National Institutes of Health

The National Institute of Nursing Research as part of the National Institutes of Health (NIH) funds research on the nursing profession and nursing service delivery systems as well as nursing care outcomes. One result of nursing practice and preparation studies is skill mix, which is the use of various levels of nursing knowledge and clinical competence. Other federal agencies, such as the National Institute of Mental Health, National Institute on Aging, the Maternal and Child Health Bureau, the Agency for Health Care Policy and Research, also fund projects involving nurses. These projects can influence nursing education by recommending or making changes in recommended health care practices and nursing care systems.

Many outcomes studies provide evidence for the basis of health policies that affect health care systems, priority setting, and reimbursement to providers, including nurses. However, conclusions based on the results of these studies are oriented more toward the future of nursing than to the basic preparation of nurses. One such conclusion is the need for an increase or decrease in the nursing workforce that is prepared for certain areas such as primary care.

Federal and state environmental policies and agencies help to shape the practice of nursing, but they also have an informal or indirect effect on education programs. For example, if agencies or institutions are hiring only nurses with nurse practitioner certification, educational programs must increase their capacity to teach these students who are requesting this preparation. Otherwise, their enrollments may substantially decrease.

Federal and state agencies remain a critically important resource for all of nursing. For example, environmental epidemiology, especially the study of hazardous waste sites in the United States, determines the nature and limitation of available data on environmental contaminants related to hazardous wastes sites. In addition, federal (e.g., the U.S. Environmental Protection Agency, National Institute of Environmental Health Sciences, and the U.S. Department of Energy) and state agencies are continuously involved in the process of defining which chemicals in the environment are of concern for human health or the levels at which action should be taken to protect human health (NRC, 1991). Such information, although it does not directly influence nursing curricula, can be a source for data and material (e.g., the TRI [Toxic Chemical Release Inventory] database with its user-friendly software) that would be valuable for the enhancement of nursing education, including continuing education programs for nurses in the field.

Federal agencies provide specific "packages" for the education of



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