https://www.infirmiere-canadienne.com/blogs/ic-contenu/2026/04/20/necessite-infirmieres-dun-doctorat
Formal structures are required to support nurses to pursue doctoral education without leaving clinical practice behind
istockphoto.com/Marco VDM
The risk of not supporting nurses to pursue PhD-level education is that theory-based science and research in the discipline of nursing will decrease because nurses lack the research training necessary to be principal investigators on interdisciplinary teams.
Canada is facing a critical nursing shortage following the COVID-19 pandemic and concurrent global crises (Tomblin Murphy et al., 2022). Nursing shortages are not new (Peters, 2023), but the impact of crises like climate change and war have spotlighted the significance of the problem (Peters, 2023). Now, more than ever, we need PhD-prepared nurses to lead transformative change and quality improvement in health care.
My story
I completed a PhD in nursing at the University of Alberta in 2024. It was a long journey during which I navigated the pandemic and multiple family crises, raised four kids, and worked full-time in nurse leadership while maintaining a casual hospital-based nursing role in one of the largest urban centres in Canada. I love the opportunities that my nursing career has brought me. I feel a strong connection to my professional identity and appreciate the monumental impact that the discipline and profession have had on shaping the Canadian health-care system.
However, in navigating my doctoral journey, I saw significant barriers to success within a system that continues to undervalue nurses as formal leaders and contributors to health knowledge. This must change.
When choosing to pursue higher education as part of a career goal in nursing scholarship, I encountered the multiple barriers that many nurses face. As my research progressed, I realized that pursuing academia as a mid-career nurse would require significant sacrifices, especially in a system where clinically practising nurses are not as well integrated into academic roles as physicians are. My area of research is nursing history, particularly the education of registered psychiatric nurses (RPNs) in British Columbia, which is an under-researched area in terms of practical application to health-care resource planning and clinical care decision-making.
I received many congratulations upon sharing that I finished my research but no invitations or interest to read or present my research other than from fellow nurses. At the end of my monumental achievement in earning a PhD, I found that my choices were to remain a nurse leader in health care or to sever that connection and pursue academia. There is no space to pursue both.
I keep asking: in a health-care system struggling to attract and retain nurses, why aren't we building a strong nursing scholar and researcher base to transform the system from within?
Barriers to higher education persist
Yes, professional nurses are needed in direct care to ensure that evidence-informed, competent care is delivered in hospitals and community-based health-care settings. Over the past 50 years, however, nurses have made great strides to become better placed within health-care leadership teams, attaining the baccalaureate entry-to-practice level for all provinces and territories (except Quebec) and creating graduate-level nursing programs across the nation (Pijl-Zieber et al., 2014). The programs exist, but many barriers prevent nurses from pursuing master’s and doctoral level degrees in nursing. That is not to say that nurses cannot and should not pursue graduate degrees in an area outside of nursing, and nurses have strategically developed academic faculty this way when professionalization shifted hospital-based training schools to post-secondary institutions (College of Registered Nurses of British Columbia, 2012; Duncan et al., 2020).
The shift from hospital-based education changed how nurses were prepared, from being trained as employees to meet the specific needs of a single hospital to being educated with a strong theoretical and practical foundation that allowed them to work across the country and internationally (Duncan et al., 2020). Data support the benefit of baccalaureate entry to practice for RNs (Duncan et al., 2020). However, nursing students may continue to conceptualize nursing as a vocational field like that of a skilled trade, which obscures the value of scholarly nursing work and, more importantly, creates a shortage of faculty to teach new nurses.
The recent nursing workforce report published by the Canadian Association of Schools of Nursing (CASN) highlighted the need for full-time nursing faculty positions, with 543 full-time faculty needed in 2022 (CASN, 2021). The CASN report is the only longitudinal, national study of nursing education in Canada; however, it only captures data on registered nurse (RN) and nurse practitioner (NP) programs. Statistics about RPN education are absent, a significant gap considering that RPNs are a key group of nurses providing care to people with primarily mental health issues in Canada (Canadian Institute for Health Information [CIHI], 2021b).1
The supply of RN faculty is an important factor affecting the country’s capacity to educate new RNs (CASN, 2021). Retirement of existing faculty, inflow of newly prepared faculty, and ability to attract and retain qualified staff impact this. The system remains siloed, with nurses having to choose to either pursue academia in post-secondary institutions or work clinically in health-care services. With the instability in undergraduate nursing education, and a dearth of full-time faculty positions, this does not seem to be a viable choice for nurses in politically and economically unstable provinces. Only a small percentage (26.8%) of RN faculty are employed on a permanent basis and more than half are currently 50 years of age and older (CASN, 2021).
Leading transformative change
What is the future of nursing — a practice-based profession and discipline that connects education to practical application in health-care settings — if nurse leaders cannot access the top of the system and prioritize PhD preparation? We can look to nursing education of the past and see how the role of nurses should not be driven by the limitations of nurses today; rather, nurse leaders in clinical settings and in academia must consider the role from a broad perspective and see how nurses are best positioned to facilitate transformative change socially, politically and economically by leading interdisciplinary research teams.
Almost two decades ago American nursing scholars were cautious about the explosion of doctorate of nursing practice (DNP) degrees being offered in the U.S. because they anticipated it would come at the risk of nurses not advancing in research (Dracup et al., 2005). While Canada has slowly built DNP programs, Canadian nurses have been pursuing their DNP in the U.S., building credentials and obtaining positions within non-research-based schools of nursing. However, this may have come at the cost of nurses being unprepared to lead research teams.
The risk of not supporting nurses to pursue PhD-level education is that theory-based science and research in the discipline of nursing will decrease because nurses lack the research training necessary to be principal investigators on interdisciplinary teams. The hallmark of a doctorate program in nursing is the expectation of using and developing nursing knowledge (Dracup et al., 2005). The divide between clinical practice and research is sometimes difficult to conceptualize because these are not distinct paths.
The Canadian context
In Canada, we have a challenging context for PhD-prepared nurses to navigate between often siloed academic and clinical spaces. Logically we understand that this work is necessary to develop the discipline of nursing and maintain the connection to clinical practice, but the support is not there financially and the research opportunities are not there.
PhD-prepared nurses provide a strong theoretical and philosophical foundation for the nursing profession. This grounding is essential to a health-care environment where traditional medical models and empirically based disciplines often fall short of embracing the core values of caring, humanistic principles, and relational practice.
Nurse leaders in clinical practice must actively foster relationships and create clear pathways for nurses to pursue graduate-level education. Without such efforts, we risk being overshadowed by other health-care professions, leaving nurses feeling undervalued, overlooked and excluded from important decision-making roles in health care.
Addressing the gap
To address the gap between clinical nursing practice and academic research, investment in structural solutions that make PhD education and research roles accessible, attainable and sustainable for nurses is needed. Collaborative partnerships between health authorities and academic institutions can support joint clinical–academic positions that allow nurses to remain embedded in practice while leading research initiatives. Protected and funded research time (funded time released from clinical roles to pursue doctoral studies) and mentorship programs (which connect practising nurses with established nurse researchers) are essential to cultivating scholars of nursing. Regional centres of excellence in nursing research could be established within health authorities to provide infrastructure and leadership support for nurses engaged in practice-based inquiry. These solutions require intentional investment, but the lasting benefit is a more resilient, research-informed nursing workforce that can internally drive and share innovation and system transformation.
Nursing is a self-regulating profession. We need PhD-prepared nurses to be research leaders and champions, answering questions about navigating nursing shortages and developing innovative models of health care to ensure access and equity for all. We need PhD-prepared nurses to be leaders of health-care research teams to bring the perspective of the most populous health-care practitioner in Canada (CIHI, 2021a).
A path forward
To move forward, formal structures are required to support nurses to pursue doctoral education without having to leave clinical practice behind. Creating roles for nurse scientists — clinicians who lead research while remaining grounded in patient care — offers a viable path forward. The emergence of nurse scientist roles, such as the one recently created at the Centre for Addiction and Mental Health (CAMH), represents a significant step forward in addressing the longstanding divide between clinical practice and research in Canadian nursing (Ling and Strudwick, 2023). These roles bridge the practice-research divide, ensuring nursing knowledge directly informs system transformation. Investing in joint clinical-academic positions, protected research time, and mentorship opportunities will help build a future where nurses are at decision-making tables, leading the research that shapes health care.
Nurses must demand support for PhD education to ensure we are prepared to identify the intersections of politics, gender issues, and social equity with health care to create transformative change. The possibilities and opportunity for nurses as clinically based leaders of health-care teams can shape health care in the future. Without this type of future-oriented thinking, the profession and discipline of nursing will die in a health-care context in which physicians remain solidly at the top and the playing field is increasingly saturated with regulated and unregulated health care professionals who do not recognize or understand the integral role that nurses have played and must continue to play in the future of health care.
For nurses to fully embrace and embody holistic health care perspectives and meaningfully integrate broad concepts like Indigenous cultural safety, anti-stigma, inclusivity, trauma-responsive care in our role as health-care leaders at all levels, from direct patient and client care to administrative roles, the need for research and scholarly work cannot be disputed.
1 Recognition must be made to the role that RPNs have played in delivery of nursing care in mental health–specific services throughout the 20th century until the 1990s with the deinstitutionalization movement (Hicks, 2008; Sealy and Whitehead, 2004). The situation of RPNs is different because there are no RPN-specific doctoral programs and only a single master of psychiatric nursing program at Brandon University, the site of the first baccalaureate psychiatric nursing program in Canada.
References
Canadian Association of Schools of Nursing. (2021). Registered nurses education in Canada statistics, 2020-2021. https://www.casn.ca/wp-content/uploads/2022/11/2020-2021-CASN-Student-Faculty-Survey-Report.pdf
Canadian Institute for Health Information. (2021a). A lens on the supply of Canada’s health workforce | CIHI. Canadian Institute for Health Information. https://www.cihi.ca/en/health-workforce-in-canada-in-focus-including-nurses-and-physicians/a-lens-on-the-supply-of-canadas-health-workforce
Canadian Institute for Health Information. (2021b). Registered psychiatric nurses | CIHI. Registered Psychiatric Nurses. https://www.cihi.ca/en/registered-psychiatric-nurses
College of Registered Nurses of British Columbia. (2012). 100 Years of Nursing Regulation 1912-2012. College of Registered Nurses of British Columbia. https://www.bccnm.ca/Documents/z_centennial/download/CRNBC-Centennial.pdf
Dracup, K., Cronenwett, L., Meleis, A. I., & Benner, P. E. (2005). Reflections on the doctorate of nursing practice. Nursing Outlook, 53(4), 177–182. https://doi.org/10.1016/j.outlook.2005.06.003
Duncan, S. M., Scaia, M. R., & Boschma, G. (2020). “100 Years of University Nursing Education”: The Significance of a Baccalaureate Nursing Degree and Its Public Health Origins for Nursing Now. Quality Advancement in Nursing Education - Avancées En Formation Infirmière, 6(2). https://doi.org/10.17483/2368-6669.1248
Hicks, B. (2008). From barnyards to bedsides to books and beyond: The evolution and professionalization of registered psychiatric nursing in Manitoba, 1955-1980. [Doctoral Dissertation, University of Manitoba]. http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=109853021&site=ehost-live
Ling, S., & Strudwick, G. (2023, January 30). Q&A: Newly created nurse scientist role blends practice with research. Canadian Nurse. https://www.canadian-nurse.com/blogs/cn-content/2023/01/30/nurse-scientist-blends-practice-research
Peters, M. (2023). Time to solve persistent, pernicious and widespread nursing workforce shortages. International Nursing Review, 70(2), 247–253. https://doi.org/10.1111/inr.12837
Pijl-Zieber, E., Grypma, S., & Barton, S. (2014). Baccalaureate Nursing Education: Has It Delivered? A Retrospective Critique. Canadian Journal of Nursing Leadership, 27(2), 27–34. https://doi.org/10.12927/cjnl.2014.23839
Sealy, P., & Whitehead, P. C. (2004). Forty Years of Deinstitutionalization of Psychiatric Services in Canada: An Empirical Assessment. The Canadian Journal of Psychiatry, 49(4), 249–257. https://doi.org/10.1177/070674370404900405
Tomblin Murphy, G., Sampalli, T., Bourque Bearskin, L., Cashen, N., Cummings, G., Elliott Rose, A., Etowa, J., Grinspun, D., Jones, E. W., Lavoie-Tremblay, M., MacMillan, K., MacQuarrie, C., Martin-Misener, R., Oulton, J., Ricciardelli, R., Silas, L., Thorne, S., & Villeneuve, M. (2022). Investing in Canada’s nursing workforce post-pandemic: A call to action. FACETS, 7, 1051–1120. https://doi.org/10.1139/facets-2022-0002
Michelle Danda, RN, PhD, CPMHN(C), graduated from the bachelor of nursing accelerated track program at the University of Calgary in 2008 and recently completed her PhD in doctoral nursing program at the University of Alberta. She is a clinical nurse specialist in Vancouver, B.C., and practised mental health and substance use nursing through the Lower Mainland, B.C.
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