7
Nursing Research

Research training in nursing prepares investigators to create new scientific knowledge to guide nursing practice, assess the health care environment, improve patient, family, and community outcomes, and influence health policy.

The science of nursing is focused on the development of knowledge to: (1) build the scientific base for clinical practice; (2) prevent disease and disability; (3) manage and eliminate symptoms caused by illness; and (4) enhance end-of-life and palliative care.1 As described by Donaldson and Crowley, such research is characterized by three themes of inquiry that relate to human well-being: (1) principles and laws that govern life processes and offer maximum optimum function during illness and health; (2) patterns of human behavior in interaction with the environment in critical life situations; and (3) processes by which positive changes in health status are affected.2 Thus, nursing studies serve to integrate the full range of biobehavioral responses of human beings.

As in many health care disciplines, much of nursing practice is not currently based on high-quality evidence. The major objective of modern nursing science is to develop the knowledge base on which to plan the most effective health care. Such research may range from fundamental basic laboratory research to community-based and translational research to improve care of groups highly susceptible to a range of different diseases.

The prevention of disease or disability is a major focus of nursing research along with a strong focus on health promotion and risk reduction across a wide spectrum of individuals and disease conditions. This approach is well exemplified by the following example of a school-based program adopted by most North Carolina schools. It is a health promotion program in exercise and diet for young children at risk for cardiovascular disease. The research results from this prevention-based program are impressive; the young people’s total cholesterol levels and measurements of body fat were significantly reduced following the education and exercise interventions, and their fitness levels, physical activity, and knowledge about cardiovascular disease risk factors improved.3

Preventing the complications of chronic disease is also a major area for research in nursing. Some of this work develops ways to help individuals and families cope with long-term chronic disease. For example, a program targeting better self-management of Type 1 diabetes examined the effectiveness of specific coping skills; the results of the study showed both improved metabolic control and higher quality of life in adolescents who used the skills. The program has been adopted in more than 100 clinical programs.4

Nursing care and research have traditionally addressed strategies for the management of symptoms associated with illnesses or their treatment. For example, in a study that focused on developing a longer-acting pain medication, investigators found that gender is a major factor in whether drugs are effective. Women responded well to seldom-used kappa-opioid drugs, but men had little benefit from those drugs.5

Influencing, redesigning, and shaping the environment for patients, families, and communities is another major area of study in nursing. Many studies have shown the influence of nursing surveillance and presence on positive patient outcomes. A shortage of nurses, a critical factor in the current health care environment, has been demonstrated to increase patient mortality and morbidity. Other studies show the benefit of home visits by advanced practice nurses in improving the health and quality of life of elders being discharged from the hospital.6

Research in nursing is often referred to as “nursing science” or “nursing research,” which has led some to confuse it with the nursing profession. This terminology exists at the National

1

NINR. 2006. NINR Strategic Plan, Pub No. 06-4832. Online at http://www.ninr.nih.gov/AboutNINR/NINRMissionandStrategicPlan/.

2

Donaldson, S.K., and D.M. Crowley. 1978. The discipline of nursing. Nursing Outlook 26(Feb):113-120.

3

NINR Strategic Plan, 2006, p. 26.

4

NINR Strategic Plan, 2006, p. 27.

5

NINR Strategic Plan, 2006, p. 28.

6

NINR Strategic Plan, 2006, p. 28.



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement



Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.

OCR for page 97
7 Nursing research Research training in nursing prepares investigators to levels and measurements of body fat were significantly create new scientific knowledge to guide nursing practice, reduced following the education and exercise interventions, assess the health care environment, improve patient, family, and their fitness levels, physical activity, and knowledge about and community outcomes, and influence health policy. cardiovascular disease risk factors improved.3 The science of nursing is focused on the development of Preventing the complications of chronic disease is also knowledge to: (1) build the scientific base for clinical prac- a major area for research in nursing. Some of this work tice; (2) prevent disease and disability; (3) manage and elimi- develops ways to help individuals and families cope with nate symptoms caused by illness; and (4) enhance end-of-life long-term chronic disease. For example, a program target- and palliative care.1 As described by Donaldson and Crowley, ing better self-management of Type 1 diabetes examined the such research is characterized by three themes of inquiry effectiveness of specific coping skills; the results of the study that relate to human well-being: (1) principles and laws that showed both improved metabolic control and higher quality govern life processes and offer maximum optimum function of life in adolescents who used the skills. The program has during illness and health; (2) patterns of human behavior in been adopted in more than 100 clinical programs.4 interaction with the environment in critical life situations; Nursing care and research have traditionally addressed and (3) processes by which positive changes in health status strategies for the management of symptoms associated with are affected.2 Thus, nursing studies serve to integrate the full illnesses or their treatment. For example, in a study that range of biobehavioral responses of human beings. focused on developing a longer-acting pain medication, As in many health care disciplines, much of nursing investigators found that gender is a major factor in whether practice is not currently based on high-quality evidence. The drugs are effective. Women responded well to seldom-used major objective of modern nursing science is to develop the kappa-opioid drugs, but men had little benefit from those knowledge base on which to plan the most effective health drugs.5 care. Such research may range from fundamental basic Influencing, redesigning, and shaping the environment laboratory research to community-based and translational for patients, families, and communities is another major research to improve care of groups highly susceptible to a area of study in nursing. Many studies have shown the range of different diseases. influence of nursing surveillance and presence on positive The prevention of disease or disability is a major focus of patient outcomes. A shortage of nurses, a critical factor in nursing research along with a strong focus on health promo- the current health care environment, has been demonstrated tion and risk reduction across a wide spectrum of individuals to increase patient mortality and morbidity. Other studies and disease conditions. This approach is well exemplified by show the benefit of home visits by advanced practice nurses the following example of a school-based program adopted by in improving the health and quality of life of elders being most North Carolina schools. It is a health promotion program discharged from the hospital.6 in exercise and diet for young children at risk for cardiovas- Research in nursing is often referred to as “nursing science” cular disease. The research results from this prevention-based or “nursing research,” which has led some to confuse it with program are impressive; the young people’s total cholesterol the nursing profession. This terminology exists at the National NINR. 2006. NINR Strategic Plan, Pub No. 06-4832. Online at http:// NINR Strategic Plan, 2006, p. 26. 1 3 www.ninr.nih.gov/AboutNINR/NINRMissionandStrategicPlan/. NINR Strategic Plan, 2006, p. 27. 4 Donaldson, S.K., and D.M. Crowley. 1978. The discipline of nursing. NINR Strategic Plan, 2006, p. 28. 2 5 Nursing Outlook 26(Feb):113-120. NINR Strategic Plan, 2006, p. 28. 6 

OCR for page 97
8 RESEARCH TRAINING IN THE BIOMEDICAL, BEHAVIORAL, AND CLINICAL RESEARCH SCIENCES Institutes of Health (NIH) in the name of the National Institute 62.5 years—clearly limiting the productive years for nursing for Nursing Research (NINR); however, the funding from science and health practice in general. Nurse-investigators NINR supports scientific research relevant to the science of tend to have a shorter career span, thus limiting the develop- nursing, and the investigators may be nurses or non-nurses. ment of nursing science and its application to nursing prac- The conditions needed for training in nursing research tice. Clearly a major driver in the short career span is the late described in the 2005 NRC report hold true today: stage at which nurse-scientists receive the Ph.D. The fact that Ph.D. training for nurse-scientists occurs Research training for nurses, as for other biomedical and be- at such an advanced age (current assistant professors in havioral researchers, needs to occur within strong research- nursing schools received the Ph.D. when they were 42.9 intensive environments that typically will be in universities years) is a direct consequence of the traditional model for and schools of nursing. Important characteristics of these nurse-scientist training. The current path from the R.N. to the training environments include an interdisciplinary cadre of Ph.D. can be remarkably tortuous. After receiving the B.S.N. researchers and a strong group of nursing research colleagues degree, nurses are encouraged to work in clinical practice, who are senior scientists with consistent extramural review and indeed a subsequent application for admission to an and funding of their investigative programs and obvious pro- M.S.N. program often requires several years of work experi- ductivity in terms of publications and presentations. These ence. Again, after receipt of the M.S.N. degree, a period of elements are essential to the environment required for excel- additional clinical exposure is customary before entering a lence in research training. (NRC, 2005, p. 73) Ph.D. program. In addition, 65 percent of such doctoral stu- dents are unfunded (or only partly funded), and it is likely To encourage the development of research training in that these students work to cover their expenses. As a result, nursing, NINR devotes at least 7 percent of its funds to graduate students in nursing spend 8.3 to 15.9 years earning research training—about double what is found in other their doctorate after entering a master’s program,8 and the Institutes. The committee supports this priority as critical to committee sees no sign that this trend is being reversed. the future of nursing research. One way to help address this problem is to reduce the number of interruptions that nursing doctoral students ChaNgiNg the Career traJeCtory experience. Once students enter undergraduate programs in for NurSe-SCieNtiStS nursing, students with interests in science should be identi- fied early and encouraged to consider doctoral education and Changing the career trajectory for nurse-researchers research. They should also have a chance to interact with involves three major efforts: (1) enhancing sustained pro- nurse-scientists early in their undergraduate years. Several ductivity for nurse-scientists to promote an earlier and such programs have already been created. more rapid progression through the educational programs In order to move undergraduates directly into doctoral to doctoral and postdoctoral study; (2) responding to the education, nursing programs need to dispel the myth that stu- shortage of nurse-investigators by increasing the number of dents need clinical practice before entering graduate school. individuals seeking doctoral education and faculty roles; and In fact, students interested in a research career may be best (3) emphasizing research-intensive training environments, served by not earning a master’s degree first, as is the case including increased postdoctoral and career development in many scientific fields. In addition, certification require- opportunities. ments for advanced practice may add two years to master’s programs, further postponing entry into doctoral education. eNhaNCiNg SuStaiNed ProduCtity Funding that supports concurrent clinical and research train- for NurSe-SCieNtiStS ing (similar to the MSTP) may facilitate movement into and through doctoral education. Nurse-scientists play a critical role in the conduct of The origins of the current educational structure in nurs- research and the generation of new knowledge that can serve ing and the hurdles it creates are summarized in the 2005 as the evidence base for practice and the improvement of report: patient health outcomes. However, nurses enter Ph.D. pro- grams mostly at a substantially later age than in any other Nursing developed both its Ph.D. and its D.N.Sc.9 programs biomedical or clinical science, limiting their years of potential to build on the master’s degree in nursing as well as to accom- scientific productivity. Faculty in many scientific fields start- modate breaks between degrees for clinical practice. Early ing their careers in their mid-30s may well have a research career of 30 to 40 years (to age 65-75). The average age of doctorally prepared nurse faculty, however, is 55.6 years National Opinion Research Center. 2001. Survey of Earned Doctorates. 8 [AACN data online]7, and the average age of retirement is Unpublished special reports generated for the American Association of Colleges of Nursing. Chicago, IL: AACN. McEwen, M., and G. Bechtel. 2000. Characteristics of nursing doc - 9 AACN. Special Survey of Vacant Faculty Positions for Academic Year toral programs in the United States. Journal of Professional Nursing. 7 2009-2020. Available at http://www/aacn.nche.edu/ids/pdf/vacancy09.pdf. 16:282-292.

OCR for page 97
 NURSING RESEARCH reSPoNdiNg to the Shortage of reliance on the master’s degree is understandable in that NurSe-iNveStigatorS it was nursing’s highest degree for many years before the establishment of a significant number of research doctoral It has been well established that not only is there both a programs. As doctoral programs were developed, they built current shortage but also there is a projected continued short- on the master’s content, which at the time was predomi- age of nursing faculty, especially those who are scientists nantly research and theory focused. Over time the master’s programs have changed to become primarily preparation for and researchers. At this time, approximately 50 percent of advanced clinical practice, yet nursing continues to require the faculty teaching in nursing baccalaureate programs are the master’s degree for entry into doctoral study in most doctorally prepared [AACN].10 This represents a marked programs. Currently, very few doctoral programs in nursing increase from the 15 percent in the late 1970s. This 50 admit baccalaureate graduates directly into the program, and percent level was reached by 1999, but it has not increased for those that do, the master’s degree is usually required as a since then despite a large increase in the number of doctoral progression step. This requirement for entry into the Ph.D. degree programs available to nurses during the same time program makes the group of advanced nurse-practitioners, period. This is a reflection of two factors: (1) other than a rather than baccalaureate students, the major pool from modest increase in the number of doctoral degrees earned in which applicants are recruited into research. This is problem- 2007 and 2008, the yield of Ph.D. degrees has been largely atic in that this practitioner pool has the same demographic static (even though the number of programs has increased, as characteristics as the profession and thus is older in average age and more limited in diversity compared to applicants shown in Table 7-1), and (2) the older age of graduates. The for science Ph.D. programs in general. Incorporation of the combination of these two factors suggests that an increasing clinical/professional content from the master’s degree as number of doctorally prepared faculty will retire in the next foundational to the Ph.D. in nursing also encourages faculty few years, but there will not be an adequate number of new to recruit and teach only nurses. Currently there are only a Ph.D.s to replace them. Nursing programs will be left with few doctorate programs in nursing that admit non-nurses. too few faculty members to conduct research and educate the Even though there are other fields that require a master’s next generation of scientists. degree as a requirement for earning the professional research A 2009-2010 Special Survey of Vacant Faculty Positions doctorate, such as the M.P.H. for the Dr.P.H., the master’s conducted by the American Association of Colleges of degree has a completely different meaning relative to the sci- Nursing (AACN) indicated that 90.6 percent of the vacan - ence Ph.D. degree. The master’s degree is usually awarded cies require an earned doctoral degree [AACN],11 yet gradu- as a “consolation prize” for students who are unable to com- plete the requirements for the science Ph.D. By making the ation rates from nursing doctoral programs are relatively master’s degree a requirement for its Ph.D. program, nursing flat. If there is any hope of filling a significant number of has created confusion as to the meaning of the degree outside these faculty positions, both the NIH and nursing schools the nursing profession. (NRC, 2005, p. 74) will need to provide incentives to increase the number of nurses who select a research career, and to do so early in Nursing is both a practice profession that requires practi- their professional development. tioners with clinical expertise and an academic discipline and science that requires independent researchers and scientists CharaCteriStiCS of NurSiNg Program from to build the body of knowledge. Each has a separate set of the reSearCh-doCtorate Study educational needs and goals. To improve the productivity and research focus of the Ph.D. in nursing, doctoral programs The data in this section come from the NRC Research- need to be structured to admit students directly from bac - Doctorate Study. The data from the study are valuable, calaureate programs, to admit non-nurses, to decrease the because they provide unique information on program, fac- number of years from high school to Ph.D. graduation, and ulty, and student characteristics. Although not time series to expand the interdisciplinary scope of their programs and data, they do provide a snapshot of nursing programs in research topics. 2006. Data were collected from 55 of the 85 programs that As outlined above, there is no consistent research career awarded Ph.D.s in nursing in 2006. Not all Ph.D.-granting trajectory evident among practicing scientists in nursing institutions agreed to participate in the study, and only pro- today. The common thread is that they entered their doctoral grams that averaged one Ph.D. or more per year submitted programs later than most other scientists, and the majority data. But these 55 programs educate a large proportion of have not benefited from postdoctoral education. As such, the Ph.D.s in nursing, and their characteristics are generally they bring with them rich clinical experiences that may help representative of nursing programs. The data support the shape the focus of their inquiry. In addition, when nurses complete their doctoral education, most move directly into AACN. 2009. American Association of Colleges of Nursing. 2008- an academic career. There they frequently encounter a set- 10 2009 Enrollment and Graduations in Baccalaureate and Graduate Programs ting in which the demands for teaching and lack of pervasive in Nursing. Washington, DC: AACN. Pub. no. 08-09-1. research programs, socialization, and further mentoring AACN. Special Survey of Vacant Faculty Positions for Academic Year 11 make continuing progress as a scientist difficult. 2009-2020. Available at http://www/aacn.nche.edu/ids/pdf/vacancy09.pdf.

OCR for page 97
00 RESEARCH TRAINING IN THE BIOMEDICAL, BEHAVIORAL, AND CLINICAL RESEARCH SCIENCES TABLE 7-1 Nursing Doctorates from U.S. Institutions, 1997-2008 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Number of Doctorates 420 399 353 414 363 437 413 394 422 415 483 505 Number of Males 13 17 14 15 24 23 35 18 35 33 35 43 Number of Females 406 380 337 399 335 414 378 376 387 382 448 462 Minorities 24 22 29 21 31 30 38 42 35 42 43 51 Citizenship U.S. Citizen 356 336 296 344 290 350 337 316 320 339 392 412 Permanent Resident 11 11 8 9 10 7 7 11 9 11 11 14 Temporary Resident 40 33 36 45 48 49 50 51 55 52 53 49 Unknown Status 13 19 13 16 13 2 5 5 10 4 6 6 Postdoctoral Plans Postdoctoral Fellow 12 12 7 20 23 29 21 23 21 37 22 33 Postdoctoral Research 2 3 3 5 8 9 8 6 8 6 5 8 Postdoctoral Trainee 0 0 0 1 0 1 2 0 2 1 2 2 Other Study 0 3 6 4 5 5 2 4 2 9 2 2 Employment 242 211 195 218 189 225 203 193 199 212 255 251 Other Plans 5 11 4 8 5 10 5 4 2 8 3 7 Unknown Plans 39 45 24 19 26 46 28 21 24 26 30 30 SOURCE: NSF. 2008. Surey of Earned Doctorates, 008. Washington, DC: NSF. finding elsewhere in this chapter concerning the aging of the would suggest that either assistant professors in nursing are faculty, the late age at which students receive a doctorate, staying longer in this rank than in other sciences, or they tend and the need for additional training support at the doctoral to move out of the assistant professor faculty role into clinical and postdoctoral levels. positions at a significant rate, to be replaced by new Ph.D.s. A final possibility is that in 2006 the number of assistant professors of nursing increased rapidly by absorbing many the faculty of the newly minted Ph.D.s, although viewed historically There are 1,471 faculty members in these 55 programs this seems unlikely. and the average size is 26, varying from a minimum of 8 to The average age of the faculty is 54, and 26 percent of the a maximum of 110. As is true of the profession in general, faculty are 60 years old or older. The age at time of degree the faculty members are primarily female (7 percent male), for new assistant professors is 42.9 years, and for associate and 14 of the programs have an all female faculty. Only professors it is 39.9 years. The professors who received their 10 of the faculty with known citizenship were temporary degree even earlier were on average 35.9 years old when they residents. Most of the nursing faculty (88 percent) had an completed their doctorate. Again this is consistent with the appointment in the nursing department or school, and only trend noted earlier in this chapter. Of the faculty who provided 12 percent were neither tenured nor on the tenure track (see information about postdoctoral training, 30.1 percent had at Table 7-2). The percentage of assistant professors in other least one postdoctoral appointment and 7.4 percent had more sciences ranges from 15 percent to 21 percent, and in nursing than one appointment. As would be expected, faculty mem- 31 percent of the tenure-track faculty are in that rank. This bers with more recent doctorates were more likely to have TABLE 7-2 Tenure and Rank Status of Nursing Faculty Rank Non-Tenured Non-Tenure Track Non-Tenured Tenure Track Tenured Total Assistant Professor 84 310 8 402 Associate Professor 40 49 343 432 Professor 40 4 535 579 Emeritus 2 15 17 Other 14 1 3 18 Total 180 364 904 1448 SOURCE: Dataset for the NRC Research-Doctorate Study.

OCR for page 97
0 NURSING RESEARCH postdoctoral training with 31 percent receiving their degree in funded training grants, and 17 percent of the students were the period 1997 to 2006. This also is likely contributing to the supported on these grants. A small percentage, 9 percent and increasing age of assistant professors on nursing faculties. 7 percent, respectively, were supported on research assistant- A majority, 64 percent or 801 of the nursing faculty, have ships and teaching assistantships. In addition to predoctoral extramural funding, and these grants support 810 students training activities, 24 of the 55 nursing programs in the fall either totally or partially. The average number of publica- of 2005 supported 99 postdoctoral trainees. tions per faculty per year during the period 2000 to 2006 was about 0.5 in nursing, which is much lower than seen in emphasizing research intensive training environments other fields in the biomedical sciences, where the range is between 1.3 and 1.9. Typically funded by the NINR, research training for nurse scientists has uses a variety of National Research Service Awards (NRSAs) and Career Development K awards. Indi- the trainees vidual predoctoral awards (F31) have been slowly increasing, In the fall of 2005, 2,176 students were enrolled in 55 but there are very limited numbers of individual postdoctoral doctoral programs, and the first-year enrollment was 442 awards (F32). In contrast, the institutional NRSAs (T32) ini- students. As is the case with the profession, 94 percent of the tially grew considerably over time, but since 2003 there have doctoral students were female. In addition 12 percent were been no steady increases in the number of slots supported underrepresented minorities, and 10 percent were temporary (see Figure 7-1). There were 245 trainees supported in 2009 residents. The enrollment status of the students is very differ- (156 predoctorates and 62 postdoctorates), which represents ent from other fields, with 1,294 (59 percent) full-time and a decline from 2003. 882 part-time. For full time-students the time to degree was The institutional and individual research training awards 3.8 years. One of the 55 programs had an M.D./Ph.D. program under the NRSA program both serve an extremely valu- with an enrollment of 3 students. able purpose in nursing research and should continue to The level of full financial support for nursing students be funded. Individual awards build scientific capability, in 2006 was only 35 percent, and 27 percent of the students and T32 institutional awards build a cadre of strong senior received no support. Presumably many of these graduate researchers. The individual predoctoral awards (F31), if students worked to offset all, or part, of the cost of their allocated for up to 5 years per award, will support full-time, education. A total of 37 of the 55 programs had externally consistent progression for research training. 30 0 Predoctorate Postdoctorate 250 78 77 71 65 66 200 60 62 Number 150 10 0 199 188 176 175 169 161 156 50 0 2003 2004 2005 2006 2007 2008 2009 Year FIGURE 7-1 Training positions at the postdoctoral and predoctoral levels. SOURCE: National Institutes of Health. 7-1.eps

OCR for page 97
0 RESEARCH TRAINING IN THE BIOMEDICAL, BEHAVIORAL, AND CLINICAL RESEARCH SCIENCES As outlined in the 2005 report, several changes to the T32 fields, however, and the need for strongly research-prepared awards would strengthen them: faculty to concentrate on the science necessary for practice, the committee believes that expanding such awards would • T32 awards should be placed only in research-intensive benefit the field. universities with strong interdisciplinary opportunities and research funding, and interdisciplinary activities should be reCommeNdatioNS a critical aspect of the initial NRSA application and annual reports. In addition to the recommendations which cross disci- • T32 awards should be allocated only to schools with plines, the committee recognizes that the graying of the research-intensive environments including a cadre of senior professoriate and need for nurse-scientists is particularly investigators with extramurally funded research and research acute in nursing. infrastructures that support research and research training. Recommendation 7–1: T32 programs in nursing should • The application process for T32 positions as predoctoral emphasize the rapid progression into research careers. trainees or postdoctoral fellows should be more formalized, Criteria should include identification of predoctoral with specific proposals submitted in relationship to their trainees who are within 8 years of high school graduation, research and the match with faculty at the institution made streamlining the master’s degree in passing to the Ph.D., explicit. and postdoctoral training within 2 years of completion • Criteria for selection of T32 fellows and trainees should of the Ph.D. be based on a consistent, full-time plan for research train- ing and long-term potential for contribution to science and Recommendation 7–2: T32 awards should focus on pro- nursing. grams where students and fellows have the opportunity • The monitoring and tracking of trainees and fellows to work with senior scientists, and applications to slots should be formalized with changes in research plans or should require applicants a specific research and mentor- mentor(s) filed as part of the annual report. ing plan. A growing number of nurse-investigators are receiving K Recommendation 7–3: NINR should increase the num- awards from NINR through the following mechanisms: K01 ber of mid- and senior career awards to enhance the Mentored Research Scientist Development Award; Minority number of scientists capable of sustaining programs of K01, Mentored Research Scientist Development Award for research and should increase the length of support for K Minority Investigators; K22, Career Transition Award and awards to 5 years to be consistent with other institutes K23, Mentored Patient Oriented-Research Career Develop- and centers. ment Award; and K24, Mid-Career Investigator Award in Patient Oriented Research. In addition, other NIH institutes Recommendation 7–4: Given the size of the NINR budget and centers support nursing research through the K mecha- and the acute need for nursing faculty, the NIH should nisms, because elements of nursing research are intrinsic to consider an infusion of support to allow NINR to more other fields. closely meet the needs. Recently, NINR staff have been advising potential K awardees to apply instead for small R-series awards. To Recommendation 7–5: To enhance the rapid progres- compete in an era of limited research dollars, the availability sion for clinical scientist training, NINR should develop of these early and mid-career awards needs to be increased and pilot-test an MSTP-like program to support clinical and encouraged. There is little systematic information on the training at the M.S.N. or D.N.P. level for those wishing outcomes of these awards, e.g., successful research grants to be clinician-scientists. and publications by awardees. Based on the success in other