Skip to main content
NCBI home page
International Journal of Nursing Studies Advances logoLink to International Journal of Nursing Studies Advances
. 2022 Jun 26;4:100084. doi: 10.1016/j.ijnsa.2022.100084

Nursing science as a federally-recognized STEM degree: A call to action for the United States with global implications

Caitlin Dreisbach a,h, Michelle L Wright b,c,h, Rae K Walker d,e,h, Ha Do Byon f,h, Jessica Keim-Malpass f,g,h,⁎
PMCID: PMC11080356  PMID: 38745631

Abstract

Nursing science contributes to advancements in patient care, public health, and innovation within numerous scientific domains. Despite commonality with United States Department of Education definitions of a science, technology, engineering, and mathematics (STEM) educational programs, nursing continues to be excluded from Department of Homeland Security STEM classification. This exclusion prevents societal recognition of nursing as a science and limits attraction of clinicians and nurse scientists born outside of the United States due to omission from various federal visa provisions the Department of Homeland Security classification provides. We evaluated existing Department of Homeland Security STEM-classified educational programs and identified methodological and content congruency among STEM-classified programs and nursing. We provide clear evidence that nursing contributes impactful STEM research; and argue that inclusion is critical for advancement of the profession and the potential to mitigate the faculty shortage. Beyond evaluation of nursing as a STEM field, we offer a policy-focused solution for development and diversification of the nursing workforce.

1. Introduction

Nurse scientists influence a wide breadth of health-oriented fields. Nurse scientists employed in academic settings, by health systems, the public sector, or in industry, are often, but not necessarily, doctorally-prepared with a background in statistics, research methodology, quantitative and qualitative methods, and experimental design. Further reinforcing their value, nurse scientists typically have robust clinical backgrounds, often having advanced nursing practice licensure or several years in direct clinical practice. Advancements in nursing science have included, but are not limited to, applications of omics to disease processes and symptom management, patient-oriented outcomes research, qualitative and quantitative methods, and health economics (Henly et al., 2015). Using community-directed and participatory research methodologies, nurse scientists like 2020 Council for the Advancement of Nursing Science Brilliant New Investigator Dr. Teresa Brockie recognize and center the expertise of communities, such as Indigenous and Native American histories, knowledge, and practices, in the scientific process (American Academy of Nursing, 2020). These innovations, in combination with their application to questions of importance to nursing science and deep contextual knowledge, have been the impetus for successful programs of research across the United States with impacts on a global scale.

As nursing education programs expand to encompass a larger point of entry into the profession (i.e., accelerated bachelor's degrees for second-degree students, master's entry), nurses are bringing additional academic skills and life experiences that influence their movement in the profession. For example, it is common to find nurse scientists with backgrounds as bedside clinicians, policy advocates, educators, and researchers that have prior experience in other careers. Further, nurse scientists are becoming more integrated into other scientific fields due to their training in patient and family-centered care and diverse epistemological perspectives. Nurse scientists are valued members of team science because of their communication skills, sophisticated backgrounds in clinical research, integration of vast methodological perspectives, and deep knowing of the patient condition.

As we create greater points of entry for a diverse workforce, we are simultaneously navigating substantial needs for nursing faculty and shortage of doctorally-prepared nurse scientists. Compared to other science, technology, and engineering (STEM) disciplines there is an imbalance of nurse scientists compared to the underlying proportion of nurses (Yordy, 2016). There are numerous contributing factors to the nursing scientist shortage, including diminishing enrollment to PhD programs, poor salaries compared to clinical roles, lack of systems support in academia, lack of financial support for PhD students, and insufficient numbers of qualified mentors. Prior solutions for closing the gap of needed nurse scientists have focused on increasing funding and scholarships for educational programs, adoption of online doctoral programs, and increasing salary support for faculty after graduation (Yordy, 2016). Despite this shortage being multi-factorial, available funding to PhD students and the ability to recruit highly-qualified international students remain two areas that are potentially intervenable with the support of focused policy advocacy.

According to the U.S. Bureau of Labor Statistics (2015), there were nearly 8.5 million STEM jobs in 2015. Currently, workers born outside of the United States account for a high percentage of STEM occupations (Hanson & Slaughter, 2016). To attract top candidates, other disciplines have looked towards policy solutions through measures such as STEM Optional Practical Training extensions. The extension allow those who have completed a STEM degree program to qualify for a 24-month extension in the United States on their F-1 student visa to work and gain experience in the discipline. Further, individuals can have a greater likelihood of securing an H1-B visa (often the first step towards their Permanent Resident Card, or Green Card) with advanced training in a recognized Department of Homeland Security STEM degree program (Hanson and Slaughter, 2016). STEM designation is important because of the rising importance placed on technical education pathways due to the severe workforce needs (R. Brown et al., 2011).

While there is no standard societal definition of STEM, most agree that STEM fields use their knowledge of science, technology, engineering, or math to understand and provide solutions to complex problems. The Department of Homeland Security provides a comprehensive list of degree programs that qualify as STEM, based on how the United States Department of Education classifies STEM programs. Despite being listed as a science under the U.S. Department of education, nursing science has to-date been excluded from both the U.S. Department of Education and thus Department of Homeland Security definitions of STEM degrees. In fact, there was a recent expansion of this list in January 2022 which represent fluid updates to the field of STEM, however nursing science has yet to be included in this federal designation.

Nursing science has already been recognized by the National Institutes of Health by the establishment of an individual institute, the National Institute of Nursing Research. The goals of the National Institute of Nursing Research align with patient-centered needs, including symptom science and self-management, and the science of caregiving (National Institute of Nursing Research, 2022). The National Institutes of Health and the National Science Foundation receive nearly $40 billion and $8.1 billion USD per year, respectively, for STEM education and research programs (National Institutes of Health, 2019; National Science Foundation, 2018). As such, this funding directly supports nurse scientist training and principal investigators through extramural grants awarded to individuals at universities across the country (Kuenzi, 2008). Despite this designation within the National Institutes of Health, nursing continues to be excluded from designation as a science by other federal designations.

We suggest that formal adoption of nursing science as a Department of Homeland Security STEM field of study could enhance our profession's ability to build and expand a diverse and qualified workforce of nurse scientists and would likely have positive spillover impacts of enhanced public recognition of the remarkable contributions of nursing science to society (US Department of Homeland Security, 2016). The purpose of this analysis was to, 1) review the existing Department of Homeland SecuritySTEM-classified educational programs to evaluate common scientific overlaps, 2) provide specific exemplars that illustrate congruence among nursing and STEM-designated sciences, and 3) offer a policy recommendation for the inclusion of nursing as an official STEM-designated degree program through the U.S. Department of Education, which would then allow for Department of Homeland Securityclassification for Optional Practical Training extensions and applications. Our policy recommendation aims to enhance the public perception of nursing science as a STEM discipline and align policy measures to increase diversity and potential funding opportunities among students seeking doctoral degrees and doctorally-prepared nurse faculty.

1.1. Case methodology

We systematically reviewed the existing Department of Homeland Security STEM-classified educational programs to uncover patterns in methodological and epistemological approaches to compare between scientific graduate programs that have already been classified as STEM and nursing science. We also reviewed the extant literature. Finally, we sought to understand the implications of our current system by facilitating discussions among foreign-born nurse scientists who have had to navigate the immigration process in the United States to elicit their contextual experiences, thus solidifying the significance of the problem.

1.2. Current STEM definitions

STEM career fields gained recognition and unifying language in 2001 by the National Science Foundation as an opportunity to solidify the role that the United States plays in the global network of innovation and development (Abram, 2019). While several definitions exist for what a STEM profession is, there are two general viewpoints which include a narrow list and a STEM plus health and social sciences. The narrow definition of STEM includes professions that are exclusively scientifically driven in nature, including mathematical science, computer science, and engineering (National Science Foundation, 2017). A broader classification called Science, Technology, Engineering, Mathematics, and Medicine (STEMM) includes medicine as it relates to the patient-oriented practice of medicine. In the same way that medicine has been conceptualized as a part of STEM, there has also been advocates within the clinical practice of nursing suggesting that the nursing profession should be considered a STEM profession (Green and John, 2020). Additionally, there is a growing movement to include arts in STEM models of education, also known as STEAM, which recognizes the deep epistemological diversity and multi-disciplinary approach that arts and humanities add to STEM fields. Nursing science training programs have been recognized by university-based, interdisciplinary Science, Technology, and Society (STS) studies programs that examine how societal norms, politics and culture impact the generation, application, and impacts of scientific and technological innovations (Walker, personal communication, 2021).

National Science Foundation is a primary organization that defines a STEM field, but Department of Homeland Security has its own definition of STEM for the purposes of extending temporary work eligibility for the international students in the STEM fields through the extension of O from 12 months up to 36 months. The STEM fields are listed on the Department of Homeland Security list with the U.S. Department of Education ’s Classification of Instructional Program taxonomy system code which was implemented to organize and collect information on students and program completion. Table 1 shows the relevant Classification of Instructional Program codes for each exemplar domain in this article.

Table 1.

Nursing research exemplars of the Department of Homeland Security STEM classified fields of study for the purposes of the 24-month STEM training extension.

Domain STEM Classification Exemplars STEM Classification of Instructional Program Taxonomy
Engineering and human factors research Biomedical engineering 14.0501
Operations research 14.3701
Human computer interaction 30.3101
Data science Data processing 11.0301
Data modeling/warehousing 11.0802
Artificial intelligence 11.0102
Informatics 11.0104
Information science 11.0401
Computer science 11.0701
Genomics Biological and biomedical sciences 26.0000
 Genomics/genome sciences 26.0807
 Human genetics 26.0806
 Physiology, pathology, other 26.0899
Biobehavioral research Biopsychology 30.1001
Behavioral sciences 30.1701
Cognitive science 30.2501
Human biology 30.2701
Psychometrics and quantitative psychology 42.2708
Medical science/scientist 51.1401
Economics Econometrics and quantitative economics 45.0603
Pharmacoeconomics 51.2007
Open in a new tab

Note. Items in this table are not exhaustive for overlap between STEM designated degrees, they are selected exemplars.

The Department of Homeland Security -designated STEM Classification of Instructional Program codes include programs for several Health Services/Allied Health/Health Sciences. One example is the Classification of Instructional Program code 51.1401, Medical Science/Scientist (National Center for Education Statistics; Department of Homeland Security, 2016). The definition of this title is “an undifferentiated clinical science program that prepares clinicians to conduct clinical and translational research in various areas” (para. 1). Although the definition of the title is very comparable, nursing science is currently not one of the Department of Homeland Security designated STEM Classification of Instructional Program codes. In the Classification of Instructional Program taxonomy system, the nursing science program (Classification of Instructional Program code: 51.3808) is defined as “a research program that focuses on the study of advanced clinical practices, research methodologies, the administration of complex nursing services, and that prepares nurses to further the progress of nursing research through experimentation and clinical applications” (para. 1) (National Center for Education Statistics, 2016). This definition perfectly aligns with the Classification of Instructional Program definition of Medical Science/Scientists, as nursing science programs are designed to prepare nurses to conduct clinical and translation research. Therefore, there should be no reason that nursing science is not recognized as a STEM field while medical science is recognized as one.

One practical importance of the Department of Homeland SecuritySTEM-designation list is that only individuals graduating from a qualified listed program are able to apply for an Optional Practical Training visa extension for up to 24 months for additional training and work. In non-STEM fields, the available Optional Practical Training period is 12 months for each higher level of study, which may not be sufficient for all the processes of job searching, training, performing, and application of a temporary work visa through the employer sponsor. The extension for the Department of Homeland Security -designated STEM fields allows sufficient time for obtaining employer sponsorship of a temporary work visa (e.g., H-1b visa) and its further sponsorship of employment-based immigrant visa (i.e., permanent resident card, also known as the green card) that allows stable residency and work permit. Optional Practical Training is usually used after a student has completed a degree (i.e., post-completion Optional Practical Training). While these graduates get real-world work experience related to their field of study during the Optional Practical Training period, it is also a narrow window of a timespan to find an employer sponsor and apply for a temporary worker visa to keep their work eligibility in the U.S. STEM-designation of nursing science by the Department of Homeland Security will provide equal opportunities for the U.S-educated nursing scientists to be established in their workplace as other scientists in the other STEM fields are. The STEM designation could provide more stable work environment for U.S.-educated international nursing scientists as they contribute to the advancement of education and science of the country through their scientific knowledge and skills. Of note, there is a dearth of research on the impact of these policies on long-term recruitment of global nurse scientists to the United States (Hira, 2010). In fact, it is difficult to determine the percent of current nursing faculty that were born outside of the United States and it is not a statistic that is routinely reported (Bittner and Bechtel, 2017; Nardi and Gyurko, 2013; “Preparing Nurse Faculty, and Addressing the Shortage of Nurse Faculty and Clinical Preceptors (2022); Yordy, 2016).

1.3. Exemplars of STEM Domains that intersect with nursing science

In this portion, we provide clear exemplars in domain areas such as engineering and human factors research, data science, genomics, biobehavioral research, and economics to illustrate the impact that nurse scientists are making in already-designated STEM areas. While these exemplars are not exhaustive in regard to Department of Homeland Security STEM programs, they provide a foundation for the research and clinical applications that nurse scientists are engaged in to impact the care of individuals and their families.

1.4. Engineering and human factors research

Several university-level nurse-engineering education programs have recently launched across the United States (Glasgow et al., 2018). These programs are led by a combination of nurse and engineering faculty, and purposefully combine the knowledge, clinical insights, and creativity of nurses with engineering methodologies designed to enhance health care innovations such as workflows, patient care devices, non-invasive wearable sensors, and human-computer interfaces (Glasgow et al., 2018). However, team science involving collaboration between nurse scientists and engineers is not a new phenomenon. Nurse scientists have a long history of invention and collaboration with engineers and technologists, from sectors such as mechanical, industrial, civil, environmental, electrical, biomedical and computer engineering. In a paper presented to the Detroit District Nurses Association during the winter of 1950, Dr. Lillian Gilbreth proposed myriad possibilities for combining nursing science with engineering methodologies involving the study of human factors, such as motion studies of caregiving (Gilbreth, 1950). Throughout the 1950s and 1960s, nurses like Bessie Blount Griffin developed and patented new technologies for patient care, like an electronic self-feeding system for individuals with paralysis and the kidney basin (Childers, 2018). The Lemelson Invention Wing of the Smithsonian Museum of American History features nurse inventions such as NICU nurse Sharon Rogone's Bili-Bonnett photo-therapy mask, the first patented and commercially available system designed to protect neonate's eyes from light associated with contemporary treatments for hyperbilirubinemia (Lemelson-MIT Program, 2019). More recently, nurses who originally trained in engineering fields such as computer and electrical engineering before entering nursing, such as Sangeeta Agarwhal, have completed National Science Foundation-sponsored scientific innovation accelerator programs such as the i-Corps, and applied their combined knowledge of both fields to invent completely new supportive care technologies, such as the A.I.-driven cancer patient navigation app, Helpsy Health (Bulgaru, 2019). The recent American Academy of Nursing-sponsored Council for the Advancement of Nursing Science Advanced Methods conference on nursing research involving sensor technologies, organized in direct collaboration with engineering faculty, highlighted numerous examples of nurse-engineering research and outlined future directions for this emerging area of nursing science (Council for the Advancement of Nursing Science, 2019).

The study of human factors, sometimes referred to as ergonomics, “use[s] knowledge of human abilities and limitations to design systems, organizations, jobs, machines, tools, and consumer products for safe, efficient, and comfortable human use” (Oregon Occupational Safety and Health, 2022). Nurse scholars have cultivated holistically-driven, life-course approaches to health assessment, promotion, and healing, including attention to structural and social determinants of health (Brown et al., 2019; Sumbul et al., 2019). Nurse clinicians also possess intimate knowledge of body systems, psychosocial processes, interpersonal and intercommunal relationships, and the contexts in which individuals and families live, work, study, heal, and die (McFarland and Wehbe-Alamah, 2014). As such, nurse scientists are ideally situated to generate, evaluate, translate, and disseminate theory, technological innovations, care models, and policies designed to address human factors impacting health and the delivery of health care, from evaluating human-computer interactions such as entering information into the electronic health record (Bakken et al., 2012) to verifying the ‘ground truth’ of constantly evolving care environments such as ‘smart homes’ (Dermody and Fritz, 2019).

Furthermore, nurse scientists are equipped with the ethical mandate, scientific credibility, translational capacity and proximity to individuals and communities they serve to push back when technological innovations cause harm, such as racist, sexist, or transmisic biases embedded in certain clinical applications involving artificial intelligence (Benjamin, 2019; Chinn, 2018). NINR-funded research centers, such as P20 research centers at the University of Massachusetts Amherst and University of Connecticut, and P30 research centers at the University of Texas-Austin and University of Washington, partner nurse scientist principal investigators and collaborators with expertise in business and entrepreneurship, design thinking, and other STEM fields such as computer science to develop, critically evaluate, and translate novel interventions and technologies, such as mHealth applications and wearable sensors, to support health and well-being in the context of chronic symptoms (Starkweather et al., 2019). Nurse scientists have also generated scholarship that reflexively interrogates and challenges dominant narratives around technological ‘fixery’ and technoscientific imperatives (Gance-Cleveland, McDonald & Walker, 2020; Hilario, Browne & McFadden, 2018; Rabelais & Walker, 2021).

1.5. Data science

Data science is the integration of computation, mathematics, and application of methods to large amounts of unstructured or structured data to provide actionable insight (Tallon and Dreisbach, 2019). Data science encompasses Classification of Instructional Program codes such as data processing (11.0301), modeling/warehousing (11.0802), and informatics (11.0104). Nurse scientists are heavily engaged in data science through analytic model building (Jeffery et al., 2018), open-source software creation (Topaz et al., 2019), data mining (Yoon et al., 2019), and data visualization (Arcia et al., 2013).

One of the most prominent nurse scientists in the data science and engineering domains, Dr. Patricia Brennan, Director of the National Library of Medicine, has utilized her technical expertise to establish an Advanced Visualization Branch at the National Institute of Nursing Research to develop and evaluate virtual reality experiences for impacting patient-centered healthcare (National Institute of Nursing Research, 2022). Earlier work from Brennan et al. (2015) illustrated how to capture and process data from everyday living and working spaces for future visualization and personal health information management.

As an example of model building, Jeffery et al. (2018) and his team utilized both logistic regression and two machine learning strategies (random forest and random survival forest algorithms) to classify an individual according to a threshold indication for clinical deterioration from an in-hospital cardiopulmonary arrest. While the algorithms reached similar performance metrics (Jeffery et al., 2018), early warning systems have the potential to enhance the classification of a disease outcome or provide interpretable predictions. These examples are not exhaustive as the breadth of nursing involvement in data science applications is substantial (Keim-Malpass and Moorman, 2021). Ultimately, nurse scientists can either act as liaisons between bedside care and data-intensive researchers or provide the key computation themselves as nurse data scientists (Dreisbach and Koleck, 2019).

1.6. Genomics

Genomic knowledge is essential for providing quality personalized care in a wide variety of contexts. Nurse scientists have been conducting genetic and genomic research for decades. Research is primarily focused on building knowledge related to symptom management, relationship of genetic variants to symptoms, disease processes, and communication of genomic risk to patients and families (Williams et al., 2016). Further, Williams and colleagues report that genomics research conducted by nurses is more likely to be disseminated via interdisciplinary networks than nurse exclusive outlets, and applied broadly across disciplines. Genomic nursing research guides clinical decision making across the lifespan and specialty areas. For example, genetic variants are factors considered when evaluating disease risk and progression, differences in drug metabolism of opiates and blood thinners, and sensitivity to cancer treatment (Calzone et al., 2018; McCormick and Calzone, 2016; Taylor et al., 2017). However, globally, there is wide variability related to the amount and quality of genomics training for nurses (Hickey et al., 2018). In the U.S., there are training resources and programs available to train the next generation of nurse clinicians and scientists to utilize genomic information in providing care (Genomic Nursing State of the Science Advisory Panel et al., 2013; Tonkin et al., 2011; Williams et al., 2016). Designation as a STEM field would help diversify the pool of nurse scientists studying and educating in genomic nursing and care delivery.

1.7. Biobehavioral research

Biobehavioral research is the integration of the biological underpinnings of a disease condition as well as the associated human behavior (Grady, 2006). Biobehavioral research, as shown in Table 1, combines psychology, cognitive science, and human biology. This is a particularly robust STEM domain for nurse scientists because nursing education, at its core, is the combination of scientific inquiry and psychological and behavioral care across the lifespan. Major nurse scientists in the field have designed interventional studies in HIV prevention for women and adolescent girls (Brawner et al., 2013), examined epigenetic changes related to smoking behaviors and breast cancer (Conway et al., 2017), and identified pain symptom clusters with sleep patterns (Tejada et al., 2019). Biobehavioral research is a strong example of the cross-cutting, interdisciplinary nature of nurse scientists to move forward both nursing science as well as other STEM-fields.

1.8. Economics

Nurse scientists participate and use health economics relevant to nursing across diverse populations, settings, and over time (Henly et al., 2015). Nursing as a profession has been studied through the lens of economics by nurse scientists as it relates to staffing, patient outcomes, quality initiatives, and workforce forecasting (Aiken, 2008; Auerbach et al., 2017; Buerhaus et al., 2018; Needleman et al., 2011; Spetz et al., 2015; Tubbs-Cooley et al., 2013). Further, cost evaluations of nursing care delivery communicate value through metrics that are translatable to administrators and policymakers (Aiken, 2008). Beyond issues pertaining to the profession as a whole, health economics has been a critical methodological application applied by nurse scientists in the assessment of novel interventions or models of care (Cozad et al., 2016; Iribarren et al., 2017; Keim-Malpass et al., 2018). Numerous economic departments have changed their formal classification of programs to the STEM classification inclusive of econometrics and quantitative economics so international graduate students can access the benefits of the STEM-designated academic programs for their application of H1-B visa (Redden, 2016).

1.9. Potential impact of STEM designation on nursing science

There is general consensus that the supply of nurse faculty is inadequate to meet the continued and growing needs of nursing programs to be able to admit future students (Bittner and Bechtel, 2017; Nardi and Gyurko, 2013). Simultaneously, the number of full-time graduate students in science, engineering, and health fields who were from outside of the United States students grew from 91,150 in 1990 to 148,923 in 2009 (Wasem, 2012). It is noted that many H1-B visa holders, (particularly those who participate in the Optional Practical Training following graduate school, are typically admitted to work in STEM fields and then become employment-based legal permanent residents (Wasem, 2012). Further, in other non-nursing science STEM sectors, it is estimated that 20 percent of the workforce is comprised of workers born outside of the United States (American Immigration Council, 2017). Additionally, for occupations with the most H-1B visa requests, wage growth has been higher than the national average (Rothwell and Ruiz, 2013). Finally, official STEM designation has positive spillover impacts (i.e., other positive impacts that were not the direct intent of the designation) in the context of inclusion on education proposals, targeted state and federal legislation, and grants and fellowships to stimulate the science and technology sectors (Kuenzi, 2008).

STEM designation of nursing could have substantial implications for bedside and community workforce development, increasing the faculty workforce, increasing representation and inclusion in science, healthcare, policymaking, and the classroom. The prospect of leveraging nursing as a STEM degree could not only invite more individuals to the United States but also create an avenue for residency if desired. To demonstrate impact, we require better baseline data about the current percentage of foreign-born nursing faculty and subsequent follow-up assessment about the potential for impact. Learning from other disciplines, currently, only 5% of H-1B visa requests are for individuals with a doctoral degree (Rothwell and Ruiz, 2013). Visa extensions related to direct policy changes through immigration standards could allow future nurse scientists more time to complete their degree programs and encourage others to pursue PhD programs. Congressional conversations regarding the expansion of available H-1B visas have been discussed but need critical advocacy and lobbying on behalf of nursing organizations such as the American Nurses Association and the American Association of Colleges of Nursing (AACN). Diversification of the nursing scientific community could benefit beyond filling vacant faculty positions but, more importantly, to create research questions and studies that address the complexity of healthcare for all patients for whom we serve. Simply put by Meleis (2005), a “shortage of nurses means a shortage of nurse scientists” (p. 111). Continuing to support current nursing students (in any degree program), expose them to nursing science concepts and career development pathways will undoubtedly help the current nursing science landscape.

We recognize that nursing science has diverse philosophical and methodological underpinnings and are not at all suggesting that quantitative approaches are superior or even the main drivers in the future state of the science. In fact, qualitative and historical methodologies, critical epistemological perspectives, and further collaboration with arts and the humanities are necessary for nursing to grow and flourish (Smith, 2019). For example, the NINR recently funded the creation of a new P30 symptom self-management research center at Johns Hopkins School of Nursing in Baltimore, focused on supporting individuals managing multiple chronic conditions through the use of innovative person-directed and community-focused models of care (School of Nursing at Johns Hopkins University, 2022). The research center represents a multidisciplinary collaboration between nurse scientists and other clinical and social design experts at the Maryland Institute College of Art (MICA). These perspectives align well with the movement towards the recognition of STEAM and the importance of elements of social justice, integration of ethics, emancipatory nursing theories and philosophies, person-centeredness, and a humanistic approach that underpins much of nursing science.

Just as nursing science is multi-dimensional, diverse, and ever-expanding, so too are the factors driving the current critical shortage of nurse scientists. We present advocacy for the inclusion of nursing science as a U.S Department of Education official STEM-designated field (which would carry over to the Department of Homeland Security list) as only one area of advocacy that, if enacted, could be effective nearly immediately. It is important to recognize that STEM designation is not just validation from other professional groups, but rather an opportunity to recognize the integral work that nurse scientists are engaged in to improve health(care) and develop the next generation of nurse scientists. We posit STEM recognition of nursing science might also help to complicate popular narratives about nursing, including the important scientific contributions of nurses who are not necessarily doctorally-prepared. Note that the purpose of this article is directly aimed at nursing science, not the clinical aspect of nursing care. While nursing as a clinical profession certainly encompasses the core components of STEM, especially in the educational preparation of nurses, it remains outside of the scope of this paper. Future discussions on advocating and policy change to add nursing practice within the STEM classification have been circulating and should continue to be a central point of discussion.

We hope that this discussion offers a starting-point for sustained conversation and advocacy for the inclusion of nursing science as STEM. This paper also recognizes the current dearth of data assessing the current status of foreign-born nurse faculty members in the United States. This discussion paper highlights various overlaps nursing science has with other STEM designated graduate programs and the case exemplars we highlight do not begin to cover the breadth of methodological or epistemological perspectives encompassed within nursing science. We also did not discuss the equally valid notion of the practice of nursing as a designated STEM discipline (just as advocates have suggested that STEM should be expanded to a STEMM designation toinclude the practice of medicine), which requires its own nuanced discussion. There has been a greater amount of attention focused on the nursing workforce as the Covid-19 pandemic has unfolded and more research is required on the nursing science, or doctorally prepared nursing pipeline to support (1) emerging scientists and (2) emerging nurses into the clinical practice. There has been a dearth of research highlighting the facilitators of the global mobility of nurse scientists and this represents an area of future research(Shaffer and Dutka, 2013).

1.10. Initial policy recommendation

We urge readers to utilize their power to advocate that nursing science be added to the STEM-designated degree list. The Department of Homeland Securityprovides directions on how to request this addition (Department of Homeland Security, 2016). Interested advocates can email the Student and Exchange Visitor Program at SEVP@ice.Department of Homeland Security.gov and include “Request for STEM Designated Degree Program List” in the subject line. Specifically, advocates should include the directive of “nursing science (Classification of Instructional Program code: 51.3808) as a STEM-designated degree” to the body of their email. Department of Homeland Securityexpanded the list of STEM professionals in January 2022, and nursing science was not included in this designation(“Department of Homeland Security Expands Opportunities in U.S. for STEM Professionals | Homeland Security 2022").

2. Conclusion

In this paper, we provide clear examples of the congruence between traditional STEM-designated fields and nursing science. We argue that the addition of nursing science as a designated STEM degree could have a measurable impact on diversity and recruitment into scientific training, such as research-focused doctoral programs, with the potential for other positive spillover impacts that could influence funding availability. Overall, increasing the visibility of nursing at the federal level through policy change could enhance the representation of diverse faculty and align the nursing scientist workforce with the communities we serve. Further work is needed on the inclusion of nursing practice in STEM, integration of STEM, STEAM and STS techniques within existing pedagogies, public perception of nursing practice and nursing science as STEM, and further conceptual development of nursing science as STEM.

Funding

Jessica Keim-Malpass is supported as a nurse fellow from a grant funded by the Gordon and Betty Moore Foundation (GBMF9048).

Declaration of Competing Interest

The authors have no financial conflicts of interest to disclose.

Acknowledgements

We would like to thank Dr. Jess Dillard-Wright, PhD, CNM, RN and Patrick McMurray, BSN, RN for their invaluable review of this manuscript. Their insight and vision into what nursing could be is a true guide for how nursing practice, at all levels, are scientific disciplines.

References

  1. Abram, C. (2019, August 26). Is nursing STEM? Retrieved November 12, 2019, from https://www.excelsior.edu/article/nursing-as-a-stem-field/.
  2. Aiken L.H. Economics of nursing. Policy, Polit. Nurs. Pract. 2008;9(2):73–79. doi: 10.1177/1527154408318253. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. American Immigration Council . American Immigration Council; 2017. Foreign-born STEM Workers in the United States. [Google Scholar]
  4. Arcia A., Bales M.E., Brown W., Co M.C., Gilmore M., Lee Y.J.…Bakken S. Method for the development of data visualizations for community members with varying levels of health literacy. AMIA Ann. Symp. Proc. 2013;2013:51–60. [PMC free article] [PubMed] [Google Scholar]
  5. Auerbach D.I., Buerhaus P.I., Staiger D.O. Millennials almost twice as likely to be registered nurses as baby boomers were. Health Aff. (Millwood) 2017;36(10):1804–1807. doi: 10.1377/hlthaff.2017.0386. [DOI] [PubMed] [Google Scholar]
  6. Bakken S., Stone P.W., Larson E.L. A nursing informatics research agenda for 2008–18: contextual influences and key components. Nurs. Outlook. 2012;60(5):280–288. doi: 10.1016/j.outlook.2012.06.001. 2008. e3. [DOI] [PubMed] [Google Scholar]
  7. Benjamin R. 1st ed. Polity; 2019. Race After Technology: Abolitionist Tools for the New Jim Code. [Google Scholar]
  8. Bittner N.P., Bechtel C.F. Identifying and describing nurse faculty workload issues: a looming faculty shortage. Nurs. Educ. Perspect. 2017;38(4):171–176. doi: 10.1097/01.NEP.0000000000000178. [DOI] [PubMed] [Google Scholar]
  9. Brawner B.M., Teitelman A.M., Bevilacqua A.W., Jemmott L.S. Personalized biobehavioral HIV prevention for women and adolescent girls. Glob. Adv. Health Med. Improv. Healthc. Outcomes Worldw. 2013;2(5):100–108. doi: 10.7453/gahmj.2013.059. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Brennan P.F., Ponto K., Casper G., Tredinnick R., Broecker M. Virtualizing living and working spaces: proof of concept for a biomedical space-replication methodology. J. Biomed. Inform. 2015;57:53–61. doi: 10.1016/j.jbi.2015.07.007. [DOI] [PubMed] [Google Scholar]
  11. Brown A.F., Ma G.X., Miranda J., Eng E., Castille D., Brockie T.…Trinh-Shevrin C. Structural interventions to reduce and eliminate health disparities. Am. J. Public Health. 2019;109(S1):S72–S78. doi: 10.2105/AJPH.2018.304844. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Brown R., Brown J., Reardon K., Merrill C. Understanding STEM: current perceptions. Technol. Eng. Teacher. 2011;70(6):5–9. [Google Scholar]
  13. Buerhaus P., Perloff J., Clarke S., O'Reilly-Jacob M., Zolotusky G., DesRoches C.M. Quality of primary care provided to medicare beneficiaries by nurse practitioners and physicians. Med. Care. 2018;56(6):484–490. doi: 10.1097/MLR.0000000000000908. [DOI] [PubMed] [Google Scholar]
  14. Bulgaru L. Can AI help Americans manage & beat cancer? Interview with helpsy's CEO sangeeta agarwal. Healthc. Weekly. 2019 https://healthcareweekly.com/artificial-intelligence-cancer-helpsy-podcast/ Retrieved from. [Google Scholar]
  15. Calzone K.A., Kirk M., Tonkin E., Badzek L., Benjamin C., Middleton A. The global landscape of nursing and genomics. J. Nurs. Scholarsh. 2018;50(3):249–256. doi: 10.1111/jnu.12380. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Childers, L. (2018, April 11). Minority nurse inventors: improving patient care through unique clinical solutions. Retrieved December 4, 2019, from https://minoritynurse.com/minority-nurse-inventors-improving-patient-care-through-unique-clinical-solutions/.
  17. Chinn P. From the editor. ANS. Adv. Nurs. Sci. 2018;41(4):303–304. doi: 10.1097/ANS.0000000000000234. [DOI] [PubMed] [Google Scholar]
  18. Conway K., Edmiston S.N., Parrish E., Bryant C., Tse C.-K., Swift-Scanlan T.…Kuan P.F. Breast tumor DNA methylation patterns associated with smoking in the carolina breast cancer study. Breast Cancer Res. Treat. 2017;163(2):349–361. doi: 10.1007/s10549-017-4178-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Council for the Advancement of Nursing Science. (2019). 2019 advanced methods conference: the expanding science of sensor technology in research on-site program. Retrieved December 8, 2019, from https://higherlogicdownload.s3.amazonaws.com/AANNET/12ebde25-5178-43b2-a724-5f650d708880/UploadedImages/2019_On-Site_Program_CANS_FINAL1.pdf.
  20. Cozad M.J., Lindley L.C., Mixer S.J. Staff efficiency trends among pediatric hospices, 2002–2011. Nurs. Econ. 2016;34(2):82–89. [PMC free article] [PubMed] [Google Scholar]
  21. Dermody G., Fritz R. A conceptual framework for clinicians working with artificial intelligence and health-assistive smart homes. Nurs. Inq. 2019;26(1):e12267. doi: 10.1111/nin.12267. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. DEPARTMENT OF HOMELAND SECURITY Expands Opportunities in U.S. for STEM Professionals | Homeland Security. (2022). Retrieved March 30, 2022, from https://www.DepartmentofHomelandSecurity.gov/news/2022/01/21/DepartmentofHomelandSecurity-expands-opportunities-us-stem-professionals.
  23. Dreisbach C., Koleck T. The state of data science in genomic nursing. Biol. Res. Nurs. 2019 doi: 10.1177/1099800420915991. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Genomic Nursing State of the Science Advisory Panel. Calzone K.A., Jenkins J., Bakos A.D., Cashion A.K., Donaldson N.…Webb J.A. A blueprint for genomic nursing science. J. Nurs. Scholarsh. 2013;45(1):96–104. doi: 10.1111/jnu.12007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Gilbreth L. Management engineering and nursing. Am. J. Nurs. 1950;(12):50. [PubMed] [Google Scholar]
  26. Glasgow M.E.S., Colbert A., Viator J., Cavanagh S. The nurse-engineer: a new role to improve nurse technology interface and patient care device innovations. J. Nurs. Scholarsh. 2018;50(6):601–611. doi: 10.1111/jnu.12431. [DOI] [PubMed] [Google Scholar]
  27. Grady P.A. Biobehavioral research at NINR and NIH. Nurs. Outlook. 2006;54(5):300–302. doi: 10.1016/j.outlook.2006.04.004. [DOI] [PubMed] [Google Scholar]
  28. Green C., John L. Should nursing be considered a STEM profession? Nurs. Forum (Auckl.) 2020;55(2):205–210. doi: 10.1111/nuf.12417. [DOI] [PubMed] [Google Scholar]
  29. Hanson G., Slaughter M. National Bureau of Economic Research; Cambridge, MA: 2016. High-Skilled Immigration and the Ride of STEM Occupations in U.S. Employment (Working Paper 22623) [Google Scholar]
  30. Henly S.J., McCarthy D.O., Wyman J.F., Heitkemper M.M., Redeker N.S., Titler M.G.…Dunbar-Jacob J. Emerging areas of science: recommendations for nursing science education from the council for the advancement of nursing science idea festival. Nurs. Outlook. 2015;63(4):398–407. doi: 10.1016/j.outlook.2015.04.007. [DOI] [PubMed] [Google Scholar]
  31. Hickey K.T., Taylor J.Y., Barr T.L., Hauser N.R., Jia H., Riga T.C., Katapodi M. Nursing genetics and genomics: the international society of nurses in genetics (ISONG) survey. Nurse Educ. Today. 2018;63:12–17. doi: 10.1016/j.nedt.2018.01.002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Hira R. U.S. policy and the STEM workforce system. Am. Behav. Sci. 2010;53(7):949–961. doi: 10.1177/0002764209356230. [DOI] [Google Scholar]
  33. Iribarren S.J., Cato K., Falzon L., Stone P.W. What is the economic evidence for mHealth? A systematic review of economic evaluations of mHealth solutions. PLoS One. 2017;12(2) doi: 10.1371/journal.pone.0170581. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Jeffery A.D., Dietrich M.S., Fabbri D., Kennedy B., Novak L.L., Coco J., Mion L.C. Advancing in-hospital clinical deterioration prediction models. Am. J. Crit. Care. 2018;27(5):381–391. doi: 10.4037/ajcc2018957. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Jeffery A.D., Dietrich M.S., Maxwell C.A. Predicting 1-year disability and mortality of injured older adults. Arch. Gerontol. Geriatr. 2018;75:191–196. doi: 10.1016/j.archger.2018.01.003. [DOI] [PubMed] [Google Scholar]
  36. Keim-Malpass J., Cohrs A.C., Lindley L.C., Leslie D.L. An economic examination of private insurance claims among adolescents and young adults who were enrolled in hospice during the last year of life. Adolesc. Health Med. Ther. 2018;9:117–120. doi: 10.2147/AHMT.S168501. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Keim-Malpass J., Moorman L.P. Nursing and precision predictive analytics monitoring in the acute and intensive care setting: An emerging role for responding to COVID-19 and beyond. Int. J. Nurs. Stud. Adv. 2021;3 doi: 10.1016/j.ijnsa.2021.100019. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Kuenzi J. Congressional Research Service Reports; 2008. Science, Technology, Engineering, and Mathematics (STEM) Education: Background, Federal Policy, and Legislative Action. [Google Scholar]
  39. Lemelson-MIT Program. (n.d.). Sharon rogone. Retrieved December 5, 2019, from https://lemelson.mit.edu/resources/sharon-rogone.
  40. McCormick K.A., Calzone K.A. The impact of genomics on health outcomes, quality, and safety. Nurs. Manage. 2016;47(4):23–26. doi: 10.1097/01.NUMA.0000481844.50047.ee. [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. McFarland M.R., Wehbe-Alamah H.B. 3rd ed. Jones; 2014. Leininger's Culture Care Diversity and Universality: A Worldwide Nursing Theory (Cultural Care Diversity (Leininger)) [Google Scholar]
  42. Meleis A.I. Shortage of nurses means shortage of nurse scientists. J. Adv. Nurs. 2005;49(2):111. doi: 10.1111/j.1365-2648.2004.03308.x. [DOI] [PubMed] [Google Scholar]
  43. Nardi D.A., Gyurko C.C. The global nursing faculty shortage: status and solutions for change. J. Nurs. Scholarsh. 2013;45(3):317–326. doi: 10.1111/jnu.12030. [DOI] [PubMed] [Google Scholar]
  44. National Institute of Nursing Research. (2022). Research Conducted at NINR (Intramural Division). Retrieved November 12, 2019, from https://www.ninr.nih.gov/researchandfunding/dir.
  45. National Institutes of Health. (2019 , January 24). Budget. Retrieved November 12, 2019, from https://www.nih.gov/about-nih/what-we-do/budget.
  46. National Science Foundation. (2017, September 15). What is STEM education? Retrieved November 12, 2019, from https://www.nsf.gov/news/news_summ.jsp?cntn_id=243502.
  47. National Science Foundation. (2018, February 22). Congressional Update and Appropriations. Retrieved November 12, 2019, from https://www.nsf.gov/about/congress/116/highlights/cu19_0222.jsp.
  48. Needleman J., Buerhaus P., Pankratz V.S., Leibson C.L., Stevens S.R., Harris M. Nurse staffing and inpatient hospital mortality. N. Engl. J. Med. 2011;364(11):1037–1045. doi: 10.1056/NEJMsa1001025. [DOI] [PubMed] [Google Scholar]
  49. Oregon Occupational Safety and Health. (2022). What is ergonomics? Retrieved December 5, 2019, from https://osha.oregon.gov/edu/grants/wrd/cergos/Pages/ergonomics.aspx.
  50. Preparing Nurse Faculty, and Addressing the Shortage of Nurse Faculty and Clinical Preceptors. (2022).
  51. Redden, E. (2016). Is econ stem? Retrieved November 11, 2019, from https://www.insidehighered.com/admissions/article/2018/02/19/economics-departments-reclassify-their-programs-stem-attract-and-help.
  52. Rothwell J., Ruiz N. SSRN; 2013. H-1B Visas and the STEM Shortage: A Research Brief. [Google Scholar]
  53. School of Nursing at Johns Hopkins University. (2022). PROMOTE center. Retrieved december 5, 2019, from https://nursing.jhu.edu/faculty_research/research/centers/promote-center/promote-center.html.
  54. Shaffer F.A., Dutka J.T. Global mobility for internationally educated nurses: challenges and regulatory implications. J. Nurs. Regul. 2013;4(3):11–16. doi: 10.1016/S2155-8256(15)30124-1. [DOI] [Google Scholar]
  55. Smith K.M. Facing history for the future of nursing. J. Clin. Nurs. 2019 doi: 10.1111/jocn.15065. [DOI] [PubMed] [Google Scholar]
  56. Spetz J., Brown D.S., Aydin C. The economics of preventing hospital falls: demonstrating ROI through a simple model. J. Nurs. Adm. 2015;45(1):50–57. doi: 10.1097/NNA.0000000000000154. [DOI] [PubMed] [Google Scholar]
  57. Starkweather A., Jacelon C.S., Bakken S., Barton D.L., DeVito Dabbs A., Dorsey S.G.…Miller J.L. The use of technology to support precision health in nursing science. J. Nurs. Scholarsh. 2019;51(6):614–623. doi: 10.1111/jnu.12518. [DOI] [PMC free article] [PubMed] [Google Scholar]
  58. Sumbul T., Spellen S., McLemore M.R. A transdisciplinary conceptual framework of contextualized resilience for reducing adverse birth outcomes. Qual. Health Res. 2019 doi: 10.1177/1049732319885369. [DOI] [PubMed] [Google Scholar]
  59. Tallon E., Dreisbach C. Using data science to understand complexity and quantify heterogeneity in the onset and progression of chronic disease. Biol. Res. Nurs. Accept. 2019 doi: 10.1177/1099800419863161. [DOI] [PubMed] [Google Scholar]
  60. Taylor J.Y., Wright M.L., Hickey K.T., Housman D.E. Genome sequencing technologies and nursing: what are the roles of nurses and nurse scientists? Nurs. Res. 2017;66(2):198–205. doi: 10.1097/NNR.0000000000000211. [DOI] [PMC free article] [PubMed] [Google Scholar]
  61. Tejada M., Viele C., Kober K.M., Cooper B.A., Paul S.M., Dunn L.B.…Miaskowski C. Identification of subgroups of chemotherapy patients with distinct sleep disturbance profiles and associated co-occurring symptoms. Sleep. 2019;(10):42. doi: 10.1093/sleep/zsz151. [DOI] [PMC free article] [PubMed] [Google Scholar]
  62. Tonkin E., Calzone K., Jenkins J., Lea D., Prows C. Genomic education resources for nursing faculty. J. Nurs. Scholarsh. 2011;43(4):330–340. doi: 10.1111/j.1547-5069.2011.01415.x. [DOI] [PubMed] [Google Scholar]
  63. Topaz M., Murga L., Bar-Bachar O., McDonald M., Bowles K. NimbleMiner: an open-source nursing-sensitive natural language processing system based on word embedding. Comput. Inform. Nurs.CIN. 2019 doi: 10.1097/CIN.0000000000000557. [DOI] [PubMed] [Google Scholar]
  64. Tubbs-Cooley H.L., Cimiotti J.P., Silber J.H., Sloane D.M., Aiken L.H. An observational study of nurse staffing ratios and hospital readmission among children admitted for common conditions. BMJ Qual. Saf. 2013;22(9):735–742. doi: 10.1136/bmjqs-2012-001610. [DOI] [PMC free article] [PubMed] [Google Scholar]
  65. U.S. Bureau of Labor Statistics. (2015). Science, technology, engineering, and mathematics (STEM) occupations: past, present, and future. Retrieved November 11, 2019, from https://www.bls.gov/spotlight/2017/science-technology-engineering-and-mathematics-stem-occupations-past-present-and-future/home.htm.
  66. Wasem R.E. Congressional Research Service; 2012. Immigration of Foreign Nationals with Science, Technology, Engineering, and Mathematics (STEM) Degrees (CRS Report for Congress) [Google Scholar]
  67. Williams J.K., Katapodi M.C., Starkweather A., Badzek L., Cashion A.K., Coleman B.…Hickey K.T. Advanced nursing practice and research contributions to precision medicine. Nurs. Outlook. 2016;64(2):117–123. doi: 10.1016/j.outlook.2015.11.009. [DOI] [PubMed] [Google Scholar]
  68. Williams J.K., Tripp-Reimer T., Daack-Hirsch S., DeBerg J. Five-year bibliometric review of genomic nursing science research. J. Nurs. Scholarsh. 2016;48(2):179–186. doi: 10.1111/jnu.12196. [DOI] [PubMed] [Google Scholar]
  69. Yoon S., Lucero R., Mittelman M.S., Luchsinger J.A., Bakken S. Mining twitter to inform the design of online interventions for hispanic alzheimer's disease and related dementias caregivers. Hisp. Health Care Int. Off. J. Natl. Assoc. Hisp. Nurs. 2019 doi: 10.1177/1540415319882777. [DOI] [PubMed] [Google Scholar]
  70. Yordy K. The Robert Wood Johnson Foundation; 2016. The Nursing Faculty Shortage: A Crisis for Health Care. [Google Scholar]

Articles from International Journal of Nursing Studies Advances are provided here courtesy of Elsevier

RESOURCES