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Impact on practice

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Nurses working in a range of clinical specialties are engaging with doctoral level study, sometimes as traditional independent research, the conventional route to a PhD, but increasingly, as part of a taught educational programme, which culminates in a research-based thesis and a professional doctorate, explains Andrew Lovell. 

andrew lovell

Doctoral level students are well rehearsed in the demands of time management; they have usually studied for several years on Bachelors’ and Masters’ programmes, negotiating the oft-discussed work-life balance, successfully bringing up their families and developing successful practitioner careers.

These are nurses who have been supported in theory in their pursuit of a doctorate, but without full understanding by senior managers of the consequences of the trend.

If a proportion of the workforce, regardless of how small, is engaged on the doctoral journey, then this will necessarily have an ‘impact on practice’.

There is little evidence to suggest, however, whether those in positions of influence relating to the question of workforce planning have fully considered the consequences of their colleagues being educated to this level, particularly with regard to a shared understanding of ‘impact on practice’.

“There seems to me to be an escalating difficulty, though, relating to working full-time in a large health care organisation and sustaining the necessary support”

A primary aspect of my role, perhaps even the most important, is doctoral supervision, and it is striking how many of my students, all nurses with significant levels of responsibility, are encountering difficulties in the support they receive.

Their developing abilities revolve around the process of decision-making, negotiating circumstances of complexity in practice, working as professional equals in the multi-disciplinary context, and providing alternative ways of solving problems.

The hazards of engaging at this level are well documented and a number of books are available to give advice on everything from studying whilst working part-time to handling one’s supervisor (e.g. Phillips et al, 2010).

There seems to me to be an escalating difficulty, though, relating to working full-time in a large health care organisation and sustaining the necessary support and encouragement over a period of time, usually in excess of six years of part-time study.

Students’ relate that support is initially forthcoming but disappears somewhere along the line, partially through a lack of understanding by many, though no means all, managers, as to the demands of doctoral study.

Primarily, however, it seems to me, the reason revolves around a different interpretation of the meaning of ‘impact on practice’.

“An understanding of ‘impact on practice’ in more expansive and inclusive terms would, perhaps, constitute the first step towards addressing the issue”

Some managers conceptualize ‘impact on practice’ in terms of the practitioner acquiring a package of knowledge and/or skills, which are then systematically applied to the clinical environment.

They subsequently struggle, when this appears not to have materialized, to fully support practitioners in the ways in which they need or want to be supported. An understanding of ‘impact on practice’ in more expansive and inclusive terms would, perhaps, constitute the first step towards addressing the issue.

There is a need, furthermore, for debate, not only in terms of the consequences for organisations of educating practitioners to doctoral level, but also as to whether a consensus is achievable with regard to ‘impact on practice’.

Doctoral study requires that practitioners engage at the highest level of educational credentials, beyond critical appraisal and analysis, into the unknown area of contextualization, deconstruction and synthesis.

A practitioner with a PhD will influence the NHS in many ways, certainly around critical thought, engagement with research and development of the evidence base, but how can the NHS and other health care providers accommodate, even embrace, such individuals?

Andrew Lovell is professor of learning disabilities at University of Chester

 

References: Phillips E et al (2010) How to Get a PhD: A Handbook for Students and Their Supervisors. London: McGraw-Hill Education

 

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