Meeting the Nation's Needs for Biomedical and Behavioral Scientists: Summary of the 1993 Public Hearings (1994)

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APPENDIX D 43 been highly regarded by our trainees (and even junior faculty). Finally, for Ph.D. trainees in biomedical human disease would be desirable. An example of that is the predoctoral program directed by Dr. Irwin Arias at Tufts University School of Medicine, about which you have already heard. In this program, Ph.D. trainees take a course in human pathobiology, which is focused on integrating basic research and human disease. This is an enormously successful program and was described by Dr. Arias in a recent article in the New England Journal of Medicine. Summary A crisis exists in the support of training for biomedical research, which needs urgent attention. This includes: • continued support of biomedical research • continued support of the NRS A program • innovative methods for bringing young people into biomedical research • new mechanisms for “bridge” support from NRSA to first “independent” funding • expanding the pool of young people going into research careers, including innovative ways of recruiting minority trainees • developing curricula for M.D. trainees in biomedical science • ascertainment that trainees’ needs drive training programs, not mentors’ needs • on-going dialogues regarding biomedical science as a national priority STATEMENT BY ADA K. JACOX, Ph.D, R.N., F.A.A.N. The American Nurses Association (ANA) is pleased to have the opportunity to discuss with the Committee the need for biomedical and behavioral research personnel. There is a tremendous need for reliable and timely estimates of supply and demand of all disciplines involved in biomedical and behavioral research. Nurse scientists conduct research in many diverse areas, and increasingly integrate the bio-psycho-social sciences into the nursing hypotheses being tested. New training programs are being developed that build on collaboration among disciplines, linking the biological/molecular and behavioral sciences with nursing research. The complexity of health care problems and the need for evaluation of methods and costs of delivering health care services, will also require increased collaboration among nurses and health services researchers. Support for the preparation of future nurse scientists from the NRSA program is critical to the establishment of the cadre of nurses with the skills and resources required to contribute to improving our national health care environment. There are several ways to estimate the current supply of doctorally prepared nurses. The 1992 National Sample Survey of Registered Nurses, conducted by the Division of Nursing, HRSA, estimates that there were 11,284 registered nurses with doctorates in 1992. This represents only 0.5 percent of the total registered nurse population (Division of Nursing, March, 1992). The American Association of Colleges of Nursing (AACN) reports enrollment and graduations in baccalaureate and graduate programs in nursing. Table 1 provides information on trends in enrollments and graduations over the last five years in a cohort of 53 schools of nursing with doctoral programs. Both enrollment and graduations show significant steady increases since 1988. In the Fall of 1992, there were a total of 2,797 students enrolled in the 54 programs offering nursing doctoral degrees; 57 percent were enrolled on a part-time basis. It is important to note that over half of the enrolled doctoral students attend on a part-time basis. Existing sources of financial support for predoctoral training are very limited, and many registered nurses find it essential to work full time while pursuing doctoral study. There is difficulty in estimating the supply of nurses with doctorates partly because an unknown number of nurses graduate each year from programs in related fields such as psychology or epidemiology, and these graduates are not tracked in any systematic way. The 1992 National Sample Survey estimates that there are 7,000 registered nurses with doctorates in related fields (Division of Nursing, March, 1992). 

APPENDIX D 44 Even with the increase in numbers of doctorally prepared nurses, the gap between supply and demand remains large. It is important to note employment trends of doctorally prepared nurses as related to demand in service settings as well as in academia. The 1984 Sample Survey reported that 9.3 percent of doctorally prepared nurses worked in hospitals (Moses, 1986). In 1988, the estimate was for 80 percent of nurses with doctorates employed as faculty, 14 percent in hospitals, and 6 percent in other areas. The latest sample survey estimates that in 1992, 63.4 percent of employed nurses with doctorates were employed in nursing education, 18.5 percent were employed in hospital settings, and the remainder were employed in other categories. Many more nurses employed in hospitals and other service settings are in research related positions conducting clinical investigations related to quality of care, effectiveness of clinical therapeutics, and ethics and clinical decision making. The most recent AACN data indicates that only 59.7 percent of nurse faculty members who have full-time appointments in schools of nursing offering doctoral programs hold earned doctorates. For institutions offering only baccalaureate level programs, the figure is 24.7 percent (Bednash, 1993). It is clear that nursing staff has a great distance to go before its academic faculty are fully prepared educationally. Another concern is the age of nursing school faculty. For the 7,750 full- time faculty reporting age data, the mean age is 47.2 years; for faculty in schools with doctoral programs the mean age is 49.2. AACN data on faculty race and ethnicity indicate that 45.1 percent of only 679 minority faculty in schools of nursing have earned doctorates (Bednash, 1993). Research training for minority nurses clearly needs to be a priority. Most of the projections of need for nurses with doctoral preparation have focused on predoctoral training and have not addressed the needs of nurses with a basic research preparation to build a program of research. The ANA Council of Nurse Researchers has advocated for more resources for postdoctoral positions so that individuals can receive the mentoring needed as they develop a research track record (ANA, 1985). Because there is such a tremendous demand for nurses with doctorates in schools of nursing, faculty have many other teaching responsibilities and often delay developing an active research program. At the same time, the competition for research funding is very keen, requiring previous experience and pilot work if applicants are to be successful. Twenty schools of nursing received BRSG support in 1991, the final year of the BRSG program, and were able to assist faculty with pilot monies for initiating research projects. Fewer than 50 nurses per year are supported by the NRSA program for postdoctoral study. The RWJ Foundation funded a clinical nurse scholars program in which they granted two years of support for post-doctoral study. This program, begun in 1982 to assist faculty in developing their research careers, was phased out in 1991. There continues to be a need to enhance the research skills of nurses through postdoctoral study as well as additional opportunities to build new skills at the mid career level. An additional source of information regarding need for doctorally prepared nurses is the Institute of Medicine Committee on National Needs for Biomedical and Behavioral Research Personnel. The 1985 Institute of Medicine Report on Research Personnel noted that “the low rate of unemployment of nurses with doctorates, the low percentage of nurse faculty members with doctorates, and the 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” (NAS, 1985). The report recommended NRSA support of 320 nurses in research training by 1991. Research training and career development are a major component of the long-range plan of the National Center for Nursing Research (NCNR) and have consistently received strong interest from Congress. The projections developed by the NAS have been critical in developing NCNR research training programs. Because of budget constraints, NCNR has been unable to follow the NAS recommendations. NCNR supported a total of 269 trainees in 1991 and a total of 261 trainees in 1992. Only 16 percent of trainees funded were in postdoctoral training. It is estimated that an additional $2.2 million would be required to bring the training program in line with the 1985 NAS recommendations. In the 1989-1990 Biennial Report to the Congress, The National Advisory Council for Nursing Research projected the need for 362 NRSA supported positions by 1995. They also included a recommendation of 50 research career awards by 1995 (a mid career award for investigators). In order to implement this recommendation, $6.8 million would be needed for the NRSA program and $2.2 million would be required for the mid careers program. 

APPENDIX D 45 Table 1. Five-Year Doctoral Enrollment and Graduation Changes in the Same 53 Schools by Region and Student Status. YEAR CHANGE SIGNIFICANCE 1988-89 1989-90 1990-91 1991-92 1992-93 PER YEAR NUMBER NUMBER NUMBER NUMBER NUMBER NUMBER P-VALUE OF OF OF OF OF OF STUDENTS STUDENTS STUDENTS STUDENTS STUDENTS STUDENTS NORTH ATLANTIC PUBLIC FULL-TIME 25 21 25 22 20 -1 0.27 PART-TIME 7 36 45 64 61 14 0.02 GRADUATES 0 0 2 1 7 1 0.09 SECULAR FULL-TIME 119 113 138 114 222 21 0.18 PART-TIME 320 300 359 479 333 20 0.44 GRADUATES 47 92 55 60 70 1 0.84 RELIGIOUS FULL-TIME 27 39 41 49 48 5 0.02 PART-TIME 45 35 37 32 35 -2 0.15 GRADUATES 10 15 10 11 12 0 1.0 MIDWEST PUBLIC FULL-TIME 201 195 205 204 222 5 0.10 PART-TIME 205 247 264 293 328 29 0.001 GRADUATES 44 43 45 63 65 6 0.04 SECULAR FULL-TIME 36 52 64 37 49 1 0.81 PART-TIME 54 100 108 89 75 3 0.71 GRADUATES 16 16 16 24 21 2 0.13 RELIGIOUS FULL-TIME . 2 7 17 20 6 0.02 PART-TIME . 5 18 21 30 8 0.03 GRADUATES . . . . . . . SOUTH PUBLIC FULL-TIME 310 274 312 337 296 3 0.70 PART-TIME 455 536 577 501 587 23 0.22 GRADUATES 83 97 107 125 118 10 0.02 SECULAR FULL-TIME . . . . . . . PART-TIME . . . . . . . GRADUATES . . . . . . . RELIGIOUS FULL-TIME . . . . . . . PART-TIME . . . . . . . GRADUATES . . . . . . . WEST PUBLIC FULL-TIME 239 283 314 283 295 11 0.24 PART-TIME 73 85 77 105 116 11 0.03 GRADUATES 32 54 39 48 71 7 0.14 SECULAR FULL-TIME . . . . . . . PART-TIME . . . . . . . GRADUATES . . . . . . . RELIGIOUS FULL-TIME 12 5 0 4 7 -1 0.51 PART-TIME 27 44 38 29 30 -1 0.75 GRADUATES 0 1 13 15 5 2 0.33 TOTAL FULL-TIME 969 984 1,106 1,067 1,179 50 0.03 PART-TIME 1,186 1,388 1,523 1,613 1,595 104 0.02 TOTAL 2,155 2,372 2,629 2,680 2,774 . . GRADUATES 232 318 287 347 369 30 0.040 Source: American Association of Colleges of Nursing, Institutional Data Systems 1992-93.