How Do Doctorally Prepared Clinical Nurses Add Value to Nursing Practice and Healthcare in Aotearoa?

Abstract

Introduction Doctorally educated nurses are few but play a vital role in nursing science, translating research into practice, and contributing to the professionalisation of nursing. Most doctorally prepared nurses work in academia, however a small percentage choose clinical work. Knowledge about the experience, perceptions, and contribution of doctorally prepared clinical nurses has increased, but requires further exploration to understand how to maximise their advanced skillsets. The aim of this research was to understand the value contribution of doctorally prepared clinical nurses in Aotearoa and to offer recommendations to support their contribution.

Methods This study used an Interpretive Descriptive methodology to approach the question of how doctorally prepared clinical nurses add value to nursing practice and healthcare in Aotearoa. Research involved in-depth individual interviews with 18 doctorally prepared clinical nurses working, or recently working, in clinical practice. Data was collected between November 2021 and November 2022. The analysis was informed by Braun and Clarke’s Reflexive Thematic Analysis.

Findings The research identified five key mechanisms doctorally prepared clinical nurses used to contributed value: being a knowledge expert; an enhanced approach to nursing practice; increased credibility/prestige of the doctorate; holding valuable conversations; and new opportunities and collaborations. The analysis also identified challenges to doctorally prepared clinical nurses’ value contribution of: tumultuous identity transitions; negative external perception; fragmented mentorship; lack of a post-doctoral pathway; and little recognition from nursing leaders and healthcare managers.

Discussion This research corroborated and extended the data about the contribution of doctorally prepared clinical nurses by providing new knowledge on the underlying mechanisms that produce value. The research also identified that participants experienced ‘othering’ by some non-doctorally prepared clinical nursing colleagues and disinterest from nursing leaders, both of which reduced their value impact. Lack of a common post-doctoral pathway for doctorally prepared clinical nurses – who were often advanced nurse clinicians – meant each nurse had to forge their own path through a liminal post-doctoral period. This research highlighted that the wider discipline of nursing appeared complicit in limiting the impact of doctorally prepared clinical nurses in the field.

Recommendations A set of recommendations were presented to better support the integration of doctorally prepared clinical nurses into the clinical environment and enhance their value contribution to healthcare: disseminating this research; integrating a doctoral qualification into early nursing career planning; voluntary registration of doctorally prepared clinical nurses for easier identification; developing a post-doctoral clinical pathway (including the introduction of a clinical scientist role); improving collegial relationships within the nursing field; mentoring for doctorally prepared clinical nurses; and brand work to improve the public image of both doctorally prepared clinical nurses and the profession of nursing.

Conclusion Doctorally prepared clinical nurses in Aotearoa contribute important value to nursing and healthcare through specific mechanisms that should be supported and enhanced. Doctorally prepared clinical nurses face challenges that limit their contribution which appear to be, at least partially, related to the culture in the profession of nursing.