This interview with Professor Ercole Vellone, coordinator of the PhD program in Nursing Science and Public Health at the University of Rome “Tor Vergata”, was conceived to offer doctoral students and professionals in the field a valuable reference for understanding the importance of nursing research in Italy. Professor Vellone, internationally recognized for his studies on self-care, shares his personal and professional experiences, addressing crucial topics such as academic challenges and the need for greater recognition of the nursing researcher’s role. Through this interview, we aim to highlight how research is not only a tool for professional growth but also a genuine service to society. The goal is to inspire a new generation of nurses to invest in doctoral education, contributing to the improvement of healthcare quality and public health.
You obtained your PhD in 2014 with Professor Barbara Riegel as your adviser. How did you approach your doctoral journey?
I had already met Professor Riegel before my PhD as we were collaborating on a research line about self-care in heart failure. The journey with Professor Riegel was incredibly enriching and interesting because I had the opportunity to work with one of the leading international experts in nursing research, particularly in cardiovascular nursing. She opened up a new world for me: I was able to connect with other international researchers, and over the years, it has been a continuous growth of high-level research. I don’t think I would have ever become a Fellow of the American Academy of Nursing without the support and guidance of Professor Riegel!
Do you miss clinical practice? Have you ever had second thoughts about your decision?
I do miss clinical practice! Above all, I miss the ability to immediately implement the results of our research with patients. If I could go back, I would make the same decision with the understanding that research is a “service” to patients, to improve their quality of life, and to colleagues, who through research can apply interventions that are more likely to benefit the individuals they care for.
Why did you decide to enroll in a PhD, and why should a nurse enroll in a doctoral program?
I chose to enroll in the PhD program after I had already become a researcher (this was an anomaly unique to Italy before the Gelmini Reform of 2010), but aside from the need to “correct” this anomaly, I would have enrolled in the PhD anyway, as I had been interested in nursing research for many years. Why should a nurse enroll in a PhD program? Because by enrolling in a PhD program, the nurse aims to contribute to the health and well-being of patients, their families, and the community through the development of new knowledge. And this knowledge (nursing knowledge!) can ONLY be developed by a nurse because ONLY a nurse understands the discipline and practice of nursing. If nurses don’t do research, no one can do it for them, and patients, their families, and the community will be deprived of the knowledge that could improve their lives.
What do you think are the major challenges that a PhD student faces during the doctoral journey and after completing it?
PhD students face many challenges, and they can only be overcome with an immense passion for research. During the PhD, the main challenge for students is to truly understand what needs to be studied. Often, even the projects submitted during the application process are not genuine research projects but are more about gathering data to satisfy personal curiosity or attempting to imitate research conducted in countries that are ahead of us in nursing research. The initial challenge is to precisely identify the “lack of knowledge” on which to base the doctoral work. This is the most difficult task for PhD students, requiring a deep study of existing literature. Then, of course, there’s the challenge of getting published, which can be particularly frustrating: there can be rejections without even peer review or rejections after peer review, and these rejections can greatly impact the PhD student’s psychological well-being. It can lead to a decrease in self-esteem, a deep disappointment in one’s ability to do research, and sometimes even result in students leaving the program after repeated rejections. But these experiences also serve as a test to see if this work is truly the right fit. In research (and scientific production), it’s very common to have research projects or papers rejected, but you can learn a lot from these rejections! If the reviewer has done a good job, there’s really a lot to learn! After the PhD, the challenges become even greater. Those starting a postdoctoral journey are most likely aiming for an academic career, so the challenges involve working on research projects, publishing extensively, developing leadership in research, and building a resume for the purpose of national scientific qualification. Additionally, in university settings, there’s not just research; there’s also teaching, supporting students, administrative tasks, and things can get complicated. Then there’s your private and family life! Sometimes it’s not easy to understand how to balance work and personal life. This balance is something that comes only with experience.
Looking back, who would you like to thank, and who not? Who helped you, and who, even indirectly, hindered you in achieving your title?
I must say right away that no one hindered me! The people I encountered in the world of research or academia have always given me a lot, so I need to thank everyone. I would like to mention their names. The first person who introduced me to the world of research was Professor Julita Sansoni: with her, I found my “calling” to become a researcher. The second person was Professor Marlene Z. Cohen, with whom I published my first international article: she gave me my first insights into scientific writing and introduced me to phenomenological research. The third person was Professor Rosaria Alvaro: she was my first mentor at university and helped me understand how the Italian academic system works. The fourth person is Professor Barbara Riegel, who introduced me to international research. Finally, I feel I must thank all the PhD students who later became research fellows and university professors, with whom I worked well and with enthusiasm!
We know that nursing research in Italy is experiencing strong growth. There is often talk of an out-of-control scientific production, with thousands of articles being published every day.
Yes, it’s true that scientific production is growing rapidly, sometimes at the expense of quality. Scientific publishing is becoming a business, and at times researchers, driven more by the frenzy to publish, don’t pay close attention to the quality of the journals. I must say that in Italy, the situation is quite under control, as we are well aware of the existence of so-called “predatory journals” and we stay away from them. However, I see that, especially in developing countries, where the criteria for becoming academics might be less stringent than in other countries, people are publishing in these journals. The creation of new journals and the increase in published articles places a great burden on editors, who are finding it increasingly difficult to review submissions. As an associate editor of the European Journal of Cardiovascular Nursing, I often find myself asking dozens and dozens of reviewers to review an article in the hope of finding at least the three necessary ones. Reviewing articles takes time from reviewers, and with the increase in articles produced worldwide, the workload for reviewers has become substantial. And it’s a completely unpaid job!
What do you think are the long-term advantages and disadvantages of this phenomenon?
The advantages are that it expands the opportunities to publish one’s work and, in some cases, allows for very specialized journals. But the disadvantages are far greater, particularly due to the spread of “junk science” that is of no use to anyone.
The ambition of every researcher, regardless of their field, is to leave a significant mark on the scientific community. This impact is measured by an index, the h-index. Do you think evaluating the impact of research is truly important?
The h-index should be evaluated with caution. A high h-index only means that a certain number of a researcher’s published works have been cited by others in their articles’ bibliographies (for example, an h-index of 10 means that at least 10 works have been cited at least 10 times each). The h-index could be more accurately described as an index of the impact of one’s published articles, NOT the real-world impact of the research. It would be very interesting and important to assess whether one’s work has been applied in clinical practice, but this kind of activity is quite challenging.
What aspects of the nurse researcher’s role in Italy need significant improvement?
Funding for nursing research needs to be strengthened—it is still very scarce. Additionally, in healthcare organizations and other professional settings, there needs to be formal recognition, including in employment contracts, for nurses who have obtained a PhD. These nurses are a resource for the organization: they could be involved in the development of care quality pathways or advanced clinical practice, all to the benefit of patients. Unfortunately, many organizations still don’t understand this, and many PhD nurses continue to be undervalued.
You are revolutionizing nursing research in Italy in both quality and quantity. In the long run, what results do you think this decision will bring?
I believe that, in time, policymakers and other professions will come to understand the value of nursing research, which is not an intellectual exercise to help nurses enter academia, but a service to the patient, their family, and the community. Research, in all fields, leads to progress. In nursing, research aims to improve the lives of patients, so, as I mentioned before, if nurses don’t conduct research, the harm will be done to the citizens, not to the careers of academics.
The academic world is often seen by many of us as an uphill battle, particularly challenging in some parts of Italy. What advice would you give to a PhD student who wants to pursue a career in research?
Yes, it’s true that an academic career is difficult (it took me 10 years to secure my position as an associate professor at the university). The advice I would give is the following:
- Start this journey only if you truly enjoy it;
- Don’t back down in the face of defeat;
- Understand that through your research, though perhaps not immediately, it can benefit patients, their families, and the community;
- Seek guidance from a good mentor.
Doing research doesn’t always mean being a scientist, as part of it also involves politics (academic roles, social commitments, etc.). Do you feel more like a scientist or a politician?
I feel more like a “scientist,” but I must say that access to an academic career is based on one’s research. You cannot become a researcher in academia by publishing little or not advancing research projects. Then, you must also be a “politician” because it’s the politician who makes decisions.
Ten years ago, you were pursuing your PhD, today you are the coordinator of the program—where do you see yourself in five years?
I will most likely continue working on doctoral education. I hope to continue my research activity and, above all, do increasingly useful research.
Strengths and weaknesses of Professor Ercole Vellone?
I wouldn’t know, ask those who work with me…
You are one of the leading experts in self-care at the international level. How much do you think your research has influenced the clinical practice of nurses to date?
I often think about the “fate” of my published work, that is, whether some nurse in the world has been able to use the results of my research in clinical practice. I’m quite familiar with the influence of my work in the research world (it’s quite simple to go on Scopus or Web of Science and see how often your work has been cited), but I know much less about the influence of my work in practice. In recent years, I have been contacted several times by clinical nurses asking to use my tools to assess self-care, and little by little, self-care is probably entering routine care. The proof is that more and more people are talking about it…
How do you think the field of self-care research will evolve in the coming years, and specifically how will artificial intelligence, in light of recent technological advancements, influence self-care?
The future is very interesting and fascinating. With artificial intelligence, it will likely be possible to assess self-care capabilities in a short amount of time and, above all, to tailor interventions as much as possible. In practice, based on the available evidence in the literature on self-care predictors and other interventions that have “worked,” artificial intelligence could provide very precise recommendations about the type of intervention that Mr. Mario Rossi should receive. For example, AI could recommend to the clinician that Mr. Mario Rossi, in order to improve his self-care, should first receive an intervention to reduce depression (because depression is a negative predictor of self-care) and then suggest identifying a support person for Mr. Mario Rossi because a caregiver enhances self-care abilities. Obviously, there’s no guarantee that it will work… but it will be up to research to discover that.