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7 NVESING RES MACH wi th the ena ctment of the Health Re search and Health Services Amendments of ~ 976 (PL 94- 278 ), NRSA training authority was extended to incl ude for the f irks tire the research training programs administered by the HERA Division of Nursing. In contrast to the basic science training support avail able to nurses through the ROSA programs of NIH or ADAMHA 3 the programs of the Division of Nursing are intended exit Acidly to prepare the nurse "to conduct scient~ fic inquiry in disciplines that have relevance in nurs ing theory and practice" (Appendix N4 ~ . Research training support has been provided to nurses since ~ 955 through special fellowships awarded by the NIH under ~ he general research authorities of the Public Health Service Ace. Between ~ 955 and ~ 974, a total of 589 nurses rece ive d pre doct oral f e l lowsh ip support f or varying per iods of time. In that period, 330 completed requirements for doctoral training in such fields as education (95 nurses}, educational psychology (17), educational administration (9), behavioral sciences (89), biological sciences (21), epidemiology (13), and statistics (3) (Bourgeois, 1975). T n 1962 Obese research training opportunities were expanded to ~ nclude an institutional training grant program that provided stipends to nurses to take up doctoral research training in a variety of areas. Training funds provided institutional support at the same time to basic science departments in such fields as anthropology, sociology, microbiology, anatomy, operations research, and clinical nursing (Matarazzo, 1971~. Table 7.1 shows the number of traineeships awarded since 1968 through these institutional training grants, as well as the number of fellowships provided during that period. Until July 1963, responsibility for research training was shared jointly by the Division of Nursing and the NIGMS ~ n the NIH. After that time, full responsibility for such training was giver. ~ o the Division of Nursing, currently de si gnat ed a component of the Bureau o f Health Manpower in the HRA (Bourgeois, 1975). In recent years the the Division of Nursing has had neither research funds nor legislative authority for research training, with the result that the overall size of research training programs has been reduced {see Table 7. 1) The s situation was exacerbated in part by the fact that the 150

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TABLE 7.1 Number of Full-time Equivalent Traineeships and Fellowships in Nursing Research Awarded by the HRA Division of Nursing: FY 1968-718 Fiscal Year TOTAL 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 (est) . . _ 170 210 217 260 213 208 149 109 35 115 62 71 83 88 95 91 64 61 23 13 Fellow 108 139 134 172 118 117 85 48 12 102 unpublished data provided by HRA Division of Nursing, May, 1977. Division was not included in the NRSA legislation of ~ 974 (which restricted research training support to the programs of the NIH and ADAMHA} . However, with the avai lability of HRSA funds Who s year, significant increases in the number of awards have been achieved in FY 1977, thus revitalizing this program of research training. Iwo decades have elapsed since the first fellowship awards were made by NIH in nursing research. During that time a number of significant changes have taken place in nursing research that bear on the future direction of training under the auspices of the NRSA program. The nursing profession has greatly intensified its commitment to research relevant to nursing practice and patient care (SchiotfelOt, ~ 975} . This is evident not only in the proliferation of research by nurses on problems encountered in nursing practice (Gortner, 1975}, but also in the rapid increment in recent years in the number of nurses s "ek ing doct ore ~ tra in ing in area s relevant to nur sing care (Leininger, ~ 976) . In the sections that follow the Committee has sought to address: (~} the current trends in nursing research that bear on the future course of research training provided through the programs of the Divi sion of Nursing, ~ 2} the changing status of doctoral training for nurses, and (3) the factors of supply and demand that influence the future growth of research training in this area. i5:

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THE NATURE OF NURSING RESEARCH Nursing research focuses on the rod e of nursing care in the prevent ion of illness, care of the sick, and the promotion and restoration of heal th. Although it reties upon and util izes the substantive scienti fic information and m~thodo~ ogy provided by the other Viol ogical and behavioral sciences, it differs from those other scientific areas in that it focuses on their relevance to nursing rather than other aspects of health care. By tradition, na tura l inc li nation, and previcu s ~raining, nurse s have a specie ~ intere st in and potential competence f or resea rch in this area and it is natural that they should wish to play a part in its advancement. Nurses view health problems differently and direct the results of then r research to quite different audiences than other biomedical and behavioral scientists. Hence, nursing research is usually done by nurses. The Committee therefore concurs that nursing research i s properly regarded today as a di stinct area of scientific inquiry. CURRENT TRENDS IN NURSING RESEARCH To understand the history that has led to nursing research as it is conducted today, one must begin with the important role pi eyed by Florence Nightingale, "a person who not only he ~ ~ broad concepts about nurse ng and the role of the nurse, but who also exemplified the research approach (in nursing} " (Gortner and Nahm, ~ 977) . It was she who sought to ~ earn What factor s were related to varying recovery (of patients}, morI:3id~ty and mortality rates... (ana who) clearly corrununicated over a century ago the need for measuring outcomes of both medical and nursing care" (SchictfelOt, 1 975) . Following the proliferation of state requirements for the licensure of nurses at the beginning of this century, 2 a need developed for the systematic assessment of the general procedures used by nurses ire patient care (Gortner and Nahm, 1977~. This is evident in the literature of nursing care, which was dominated largely by descriptive studies during the ~ 93 0 ' s and ~ 9 40' s . It was federal interest in nursing practice after World War II that further stimulated research focus' ng on specific clinical skills. 3 By the 1950's, assessments were forthcoming on the role of the nurse in psychiatric services, pediatric care, maternal and child health care, and Fraternity care (Nahm, ~ 957) . The case study method contributed to a shift away from a primary cone ern with professional procedures to an interest in the rod e of the patient in nursing care (Mauksch and Mauksch, 19501. Coon nursing research expanded to include studies on the psychological, social, and physiological 152

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phenomena that affect the individual' s approach to health or ability to cope with threats to well-being, as treated by the nurse (Sch~ otfe~ Ot, ~ 972) . This new research emphasis was given Impel us in 1952 with the appearance of a journal entitled Nurse nq_Research. This journal solicited studies on such topics as child care during hospitalization and the effects of unrestricted versus restricted visiting on patient recovery. In ~ 960, the American Nurses' Association established a ~ ist of priorities for nursing research that reflected these new emphases . This list included the ef fects of the performance of nursing acts on patient care, nursing needs of patients, and nursing in different categories of illness, such as that who ch requires surgi Cal care (e . g ., Blake, 1962) . As nursing research grew from a concern with the organization and practice of nursing to a broader treatment of the general ~ mpairments that accompany heal th problems, such as pain, anxiety, and suffering and the specific needs of patients and potentia ~ users of the health care system {Gortner, Bloch, and Phillips, ~ 976), the avai ~ ability of federal support played a major role in the development of nursing research as an area of scientific inquiry. As early as 1958, the Division of Nursing awarded Faculty Research Development grants to schools of nursing to fund the acquisition of needed research equipment and to support research faculty. In 1966, this program phased out, and in its place a program of institutional research support was initiated, since it was felt that ''many of the original goals of the early faculty development had been achieved" {Gortner, 19731. However, the pressures for highly qualified faculty and clinicians in recent years have led to separate authority for advanced nursing training under the Nurse Training Act of 1975 (PL 94-63) ,4 to "plan, develop and operate; significantly expand or maintain existing" graduate ~ programs In nursing. In addition to faculty support, other extramural research grants and fellowships have fostered the expansion of nursing research (Figure 7.1 and Gortner, 1976~. In FY 1977, research support through the Division of Nursing will peak at $5 million, with an additional $1 million available for research training.s In testimony before the U.S. House of Representatives Subcommittee on Public Health and Environment in 1975, a representative of the American Nurses' Association identified four problem areas as high priorities for nursing investigators today {cle land, 1975), many of which are shared by investigators from other fields. These areas demonstrate the continued expansion of nursing research: (~) studies to reduce comply cations of hospitalization and surgery ~ sleep 153

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4000 ID ~ 3000 o 2000 1 000 Total Nursing Research Nursing Research Project Grants - Special Fellowships in Nursing Research Nurse Scientist Graduate Training Grants O 1956 1958 1960 1962 1964 1966 FISCAL YEAR /_ ~ _' ~ ,- 1 1 1 1968 1970 1972 1974 FIGURE 7.1 Total annual expenditure for extramural nursing research and research training, FY 1956-75. From HRA (1976). 154 .,

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deprivation, anorexia, neurosensory imbalances, eta . ); {2) studies to improve the outlook for high- risk parents and high-risk infants; (3} studies to improve the health care of the el derly; and (4) studies of life--hreatening situations, anxiety, pain, and stress. In a statement before the President's Pane] on Biomedical Research in the same year, a number of other areas were added to the s list of priory ties {J"cox and Walike, ~ 975} studies of adaptation to chronic i, Iness and "he development of self-care systems; (2} (3) studies to f a ci litat e the suc ce s s ful utile ization of new technological Bevel operant in patient care; and studies of effective intervention in community mental health settings. : It is Cal ear that nursing research today reflects "he role of nursing care in addressing questions that arise from the treatment of disease, the prevention of =1 Iness, and the maintenance of heats h (American Nurses' Association, 1976) . With federal research funds directed to schoc~ s of nursing, and a renewed interest in providing federal monies for faculty development, research by nurses has become firmly established in school s of nursing. There has been a significant expansion in the number of nurses seeking doctorates in basic science departments outside schools of nursing in recen'_ years, and also an increase in the number seeking doctoral training in nursing research, as it is now beginning to be provided through schools of nurs ing. DOCTORAL TRAINING IN NURSING RESEARCH In contrast to the medical or dental professions, in which a doctoral e is conf erred on the individual completing professional training, the baccalaureate in nursing is usuall y the h ighe st ace demi c degre ~ awarde ~ to the nurs e to complete professional training. There are over ~ million registered nurses in the United States today with professions ~ nurse training (American Nurses' Association, ~ 976) . While the first basic programs in nursing ~ eading to a baccalaureate were established in ~ 55

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1909 (B. auch, ~ 955), it was not until the 1950' s that an expansion in the number of ins' itutions offering baccalaureate training was evident (Matarazzo, 1971~. Today ~ here are over 1, 400 programs ire the United States offering professional training in nursing. Of these 1, 400 programs, more than 350 offer a nursing diploma after training at a hospital, about 640 offer an associate of arts degree after course work In a community or Eunice college, and about 340 offer a baccalaureate or higher degree. In addition there are 100 nursing programs that offer a masters degree to students who are registered nurses and 16 that offer the doctorate (National League for Nursing, ~g761. As efforts were mad" to enhance the quality of nursing care through advanced education, i' was apparent that there was a critical shortage of doctorally trained nurses to provide the necessary leadership in schools of nursing through research and teaching (Leininger , ~ 97 4 ~ . Even today there are ~ ess than 2, 000 registered nurses who have completed doctoral education, scarcely more than an average of one doctoral ly trained nurse for each school Of nursing in the United St ates (Jacob and Hansen, 1976) . Indeed, the f irst Ph. D. awarded to a nurse was in the field of psychology and counsel ing in 1927 (Matarazzo, 1971~ . In ~ 973 it was estimated that, of the 1, 020 nurse doctoral es who completed their advanced training between ~ 92 7 and ~ 97 3, 5 07 held Ph. D. ' s in a variety of basic sciences and: nursing, 4 ~ 7 held Ed. D. ' s, and 39 held doctorates in ~ variety of other fief ds ~ ncluding medicine and law (Pitel and Vian, 1975~. Today there is lit ~ le consensus as to the appropriate doctoral training for the nurse (sch. otfelOt, 1971), but f ive options may be said to be general ly available: ~ ~ ~ doctoral training in nursing denoting preparation in areas emphasizing clinical skills (D.N., D.N.S., D.N.Ed., DPHN}, (2) a Ph.D. in nursing with a minor in a basic science field re~ ated to nursing, {3) a Ph. D. in science with a minor in nursing, (4) a Ph.D. in a science relevant to nursing with DO concurrent training in nursing, and (51 a professional doctorate in such fields as education (Ea. D. ~ . Despite the variety of options available to the nurse seeking advanced doctoral training, the ma jority of nurses with doctors be s have completed their training in non-nursing areas, such as education or the basic biological or behavioral s cienc es. Hence, there is a growing trend within the profession of nurs ir.g to upgrade the type and number of doctoral programs ire school s of nursing (Ph.D. in nursing) that would assure doctoral- level training on problems of direct interest to nursing research (Leininger, ~ 977) . For example, while there were ~ 4 doctoral degree programs in nursing in ~ 97 6, it i s expected that this wit ~ increase to over 20 new or modified programs by 1981 (Leininger, 1976~. 156

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The changing status of doctoral training in the prof ession of nursing has imps i cations for the future course of research training through the NRSA programs administered by the Division of Nursing. Both the special research fed ~ owship program, which was initi aged in ~ 9 5 5, and the research training grant program, which originated in ~ 962, must be redirected to ~ eke into account the growth of nurs ing research as a di strict area Of scienti f ic enquiry and its recen' growth in programs of training in schoc~ s of nursing. The Committee will treat the implications of these trends more full y in the section on recommendations for future MESA Bevel opment. ASSESSMENT OF THE LABOR FORCE The rapidly growing interest in doctoral trai n ing among nurses is evident i n the fact that nearly one-third of nurses who hold doctorates compl eted their training between 1971 and ~ 975. In the f ace o f this rapid expansion in the number Of doctoral ~ y trained nurses, the Committee sought to assess the extent to which the market has been able to absorb these emerging doctorates. Focusing on recent doctorates, the survey instrument that had been designed to assess the market for biomedical and behavioral science doctorates (see Chapter 3 and 4, and Suppl ement 6} was sent to the 551 nurses who earned doctoral degrees between 197 ~ and ~ 975. About 78 percent of these nurses responded to the survey. Responses from this group indicated that nurses with recent doctorates have had no difficulty in finding positions in academia. In fact, the unemployment rates and other factors revealed that the employment opportunities for nurs es were better than the opportunities for other biomedical and behavioral scientists: An average of only O. ~ percent of the nurses' ~ ime since earning a doctorate has been spent in search of a job (Appendix I 2~. Almost 9 5 percent of these graduates held ful ~ -time po sit ion s, whil e on ly 1.5 were seeks ng empl oyment in October 1976 (Appendix I 3). Al 1 but 3 percent o f the nur se s i n the labor force hel ~ posits ons for which they considered their doctora tra ining re levant (ApFendi x I 1 0 ~ . 157

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. More than 9 0 percent of the nurses were employed in educational institutions; the largest number of these worked in nursing schools, two- year colleges, or universities (Append) x ~ 4) . An average of 7 0 percent of the nurses' time was spent in teaching and administrative activities, with only 3 percent devoted to research (Appendix I 5). More than three-fourths of the nurses were currently engaged in some research acts ark ty, and 95 percent of ~ has e employed f ul l-time considered their predoctoral research experience useful to their present responsibilities {Appendix I 9~. As me ght be expected, almost all of those doing research cons ide r Ed the i r work di rectI y or indi rectly related to health (Appendix ~ 6 ~ . About one-third of all these researchers, and 41 percent of those who had received BRA predoctoral training support, were being funded }:y federal research Grants and contracts, but none of the respondent nurses hall postdoctoral appointments at the time of ~ he survey. In contrast with other biomedical and behavioral scientists, doctoral nurses received more federal training support in the f irst two years of graduate school than in 1 ater years (Appendixes I ~ ~ . ~ and ~ ~ . 2) . Although 4 ~ perc ent of ~ he nurses relied on f ederal Draining funds as their primary source of support in their fourth year of gra due ~ e s choo I, an almo s t equa ~ number re ~ fed on per s one resources. Approximately 60 percent of those who had rece ived any f ederal support whi le in gradual e school indicated that without such support they would not have been able to f inish their doctoral program (Appendix I ~ 2} . However, only 30 percent of the nurses felt that the availability of financial assistance had influenced their se Sect ion of a doctoral f ield (Appendix I ~ 3} . Ire seminary, tiles e findings suggest that opportunities for the employment of doctoral ly trained nurses are very favorable at this time. 158

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OUTLOOK FOR THE LABOR< MARKET IN NURSING RESEARCH There is an uneven distribution of nurse-doctorates among schools of nursing tcday. Indeed, it has been estimated that nurse faculty varies from one faculty member with a doctorate at some schools to 28 In other schools of nursing as of February 1974 (Leininger, 1976~. In its 1977 report, the Western Interstate Commission for Higher Education (WICHE) Projected a large need for doctorally prepared nurse faculty in future years, as indicated in the findings from a survey of a number of schools of nursing in the western portion of the United States in 1976 (WICHE, 1977~. These findings have been corroborated by a similar study by the committee on Institutional Cooperation (CIC} throughout a 13-state Midwest Region in 1976 (CIC, 19761. Beyond the need for acctorally prepared faculty with a specialty in clinical practice, these studies have shown an interest among schools of nursing in faculty with research skills. Indeed, this interest in advanced training in nursing research as a specialty area has been reflected in the number of conferences convened in recent years to address the doctoral training of nurses and the avenues by which such training may bus+ be achieved (e . g. SchlotfelOt, ~ 97 1; Lamberston, 976) . Current information suggests that the market for doctorally trained nurses is essentially quite large at this time, and that it may be expected to expand as the press of doctoral enrollments in schools of nursing requires the expansion of suitable research and teaching faculty (Leininger, ~ 97 6 ~ . Rather than attempting to estimate specific numbers of skilled nurses-doctorates needed to meet this growing demand, the Commi tte e ha s el e cte ~ in i t s pres ent r eport simply to provide general advice on the direction that the Divi sion of Nursing should take in setting the level of NRSA awards appropriate to meet this need in the next few years. It i s anticipated that further data collection in the coming year we Il facilitate the development of estimates to clearly understand the rate of expansion in the market for doctorally trained nurses and its relation to future training needs. NURSE TRAINING FUNDED BY NIB AND ADAMS The Committee recognizes that a number of nurses have completed doctoral and postdoctoral work In basic science fields. In this chapter the committee wishes to deal one y with training for nursing research and nei ther discusses nor 159

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makes recommendations for nurses who wish to reorient their careers as basic biomedical or behavioral scientists. The Committee is aware the+ NIH and ADAMHA support the training of nurses in basic science fields. This is a d~si~ab~ e development, but ~ t does not fall within the category of nursing research as defined in this report. Accords ngly, research training for nurses funded by NTH or ADPMHA i s included within the recommendations of the Cocci Stem f or the othe r ba si c science f i el ds covered by thi s report. RECOMM~NDATI ONS The Committee bed ieves that it is important that the leaders and teachers in the nur sing prof e s sion be in a pos it i on to contribute ~ o the advancement of knowledge in f ields related to nursing. The op' imum institutional arrangements for festering research training in the area of "caring" for the patient are not yet entirely Cal ear. several leading schools of nursing are eager to develop qualified graduate programs. In most cases these shou ld probably be related to Cohen departments in the university that are prepared to of fer basi c training in other fields of biomedical and behavioral sciences. Whether the overall supervision of such programs shout ~ be ad~ninis~ered by the nursing school itself or the school of graduate studies that includes the other affiliated basic science departments is an administrative deta if that wil ~ undoubtedly vary f rom institution to ins' itution. whi le this experimentation with appropriate curricula and aiming strati ve arrangements is proceeding, the Committee be1 ~ eves the ~ government agencies should adopt a sympathetic and encouraging attitude and be prepared ~ 0 provide funding either in the f orm of re search training fellowships or carefully designed research training grants as fully qualif fed graduate programs in schools of nursing become identified. The s Equation is rapidly changing, and the Ccm~rittee thus regards any quantitative sugge stion! it may make at this time as tentative and sub ject to modif ication on an annual ba s i s . However, the obvious demand for teachers and researchers with graduate training in nursing research makes it liked y that training funds could be productively used for the next severe ~ years on an expanding basis. The Commi Ate e recogn i ze s that ~ here i s of ten no clear line of demarcation between nursing research and other areas of biomedical and behavioral research. Some f legibility in ciassi fication of particular projects by the Division of Nursing is therefore necessary to impl event the following Committee recommendations. 160

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Predoc ~ oral,Postdoctora' Training There is evidence of rapid expansion in graduate enrollments in school s of nursing today, and a real need to strengthen facul By through an increase in doc~orally trained nurses capable of providing necessary leadership through research and teaching. As NRSA authority has been extended to the Division of Nursing, it is clear that predoctoral training cant inue s to be the appropri ate ~ evel f or re s earch training emphasis at this time. However, the Committee is also aware that nursing research as an area of inquiry can advance if support for postdoctoral training is also provided, particularly for those nurses who have completed their doctoral training in prior years and now wish to update their research skills. As a result, the Committee suggests that a shad ~ proportion of both train=eships and fellowships be made available for postdoctoral research training in the coming years and that this proportion increase at the rate prescribed below. Recommendation. The Committee recommends that, as property qual if fed candidates present themselves, up to ~5 percent of the total number of research training awards made available through the Division of Nursing in FY ~ 979 be made at the postdoc' oral level. The committee recommends that this proportion be increased as evidence suggests such an increment to be appropriate (see Table 7. 2) . The Committee Blends tines" level s only as guidelines and recognizes that there may not be a sufficient number of well-qualified app! ~ cants f or postdoc~ oral training in nursing re search to take advantage of this opportunity in the near future . TABLE 7~2 Recommended Distribution of Predoctoral and Postdoctoral Awards for Training in Nursing Research: FY 1979, {980, and-1981 Fiscal Year Level of Training 1979. 1980 1981 . TOTAL 225 240 270 Predoctoral 193 190 205 Postdoctoral 32 50 65 161

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Trainee ships As in other emerging areas of scientif ic inquiry, the ~ rai n ing grant p lays an impor tent rol e in nur s ing re s earch by bring) ng the theory and methods of the basic sciences to the probe ems of n urs ing care . Training grants may be given to schocis of nursing to establish interdiscip~ inary programs for nurses ~ n cooperation with undo varsity departments of basic science. In this situation 4_raineesh~ps are given to nurses to study toward doctoral degrees in nursing and in the biological, physical, or behavioral sciences. With the growth of a distinct body of knowledge in nursing research it is also possible at this time to place a limited number of training grants in well-qualified schools of nursing for the purpose of providing training in this area . The trainee ship i s given to the nurse to take up research training in a graduate department of nursing. The Committee is cognizant of the need to stimulate nurs ing research and the production of adequately trained nurse-doctorates at this time through the training grant . At the same time, owing to the scope of training provided through this mechanism by the Division of Nursing today, the Co~u~i~tee is aware of the need to proceed gradually as this program ~ s put into place, in a manner that will assure the prov i s i on o f awe rd s to graduate department s that are r eady To provide training in nursing research comparable in quality to training provided for Ph.D.'s in other areas. As a result t, the Committee has been able only to suggest through its recommendations this year the direction of grow Oh sought through ~ hi s program of trainee ship awards . It is the Committee' s intention to review these recommendations in the coming year in light of additional da ta th at wi ~ ~ b e made ava i ~ at ~ e to the Commi t tee by th e Division of Nursing, and to make whatever adjustments that are useful to f aster training through this program of awards . Recommendation: The Committee recommends that the program of ~ nstitutional grant support for research training provided by the BRA Divi sion of Nursing be expanded to meet the needs for investigators i n nursing research. In view of the limited program of support in FY ~ 977, the Committee recommends that the program be expanded gradually to a total of 95 traineeship awards in FY 1981 (see Table 7.3~. In. addi tion to providing awards for training in basic science departments aff iliated with nursing schools, the Committee also recorrunends that a limited number of awards be provided f or research Bra ining in graduate departments of well- qual i f i ed s choo l s of nur s ing in the ar ea o f nur s ing research. The Commi ttee wil ~ review its recommendations in 162

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TABLE 7. 3 Recommended Distribution of Traineeships in Nursing Research by Institutional Setting: FY 1979, 1980, and 1981 Fiscal Year Research Training Site 1979 1980 1981 TOTAL 50 65 95 Grad. depts. of nursinga 10 15 20 Nonnursing dents. 40 50 75 "Grad. depts. of nursing" refers to research traineeships made available to nurses through institutional training grants put into graduate departments in schools of nursing. "Nonnur sing dents." refers to research traineeskips made available to nurses through institutional training grants administered jointly by graduate departments in schools of nursing and departments of basic science outside the schools of nursing, providing a "dual track" program of training for the nurse scientist. 163

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the coming year to determine whether further ad justmen+s are nece ssary ei ther in the tote ~ number o f awards recommended or in allocate on by training site. Fellowships Nurses have had fellowships in the past for doctoral training in ~ he biological and behavioral sciences, as well as for training in such fields as education, educational administration, and public heal th administration. It is the bel i ef o f th ~ Committee that re se arch training in area s red event to the enhancement of nursing educaticn, administration, and curriculum development is appropriate under the auspices of NFSA support. However, the Committee would ~ Ike to stress that training emphasis in non science areas should be on research and not on professional ~raining, since it is research training that will advance re search on nurs ing care . In view of the need to increase the number of doctorally trained nurses in the area of nursing research, the ~ committee views as an important f irst step the reorientation of the fed lowship program under the auspices of NRSA support. The Committee recommends a substantial reduction in fe ~ ~ owship support in nonscience departments outside the schools of nurs ing, and, in view of the growing capability among wet 1-qualif~ ed schools of nursing to take up research training at this time, the Committee recommends that a limited number of awards be used for training in schools of nursing as wall as in other parts of the university interposed in the problems of nursing care. This reorientation, furthermore, should be accomplished through the maintenance of the total number of awards through FY 1981. Recommendation: The committee recommends that a significant reorientation take place in the fellowship award program whi ~ e ma inta ining the program at a tot al c omparab le to the estimated number of awards in FY ~ 978 ~ ~ 75 awards} . The co~runi~tee recommends a substantial reduction in the number of awards for research training in conscience departments. The Committee also recommends a shift in training emphasi s to provide research training opportunities to nurses in wel1-qualified graduate departments both within schools of nursing and in other departments interested in the problems of nursing care. In this way research training through the fellowship mechanism will assure the advancement of nursing research. In view of the impact of this proposed rev ientati on, the C ommi~tee wi ~ ~ revi ew it s r ecommendations 164

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TABLE 7.4 Recommended Distribution of Fellowships in Nursing Research by Institutional Setting: FY 1979, 1980, and 1981 Fiscal Year Research Training Site 1979 1980 1981 TOTAL 175 175 175 Grad. depts. of nursing 50 75 100 Nonnursing depts. totalb 125 100 75 Basic science depts. 75 75 75 Nonscience depts. 50 25 0 "Grad. depts. of nursing" refers to research fellowships made available to nurses for research training in schools of nursing. "Nonnursing depts." refers to research fellowships made available to nurses to take up training either in basic science departments outside schools of nursing (basic science depts.) or in such professional/applied schools as schools of education or schools of business administration (conscience depts.) 165

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TABLE 7.5 Recommended Distribution of Predoctoral and Post- doctoral Traineeships and Fellowships for Training in Nursing Researth: EM 1979, 1980, and 1981 Fiscal Year Traineeships Fellowships Total 1979 Total 50 175 225 Pre 43 150 193 Post 7 25 32 1980 Total 65 175 240 Pre 50 140 190 Post 15 35 50 1981 Total 95 175 270 Pre 70' 135 205 Post ^5 40 65 166

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300 250 oh C] ~ 200 O 150 m ~ 100 Z 50 _ O 1 1 1 1 968 _ _ ~ \ A \ \ TO ~ Fellowships _ 1970 1972 1974 'V/ Traineeship,' FISCAL YEAR 1976 1978 t980 (Estimates) Recommendations) FIGURE 7.2 Distn~ution of traineeships and fellowships for training in nursing research including Committee's recommended levels for FY 1979, 1980, and 1981. )67

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in the coming year to determine whether further adjustments are necessary, either in the total number of awards recommended or In the al location by type of training site (Table 7.4~. Summary The Committees recommendation is made in light of the knowledge the' institutior~al support has been forthcoming from the Advance Nurse Training Programs of the Nurse Training Act of 1975 (PL 94-63~. The research training grants available under the NRSA Act will not duplicate the quite different grants now available under the new authority of ~ he Nurse Tra ining AC t, which i s directed toward advanced prof essional training for nurses rather than for research . t~alnlr~g. In recommending a maintenance of the total number of fellowship awards through FY 1 981, the Ccmmitte" is cognizant ~ hat a growing interest in advanced training within the professional sector may require, ultimates y, and expansion of this program. However, the Committee at this time has not had available to it the information necessary to determine any further growth of this program. Instead, the Conunitt~= views as an important and necessary first stem, the reorientation of emphasis in training away from nonnursing professional fiel ds toward direct experience in nursing research as provided by school s of nursing and in ba sic science departments relevant to nursing research. Tabs e 7.5 specifies the distribute on of these awards for traineeships and fellowships. Specifical ly, up to 15 percent of the total number of train~eships and up to ~ 5 percent of the tote' number of fellowships recommended for FY ~ 979 should be made avail fable at the postdoctoral level. Simil arly, up to 20 percent of the traineeships and up to 20 percent of the fellowships in FY ~ 980 should be for postdoctoral ~raining, and up ~ 0 25 percent in each category in FY ~ 981, shoul ~ evidence accrue suggesting that such an expanse or, is possible. As recommended by this committee, the future direction of research training provided through the programs administered by the HRA Division of Nursing would be that shown ~ ~ Figure 7. 2. 168

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FOOTNOTES 1. Nurse investigators are e, igible for LISA support through ADAMHA in basic biomedical or behavioral sciences or in heal th services research. 2. The designation "registered nurse" dates to the passage of the Nurse Practice Act in 19 03 in North Carolina. It was no ' until ~ 9 2 3 that all states required such licensure. 3. In 194B, the Surgeon General of the PHS established the Dive sion of Nursing Resources to determine the supply and distribution of nurses in the United States, the quality and costs of educate on, job satis faction, and patient sati sfaction with nursing care. 4. The Nurse Training Act of 1975 [Section 821 (a) (~} ~ specifies that: "The Secretary may make grants to and enter into contracts wi ' h public and nonprof it collegiate Schools of Nursing to meet the costs Of pro jects to (A} plan, develop, ant] operate, (B} so gr.ificantly expand, or (C) maintain exi sting pr ograms f or the advanced ~ r aining of professional nurses.... " 5. Private communication, HRA Division of Nursing, May 1977. 169