nursing facilitates faculty research through administrative organization, support services, faculty appointments, promotions and tenure criteria, faculty assignments, and salaries.

3. The faculty is expected to conduct continuing research and disseminate its knowledge, assist students through development programs, and socialize students into the research arena.

4. Faculty research determines and is congru- ous with the school of nursing's research program goals. Research goals and themes guide faculty and student research selection, and student research is determined primarily by faculty research.

5. The areas on which research will concentrate are identified.

6. Student research is supported through assistantships, joint publications, and support for presentations or publications.

7. Postdoctoral training is recommended, encouraged, and supported.

8. Program graduates publish papers and dissertations within three years of course or program completion.

9. Faculty, students, and alumni present

94 JOURNAL OF PROFESSIONAL NURSING MARCH-APRIL 1985

I0.

11.

scholarly papers at regional and national meetings.

Dissertations and faculty research enhance the body of knowledge about nursing.

Research goals include solving clinical problems and validating clinical nursing inter- ventions.

Evaluation of Program

The program is evaluated on the basis of:

I. Student and alumni accomplishments.

2. Its operation, including admissions, student progress, and graduation policies.

3. Faculty and student qualifications.

4. The learning environment it provides, including accessibility of faculty and other support systems.

5. Its curriculum.

6. Its resources and its relationships, both intra- and inter-institutional.

7. The knowledge and theory it contributes to nursing.

These indicators of quality in doctoral programs in nursing complement those identified by the Coun- cil of Graduate Schools.

The Nature of the Doctorate and Criteria for Quality

MICHAtI.J. PELCZAR, JR, PHD President, Council of Graduate Schools in the United States

INTRODUCTION

Approximately one year ago, the National Com- mission on Student Financial Assistance (NCSFA) issued a report entitled Signs of Trouble and Ero- sion: A Report on Graduate Education in America. Dr. John Brademas, former Congressman from In- diana and now president of New York University, chaired the subcommittee of the NCSFA that prepared the report. One of its chapters, "Importance of Graduate Education and Research," opens with these words:

Most Americans are aware in a general way of the importance of the graduate enterprise to the nation. We realize that such triumphs as putting footprints on the moon, im- planting artificial hearts, and orbiting satellites are the results of scientific and technological brilliance. We may also understand that these developments could not have

been conceived, much less realized, without new genera- tions of scholars and scientists making dramatic intellectual progress in areas such as materials and metals; human physiology and behavior; astronomy; systems management; mechanical, electrical, and chemical engineering; and the chemistry and physics of energy.

Few of us comprehend, however, that graduate education and research are the bedrock of every important area of our national life. They support our commerce and indus- try, are crucial to our foreign policy and security, and are the foundation of our hopes for enhancing American life and culture.

This report, more clearly than many others, articulates without reservation the nation's need, indeed the world's dependence upon, more and better higher education. When I hear moaning and groan- ing about a presumed surplus of PhD's, I recall the comment of Norman Hackerman, president of Rice University. Hearing talk about surplus PhD's, he retorted that mankind stands at the bottom of a mountain of ignorance.

DOCTORAL DEGREES-THE PhD

Among the policy statements of the Council of Graduate Schools (CGS) in the United States are two publications on doctoral degrees:

I. The Doctor o f Philosophy Degree 2. Requirements for the PhD

The Association of Graduate Schools also has two statements:

1. The Degree of Doctor of Philosophy: A Statement Policy

2. The Research Doctorate in the UnitedStates

The introductions to the CGS policy statements underscore that the doctor of philosophy degree is awarded as the mark of highest achievement in preparation for active scholarship and research. The statements go on to identify the conditions necessary for a PhD program, namely:

1. Its nature and purpose, which a) prepare students for a lifetime of intellectual inquiry (creative scholarship and research), b) lead to careers in government, business, and in- dustry, as well as academia; and c) result in extension of knowledge.

2. The institutional organization, that is, the graduate school, graduate council, and com- mittees.

3. Faculty responsibilities for maintaining

AACNIDHHS DOCTORAL PROGRAMS IN NURSING 95

creativity and scholarship, and for advising students.

4. Administrative services and physical facilities, such as libraries, laboratories, and computer capacity.

5. Guidelines for degree requirements, including admission, advising, residence, examinations, candidacy (admission to), research and the dissertation, financial aid, working relationships, and employment guidance.

The decision to initiate a doctoral program is based on many factors, the most important of which are as follows:

1. The need exists according to local, regional, and national evidence. One must know about the many consortium arrangements. For example, the Western Interstate Com- mission for Higher Education, the Consor- tium for Institutional Cooperation, and the Southern Regional Educational Board, as well as individual state coordinating boards, are alert to opportunities for program coordination and vigorously oppose what they interpret as duplication.

2. There must be clear evidence of the potential for a high-quality program.

3. The faculty must already be productive in research and fully supportive of the new program.

4. The administration must fully understand its responsibilities and must be supportive of the new program.

5. Library facilities must be adequate for doctoral study in the new program area as well as in supporting areas.

6. Laboratories and comparable facilities must be available and adequate for the new program.

7. The faculty offering the new doctoral program should have already offered master's degree programs of substantial quality.

8. Appropriate administrators must be available, and administrative procedures must be established.

Having met the above conditions, the institution that takes the following steps increases the likelihood that its doctor of philosophy program will be sound:

1. Appoint a depattmental or interdepart- mental committee to develop the proposal for the new doctoral program.

2. Identify the reasons for offering the new program:

a. What are the local, regional, and national needs for such a program?

b. How many students are likely to participate in it?

c. How will the program contribute to the other university departments and to other institutions? How will it contribute to the state, the region, the nation?

3. Develop a detailed plan for the new program. Include goals and objectives, academic procedures, estimated costs to the institution, and a statement of standards to be met.

4. Invite outside consultants to visit the campus for a review of the proposal and to make recommendations.

DOCTORAL PROGRAMS OTHER THAN THE PhD

Each year, the National Research Council conducts a survey of earned doctorates. Research and applied- research doctorates in all fields are included, but professional doctorates st~ch as the MD, DDS, o n , DVM, andJD are not. It may surprise you to know that the survey containsdata on 43 doctoral titles other than the PhD, including the doctor of arts, doctor of education, doctor of engineering, doctor of forestry, doctor of library science, doctor of music, doctor of nursing science, and doctor of social work.

What is the distinction between these titles and the title of PhD? Actually, the distinction is often blurry. Take the EdD and the PhD in education, for example. I recently asked Dr. Barbara Schneider, professor of education at Northwestern University to prepare an article for the CGS "Communicator" on the differences between these two degrees. She consented with an essay entitled "EdD and PhD Pro- grams: An Issue of Distinction." Her opening para- graph reads:

Many graduate schools of education within multipurpose research universities continue to offer two types of doctoral programs-EdD, ostensibly for those seeking a professional career, and the PhD for those seeking a research career in education. Since the inception of this dual-track system, educators have engaged in endless rhetorical debates to


justify the existence of the two degree programs. Their ardu- ous efforts, it would appear, have been futile; for the pas- sage of time has done little to resolve the issue of distinction between the two degrees.

Generally, the emphasis of the graduate school doctorate other than the PhD is considered to be education and training for the "practitioner" for example, doctor of music, doctor of architecture, doctor of fine arts. However, this distinction becomes somewhat obscure in terms of the accepted comprehensiveness of the PhD. To quote from Spurr's book Academic Degree Structures:

At the core of the neverending dispute on the merits of the PhD program is the argument as to whether the PhD degree exists primarily to train research scholars in the traditional arts or sciences or whether it should also encompass the preparation of college teachers and advanced professionals in general . . . .

In short, there is no reason why the PhD cannot be offered as a three- or four-year program suitable for turning out research workers, teachers, and professionals. Th.e only question is whether the faculties of the individual departments will face up to the multi-variant careers of the products of their doctoral programs and build in the necessary flex- ibility. Parallel doctoral programs with other names are created only to circumvent the nostalgic purists.

Spurr's comments remind me of a speech given by WilliamJ. Bennett at the University of Chicago on February 21, 1984. Bennett, chairman of the Na- tional Endowment for the Humanities, commented about humanities programs:

Graduate humanities programs in too many American universities have become insignificant, lifeless, and point- less . . . . We need to connect graduate study in the humanities to life's most compelling questions or we will ~ t c h such study disappear into a richly deserved obscurity.

Need, quality, resources, and commiiment are the key prerequisites for a successful doctoral program. There must be justification ofneedfor the program; there must be evidence that the proposal, when im- plemented, will establish a program of high quality; there must be assurance that adequate resources are available; there must be university commitment for the long term.

THE ISSUE OF QUALITY

Speaking and writing on quality in graduate education has become almost as commonplace as the promises of politicians during a campaign. Thus, one would expect that we in higher education would have by now a precise definition of quality in graduate

education as well as methodology for assessing it. Not so. Why?

A description by Robert Pirsig, in Zen and the Art of Motorcycle Maintenance, explains our difficulty:

Quality, you know what it is yet you don't know what it is, but that's self-contradictory. For some things are better than others, that is they have more quality. But when you try to say what the quality is, apart from the things that have it, it all goes poof. There is nothing to talk about. But if you can't say what quality is, how do you know what it is, or how do you know that it even exists? If no one knows what it is, then for all practical purposes it really does exist. What else are grades based on? Why else would people pay fortunes for some things and throw others in the trash pile? Obviously some things are better than o t h e r s . . , but what's the 'betterness'? . . . So round and round you go, spinning mental wheels and nowhere finding any place to get traction. What the hell is quality? What is it?

REPUTATIONAL SURVEYS OF GRADUATE PROGRAMS

National surveys conducted to assess quality in graduate programs date back to the early 1920s. Ray- mond Hughes conducted a survey in 1925, in which he included universities that awarded doctoral degrees. He ranked 38 universities in 20 graduate disciplines on the basis of how many top scholars the schools employed. Hughes conducted another study in 1934. In this second study, 59 universities and 35 graduate disciplines were included. Ratings were based on an assessment of the staff and of facilities for the preparation of doctoral students. Note that in both Hughes studies the ratings focused on doctoral education and evaluations by faculty. In 1957, Hayward Keniston ranked 24 graduate programs at 25 universities. The Keniston rating was done by department chairpersons, who were asked to name the five top departments in their fields using faculty quality and doctoral program quality as the criteria for "top."

The Hughes and Keniston surveys were limited in scope. They did, however, establish certain prece- dents, namely, programs were "ranked" and the criteria for ranking emphasized doctoral education.

In 1966, Allan M. Cartter published the results of a major survey in An Assessment of Quality in Graduate Education-A Comparative Study i of Graduate Departments in 29 Academic Disciplines. He surveyed 106 universities offering doctoral programs--every university that awarded an average of 10 doctoral degrees a year in the 1953-to-1962 period


was included. Thirty graduate programs (disciplines) were surveyed. The evaluators were 900 department chairpersons and 1,700 senior and 1,400 junior profes- sors. They were asked to rate programs in terms of two basic questions:

1. Which of the terms below best describes your judgment of the quality of the institutions listed? Consider only the scholarly competence and achievements of the present faculty.

a. Distinguished

b. Strong

c. Good

d. Adequate

e. Marginal

f. Not sufficient to provide acceptable doctoral training

g. Insufficient information

2. How would you rate the institutions below if you were selecting a graduate school in which to work for a doctorate in your field today? Take into account the accessibility of faculty and their scholarly competence, curricula, educational and research facilities, the quality of graduate students, and other factors that contribute to the effectiveness of the doctoral program.

a. Extremely attractive

b. Attractive

c. Acceptable

d. Not attractive

e. Insufficient information

The Cartter report was followed in 1970 by the Roose-Andersen survey entitled '~A Rating of Grad- uate Programs." This survey was similar in concept and conduct to the Cartter report, but it included more universities and more graduate programs.

It is interesting to observe that in 1925 Hughes rated 38 universities in 20 different programs and concluded the top 10 institutions were the Univer- sity of California, the University of Chicago, Colum- bia, Cornell, Harvard, Johns Hopkins, the Univer- sity of Michigan, Princeton, the University of Wisconsin, and Yale.

This list of the "top 10" was shuffled in the studies following the Hughes report. In 1970, the Roose-

Andersen report listed the "top 10" as follows: the University of California, the University of Chicago, Harvard, the University of Illinois, the University of Michigan, Massachusetts Institute of Technology, Princeton, Stanford, the University of Wisconsin, and Yale.

Many of the same institutions appear on both lists, developed 50 years apart. There are only three changes: Illinois, MIT, and Stanford were added; and Columbia, CorneIl, and Hopkins were dropped. Each successive study in this series of studies was bigger, had more participants, assessed more programs, and claimed to be more refined than the one preceding it; and each successive study was much more expen- sive than its predecessor to conduct.

MAJOR CHARACTERISTICS OF EARLY PROGRAM EVALUATION SURVEYS

The surveys thus far mentioned have the following characteristics in common:

1. Quality was cvaluated on the basis ofa repu- rational survey.

2. Institutions (and their programs) were ranked, that is, the question "Who is number one?" was answered.

3. Evaluation was based solely upon research- related characteristics.

RANKING OF PROGRAMS

Many persons sharply criticize the ranking of programs and institutions. Their criticisms can be sum- marized as follows:

1. The raters are likely to reflect bias. Many departments may be given a high rating because of what is called a "halo effect." A program at an elite university, for example, may be rated highly simply because it is at that university, rather than on the basis of objective evaluation.

2. These assessments contribute little to aug- ment the knowledge of deans or department chairpersons about their programs. Thus, the surveys make no contributions to improvement efforts.

3. There is a tendency for the assessments to reinforce the status quo. Their methodologies favor traditional offerings.

4. Large, orthodox programs are rewarded with


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6.

good ratings for rigidity and concentration on research and scholarship, while quality of teaching and undergraduate education are ignored.

The results of the surveys, despite precau- tions, are likely to be misused.

Finally, the characteristics of program quality are multidimensional. All graduate pro: grams do not have the same objectives. Therefore, a single set of criteria cannot determine the quality of all programs.

CGS-GREB SELF-ASSESSMENT OF QUALITY OF GRADUATE PROGRAMS

In 1972, the Council of Graduate Schools, in col- laboration with the Graduate Record Examinations Board, set out to design a more objective process for evaluating programs. Twelve graduate deans con- vened for a day in Chicago to initiate the plans. They addressed the question: What criteria contribute to the quality of a graduate program? Mary Jo Clark of the Educational Testing Service also participated in these deliberations and has served in a professional capacity since that time on this project. Funding for certain portions of the study was provided by the National Science Foundation and the Fund for the Improvement of Postsecondary Education.

In designing an evaluation that would yield useful information about program quality, they kept in mind:

1. The need to recognize the multidimensional characteristics of quality: Not all programs can or should be judged by the same criteria.

2. The need for diagnostic information: What are the strong features of a program? What are the weak features?

3. The desire for an overall characterization of a program.

4. The strict avoidance of program rating.

The Graduate Record Examinations Board and the Council of Graduate Schools in the United States developed a new graduate program self-assessment service for master's and doctoral programs. Three questionnaires, designed for graduate faculty, students, and alumni, have been produced.

The new underlying assumption is that the per- ceptions and judgments of faculty, students,- and alumni can contribute to a better understanding of the functioning and quality of a department or pro-

grams. Specifically, this new service allows comprehensive information about an institution's graduate programs to be contributed confidentially. Question- naire responses are processed by the Educational Test- ing Service (ETS) and reported in summary form to the department, university, or agency that commis- sioned and conducted the survey. To enhance in- terpretation of the collected data, judgment items from the three questionnaires are clustered so that mean responses can be reported for the following 16 program characteristics: environment for learning, scholarly excellence, quality of teaching, faculty concern for students, curriculum, departmental procedures, available resources, student satisfaction with program, assistantship or internship experiences, faculty work environment, faculty research activities, faculty professional activities, faculty program involvement, resource accessibility, student accomplishments, and employment assistance.

In 1979, the Forum on Doctoral Education in Nursing arranged with ETS for the self-assessment of 18 doctoral programs in nursing; and five years later, in 1984, this review is being repeated.

ASSESSMENT OF RESEARCH-DOCTORATE PROGRAMS IN THE UNITED STATES

The Conference Board of Associated Research Council, the American Council on Learned Socie- ties, the American Council on Education, the Na- tional Research Council, and the Social Science Research Council developed and conducted an assessment of research-doctorate programs in the United States. The origin of this study dates back to September 1976, when the Conference Board held a three-day meeting to consider whether a study of programs in graduate education should be undertaken. Academic administrators, faculty members, and agency and foundation officials participated in lively discussion. After extended debate, the conference recommended that a study with emphasis on the effectiveness of doctoral programs in educating research personnel be undertaken.

Following the conference, a 13-member committee was formed to develop a study limited to research- doctorate programs and designed to improve upon the methodologies of earlier studies. In its deliberations, the planning committee carefully consjdered the criticism of earlier assessments of quality in graduate programs. Particular attention was paid to the feasibility of compiling a variety of specific measures (for example, faculty publication records, quality of


research-doctorate programs). Attention was also given to improving the survey instrument and procedures used in the Cartter and Roose-Anderson studies. In September 1978, the planning group sub- mitted a comprehensive report describing alternative strategies for evaluating the quality and effectiveness of research-doctorate programs.

Results of the Conference Board study, entitled "An Assessment of Research Doctorate Programs in the United States," were published in a series of five separate documents. The first of these was available in the fall of 1982. The other four were issued at later dates.

The Conference Board surveyed doctoral programs in 32 broad fields of study:

1. Mathematical and physical sciences-- chemistry, computer sciences, geosciences, mathematics, physics, and statistics/bio- statistics.

2. Humanities--art history, classics, English language and literature, French language and literature, German language and literature, linguistics, music, philosophy, and Spanish and Portuguese languages and literature.

3. Engineering--chemical engineering, civil engineering, electrical engineering, and mechanical engineering.

4. Biological sciences-- biochemistry, botany, cellular/molecular biology, microbiology, physiology, and zoology.

5. Social and behavioral sciences--anthro- pology, economics, geography, history, political science, psychology, and sociology.

Program information was received from approximately 228 universities, and the data were reviewed by approximately 5,000 evaluators.

A total of 16 measures or program characteristics was used to evaluate individual research-doctorate programs. These 16 measures were grouped as follows, under the major heading of program size, characteristics of graduates, reputational-survey results, university library size, research support, and publication records:

Program Size

1. Reported number of faculty members in the program, December 1980.

2. Rcported number of program graduates in

last five years (July 1975 through June 1980).

3. Reported number of full-time and part- time graduate students enrolled in the program who intend to earn doctorates, De- cember 1980.

Characteristics of Graduates

4. Fraction of FY1975-79 program graduates who had received some national fellowship or training-grant support during their graduate education.

5. Median number of years from first enrollment in graduate school to receipt of the doctorate (FY1975-79 program graduates).

6. Fraction of FY1975-79 program graduates who, upon completing requirements for the doctorate, had made definite commitments for postgraduation employment.

7. Fraction of FY1975-79 program graduates who, on completing requirements for the doctorate, had made definite commitments for postgraduation employment in PhD- granting universities.

ReputationaLSurvey Results

8. Mean rating of the scholarly quality of program faculty.

9. Mean rating of the effectiveness of the program in educating research scholars/ scientists.

10. Mean rating of the improvement in program quality in the last five years.

11. Mean rating of the evaluators' familiarity with the work of program faculty members.

University Library Size

12. Composite index describing the library size in the University in which the program is located, 1979-80.

Research Support

13. Fraction ofprogram faculty members holding research grants from the National Science Foundation, the National Institutes of Health, or the Alcohol, Drug Abuse, and Mental Health Administration at any time during the FY1978-80 period.

14. Totalexpenditures reported by the univer-


sity for research and development activities in a specified field, FY1979.

Publication Records 15. Numberofpublished articles attributed to

the program, 1978-79.

16. Estimated"overall influence" of published articles attributed to the program, 1978-79 (raw values are not reported).

This study has several distinctive features. It is characterized by a sharp focus and a multidimensional approach:

1. It concerns only programs awarding research doctorates. Other purposes of doctoral training are acknowledged to be important, but they are outside the scope of this survey.

2. The multidimensional approach recognizes the limitations of studies that make assessments solely in terms of quality perceived by peers- the so-called reputational ratings. Consequently, a variety of quality-related measures are employed in the study and are incorporated in the presentation of its results. Numerous cautions are given about interpreting the data.

The results of this study have elicited mixed reac- tions. Some of the observations made by Dean Alfred S. Sussman, University of Michigan, are:

1. We conclude that the "objective" measures used in the Conference Board report contribute little beyond descriptive information to the study. This is true even of the two measures of scholarly publications, despite their frequent use by newspapers and other in- terpreters of the results.

2. Clearly, the data in the report already have been used widely and will continue to be. In the absence of better studies, the Con- ference Board report fills an important niche; and its ratings, in a general way, especially of the higher-ranking programs, appear to meet with the agreement of aca- demics.

Robert Kruh, dean of the graduate school, Kansas State University, remarked that the study really is a "compilation of opinion." I call your attention to a report in the December 1982 issue (Vol. 32: No. 12) of NewsReport, National Academy of Sciences, for a more detailed summary of this study under the

title "Assessing Doctoral Programs' Quality Is an Art Subtler Than Scorekeeping."

CONCLUDING REMARKS

The issue of quality is one that will continue to be with us, and it should be. Today, most graduate schools have in place a system of program review to maintain vigilance over the status of their programs.

At times, I think we overcomplicate the process of assessing quality. It seems to me that we need to have a good profile of the students (their creden- tials on admission and their progress), the faculty (scholarly performance), and the alumni (the positions they occupy). These three sources of information can give us a handle on quality.

Bibliography

Association of Graduate Schools: The Doctor of Philosophy: A State- ment Policy. Washington, DC, AGS, 1979

Association of Graduate Schools: The Research Doctorate in the United States. Washington, DC, 1976

BrademasJ: Importance of graduate education and research, in Signs of Trouble and Erosion: A Repoct on Graduate Education in America. New York, National Commission on Student Financial Assistance, 1983

Blackburn RE I-ingenfeher PE: Assessing Quality in Doctoral Programs: Criteria and Correlates of Excellence. Ann Arbor, Center for the Study of Higher Education, University of Michigan, 1973

Cartter AA: An Assessment of Quality in Graduate Education--A Com- parative Study of Grac!uate Departments in 29 Academic Disciplines. Washington, DC, American Council on Education, 1966

Conference Board, Committee on an Assessment of Quality-Related Characteristics of Research-Doctorate Programs in the United States: An Assessment of Research-Doctorate Programs in the United States. Washington, DC, National Academy Press, 1982

Council of Graduate Schools in the United States: The Degree of Doc- tor of Philosophy. Washington, DC, CGS, 1980

Council of Graduate Schools of the United States: The Doctor of Phi- losophy Degree. Washington, DC, CGS, 1977 (ERIC Document Reproduction Service No. ED 153 546)

Council of Graduate Schools in the United States: The Organization and Administration of Graduate Schools in the U.S. Washington, DC, CGS. 1981

Council of Graduate Schools in the United States: Requirements for the Phi). Washington, DC, CGS, 1979 (ERIC Document Reproduc- tion No. ED 187 280)

Dolan WP: The Ranking Game: The Power of the Academic Elite. Lin- coln, NE, University of Nebraska Press, 1976

Frankena WK: The Philosophy and Future of Graduate Education. Ann Arbor, University of Michigan Press, 1978

Hughes RM: Report of the Committee on Graduate Instruction. Educa- tional Record 15:192, 1934

Hughes RM: A Study of the Graduate Schools in America. Oxford, OH, Miami University Press, 1925

Keniston H: Graduate Study and Research in the Arts and Sciences at the university of Pennsyh~nia. Philadelphia, University of Penn- syls~nia Press, 1959

National Board on Graduate Education: Outlook and Opportunities for Graduate Education. Washington, DC, National Academy of Sciences, 1978 (ERIC Documentation Reproduction Service No. ED 199 568)

AACN/DHHS DOCTORAL PROGRAMS IN NURSING I01

National Research Council, Commission on Human Resources, Board on Human-Resource Data and Analyses: A Century of Doctorates. Washington, DC, National Academy of Sciences, 1978 (ERIC Documentation Reproduction Service No. ED 156 064)

Pelczar M J Jr: An assessment of research doctorates in the United States. American Society of Engineering Education, 1983 Conference Pro- ceedings, 837

Pelczar MJJr: Providing for new knowledge in our changing society. Change (March 1984) 18

Pirsig R: Zen and the Art of Motorcycle Maintenance. New York, Mor- row, 1974

Roose KD, Anderson CJ: A Rating of Graduate Programs. Washing- ton, DC, American Council on Education, 1970

Schneider B: EdD and PhD programs: an issue of distinction. Commu- nicator (August 1984)

Spurr SH: Academic Degree Structures: Innosutive Approaches. New York, McGraw.Hill, 1970

Issues in Doctoral Preparation in Nursing: Current Perspectives and Future Directions

I-INDA K. AMOS, RN, EDD, FAAN President, American AssoMa/ion of Colleges of Nursing

Considerable advancements have been made in doctoral preparation in nursing, and in nursing research. \VC'e can be proud of the developments of the past decade. I agreed to present a paper at this conference because of my growing concern in the past two to three years about the unresolved issues in doctoral education in nursing, and because of what I consider to be an increasing need for an action plan to deal systematically with them. These issues will be the focus of my paper.

In 1964 in the United States, there were four doctoral programs in nursing, and in 1974 there were nine. Today, we have 30 programs in operation. 1.2 Forty-one institutional representatives have been in- vited to this conference because they plan to have an operational program with enrolled students by the fall of 1985. The doctoral survey of Anderson et al. indicates that by 1988, when 43 new doctoral programs in nursing will be operating, the total will be 73. 3 These figures represent a growth of 334 per cent between 1974 and 1984, and a projected growth of 243 per cent between 1984 and 1988 (just a four- year time span). Note that these figures are not an estimate of the number of programs; rather, they are figures reported by the institutions planning the programs. Whether all of the programs materialize as planned will be known only with time. Of the 30 programs existing in 1984, 18 offer the PhD; eight the DNS or DSN; and one the EdD. Of the planned programs, 36 offer the PhD and seven offer the DNS.t.3

We have not only seen a large growth in the number of doctoral programs in nursing, we have wit-

so__

6o__

40._

20

1964-1974 1976 1978 1980 1982

N 4 9 14 21 22 25

m

1984-198! "I'988

30 41 73

Figure 1. Growth of doctoral programs in nursing in the United States. Data from National League for Nursing: NI.N Nursing Data Book: Statistical Information on Nursing Education and Newly Licensed Nurses. New York, NUN, (applicable years); American As- sociation of Colleges of Nursing; and Anderson E, Roth P, Palmer I: A national survey of the need for doctorally prepared nurses in academic settings and health service agencies.J ProfNurs 1:23-33, 1985.

nessed a growth in student enrollment. In 1965, 211 students were enrolled in these programs on a full- or part-time basis, and in 1983 there were 1,519:663 full-time and 856 part-time: .z This shift to 56 per cent enrolled on a part-time basis is important for us to bear in mind; it means that the time for degree completion can be significantly lengthened.

Graduations from doctoral programs in nursing have also increased, but not as dramatically as the number of programs or enrollments. In 1975, there were 74 graduations; in 1979, there were 101; and in 1983, 139 individuals graduated with doctoral degrees in nursing: The graduation numbers are expected to increase, but the increasing number of part- time students will undoubtedly hold the growth rate at a moderate level.

140--

I00--

80~

6 0 - iiiiii! 1975 1977 1979 1981 1983

N 74 59 101 121 139

Figure 2. Graduations from doctoral programs in nursing. Data l~om National League for Nursing: NLN Nursing Data Book 1983-8-t: Statistical Information on Nursing Education and Newly Licensed Nurses. New York, NLN, 198.4. -

102 JOURNAL OF PROFESSIONAL NURSING - MARCH-APRIL 1985

o01

2 0 0 ~

_1965 1970 1975 1980 - 1983

Total N 211 312 506 1019 1519

}~.T.= I

P T--I I

Figure 3. Full and parttime enrollments in doctoral programs in nursing. Data from National League for Nursing: NLN Nursing Data Book: Statistical Information on Nursing Education and Newly Licensed Nurses. New York, NLN, (applicab.le years); and from American Association of Colleges of Nursing.

NEED FOR DOCTORALLY PREPARED NURSES Projected need for doctorally prepared nurses con-

tinues to far exceed the current capacity of our programs. The Third Report to the Congress, in Febru- ary 1982, on "Nurse Supply, Distribution, and Requirements" estimated that we will need 13,490 doctorally prepared nurses by 1990. 4 Palmer's "Na- tional Survey of the Need for Doctorally Prepared Nurses in Academic Settings and Health Service Agencies" reports:

A total of 1,790 faculty, 291 in undergraduate-only programs, and 1,499 in schools with both undergraduate and graduate programs were doctorally prepared as of Febru- ary 1983, and represent 25 per cent of the total budgeted positions. Preference for faculty with doctoral preparation was estimated at 5,678 positions, or 78 per cent of the total budgeted positions. 3

The report goes on to say that the 232 schools project 3,489 nurse doctorates will be required by 1988. "The projected need within the next five years is to triple the number of existing nurse doctorates for available faculty positions."3 Academic health centers, community hospitals, and home health departments also reported significant projected needs for doctorally prepared nurses.

The Institute of Medicine's (IOM) 1983 report on "Personnel Needs and Training for Biomedical and Behavioral Research" and '~Nursing and Nursing Edu-

cation" attest to the need for significantly more doctorally prepared nurses. ~.6

The ANA Directory of Doctorally Prepared Nurses reports that in 1984 there are 3,650 doctorally prepared nurses. 7 While some nurses will obtain doctoral preparation in disciplines other than nursing, only 67 did so in 1981-82. Even if the average graduation rate is 200 individuals per year for the next four years, we will fall over 9,000 short of the WICHE- based model, which projects a need of 13,490 doctorally prepared nurses for 1990.

The past and projected growth rates in doctoral programs and for doctorally prepared nurses have been significant; the shortfall in meeting projected needs is also significant. Recognition of the major discrepancy between supply and demand places considerable pressure on the profession, on institutions with doctoral programs in nursing, and on institutions with growing capability to provide doctoral programs in nursing. How our institutions respond will be critical to the continued advancement of the nursing profession and, more important, to the quality of nursing practice, research, and education.

The need to advance the quality of patient care is apparent in every sector of health care delivery. The opportunity for nursing to make a significant difference in quality and cost of care and in mechanisms of delivery of that care has never been better. Significant reforms in financing health care, along with changing public sentiment, demographic shifts, and increasing emphasis on self-care, home care, and prevention, present multiple challenges, which can be met by the unique competency found at the core of nursing. Coordination, management, and delivery of care in the new health care arena require qualified leadership. The leaders and the researchers who will make important differences in the delivery and quality of that care will come from our doctoral programs in nursing. The attributes and magnitude of our responses will be largely functions of the quality of doctoral programs in nursing.

The availability of a core of doctorally prepared nurses in our academic health centers and clinical areas is an exciting prospect. That core would stimu- late and greatly supplement the development of research and the capability of our programs to advance. It would mean the opportunity for nursing to gener- ate, verify, and implement policy. Health care needs this cadre of credible, doctorally prepared nurses to bring the nursing perspective to the issues.

What then are the issues in doctoral education in nursing? I have chosen to group the major ones

AACN/DHHS -. DOCTORAL PROGRAMS IN NURSING 103

into six categories. They are quality, the nature of the doctoral degree in nursing, the program of study, institutional capabilities, school of nursing capabilities, and students.

THE QUALITY OF DOCTORAL PROGRAMS IN NURSING

Much has been written about quality in doctoral programs, and you have been provided with several papers from the 1984 National Forum on Doctoral Education in Nursing (Doctoral Forum) addressing this very topic. The issue before us is how to ensure quality in our doctoral programs in nursing. Is the quality of our existing and proposed programs in question? I think it is. The IOM's 1983 report, "Per- sonnel Needs and Training for Biomedical and Be- havioral Research" states:

The relative scarcity of doctorally prepared faculty in nursing schools is likely to have several effects. First, nurses with new doctorates can find ready employment in schools of nursing and are less likely to pursue pure research careers where funding is hard to obtain. Second . . . . nursing school faculty with doctorates are likely to be heavily engaged in teaching and administration at the expense of research, and third, nurses being educated by faculty who do not have the research degree and are not primarily engaged in research do not have the role models who might lead them to research careers. Finally, as this committee noted in 1981, the rapid growth of doctoral training programs (which the data suggest has outstripped the growth in the supply of doctorally prepared faculty) has resulted in programs of less than optimal quality)

While this is certainly not the case in all situa- tions, we must be aware of the increasing pressure that will result with major expansion. Quality and credibility will become major issues raised both within and outside the profession. A common set of standards that provides direction for our programs is critical at this time. Assessment of quality standards cannot be based on simple, quantitative requirements, but must include judging the goals we share for doctoral preparation in nursing.

In 1978, the Council of Graduate Schools in the United States conducted a study on quality in graduate programs resulting in a publication entitled The Assessment of Quality in Graduate Education: Sum- mary ofa MultidimensionaIApproach. It is the basis for research now being conducted by W. L. Hol- zemer, in which many are participating. The Council of Graduate Schools provides some guidelines about faculty, students, alumni, physical and financial resources, and department operations. Some of them should prove helpful as we develop our own specific guidelines for programs in nursing, s

THE NATURE OF THE DOCTORAL DEGREE IN NURSING

At the present, doctoral programs in nursing offer several degrees: the PhD, DNS, EdD, and ND. The debate over the nature of the degrees and distinguishing characteristics of the degrees as they cur- rently exist has gone on since the initiation of doctoral programs in nursing. The PhD is the academic research degree, the DNS or DSN is the clinically focused advanced professional degree, and the ND is a professional doctorate. My remarks will focus primarily on the research and clinical doctorates. Schlot- feldt argues convincingly for the initiation of the ND, or the professional doctorate.9 It is characterized as a postbaccalaureate entry-level professional degree. I firmly believe that if we had more programs of this nature, we would be better able to achieve our goals in nursing practice. Furthermore, the programs would provide a firm basis for either the research or the clinical doctorate.

Cleland, Grace, and others have argued for having both the research and the clinical doctorate. Grace states:

� 9 there is a need first for the development of sound research doctoral programs in nursing focused upon the generation of new knowledge. Once these programs are firmly established, there is a need for the development of clinical doctoral programs focused upon testing out knowledge in the clinical practice area. The time is now for this next step of doctoral program development. What precludes us from making this next step? The problem of the self- esteem of nurses has been identified by Matarazzo as a problem that plagues us to this day. There are many facets to this phenomenon. One is the "Avis" phenomenon of"We try harder" perceiving ourselves to be second best. This is evidenced by our holding to the belief that all nurses can and should do everything equally well. Assuming that nurses can be researchers, expert clinicians, and teachers simultaneously imposes a burden found in very few other academic disciplines. In fact, there is some rather good evidence coming out of the psychology profession that those with a bent to research, as contrasted to the expert clinicians, are different groups of students with distinctly different psychological attributes and modes of thinking. Doc- toral programs in ps~zhology clearly differentiate a clinical and research track that are comparable but different . . . . In nursing, we need both our scholar-theoretician and our performing artists, the clinicians. And most certainly, there needs to be carefully constructed communication between groups lest they begin to track off in different directions, thus producing a cacophony, t~

Indeed, the case for both doctoral programs has been made repeatedly. Clearly, practice requires an underpinning from both theoretical and applied science, Researchable problems are guided by theo- retically derived hypothesis or scientific formulation.


Hypotheses are tested for relevance to theory or scientific formulation. Persons with the advanced professional doctorate apply knowledge to clinical problems, while those with the research doctorate focus on the development of new knowledge and theories. Major arguments for the clinical/professional doctorate are:

1. It prepares expert practitioners to advance the quality of care.

2. It brings research findings into the practice of nursing in a more timely manner.

3. It responds to the critical challenges and opportunities in the management and delivery of health care.

At the 1984 Doctoral Forum, a report on the analysis of the goals and curricula of doctoral programs in nursing in this country revealed few or no distinguishing characteristics between the PhD and the DNS or DSN programs. Most state that at least they are preparing scholars and researchers. Certainly nursing needs a greatly expanded knowledge base, but we have also reached the point of needing the con- fidence to apply the knowledge we have to the systematic resolution of clinical problems. It is past time to initiate programs that prepare both research and clinical doctors of nursing. Clear identification of the distinguishing characteristics of the two degrees should provide us some direction for future program development. Some of the major distinctions have to do with program goals. The PhD would focus on the generation of kno~cledge and theory, and the DNS on using knowledge to resolve clinical problems and applying research findings in practice settings. The PhD program would emphasize theories in nursing; theory development; philosophy of science; research methods, including qualitative and quantitative designs; experimental methods and measurements; advanced statistics; and issues in nursing, along with cognates. The program leading to the clinical professional doctorate would include theories in nursing, research methods, advanced statistics, issues in nursing, and clinical nursing and prac- tica, along with some cognates. The clinical courses would provide the important link between theory and knowledge and the practice reality. The other significant distinction between these degree programs should be the nature of the dissertation or scholarly research.

THE PROGRAM OF STUDY

The issues involved with the program of study in-

clude questions about appropriate areas of specialization, if any; how to prepare for the research and/or clinical role; the relationship to the program of supporting cognates; and the essential core in nursing at the doctorate level. Identifying an essential core seems to me the most important issue. Is the core defined? This is a pragmatic concern as well as a theoretical one. In view of the economics of higher education, nursing, as a relatively new doctoral program, is being evaluated for its unique contributions rather than for duplication of existing programs. The question is whether the dissertation research could have been done in an already existing department of the university. Would preliminary examination outcomes be similar in doctoral nursing programs of common purpose? If not, then this is an area requiring further definition.

INSTITUTIONAL CAPABILITIES

The fourth area of issues in doctoral programs in nursing is related to institutional capabilities. De- velopment and maintenance of a successful doctoral program will be influenced by the degree of congruence between the central mission of the institution and the nature of the degree program being proposed. Does the central mission of the university support the research program, the clinical program, both programs, or neither of them? Incon- gruous missions can lead to difficulty when the goal is implementing a program that can support the teaching, research, and practice activities of various faculty members. To be successful, a doctoral program in nursing must be strong and must enjoy a good relationship with the graduate school. Likewise, the strength of departments in the supporting disciplines cannot be overlooked, for the cognates lend refinement and depth to the major field of study. The adequacy of research resources, such as the library, laboratories, and computer facilities, and of funds for teaching and research assistantships, for faculty research, and for equipment requires careful and continuous assessment. The financial health and resources of the institution need careful examination, for new doctoral programs will require new [CSOUfCCS.

SCHOOL OF NURSING CAPABILITIES

Critical factors in assessing and monitoring a school's ability to provide a quality doctoral program include faculty preparation, experience, productivity in externally funded research, and publication of research, as well as the existence of at least two to three


continuing major research projects in which students can be involved as research assistants.

The need for doctorally prepared faculty has been described as being at a near-crisis level. The lack of senior experienced researchers with proven and continuing track records in externally supported research programs will soon be extreme. Themes as well as diversity in the faculty research programs are important and must "fit" the goals of the doctoral programs and its area of specialization. A cadre of faculty for the doctoral program is necessary because the de- mands for research, student advising, and research guidance only accelerate each year the program is in operation until near-balance is achieved between the number of student admissions and the number of graduations. Mitsunaga found, in her survey of doctoral students in nursing, that "the ratio 9fd0c- total program faculty to graduate students (master's and doctoral) ranged from 1:18 to 20:1. Although the mode was 1:5, the median was 1:8. What do these ratios mean? ''1o She poses a valid question. What is a desirable range for faculty:student ratio in doctoral programs?

For programs offering the clinical doctorate, a careful assessment of the school's practice facilities and environment is of major importance. Clinical environments that support the school's education and research missions, plus clinician role models whoare available for the students, greatly enhance the ability of a program to achieve its goals. A supportive structure and environment in the school is necessary for all doctoral programs if the faculty and students are to be able to devote their energies to the achievement of program goals.

Development and maintenance of a quality doctoral program will also require a reliable financial base for faculty, program support, equipment, laboratories, and computers. Assessment of the environment of the school of nursing must include evaluation of faculty support of the program's goals, work loads, opportunities for continued research, funds for research, leaves and sabbaticals, and availability of research and teaching assistants. An agreed- upon program of study, with specific policies and procedures for admission and for determining the progress of students, and an overall evaluation plan are essential to the initiation of a program and require periodic monitoring.

STUDENTS

Finally we come to the s tudents- the very heart of the doctoral program. The quality and size of the

applicant pool, admission standards, and enrollment goals and limits must be continually assessed in relation to the program goals and resources. The fit of the student goals with the program objectives and with the research and/or practice activities of the faculty seems to me one of the major issues. Most goal-directed students come into a doctoral program with some idea about where their research interests lie. Matching student goals with program and faculty resources is sometimes difficult, but honesty with ourselves and the students about the strengths and limitations of our programs is a critical quality issue.

The socialization process for the student in a doctoral program is of paramount importance. Promot- ing positive and strong relationships with faculty in research, providing teaching assistantships, and meeting with students in informal settings will advance the development of a true community of scholars. The need to establish clinical practice internships or preceptorships must be considered for the students enrolled in clinical doctorate programs.

I have covered a lot of territory that many of you are familiar with. I did so to remind us of the many critical and complex issues that must be considered in any discussion of quality factors or standards for the development and maintenance of doctoral programs in nursing. But now, how do we ensure continued development and orderly expansion of quality doctoral programs in nursing to meet future needs for doctorally prepared nurses? I suggest that the four major outcomes of this conference should be:

1. A set of criteria for developing and refining doctoral programs in nursing.

2. An agenda defining the future federal role in supporting doctoral education in nursing.

3. Commitment to leadership that will result in the development of clinical and research doctoral programs that are distinct, yet mutually supportive, entities.

4. Delineation of essential components for a National Data Bank on Doctoral Programs in Nursing, which the American Associa- tion of Colleges of Nursing is planning to initiate.

Therefore, this working conference should agree on a basic set of criteria for establishing and maintaining quality doctoral programs in nursing. Differ- ent criteria should be specified for the PhD and the DNS. Criteria with wide and general acceptance by colleagues involved in doctoral education in nurs-


ing could prove to be a powerful force to set the direction for what we consider nursing's preferred future.

The criteria that I propose we develop would serve four basic purposes:

1. Guide faculties in selfassessment to determine readiness for the initiation of a program.

2. Assist individual colleagues serving as external reviewers of doctoral programs in nursing.

3. Set standards for the petiodic assessment and revitalization of continuing doctoral programs in nursing.

4. Communicate the standards for doctoral education in nursing to colleagues in nursing and other disciplines, the public, and the consumer.

Let me hasten to indicate that I am not propos- ing we undertake accreditation for doctoral programs in nursing. Nor do I envision that establishing and promulgating a set of criteria at this time is a fore- runner to accreditation in future years. It is my assumption and understanding that most universities, through their graduate schools or some other mech- anism, have established periodic evaluation programs for new and existing graduate programs. Where such mechanisms are not in place, the faculty of a school of nursing can establish its own periodic self-assessments, by both internal and external reviewers. It is common for the monitoring of the professional and clinical doctorate programs in nursing to be separate from the monitoring of the graduate school, but that depends, of course, on the individual institution.

The history of doctoral programs in nursing is such that the establishment of a specific set of criteria prior to this time may not have been appropriate and, in fact, may have slowed our progress. Now, however, several compelling reasons make this proposal not only timely, but critical to the continued advancement of doctoral education in nursing:

1. There is a history--brief, yet significant-- of doctoral programs in nursing. The profession has profitted and learned from the experiences and progress of the current programs.

2. There is a significant identifiable body of knowledge in nursing to support doctoral study in the field, and there is need for both

.

.

the research and the clinical doctorate to advance knowledge and clinical practice.

Scarce human and financial resources during tight economic times in higher education, major reforms in health care delivery and financing, and unprecedented growth in technology and knowledge present opportunities and challenges for nursing that we cannot afford to overlook if we are to improve the quality of care and promote the development of health policies that are in the best interest of the consumers we serve.

Rapid growth in the immediate past and projected near future in the number of doctoral programs in nursing will place tremen- dous strain on graduate education throughout this country for at least the next decade. Without a carefully developed set of standards that are widely utilized by the profession, we are in danger of diluting our strength. Some will criticize the call for specific criteria, but I think that lessons from our history illustrate how sound criteria pro- tect program quality and advance the profession. Criteria can set the foundation upon which unique and innovative programs can develop.

We also have a responsibility to set forth an agenda for the federal government's future role in advanc- ing the quality of doctoral education in nursing. Such an agenda might deal with initiatives to assist in up- grading the quality and comprehensiveness of our research library holdings. Few institutions have a comprehensive and systematic way to identify all the materials required in their research libraries. Few, if any, institutions have unlimited resources to maintain comprehensive holdings in all disciplines. Avail- ability of a central, comprehensive, computer-ac- cessed data bank on research in nursing would facilitate the expansion of the knowledge base in nursing.

The federal government could also assist programs by providing more adequate funds to update laboratories and research. Federal support for graduate student financial assistance should be expanded.iFu- ture directions for Advanced Nurse Training, the Center for Nursing Research, and the National In- stitute of Nursing should be discussed in light of the fact that the appropriations will be expanded this year if the new legislation is passed. Incentives


to expand postdoctoral programs should be continued th rough new investigator awards. Grants and traineeships that emphasize research, and pre- and postdoctoral fellowships should be con t inued and expanded. These are bu t a few ways the federal government can cont inue suppor t ing doctoral programs in nursing. I am sure you can think o f many

more. In conclusion, we have come to a poin t in the his-

tory o f doctoral preparation in nursing when we must exert concerted leadership because of our responsibility and accountabil i ty for the quali ty o f the future evolution of doctoral educat ion in nursing. I look forward to a productive and s t imulat ing work- shop over the next two days.

References

1. Division of Public Policy and Research: Nursing Student Census with Policy Implications. New York, National League for Nursing, 1984

2. American AssociationofCoIlegesofNursing: unpublished data

3. Anderson E, Roth P, Palmer I: A national survey of the need for doctorally prepared nurses in academic settings and health service agencies. J Prof Nuts 1:23-33, 1985

4. Third Report to the Congress, February 17, 1982. Nurse Supply, Distributions, and Requirements. Nurse Train- ing Act of 1975, DHHS Publ. No. HRA 82-7

5. Institute of Medicine: Personnel Needs and Training for Bio- medical and Behavioral Research, Chapter 6. Washing- ton, DC, National Academy Press, 1983

6. Institute of Medicine: Nursing and Nursing Education: Pub- lic Policies and Private Actions. Washington, DC, Na- tional Academy Press, 1983

7. American Nurses' Association: Directory of Doctorally Pre- pared Nurses. Kansas City, MO, ANA, 1984

8. Council of Graduate Schools in the United States: The As- sessment of Quality in Graduate Education: Summary of a Multidimensional Approach. Washington, DC, CGS, 1978

9. Schlotfeldt RM: Doctoral study in basic disciplines- a choice for nurses. Nurs Forum 5:68, 1966

10. Grace HK: Doctoral education in nursing: dilemmas and directions, in Chaska NL (ed): The Nursing Profession: Time to Speak. New York, McGraw-Hill, 1983

11. Mitsunaga B: Operationalization of Quality Dimensions in Nursing Doctoral Programs, in Proceedings of the Na- tional Forum on Doctoral Education in Nursing, June 1984

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Institute of Medicine: Personnel Needs and Training for Bio- medical and Behavioral Research, Chapter 6. Washington, DC, National Academy Press, 1983

Leininger hi: Doctoral programs for nurses: trends, questions, and projected plans. Nurs Res 25:201, 1976

MatarazzoJD, Abdellah FG: Doctoral education for nurses in the United States. Nuts Res 20:404, 1971

Mitsunaga B: Operationalization of quality dimensions in nursing doctoral programs, in Proceedings of the National Fo- rum on Doctoral Education in Nursing, June 1984

MurphyJF: Doctoral education in, of, and for nursing: a historical analysis. Nurs Outlook 29:645, 1981

National League for Nursing: Nursing Student Census With Policy Implications. New York, NLN, 1984

Newman MA: The professional doctorate in nursing: a position paper. Nuts Outlook 23:704, 1975

Pelczar MJ: Providing for new knowledge in our changing society. Change (March 1984) 11

Rosenzweig RM: The rationale for a federal role in graduate education. Change (March 1984) 11


Schlotfeldt RM: Doctoral study in basic disciplines-a choice for nurses. Nurs Forum 5:68, 1966

Simon P: Congressional response: reauthorizing the higher education. Change (March 1984) 13

Third Report to the Congress. Nurse Supply, Distributions, and Requirements. Nurse Training Act of 1975, DHHS Pub. No. I-IRA 82-7, February 17, 1982

Ver Steeg CL: Who will help the graduate student? Change (March 1984) 22

Discussion: Areas in Which Quality Control Is Essential

Moderator: ROSE MARIE CHIONI

The participants were asked by the conference plar/ning group to work through the issues identified as important and for which participants would develop assessment criteria. Dr. Chioni noted that the Division of Nursing's present interest in promot- ing the quality of doctoral-level education is merely an extension of its long-range activity in this area. The Division of Nursing sponsored two previous conferences entitled "Future Directions for Doctoral Edu- cation in Nursing" and "The Doctorally Prepared Nurse." Proceedings of both conferences have been widely circulated.

Dr. Chioni also acknowledged with appreciation the annual National Forum on Doctoral Education in Nursing and its members' willingness to share selected papers with the conference participants. As the group participants worked, those who had read the papers realized their value for this conference. The Doctoral Forum participants had also expressed interest in the proceedings of the current conference.

Dr. Chioni acknowledged that Dr. Linda Amos had given a summary of many of the major issues that confront doctoral education in nursing. Dr. Amos reminded the conference participants of the need to set priorities in supporting doctoral education in nursing and to identify the essential components of a national data base on doctoral programs in nursing that the American Association of Colleges of Nursing is planning to initiate.

Dr. Chioni solicited additional topics for discussion. Several items were suggested and assigned to the six work-group areas. The final topics assigned to each work-group area were as follows:

1. Faculty Qualifications

a. Research

b. Knowledge development

c. Publications

d. Faculty members as mentors

e. Educational preparation

2. Program of Study

a. Core content (research, theory, issues) and rigor of the program

b. Balance of nursing with cognate fields

c. Balance of clinical nursing and clinical research

d. Nature of dissertation

3. Resources and Relationships

a. Educational resources: graduate school, computer services, libraries, laboratories, clinical facilities

b. Financial and political resources: group support, student support and fellowships, state approval, legislative support

4. Students

a. Qualifications; pool of applicants

b. Student access to program

c. Method of financial support

d. Full- versus part-time study

e. Employment or career advising

f. Evaluation of student progress

g. Length of time to complete program

h. Faculty as'students

5. Research

a. Internal and external support for research

b. Research climate

c. Nature of dissertation

6. Evaluation of the Program

a. Mechanisms: self-study, peer review, external review

b. Using indicators developed at this conference

The consensus was to develop one set of criteria for quality doctoral education in nursing. Schools planning a new doctoral-level program may need guidelines to help them meet the criteria for a quality program.

The conference guidelines were examined in light of the previous discussion of the content of the work groups. The participants discusssed whether the groups should consider all graduate education in


nursing. It was agreed that only post-entry-level doctoral education in nursing would be addressed.

A second discussion centered on the nature of the advanced professional practice degree (DNS) and the curricular focus or emphasis of the functional content of a professional practice discipline, that is, service, education, and research. It was agreed that all advanced doctoral education requires preparation in research, and that all nursing education requires at least a foundation of clinical knowledge.

Following the discussion, the conference guidelines were reworded and took the following form:

1. The doctoral programs discussed will be those which constitute advanced degrees in nursing. �9

2. The doctoral programs discussed will be those which prepare for research.

3. It would be well to focus on the common quality criteria of doctoral programs that re- late to both types of degrees, identifying different criteria, where appropriate.

4. Criteria would be appropriate for an ongo- ingprogram that has had some time to develop.

Reports of Work Groups

F a c u l t y Q u a l i f i c a t i o n s

Leader: MITZ! DUXBURY

The distinctions between the advanced professional (clinical research) degree (for example, the DNS) and the academic research degree (the PhD) are not yet clear enough to permit distinct differentiations between the qualifications of faculties for these programs. The differences will become clearer when the indicators of quality programs of study delineate the essential components of these two programs. The indicators of faculty qualifications, therefore, apply primarily to programs awarding the academic research doctorate, the PhD.

RESEARCH

1. Faculty members must have training in research. Minimum" qualifications are an earned academic doctoral degree, ideally with postdoctoral research training.

2. Faculty members must be actively engaged in continuing research related to the pro-

gram of study; doctoral students must participate in the research.

3. Faculty members should hold "full mem- bership" appointments in the graduate school (at institutions with graduate schools).

4. A core of nurse faculty members holding earned doctoral degrees in nursing should be on the faculty, and/or the program should demonstrate that an increase in the relative size of this group will occur over time.

5. Other faculty members should be nurses with earned doctoral degrees in related disciplines. In some circumstances, when special expertise is required and unavailable

�9 from the nurse faculty, qualified nonnurse faculty members may hold faculty appointments. There is virtue in bringing in expertise from other disciplines. Interdiscipli- nary arrangements should be encouraged and supported through joint appointments.

6. Faculty members from the school of nursing should not be graduate students in that school's doctoral program.

KNOWLEDGE DEVELOPMENT

1. Faculty members should undertake research with a view to better understanding the phenomena of nursing.

2. Faculty research and/or knowledge development should take place in the context of the history and philosophy of science.

3. Researchers should be sensitive to and supportive of different ways of knowing. Re- searchers should recognize and be willing to challenge and demystify entrenched views (sacred cows) in nursing that impede knowledge development. Researchers should focus on areas of expertise. This expertise will be reflected in the research itself, through publication, in presentations, in student research, and in work of the graduates in their own careers.

4. Knowledge development is not limited to empirical study.

5. Knowledge development places nursing inquiry into the larger context of human inquiry.


PUBLICATIONS

1. Faculty members should publish the products of their scholarly activity and research, which should continually explore new perspectives and new knowledge.

2. Products of this scholarship should be sub- jected tO peer review.

3. University criteria for quality and quantity should be rigorous.

4. The publications of the faculty members should have impact or potential for impact on the discipline.

5. The publications of the faculty members should be cited often by others.

6. The products of scholarship should be reproduced in other languages, when appropriate.

FACULTY MEMBERS AS MENTORS (ADVISING)

1. The faculty members advising doctoral students will:

a. Have research programs in place in which students actively participate.

b. Involve doctoral students in the dissemination of research findings.

c. Serve as program advisers as well as research advisers.

d. Provide for a "good match" between faculty and student research and between the individual faculty member and the student.

e. Be career advisers for students.

f. Provide mentor-student relationships that are different in that the adviser and the student develop knowledge together. This relationship is a collegial relationship, involving mutual sharing, mutual problem solving, and mutual development. These are critical elements in this teaching modality.

2. The role of the mentor includes teaching the habits and attitudes of inquiry, an important component of the socialization process.

3. The mentor-student relationship is a special kind of teaching-learning experience.It provides a strong support system for an ad- visee and helps develop appropriate role be-

.

haviors for the student in the political, economic, and academic environments.

The mentor attends to the gestalt of the development of a scholar. The attitude of the mentor is free of punitive or coercive elements.

Program of Study

Leader: ENID GOLDBERG

Participants began by discussing how research for the PhD program and research for the professional doctoral degree (DNS) differ. For example, research for a PhD might investigate how teaching within the family influences the development of body image in the child. Research in a DNS program might focus on the kind of tactile stimulation from parents that will result in the development of a premature baby's body image. Some group members believed there was no need to distinguish between types of research for the two doctoral programs. Yet other members believed that the graduate faculty of a university would insist upon a distinction. The majority of graduate faculty members in a university setting see the professional degree as a practice- oriented degree. However, members did agree that there should be no difference in the quality of the criteria used in r~search in the two programs.

Prior to the dissertation, continuous opportunity should be provided for the student to participate in research activities as a part of the program of study. The dissertation should add to the body of nursing knowledge. The DNS program of study emphasizes advanced clinical practice to integrate research in practice with the development of nursing knowledge and the improvement of nursing practice. The PhD emphasizes the development and advancement of nursing knowledge.

Core content was discussed briefly. Some members believed all students should take a certain number of core courses. Others believed that core content should be identified and that the learning modality could vary.

During the next period of discussion, several items were suggested as important in the curriculum of the program of study:

1. Comparative research design

2. Advanced methodology and statistics

3. Theory development

AACN/DHHS DOCTORAL PROGRAMS IN NURSING I 1 I

4. Research

5. History and philosophy of nursing science

6. Health policy

7. Statistics, at least through the intermediate level

8. Ethics

Then a participant asked whether or not intermediate statistics should be considered a prerequisite. It was realized that content and direction of the program would be influenced by faculty expertise and interest.

In-depth study in either qualitative or quantitative research methodology is essential and should re- late to the dissertation. The group believed statistics was a larger problem and that multivariate analysis, experimental design, analysis of variance, computer-based statistics, and comparative research design should be included. Ifa faculty member does not have expertise in those areas, facultyfrom other schools will have to be engaged. A joint or adjunct appointment may be required.

Students must have adequate technological assistance. Some individuals stated that their students would have to learn to use computers, but quickly added that no credit should be given for doing so. Therefore, it might be reasonable to state that the program of study makes provision for developing computer skills.

Discussion then returned to the history and development of nursing theory and of nursing science. The group believed that the study and analysis of nursing theory belonged at the master's level. At the doctoral level, the history and philosophy of nursing science should include the history and philosophy of science. The individual teaching the history and philosophy of nursing should be familiar with the history of science.

Additional program of study content was discussed, including power, politics, leadership, ethics, health policy, and decision making, with the real- ization that decision making is involved in all levels of study, including research. It was evident that students have to take certain courses before entering the doctoral program because of the diversity of their backgrounds. Their program of study should include critical analysis of social, ethical, and political issues.

The same criteria should be used for PhD and DNS programs, whether they are new or established programs.

The final recommendations of the Program of Study group were as follows:

1. The purpose of doctoral education in nursing is the development of nursing knowledge. The primary emphasis of the PhD is on research and creative scholarship. The professional degree (DNS) emphasizes advanced clinical experience with the integration of research and practice to improve nursing care.

2. The program of study is determined by the conceptualizations of the phenomena of the discipline of nursing. The programs of study for the PhD and the professional doctoral degree (DNS) include:

a. History, philosophy, and future directions of nursing science

b. Comparative research designs, methods, and intermediate statistics

c. Theory construction

d. Critical analysis of social, ethical, and political issues of importance to the discipline

e. Depth of study in statistical methods specific to the dissertation

f. Acquisition of knowledge and skill in computer technology

g. Qualitative and quantitative research design

h. Student involvement in research activities

3. Core content as defined�9 the institution can be provided in a variety of ways, and should not be restricted to formal course work. Cognates are substantive courses in fields other than nursing that supplement the research or could be used in development of a minor field of study. The balance between nursing and cognate fields would depend upon the philosophy, purpose, and objectives of the program.

At the general discussion on the third day of the meeting, the Program of Study guidelines were changed so that the new programs of study for both the PhD and the professional nursing degree (DNS) would include:


1. History, philosophy, and future directions of nursing science

2. Comparative research designs, methods, and techniques of analysis appropriate to the level of study

3. Theory construction

4. Critical analysis of social, ethical, and political issues of importance to the discipline

5. Data management, tools, and technology

6. Student research opportunities

Educational Resources

Leader: RHEBA DE TORNYAY

GRADUATE SCHOOL

Although not all universities have an entity known as a graduate school, all universities have a body cbarged with the responsibility for determining the quality of programs within the university. Therefore the term "graduate school" is used to mean such a body within the institution. The nursing graduate program must meet the generally accepted national standards for quality of the doctoral degree, and no attempt should be made to bypass the standard- setting groups of either the institution or the regional approval body in order to begin or continue such a program. For example, approval for what is generally known as the professional degree (DNS) may be primarily controlled within the school of nursing, while approval for the PhD degree may be subject to the control of the graduate school or other general university group. However, the program- approval route should not be the factor that determines which type of degree will be offered, nor should the nursing faculty choose a route specifically to bypass the necessary approvals. Choosing a degree program should not be based on expediency. The type of degree offered should be determined by the objectives and goals of the faculty. It was also noted that the school of nursing faculty should be represented on the university approval council.

COMPUTER SERVICES

The use of modern technology was seen as essential for the doctoral program in nursing to develop and thrive. Therefore, it was agreed that:

1. The university and the school of nursing need to be aware of advances in technology and take advantage of them.

2. Adequate access to consultation, technology, maintenance, and adequate courses in computer sciences for students and faculty are essential.

3. An equitable system for using technical equipment and services must be established and enforced by the university to ensure that the schoo! of nursing will have access to its share of the computer resources.

LIBRARIES

Today, libraries are undergoing major changes. The rapid retrieval of knowledge is essential for a quality doctoral program in nursing. Because the library is our repository of knowledge, it is essential that:

1. Library facilities be adequate, and capable of taking advantage of advances in technology, especially telecommunications.

2. For new doctoral programs, resources be al- located to ensure the acquisition of library materials needed for advanced nursing science development and to make sure that the technology for rapid retrieval of information is in place.

LABORATORIES, CLINICAL RESEARCH CENTERS, AND CLINICAL FACILITIES

Because nursing practice and research in nursing often take place in the same location, the group chose to consider these facilities together. The group stressed that the facilities should include, but not be limited to, the following:

1. Laboratories must support and be appropriate to the educational program. They must provide space and equipment to meet the research objectives of the program, including animal research, human physiological research, and behavioral research.

2. Clinical research centers that are designed specifically for studies in the health sciences must be accessible to the faculty and students of nursing programs at the doctoral level.

3. Clinical facilities are defined as the on-site operations that permit students and faculty members to develop expertise in a given clinical area. All doctoral programs must have access to clinical facilities appropriate to their goals and objectives.

AACN/DHHS DOCTORAL PROGRAMS IN NURSING 1 13

. Formal arrangements for access to clinical facilities must exist for the doctoral students and faculty members to fulfill their educational missions.

FINANCIAL AND POLITICAL RESOURCES

The following eight statements represent the group's consensus in the areas of program support, student support, state and regional approval of the program, and legislative support:

1. The dean and the faculty are sensitive to and cognizant of the political nuances of higher education, legislative, and approval bodies.

2. The dean and faculty maximize interdepen- dent relationships with other university departments, campuses, other institutions of higher education, health care agencies, and community agencies.

3. The university acknowledges its obligations to provide nursing programs with financial support commensurate with that provided to other graduate programs. Ongoing institutional support for the operation of the school and of its programs is evident.

4. With all programs, but in particular with a new program, support from the appropriate approval bodies, both intramural and ex- tramural, is evident.

5. Funding for continuing faculty research is sufficient to provide a measure of financial support for doctoral students participating in that research.

6. The university provides nursing-student financial support commensurate with that provided for other doctoral students.

7. All avenues of financial support for the program and students are explored. For example, private support is sought to supplement student and faculty research endeavors.

8. Because resources are finite, they are reserved for qualified students who demonstrate potential for expedient, successful completion of the doctoral program in nursing.

Students

Leader: MARIE L. O'KOREN

QUALIFICATIONS AND POOL OF APPLICANTS

Initially, discussion centered on defining the term

"a pool of applicants." There are, it was pointed out, many ways to identify a pool. Some programs require only that respondents indicate interest in the program to be eligible for the pool. In contrast, others require that selected admission criteria be met and that there is a serious intent on the part of the respon- dent to make application to the program. The consensus was that the pool of applicants should con- sist only of those who are qualified and serious about entering the program.

The topic of admission criteria was next pursued. First, the merits of the Graduate Record Exam and Miller Analogies Test scores were considered. It was determined that a combined verbal and math GRE score of 1000 should be accepted as a minimum for most graduate programs. It was the general belief that few, if any, programs are using the analytic score as a cut-off criterion. Next, grade point average as a requirement was discussed. Reference was repeatedly made to the Mitsunaga study data on GPA's and to the fact that 94 per cent of the respondents indicated that 3.0 and 3.5 were the minimally acceptable GPA's. Other admission requirements discussed were interviews with applicants, the value of references, licensure requirements, master's preparation ' in nursing, work experience, and the completion of. a master's thesis. It was believed by some that the more clearly an applicant articulates career goals and the nature of the intended dissertation topic, the better the chance for success in the program. Opin- ion was divided on the value of and need for work experience, a license requirement, and a master's thesis. However, it was generally agreed that a master's degree in nursing should be required.

The group agreed that while most universities have minimal requirements for admission to graduate programs, the nursing program could formulate criteria that were more stringent, but could accept no less than the institutional requirements. There was agreement that a great deal of subjective evaluation of applicants takes place, and that every attempt should be made to quantify subjective measures to achieve greater objectivity.

Much discussion was generated about the applicant who does not meet the specific admission criteria, yet demonstrates potential to complete the program. The consensus of the group was that this applicant should be considered on an individual

basis.


1. A pool of serious, qualified applicants is


identified to support the need for the program.

2. Admission criteria consistent with those of the institution and rigorous enough to pre- sume student success in the program are established. Data on admission criteria and student performance are retained to establish a basis for success prediction.

3. Provision is made for review of the excep- tional applicant who does not meet the established criteria.

STUDENT ACCESS TO PROGRAM

Consideration was given to the location of the doctoral program. The opportunity for doctoral study in the field shouId be accessible to those who desire it and whose career goals are well suited to the goals of the program. It was believed essential that admission and progression standards facilitate entrance into the program and smooth continuation through it.

It was indicated that unnecessary duplication of programs should be avoided wherever possible so as to ensure judicious use of finances, especially in pub- licly supported schools.

It was considered important that information on faculty expertise, clinical facilities, research opportunities and support, and other resources that enhance learning opportunities for the student be dis- seminated to prospective applicants.


1. Location of the program facilitates the enrollment of students appropriate to the program's goals.

2. Information on faculty expertise and resources is distributed to potential applicants.

METHOD OF FINANCIAL SUPPORT

The lack of financial assistance for doctoral students was viewed as a major problem. Much discussion was devoted to the employment of doctoral students as research assistants, teaching assistants, and graduate assistants. The variation in institutional policies creates problems in formulating specific definitions and expectations of these categories of financial assistance. In some instances, the number of hours the assistants were required to work precIuded a full-time, or even a reasonable part-time, study load.

There was general agreement that the opportu-

nities for financial assistance provided by the institution should be equal for all doctoral students. It was indicated that because of federal traineeships and other financial aid, nursing is not as aggressive in seeking institutional aid that might be available to its students. Moreover, nursing faculty members and students tend to be hesitant about exploring other sources of funding both within and outside the federal sector. Faculty members should be knowledge- able about these sources, and students should be encouraged to apply for funding from them.

There was also general agreement that the school of nursing, in planning its doctoral program, should give serious consideration to developing a plan for financial assistance. If the plan could not be im- plemented upon initiation of the program, the plan would be in place in the event that funds became available.


1. Doctoral students in nursing are provided the same opportunities to apply for university-sponsored financial assistance that doctoral students in other disciplines enjoy.

2. The school has a clearly defined financial assistance program for doctoral students that would go into effect if funds became available.

3. Students are made aware of sources of financial support through information about other agencies in the federal and local government, contacts in the various health agencies, and interactions with students in other disciplines. Assertive competition for funding is fostered and encouraged.

FULL- VERSUS PART-TIME STUDY

Initially, the discussion centered on attempting to define part-time and full-time status. This task was found to be virtually impossible, since policies governing student status vary so much from institution to institution. Much attention was given to the difficulties encountered by the part-time student. First, it is believed that the part-time status detracts from the continuity of learning experiences in the program and tends to give the student a piecemeal perception of doctoral study. Second, the part-time student may not have as sound a support system, since contacts with faculty members and other students may be sporadic. Third, it may take the part-


time student two to three times longer to complete the program. Because faculty members may move to other institutions during that period, the student may forfeit the continuous assistance and commitment of the faculty members that full-time students enjoy. Finally, the part-time student tends to have much less opportunity to participate in the socialization process, an essential component of doctoral study.

There was consensus that part-time students should be strongly encouraged to pursue full-time study whenever possible.


1. Part-time students are encouraged and helped to achieve full-time status.

2. A support system for part-time students has been established.

3. The socialization process is viewed as.essential to the doctoral program, and program activities encourage socialization for full- time and part-time students.

4. There is concern that part-time students may forfeit the continuous assistance and commitment of faculty members because faculty changes are likely to occur during the time it takes these students to complete the program. Students have adequate faculty research support to achieve research objectives.

EMPLOYMENT OR CAREER ADVISING

Time limitations prevented a lengthy discussion about the employment of graduates from the doctoral program. In view of the rapidly changing health care scene, it is believed that some positions may be available in limited number, while others may be in entirely new health care settings. These changes will be reflected in the types of positions available in schools of nursing. Nevertheless, faculty members must assist students seeking positions for which they have been prepared.

.

Consensus Statement

Students receive job counseling and place- ment assistance.

EVALUATION OF STUDENT PROGRESS

Time constraints permitted only very limited discussion of this issue. Procedures serving as evalua-

tion checkpoints, such as preliminary or qualifying examinations, comprehensive examinations, and the final defense of the dissertation, were considered. The value of each was superficially discussed. It was concluded that regulations and policies pertaining to these procedures should be made clear to all faculty members and students. The policies should be in print and readily available.

Consensus Statement

The sequence of requirements for progress in the program is made clear. Evaluation milestones, such as qualifying and comprehensive examinations, admission to candidacy, and the final defense, are set forth.

AACN DATA BANK AND DIVISION OF NURSING

The group was also given the charge of suggest- ing essential components for the AACN Data Bank and legislative policy recommendations for the Di- vision of Nursing. The group listed the following essential components for the AACN Data Bank:

1. Sources of financial assistance to students

2. Definitions of part-time and full-time status

3. Evaluation mechanisms used for admission and their value as predictors of success

Recommendations for the Division of Nursing:

1. Increased federal funds for the support of doctoral students should be made available.

2. Increased federal funding for the support of doctoral programs should be made available where need is demonstrated. The proposal for federal support should demonstrate that contributions from the applicant institution will increase during the term of financial assistance.

Research

Leader: JOYCE J. FITZPATRICK

The group agreed that research is the basis of all doctoral-level study and thus found it easy to agree on most issues. A few controversial topics, such as postdoctoral training, research assistantships, and faculty research goals, were discussed at some length. The discussions identified both research indicators of quality in doctoral programs and aspects of the program of study, faculty activities, and student performance directly related to the research content.


The adequacy of financial and faculty resources for research for the school of nursing in comparison with the rest of the university were considered. It was agreed that:

1. The university and school of nursing consider research a priority and have adequate funding for it.

2. The school of nursing facilitates faculty research through administrative organization, supportservices, faculty appointments, promotions and tenure criteria, faculty assignments, and salaries.

3. The faculty is expected to conduct continuing research and disseminate its knowledge, assist students through development programs, and socialize students into the research arena.

4. Faculty research determines and is congru- ous with the school ofnursing's research program goals. Research goals and themes guide faculty and student selection, and student research is determined primarily by faculty research.

5. The areas on which research will concentrate are identified.

6. Student research is supported through assistantships, joint publications, and support for presentations or publication.

7. Postdoctoral training is recommended, expected, and supported.

Discussions of research content concluded that the students must understand research methods and understand, in depth, two or more methods that evolve from the dissertation experience. Research experience prior to the dissertation was recommended. Suffi- cient computer facilities should be available for faculty members and students to develop sound knowledge and skill in data management, tools, and technologies. In-depth knowledge of statistics and competence in the use of computers for data analysis are expected.

Doctoral education in nursing has a focus on research; thus, the dissertation focuses on adding new knowledge. The student's research should complement the faculty emphasis, while faculty members assigned to the dissertation committee should provide research interest and expertise to guide the student's work. Criteria for chairing a dissertation committee include postdoctoral research, funded

research, and published research. Also, the number of advisees must be considered in assuming additional dissertation committee assignments. Indica- tors of quality based on student performance include:

1. Program graduates publish papers and dissertations within three years of course and/or program completion.

2. Faculty, students, and alumni present scholarly papers at regional and national meetings.

3. Dissertations and research enhance the body of knowledge about nursing.

4. Research goals include solving clinical problems and validating clinical nursing inter- ventions.

The group attempted to distinguish between the DNS program and the PhD in nursing program. The PhD-prepared nurse is different from the practitioner-oriented doctoral nurse. The latter is expected to be prepared for the application or transmission of knowledge. The distinction between the PhD and the DNS is at the curricular level, where the PhD has an in-depth research experience and the DNS has a balance of application, validation, and research. It was noted that each school determines how the research taught there differs at the undcrgraduate, master's, and doctoral levels.

Evaluation of the Program

Leader: ROSE MARIE CHIONI

Group Six addressed the issue of ensuring quality in doctoral nursing programs through program evaluation. The group identified several philosophical statements to provide a framework for developing and implementing an evaluation program. The philosophical framework included the following statements:

1. Specialized accreditation for doctoral programs in nursing is not appropriate.

2. Evaluation is a continuing process planned in advance of review.

3. It is the responsibility of the university to review programs.

4. Indicators of quality should be the same throughout the university (nursing should not ask for exceptions).

5. Peer-oriented quality assessment of pro-


.

.

grams-not a statement of standards-is the focus of evaluation.

Each university is responsible for determining how it will apply the indicators of quality.

The purpose of quality review is to make recommendations, not to approve a program.

PARAMETERS FOR THE REVIEW OF QUALITY

The group recommended using the words "indicators of quality" (as opposed to "criteria" or "standards") so as to be consistent with the Council of Graduate Schools. It further identified the essential parameters (areas) within which each program should develop an evaluation plan. They were:

1. Student and alumni accomplishments.

2. Its operation, including admissions, student progress, and graduation policies.

3. Facu!ty and student qualifications.

4. The learning environment it provides, including accessibility of faculty members and other support systems.

5. Its curriculum.

6. Its resources and its intra- and interinstitu- tional relationships.

7. The knowledge and theory it contributes to nursing.

Although the above parameters can be reorganized by the various schools, all areas must be present in an evaluation plan.

MECHANISMS FOR EVALUATION OF A DOCTORAL NURSING PROGRAM

Each program should develop an evaluation plan within the stipulated parameters. Multiple indicators, both objective and subjective, and data sources should be used. The mechanisms should include both internal and external review with planned evaluation questions. The internal review should include self-study by the faculty, peer review by other graduate faculty in the university, and review by the graduate school. Peer review by faculty members from other schools in the university and from other schools of nursing should be carried out prior to beginning a program, should be an ongoing process, and should periodically take place as a systematic formal review. A full external review should be undertaken at least every seven years, and the review should be congruent with the university's requirements. External reviewers

should include nursing faculty members from other doctoral and nursing programs.

The indicators of quality for doctoral programs in nursing should be used in conjunction with the Council of Graduate Schools' statements of policy.

OTHER RECOMMENDATIONS:

1. The evaluation plan should include review of all faculty members, tenured and non- tenured, and should assess the quality of their research and teaching.

2. Schools should not receive federal monies unless there is fiscal support from the university.

3. Federal monies should not be given to new doctoral programs in nursing unless the programs are recommended after external review by qualified peers.

Next steps in the development of indicators for quality in doctoral nursing programs:

1. Publish proceedings of conference.

2. Send the mai~eriais to currentlyloperating doctoral programs for faculty input.

3. Incorporate appropriate suggestions from faculty members through either a second conference or a committee (perhaps of AACN).

4. Send out final document to AACN and other organizations for their use and possible adoption as policy.

AACN DATA BANK

The group strongly supported a higher priority for graduate student support through traineeships and pre- and postdoctoral fellowships. It further suggested that the AACN Data Bank should contain answers to the following questions. Funding might be sought from the Division of Nursing.

1. How many postbaccalaureate students are being admitted to doctoral nursing programs?

2. What is the educational preparation of doctoral faculty members (for example, nurse versus nonnurse, nursing versus nonnursing degrees, how many have had postdoctoral preparation)?

3. Are research assistant or teaching assistant experiences required in doctoral programs?

118 JOURNAL OF PROFESSIONAL NURSING MARCH-~APRIL 1985

What is the ratio of research assistants or teaching assistants to faculty members?

4, What is the length of time students are in doctoral programs?

In addition, the data bank should be a source of information (a repository) on the dissertations by doctoral students.

Consensus Development and Recommendations

Afoderator: ROSE MARIE CHIONI

Following work-group presentations, conference participants sought to answer some remaining questions and clarify some controversial issues. Trying to reach consensus sparked lively and penetrating discussions on several issues. Participants struggled together to reach sound decisions, which they realized would shape the future of nursing.

The first issue discussed was a recommendation from the Research Group about the nature of the doctor of philosophy degree. The issue was addressed first because opinions on it might influence how much agreement there could be in the other areas the work groups discussed. The Research Group recommended that the doctor of philosophy in nursing be the research degree and that its in-depth focus be on research. The Research Group came to this conclusion after considerable discussion about the future directions of education in nursing. They recommended, then, that the American Association of Colleges of Nursing consider a conference, such as this present conference, to consider the professional practice degree (DNS). The discussions of the Re- search Group focused during this conference on the research, that is the PhD, degree.

In the discussion following, the doctor of philosophy degree was consistently recognized as a research degree. The focus of the doctor of science in nursing degree was less clear, and the issue was further clouded by a discussion of the first-professional degree, which was not considered to be an advanced doctoral degree.

Differentiation of degree programs which have emphasis on basic research, applied research, or clinical research and professional practice, which incorporate service, education, and research was the center of the debate to limit this conference's statement. Much thought was given to the need for a conference to distinguish between doctoral programs in nursing. In general, the total group supported the

need for basic research (PhD) and the advanced professional practice doctorates (DNS) in nursing. The desire was to make sure that a fair statement be forthcoming from the American Association of Colleges of Nursing that would guide the future of doctoral education in nursing. The various work groups had struggled to identify the similarities and differences of programs. Most participants agreed that it would be a great service for the American As- sociation of Colleges of Nursing to clarify the common quality indicators, for this action could posi- tively influence the future of nursing. The wisdom of seeking differentiations at this time was questioned by many. Finally, the agreement was to focus on the advanced research degree (PhD). There was some interest in having a subsequent conference to study the entry-level (ND) and advanced doctoral degrees in nursing (DNS).

Points were made by the majority of the participants about this recommendation from the Re- search Group. For example, one participant noted that the difference between the two programs lies in the outcome or the expectations of the programs of study. The purposes of the two programs are different. In the context of knowledge for the profession, the doctor of nursing science program is geared toward improving nursing care, and the doctor of philosophy program focuses on basic research. The same participant believea it would be a disservice for either type of doctoral program to claim exclusive "ownership" of research. Both are research-based degrees, but the direction of the research is different.

Another participant reported that her group had struggled with the differentiation issue. The distinction they made, she explained, was that it is important for nursing to have both kinds of degrees, and all doctoral programs should include research, for research is one goal of doctoral programs. The in- clusion of research is what her group talked about as one of the distinctions. Traditionally, the doctor of philosophy has been considered the research degree regardless of discipline. Professional practice disciplines, however, have the struggle to prepare for the integration of research into service and education. A major issue discussed was lack of clarity between the two degrees and nursing's current lack of clarity at the level o f entry into practice.

It was recognized that some programs have not clarified their focuses; thus, some doctor of nursing science programs seem more like doctor of philosophy programs and vice versa. Most participants would urge these programs to convert to the degree award

AAGN/DHHS * DOCTORAL PROGRAMS IN NURSING 119

appropriate to their focus. Indeed, one program has started this process, and another university is offering both degrees.

The importance of student choices was also noted. The reality is that not everyone wants the same doctoral preparation. Some want to prepare for an academic career that emphasizes research. Others are interested in top management positions, executive positions, and direct practice roles that may include some investigation but not as the primary focus. These arguments supported the need to have both degree prograin~s available.

Following considerable discussion, another participant stated her belief that this recommendation seemed to mean more in terms of what it didn't say than what it did say. Her observation sparked further discussion. Again, more conferences, in particular on the doctor of nursing science degree program, were recommended.

Another participant suggested that confusion is to be expected when changes are being made. She recalled the confusion that arose when baccalaureate and then graduate programs were started in nursing and pointed out that now all of the conferees have these programs. She said that the process of clarifying these programs for themselves and for the public was useful and aided in the determination of what graduates of the respective programs were qualified to do. She noted that participants may not be disagreeing as much as it would seem, but rather that political considerations and faulty communication might be blurring the consensus. She concluded that the conferees really do support two doctoral programs in nursing: first, a doctor of philosophy (PhD) program, whose primary purpose is basic disciplinary nursing research, and whose graduates basically perform as researchers; and, second, a doctorate in nursing (DNS) program, whose primary focus is the improvement of patient care through research and other methods.

Another participant moved the conference toward consensus when she commented on the nature of the dissertations in the two programs. She believed it was the general consensus that distinction between programs should not be based on the dissertations. She felt that the program itself, that is the program of study, should delineate the difference between the two. She noted that the dissertation is a report of the research.

The moderator then facilitated the group's deliberations by noting the need to convene a group at another time to outline the differences between the

doctor of philosophy and the doctor of nursing science programs. She suggested that the report should strongly recommend planning such a conference.

The groups at the conference generally approached their task as noting the commonalities between the doctor of philosophy and the doctor of nursing science and did not limit their consideration to either degree. A participant then proposed revision of the Research Group statement to incorporate the prevailing approach at this conference, since "it's not realistic to say we're going to call another meeting in the immediate future to clarify." Several others agreed with this conclusion.

The conferees addressed the Purpose Statement put forth by the Program of Study work group. "The purpose of both programs is to develop nursing knowledge, with the doctor of nursing science or the professional practice degree emphasizing advanced clinical experiences for the integration of research and practice to improve nursing care." Again, lively and penetrating discussion took place. Congruence between the Program of Study work group statement and the Research Group recommendation began to emerge. The Program of Study group had taken several more hours to work than the other groups to establish indicators that would address both degrees equally well in a. statement.

The moderator noted that in all areas under consideration, there are similarities and differences in the programs. "It's those distinctions that we have not had time to clarify. We haven't had time for the discussion that would lead to some consensus" about the distinctions between the degrees. Then conferees concentrated on the wording of a definitive statement on the basic differences between the doctor of nursing science degree and the doctor of philosophy degree in nursing. The following statement is the consensual foundation for the indicators of quality doctoral programs in nursing:

The purpose of doctoral education in nursing is the development of nursing knowledge. The primary emphasis of the doctor of philosophy is on research and creative scholarship. The professional degree emphasizes advanced clinical experience for the integration of research and practice to improve nursing care.

During the discussions that led to the above con- ~sensus statement, several participants noted that the established policies and indicators for general education should be the reference points for defining the specifics of nursing education. It was noted that

120 JOURNAL OF PROFESSIONAL NURSING MARCH-APRtL 1985

the more it deviated from established policies and criteria, the more isolated nursing would become from the general stream of education. Thus, the conferees agreed to complement the existing indicators and policy statements of the Council of Graduate Programs.

A second major issue in reaching consensus was related to the external review process and procedures. Clarification was requested concerning how external review fits into the planning, developing, funding, and implementation phases of doctoral programs. It was agreed that no clear directions on when and how to use external review exist, since each university has different needs, resources, and policies. Program review in all phases is generally a positive force to enhance the quality of a program. Ex- ternal peer reviews in funding applications require blind review with priorities set according to the strength and merit of each individual application. It was agreed that the indicators for quality in establishment and operation of doctoral programs identified in this conference should facilitate and strengthen external reviews. Proliferation of doctoral programs in nursing can be tempered by using these indicators, since only those programs with the potential to be good quality would be approved and ap- propriately funded.

A third issue raised for clarification was the inter- active influence of faculty and student research and its congruence with the mission of the school of nursing and the university. It was generally acknowledged that the faculty research fits the program goals. Con- sequently, the recruitment and selection of faculty members and graduate students are guided by these goals and themes.

Several specific questions were raised about statements made by the Program of Study, Faculty Qual- ifications, and Student work groups. The statements were quickly clarified and edited to the satisfaction of the participants. The results of all of these discussions and the consensus reached appear in an earlier section, "Consensus Statements."

The content of this conference was viewed as a foundation for further deliberation by universities, schools of nursing, and the American Association of Colleges of Nursing.

Concluding remarks by Dr. Linda Amos, Presi- dent of the American Association of the Colleges of Nursing, emphasized that the substantive content of the conference will enlighten the public about doctoral education in nursing. The indicators will be of use to those developing programs, and also to

review bodies within universities and to external reviewers. She was particularly pleased with the high level of consensus reached at this conference.

Dr. Amos affirmed that the report of the proceedings will be reviewed further and that additional dissemination of the information will depend upon subsequent recommendations. The Board of the American Association of Colleges of Nursing will consider the next steps required to develop and maintain quality doctoral education in nursing. One consideration will be the need for another conference to discuss advanced professional degrees and/or the graduate programs for entry into practice. Since there are institutions with plans to develop ND programs, such a conference would be timely to identify the characteristics of those programs prior to their implementation. These suggestions for conferences, or other options, for reaching further consensus on quality in doctoral education in nursing will be presented to the appropriate groups.

Dr. Amos thanked participants for their commitment to quality doctoral education in nursing and to reaching consensus on the issues. Special appreciation was expressed to the group leaders, the recorders, and the Division of Nursing--including Jo Eleanor Elliott and Thomas Phillips, and Gretchen Osgood, who helped arrange the program. Dr. Bar- bara Redman and Kip Lester of the American As- sociation of Colleges of Nursing were recognized for organizing a successful and productive conference.

Jo Eleanor Elliott, Director of the Division of Nurs- ing, closed the conference by thanking the planning committee staffand participants. She noted the Di- vision's continuing efforts to support high-quality nursing research through its Nursing Research and Analysis Branch, nursing service through the Na- tional Research Service Awards, and nursing education through the Professional Nurse Traineeship and the Advanced Nursing Training programs. She emphasized that nursing is a practice field and that the goals of all doctoral education in nursing are service, education, and research. She said that the question to be answered is, "Is nursing making a difference in health care, in the patient care and health care arena?

"Since Monday evening, you have struggled with the most difficult of all tasks: addressing quality. Dr~ Pelczar spoke on this difficulty Monday night. We can see quality, describe evidence of quality, know when there's quality and when there's not quality. But to define quality, to determine its indicators, and to ensure its presence in education is difficult.


It is, however, essential to continue the struggle so that we have quality doctoral programs throughout the country and so that new programs will take into account the indicators discussed these two days."

She concluded by expressing her belief that at this

Doctoral Programs in Nursing: Consensus for Quality

PARTICIPANTS

Group 1-Faculty Qualifications

Mitzi Duxbury, Leader Phyllis Kritek

Florence Downs Elizabeth Grossman Patricia Castiglia

Evelyn Barritt

University of Illinois University of Wisconsin,

Milwaukee University of Pennsylvania Indiana University. State University of New York,

Buffalo University of Miami

Group 2-Program of Study

Enid Goldberg, Leader Mary Conway Sandra J. Weiss

Carmen Westwick Carolyn Williams Sue Hegy~ary Marjory Gordon

University of Pittsburgh Medical College of Georgia University of California,

San Francisco Boston University University of Kentucky Rush University Boston College

Group 3--Educational Resources

Rheba de Tornyay, Leader Lois Hoskins

Mary E. Reres

Sherry T. Boyd Michael Carter Irene Palmer

University of Washington Tile Catholic University of

America University of California,

Los Angeles Oregon Health Sciences University University of Tennessee University of San Diego

Group 4--Stuclents

Marie L. O'Koren, Leader Shake Ketefian Gail Malloy

University of Alabama University of Michigan Adelphi University

conference, all the conferees had taken a substantive step toward attaining and sustaining quality doctoral education: "You will find that you indeed have made a difference in the future direction of nursing."

Lorene R. Fischer Sydney Krampitz Joan Rinehart

Wayne State University University of Kansas Widener University

Group 5--Research

Joyce J. Fitzpatrick, Leader Patricia Hummel Carole Anderson Lois Malasanos Linda Amos Sally Miller Mabel Wandeh

Case Western Reserve University University of Wisconsin, Madison University of Rochester University of Florida University of Utah New York University University of Texas

Group 6--Evaluation of the Program

Rose Marie Chioni, Leader Edna Menke Jean Watson Gladys Sorensen Ellen Fahy Elizabeth Lenz Hesook Suzie Kim

University of Virginia Ohio State University University of Colorado University of Arizona University of Minnesota University of Maryland University of Rhode Island

STAFF

American Association of Colleges of Nursing

Barbara Redman Kip Lester Jeannette Spero Dorothy DeMaio Marion Murphy

Division of Nursing

Jo Eleanor Elliott Gretchen Osgood Thomas Phillips Patricia Moritz

JoAnn Jamann, Editor Columbia University

ATTENTION ALL NOMINATED PEER REVIEWERS

The Journal of Professional Nursing received over 400 names of faculty members chosen by their deans as potential peer reviewers. Letters were sent out in November 1984 requesting current vitas. Criteria were set for acceptance as a peer reviewer once the majority ofvitas were received. Individuals not meeting the major cri terion- having been published in at least one refereed journal or book or written a chapter in a published book in their area of expertise--will be sent a letter inviting them to notifyJournal staff of any appropriate changes in their vitas. Individuals accepted as peer reviewers will not be receiving a letter of acceptance; rather their names will be published in the November/December 1985 issue. If you are not sure of your status as a peer reviewer, call Ruth Lamothe at AACN headquarters: (202) 463-6930.

Documents

Proceedings of Doctoral Programs in Nursing: Consensus for Quality