Doctoral education, in particular researched focused programs (PhDs), needs to create a pipeline of nurse investigators capable of delivering measurable improvements in policy, practice, economic efficiency, and patient outcomes. This editorial argues for a reform agenda that shifts PhD programmes away from supporting isolated, low-cost and stand-alone projects to programmatic and team-based research embedded in health-service partnerships and authentic consumer engagement. The aim is to build a pipeline of researchers able to design for impact, navigate implementation contexts, secure funding, work with routine health data, and translate evidence into adoption at scale (American Association of Colleges of Nursing 2022). Health systems are increasingly complex and interdependent, and nursing research has the potential to be central to designing new models of care and health system solutions. This could be nursing's moment to drive patient centred reform. A pipeline of PhD prepared nurses is needed, yet the output of nursing PhD education does not consistently translate into successful research trajectories or demonstrable change to real world situations. Many nursing PhD candidates undertake studies focused on their own practice-generated research questions which, while meaningful, often result in part-time and isolated candidatures. They complete their PhD with limited grant writing experience, modest research networks, and inadequate publication trajectories. These conditions constrain competitiveness for postdoctoral opportunities and reduce the likelihood of sustained impact. Recent evidence underscores that these outcomes are not simply a matter of individual capability. A systematic mixed-methods review of ethical challenges in nursing doctoral supervision found that misaligned expectations, inadequate feedback, and limited institutional support are recurring, multi-level problems that can undermine doctoral progression and outcomes (Godskesen et al. 2025). The persistence of small, low-cost, supervisor-led qualitative or mixed-method studies reflects earlier academic traditions in the nursing discipline. Such work yields valuable insight into sociocultural and experiential dimensions of care, often descriptive or theoretical frameworks, and whilst significant in advancing specific areas of knowledge to advance the art and science of nursing, there is little evidence that it leads to tested interventions, policy change, or practice or system-level improvement. Yet this need has been articulated by organisations such as the American Association of Colleges of Nursing (2022). In today's research environment, impact is evidenced by measurable change including change in policy, practice adoption, cost offsets, and improvements in patient-reported outcomes rather than by publication counts alone. PhD programmes must therefore develop students' capacity to design for impact. Implementation science, research translation, patient experience, and patient journey studies are natural homes for nursing inquiry and when paired with rigorous designs and authentic consumer partnership, they enable movement from problem description to solutions (Trautman et al. 2018). Reform can begin with program architecture. Instead of individual thesis projects, candidates could be embedded in coordinated research agendas with shared milestones, pooled data resources, and aligned dissemination strategies. Candidates should anticipate barriers to adoption, investigate local context, or plan for scale from the outset. This approach to PhD study does not mean abandoning the practice-based questions of candidates but instead fitting them into a broader program and framework that builds on the work of others and subsequently strengthens evidence. To move away from small low-cost research projects, PhD research programmes need to do more to prepare nursing students for grant success. Developing grantsmanship is critical as Australian university funding models shift in 2026 to an environment where unfunded research will become difficult to sustain. This urgency is underscored by evidence suggesting that nursing is currently ill-equipped for this competitive landscape (Australasian Nursing and Midwifery Clinical Trials Network 2025). While global data remains limited, a recent Australian examination of two grant programmes showed that nursing was underrepresented in grant success (Eckert et al. 2022), driven not by rejection alone, but by a shortage of applicants and poor research pathways. This structural weakness often begins during doctoral education, where candidates frequently graduate with limited competitive funding experience. Nursing research should have distinct advantages in producing research impact and PhD programs should build students’ skills to exploit these. Nursing's proximity to patients and communities will be a decisive advantage if PhD work moves beyond consumer participation compliance to genuine co-ownership. For many nursing PhD students, their research questions have grown from questions in practice and in this way have been very close to consumer concerns. One might imagine even that nursing researchers had an ‘edge’ in consumer engaged research. But this new more formal consumer partnership approach goes further than traditional practice research questions and requires consumer committees and consumer research partners and so has not provided any natural advantage to nurse researchers. Candidates need training and resources to recruit and support consumer partners, ensure shared decision-making, compensate consumers ethically, and to evaluate both the quality and the impact of partnerships. When consumers help shape research questions and implementation pathways, relevance increases and adoption accelerates. Practice development is largely a nursing methodology of critical social science where a systematic and continuous process of change focuses on person centred care and increased effectiveness (McCormack et al. 2009). It is well suited to deliver impact that helps to transform health because studies focus on real-world care scenarios, often using participatory action research. Yet the practice development evidence base does not clearly articulate patient benefits or outcomes. Strong research project design is fundamental to research impact. Research programs must enable supervisory teams that provide complementary expertise. Relevant expertise may range across experimental, quasi-experimental, correlational, quantitative, and qualitative methods and include capacity in biostatistics, health economics, and health-data governance. Methodological breadth should become normative. Scaled qualitative designs grounded in established consumer input should be used to shape interventions rather than to conclude the inquiry. Case-based mixed methods could connect context, mechanism, and outcomes or have candidates anticipating barriers to adoption, investigating local context, and planning for scale from the outset. Experimental and quasi-experimental approaches, such as vignette-based decision studies and pre/post designs with comparison groups, could test effects. Natural experiments should leverage policy or service change to estimate real-world impact. Large-scale case comparisons and secondary analyses should turn routine datasets into actionable information. Practice development work rooted in participatory action and critical social science could be paired with explicit evaluation of patient-level outcomes. Nursing PhD programs are an important pipeline for nursing research and health services change but need reform to fully benefit from ‘nursing's moment’. Nursing PhD programs can catalyse change by redesigning curricula around impact-oriented methods and implementation and translation science. PhD programs could improve students' research trajectories by intentional programmatic research. This would not mean the same solution for all. For one curricula, this might involve embedding PhD candidates within clinical improvement programmes with rapid cycles of intervention testing and refinement. Students would be educated in implementation science fundamentals, such as context assessment, barrier analysis, and facilitation strategies, and able to use existing policy or service interventions to examine impact (see, e.g., Xiong et al. 2024). To increase impact, mixed methods designs could use case-based examination of phenomena or methods that focus on service impact (see, e.g., Rouhi et al. 2019) rather than describe general perceptions. Another program might focus on developing graduates confident with administrative data sets and able to plan and deliver trials and quasi-experiments as well as robust mixed-methods. Student access to sufficient biostatistics and health-economics expertise to support setting sample sizes, estimating effects, and modelling costs would involve a multidisciplinary team, ensuring students gain a range of team skills. Programmatic approaches to research likely facilitate access to supervision and mentorship characterised by expertise, research role modelling, and sustained engagement; all factors that have been associated with research capability, academic performance, and professional development (Watson et al. 2025). Nursing PhD education has long produced thoughtful scholars. The current health environment, though, needs PhD programs that consistently produce impactful investigators whose work changes practice, health systems, or experiences rather than changing conversations. Aligning PhD programmes with methodological breadth, co-owned consumer engagement, and programme-based team science will strengthen nurse-led research and deliver needed real-world outcomes. A future where nursing PhD graduates demonstrate design literacy across methods is essential. Graduates should also be adept at grantsmanship from scanning opportunities to constructing budgets and credible impact statements while engaging stakeholders across consumers, clinicians, managers, and policy actors. Proficiency in research translation, including knowledge brokering, policy briefs, and change-management planning, must sit alongside the ethics of participatory research where consumers serve as co-researchers. Nursing PhD programs can catalyse change by redesigning curricula around impact-oriented methods and implementation science. By adopting programme-embedded candidature in which theses contribute to shared agendas and assembling supervisory teams with complementary methodological and translational strengths, we can build a pipeline of successful and impactful nurse researchers. The authors have nothing to report. The authors declare no conflicts of interest. The authors have nothing to report.
Stirling et al. (Thu,) studied this question.