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6. Nursing Research
Abstract
The Division of Nursing of the Health Resources
and Services Administration currently provides the
major portion of funds for nursing research supported
by the federal government. About $9 million in
research grants and contracts was awarded by this
agency in FY 1984. A substantial amount of nursing
research is also sponsored by the NIB, the Veterans
Administration, and private organizations such as the
American Nurses Foundation and the Robert Wood Johnson
Foundation. Funds provided by these organizations
have supported recent studies on the health and care
of premature infants which have shown how they respond
to specific nursing interventions. Other studies have
focused on care and prevention of disability in the
elderly.
In most but not all of these studies, the
principal investigator is a nurse with a doctorate
degree. Although the annual production of nurses with
doctorate degrees is increasing, only about 8 percent
of nurses serving as full-time faculty members held
doctorate degrees in 1982. The lack of nurses with
doctorates to serve as faculty exercises a qualitative,
as well as quantitative constraint on the continued
growth of doctoral programs in nursing. There does
not appear to be any substantial amount of support
available for training in nursing research other than
that provided by the Division of Nursing, BRSA, under
the NRSA program. -
According to a recent statement by the American Nurses'
Association:
Nursing research generates knowledge about health
and health promotion in individuals and families and
knowledge about the influence of social and physical
environments on health. Nursing research also
addresses the care of persons who are acutely or
chronically ill, disabled, or dying, as well as the
care of their families. In addition, nursing research
studies therapeutic actions that minimize the negative
123
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124
effects of illness by enhancing the abilities of
individuals and families to respond to actual or
potential health problems. Nursing research also
emphasizes the generation of knowledge about (a)
systems that effectively and efficiently deliver
health care, (b) the profession and its historical
development, (c) ethical guidelines for the delivery
of nursing services, and (d) systems that effectively
and efficiently prepare nurses to fulfill the
profession's current and future social mandate.
Nursing research complements biomedical research, which is
primarily concerned with causes and treatments of disease. In
its attention to the study of nursing interventions,
procedures, and methods of patient care it also complements
clinical research by members of other health professions. And,
in its attention to the costs and outcomes of different types
of procedures, settings, and providers of care, it contains a
large component of health services research.
The Division of Nursing, HRSA, classifies nursing research
into six categories:
1. Fundamental research, which establishes a foundation for
further investigations rather than contributing to the
solution of specific health problems. It may use human or
animal subjects to investigate the ways in which human beings
and human systems function and behave, and the ways in which
humans think, feel, act, and interact, e.g., studies of the
interaction of mothers or fathers with their new infants;
Nursing practice research, which directly addresses nursing
practice problems, often by assessing the effectiveness of
nursing procedures, techniques, and methods, either physical,
psychosocial, or cultural. Dependent variables usually
involve client outcomes, and studies often employ
experimental methods;
4.
Nursing profession research, which addresses the nurse as a
professional, with studies of cognitive, attitudinal, and
behavioral characteristics of nurses which may influence
nursing practice;
Nursing services administration research, which investigates
the structure in which nursing care is provided as well as
the physical and social environment in which nurses and
clients interact;
Nursing education research, which is concerned with the
educational process, including studies of the curriculum and
student-faculty interaction; and
6. Utilization of research findings, which includes studies of
the utilizatiion of research findings in practice and
education.
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125
EXAMPLES OF NURSING RESEARCH
An important step in the maturation of nursing research came in
1983 with the publication of the first Annual Review of Nursing
Research (Werley and Fitzpatrick, eds.~. This publication provides an
overview of the field, highlighting significant advances and
suggesting areas where additional research is needed.
Nursing researchers have made important advances in the study of
the health care of infants, young children, and the elderly. Nurse
investigators, for example, "have been concerned with questions about
how premature infants respond to extrauterine living and how nursing
action influences the response and well-being of premature infants"
(Barnard, 1984, p. 4~. In one clinical study, premature infants were
given finger sucking opportunities twice a day, which appeared to
promote neuromuscular coordination, alert activity, alert inactivity,
and deep sleep (Anderson and Vidyasagar, 1979, cited in Barnard,
1984~. Another study showed that sucking during and after tube
feedings advanced premature infants' readiness for bottle-feeding by
several days. These infants gained weight faster and left the
hospital four days earlier than comparison infants not on the sucking
protocol {Measal and Anderson, 1979, cited in Barnard, 19841. The
role of sucking as a regulator of infants' physiological and
behavioral responses is an important area for research. Other
significant nursing research is addressing the effects of various
stimuli (tactile, auditory, kinesthetic, and visual) on preterm
infants' neurological and mental development, and weight gain
(Barnard, 1984~. This research has significant implications for the
effectiveness and cost of neonatal nursing care. m e average cost of
initial neonatal intensive care is estimated to exceed $13,000
(Institute of Medicine, 1985, p. 229), and almost 7 percent of
newborns in the U.S. are at risk because of low birthweight.
Nurse researchers also have addressed important questions in
clinical geriatric nursing: the maintenance of health, prevention of
illness and disability, and care of the ill elderly. This research is
of great importance as life expectancy increases; data from the 1980
census show that 1.5 percent of persons age 65-74 were in nursing
homes; the percentage rises to 6.6 percent for persons 75-84, and 22.7
percent for persons 85 and over. In 1983, almost $29 billion was
spent on nursing home care (Gibson et al., 19841. Two issues in the
clinical care of the ill elderly that are being addressed by nursing
researchers are {1) the prevention and treatment of decubitus ulcers
and (2) the prevention or reduction in the frequency of incontinence.
Gerber and Van Ort (1979, cited in Wolanin, 1984), for example, tested
the use of topical insulin in treating decubiti with good results.
Catanzaro (1981, cited in Wolanin, 1984) conducted a qualitative study
of the perceptions of the elderly regarding incontinence; other,
experimental studies have employed behavior modification techniques to
control incontinence (Wolanin, 19841.
As these examples illustrate, the nature of problems studied by
nurses is influenced strongly by the nature of problems they encounter
in the clinical setting. While these problems might be studied by
investigators from other health professions, they generally are not.
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126
SOURCES OF SUPPORT FOR NURSING RESEARCH AND TRAINING
Division of Nursing, HRSA
Nursing Research
The Division of Nursing of the Health Resources and Services
Administration (PHS, DHHS) is the primary source of funding for
nursing research and research training in the federal government.
Since January 1985, the Nursing Research Grants Program has been
administered by a Center for Nursing Research. Replacing the research
component of the former Nursing Research and Analysis Branch, the
Center is intended to provide increased visibility to nursing research
in DHHS. In establishing the Center, no additional budget allocation
was made by the Secretary.
The Division supports five types of grants under its Nursing
Research Grants Program, as described below.
NURSING RESEARCH PROJECT GRANTS support discrete, specified,
circumscribed projects in an area representing the investigator's
interest and competencies.
NURSING RESEARCH PROGRAM GRANTS support clusters of at least three
studies focused upon a single theme.
NEW INVESTIGATOR NURSING RESEARCH AWARDS (NINRA) support small
studies of high quality carried out by new investigators.
UTILIZATION OF RESEARCH IN NURSING AWARDS (URNA) support projects
to bridge the gap between the generation of knowledge through
research and the utilization of such knowledge in nursing
practice, nursing education, or nursing services administration.
NU=ING SEARCH ISIS GRANTS FOR DOCK PRODS IN NURSING
(NRE/DPN) stimulate nursing research in areas that emphasize
special health needs of the nation, and advance the research
efforts and resources of faculty in schools of nursing offering
doctoral programs.
The stated purpose of the Nursing Research Grants Program is "to
enlarge the body of scientific knowledge that underlies nursing
practice, nursing education, and nursing services administration; and
to strengthen these areas through the utilization of such knowledge."
Principal investigators need not be nurses. The NRS/DPN projects,
however, are specifically designed for schools of nursing that offer
doctoral programs. Applications for all five types of grants are
submitted to the Division of Research Grants of the National
Institutes of Health; they are then assigned to the Division of
Nursing on the basis of nursing relevance, where they are subject to
interdisciplinary peer review.
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127
Grants are awarded in a number of content areas (Table 6.1~. As
shown, most projects in recent years have been in the areas of
fundamental research and research on nursing practice. Fundamental
research provides basic knowledge about the person before
intervention; nursing practice research looks at the interaction
between the nurse and the patient. Examples of some recent projects
include "Models of Newborn Nursing Services," "Stress Response:
Assessment and Change," and "Acute Confusional States in Elderly
Patients."
Table 6.2 shows the earned doctorates of principal investigators
(PIs) working under research grants from the Division of Nursing.
Nurses have represented between 75 percent and 85 percent of the
awardees in each year since 1974. The proportion of nurse PIs holding
doctorates has increased from about 50 percent in 1974 to 96 percent
in 1983. Nearly all of the non-nurse PIs have held doctorates.
TABLE 6.1 Nursing Research Grants Active at End of Fiscal Years 1969~3, by Content
Categorya
Fiscal Year
Content Category 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983
A Fundamental 5 6 9 7 9 10 12 9 10 11 8 10 11 9 12
B Nursing Practice 6 6 4 7 11 9 9 6 9 14 20 25 23 16 19
C Nursing
Profession 6 6 6 6 7 4 2 1 6 7 4 3 3 3 7
D Delivery of
Nursing
Services 9 6 6 4 5 6 4 2 1 1 1 1 2 2 5
E Nursing
Education 4 4 1 3 2 1 1 1 1 1 0 0 0 0 1
F Research
Conferences 3 3 3 5 5 0 ~ 0 0 0 0 0 0 0 0
G1,2 (Faculty)
Research
Development 16 17 14 16 13 15 11 9 12 10 9 4 0 0 0
G3 Program Grants 0 0 0 0 0 0 0 0 0 0 0 4 6 5 3
G4 NRE/DPN
Grants 0 0 0 0 0 0 0 0 0 0 0 10 13 13 14
H Utilization of
Research
Findings 0 0 0 0 0 0 1 1c 1c 1c 1c 1c 0 0 0
4b Development of
Methodology,
Tools _ 4 1 1 2 2 _ _ 5 8 8 n/a n/a n/a n/a
TOTAL 54 52 44 49 54 47 44 33 45 53 51 58 58 48 61
a Count includes projects which were extended without receiving funds during the fiscal year under consideration.
b Category 4 was in the classification system used until 1979.
c Also G2.
SOURCE: Division of Nursing, HRSA.
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128
TABLE 6.2 Doctoral Degree Status of Principal Investigators on Active Research Grants from
the Division of Nursing, 1974483
Fiscal Nurses with Nurses without Non-Nurses with Non-Nurses without
Year of _ Doctorates Doctorates Doctorates Doctorates Total
Grant N % N % N % N To N
1974 17 37 18 39 11 24 O 0 46
1975 23 52 10 23 11 25 0 0 44
1976 19 58 7 21 7 21 0 0 33
1977 29 64 5 11 10 23 1 2 45
1978 32 60 8 15 12 23 1 2 S3
1979 30 59 10 20 11 21 0 0 51
1980 40 69 10 17 8 14 0 0 S8
1981 38 66 7 12 13 22 0 0 S8
1982 34 71 4 8 10 21 0 0 48
1983 49 80 2 3 9 IS 1 2 61
SOURCE: Division of Nursing, HRSA.
Table 6.3 shows the amount of money appropriated and awarded to
nursing research grants and contracts from 1956 through 1984. In
1956, 8498,000 was awarded. This amount has increased since then,
reaching a plateau of $5 million in the late 1970s and early 1980s; it
was increased to $9 million for FY 1984. Figure 6.1 shows this
history from 1969 on, in constant 1972 dollars.
Training for Nursing Research
In FY 1984, 117 students were being supported under the NRSA
awards funded through the Division of Nursing, for a total of $955,487
(Table 6.4~. Two million dollars have been appropriated for PY 1985
and about 170 trainees and fellows are expected to be supported. To
be eligible under the predoctoral and postdoctoral Nurse Fellowship
Program, applicants must be registered professional nurses with an
active license and a degree in nursing at the appropriate level.
Predoctoral stipends are $6,552 per year; postdoctoral stipends begin
at $15,996. Institutions can receive $3,000 for each predoctoral
trainee and $5,000 for each postdoctoral trainee annually.
Support of research training by the Division of Nursing is
primarily at the predoctoral level. In FY 1984, for example, of 102
applications received, just 5 were from postdoctoral applicants; 2 of
these were approved (Table 6.5~.
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129
TABLE 6.3 Nursing Research Grants and Contracts Awarded, FY 1956~4 ($ thousands)
New Renewal Continuation T&(S)
Amount Grants Grants Grants Grantsa Contracts
Fiscal Approp- Amount
Year riated Awarded N $ N $ N $ N $ N $
1956 $ 498
1957 525
1958 725
1959 976
1960 1,208
1961 1,449
1962 1,476
1963 1,814
1964 $1,999 1,999
1965 1,953 1,952
1966 2,170 2,166
1967 2,230 2,087
1968 2,655 2,593 22 $ 744 4 $266 32 $1,475 2 + (3) $108 0 $ 0
1969 2,593 2,593 16 642 4 158 33 1,720 (4) 73 0 0
1970 2,625 2,155 10 524 1 76 28 1,390 (6) 165 0 0
1971 2,455 1,955 11 781 3 92 18 1,039 (4) 43 0 0
1972 2,455 2,439 18 865 1 56 21 1,283 (9) 99 1 136
1973 2,455 2,454 9 519 1 61 27 1,704 (8) 98 1 72
1974 2,660b 2,631 13 877 2 161 19 1,378 (10) 99 1 116
1975 1,200 3,374c 11 962 8 783 20 1,307 1 + (4) 2W 1 118
1976 2,804 2,801 1 80 0 0 29 2,617 (1) 11 1 93
1977 5,000 4,991 25 2,674 5 327 7 954 3 + (7) 484 3 553
1978 S,OOOd 4,979 15 1,413 1 103 31 3,447 (1) 16 0 0
1979 S,OOOe 4,944 10 929 3 366 30 3,514 2 + (1) 135 0 0
1980 5,000f 4,986 26 2,882 4 465 16 1,580 (4) 58 0 ~
1981 5,000g 4,950 16 1,592 1 98 29 3,066 2 + (1) 195 0 0
1982 3,4006 3,376i 3 184 1 84 37 3,001 2 + (0) 107 0 0
1983 5,000, 4,995 30 3,030i 8 717 14 1,245 0 + (1) 2 0 0
1984 9,0001 8,986 45 4,591m 2 269 31 3,097 1 + (1) 80 3 868
a Transfers and supplements. A "transfer" is a change of grantee institution; a "supplement" refers to additional funds
provided to a funded project.
b Funds reprogrammed.
c Includes $2,412,000 from Nursing Special Projects Funds.
a' Minus $17,000 retained for BHM evaluation activities.
e Minus $50,000 retained for BHM evaluation activities.
f Minus $13,000 retained for BHPr evaluation activities.
g Minus $50,000 retained for BHPr evaluation activities.
h Minus $24,000 retained for BHPr evaluation activities.
i Includes $1,000,000 appropriated for the Nursing Research Grants Program in urgent supplemental appropriation.
i Minus $4,355 retained for BHPr evaluation activities.
k Includes $197,094 transferred to NCHSR for one cooperatively funded project.
~ Minus $90,000 retained for BHPr evaluation activities.
m Includes $747,376 transferred to NIA for 4 cooperatively funded projects.
SOURCE: Division of Nursing, HRSA.
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130
3.6
3.2
2.8
2.4
An
2 . 0
I_
Appropriated
of Awa rded
:
1.6
0.8
i'
60 62 64
66 68 70 72
PI SCAL YEAR
74 76
78 80 82 84
FIGURE 6~1 Funding for nursing research "rants and contracts, 1960-83 (1972 $, millions). Data
are from the Division of Nursing, HRSA.
TABLE 6.4 National Research Service Awards in Nursing, FY 1982-84a
Predoctoral
N
Postdoctoral
N
Total
N
If
1982
New 56 2 58 492,400
Continuing 62 0 62 467,110
Total 118 2 120 959,510
1983
New 43 354,231 3 58,548 46 412,779
Continuing 64 513,562 2 33,590 66 547,152
Total 107 867,793 5 92,138 112 959,931
1984
New 47 389,724 2 45,952 49 435,676
Continuing 66 496,786 2 23,025 68 519,811
Total 113 886,510 4 68,977 117 955,487
a All awards represent fellowships.
SOURCE: Division of Nursing, HRSA.
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131
TABLE 6.5 NRSA Applications Reviewed by Scientific Review Groups, by Status of Application,
FY 1984
Date of Review
Total Number Number Number
Applications Approved Disapproved Deferred
34 23 10
20 13
_ 3
102 67
October 13-14, 1984
February 2-3, 1984
May 10-11, 1984
TOTAL APPLICATIONS
16
32
Predoctoral Applications 96 64 29 3
Postdoctoral Applications 5 2 3 0
Institutional Training Grants 1 1 0 0
SOURCE: Division of Nursing, HRSA.
Most of the applicants and trainees sponsored through the division
are doing work in nursing (Table 6.6~. Of approved applicants in
1984, 66 percent were in the nursing discipline. Among the stated
research interests of 1984 awardees were "Coping with Spinal Cord
Injuries and Rehabilitation," "Psychometric Methods for Nursing
Research," "Nursing Care Delivery Systems in Rural Areas, n and
"Nursing Strategies in Infection Prevention of Cancer Patients."
It is estimated that approximately 1,000 individuals have received
training grants in the area of nursing since the inception of the NRSA
awards.
TABLE 6.6 Disciplines of NRSA Applicants, by Status of Application, FY 1984
Discipline
Total Number Number Number Number
Applications Approved Disapproved Deferred Withdrawn
64 44 18
4 1 2
1
Nursing
Human Development
Physiology
Epidemiology
Anthropology
Psychology
Sociology
Social Psychology
Education
Educational Psychology
Health Services
Public/Community
Health
History
Rehabilitation Education
Policy/Ethics
TOTAL
SOURCE: Division of Nursing, HRSA.
l
2
2
6
2
1
2
2
2
102
44
1
l
2
1
l
3
2
2
2
67
1
l
3
2
32
1
3
l
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132
National Institutes of Health
In December 1984, an NIH Task Force on Nursing Research delivered
its report to the NIH Director. The report focused primarily on the
support of nursing research by NIH in fiscal year 1983. The report
uses a working definition of nursing research at NIH: research
conducted by the nurse principal investigator (PI); or nursing care
research.) The task force was able to classify 108 extramural
activities funded by NIH in FY 1983 as nursing research or as having
components of nursing research. A total of $6.6 million was awarded
to the nursing portions of these activities. The awards were made
through 14 types of activities in the extramural program (Table 6.7~.
Table 6.8 shows which unit of NIH supported the activities. Seventy
percent of the total funding came from either the National Cancer
Institute or the National Institute on Aging.
A major program of the National Cancer Institute involving nursing
research is the Clinical Cooperative Group Program. The 15 cooperative
groups support oncology nursing or nursing research subcommittees.
Activities of nurses in the clinical research effort include participa-
tion in protocol development (with particular emphasis on the potential
impact of different treatment options on patient compliance), facilita-
tion of the informed consent process, development of nursing care and
patient education approaches to dealing with side effects of therapy,
data management, attendance at scientific meetings, and presentation
and publication of research results.
The individual units were asked to classify their projects into
one of five focus areas. These areas were defined as follows:
Research--scientific inquiry in the cause, diagnosis,
and prevention of diseases, in the promotion of
health, in the processes of human growth and
development and in the biological effects of
environmental contaminants. The principal investigator
iS a nurse.
The full definition follows: 1. Research conducted by the nurse
principal investigator: scientific inquiry in the causes, diagnosis,
and prevention of diseases; in the promotion of health; in the
processes of human growth and development; and in the biological
effects of environmental contaminants. 2. Nursing care research:
research directed to understanding the nursing care of individuals and
groups and the biological, physiological, social, behavioral, and
environmental mechanisms influencing health and disease which are
relevant to nursing care. Nursing research develops knowledge about
health and the promotion of health over the full lifespan, care of
persons with health problems and disabilities, and nursing actions to
enhance the ability of individuals to respond effectively to actual or
potential health problems (Task Force Report, p. 1~.
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133
TABLE 6.7 Activities of NIH Grants with Nursing Research Components, FY 1983
Activity (Code)
Research Project (Rot)
Research Demonstration and Dissemination (R18)
Comprehensive Center (P60)
Biomedical Research Support Grant (S07)
Specialized Center (P50)
Research Program Projects (P01)
Academic Teacher Award (K07)
General Clinical Research Center (M01)
Research and Development Contracts (N01)
Contracts (unspecified)
New Investigator Research Award (R23)
Intragency Agreement (Y01)
Small Grants (R03)
Small Business Innovation Research (R43)
TOTAL
SOURCE: NIH Task Force on Nursing Research, December 1984.
Number of Awards
21
20
19
15
8
5
2
l
l
108
TABLE 6.8 NIH-Funded Extramural Projects in Nursing Research or with Nursing
Research Components, by Supporting Unit, FY 1983
Institute/Division
Nat'l. Cancer Institute
Nat'l. Institute on Aging
Division of Research Resources
Nat'l. Institute of Arthritis, Diabetes, and
Digestive and Kidney Diseases
Nat'l. Heart, Lung, and Blood Institute
Nat'l. Institute of General Medical Sciences
Nat'l. Institute of Allergy and Infectious Diseases
Nat'l. Institute of Neurological and
Communicative Disorders and Stroke
TOTAL
SOURCE: NIH Task Force on Nursing Research, December 1984.
Number of
Awards
$ Funded
% of
Total $
40
30
30
22
20
13
11
6
3
_ 658,000
108 6,646,682
2,641,012
2,025,456
173,133
194,645
713,726
156,359
84,342
3
11
2
1
0
00
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136
TABLE 6.10 V.A. Research Projects with Nurse Principal Investigators, by Position of Principal
Investigator and Area of Research, FY 1984
Position of
Principal Investigator
Staff Nurse
Head Nurse
Instructor
ACNS/E
Nurse Practitioner
Infection Control Nurse
Clinical Specialist
Supervisor/C oordinator
ACNS
Nurse Researcher
ACNStResearcher
Other
TOTAL
SOURCE: Veterans Administration.
Clinical
24
12
6
5
12
27
7
6
14
38
151
Area of Research
Administration
4
3
2
3
1
6
24
Education
5
2
l
5
The grants program supports nursing research directed by a
registered nurse. It is designed primarily for beginning nurse
researchers, but experienced researchers entering a new area of
investigation are also considered for awards. From 1955 through 1984,
the program awarded 206 grants for a total of more than $1 million.
In 1985, 32 grants of up to $2,500 each are expected to be awarded.
Robert Woocl Johnson Foundation
Total
29
12
11
5
6
13
34
10
3
8
20
-
190
~ ~ _ _—~ ~
The Robert Wood Johnson Foundation supports nursing research
through its grants program and through its relatively new Clinical
Nurse Scholars Program. Since 1982, the Foundation has supported, or
is supporting, 17 projects in the area of nursing research, for a
total commitment of $3.5 million. Research subjects have included
"Increasing Communication Ability in Stroke Patients," ''Program to
Improve Health Outcomes for Teenage Mothers and Their Infants, n
"Survey of the Role of Nurse Midwives in United States Health Care,
and "Sources of Nurse Satisfaction and Nursing Shortages in Hospitals."
The Clinical Nurse Scholars Program supports individual researchers
during two-year postdoctoral fellowships for advanced, in-hospital
clinical practice and research. Scholars are based at the academic
health centers of one of three institutions: the University of
California, San Francisco; the University of Pennsylvania; or the
University of Rochester. The first group of nine scholars received
awards for 1983-85, and nine additional scholars were funded for
1984-85 and for 1985-86. Up to nine awards may be made each year.
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137
The goal of the program is to prepare a group of nursing faculty and
clinicians who can place renewed emphasis on clinical teaching,
practice, and research at their own institutions. Applicants must be
registered nurses with earned doctorate degrees. Most recipients take
a leave of absence from their employing institutions in order to
accept the fellowship; stipends are based on the recipient's current
salary level. A total of $3.3 million has been allocated to this
program thus far; much of this amount was in start-up and
administrative costs.
Sigma Theta Tau
Sigma Theta Tau, the national honor society of nursing has awarded
a small number of nursing research grants each year since 1936. The
purpose of its grant program is "to encourage qualified nurses to
contribute to the advancement of nursing through research." Applicants
must be registered nurses holding a master's degree or a doctorate.
The maximum award is for $3~000O In 1984, the program received 33
applications. Ten were funded, for a total of $27,532. Local
chapters of Sigma Theta Tau commonly make a small number of research
awards each year, usually not exceeding $1,000, to their members.
NURSES WITH DOCTORAL DEGREES
Doctorate Degrees Awarded
The number of nurses receiving doctorates each year has been
accelerating since 1978 (Figure 6.2~. Data from the National League
for Nursing show that 31 doctorates were awarded to nurses in academic
year 1964-65; by 1981-82 that number had increased to 204.
Many nurses earn doctorates in fields other than nursing, however.
According to the American Nurses' Association, before 1950 nurses
earned the Ph.D. and the Ed.D. in equal numbers; between 1950 and
1964, more than half received Ed.D. degrees; but since 1965, the Ph.D.
has been the most prevalent of doctoral degrees earned by nurses. The
nursing science doctorates, D.N.S. and D.N.Sc., have been awarded only
since the 1960's, but their numbers have been increasing. Of the
3,648 nurses with doctorates surveyed by ANA in its 1984 study, 53.9
percent held the Ph.D., 32.5 percent the Ed.D., and 7 percent the
D.N.S./D.N.Sc. The remaining 6.6 percent had other doctoral degrees.
The ANA's 1984 survey also collected data on the major area of the
degree awarded. Respondents reported that 37 percent of the degrees
were in education, 12 percent in nursing, 3 percent in public health,
and 4 percent in the biomedical sciences. The remainder had a variety
of major areas or did not report a major area.
For its 1980 survey, the ANA identified 2,348 U.S. nurses with
earned doctorates. Of these, 1,964 completed and returned the
questionnaires (83.6 percent response).
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138
220
200
180
160
140
120
100
80
60
40
20
lo
it/
Al l Departments ~ /
X~ w~ sex an All ~
64
x
~ Nursi ng Education Departments
xx
, - ~~+ xx
I , I I l I I I I
66 68 70 72 74 76 78 80 82
YEAR
FIGURE 6.2 Research doctorates awarded to nurses, 1965-82 (academic years). Data are from
the National League for Nursing (1981-84~.
The federal government has been the most common source of support
for nurses during doctoral study. Since 1950 more than 40 percent of
the nurses with doctorates who had outside support while studying for
the degree received that support from a federal grant for training or
research (ANA, 1981, p. 37~.
Doctoral Programs in Nursing
The number of doctoral programs in nursing also has been increas-
ing steadily over the past 20 years (Figure 6.3~. According to the
NLN, in 1962-63 there were four programs in nursing schools or
departments that awarded doctorates. In 1983-84 there were 30 such
programs. Of that number, 21 granted the Ph.D. degree, 8 awarded a
nursing science degree, and 1 awarded the Ed.D. (Table 6.113.
The enrollment of nurses in doctoral programs has been increasing
as well (Figure 6.4~. The NLN reports that much of this increase is
due to the rising number of part-time students.
OCR for page 139
139
30
28
26
24
22
`,, 20
CC
~3
o
18
16
14
12
10
8
6
4
2
o
-
62 64 66 68 70 72 74 76
YEAR
78 80 82 84
FIGURE 6.3 Research doctoral programs administered by schools or departments of nursing
1963-84 (academic years). Data are from the National League for Nursing (1981-84~.
TABLE 6.11 Doctoral Programs in Nursing, 1983-84
Degree Granted
Ph.D.
D.N.Sc.
D.N.S.
D.S.N.
D.N.
Ed.D.
Number of Programs
21
3
2
l
TOTAL
SOURCE: Sigma Theta Tau (1984a).
30
OCR for page 140
140
1.8:
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YEAR
All Doctoral Programs /~/ xx.~*
~ / xx
/ x+~+
~ ax
J fix
x
x
xx
x
"xX ~ Nurs i no Doctoral Prnarams
1 1 _ t ~
77 79 81 83
FIGURE 6.4 Nurses enrolled in research doctoral programs, 1965-83 (academic years).
Data are from the National League for Nursing (1981-84~.
Nurse Faculty with Doctorates
In nursing education programs, the number of faculty members who
hold doctorates has been increasing but still is a small proportion of
the total faculty (Figure 6.5~. In 1982, only 8.4 percent of all
full-time nurse-faculty members held doctorates; 16.1 percent of those
employed in programs offering the baccalaureate and higher degrees
held the doctorate. The NLN reports that of the 1,657 full-time nurse
faculty holding doctorates, 92 percent were employed in programs
offering the baccalaureate and higher degrees.
Employment of Nurses with Doctorates
In 1980, 91 percent of the nurses with doctorates were employed,
most (88 percent) full-time (ANA, 1981~. Approximately 6 percent were
retired, and approximately 2 percent were in temporary positions.
Only about 1 percent were reported to be unemployed and seeking
employment.
OCR for page 141
141
20
at
,_, 10
Lo
lo
L
r --Al ~ Programs
Baccalaureate & Higher
It
LO
Led
_
{.,;
~ l
iffy
i,/..`
64 66 68 70 72 74 76 78 80 82
YEAR
FIGURE 6.5 Percentage of full-time nurse faculty who hold research doctorate degrees,
1964-82 (academic years). Data are from the National League for Nursing (1981-84~.
By far the largest proportion of all nurses with doctorates (61
percent) were employed in schools of nursing offering the
baccalaureate and higher degrees; 4 percent worked in schools of
nursing offering less than the baccalaureate. Another 6 percent ware
faculty members in other departments of educational institutions.
Government agencies {4 percent), hospitals (2 percent), and public
health settings (1 percent) accounted for the other specified
employment settings of nurses with doctorates.
In institutions having both baccalaureate and higher degree
programs in 1982, about 20 percent of full-time nurse faculty were
assigned exclusively to the graduate programs, and another 18 percent
were assigned part-time to graduate programs and part-time to
baccalaureate programs. The remainder spent full-time with the
undergraduate programs.
As indicated in Table 6.12, 4.6 percent of nurses with doctorates
reported that their major function was research. This percentage was
highest (18.1 percent) for those employed by government agencies.
When broken down by degree {Table 6.13), the percentage was highest
for those whose doctorate was in the biomedical sciences.
Table 6.14 shows the responses of nurses with doctorates as to
what percentage of time is spent on research (ANA, 1981~. Nurses in
health professions schools other than nursing reported spending almost
30 percent of their time on research. Those in nursing programs at
the baccalaureate and higher level spent only about 12 percent of
their time on research.
OCR for page 142
142
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OCR for page 144
SOURCE: American Nurses' Association (1981).
144
TABLE 6.14 Average Percentage of Time Spent in Research by Work Setting and Percentage of
Nurses with Doctorates, 1980
% Time % of Nurses
Setting in Research with Doctorates
School of Nursing (Baccalaureate and Higher) 11.8 ~ 70 1
School of Nursing (Hospital) 0.8 J
School of Nursing (Associate Degree) 2.3 ~ 4 6
Other Health Professional School 28.4 |
Other Department or School 11.1 ~ 7 1
Hospital in Service 11.5 |
Hospital Nursing Administration Work 12.3 . 2 9
Public/Community Health Agency 4.0 .
Federal/State/Local Government 20.6 6.0
Other 14.3 9.3
100.0
SUMMARY
In 1983, an Institute of Medicine committee (IOM, 1983a, p. 149)
concluded that:
Unlike the situation with respect to the basic
supply of generalist nurses, where we have found the
likelihood of a general balance between supply and
demand in 1990, the committee concludes that there is
both a serious current and probable 1990 shortage of
nurses educationally prepared for administration,
teaching, research, and advanced clinical nursing
specialties. ... there is such an obvious gap between
the present supply ... and even conservative estimates
of future advanced positions required ... that
existing program capacity and sources of student
support at the graduate level should be expanded.
We agree with these findings.
nurses with doctorates, -
· ~ ~ ~ _ ~ e ~ ~ ~
The low rate of unemployment of
the low percentage of nurse faculty members
wean aoccorates, ana one rapid growth in the number of doctoral
programs in nursing lead the committee to conclude, even in the
absence of numerical projections, that there is and will continue to
be unfilled demand for researchers in this area.
There is also a growing need for training support in nursing
research. In FY 1985, appropriations for NRSA programs of the
Division of Nursing more than doubled from the previous year to 82
million, and the number of trainees and fellows increased to 168.
Applications for fellowships increased by about 50 percent in FY 1985
and are expected to increase by another 30 percent in FY 1986.
.
OCR for page 145
145
NRSA fellowships and traineeships constitute one of the principal
sources of support for nurses pursuing predoctoral and postdoctoral
research training. However, the committee notes that funding levels,
although increasing, have not been sufficient to allow programs to
reach the levels it has recommended in the past. The importance of
the problems addressed in nursing research, the continued demand for
nurse faculty with research training, and the growing pool of
fellowship applicants all indicate that nursing research is a rapidly
developing area. Research training levels should be raised from the
current number (168 in FY 1985) to about 320 in 1990.
OCR for page 146
Representative terms from entire chapter:
nursing care
