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Corresponding author: Heather J. Kelley, RWJF Future of Nursing Scholars, School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Philadelphia, PA 19104.
Professor, Nightingale Professor in Honor of Nursing Veterans, Director, RWJF Future of Nursing Scholars, School of Nursing, University of Pennsylvania, Philadelphia, PA
Students in the RWJF FNS program were funded to complete the PhD within 3 years.
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As of May 1, 2022, 181 scholars graduated with 20 scholars still enrolled.
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The FNS program provided students with financial support, mentorship, and a concentrated leadership development program.
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Nurses from 46 schools pursued their PhDs as Future of Nursing Scholars.
Abstract
Background
Following the 2010 report, “The Future of Nursing: Leading Change, Advancing Health,” Robert Wood Johnson Foundation created the Future of Nursing Scholars program to increase the number of PhD-prepared nurses who could assume leadership roles earlier in their careers by shortening the PhD education trajectory and developing leadership skills.
Purpose
The purpose of this paper is to describe the state of the field at program launch, the program development, and operations.
Methods
A descriptive narrative was used, which relied on literature review focused on nursing PhD program completion and presentation of FNS program objectives and findings.
Findings
Nurses from 46 schools pursued their PhDs as Future of Nursing Scholars. As of May 1, 2022, 181 scholars graduated with 20 scholars still enrolled. Preliminary results suggest accelerate PhD programs featuring intensive mentoring and financial support can produce well-prepared nurse researchers ready for postdoctoral positions and leadership roles.
Discussion
Program attributes including financial support and leadership development initiatives may be replicated.
From 2008 to 2010, the Robert Wood Johnson Foundation (RWJF) and the Institute of Medicine (IOM - now the National Academy of Medicine) Committee on the Future of Nursing hosted informational forums across the country, met with nurses and other health care leaders, and reviewed submitted research briefs to prepare their report, “The Future of Nursing: Leading Change, Advancing Health” (
). The report included a series of recommendations under six main foci: (a) improving access to care, (b) fostering interprofessional collaboration, (c) promoting nursing leadership, (d) transforming nursing education, (e) increasing diversity in nursing, and (f) collecting workforce data. As part of the section on nursing education, the committee recommended the doubling of the number of nurses with a doctorate degree by 2020 in order to replenish an aging faculty workforce, as well as to advance nursing science and clinical leadership. The committee determined that creative approaches to nursing education were required to promote more rapid academic progression of nurse faculty and scientists.
Several recent commentaries and reports have pointed out the critical importance of PhD-prepared nurses (
). Nursing research provides real-world solutions to seemingly intractable health and health care problems. From the bedside to the community, PhD prepared nurse researchers have generated new models of care, foundations for public policy, and care techniques that changed the way health care is provided and the experiences the public have when interfacing with the health care system. Research doctorate-prepared nurses also shape and prepare the next generation of practitioners, leaders, and scholars through their roles as faculty members and as mentors across the nursing curricula.
Although there has been a 43% increase in PhD graduations between 2008 and 2017 (
), there are warning signs that this upward trend will not be sustained. From 2008 to 2013, enrollments in PhD programs slowly climbed but then peaked in 2013 (3,975 in 2008 and 5,122 in 2013). Enrollments have since trended downward by almost 10% (4,632 in 2017).
shows a troubling 14% drop in enrollments from 2014 to 2017. Thus, after a period of slow growth, the nursing PhD pipeline flow is now slowing and almost stagnant.
Following the release of the IOM report, RWJF joined with the American Association of Retired Persons (AARP) Foundation and AARP to create The Future of Nursing: Campaign for Action to improve America's health through nursing. The Campaign, currently coordinated through the Center to Champion Nursing in America (CCNA), is also an initiative of the AARP Foundation, AARP, and RWJF (
). RWJF then focused its nursing priorities on the IOM committee's recommendations. While the CCNA focused on increasing the number of nurses with a baccalaureate degree, RWJF focused on another IOM committee recommendation: increasing the number of nurses who complete a doctoral degree. Data (then and now) indicate that enrollment in Doctorate of Nursing Practice (DNP) programs was rapidly increasing, while enrollment in PhD programs was stagnant. To respond to this challenge, in 2013 RWJF launched the Future of Nursing Scholars (FNS) program to create a large and diverse cadre of PhD-prepared nurses who were committed to long-term leadership careers that would advance science and discovery, strengthen nursing education, and bring transformational change to nursing and health care. RWJF committed $20 million to the program and developed a philanthropic collaborative to bring other funders to the table. Through a competitive selection process, the University of Pennsylvania School of Nursing was chosen as the National Program Office. Development of the FNS program emanated from the program office and incorporated three key pillars: science, innovation, and policy. The FNS program provided financial support (tuition and stipend), mentoring, and leadership development activities, as well as competitive postdoctoral research support, to build the capacity of a select group of future nurse leaders.
, there are concerns about the length of time it takes nurses to complete a PhD. The authors acknowledged a shared recognition that completion length had become too long and that notable gaps of time exist in between each degree attained (i.e., in between BSN to MSN and then MSN to PhD).
, “The nursing profession has grown accustomed to a post-master's to doctorate trajectory of 6 or more years.” In response to concerns about program length and faculty shortages, the FNS program was designed to support nurses to complete their PhD program in 3 years. In the New Jersey Nursing Initiative (NJNI), an earlier RWJF program, selected nurses in New Jersey completed their PhD successfully in 4 years (
). Many program participants reflected that a 3-year trajectory would have been very attractive and doable if they received targeted mentoring and additional research funds.
Following the positive experience with NJNI, RWJF sought to develop a national program which could build upon their success while expanding its reach beyond New Jersey and with a larger number of scholars. For FNS, a 3-year benchmark was established to shorten completion times, with an assumption that postdoctoral studies were a necessary part of developing well prepared nurse scientists. At the same time, there was also a growing debate in research-intensive nursing PhD programs that curricula and student success benchmarks needed re-envisioning. The AACN released its seminal report, The Research-Focused Doctoral Program in Nursing–Pathways to Excellence, shortly after the IOM report and as the FNS program was being developed (
). Although some schools were already experimenting with accelerated programs, e.g., University of Michigan, University of Texas Houston, and University of California San Francisco, this was not a widely supported model. Critics, such as Ketefian and Redman, suggested that 3-year programs threaten the quality of nursing PhD programs. However, they make this claim with no analysis of the curricula offered by schools. Even so, the FNS program was developed to be an innovative and risk-taking approach to accelerated PhD education, as it was shaped by the experiences of these earlier programs while also creating a new PhD program model incorporating financial support, intensive mentoring, and content on leadership and policy development, and a competitive postdoctoral option. The program requested that schools identify candidates who saw the 3-year program trajectory as manageable and valuable to their long-term research career goals. Though the FNS program was not for everyone, it was a very appealing option for nurses familiar with and energized by research, and who were looking for an accelerated PhD trajectory in order to enter their research and leadership career earlier.
In 2019, the University of Pennsylvania School of Nursing held a summit to discuss re-envisioning research focused nursing PhD programs (
). The summit was designed to encourage new ways of approaching nursing science to foster the successful careers of nursing PhD graduates. In the course of their deliberations, participants found that it was important that schools of nursing be willing to consider new educational models and to reconsider indicators of programmatic success. The FNS program provides an exemplar of an educational model that can transform nursing research-focused education.
Program Funding and Scholar Support
In 2013, RWJF committed $20 million to develop and support the FNS program. A philanthropic collaborative was developed (see Ladden et al. in this issue) to expand the reach of the program and to engage other funders to support nursing education. The other funders included three local philanthropies: Independence Blue Cross Foundation (the program's inaugural funder), the Rhode Island Foundation, and a Michigan funders collaborative, and six health systems: Northwell Health, Cedars-Sinai Medical Center, Sharp HealthCare, Rush University Medical Center, Cincinnati Children's Hospital, and Memorial Sloan Kettering, Care Institute Group, Inc., United Health Group, and Johnson & Johnson Services Group, Inc.
Financial insecurity may detract students from entering the PhD pipeline, especially if they leave positions in practice that have supported families or provided health insurance. Additionally, many younger applicants to PhD programs carry debt from previous degrees. For this reason, and to help the scholars move towards completion with minimal work obligations, the FNS program provided a stipend over 3 years of $75,000, similar to the NIH grantee levels, and schools provided additional resources of $50,000 for tuition support, health insurance, travel and research funding. Many scholars did continue to work, depending on their life circumstances, yet they were able to successfully complete the FNS program requirements in 3 years. Some scholars in the program were able to combine T32 support with the FNS support.
Program Description
The National Program Office developed four key broadly focused goals that would have an impact on the overall field, students, schools and funders (Table 1). In particular, the goals set benchmarks to increase the number and diversity of PhD-prepared nurses; to support accelerated programs with curricular changes; increase investment in nursing education; and to ensure successful PhD completion, and leadership development.
Table 1Initial FNS Program Goals
Goal 1
Dramatically increase the number and diversity of nurses with PhDs, in support of the IOM recommendation to double the number of nurses with doctorate degrees by 2020.
Goal 2
Encourage schools to make ongoing changes to their curricula to allow for a 3-year completion option for interested students.
Goal 3
Grow the number of funders investing in nursing education by making the case for PhD-prepared nurses.
Goal 4
Develop the leadership skills of the program scholars.
The program graphic (Figure 1) demonstrates the transformational leadership model that guided program activities. RWJF and the NPO selected a distinguished, interprofessional, and culturally diverse National Advisory Committee (NAC) to advise RWJF on school selection, advise the program office on the program curricula, and serve as national mentors to the scholars. The NAC also contributed to the development of a program logic model (Figure 2).
Figure 1RWJF Future of Nursing Scholars program transformational leadership model.
For each of the five funding cycles, schools of nursing submitted proposals demonstrating their plans to successfully support up to two scholars more than their usual admission numbers to complete the program in 3 years. Schools were challenged to adapt and re-envision their curricular plans to allow for completion of the dissertation in the third year. These proposals included comparisons of their typical curricula with their proposed accelerated curricula, discussion of available research supports, and information about the faculty mentors who would be assigned to scholars upon admission. Applications were reviewed by the NAC who made recommendations to RWJF. The NAC considered a series of questions for each proposal (Table 2) when reviewing the proposals.
Table 2NAC Review Criteria
1
Has the applicant (the school) demonstrated how the school's curriculum plan will facilitate student success in completing a 3-year PhD program?
2
Has the applicant demonstrated effective methods of student support and mentoring?
3
Has the applicant demonstrated that the school has sufficient research infrastructure to foster the scholar or scholars’ preparation for a research career and successfully complete the research-focused doctoral program in 3 years?
4
Has the school demonstrated its commitment to diversity?
5
Has the school demonstrated its commitment to collaboration across disciplines?
6
Has the school demonstrated its commitment to increasing the number of nurses with PhDs and to use these funds to increase the number of students enrolled in the PhD program?
Once admitted to the program, each school selected their scholars from their incoming doctoral class. They were asked to make student selections that would demonstrate a commitment to diversity, while also considering students with research goals that would enable them to complete their PhDs in 3 years. The program admitted its first cohort of scholars in fall 2014. New cohorts were added each year, with the fifth and final cohort beginning their PhD programs in fall 2018. Nurses from 46 schools pursued their PhDs as FNS. As of May 1, 2022, 181 scholars graduated with 20 scholars still enrolled. The FNS program provided each scholar with financial support, intensive mentoring, and extensive leadership development activities designed to connect them with influential mentors in health care, research, business, education, policy, innovation, and other key areas. The scholars all enrolled in full-time research-focused PhD programs and were required to complete their degree in three academic years.
Realizing that schools might need support for themselves and their scholars, program leaders put into place several support mechanisms. Thus, the FNS program provided scholars with additional learning opportunities and support through its leadership development program (LDP). The LDP consisted of monthly calls and webinars, as well as yearly in-person meetings. The LDP began with a boot camp which served as both program orientation, cohort development, and as a working meeting focused on developing skills, such as academic writing. The event took place prior to the scholars’ entry into their doctoral program.
During the boot camp, scholars participated in sessions facilitated by Chris Musselwhite, EdD, founder of Discovery Learning, focused on understanding and maximizing influencing styles and change styles. Prior to attending the event, the scholars completed the Change Style Indicator (
) questionnaire and the Influencing Style Indicator as a foundation for learning exercises focused on understanding, harnessing and optimizing change (a guided activity); understanding personal preference for change and the emotions of change; influencing for positive outcomes (a guided activity); and understanding and optimizing preferred influence styles (
). The scholars supported each other through a peer coaching guided activity which allowed them to explore and discuss perceived challenges or anxieties around completing a 3-year PhD program. This group work, facilitated by Musselwhite and his colleagues, helped to prepare the new PhD students for the stresses they were about to experience in an accelerated degree program.
Scholars were provided with a guide (referenced in the program as a “passport”) which outlined the content-based webinars and calls presented by the program office throughout their 3-year doctoral program. The passport described for scholars the timeline for these activities and the competencies they were designed to address. These included: research skills, translating research to practice and policy, communication skills, interdisciplinary engagement, research leadership engagement, mentorship, diversity, leading and influencing, building a culture of health, career trajectory, developing champions/managing up, and networking. These sessions and relevant competencies are outlined in Table 3, Table 4, Table 5. Program leaders also held one-on-one calls with each scholar twice a year and additionally as needed.
Table 3Academic Skills Competencies Addressed via the FNS Leadership Development Program
Competencies
In-Person Meetings
Webinars
“Ask the Experts” Calls
Research skills
Boot camp & program orientation Summer institute: policy intensive Summer institute: science and innovation
Writing workshop follow up Responsible conduct of research Funding for science Data analysis Tips on publishing Post-docs at the NIH Post-docs, policy, and leadership Planning for an academic career How to look for teaching positions How to look for non-federal funding
Ask a librarian Ask a mentor Ask a community-based researcher Ask a post-doc
Translation skills
Summer institute: policy intensive Summer institute: science and innovation
Writing workshop follow up How policy gets made Entering the conversation Data analysis Tips on publishing How to manage staff How to mentor
Ask a policy-maker
Research leadership engagement
Boot camp & program orientation Summer institute: policy intensive Summer institute: science and innovation
Responsible conduct of research Funding for science Data analysis Tips on publishing How to look for non-federal funding
Table 4Career Development Competencies Addressed via the FNS Leadership Development Program
Competencies
In-Person Meetings
Webinars
“Ask the Experts” Calls
Interdisciplinary engagement
Boot camp & program orientation Summer institute: policy intensive Summer institute: science and innovation
Conducting culturally competent research
Ask a community-based researcher Ask a policy-maker
Career trajectory
Funding for science Post-docs at the NIH Post-docs, policy, and leadership Planning for an academic career How to look for teaching positions How to manage staff How to mentor Writing a 5-year plan
Ask a mentor Ask a chief nursing officer Ask a post-doc Ask a dean
Entering the conversation Working with people in positions of power Post-docs at the NIH Post-docs, policy, and leadership Planning for an academic career Writing a 5-year plan
Ask the campaign Ask a community-based researcher Ask a chief nursing officer Ask a post-doc Ask a dean
Business and entrepreneurship
Summer institute: science and innovation
Prep for summer institute on science and innovation How to manage staff How to mentor
Table 5General Skills Competencies Addressed via the FNS Leadership Development Program
Competencies
In-Person Meetings
Webinars
“Ask the Experts” Calls
Communication
Boot camp & program orientation Summer institute: Policy intensive Summer institute: Science and innovation
Writing workshop follow up How policy gets made Entering the conversation Tips on publishing Working with people in positions of power Planning for an academic career How to look for teaching positions Conducting culturally competent research How to manage staff How to mentor Writing a 5-year plan
Ask a policy-maker
Mentorship
Boot camp & program orientation Summer institute: Policy intensive Summer institute: Science and innovation
How to manage staff How to mentor
Ask a community-based researcher Ask a mentor
Leading
Boot camp & program orientation Summer institute: policy intensive Summer institute: science and innovation
Working with people in positions of power How to look for teaching positions How to manage staff How to mentor
Ask a chief nursing officer Ask a policy-maker
Influencing
Boot camp & program orientation Summer institute: policy intensive Summer institute: science and innovation
How policy gets made Entering the conversation Working with people in positions of power Conducting culturally competent research How to manage staff How to mentor
Ask a policy-maker
Developing champions/managing up
Boot camp & program orientation
Working with people in positions of power
Ask a mentor
Adopting a culture of health
Boot camp & program orientation Summer institute: policy intensive Summer institute: science and innovation
Balancing Work/home/school: Stress management Conducting culturally competent research
Embracing diversity
Boot camp & program orientation Summer institute: policy intensive Summer institute: science and innovation
Conducting culturally competent research How to manage staff How to mentor
During their final 2 years in the program, scholars and their mentors attended two Summer Institutes, week-long meetings focused on Science and Innovation or Science and Policy. During these institutes, scholars participated in an intensive set of research review huddles based on a model developed by the RWJF Nurse Faculty Scholars program (
). The scholars and mentors had the opportunity to work on their public speaking and presentation skills by presenting their doctoral work in a 10-min format and receiving immediate feedback from their peers and mentors from other programs. Each scholar also participated in a post-presentation “huddle” during which they received more in-depth feedback. All scholars also received written feedback from the participants in their presentation rooms. These sessions provided critical opportunities for scholars and mentors to learn from others and to assess the scholar's research progression and dissertation status. The sessions also gave scholars the opportunity to learn how to speak concisely about their work to an audience that was not always familiar with their topic. This skill was further developed in a communications training session offered to all scholars at the end of their first year. This session was led by a trained actress and focused on developing scholars’ presence and communication when sharing their research.
During the Summer Institute: Science and Policy, scholars were exposed to policymakers at a variety of levels. They learned how to consider policy in their own topic areas and to develop plans for using their research findings to effect policy changes. During the Summer Institute: Science and Innovation, using a series of activities, scholars were challenged to consider themselves as innovators. Cohort 1 and 2 scholars worked with MakerNurse (www.makernurse.com), an innovative nursing platform that helps transform creative nurse-driven ideas into practical prototypes. This allowed scholars to consider technological changes at the bedside which nurses could enact to improve care. Cohort 3-5 scholars learned about design thinking from leaders at Cambia Grove (www.cambiagrove.com), “a health care innovation hub focused on bridging the gap between entrepreneurs and the traditional health care sectors.”
Mentorship was another critical element in the FNS program, as the scholars were moving rapidly through their doctoral work and it was expected they would need more intensive focus from advisors (see Gillespie, et al. in this issue). Mentors would also mitigate some of the expected tension between faculty who believed in traditional education trajectories (i.e., greater than 3 years) and those who supported our program mission.
advised nurse educators to carefully identify nurses with strong potential for a career in research and mentor them well. To provide as strong a foundation as possible, the FNS program advised all selected schools to carefully choose their scholars from their pool of applicants with several criteria in mind, including, but not limited to: whether the applicant's research plans supported their ability to complete an accelerated PhD program; whether the applicant's research interests matched with research-experienced faculty members at the school willing to support the 3-year plan; and whether the applicant's research interests would be a methodological and topic match for a mentor at the school. The mentors’ commitment, not only to the scholars but also to the 3-year completion requirement, was intensive and the schools, for the most part, recognized the critical role of the mentor and assigned wisely. Many of the mentors engaged their FNS scholars in their own research and scholarship in a more intense way than typically done, and scholars found inspiration in participation and support for discovery. Additionally, the program office recommended that scholars include interdisciplinary mentors on their dissertation team to provide different perspectives on their doctoral work.
The program office identified postdoctoral training as a critical part of the scholars’ post-program success. As science is rapidly changing, the program leaders realized that scholars in accelerated programs might need additional training in research methods and their focus areas following PhD completion, but a post-doc has become an increasingly important part of post-PhD training in general.
suggest that the PhD is a requirement for new nurse scientists, but that postdoctoral work allows PhD graduates to “become independent, productive researchers” and will “provide more in-depth study… to enhance the formation of an expert researcher.” In addition to providing program content on public and private postdoctoral funding opportunities and discussions with program offices and successful nurse scientists, the program also received some additional funding from RWJF to provide competitive postdoctoral research support for scholars who might eventually be entering faculty positions in research-intensive universities. The program office believed the postdoctoral grants would foster continuous improvements in health care and would jumpstart the scholars’ careers in education and research. Scholars who successfully completed their PhDs in three academic years were eligible to be considered for these postdoctoral awards. Scholars were required to submit their postdoctoral award proposal in December of their final year in the doctoral program. Some scholars were not yet prepared to submit at that time, which could allow for the relatively small number of applications received. The program received 43 postdoctoral applications (out of 201 scholars) and was able to provide funding for 14 FNS postdoctoral awards. However, the number of FNS scholars participating in postdoctoral fellowships is not limited to the FNS post-doc award. As noted by Giordano, et al. in this issue, more than a third of FNS graduates completed or are currently enrolled in postdoctoral fellowships (n=69/201).
Conclusion and Implications for Nursing PhD Education
In 2015, the IOM released an update to the original report titled, “Assessing Progress on the IOM Report The Future of Nursing” (
). The committee noted that the original IOM report did not specify between DNPs and PhDs in the recommendation that the number of nurses with a doctorate degree be doubled by 2020. Given the incremental increase in the number of nurses with a PhD, the committee found that, “the number of nursing students pursuing a PhD needs to be increased. There are barriers to meeting the demand for PhD programs for nurses, including issues of insufficient faculty.”
Rather than seeing PhD completion as an endpoint, the FNS program conceptualized accelerated pre-doctoral work as a beginning foundation that graduates could build on through postdoctoral work and a continued research career. The pre-doctoral period is critical for retaining and situating scholars to generate and begin addressing questions they believe are important. Furthermore, this period is vital to develop a long-term plan for gaining additional knowledge and skills they will need over a career lifetime as a scholar and scientist. Three-year graduates may need a postdoctoral program of one to 3 years to hone their skills and successfully develop a long-term and sustainable research trajectory before they take on faculty roles. However,
make no mention of doctoral program length as relating to a program's rigor in their concept analysis on the topic. Longitudinal data will be needed to map out the career trajectories and successes of the FNS scholar graduates.
Given the critical need for more PhD prepared nurses in the U.S. and the concerns about the length of time required to complete a PhD, it is essential that innovative approaches like the FNS model be integrated into nursing education. Although the FNS program has now closed, we believe certain program offerings may be cost-effective and replicable by other schools. In this issue, Villarruel outlines the importance of embracing new innovations in doctoral education, noting that many of the changes that schools undertook to support an accelerated timeline (i.e., curricular adjustments, changes in dissertation formats) can and should continue. The curricular changes that participating schools utilized are discussed by Giordano, et al. also in this issue and could be integrated into doctoral programs regardless of whether their schools participated in the FNS program.
In order to support 3-year programs, we also encourage schools to provide scholar financial support to reduce the need for accelerated students to minimize work outside of their doctoral programs. Other support by schools, including close mentorship, appropriate mentorship match, additional content to support grant writing and sources of grant support should be integrated into individual school programs. Additionally, schools need faculty who believe in and support accelerated PhD programs to help students progress through their studies. Schools must also be prepared to support students on an expedited program track not just financially, but also with appropriate mentorship. Students who choose a 3-year program should be aware of the intensity of the timeline, and schools should remember this trajectory is not for everyone.
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