The New Generation

There is a critical need for PhD-educated nurses to conduct important research and teach the students who will become tomorrow’s health‑care professionals.

Jennifer Allford - 1 December 2023

Harkeert Judge, ’15 BScN, ’23 PhD, and her husband Morgan Wadams, ’15 BScN, ’23 PhD, met during their undergraduate studies in the Faculty of Nursing. Judge and Wadams, who were married in 2019, each worked for a year after their BSc in nursing — he at the Edmonton Remand Centre and she at a trauma ward at the University of Alberta Hospital. Both wanted to broaden their horizons, so they enrolled in a master’s program at the U of A.

They signed up for an fast-track master of nursing program in the Faculty of Nursing, informally called the bypass program, which shaves time off post-graduate studies by letting outstanding master’s students move into a PhD program after only one year. Students must have exceptional academic standing and have completed specified coursework. Judge and Wadams both qualified.

“We learned more about the PhD program and the fun that can be associated with doing research — and the doors that doing a PhD can open,” says Wadams, who researched the experiences of men living with HIV as they transitioned in and out of Alberta correctional facilities.

“We didn’t know exactly what we were getting ourselves into,” says Judge, who researched how nurses practise patient- and family-centred care. “We just thought, ‘This is a good opportunity to learn,’ and we wanted to build our repertoire and stay in nursing because nursing is so diverse.”

Judge and Wadams were interested in the variety and depth of nursing that a PhD can bring, but they might not have been aware how valuable they are to the future of the profession.

Shortage of PhDs

When Greta Cummings, ’86 MEd, ’03 PhD, started as a professor in the Faculty of Nursing in 2013, the faculty had 66 tenure track professors with tri-partite roles in research, teaching and service. A decade later, she’s the dean of the faculty, and there are half as many such professors.

Nursing faculties everywhere are seeing drops in the number of candidates available to fill teaching positions. “This has been forecast for 20 years, and it’s actually coming to pass that the numbers of professors are dropping,” says Cummings. “The main problem is not having enough PhD-prepared nurses who want to become academic professors.”

The Faculty of Nursing is ranked first in Canada and fifth globally, according to the 2023 QS World University Rankings by Subject. Maclean’s 2024 Canadian University Rankings named it the top nursing program in Canada, with first place in program reputation and research. But rankings don’t insulate the faculty from the shortage of nurses wanting to enter academia, which raises important questions. With fewer tenure-track professors, who will do the research that informs professional practice and underpins curriculum? Who will use it to teach the next generation?

“It’s a very serious problem, to the point that this could cause the death of our profession if we can’t right this,” says Diane Kunyk, ’78 BScN, ’02 MN, ’11 PhD, vice-dean in the Faculty of Nursing. “This is escalating and it isn’t just for the University of Alberta. It’s a global phenomenon.”

The Canadian Association of Schools of Nursing has also raised the alarm. A 2017 position statement reported that “the number of nurses graduating with PhDs is insufficient to fill existing vacancies, and an aging academic workforce is further perpetuating a faculty shortage.” With most Canadian nursing professors over the age of 55 and staring down retirement, unoccupied faculty positions are projected to increase. The association, like the Faculty of Nursing, suggested prioritizing doctoral education to try to address the problem.

Nursing programs are trying to address the problem, says Cummings, but the demand is daunting.

“Every program is growing and trying to grow their doctoral program. And ours is growing fast, which is also good,” she says. “But the demand for academic professors in all of these schools has also gone up because they need to be able to teach all these students and guide them through anywhere from a three- to five-year program.”

Samantha Louie-Poon, ’16 BScN, ’23 PhD, decided to do a doctorate in nursing for that reason: she wanted to mentor the next generation of nurses. “Specifically, I wanted to mentor populations with diverse experiences and nurses that come from systematically marginalized experiences and communities, similar to my experiences,” she says. Louie-Poon, who is of Chinese descent, recently began a two-year postdoc at Dalhousie University, where she is studying racism and pain management for Asian children in Canada.

Kunyk says doctorate-level nurses not only teach but also — like Louie-Poon — conduct crucial research that improves care for patients and the public.

“Without nurses with doctorates, we’re not developing our nursing knowledge and nursing research,” Kunyk says. She notes that nursing research includes everything from investigating pain management to the root causes of vaccine hesitancy, from assisting ailing seniors at home to helping children with chronic diseases. “Nurses research really important things that other professions aren’t looking at but that are very immediate to the public.”

Louie-Poon hopes her research will have that kind of immediate benefit. “I want to foster inclusive spaces to provide meaningful inclusion,” she says, “and to let the next generation of nursing students and nurses know that they have a place within nursing and nursing leadership.”

With need comes opportunity. Cummings says there is huge potential for doctorate-level education to open the field to diverse nursing leaders interested in equally diverse fields of study. “You can do whatever you want when you’re in nursing, from any kind of specialty across the lifespan,” she says.

If the shortage of doctorate-level nurses is bad news, the good news is that Cummings, Kunyk and their colleagues across the country and around the world are working on myriad solutions to attract more nurses like Louie-Poon, Judge and Wadams to PhD programs. Those solutions begin with awareness, says Cummings. “I am hoping we can turn things around,” she says. “This is an amazing profession. It really is the best job — to be able to work with young people who want to become nurses.”

Addressing the Problem

Attracting nurses into doctoral programs requires more than pitching the many professional benefits of undertaking a PhD in nursing. It also means addressing the overlapping factors that contribute to the shortage — a feat that requires creativity, flexibility and, perhaps most of all, funding.

One factor is that freshly graduated nurses often want to spend some time working before considering graduate studies. Once they are on the front lines, it can be hard for them to walk away from the steady paycheque to go back to school.

“And to exit the workforce for years to get a PhD without financial support is difficult,” says Kunyk. “If they exit, they lose workplace benefits, and employers may not grant them time off because of the nursing shortage.”

That said, experience can sometimes be a motivator.

Louie-Poon says her practice inspired her research. She worked as a registered nurse for four years at the Stollery Children’s Hospital in Edmonton before starting graduate studies, where her research focused on anti-racism strategies for mental health resources, specifically within Asian populations.

“As nurses, I think we come into research informed by a combination of things, from a professional clinical practice to bedside nursing — and we’re also informed by our own experiences,” she says. Louie-Poon is primarily focused on research now, but she is looking forward to eventually teaching and working with students at a research-intensive university.

The Faculty of Nursing is working to secure better doctoral funding — more awards and scholarships — so more people can afford to go to graduate school. “If we can help them financially, they can devote themselves full time to studies and graduate faster,” Kunyk says. Ideally, she says, Canadian universities could match many American nursing programs that are able to offer substantial funding for more intensive doctorate programs that take place over a shorter time.

Drawn by this “choose your own adventure” aspect of a PhD in nursing, Judge and Wadams started their doctorates in 2017 and graduated in 2023. “Your interests and all the people you meet along the road to completion lead to an individualized route of where you want to go,” says Wadams, who is now an assistant professor in the Faculty of Nursing at MacEwan University. “There are many different routes to pursue afterwards, and many have some kind of a teaching component.”

Judge, who is working as a casual RN at the University of Alberta Hospital, is inspired by the nurse educators she has met and plans to conduct research that will improve the profession.

“Part of the shortage is that nurses get burnt out with different workplace settings and situations,” she says. “But there are different practice settings that require nurses to research, explore and create solutions to give that knowledge back to new nurses.” Speeding up the time it takes to complete postgraduate studies, as the U of A’s fast-track program does, not only saves the student time and money in the short term, it gives the graduate a longer career to teach and research, which in turn helps preserve the professoriate.

At one point, Kunyk says, the only option was to juggle competing priorities and accept a shorter academic career.

“Because we practise nursing and often have caregiving responsibilities, by the time we do our PhD, it’s later in life,” says Kunyk. “So, instead of having a 40‑year career, you’re having a shorter one, maybe 20 years.” That means a quicker turnover of nursing school faculty and the need for constant recruitment.

Another factor that limits the number of nurses pursuing doctoral studies is the fact that most nurses are women. “Despite best efforts, most nurses are still female,” says Kunyk. “Often PhDs are undertaken during child-bearing years.”

Once children are born, women are more likely than men to take time off to care for them, according to Statistics Canada. When women go back to work, many will carry more of the child-care and household duties — all of which makes it hard to find the time, energy and money to pursue a career in academia.

Judge, who is expecting her first child in January, admits her career trajectory is now a little more complicated. “I am hoping to teach; it’s just life is a little harder to plan a career around when you’re pregnant,” she says. The fast-track bypass program she and Wadams completed helped the couple decide they could manage the major life changes.

Creative Recruiting

As many front-line nurses leave the profession due to post-pandemic burnout and working conditions, more nursing programs are popping up in an attempt to address the shortage. Not all of them have a legacy of excellence, and it can be hard for prospective students to sort out which program will best meet their needs. But that means more competition for students considering doctorates, as well as a smaller pool of nurses who already have their PhDs and can teach. “Every school has vacancies in their tenure-track programs,” says Cummings.

That’s why the U of A Faculty of Nursing is always in recruitment mode. That includes formal recruitment, such as identifying undergraduate students who may want to pursue graduate studies and inviting PhD students and postdocs to teach a course. It also includes more informal methods. “For example,” says Kunyk, “we had one faculty member return from Ireland recently. When doing presentations, she lets the audience know we are recruiting doctoral students.”

About 40 per cent of the graduate students in nursing at the U of A are international students, and each one is in high demand. “We’re all competing for the same brightest and the best,” says Cummings.

While the Faculty of Nursing’s excellent rankings are “huge for attracting talent,” Cummings says, it’s still expensive to bring international students to Edmonton. And the pandemic has caused many international students to want to study closer to home.

As the shortage of PhDs in nursing becomes more acute, experts across the country are paying attention. “I would say that nursing leaders across the country are starting to recognize the shortage as a challenge,” says Cummings. “In my view, this is a federal and provincial issue in Canada.”

In 2021, the Canadian Association of Schools of Nursing said nursing schools projected a need to fill more than 500 vacancies for nursing faculty and teaching positions across the country. “It needs a concerted national effort to support the education of nurses and doctoral programs,” Kunyk says.

Cummings, meanwhile, is hopeful the trend can be reversed. And she’s quick to point out that there are fewer vacancies in Canada than some other countries. “When I look at some of our collaborators around the world, we still have it really good here.”

But she sees a dangerous gap ahead. A 2022 report from the World Health Organization said there are far fewer people with doctoral degrees in nursing than in other professions. That represents a decreased overall capacity in the profession to prepare the next generation of nurses.

“We need to use all of the connections, networks, resources that we have to shine a light on it and to encourage young people to consider this as a good career pathway — and we need to help them fund it,” says Cummings. “Nurses are good at trying to solve problems. And this is a big problem that needs to be solved.”

Louie-Poon shares the motivation to improve the nursing profession, and she encourages other nurses to consider doing their doctorates so they can help their communities, too.

“As nurses with PhDs, we have a lot to offer,” she says. “We explore so many areas within nursing. Hopefully we can get more PhD-trained nurses in Canada and across the globe.”