1: THE HISTORICAL AND POLITICAL PATH OF DOCTORAL NURSING EDUCATION ■ 15
aptly called the “art and science [or art versus science] of nursing” (1988, p. 8), that has
led many practicing nurses (both professional and advanced) to view the “nursing ivory
tower” as too removed from practice (and its realities) and, in some eyes, even irrelevant.
■ THE EVOLUTION OF THE NEED FOR THE NURSE
WITH A DOCTORATE
With the first step in the movement of nursing into the university setting— which in-
cluded various landmark events such as: (a) the first constituted nursing school in a
university (albeit under Medicine) at the University of Minnesota in 1909; (b) the first
individual (Professor Adelaide Nutting) appointed as a nursing professor at Teachers
College in 1910; and (c) the first independent nursing school at Yale University in 1924—
nursing began its slow path to perceiving the need for the profession to produce nurses
with doctorates (Donohue, 1996). If nurses were indeed going to be full members of the
academy (a rather oblique term that includes the members of the formal academic com-
munity) with other disciplines, this would be essential. The Flexner Report on the state
of medical education in 1910 also had implications for nursing education. Although this
report was in many ways very critical of institutionalized medicine,^7 medicine’s domi-
nance over nursing was under way (Hiatt, 1999). Further, and perhaps most important-
ly, the derision of medicine did not elevate nursing or the status of nurses. This widely
publicized report on medicine also made it obvious to nursing leaders that they would
likewise need to evaluate the state of nursing education even as the profession was in its
early formative years. A subsequent 1912 report titled The Educational Status of Nursing
(Nutting, 1912), which became the first comprehensive survey of schools of nursing,
was likewise critical of the about 1,100 schools of nursing that responded. Of this report
Melosh (1982) writes, “315 schools, or nearly 45%, reported that they did not have a sin-
gle paid instructor, and 299 did not maintain a library. Instead the nursing ‘curriculum’
in many hospitals consisted of two or three years of ward work” (p. 41).
■ THEN: THE DOCTORAL- PREPARED NURSE EMERGES
FROM A MINISCULE POOL
The ultimate movement of nursing into the college and university from the hospital-
based diploma settings has taken place ever so slowly in the past 100 years or so (diplo-
ma programs are still in operation in Pennsylvania and Ohio and sparingly elsewhere).
And while, according to Edward Salsberg (2015) in the prestigious blog Health Affairs,
the average nurse is first educated in a community college, 4-year college or university
(more than 98% of all new nurse graduates in 2014), it is certain that the early nursing
leaders who sought the increasing professionalism of nursing did not intend that nurs-
ing education should be from a community college rather than from a university or other
4- year degree granting institution (National League for Nursing [NLN], 2007). Among
the 1.4 million nurses who entered the profession between 1970 and 1994 with either an
associate degree (AD) or BSN, 59% entered with an AD and 41% a BSN (Aiken, Cheung, &
Olds, 2009). NLN (2007) data from 2006 to 2007 indicated that 60% of new graduates were
AD prepared and 31% BSN prepared. Only in 2011 did BSN- prepared nurses become pre-
dominant over associate degree in nursing (ADN)/ diploma- prepared nurses and more
recent data from 2013 indicate that the BSN degree is proliferating with between 55% and
61% of nurses now having a BSN degree or higher (Budden, Zhong, Moulton, & Cimiotti,
2013; Health Resources & Services Association [HRSA], 2013; Robert Wood Johnson
Foundation, 2015). Furthermore, in California (our largest state), and sometimes called