institution also took the lead in doctoral education a decade later. The establishment of programs to develop advanced clinical skills occurred later. By 1949, Yale University Graduate School offered a master's of science in mental health (this program moved to the School of Nursing in 1958). In 1954, Hildegard Peplau founded at Rutgers one of the first master's programs to prepare clinical nurse specialists. The first nurse practitioner program was started a decade later by Loretta Ford at the University of Colorado.

Three phases of doctoral education have been distinguished (Grace, 1978; Murphy, 1985; Hart, 1989). Before 1960, the emphasis was on functional role preparation, because nurses largely needed the EdD degree to develop the baccalaureate and higher education programs that began to be established during those years. In the 1960s, the importance of the PhD for research training gained favor as nurses sought degrees in other disciplines so as to apply that learning in developing the scientific base of their profession. Since the 1970s, the emphasis has largely been on research training within nursing. The clinical research orientation that began to take hold in the 1960s (Wald and Leonard, 1964) reached fruition in 1986 with the establishment of the National Center for Nursing Research, now the National Institute of Nursing Research (NINR), within the National Institutes of Health (McBride, 1987). That agency is organized to promote study of three general areas: (1) fostering health and preventing disease, (2) facilitating care of persons who are acutely or chronically ill, and (3) improving the delivery of nursing services (Merritt, 1986).

Uncontrolled Diversity Versus Innovative Career Ladder

Nursing in 1995 is a heterogeneous field; it covers the full spectrum of academic degrees from the associate degree through postdoctoral training. (See Table 2 for an overview of graduations from nursing programs in the last academic year for which full data exist, 1991–1992.) Seventy-one percent of the undergraduate degrees awarded that year were at the ADN level; if anything, "the proportion of new entrants into nursing that come from baccalaureate programs has declined" in recent years (Friss, 1994, p. 615). Of the 1,853,024 employed nurses in March 1992 (out of about 2.2 million altogether), 31 percent had baccalaureate degrees in nursing or a related field, 31 percent had associate degrees in nursing, and 30 percent were graduates of diploma programs; only 8 percent had graduate degrees in nursing or a related field (Moses, 1994).

The traditional academic ladder for nurses begins with basic preparation at the undergraduate level—with a distinction between more technical preparation with the 2-year ADN and more professional preparation with the 4-year BSN—then presupposes advanced preparation in a specialty area at the master's level. At the doctoral level, the emphasis is on in-depth study of some specific problems within the specialty area for the purpose of expanding the field's knowledge base.



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