Studying for a nursing PhD equips nurses as researchers to drive improvements in patient care. This article looks at what motivated two nurses to take the PhD route

Abstract

Healthcare research is central to providing high-quality, evidence-based care and the role of nurses as researchers is being promoted and supported nationally. Despite this, nurses undertaking a PhD are under-represented compared with other professional groups, even though a nursing PhD can open up new career avenues. In this article, two general nurses describe their experiences of the PhD journey, including what motivated them, the routes they took and tips for getting started.

Citation: Lees-Deutsch L, Stafford-Umughele A (2020) The challenges and benefits of undertaking a nursing PhD. Nursing Times [online]; 116: 3, 24-26.

Authors: Liz Lees-Deutsch is consultant nurse in acute medicine, University Hospitals Birmingham, Heartlands Hospital and lecturer, University of Birmingham; Augusta Stafford-Umughele is return to practice student, Swansea University.

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Introduction

The last 12 years has seen a drive by the National Institute for Health Research (NIHR) to develop the research skills of nurses and other health professionals to increase the body of healthcare knowledge and innovations that improve patient care. NIHR options for embarking on a clinical academic pathway include:

  • Academic internships (including preclinical academic fellowships);
  • Clinical doctoral research fellowships;
  • Clinical lectureships;
  • Senior clinical lectureships.

More recently, Health Education England laid out its vision for developing the NHS workforce that embraced five global drivers of change in delivering healthcare: demographics; technology; current and future service models; patient and staff expectations; and associated social, political and environmental factors (HEE, 2017). Specifically, in the area of research and practice, it highlighted the need to respond to “changing patterns of service and embrace research and innovation to enable it to adapt to the changing demands of public health, healthcare and care services”.

However, although research by nurses and other health professionals that supports innovative, high-quality and evidence-based patient care is being promoted and supported nationally, there are still fewer nurses taking NIHR-funded PhDs compared with other professionals (Council of Deans of Health, 2013). Nurses are by far the largest professional group in healthcare; the number of nurses on the Nursing and Midwifery Council register is greater than the combined registers of the General Medical Council and the Health and Care Professions Council, so it is clear that the profession is underrepresented.

This article describes the various routes to a PhD, what it involves and why nurses may choose to embark on this journey. It shares the experiences and insights of two general nurses who embarked on this journey.

Although we took different career routes and made different decisions at key points along the way, we both had similar motives for completing a PhD. By sharing our stories, we hope to encourage other nurses who are contemplating a research career to follow in our footsteps.

Funding routes

As well as the ongoing national drive by the NIHR, health and nursing charities advertise PhD studentships for themed research related to their cause. Universities also advertise PhD studentships for work on projects that already have funding. There may be ways to negotiate study leave and adjust your working hours to accommodate work and study. Another option is self-funding, which means you are not tied to research themes set by funders. Regardless of the route you take, your PhD will be closely governed by the university where you choose to study.

What does a PhD involve?

Nurses often consider a PhD if they want to challenge themselves and develop new skills; others may have a desire to ‘invent for the real world’ through a research career. Typically, a PhD requires you to:

  • Produce a viable research proposal for the number of years you have allocated for your PhD;
  • Conduct a literature review to identify the research gap;
  • Work up your research proposal detailing your research methods;
  • Conduct the research;
  • Produce a thesis;
  • Defend your thesis in an oral examination known as a viva.

Passing the viva by demonstrating your original contribution to knowledge is what distinguishes a PhD from any other degree, but each stage of a PhD brings its own challenges, because of the time required to complete the work.

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Potential barriers

A PhD usually takes 3-5 years, depending on whether you choose full- or part-time study. Over this period, people’s life situations can change, it can require significant tenacity to balance PhD study with career, family and life events. It may take longer and changes are sometimes negotiated throughout the course of the PhD. Learning how to apportion your time is a crucial skill you will need to develop.

A PhD can also bring financial challenges, particularly if you are funding yourself, even if this is only a drop in salary during your period of study. Self-funding may also mean not having a base organisation where you can conduct your research. Securing the assistance of a gatekeeper, someone who is employed at the organisation where you wish to do the research is essential. Contact with researchers and clinical staff (as needed) at an early stage can save valuable time by helping with issues such as gaining access to the research site, and locating and introducing yourself in the area.

Although you will probably meet like-minded students on courses you choose to take, you will also need to be self-motivated to study alone for at least some of the time. Some people are put off taking a PhD because they fear it will be a long and lonely journey, but seeking support from supervisors, colleagues and former PhD students can help negate this.

Lack of a clear job plan/career prospects after completing a PhD can be an issue for some, but having a realistic idea of where you would like to be working or what you would like to do after your PhD can help with early preparation to steer you towards your goals. For example, training in additional skills, presenting at conferences and networking over the duration of the PhD will enhance your prospects of paid employment afterwards. Your PhD will also give you an in-depth understanding of your topic, and on-going research interests and methodological preferences, to take you forward.

The following case studies describe our experiences of embarking on a PhD, including our careers leading up to it and the different routes we took. They also describe the lessons we learned along the way, including our tips (Box 1 and Box 2) to ensure success.

Box 1. Tips from Liz Lees-Deutsch

  • Be honest with yourself why you want to do a PhD
  • Seek support early on from research and development, other academics and your local university
  • Ask yourself whether you are self-motivated to study
  • Choose a topic that holds your interest and that you would like to continue with in your career
  • Think what you will do when you have finished the PhD
  • Talk to others who have gained national funding
  • Look up authors of key works in your chosen area of study to find a PhD supervisor

Box 2. Tips from Augusta Stafford-Umughele

  • Apply for PhD funding if you can, as it can be hard covering fees and additional expenses as a self-funded student
  • Select a topic that interests you and that you can build on in the future
  • Choose your supervisor carefully – research the lecturers, their experience and special interests, their work with PhD students and their publications
  • If you choose to study part time, allocate a couple of days a week to your PhD study
  • Build a support network – studying for a PhD can be a lonely road at times

Case study 1: Liz Lees-Deutsch

I qualified as a general nurse in 1991. In the following eight years I gained a variety of nursing experience, including working in older persons’ care, acute surgery and medical admissions. I then moved to the US for a year on a Florence Nightingale Scholarship to study intermediate care delivery.

Following my return, I managed a community hospital in Birmingham. After a year, I moved to a community role as lead nurse in a rapid response nursing team before moving back into acute hospital care to take on the role of consultant nurse, where my main interest has been service improvement.

My journey into my current area of expertise, patient discharge, began when a former clinical director dared to suggest ‘nurses simply followed doctors’ discharge orders’.

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Once I had managed to get work published, my mission was to share what I was doing through robust data collection and a systematic approach to writing, as I never saw the point of doing work unless it could be shared. At the back of my mind, I also had the idea of studying for a PhD to delve deeper into the theory and social science underpinning patient discharge.

As a consultant nurse, I took three secondments; in older persons care, at a faculty of education and my current secondment (one day a week) at the University of Birmingham. I also took a BSc degree in nursing, a master’s degree and a health service management diploma.

In 2013, while on secondment at the faculty of education, I was encouraged by the head of education to apply for a PhD fellowship. Although this seemed a natural next step for me, I was unsure what further study would add and was worried about leaving clinical practice behind. However, I felt a PhD could break the glass ceiling that I felt at times had held me back from academic career progression.

The research career pathways the NIHR provided were new to me, and the process of applying for a PhD felt like scaling a mountain without any equipment, putting me on a huge and rapid learning curve. When considering an application for national funding, the NIHR panels judge the merits of the applicant and the employing organisation, as well as the applicant’s research proposal and intended career pathway (Association of UK University Hospitals, 2016).

I wanted to create a risk assessment for discharge for patients admitted to hospital and my intended career pathway was to become a clinical academic nurse. My line manager provided guidance and a supporting statement. The proposal also required a full literature review to ensure the research gap I envisaged was real. I chose the University of Manchester as my place of study as I had studied there before, and was required to submit my research proposal and key milestones for three years of study.

Despite preparations over 12 months, my first application to the NIHR was unsuccessful. At interview, the panel felt I had the right attributes, but had insufficient support from my organisation. An onward career pathway is a critical aspect of gaining any research funding and they felt my organisation lacked the vision to find me suitable employment on completion. Undeterred, I reapplied a year later following a clear strategy (see tips in Box 1). In 2014 was offered full funding, along with three years’ salary and training costs.

The next stage was quite daunting, as I had to leave my full-time post, become a student and learn completely new skills. I met my supervisors every month; one supervisor gained a promotion and left soon after I started, but the other saw me through to the finish. I completed my PhD in 2018 and then had a post-doctoral fellowship funded by Health Education England and hosted through the University of Birmingham. This gave me time to complete further publications arising from my PhD, progress research work, consider funding streams and complete further research methods training. I got funding from the Burdett Trust for Nursing for evaluation work of an education programme in acute medicine (Lees-Deutsch et al, 2019).

I also got a place on the NIHR 70@70 national nurse and midwife leadership programme, giving me three years of part-time funding. As a result, my role is now much more collaborative with researchers, lecturers and clinicians, with the aim of securing further funding this year to continue my patient discharge research.

Case study 2: Augusta Stafford-Umughele

Having trained at the North Middlesex Hospital, I enjoyed working as part of a team helping patients move from an ill and helpless state to full recovery and discharge home.

I decided to study for a master’s degree in human resource management at Middlesex University Business School. Fundamental to this decision was my interest in staff behaviour across the team and my intention was to gain a management qualification I could combine with nursing. Throughout this time I worked as a staff nurse and then as a sister in a London nursing home.

As part of my master’s degree, I completed a placement in a personnel department at the hospital where I trained as a nurse and was asked by my mentor to evaluate the advanced nursing skills course for post-registration nurses. My findings showed nurses were not being given the opportunity to perform advanced skills and lacked confidence because they were not using the skills frequently enough. After completing my course, I worked in nurse recruitment, where I further developed my interest in advanced nursing roles.

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In 2001, I decided to leave my job in nurse recruitment to look after my four young daughters. It was not until 2010 that I planned my return back to work. Having been out of work and education for nearly 10 years, and with a young family to support, the idea of resuming work or study was daunting, and I decided to search for courses that were more compatible with family life.

In January 2012, my New Year’s resolution was to take a PhD in nursing, which I had wanted to do for many years. I planned to explore advanced nursing roles, potentially building on elements from my master’s degree. My aim was to increase understanding of how advanced practice had developed and the benefits of having experienced highly skilled nurses in these roles. In particular, the shortage of doctors across the UK meant the topic and the timing felt right.

I looked into the distance learning PhD programme at the University of Manchester’s School of Nursing. Distance learning enabled me to be based at home in Wales and travel only occasionally to Manchester, access learning modules from home and attend courses as needed around the UK. I felt satisfied that advanced practice was worth exploring further and contacted two senior lecturers with an interest in nursing roles and patient care quality to see if they would be interested in supervising my research. I received a positive reply.

My PhD was self-funded. I chose this route as I was not employed so did not have an employing organisation to support my application. The online application process was straightforward; the only challenge was professional references, as I had been out of work and education for 10 years and had to establish my ability to study at PhD level. I was advised to do another master’s degree, which I was not keen to do. Then the university offered me the opportunity to take individual modules from its master of research programme as a route onto the PhD nursing programme. Having completed these, I was admitted onto the PhD nursing full-time programme in September 2013.

The programme involved me attending a couple of 3-4-day workshops in the first year and completing other elements via Blackboard, an online learning system provided by the university. I went to seminars and presentations and had supervision once a fortnight via Skype with my three supervisors, as well as arranging to see them whenever I was at the university.

Following my viva, my final submission was in March 2018 and, since then, I have provided qualitative analysis and a report for an educational research project, and I am gradually publishing aspects of my thesis. I am now taking a return to practice course to update and participate in clinical practice, with a view to working in nursing research, as opportunities arise.

Conclusion

Despite the inevitable hard work undertaking a PhD has been, we both thoroughly recommend PhD study to nurses. We have gained invaluable skills in research methods, ethics, theory and writing (to name a few) and these will help us to progress to the next stages of our career. Reflecting back, we are both approaching the last 10 years of our careers, ideally, the decision to undertake a PhD should be supported at a reasonably early career stage to build your research skills over your employment lifetime.

Key points

  • There is a national drive to encourage more nurses into research
  • Studying for a PhD equips nurses as researchers to increase knowledge and drive improvements in patient care
  • As the largest professional group in healthcare, nurses taking PhDs are under-represented compared with other groups
  • Nursing PhD programmes require commitment, but can offer flexibility, so you can pursue them at your own pace
  • When applying to study for a PhD, it helps to learn from others who have already been down that route



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