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NML-ISSUE 5 VOL 2

THE GROWING NUMBER OF NURSES AND MIDWIVES WITH PhDs, WHAT DOES IT MEAN FOR THE PROFESSION AND UGANDA

By Assoc Prof Rose Clarke Nanyonga (Vice Chancellor, Clarke International University) and Elizabeth Pearson (Lecturer and Director NHCC Uganda)

In recent years, Sub-Saharan Africa (SSA), including Uganda, has witnessed a remarkable surge in the number of nurses and midwives achieving the pinnacle of academic achievement – a Doctor of Philosophy (PhD). This transformative shift carries profound implications for the future of healthcare professions, the robustness of health systems, advancements in nursing scholarship and science, as well as the overall well-being of nations like Uganda. In our previous editorial published in Issue 2, Vol 2, April 2023, we spotlighted the achievement of two colleagues and reported 18 nurses and midwives who had earned PhDs. We also shed light on the challenges they encounter related to finding good mentors and adequate funding for program completion. In this current issue, we delve into the potential future paths and advantages of fully integrating these highly qualified professionals into the healthcare system Between 2000 to-date, there are over 38 nurses and midwives in Uganda who hold PhDs from various Universities across the globe with doctoral studies in advanced nursing and midwifery science, research, leadership & policy, and clinical practice. This is an updated list following the previously reported 18 (Think tank will continue to update the database).

Elevating the Nursing and Midwifery Professions:

The future trajectory of the nursing and midwifery professions will rely significantly on the pivotal role played by PhD-prepared nurses and midwives. A Doctor of Philosophy (PhD) signifies a dedication to philosophical inquiry and scholarly rigor, representing the highest academic achievement across all fields of study. These professionals serve as the driving force behind the integration of cutting-edge research findings into clinical practice, policy formulation, and implementation. In the face of evolving healthcare landscapes characterized by aging populations, a surge in chronic conditions, (as is the case in Uganda), and persistent staff shortages, the expertise of PhD-prepared nurses and midwives becomes indispensable. Their research endeavors will not only enhance the quality of patient care but also contribute extensively to the development of evidence-based workforce and clinical practice policies that will shape the direction of healthcare delivery systems. (AACN, 2016) As the healthcare sector continues to navigate complexities and challenges, the knowledge, skills, and leadership of PhD-prepared professionals will remain instrumental in driving innovation, improving patient outcomes, strengthening the education of nurse and midwife scientists, and advancing the overall effectiveness and sustainability of nursing and midwifery Cashion et al., 2019)

According to van McNelis et al., (2019), the infusion of advanced education brings with it a new era of leadership and influence within the nursing and midwifery professions, while their scarcity poses a significant hurdle in the progression of the professions, impacting both the education and the delivery of care. There is a pressing need for an increased number of PhD-prepared nurses and midwives to lay the scientific groundwork for the disciplines and to facilitate the expansion of nursing and midwifery education programs to accommodate new cultures of learning and practice, innovations, and the changing demographics of new students. (Cashion et al., 2019) This shortage not only affects the depth of research and knowledge generation within the fields but also limits the capacity to train the next generation of nursing and midwifery professionals adequately. Addressing this scarcity is crucial for the sustainable growth and advancement of nursing and midwifery as robust and impactful disciplines.

Strengthening Health Systems:

Nurses, constituting about half of the global health workforce, serve as the primary access point for nearly 90% of healthcare consumers worldwide. Bvumbwe and Mtshali (2018) In every health system, they are widely acknowledged as the backbone. Attaining ambitious health objectives such as Universal Health Coverage (UHC), the Sustainable Development Goals (SDGs), and the emerging One Health (OH) concept necessitates maximizing their involvement at all levels of the healthcare system. (WHO, 2021; Mendes et al., 2020; iAHO-HWF, 2023; MoH, 2020) Despite their essential roles, nurses and midwives continue to encounter challenges, including inadequate representation in high-level policy decision-making positions, leadership, and governance (Bvumbwe and Mtshali, 2018).

More acutely, barriers related to regulation, leadership, education, and practice for nursing and midwifery professionals have led to a devaluation of their worth, relegating them to a frequently low social status. The Plan of Action for Scaling up Quality Nursing and Midwifery Education and Practice for the African Region 2012 - 2022 provided a framework for the transformative and scale-up of health professions education for Sub-Saharan Africa. In their integrative review examining “Nursing education challenges and solutions in Sub-Saharan Africa” Bvumbwe and Mtshali (2018) report six critical themes that emerged: curriculum reforms, profession regulation, transformative teaching strategies, collaboration and partnership, capacity building, and infrastructure and resources. This underscores the critical role of PhD-prepared nurses and midwives. Their integration into the healthcare workforce strategies for the Sub-Saharan African countries would benefit not just the professions but also the healthcare systems immensely as they will strengthen the capacity to address ongoing challenges. Their advanced knowledge and skills, obtained in most cases from other continents, can not only create pathways for their inclusion in critical policy decisions but also contribute to more effective patient care interventions, thereby improving health outcomes for all. PhD-prepared nurses and midwives have a proven ability to implement evidence-based practices based on the clinical needs of the nation. (Dagne and Beshah, 2021) The result is a practice that is not only evidence-based but forward-thinking and responsive to evolving healthcare needs. The diversification of expertise within this healthcare workforce augurs well for health systems' overall resilience and adaptability.

Fostering Nursing Scholarship and Science:

A core impact area for these cadres is the acceleration of nursing scholarship and scientific inquiry. (Dagne and Beshah, 2021) With the capacity to conduct rigorous research, these professionals can delve into healthcare challenges unique to their contexts and regions. This has the potential to give rise to a body of knowledge that is not only relevant, informs practice but also contributes to the global advancement of nursing and midwifery care. Additionally, nurses and midwives with PhDs play a crucial role in building research capacity through mentoring and supervising others, fostering a culture of inquiry and evidence-based practice. This type of research can lead to innovative solutions, improved patient outcomes, and a better understanding of health disparities.

Policy Development and Advocacy:

Nurses and midwives with PhDs are often at the forefront of leadership positions within healthcare institutions, academic settings, and policymaking bodies. Their input and influence can shape policies, guidelines, and strategies to improve healthcare delivery, especially in areas such as maternal and child health, infectious diseases, and non-communicable diseases. In addition, with their advanced knowledge and research findings, they can actively participate in the development of healthcare policies and guidelines. (Costa Mendes et al., 2020) They advocate for policies that prioritize public health, equity, and access to essential services. Their input helps shape policies that are evidence-based and responsive to the needs of underserved populations. (Cashion et al., 2019)

Enhancing Absorption and Relevance

It's crucial to recognize that PhD-prepared nurses and midwives encounter notable challenges concerning their practice, role acceptance, research funding, administrative support, reimbursements, and career advancement (Negarandeh and Khoshkesht (2022). To recognize and optimize the contributions of these professionals in countries like Uganda, it is imperative to establish an environment that fully utilizes and values their expertise. This involves creating supportive cultures and robust structures that elevate the roles of nursing and midwifery professionals: (van Dongen et al., 2022; WHO, 2020).

  1. Policy Frameworks: Implementing policies recognizing the value of advanced nursing and midwifery roles is essential. Governments should develop clear guidelines for the integration of PhD-prepared nurses and midwives into healthcare systems, outlining their responsibilities, scope of practice, and career pathways.

  2. Professional Recognition: Establishing professional recognition programs and incentives can motivate nurses and midwives to pursue PhD education. Recognition through awards, promotions, and leadership opportunities can encourage others to advance their education and contribute to the field.

  3. Research Funding: Governments and institutions should allocate funding specifically for nursing and midwifery research. This includes grants, scholarships, and fellowships to support PhD candidates in conducting research that addresses local health challenges and informs evidence-based practice.

  4. Career Development: Creating clear career progression pathways for PhD-prepared nurses and midwives is crucial. This includes opportunities for academic positions, research leadership roles, policy advisory positions, and clinical specialization.

  5. Collaborative Partnerships: Encouraging collaborations between nursing and midwifery professionals, healthcare institutions, universities, and research organizations can enhance knowledge exchange and research dissemination. Collaborations also facilitate interdisciplinary approaches to healthcare challenges.

  6. Continuing Education: Providing continuous learning opportunities, such as workshops, seminars, and conferences, ensures that PhD-prepared nurses and midwives stay updated with the latest advancements in their fields. This also fosters a culture of lifelong learning and professional development.

  7. Leadership Training: Offering leadership development programs equips PhD-prepared nurses and midwives with the skills to lead teams, manage projects, and advocate for policy changes. Leadership training empowers them to drive innovation and influence healthcare decisions.

  8. Public Awareness Campaigns: Educating the public about the roles and contributions of nurses and midwives with PhDs can change perceptions and promote respect for their expertise. This includes media campaigns, community engagements, and public lectures.

  9. Mentorship Programs: Establishing mentorship programs pairs experienced PhD-prepared nurses and midwives with early-career professionals. Mentorship fosters career guidance, skill development, and knowledge sharing, creating a supportive network within the profession.

  10. Quality Improvement Initiatives: Encouraging PhD-prepared nurses and midwives to lead quality improvement projects enhances patient care outcomes. These initiatives focus on evidence-based practices, patient safety, and healthcare efficiency.

By implementing these strategies, Uganda and other countries can harness the full potential of nurses and midwives with PhDs. This not only improves healthcare delivery but also elevates the status of the nursing and midwifery professions, ultimately benefiting the health and well-being of their populations.

In conclusion, the growing number of nurses and midwives attaining PhDs in Uganda and other Sub-Saharan African countries is a harbinger of positive change. It represents a shift towards a more dynamic, knowledgeable, and influential nursing and midwifery workforce. As these professionals continue to make their mark, the ripple effects will be felt across health systems, scholarly endeavors, scientific advancements, and, most importantly, in the quality of care provided to communities throughout the region. However, this requires the intentional integration of their roles, skills, and expertise within healthcare systems.

References

  1. AACN (2016). Advancing Healthcare Transformation: A New Era for Academic Nursing. Retrieved March 30th from https://www.aacnnursing.org/Portals/42/Publications/AACN-New-Era-Report.pdf

  2. Cashion, A. K. , Dickson, V. V. , & Gough, L. L. (2019). The value and importance of PhD Nurse Scientists. Journal of Nursing Scholarship, 51(6), 611–613. https://doi.org/10.1111/jnu.12525

  3. McNelis, A. M. , Dreifuerst, K. T. , & Schwindt, R. (2019). Doctoral education and preparation for nursing faculty roles. Nurse Education, 44(4), 202–206. 10.1097/NNE.0000000000000597

  4. Global Strategic Directions for Nursing and Midwifery. WHO. 2021. Retrieved March 30th 2024, from: https://www.who.int/publications/i/item/9789240033863

  5. Bvumbwe, T., and Mtshali, N. (2018) Nursing education challenges and solutions in Sub-Saharan Africa: an integrative review. BMC Nurs 17, 3. https://doi.org/10.1186/s12912-018-0272-4

  6. WHO (2021). One Health. Retrieved March 29th, 2024, from https://www.who.int/healthtopics/one-health#tab=tab_1

  7. iAHO-HWF (2023). Nursing and midwifery workforce: a key component in achieving UHC. Retrieved 13th March 2024 from: iAHO_HWF_regional_Factsheet.pdf (who.int)

  8. Ministry of Health, Uganda Health Sector Development plan 2015/16 - 2019/20 Assessed via Https://Www.Health.Go.Ug/Cause/MinistryOf-Health-Strategic-Plan-2020-21-2024-25/

  9. Dagne, A. H., & Beshah, M. H. (2021). Implementation of evidence-based practice: The experience of nurses and midwives. Plos one, 16(8). https://doi.org/10.1371/journal.pone.0256600

  10. Mendes, I.A.C., Ventura, C.A.A., Silva, Í.R. et al. Alignment and contribution of nursing doctoral programs to achieve sustainable development goals. Hum Resour Health 18, 86 (2020).

  11. Van Dongen LJC, Hafsteinsdóttir TB. (2022) Leadership of PhD-prepared nurses working in hospitals and its influence on career development: A qualitative study. J Clin Nurs. 2022 Dec;31(23-24):34143427. doi: 10.1111/jocn.16168.

  12. Negarandeh, R., & Khoshkesht, S. (2022). Expected roles of PhD graduated nurses: a scoping review. Florence Nightingale journal of nursing, 30(2), 202. https://doi.org/10.54614%2FFNJN.2022.21233

  13. WHO (2020). State of the World’s Nursing Report. WHO. 2020. https://www.who.int/publications/i/item/9789240003279

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NML-ISSUE 5 VOL 2