Letter to the editor

Abstract

Thank you for the opportunity to contribute to the vigorous debate surrounding the Jan-Feb article, An Eye Toward the Future: Pressing Questions for Our Discipline in Today's Academic and Research Climate by Algase, D et al. This piece, which addresses the question of whether non-nursing faculty (NNF) should be granted tenure track within schools of nursing (SONs), reflects larger, ongoing identity crises within nursing science, and comes at a moment in our nation's history when the future direction of nursing science has arguably never been more integral to the health and safety of US populations.The authors raise logistical and philosophical objections to including NNF on SON tenure tracks and submit three narrow means of involving NNF in nursing education and research moving forward. While they extend some olive branches towards interdisciplinarity, the authors ultimately stand against NNF tenure.As a nursing school that prides itself on disruptive, nurse-led, team science, we value the authors’ elevation of this topic and the thoroughness with which they make their case—but we must wholeheartedly disagree with their position. Emory School of Nursing ranks number five in National Institute of Health Funding among US nursing schools; our faculty received $9.6 million in federal funding for their programs of research in FY2019 alone; and our school was tied for No. 1 in total grants awarded that same year. This is no accident: Emory Nursing researchers are effective because they know that successful nursing science and interdisciplinary team science are one and the same.If nursing science is to be appropriate in its methodologies, precise in its interventions, sustainable beyond funding periods, and impactful to human health over time, it must approach research questions through multiple simultaneous lenses. In virtually no case could one of our research questions be framed, or the studies be responsibly carried out, by a single discipline. We hope that by responding thoughtfully to the authors’ concluding questions, we may demonstrate the truth of this claim. In addition to the responses below, we welcome all opportunities to share how our tenured NNF have helped to propel Emory as a national leader in nursing education and science.What explains/drives the current trend of rising numbers of NNF to the faculty of leading nursing schools/colleges?The authors’ thesis conflates two distinct issues to the detriment of their overall argument: (a) The value of interdisciplinary NNF to research programs within schools of nursing (SONs), and (b) the professional advancement of NNF within nursing schools. We discuss the factors driving inclusion of NNF as they relate to both concerns.On the first matter: The evolution of diverse faculty within SONs—particularly within research-intensive institutions—reflects our profession's inherent emphasis on interdisciplinary science and the NIH's calls for translational team research. Nursing is, by definition, interdisciplinary; this extends to the theoretical frameworks and “substantive structure” to which the authors refer. They submit the example of a person pursuing independent research in psychology without first studying under a psychologist—who is to say that “no reputable psychologist would recognize” this person's work as credible? Perhaps if the research at-hand dealt with the psychological trauma of repeat assault of non-gender conforming people during juvenile incarceration, the abstract ‘psychologist’ evaluating the work would respect the decision to train under a gender theorist, or a social worker, or a nurse LGBTQI+ activist, or a public defender—or understand the value of having all of these individuals sit on a dissertation committee (or collaborate on a research team). They might also recognize that a substantial portion of the psychological insights derived through this research will not have come from faculty at all—but rather from the student's exhaustive self-directed readings and the mixed-methods data they collect in partnership with survivors. (Or maybe they would prefer for the student to simply read Freud?) Healthcare problems are complex—they do not live within singular “substantive structures;” why would we seek research solutions that do?Next, the focus on tenure track positions and employment priorities is separate from conversations about designing environments that will support the generation of new knowledge. In well-funded nursing schools, there tend to be sufficient bodies of researchers, and an NNF does not “replace” a faculty member holding a degree in nursing. Faculty are not this interchangeable. When it comes to considering faculty for different positions—such as bringing a funded research program or leading a clinical education program—the nursing Dean will consider the most appropriate candidates. Any blanket doctrine that dictates the type of individuals available for consideration would undermine the school's mission in the long-run.Less than half of the nation's 135 PhD in nursing programs have robust extramural research programs. In other schools, with few researchers and hardly any funded research, it is quite possible that the faculty member who has been successful in achieving funding for their research program is best suited to educate doctoral students, regardless of their degrees. If the passionate, prolific, and well-funded NNF is elevating the caliber of the school's graduates and advancing the school as a whole, they should not face arbitrary barriers to their professional fulfillment. Furthermore, the literature on the nursing researcher shortage is well established, along with the limits on our capacity to graduate PhD-prepared nurses. If the number of PhD nurse researchers is not growing, how will we mentor the next generation in launching their research careers? The demand for nurses has never been greater, and few schools are able to raise their nursing faculty numbers sufficiently to also increase enrollment of students.What is the impact of NNF on nursing science?In most instances, we cannot tangibly measure the impact of NNF on nursing science NOR have we consistently measured the impact of nursing faculty on nursing science. The impact question is difficult, given that we don't have standard metrics for what advancement of a discipline looks like. Neither do we have a sense of which outcomes might be most meaningful to nursing. Again, because nursing is inherently interdisciplinary, with touchpoints across the lifespan, cultural settings, and practice locations, it begs the question: What is the merit of trying to stack up all NNF, or all nursing faculty, against some uniform measure of impact? At times, discoveries by single investigators have led to huge advancements of science. The examples can be seen in individuals who have received notable recognition of how their findings have changed the direction of a field. That is not typically the case in nursing science: Nursing research tends to have small, incremental effects on the ways in which we practice, and the ultimate effect of many nursing interventions is deeply personal and highly subjective.The best indication of a school's impact on nursing science lies in its doctoral graduate outcomes. And, if a doctoral student is mentored by an interdisciplinary team, no one person on that committee is responsible for the person's outcomes (or the future impact they will have on nursing science). Rather, each member's contributions complement and amplify those of the others. Likewise, the schools within which a student's mentor(s) hold their appointments is not relevant to the student's ability to learn. The committee is nurturing and imparting knowledge; the locations of committee members’ offices do not alter the amount or caliber of knowledge that the student acquires.How best can we leverage the expertise of our NNF to advance our discipline? Is it a) to train nurses to integrate newer methods or approaches they bring? or b) to adapt their theories to frame nursing questions, either of which can extend our ability to answer nursing questions? Is there evidence of progress?This is an interesting question, but not an important one. According to the American Association of Colleges of Nursing (AACN), nursing research can advance nursing practice, shape health policy, and improve health on a global scale. It is not essential for our scientific discoveries only to advance our discipline if we are having meaningful impact on health in general or the policies that improve health.The NINR ‘Stories of Discovery’ underscore the diversity of nursing science impacts, which extend far beyond the immediate field and scope of nursing. What is notable is that many cases feature nursing scientists who are not only faculty in SONs but are also nurses who hold scientific appointments in other departments. The cases include non-nurses with powerful research that has changed nursing care as well. The NINR project illustrates the erroneous premise of this paper that the school in which an individual holds an academic appointment somehow defines their potential impact on nursing science.If one searches for prominent nursing discoveries, a number of wonderful contributions can be found that have been made by practicing nurses or DNP students not holding tenure track positions in SONs: In the 1950s, Sister Jean Ward discovered the ability of light to decrease jaundice in newborns, and subsequent nurses have influenced practice by testing the effects of delaying newborn baths on rates of hypothermia. Historically, nurses have made significant discoveries that have improved patient care, including creating disposable sanitary napkins, designing crash carts and ostomy bags, and inventing disposable baby bottles. Nurses today are embracing innovation and leading interdisciplinary teams to engineer health technologies, generate effective models of care, and streamline business operations to improve health outcomes. Sometimes, these discoveries are tied to SONs, but most often they are embedded in hospitals, clinics, homes, or communities where discovery and translation can be accelerated.Since the present trend limits and challenges our capacity to strengthen and safeguard the boundaries and development of our discipline and diverts resources for so doing, how best should we respond?The best response is no response. We have no boundaries to safeguard and should encourage nurse and non-nurse scientists to work together in teams across many settings. With today's challenges in encouraging nurses to obtain doctorates, and the long path to independent funding, the focus on who hires a person, in what department, and on which track distracts us from our real challenges.Nursing has a long history of blurring lines between practice and science. At times, this has led to a reductionist view of nursing that is overly focused on clinical practice and not on the broader factors that influence health. Nursing science should not stay within—and does not “own”—the knowledge base that underlies the practice of nursing. A nurse researcher studying strategies to improve HIV medication adherence, for instance, generates knowledge that can be applied in nursing practice but that also should inform the habits of many other disciplines. Why would we try to keep or claim that knowledge for ourselves?Nursing does not own strategies for medication adherence any more than we own the knowledge on caregiver stress or the data in the nursing section of the electronic health record. No discipline should put a wall around knowledge with a sign that says “no trespassing.” Adoption of nursing discoveries by other disciplines is a good thing. If what's important to the authors is strengthening and safeguarding boundaries, they could try building a wall around their school of nursing. Maybe Mexico will pay for it?Credit StatementAll authors, Hayes, R., Hepburn, K., Smith, K., and McCauley, L., meet the definition of authorship according to ICMJE guidelines: Authorship credit is based on (a) substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; (b) drafting the article or revising it critically for important intellectual content; and (c) final approval of the version to be published.Sincerely, Thank you for the opportunity to contribute to the vigorous debate surrounding the Jan-Feb article, An Eye Toward the Future: Pressing Questions for Our Discipline in Today's Academic and Research Climate by Algase, D et al. This piece, which addresses the question of whether non-nursing faculty (NNF) should be granted tenure track within schools of nursing (SONs), reflects larger, ongoing identity crises within nursing science, and comes at a moment in our nation's history when the future direction of nursing science has arguably never been more integral to the health and safety of US populations. The authors raise logistical and philosophical objections to including NNF on SON tenure tracks and submit three narrow means of involving NNF in nursing education and research moving forward. While they extend some olive branches towards interdisciplinarity, the authors ultimately stand against NNF tenure. As a nursing school that prides itself on disruptive, nurse-led, team science, we value the authors’ elevation of this topic and the thoroughness with which they make their case—but we must wholeheartedly disagree with their position. Emory School of Nursing ranks number five in National Institute of Health Funding among US nursing schools; our faculty received $9.6 million in federal funding for their programs of research in FY2019 alone; and our school was tied for No. 1 in total grants awarded that same year. This is no accident: Emory Nursing researchers are effective because they know that successful nursing science and interdisciplinary team science are one and the same. If nursing science is to be appropriate in its methodologies, precise in its interventions, sustainable beyond funding periods, and impactful to human health over time, it must approach research questions through multiple simultaneous lenses. In virtually no case could one of our research questions be framed, or the studies be responsibly carried out, by a single discipline. We hope that by responding thoughtfully to the authors’ concluding questions, we may demonstrate the truth of this claim. In addition to the responses below, we welcome all opportunities to share how our tenured NNF have helped to propel Emory as a national leader in nursing education and science. What explains/drives the current trend of rising numbers of NNF to the faculty of leading nursing schools/colleges?The authors’ thesis conflates two distinct issues to the detriment of their overall argument: (a) The value of interdisciplinary NNF to research programs within schools of nursing (SONs), and (b) the professional advancement of NNF within nursing schools. We discuss the factors driving inclusion of NNF as they relate to both concerns.On the first matter: The evolution of diverse faculty within SONs—particularly within research-intensive institutions—reflects our profession's inherent emphasis on interdisciplinary science and the NIH's calls for translational team research. Nursing is, by definition, interdisciplinary; this extends to the theoretical frameworks and “substantive structure” to which the authors refer. They submit the example of a person pursuing independent research in psychology without first studying under a psychologist—who is to say that “no reputable psychologist would recognize” this person's work as credible? Perhaps if the research at-hand dealt with the psychological trauma of repeat assault of non-gender conforming people during juvenile incarceration, the abstract ‘psychologist’ evaluating the work would respect the decision to train under a gender theorist, or a social worker, or a nurse LGBTQI+ activist, or a public defender—or understand the value of having all of these individuals sit on a dissertation committee (or collaborate on a research team). They might also recognize that a substantial portion of the psychological insights derived through this research will not have come from faculty at all—but rather from the student's exhaustive self-directed readings and the mixed-methods data they collect in partnership with survivors. (Or maybe they would prefer for the student to simply read Freud?) Healthcare problems are complex—they do not live within singular “substantive structures;” why would we seek research solutions that do?Next, the focus on tenure track positions and employment priorities is separate from conversations about designing environments that will support the generation of new knowledge. In well-funded nursing schools, there tend to be sufficient bodies of researchers, and an NNF does not “replace” a faculty member holding a degree in nursing. Faculty are not this interchangeable. When it comes to considering faculty for different positions—such as bringing a funded research program or leading a clinical education program—the nursing Dean will consider the most appropriate candidates. Any blanket doctrine that dictates the type of individuals available for consideration would undermine the school's mission in the long-run.Less than half of the nation's 135 PhD in nursing programs have robust extramural research programs. In other schools, with few researchers and hardly any funded research, it is quite possible that the faculty member who has been successful in achieving funding for their research program is best suited to educate doctoral students, regardless of their degrees. If the passionate, prolific, and well-funded NNF is elevating the caliber of the school's graduates and advancing the school as a whole, they should not face arbitrary barriers to their professional fulfillment. Furthermore, the literature on the nursing researcher shortage is well established, along with the limits on our capacity to graduate PhD-prepared nurses. If the number of PhD nurse researchers is not growing, how will we mentor the next generation in launching their research careers? The demand for nurses has never been greater, and few schools are able to raise their nursing faculty numbers sufficiently to also increase enrollment of students. The authors’ thesis conflates two distinct issues to the detriment of their overall argument: (a) The value of interdisciplinary NNF to research programs within schools of nursing (SONs), and (b) the professional advancement of NNF within nursing schools. We discuss the factors driving inclusion of NNF as they relate to both concerns. On the first matter: The evolution of diverse faculty within SONs—particularly within research-intensive institutions—reflects our profession's inherent emphasis on interdisciplinary science and the NIH's calls for translational team research. Nursing is, by definition, interdisciplinary; this extends to the theoretical frameworks and “substantive structure” to which the authors refer. They submit the example of a person pursuing independent research in psychology without first studying under a psychologist—who is to say that “no reputable psychologist would recognize” this person's work as credible? Perhaps if the research at-hand dealt with the psychological trauma of repeat assault of non-gender conforming people during juvenile incarceration, the abstract ‘psychologist’ evaluating the work would respect the decision to train under a gender theorist, or a social worker, or a nurse LGBTQI+ activist, or a public defender—or understand the value of having all of these individuals sit on a dissertation committee (or collaborate on a research team). They might also recognize that a substantial portion of the psychological insights derived through this research will not have come from faculty at all—but rather from the student's exhaustive self-directed readings and the mixed-methods data they collect in partnership with survivors. (Or maybe they would prefer for the student to simply read Freud?) Healthcare problems are complex—they do not live within singular “substantive structures;” why would we seek research solutions that do? Next, the focus on tenure track positions and employment priorities is separate from conversations about designing environments that will support the generation of new knowledge. In well-funded nursing schools, there tend to be sufficient bodies of researchers, and an NNF does not “replace” a faculty member holding a degree in nursing. Faculty are not this interchangeable. When it comes to considering faculty for different positions—such as bringing a funded research program or leading a clinical education program—the nursing Dean will consider the most appropriate candidates. Any blanket doctrine that dictates the type of individuals available for consideration would undermine the school's mission in the long-run. Less than half of the nation's 135 PhD in nursing programs have robust extramural research programs. In other schools, with few researchers and hardly any funded research, it is quite possible that the faculty member who has been successful in achieving funding for their research program is best suited to educate doctoral students, regardless of their degrees. If the passionate, prolific, and well-funded NNF is elevating the caliber of the school's graduates and advancing the school as a whole, they should not face arbitrary barriers to their professional fulfillment. Furthermore, the literature on the nursing researcher shortage is well established, along with the limits on our capacity to graduate PhD-prepared nurses. If the number of PhD nurse researchers is not growing, how will we mentor the next generation in launching their research careers? The demand for nurses has never been greater, and few schools are able to raise their nursing faculty numbers sufficiently to also increase enrollment of students. What is the impact of NNF on nursing science?In most instances, we cannot tangibly measure the impact of NNF on nursing science NOR have we consistently measured the impact of nursing faculty on nursing science. The impact question is difficult, given that we don't have standard metrics for what advancement of a discipline looks like. Neither do we have a sense of which outcomes might be most meaningful to nursing. Again, because nursing is inherently interdisciplinary, with touchpoints across the lifespan, cultural settings, and practice locations, it begs the question: What is the merit of trying to stack up all NNF, or all nursing faculty, against some uniform measure of impact? At times, discoveries by single investigators have led to huge advancements of science. The examples can be seen in individuals who have received notable recognition of how their findings have changed the direction of a field. That is not typically the case in nursing science: Nursing research tends to have small, incremental effects on the ways in which we practice, and the ultimate effect of many nursing interventions is deeply personal and highly subjective.The best indication of a school's impact on nursing science lies in its doctoral graduate outcomes. And, if a doctoral student is mentored by an interdisciplinary team, no one person on that committee is responsible for the person's outcomes (or the future impact they will have on nursing science). Rather, each member's contributions complement and amplify those of the others. Likewise, the schools within which a student's mentor(s) hold their appointments is not relevant to the student's ability to learn. The committee is nurturing and imparting knowledge; the locations of committee members’ offices do not alter the amount or caliber of knowledge that the student acquires. In most instances, we cannot tangibly measure the impact of NNF on nursing science NOR have we consistently measured the impact of nursing faculty on nursing science. The impact question is difficult, given that we don't have standard metrics for what advancement of a discipline looks like. Neither do we have a sense of which outcomes might be most meaningful to nursing. Again, because nursing is inherently interdisciplinary, with touchpoints across the lifespan, cultural settings, and practice locations, it begs the question: What is the merit of trying to stack up all NNF, or all nursing faculty, against some uniform measure of impact? At times, discoveries by single investigators have led to huge advancements of science. The examples can be seen in individuals who have received notable recognition of how their findings have changed the direction of a field. That is not typically the case in nursing science: Nursing research tends to have small, incremental effects on the ways in which we practice, and the ultimate effect of many nursing interventions is deeply personal and highly subjective. The best indication of a school's impact on nursing science lies in its doctoral graduate outcomes. And, if a doctoral student is mentored by an interdisciplinary team, no one person on that committee is responsible for the person's outcomes (or the future impact they will have on nursing science). Rather, each member's contributions complement and amplify those of the others. Likewise, the schools within which a student's mentor(s) hold their appointments is not relevant to the student's ability to learn. The committee is nurturing and imparting knowledge; the locations of committee members’ offices do not alter the amount or caliber of knowledge that the student acquires. How best can we leverage the expertise of our NNF to advance our discipline? Is it a) to train nurses to integrate newer methods or approaches they bring? or b) to adapt their theories to frame nursing questions, either of which can extend our ability to answer nursing questions? Is there evidence of progress?This is an interesting question, but not an important one. According to the American Association of Colleges of Nursing (AACN), nursing research can advance nursing practice, shape health policy, and improve health on a global scale. It is not essential for our scientific discoveries only to advance our discipline if we are having meaningful impact on health in general or the policies that improve health.The NINR ‘Stories of Discovery’ underscore the diversity of nursing science impacts, which extend far beyond the immediate field and scope of nursing. What is notable is that many cases feature nursing scientists who are not only faculty in SONs but are also nurses who hold scientific appointments in other departments. The cases include non-nurses with powerful research that has changed nursing care as well. The NINR project illustrates the erroneous premise of this paper that the school in which an individual holds an academic appointment somehow defines their potential impact on nursing science.If one searches for prominent nursing discoveries, a number of wonderful contributions can be found that have been made by practicing nurses or DNP students not holding tenure track positions in SONs: In the 1950s, Sister Jean Ward discovered the ability of light to decrease jaundice in newborns, and subsequent nurses have influenced practice by testing the effects of delaying newborn baths on rates of hypothermia. Historically, nurses have made significant discoveries that have improved patient care, including creating disposable sanitary napkins, designing crash carts and ostomy bags, and inventing disposable baby bottles. Nurses today are embracing innovation and leading interdisciplinary teams to engineer health technologies, generate effective models of care, and streamline business operations to improve health outcomes. Sometimes, these discoveries are tied to SONs, but most often they are embedded in hospitals, clinics, homes, or communities where discovery and translation can be accelerated. This is an interesting question, but not an important one. According to the American Association of Colleges of Nursing (AACN), nursing research can advance nursing practice, shape health policy, and improve health on a global scale. It is not essential for our scientific discoveries only to advance our discipline if we are having meaningful impact on health in general or the policies that improve health. The NINR ‘Stories of Discovery’ underscore the diversity of nursing science impacts, which extend far beyond the immediate field and scope of nursing. What is notable is that many cases feature nursing scientists who are not only faculty in SONs but are also nurses who hold scientific appointments in other departments. The cases include non-nurses with powerful research that has changed nursing care as well. The NINR project illustrates the erroneous premise of this paper that the school in which an individual holds an academic appointment somehow defines their potential impact on nursing science. If one searches for prominent nursing discoveries, a number of wonderful contributions can be found that have been made by practicing nurses or DNP students not holding tenure track positions in SONs: In the 1950s, Sister Jean Ward discovered the ability of light to decrease jaundice in newborns, and subsequent nurses have influenced practice by testing the effects of delaying newborn baths on rates of hypothermia. Historically, nurses have made significant discoveries that have improved patient care, including creating disposable sanitary napkins, designing crash carts and ostomy bags, and inventing disposable baby bottles. Nurses today are embracing innovation and leading interdisciplinary teams to engineer health technologies, generate effective models of care, and streamline business operations to improve health outcomes. Sometimes, these discoveries are tied to SONs, but most often they are embedded in hospitals, clinics, homes, or communities where discovery and translation can be accelerated. Since the present trend limits and challenges our capacity to strengthen and safeguard the boundaries and development of our discipline and diverts resources for so doing, how best should we respond?The best response is no response. We have no boundaries to safeguard and should encourage nurse and non-nurse scientists to work together in teams across many settings. With today's challenges in encouraging nurses to obtain doctorates, and the long path to independent funding, the focus on who hires a person, in what department, and on which track distracts us from our real challenges.Nursing has a long history of blurring lines between practice and science. At times, this has led to a reductionist view of nursing that is overly focused on clinical practice and not on the broader factors that influence health. Nursing science should not stay within—and does not “own”—the knowledge base that underlies the practice of nursing. A nurse researcher studying strategies to improve HIV medication adherence, for instance, generates knowledge that can be applied in nursing practice but that also should inform the habits of many other disciplines. Why would we try to keep or claim that knowledge for ourselves?Nursing does not own strategies for medication adherence any more than we own the knowledge on caregiver stress or the data in the nursing section of the electronic health record. No discipline should put a wall around knowledge with a sign that says “no trespassing.” Adoption of nursing discoveries by other disciplines is a good thing. If what's important to the authors is strengthening and safeguarding boundaries, they could try building a wall around their school of nursing. Maybe Mexico will pay for it? The best response is no response. We have no boundaries to safeguard and should encourage nurse and non-nurse scientists to work together in teams across many settings. With today's challenges in encouraging nurses to obtain doctorates, and the long path to independent funding, the focus on who hires a person, in what department, and on which track distracts us from our real challenges. Nursing has a long history of blurring lines between practice and science. At times, this has led to a reductionist view of nursing that is overly focused on clinical practice and not on the broader factors that influence health. Nursing science should not stay within—and does not “own”—the knowledge base that underlies the practice of nursing. A nurse researcher studying strategies to improve HIV medication adherence, for instance, generates knowledge that can be applied in nursing practice but that also should inform the habits of many other disciplines. Why would we try to keep or claim that knowledge for ourselves? Nursing does not own strategies for medication adherence any more than we own the knowledge on caregiver stress or the data in the nursing section of the electronic health record. No discipline should put a wall around knowledge with a sign that says “no trespassing.” Adoption of nursing discoveries by other disciplines is a good thing. If what's important to the authors is strengthening and safeguarding boundaries, they could try building a wall around their school of nursing. Maybe Mexico will pay for it? Credit StatementAll authors, Hayes, R., Hepburn, K., Smith, K., and McCauley, L., meet the definition of authorship according to ICMJE guidelines: Authorship credit is based on (a) substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; (b) drafting the article or revising it critically for important intellectual content; and (c) final approval of the version to be published.Sincerely, All authors, Hayes, R., Hepburn, K., Smith, K., and McCauley, L., meet the definition of authorship according to ICMJE guidelines: Authorship credit is based on (a) substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; (b) drafting the article or revising it critically for important intellectual content; and (c) final approval of the version to be published. Sincerely,