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6. NURSING RESEARCH PERSONNEL INTRODUCTION In its 1977 report, the Committee made its initial rec-ommenda- tions concerning the direction the HRA's Division of Nursing- should take-in developing its program of NRSA support.1 Recognizing nursing research to be a distinct area of scientific inquiry, the Committee defined nursing research as follows: ' ' ' Nursing research focuses on the role of nursing care in the prevention of illness, care of the sick, and the promotion and restoration of health. Although it relies upon and utilizes the substantive scientific information and methodology provided by the other biological 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. (NRC, 1975-77: 1977 report, p. 152) The Committee devoted much of its assessment in that report to a review of those trends in nursing research that have given rise to the emergence' of an interest in and need for doctoral education in this health profession. Findings from a survey of 500 nurses who had completed their doctoral training between 1971 and 1975 were reported. These findings led the Committee to conclude that the market for doctorally trained nurses i s quite large, and that the obvious demand for teachers and researchers with graduate training "makes' it likely that training funds could be productively used for the next several years on an expanding basing (NRC, 1975-77 : 1977 report ~ . Because the extension of the NRSA authority in 1976 to in- clude the Division of Nursing actually revitalized a program of research training that then was providing support for 35 indi- viduals (NRC, 1975-77: 1977 report), the Committee's recommen- dations had to address, in part, changes in research training emphasis, given the thrust of the new training authority. Specifically, the Committee noted that predoctoral research training continued to be the appropriate level of training to meet the urgent need for doctorally trained individuals capable of providing research and teaching leadership. Whereas past 128

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training opportunities provided by the Division of Nursing almost exclusively resulted in predoctoral support (Bourgeois, 1975), the Committee proposed that up to 15 percent of the total number of awards could be made at the postdoctoral level as "properly qualified candidates present themselves" (NRC,-1975-77: 1977 report). Opportunity for postdoctoral training was considered appropriate by the Committee, since nurses who had completed their doctoral training in prior years might wish to update their research skills to keep up with recent advances in nursing re- search. The Committee also called for a significant reorientation of the program of fellowship support. It was noted that fellowship support in the past had been used for doctoral training in such fields as education and administration, as well as in'the biolog- ical and behavioral sciences. The Committee recommended a sub- stantial reduction in the number of fellowships for study in conscience departments and emphasized that training under the NRSA authority should be in research and not in professional fields. - The Committee recommended an expansion of institutional training awards to permit the development of nursing research through interdisciplinary training and recommended such grants be given to schools of nursing to establish programs for nurses in cooperation with university departments in the biological, phys- ical, or behavioral sciences. Similar to the Nurse Scientist Training Program of 1960's (Matarazzo, 1971),'these institutional arrangements would give traineeships to nurses for study in basic science departments that had established relationships with schools of nursing, although the details of this approach would have to be developed to meet the provisions of the NRSA author- , ity.` The Committee also recommended that a few institutional awards be made available for training in graduate departments in we11-qualified schools of nursing. Recognizing the advances that have been made in nursing research in recent years, the Committee' suggested that a few nursing faculty might provide quality train- ing in nursing research tinder' the auspices' of the NRSA authority.' Given the innovative thrust of these recommendations, the ' Committee set as its goals for this report a review of the 'NRSA program development by the Division' of Nursing. A summary of the recent developments in doctoral training opportunities in nursing research is a~so'provided. ~ The Committee acknowledges the valuable contributions made by the representatives of the nursing community who provided infor- mation to the Committee either et' its public meeting convened' earlier this year or through private communications. These'ob-' ' servations have greatly assisted the Committee in its de~ibera- tions. ' ' Findings from the NRC Surveys of Doctoral and Pending Doctoral Programs for Nurses are also presented in taxis report. 129

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This series of interviews and site visits has provided the Committee with important information regarding the current climate for research training in schools of nursing. TRENDS IN DOC TORAL EDUCATION FOR N URS ES Today there are over 1,400 programs in the United States offering training for registered nursing. Of these, more than 350 offer a nursing diploma after training at a hospital, about 640 offer an associate of arts degree after coursework in a community or jun- ior college, and about 340 offer a baccalaureate or higher de- gree. In addition, there are over 100 nursing programs that offer a masters degree and 16 that offer the doctorate (National League for Nursing, 1977a and b). The changing status of doctoral education in nursing is evident not only in the proliferation of doctoral programs in schools of nursing in recent years (Leininger, 1976) but also in the fact that nearly half of the 1,800 nurses with doctoral training earned these degrees some time in the last decade. Doctoral programs have been established in schools of nursing in response to a variety of local as well as national needs. Be- cause the Committee's recommendations for NRSA program develop- ment are based on the demand for doctorally trained personnel, the following review of doctoral programs in nursing serves as a useful background to the survey findings subsequently reported in this chapter. At the present time nursing education is influenced by the presence of four major regional education authorities. These include: - 0 the New England Board of Higher Education (NEBHE), established in 1955 by formal agreement among six member states (Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont); o the Southern Regional Education Board (SREB) formed in 1948 for regional planning among the following 14 member states: Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North and South Carolina, Tennessee, Texas, Virginia, and West Virginia; the Western Interstate Commission for H igher Education (WICHE), formed most recently ~ 1955 ~ to coordinate ed ucational planning among 13 member - states (Alaska, Arizona, Cal i fornia , Colorado , Hawaii r Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming). 130

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o the Committee on Institutional Cooperation ~ CIC ), formed in 1962 in the Midwest to coordinate educational planning and resources among the " Big Ten" universities. (At the present t ime a feasibi~ ity study is under way to develop a Midwest Alliance which would encompass 13 mid- western states, thereby expanding the planning endeavors in the greater Midwest region ~ . These regional planning boards have pl eyed an important rot e in identifying the needs and resources in schools of nursing, in promos i ng re sear ch through the ava i ~ ab i ~ i ty 0 f " se ed money" , and in helping institutions study problems in nursing education that might require interstate assessments (NEBHE, ~ 975; SREB, - 1975; CIC, 1976; WCHEN, 19751. As data from the Survey of Doctoral and Pending Doctoral Pro- grams for Nurses reveal, the availabil ity of regional coordinat- ing authorities has determined to some extent the location and emphasis of doctoral programs for nurses. FINDINGS FROM THE SURVEYS OF D~TO=L AND PENDING DOCTORAL PROGRAMS FOR NURSES As a part of the continuing ef fort to provide the Committee with information describing developments in graduate education for nurses, the Ad Hoc Advi very Group on Nursing Research Personnel conducted two surveys of a selected number of schools of nursing which either provide doctoral programs for nurses, or are devel - oping doctoral programs at this time. Site visit interviews wi th the deans were arranged to gain a better understanding of the factors influencing the development of the programs at the in- stitutions surveyed. As of October 1977, 16 schools of nursing offered doctorates (Table 6. ~ and Figure 6.~) . Because it was not feasible e to visit all doctoral program sites, 10 were chosen (Table 6. 2) . These varied with respect to type of degree offered, age/si ze of the program, and regional location. The Ad Hoc Advisory Group also identified f ive institutions where preparations to initiate doctoral programs were under way Stable 6.2~. The que st donna ire developed for the Survey of Doctoral Pro- grams for Nurse s ~ Append ix I ~ sought in format ion in four cate- gories: graduate program development ~ incl uding enrollments, number of degrees awarded, and criteria for admission); sources of doctoral/postdoctoral support for training; faculty charac- teristics; and amount and type of research act ivities by the faculty. A similar form was OCR for page 128
TABLE 6.1 Schools of Nursing with Doctoral Programs, 1977-78a Location Institution Alabama (Birmingham) Arizona (Tucson) California (San Francisco) University of Alabama University of Arizona University of California, San Francisco Washington, D.C. Catholic University Illinois (Chicago) Massachusetts Michigan (Ann Arbor) (Detroit) New York Ohio (Cleveland) Pennsylvania Texas (Demon) (Austin) Utah (Salt Lake City) Rush University University.of Illinois, Chicago Boston University University of Michigan Wayne State University New York University Col~hia, Teachers University Case Westerns Reserve University University of Pittsburgh Texas Woman's College University of Texas, Austin University of Utah From National League for Nursing (1977a). 132

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~~ - ~ to - - . - W-- o . . Doctoral Sites ~ f O Pending Sites ~ ~ Jo . . FIGURE 6.1 Schools of nursing with doctor;`! or pending doctors programs, 1977-78. Drawing based on unpublished data from American Association of Colleges of Nursing, Washington, D.C., 1978, and NRC, Surveys of Doctoral and Pending Doctoral Programs for Nurses, Washington, D.C., 1978. The surveys and site vi sits were conducted between December 1977 and April 1978. The following high] ights are derived from the summary tables found in Appendix I: 0 Both master and doctoral program enrollments in schools of nursing have increased since 1974, with proj ect ions showi ng continued growth through 1982-83 ~ Append ixes I 1. l-I 2 ~ . Some institutions, especially those in the West and in the Northeast, reported plans to stablize master's degree enrollments in order to permit development of doctoral programs (Appendix I 1.2), while the remaining institutions anticipated growth at both levels of train) ng through 1982-83 . No institution reported a curtailment in master's degree enrollments to permit the exclu- sive development of doctoral training. O In 1977 - 78 more doctoral st udents in nursing research received stipend support than in 1974-75 in every category of support (Appendix ~ 3~. It appears that institutional commi tment to doctoral program development at a school of nursing is reflected in part in the increased support provided from state and institutional sources for doctoral students. Similarly, the expanded federal commit- 134

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ment to doctoral education for nurses has permitted an increasing number of stipends in some institutions. While doctoral enrollments and available student support have expanded in recent years at almost every institution surveyed, a comparison of the research environments reveals a high degree of variability among the institutions at this time. Over half the institutions with doctoral or pending doctoral programs reported fewer than 20 faculty members engaged in at least one research project in October 1977 (Appendix I 4.1). Research projects which were funded typically were funded at a level well below $100~000 per fiscal year (Appendix I 6.1). A number of institutions, it must be added, are strengthening research activities through research development support (Appen- dix I 7.1-I 7.2). However, most deans believe their single greatest need at this time to be research faculty (Appendix I 8.1). This response was unanimous for institutions located in the Northeast (Appendix I 8.2). Table 6.3 summarizes the survey findings with respect to the variability of the research climate among the schools of nursing with doctoral programs included in this survey: o Over half the institutions had more doctoral students than the number of faculty engaged in at least one research project. This ranged from a ratio of 200 doctoral students to four research faculty at one institution, to five doctoral students to 35 research faculty at another (Table 6.3~. O On average only seven faculty members were engaged in more than one research project at each institution providing doctoral training, although this number varied from zero at two institutions to 18 at another (Table 6.3~. O Of the 10 schools of nursing with doctoral programs included in this survey, seven had been awarded federal research grants or contracts, ranging from one grant at one site to 12 at another (Table 6.3~. Half the institutions with doctoral programs held federally funded research development grants or contracts in October 1977 (Table 6.3~. While the variability in these research components can be attributed in part to the age of the doctoral program and dif- ferences in training emphasis, it is clear that certain programs possess a greater number of attributes that make up a sound doc- toral training experience than others. Because a strong research climate is essential to the produc- tion of doctorates in every area of scientific inquiry, the Com- 135

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mittee and its Ad Hoc Advisory Group on Nursing Research believe- that a unified effort to strengthen existing and proposed'doc- toral training programs in schools of nursing with respect to ~ research involvement by the faculty is critical at this time. -In fact, the Commmittee would urge the professional community of nursing to give serious consideration to slowing voluntarily the proliferation of new programs for doctoral training in nursing until existing programs acquire greater strength in those aspects which contribute to quality doctoral education: a high propor- tion of faculty actively engaged in research; adequate research facilities; research grant and contract support; and provision of opportunities for students to gain research experience in addi- tion to basic clinical and administrative skills. A number of factors seem to be contributing to the variation in research climate noted among those institutions surveyed. Some of these factors can be addressed locally, while others require direct federal involvement. o As doctoral programs have developed, faculty often have been required to shift their emphasis from teaching/administration to research. In many instances, doctorally trained faculty who had not been actively involved in research have been given little opportunity to update their research skills. Some institutions have adored "research coordinators" to graduate program staff. These individuals primarily serve as advisors to faculty interested in developing research proposals or coordinate research efforts with other staff or departments. These research coordinators also convene seminars and workshops to review re- search ideas, provide refresher courses, or plan research strat- egies. 0 In some institutions, federal policies relative to the renewal of research development funding have disallowed certain institutions from continuing to receive needed support. Deans, for example, have indicated that faculty turnover in recent years and the addition of new faculty with active research interests lead to changing research development needs. Some doc- toral training institutions that have received up to lo years of development support through such programs as the Faculty Research Development Grants program of the Division of Nursing (Gortner, 1973; NRC, 1975-77: 1977 report) find that they are now ine~igi- ble for further research development support despite the fact that this continues to be a need at their institutions. In view of the urgent need to upgrade the research climate in schools of nursing that now are engaged in doctoral training or 137

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shortly will be, it is clear that a review of federal regulations for research development support in schools of nursing is needed. Such a review hopefully would lead to a resolution of the current dilemmas discussed here. RECOMMENDATIONS It has been only 2 years since the NRSA authority was extended to include the predoctoral and postdoctoral research training pro- grams offered through the Division of Nursing (NRC, 1975-77: 1977 report). Since that time the Division has completed 1 year of NRSA program support (FY 1977) and has continued to develop this program generally along the lines suggested by the Committee in its recommendations announced last year (Gortner and Bourgeois, 1978). The Committee and its Ad Hoc Advisory Group on Nursing Research have had the opportunity to consult with representatives from the Division of Nursing about these Commmittee recommenda- tions. These discussions have been beneficial in monitoring NRSA program development by the Division and in guiding the Commit- tee's deliberations this year. The Committee has seen no evidence from the Division of Nursing, from NRC survey activities or from the professional community suggesting that either the scope or direction of NRSA program development recommended by the Committee is inappro- priate. The Committee has devoted its attention this year, therefore, largely to a refinement of its previous recommenda- t~ons e The Committee recognizes, of course, that the recommendations it is making may require modification as the Division of Nursing undertakes its initial implementation in FY 1979. The Committee sees no need to review these recommendations annually, since a period of time must elapse before their full impact on the development of doctoral education in nursing will be evident. The Committee reserves the right, of course, to comment in the future on the general direction of NRSA program development by the Division of Nursing but generally views this year's recommendations as guidelines for NRSA program development beyond FY 1982. Predoctoral/Postdoctoral Training In its 1977 report, the Committee suggested that up to 15 percent of the total number of awards made by the Division of Nursing be made at the postdoctoral level "as properly qualified candidates present themselves" (NRC, 1975-77: 1977 report). AS figures for FY 1977 (Table 6.4) reveal, the ratio of pre- doctoral to postdoctoral awards by the Division are well within the guidelines suggested by the Committee for FY 1979. 138

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Supplementary data received by the Committees reveal, however, that this proportion is not evident when traineeships and fellowships are assessed independently. Instead, the Com- mittee notes that six of the seven institutional trainees sup- ported in FY 1977 were postdoctoral appointees. The Committee would like to clarify its recommendation regarding postdoctoral research training support in nursing re- search . There is a real need to expand the pool of doctorally trained research personnel in nursing to provide research faculty for the rapidly proliferating doctoral programs in nursing. Primary emphasis, therefore, should be placed on predoctoral re- search training at this time. To meet these needs, the Commit- tee emphasizes, therefore, that no more than 15 percent of the institutional traineeships and 15 percent of the individual fel- lowships are to be made available for postdoctoral research training as qualified candidates present themselves. This leaves the majority of awards at the predoctoral level for both mech- ani sms of support . Recommendation. The Committee recommends that up to 15 percent of the total number of research training awards made available by the Division of Nursing be made at the postdoctoral level as qual i f fed cand idates present themselve s. . . Tra ineeships In its 1977 report, the Committee recommended that training grants be given primarily to schools of nursing to establish in- terdisciplinary programs for nurses in cooperation with univer- sity departments in the biological, physical, or behavioral sciences. Acknowledging that nursing research has become a distinct area of scientific inquiry, the Committee recommended that a limited number of institutional grants be provided for research training in graduate departments of well-qualified schools of nur s i ng . Until a greater number of schools of nursing with doctoral programs can demonstrate a capacity to provide a strong research environment for doctoral candidates, the Committee reaffirms its recommendation that the ma jority of institutional awards should be given to nursing schools for training doctoral candidates in basic science departments that have established relationships with schools of nursing in the pattern of the former Nurse Scien- tist Training Program. The Committee recognizes, of course, that restrictions such as the limit on the proportion of funds avail- able for institutional costs under the NRSA authority will re- quire a new approach to this former program of institutional training arrangements. 140

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The Committee recommends not restricting NRSA i nsti tut tonal awards to graduate departments in school s of nursing. At a t ime when substantial Hi f ferences in the qual ity of the research en- vironment exist in the various schools of nursing engaged in doc- toral education, the approach described above would assure the production of we~-qualified investigators. - Recommendation. The Committee recommends that the program of inst i t ut iona, tr a i n ing gr ant suppo r t i n nur s i ng re sear ch cont i nue to be expanded at the rate specified in Table I. 2. The Committee recommends that institutional awards be made primarily for train- ing nurses in basic science departments that have establi shed re- lationships with schools of nursing, in the pattern of the former Nurse Scientist Training Program, and that only a limited number of training grants be provided for research training in graduate departments in well-qualified schools of nursing. Fe] 1 owsh i ps In its ~ 977 report, the Committee called for ~ ma jar reorienta- tion of fellowship support so that a substantial reduction would occur in the number of ind ividuals rece iving fellowships in non- science departments (NRC, 1975-77: 1977 report). Data from the Division of Nursing reveal that a signif leant step in this direction has been taken in the past year. Of the total number of fell owship applications approved during FY ~977 through January 19 7 B. only 2 5 pe rcent repr e sensed f i eld s other than the ba s i c b i omen i c al, behavi or al, and cl i n i cal sc i e nce s ( Gortner and Bourgeo i s, 19 7 8 ) . In view of the fact that this change in program emphasis is continuing, the Committee recommends that the total number of fell owship awards remain at 175 through FY 1982 when f urther as- se ssment of the dev e l opme n t of th i s pr og r am wi ~ ~ be mad e ~ Tabl e 1.2) . . Recommendat ion. The Commi ttee recommends that the annual , . . . number of fellowship awards by the Division of Nursing remain at 175 through FY ~ 982, while the shift to training in nursing research i s compI eted . 141

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Midcareer Research Training The Commi ttee and its Ad Hoc Advi very Group on Nur sing Research Personnel note that there are a number of doctoral ly trained nurses who may need to have their research skills upgraded be- cause of advances in nursi ng research. There also are nurses whose employment experiences have prepared them to pursue doc- toral training as a midcareer development. This pool of potential investigators represents a promising, yet largely untapped, resource for nursing research. It is clear that the current NRSA stipend level i s inadequate to attract such personnel into research careers. It is less clear whether the payback provi signs are suf f iciently flex ible to encourage these ind ividuals to -seek NRSA support . Because opportunities for mi`3career research training would enrich the rapidly expanding nursing research labor ~force, in the coming year the Committee will assess the means by which training support should be made available to recruit research personnel at this stage of their professional career development. 1 142

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FOOTNOTES I. The Heal th Research and Health Services Amendments of 1976 ~ P. L. 94-278 ~ extended the NRSA authority to include the programs of research training offered by the HRA Divi sion of Nursing . The 1977 Committee report was the first attempt to address training needs in nursing research. 2. In addition to payback requirements, such provisions as the period of support and the amount of institutional allowance are unique to the HRSA program and would require a reformulation of the former Nurse Scient i st Tra ini ng Program. 3. Correspondence from Dr. Susan Gortner, BRA Division of Nursing, to Pamela Ebert-Flattau, Committee staff, March 20, 1978. l 143

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