When Elisa Patterson first decided to become a nurse, she had a simple goal: helping women thrive during pregnancy, labor and delivery. She earned her bachelor’s and master’s degrees in the science of nursing, became a nurse-midwife in Colorado, and joined the American College of Nurse-Midwives, a professional women’s health organization.
But reaching that goal proved more difficult than she had anticipated. Many women, she found, lacked access to high quality, affordable pre- and post-natal care. Some were pressured into having unnecessary cesarean sections that jeopardized their health. And others simply didn’t know that they needed to see health care professionals during the first trimester of their pregnancies.
Patterson soon realized that she could not surmount these problems with clinical skills alone; she needed tools that would enable her to influence the health care system at large.
She became active in her professional organization, took a 12-week course on health policy in her home state, and later enrolled in the University of New Mexico’s Ph.D. in Nursing Program and concentrated in health policy. The health policy concentration—funded by the Robert Wood Johnson Foundation (RWJF)—gives nurses, especially those from underserved racial minority populations in the Southwest, the research and advocacy tools they need to become leaders in health policy at the local, state and national levels.
This kind of program “enables us to look at the big picture and make contributions to health care and nursing care writ large,” says Sally Cohen, Ph.D., R.N., F.A.A.N., associate professor and director of the RWJF Nursing and Health Policy Collaborative at the University of New Mexico.
Patterson is living proof. Now in her second year of the program, she plans to conduct a cost-effective analysis of elective repeat cesarean sections and vaginal deliveries after cesarean sections. Providing policy-makers with actual dollar figures, she hopes, will encourage decision-makers to create incentives to slow the growth of unnecessary C-section deliveries. That, she says, would improve the health of pregnant women and lead to considerable cost savings in the health care system.
Patterson is one of just 10 RWJF Nursing and Health Policy Fellows who are enrolled in the nursing health policy doctoral concentration at the University of New Mexico, a program that Cohen says “is on the vanguard of change” in nursing education. An increasing number of nursing doctoral programs are offering courses in health policy, Cohen says. In January, the American Association of Colleges of Nursing (AACN) made health policy the theme of a conference on doctoral-level nursing education. “It was a sign of the times,” Cohen notes.
Through the program at the University of New Mexico, three doctoral students a year receive funding that covers tuition, health insurance, monthly stipends, and the cost of computers, books and travel to health policy conferences. Participants are also able to take advantage of interdisciplinary activities with social science doctoral fellows from the RWJF Center for Health Policy at the University of New Mexico and are required to complete a field placement in a public or private health policy setting, such as an advocacy or government organization.
“A lot of the issues related to reducing disparities in health have to do with how things get paid for and what kinds of federal and state policies there are to help improve conditions for underserved populations,” says Nancy Ridenour, Ph.D., R.N., dean of the College of Nursing at the University of New Mexico and an alumnus of the RWJF Health Policy Fellows program and the RWJF Executive Nurse Fellows program. “There’s an emerging recognition across the country that nurses need to be much better skilled in this area.”
Clinical and Research-Based Nursing Doctorates on the Rise
Expanding opportunities for doctoral nursing students to study health policy is an integral part of the overall growth in doctorate programs for nurses.
The number of doctoral programs that prepare nurses for careers in research and education is on the rise, as is the number of doctorate programs that focus on clinical skills, according to the AACN.
There are now 120 research-based doctorate degree programs and another eight are in development, the AACN reports. And there are now 120 clinical-based doctorate degree programs for nurses. Another 161 such programs are in development. Nearly three-quarters of schools with advanced practice registered nurse programs are now offering or planning to offer a doctorate in the practice of nursing.
More doctorate-level programs mean more doctorate-level students. Enrollment in doctorate-level nursing programs has jumped 20 percent from 2008 to 2009, AACN finds. During that period, the number of students in research-focused doctoral programs jumped 5 percent to 4,177 and the number of enrollees in Doctor of Nursing Practice (D.N.P.) programs soared 51 percent to 5,165.
More highly educated nurses will benefit patients, nurses and the health care system at large, says AACN CEO and Executive Director Geraldine Bednash. With a deeper understanding of health policy, more doctorate-prepared nurses will be able to effect systemic health care changes that improve patient outcomes.
D.N.P.-prepared nurses, meanwhile, will be better able to manage increasing numbers of patients with more complex conditions. And they can fill faculty positions that are needed to train the next generation of nurses—and curb the looming shortages of nurses.
“Doctorally prepared practitioners will affect how care is delivered and how it is monitored,” Bednash added.
But even though doctorate-level nursing programs are on the rise, there are still not enough programs to meet demand. More than 1,000 qualified applicants to doctorate-level programs were denied admission last year, according to the AACN. That’s mainly because schools don’t have enough faculty members to expand class sizes, lack access to clinical teaching sites, have limited classroom space, and face cuts to their budgets. “Bringing more nurses into graduate programs is urgent given the calls for more expert nurses to delivery high quality, cost-effective care in a health care system undergoing reform,” says Kathleen Potempa, Ph.D., R.N., F.A.A.N., AACN’s president.
The surge in nurses with doctorate degrees has created some controversy about whether, like physicians, they should be referred to as doctors. But Bednash brushes off the ‘Dr. Nurse’ debate. “It’s a straw horse,” she says.
William Holzemer, R.N., Ph.D., F.A.A.N., dean and professor in the College of Nursing at Rutgers, the State University of New Jersey, agrees. The College of Nursing at Rutgers is a part of the New Jersey Nursing Initiative, which is a project of RWJF and the New Jersey Chamber of Commerce Foundation that aims to increase the number of nurse faculty and, ultimately, the registered nursing workforce in New Jersey.
The critical issue, he says, is that an increasing number of nurses will have advanced degrees. They will be able to treat patients with more complex conditions as well as train new nurses. In doing so, they can help stem a nurse shortage that would otherwise threaten patient care, and they can help expand the qualified pool of primary care providers. “It’s a win-win all around,” Holzemer says.