Abstract
Background
Developing the next generation of nurse researchers must be a priority to advance the discipline’s science. A comprehensive description of the current federally - funded research is useful for understanding the research enterprise in Schools of Nursing.
Purpose
To describe the past 5 years of National Institute of Health (NIH) funding patterns in US Schools of Nursing.
Method
Data were extracted from NIH RePORTER for years 2014–2018. The total number of award types (F, K, R, U, P and T) granted to a School of Nursing in the US was summarized and organized by Institute. Grants were then characterized according to whether the Principal Investigator had a nursing degree (yes or no). Finally, the total funding from each NIH Institute/Center that was awarded to a School of Nursing was assessed.
Findings
Nearly 50% of the National Institute of Nursing Research’s (NINR) extramural budget is awarded through grants to Schools of Nursing in the US. NINR funds 80% of training grants and >70% of Center grants, which support the education and infrastructure for research, respectively, at Schools of Nursing. Among top ranked research-intensive Nursing Schools, awards to non-nurse Principal Investigators (PIs) averaged 34.5% across all years. The percentage of NIH funds awarded to non-nurse PIs ranged from 0% at 3 Schools to as high as 97% at 1 School of Nursing. Over the past 5 years, the following Institutes have consistently been the largest funders (total dollars) to Schools of Nursing: NINR, National Institute of Aging, National Institute of Minority and Health Disparities, National Cancer Institute and National Institute of Child Health and Human Development.
Conclusion
These findings highlight the current funding streams for Schools of Nursing as well as opportunities for expansion. Preparing a cadre of nurse scientists who can generate new knowledge to advance our health care is critical to the success of our profession and to ensuring the health of the people for whom we provide care.
At a time when a tsunami- like wave of retirements is occurring among nurse faculty, developing the next generation of nurse researchers is a priority to sustain the discipline’s science (Dreher, Smith Glasgow, Cornelius, & Bhattacharya, 2012). For nursing to remain at the forefront of new knowledge development, nurse scientists capable of conducting independent research must be developed and the number expanded (Reid Ponte, Hayman, Berry, & Cooley, 2015). Hypothesis-generating and intervention-testing research is critical to building the science that underpins nursing practice (Abdellah & Levine, 1965). Yet, maintaining a research-intensive environment in a school of nursing is challenging at best.(Andrews, Corbett, Dail, & Pinto, 2019) To name a few, there are challenges in recruiting and maintaining productive research faculty, the financial costs associated with obtaining funding (Kulage et al., 2015), and balancing the critical need for teaching that often competes with research productivity (Smeltzer et al., 2014).
Related to the above is that while the research-focused doctoral programs awarding a terminal PhD degree are critical to preparing a cadre of nurse scientists who are capable of generating new knowledge to advance the science (American Association of Colleges of Nursing, 2006), the capacity of doctoral programs for successfully training competitive nursing scientists is inconsistent (Anderson, 2000; Kim, McKenna, & Ketefian, 2006) because of differences in resources and the competencies of the faculty (Potempa, Redman, & Anderson, 2008). As currently structured, many PhD programs in nursing may not have the capacity to prepare students to lead innovative scientific research aligned with the national priorities for health sciences research (Henly et al., 2015). For example, in a recent review of PhD programs, findings suggest that nursing PhD programs are continuing to implement curricula better suited to the past(Wyman & Henly, 2015). In response, there are now recommendations for nursing curricula to include emerging areas of science and technological advances in data collection and capture, storage, retrieval, and analysis, specifically incorporating advances in biological sciences, biophysical and imaging technology, informatics technology and computing, mathematical/statistical modeling, and engineering for point-of-care technologies (Dunbar-Jacob, 2013; Wyman & Henly, 2015). Other recommendations for excellence suggest the inclusion of research training to expose PhD students to team science to prepare graduates to effectively engage with interdisciplinary colleagues to conduct cutting-edge nursing research and compete successfully for precious research resources.(American Association of Colleges of Nursing (AACN), 2010)
It is well recognized that at the forefront of nursing is the need to increase scientific discoveries that improve health outcomes for the populations that we serve. A registered nurse who conducts research has the potential to uncover new information that can underpin practice. Therefore, sustaining and expanding the research enterprise in Schools of nursing must be a priority (Berkowitz, 2015). To better understand the current funding landscape in the US, this paper seeks to describe the success of nurse scientists and Schools of nursing in obtaining funding to support research. Little attention has been paid to current funding patterns in Schools of nursing, and funding patterns can elucidate scientific expertise in our discipline as well as gaps in our workforce. As such, the purpose of this paper is to describe the current National Institute of Health (NIH) funding patterns in US Schools of nursing over the past 5 years. To achieve this goal, this paper seeks to address the following three aims:
Describe the total number and amount ($) of grants awarded to Schools of Nursing over the past 5 years and the percentage of grants funded by the NINR.
Compare the number and award amounts of grants to nurse and non-nurse PIs at the top funded schools of Nursing over the past 5 years.
Assess the total funding by each NIH Institute/ Center to Schools of Nursing and the % of the total Institute/ Centers’ budget that is being awarded to Schools of Nursing over the past 5 years.
Methods
Data were extracted from the NIH RePORTER database, a database publicly accessible at https://exporter.nih.gov/. The search was limited to Schools Nursing (Organization Type) and to NIH (vs. AHRQ, CDC) funding from 2014–2018. NIH is the largest federal funder of biomedical research and so this can provide a global snapshot of the current funding patterns. Further, complete data on AHRQ and CDC grants is not available through a public website. NIH RePORTER lists the total number of grants awarded to Schools of Nursing and ranks each School of Nursing by number of awards and dollar amount. Following this, data were downloaded for all grants awarded to Schools of Nursing in the years: FY14-FY18. Total NIH funding was summed for all grants awarded in each fiscal year. The data were then segregated by activity code and specifically categorized as a Research Grant (R- and U-series), Training Grant (F- and T- series), Center Grant (P-series), or a Career Development Grant (K-series).
F-series and T-series grants both provide research training opportunities to trainees at the undergraduate, graduate and post-doctoral levels. F-series grants, fellowship awards, are aimed at individual researchers and T-series grants, training awards, are secured by senior investigators and trainees are selected by the investigator to be supported through the training grant. Similar to the F-series, pre-doctoral and post-doctoral trainees can be supported through a T-series grant.
Program project/center grants are large, multi-project efforts that generally include a diverse array of research activities. A P01 grant is a multidisciplinary, center with a basic theme. P20 grants are exploratory grants to support planning for new programs, expansion or modification of existing resources, and feasibility studies to explore various approaches to the development of interdisciplinary programs. P30 is a Center Core Grant to support shared resources and facilities for categorical research by several investigators from different disciplines who provide a multidisciplinary approach to a joint research effort or from the same discipline who focus on a common research problem. Finally, a P60 grant funds a comprehensive center to support a multipurpose unit designed to bring together into a common focus divergent but related facility within a given community. Research career development awards (K-series) provide research training opportunities to trainees at the postdoctoral, early and mid-career stages.
Each grant was then further categorized by Institute/ Center. For each grant type, the total number awarded to Schools of Nursing in each year was calculated. The percentage of each award type funded by the NINR was also calculated by dividing the total number of grants funded by NINR by the total number of grants funded for each grant type.
Figure 1 illustrates how to decipher the NIH grant number and Table 1 lists the acronyms, full names and codes for each NIH Institute/ Center. The guidelines above were used to categorize each grant awarded to Schools of Nursing from FY14-18. A research assistant reviewed the categorization of the data to ensure that it was consistent with the author’s coding.
Figure 1.
Deciphering NIH Grant Numbers available through the NIH website
Table 1.
National Institute of Health (NIH) Institute/ Center acronym, full name and code
| Acronym | Full Name | Code |
|---|---|---|
| FIC | John E. Fogarty International Center | TW |
| NCATS | National Center for Advancing Translational Sciences (NCATS) | TR |
| NCCIH | National Center for Complementary and Integrative Health | AT |
| NCI | National Cancer Institute | CA |
| NEI | National Eye Institute | EY |
| NHGRI | National Human Genome Research Institute | HG |
| NHLBI | National Heart, Lung, and Blood Institute | HL |
| NIA | National Institute on Aging | AG |
| NIAAA | National Institute on Alcohol Abuse and Alcoholism | AA |
| NIAID | National Institute of Allergy and Infectious Diseases | AI |
| NIAMS | National Institute of Arthritis and Musculoskeletal and Skin Diseases | AR |
| NIBIB | National Institute of Biomedical Imaging and Bioengineering | EB |
| NICHD | Eunice Kennedy Shriver National Institute of Child Health and Human Development | HD |
| NIDA | National Institute on Drug Abuse | DA |
| NIDCD | National Institute on Deafness and Other Communication Disorders | DC |
| NIDCR | National Institute of Dental and Craniofacial Research | DE |
| NIDDK | National Institute of Diabetes and Digestive and Kidney Diseases | DK |
| NIEHS | National Institute of Environmental Health Sciences | ES |
| NIGMS | National Institute of General Medical Sciences | GM |
| NIMH | National Institute of Mental Health | MH |
| NIMHD | National Institute on Minority Health and Health Disparities | MD |
| NINDS | National Institute of Neurological Disorders and Stroke | NS |
| NINR | National Institute of Nursing Research | NR |
| NLM | National Library of Medicine | LM |
Results
The total number of grants awarded to Schools of Nursing increased by 11% from FY14 to FY18 (Table 2). The total amount of funding awarded to Schools of Nursing remained relatively consistent in FY14-16. On the other hand, there was a considerable increase of 10.2% from FY16-FY17 and an even larger increase of 12.9% from FY17 to FY18. In sum, the total amount of funding ($) increased by 28.5% over the past 5 years. The total dollars awarded to the top-funded school of nursing has varied considerably with the highest total dollar amount of $14,010,457 in FY15 at UCSF but almost half that amount, $7,829,770 in the following year, FY16 at Emory University.
Table 2.
Overview of NIH Grants and Funding Mechanisms to Schools of Nursing FY14-18
| FY14 | FY15 | FY16 | FY17 | FY18 | |
|---|---|---|---|---|---|
| Total Number of Grants | 400 | 386 | 400 | 438 | 444 |
| Total Number of Schools who received NIH funding | 63 | 66 | 69 | 67 | 70 |
| Number of Awards per School (Range) | 1–26 | 1–28 | 1–27 | 1–31 | 1–27 |
| Total NIH funding to Schools of Nursing | $133,532,047 | $135,391,339 | $137,967,423 | $151,998,248 | $171,560,204 |
| Total Funding by School (Range) | $2,573 - $10,149,031 | $27,989 - $14,010,457 | $1 - $7,829,770 | $21,0939,324,875 | $149,541 - $13,218,555 |
| # Research Awards (R and U) [% funded by NINR] | 259 (39.4) | 244 (38.9) | 258 (32.9) | 279 (30.8) | 299 (34.4) |
| # Institutional Training Awards (T) [% funded by NINR] | 27 (88.9) | 24 (95.8) | 26 (96.2) | 25 (80) | 25 (80) |
| # Individual Training Awards (F) [% funded by NINR] | 58 (94.8) | 51 (96.1) | 54 (88.9) | 54 (81.5) | 44 (77.2) |
| # Career Awards (K) [% funded by NINR] | 37 (64.9) | 42 (57.1) | 40 (52.5) | 43 (53.5) | 53 (49.1) |
| # Center (P) [% funded by NINR] | 16 (56.3) | 17 (52.9) | 19 (73.7) | 13 (76.9) | 20 (70) |
Over the past 5 years, of those Schools of nursing who received NIH funding, the total number of grants ranged from 386–444, and the total number of awards per school ranged from 1 – 31, with total funding ranging from $2,573 to $13,218,555. The total number of Schools who received NIH awards ranged from 63 (FY14) to 70 (FY18), an 11% increase in the number of Schools receiving a NIH award. Awards were comprised of: training (F, T), career development (K), center (P), research grants (cooperative (U) and research (R)) types of awards. Most of the awards across all years were R-series awards. Of R and U-series awards, NINR funded between 30.8 −39.4% of these types of awards.
Training (F,T) and Career Development (K) Awards
F-series grants awarded to Schools of Nursing in FY14 and FY15 were almost exclusively funded by NINR. Whereas in FY18, only 77.2% of these awards were funded by NINR. At the same time there was a 24.1% decrease in the total number of F-series awards to Schools of Nursing from FY14 to FY18. The total number of T-series grants has remained relatively stable with between 24–27 grants being awarded in any given year. In FY16, 96.2% of T-series grants were funded by NINR and in FY17 and FY18 only 80% were funded by NINR. Overall, across all years, nearly 80% or greater of all NIH support for training is funded through NINR.
The total number of K-awards increased by 43.2% from FY14-FY18. At the same time the total number of K-awards funded by NINR was nearly the same across each year: 24 in FY14 and FY15, 21 in FY16, 23 in FY17 and 26 in FY18. - In FY18, the following Institutes awarded K-awards to Schools of Nursing: NIA (N=8), NIDA (N=4), NIMH (N=3), NCI (N=3), NHLBI (N=2), NIAAA (N=1), NIAID (N=1), NIDDK (N=1), and NIEHS (N=1). Of the twenty-four K-awards from these Institutes, half were awarded to non-nurse PIs.
Program Project/Center Grants (P series)
From FY14-FY18, Schools of Nursing were award P01, P20, P30, and P60 types of Center grants. The total number of Center grants has ranged from a total of 13–20 across all Schools of Nursing with no clear inflection point over time. On the other hand, the percentage of Center grants funded by NINR increased by 111%.
Top NIH Funded Nursing Schools in the US
In the past 5 years, 15 Schools of Nursing have reached the rank of top 10 in NIH awards. On average, across all 15 Schools over 5 years, 34.5% (range 28.9% - 38%) of NIH funding was award to a non-nurse PI. Of these Schools, the number of non-nurse awardees receiving NIH funding has ranged from 0–97% of the total grants awarded. Table 3 illustrates the total funding amount, rank and % of funds awarded to a non-nurse PI at each School of Nursing over the past 5 years. There are some trends within Schools, but no apparent cross-school funding patterns are evident (Figure 2), suggesting such trends may be idiosyncratic to each school. For example, the University of Utah and John Hopkins University had only nurse-PI led projects in FY14 and FY14,15, respectively and have since seen a steady increase in the number of non-nurse PI funded projects. Likewise, UCSF, Emory, the University of Washington and UCLA have consistently had a percentage (25%, 36%, 52.5%, 30%) of grants led by non-nurse PIs. Although, the percentage has roughly doubled (56%, 48%, 74.6%, 54%) across the 5-year study period. The Universities of Pennsylvania and Michigan saw a spike in non-nurse PI funded projects in FY16. AT THE SAME TIME, there are Schools who consistently have very few (<10%) non-nurse PI funded NIH grants (e.g. Columbia University and Case Western Reserve University) and other Schools of Nursing who consistently have greater than 50% of their NIH funded projects led by non-nurse PIs (e.g. New York University, University of Washington).
Table 3.
Top Ranked Schools of Nursing by Total NIH Funding, Rank and % non-Nurse PI NIH funding
| FY14 | FY15 | FY16 | FY17 | FY18 | ||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| School of Nursing | Rank NIH$ | Total Funding | Total Funding with only Nurse PI funded Project | % non-Nurse PI NIH Funding | Rank NIH$ | Total Funding | Total Funding with only Nurse PI funded Project | % non-Nurse PI NIH Funding | Rank NIH$ | Total Funding | Total Funding with only Nurse PI funded Project | % non-Nurse PI NIH Funding | Rank NIH$ | Total Funding | Total Funding with only Nurse PI funded Project | % non-Nurse PI NIH Funding | Rank NIH$ | Total Funding | Total Funding with only Nurse PI funded Project | % non-Nurse PI NIH Funding |
| Penn | 8 | 5975295 | 5163217 | 13.6 | 6 | 5928951 | 5004466 | 15.6 | 2 | 7565890 | 4064463 | 46.3 | 1 | 9324875 | 5832257 | 37.5 | 1 | 13352127 | 9245726 | 30.8 |
| UCS F | 1 | 10149031 | 7564171 | 25.5 | 1 | 14010457 | 7035700 | 49.8 | 3 | 7273200 | 4407992 | 39.4 | 2 | 8835590 | 5374881 | 39.2 | 2 | 9115251 | 3996811 | 56.2 |
| Emory U | 11 | 3818746 | 2416678 | 36.7 | 4 | 6508794 | 4483974 | 31.1 | 1 | 7829770 | 4252394 | 45.7 | 4 | 7877737 | 4880980 | 38 | 3 | 8974147 | 4643355 | 48.3 |
| Pitt | 6 | 6299076 | 5012049 | 20.4 | 10 | 4399347 | 3444660 | 21.7 | 7 | 5477083 | 4584449 | 16.3 | 6 | 7327422 | 6125370 | 16.4 | 4 | 8853753 | 7395394 | 16.5 |
| NYU | 3 | 6656806 | 2071778 | 68.9 | 8 | 5374570 | 1889416 | 64.8 | 10 | 4672902 | 130664 | 97.2 | 11 | 4874497 | 1232160 | 74.7 | 5 | 8207207 | 3596737 | 56.2 |
| Columbia U | 17 | 2506751 | 2352413 | 6.2 | 16 | 2886035 | 2721820 | 5.7 | 11 | 4512132 | 4172571 | 7.5 | 5 | 7430108 | 6260081 | 15.7 | 6 | 8133087 | 8069549 | 1 |
| U of Was hington | 4 | 5762143 | 2735974 | 52.5 | 7 | 5889372 | 2332191 | 60.4 | 5 | 6405970 | 2720439 | 57.5 | 3 | 8075904 | 2720923 | 66.3 | 7 | 7676095 | 1948996 | 74.6 |
| Duke University | 9 | 4327395 | 3163749 | 26.9 | 9 | 4856086 | 4023775 | 17.1 | 4 | 6471139 | 5440942 | 15.9 | 10 | 4933823 | 4318900 | 12.5 | 8 | 5173656 | 4222090 | 18.4 |
| U.Michigan | 18 | 2502606 | 1948178 | 22.2 | 12 | 3893460 | 1771524 | 54.5 | 12 | 4477102 | 1698724 | 62.1 | 8 | 5317251 | 2618930 | 50.7 | 9 | 5065951 | 3544920 | 30 |
| John Hopkins | 5 | 6323211 | 6323211 | 0 | 3 | 6827126 | 6827126 | 0 | 6 | 5899204 | 4019128 | 31.9 | 12 | 4807222 | 3283928 | 31.7 | 10 | 4909639 | 3556783 | 27.6 |
| Case Western Reserve | 22 | 1946095 | 1857804 | 4.5 | 14 | 3142162 | 3142162 | 0 | 14 | 4105909 | 3907784 | 4.8 | 7 | 5555062 | 4828706 | 13.1 | 11 | 4870788 | 4670788 | 4.1 |
| UIC | 2 | 7442939 | 4316301 | 42 | 11 | 4161439 | 2018298 | 51.5 | 8 | 5222651 | 2635630 | 49.5 | 9 | 5060445 | 2171026 | 57.1 | 12 | 4524797 | 2297128 | 49.2 |
| U Maryland Baltimore | 10 | 3828731 | 3014381 | 21.3 | 21 | 1990913 | 1990913 | 0 | 13 | 4472650 | 3974343 | 11.1 | 15 | 4120631 | 2862834 | 30.5 | 16 | 3816195 | 2533680 | 33.6 |
| UCL A | 7 | 6191737 | 3713236 | 40 | 5 | 6204293 | 4287166 | 30.9 | 9 | 5089493 | 3525192 | 30.7 | 24 | 2440612 | 1651526 | 32.3 | 20 | 2953371 | 1361001 | 53.9 |
| U Utah | 16 | 2640445 | 2640445 | 0 | 2 | 7022879 | 6293003 | 10.4 | 18 | 2793942 | 1464564 | 47.6 | 23 | 2513295 | 1823908 | 27.4 | 26 | 2223023 | 749653 | 66.3 |
Figure 2.
% NIH AWARDS at Schools of Nursing led by a non-nurse PI BY YEAR
Institutes Awarding Grants to Schools of Nursing
Table 4 illustrates the number of awards and total funding awarded to Schools of Nursing from FY14-18 by each Institute and Center at the NIH. Additionally, Table 2 presents each Institute/ Center’s total extramural budget and the percentage of their budget that was awarded to a School of Nursing. NINR has consistently been the largest, both in total dollars and total awards, grantor to Schools of Nursing. In fact, 45–50% of the NINR extramural budget was awarded to Schools of Nursing over the past 5 years. NIA was the second largest funder of total dollars and number of awards to Schools of Nursing in FY17 and FY18, but the total number of awards and total dollar amount was approximately ‘A of the NINR grants. Over the past 5 years, the following Institutes have consistently been the largest funders (total dollars) to Schools of Nursing: NINR, NIA, NIMHD, NCI and NICHD. At the same time, in the past 5 years, NEI and NCATs have not awarded any grants to Schools of Nursing. Further, NLM did not award any grants in FY18 and NIBIB did not award any grants in FY17 and FY18 to a School of Nursing.
Table 4.
Number of Awards and Total Funding to Schools of Nursing by NIH Institute/ Center (FY14-18)
| FY14 | FY15 | FY16 | FY17 | FY18 | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Institute/ Center | SON Awards | SON funding | % | SON Awards | SON funding | % | SON Awards | SON funding | % | SON Awards | SON funding | % | SON Awards | SON funding | % |
| NINR | 213 | $56, 761, 827 | 50 | 203 | $56, 209, 185 | 49.6 | 190 | $54, 011, 824 | 6.5 | 199 | $54, 198, 006 | 45.2 | 193 | $64, 342, 872 | 48.7 |
| NIMHD | 14 | $6,872,750 | 2.6 | 15 | $7,016,979 | 3 | 10 | $8,844,192 | 3.7 | 24 | $14,334,324 | 5.8 | 22 | $14,088,636 | 5.4 |
| NLM | 1 | $682,028 | 1.4 | 1 | $520,655 | 0.9 | 2 | $966,995 | 1.4 | 2 | $530,470 | 0.7 | 0 | $0 | 0 |
| NIDA | 21 | $10,113,639 | 1.2 | 20 | $8,807,328 | 1 | 21 | $8,904,828 | 1 | 20 | $8,302,775 | 0.9 | 18 | $8,760,779 | 0.9 |
| FIC | 3 | $677,898 | 1 | 3 | $639,845 | 0.8 | 2 | $501,601 | 0.7 | 2 | $501,901 | 0.7 | 2 | $412,600 | 0.5 |
| NICHD | 20 | $6,821,003 | 0.7 | 26 | $8,777,265 | 0.8 | 32 | $10,795,210 | 0.9 | 33 | $12,446,187 | 1.2 | 27 | $10,696,028 | 1 |
| NIA | 18 | $6,980,164 | 0.7 | 20 | $6,883,400 | 0.7 | 35 | $12,160,740 | 0.9 | 47 | $17,674,562 | 1 | 58 | $22,705,963 | 1.1 |
| NCCIH | 3 | $614,499 | 0.6 | 3 | $879,448 | 0.9 | 4 | $1,381,001 | 1.2 | 4 | $827,627 | 0.7 | 4 | $1,088,207 | 0.9 |
| NCI | 35 | $14,804,347 | 0.5 | 35 | $17,147,307 | 0.5 | 33 | $12,913,691 | 0.4 | 33 | $12,021,070 | 0.3 | 35 | $12,920,860 | 0.4 |
| NIMH | 15 | $5,262,285 | 0.4 | 10 | $4,201,580 | 0.4 | 15 | $5,824,229 | 0.5 | 17 | $6,325,438 | 0.5 | 18 | $7,492,155 | 0.5 |
| NHLBI | 17 | $9,720,483 | 0.4 | 13 | $5,475,991 | 0.2 | 12 | $6,197,784 | 0.2 | 17 | $8,854,678 | 0.3 | 16 | $9,276,787 | 0.3 |
| NIDDK | 13 | $5,098,840 | 0.3 | 12 | $4,094,236 | 0.3 | 12 | $3,909,851 | 0.2 | 10 | $3,684,507 | 0.2 | 9 | $2,871,141 | 0.2 |
| NIDCD | 2 | $967,787 | 0.3 | 2 | $739,992 | 0.2 | 1 | $264,350 | 0.1 | 1 | $264,350 | 0.1 | 1 | $194,375 | 0.1 |
| NIBIB | 2 | $811,901 | 0.3 | 3 | $6,345,342 | 1.9 | 3 | $370,159 | 0.1 | 0 | $0 | 0 | 0 | $0 | 0 |
| NIEHS | 5 | $972,166 | 0.2 | 4 | $1,840,587 | 0.4 | 4 | $1,680,938 | 0.3 | 3 | $1,612,180 | 0.3 | 7 | $2,388,928 | 0.5 |
| NIAMS | 2 | $536,916 | 0.1 | 1 | $169,975 | 0 | 1 | $337,526 | 0.1 | 3 | $1,300,787 | 0.3 | 3 | $915,770 | 0.2 |
| NINDS | 3 | $1,119,058 | 0.1 | 2 | $1,030,628 | 0.1 | 2 | $633,456 | 0 | 3 | $354,396 | 0 | 2 | $848,034 | 0.04 |
| NIDCR | 1 | $242,036 | 0.1 | 1 | $679,628 | 0.2 | 3 | $1,383,098 | 0.5 | 2 | $1,147,830 | 0.4 | 3 | $1,880,552 | 0.6 |
| NIGMS | 7 | $1,813,392 | 0.1 | 7 | $1,649,913 | 0.1 | 7 | $1,539,821 | 0.1 | 3 | $560,955 | 0 | 3 | $531,094 | 0.02 |
| NIAID | 4 | $2,410,151 | 0.1 | 4 | $2,033,220 | 0.1 | 5 | $2,182,506 | 0.1 | 8 | $4,239,492 | 0.1 | 8 | $4,470,661 | 0.1 |
| NHGRI | 1 | $248,877 | 0.1 | 1 | $248,835 | 0.1 | 1 | $248,885 | 0.1 | 0 | $0 | 0 | 0 | $0 | 0 |
| NIAAA | 0 | $0 | 0 | 0 | $0 | 0 | 3 | $1,141,697 | 0.3 | 5 | $1,322,655 | 0.4 | 8 | $3,703,388 | 1 |
| OD | 0 | $0 | 0 | 0 | $0 | 0 | 2 | $1,773,041 | 0.3 | 2 | $1,494,058 | 0.2 | 2 | $1,737,194 | 0.2 |
Discussion
Over the past 5 years, NINR has funded about half of the total research awarded US Schools of Nursing. Of this, the percentage of Center grants funded by NINR has more than doubled over the past 5 years. Although center grants provide infrastructure to Schools of Nursing and promote thematic skills and expertise, to the extent that these Centers are confined to the mission of NINR, the expertise and research support at Schools of Nursing may thus be limited. Moreover, from FY14-16, NINR was nearly the exclusive funder of training programs to Schools of Nursing, suggesting further potential for scientific entrenchment. In the past 2 years, there has been a slight downward trend in this pattern with closer to 80% of training programs at Schools of Nursing being funded through NINR. Funded training programs through non-NINR Institutes/ Centers may provide training for pre-doctoral and post-doctoral trainees who are then better prepared to compete for cross-Institute NIH funding. If additional and more varied funding streams were tapped to educate future nurse scientists, perhaps pre-doctoral and post-doctoral students would have more scientifically diverse training. This may also allow our pre-doctoral and post-doctoral students to be more competitive for seeking funding from Institutes and centers other than NINR once they graduate. The relationship between receiving training funded through a F- or T-series award through NINR and how this translates into future success to secure NIH funding was not within the scope of this paper but warrants further study. In addition, the influence of non-nurse scientists as mentors for F or T-series fellows should also be explored.
Related to the above, over the past 5 years, nearly 50% of the NINR extramural budget was awarded to Schools of Nursing. While NINR may remain the predominant funder for Schools of Nursing in the US, nurse scientists must expand their capacity to secure funding from Institutes other than NINR. For example, given the budgets of the NHLBI, NCI and NIAID, there is clearly an opportunity to expand and seek funding from them.
In addition to the Institutes (i.e. NHLBI, NCI and NIAID) with largest budgets in the NIH, consideration of Institutes, such as NIAMS, NINDS and NLM, from which Nursing Schools have not received consistent funding over the past 5 years is an opportunity for expansion. For instance, in the case of NINDS, no Schools of nursing were awarded grants from this Institute. Yet, nurses provide care and understand the needs of persons who are affected by neurological disorders and stroke and so it should be part of our larger vision as nurse leaders to equip our next generation of nurse scientists to study the questions that are most relevant to our patients. Similarly, even though informatics is a core-competency and focus of nursing education, currently, in FY18 NLM did not fund any grants to Schools of Nursing. This is not surprising because few nursing students and scientists are taught to work with big data and instead nurses rely on other health professionals.(Marion E Broome & Fairman, 2018) This information can be used to inform whether emerging nurse scientists in Schools of Nursing have the opportunity to learn the content, gain the skills and become experts in domains that can be funded by the NIH Institutes and use this information to better prepare the next generation of nurse scientists.
Close attention should be paid to the current award of NIH grants to non-nurse PIs in Schools of Nursing. Among top ranked research-intensive Nursing Schools, awards to non-nurse PIs were as high as 97% over the past 5 years. Hiring of non-nurse PIs at Schools of Nursing needs to be carefully considered in light of the growing shortage of nurse researchers. Since developing junior faculty members into successful nurse scientists requires protected time for research, start-up funds, salary support in summer, and significant time investment in mentoring by senior faculty (Marion E Broome & Fairman, 2018), Schools of Nursing may be more likely to hire non-nurse faculty because they are more likely to be successful at securing NIH funding. If this is the case, then Schools of Nursing need to determine if there is training and education that needs to be included in our PhD and post-doctoral programs so that nurse PIs are better equipped to compete for NIH funding.
At the same time, non-nurse faculty in Schools of Nursing conduct research that is relevant and necessary to the practice of nursing and the inclusion of non-nurse faculty supports interdisciplinary efforts. However, further consideration of the need for balance between nurse PIs and non-nurse PIs and a careful assessment of Schools of Nursing where more NIH grants are awarded to non-nurses than to nurses. A bifurcated faculty structure in which all PhD prepared nurses are responsible for teaching and all non-nurse PhD faculty bring in research funding creates a structure where PhD prepared nurses cannot become successful academic leaders (McBride, 2019), because their work does not comprise teaching, research, service and scholarship.(Marion E. Broome, 2012) Careful attention should be paid to assure that non-nurse PIs are not only hired to bring in NIH dollars to increase rank, but are in fact contributing to the advancement of nursing science.
As the current generation of nurse scientists retires, training the next generation is imperative to sustain our discipline. To achieve this goal, Nursing PhD programs must sustain excellence and relevance and develop a diverse community of nurse scientists. Additionally, cross-institutional and interdisciplinary collaboration is critical as emerging areas of science need to be integrated into our doctoral training programs (Villarruel & Fairman, 2015). Despite the Future of Nursing Report recommendation to double the number of nurses with a doctorate by 2020 (Nursing, 2011), caution should be paid to filling the gap in our nursing academic workforce by truncating the time and rigor and quality of PhD training programs. This has the potential to result in nurse scientists who are ill-prepared to lead scientific advances and compete with their non-nurse peers for NIH funding. Additionally, the structure of our PhD programs may need to be more closely aligned with those of our peer disciplines, both in terms of overall length and structure. For example, a study of US nursing PhD alumni demonstrated that graduates, attended classroom-based programs, who had worked as research assistants and worked no more than 12 hours/ week as a nurse during their PhD education, were more likely to have successful publication records and receive external funding than graduates who did not have these experiences (Ellenbecker, Nwosu, Zhang, & Leveille, 2017). Many nurses have not received training and education that is comparable to their peers in other disciplines. For example, current initiatives through the RWJF foundation provide financial support for nurses to complete their PhD degree in 3 years.(Robert Wood Johnson Foundation, 2019) In comparison, the median number of years to doctorate is 6 years.(Kang, 2017) A 3 year deficit in training time brings into question the ability for a PhD prepared nurse to compensate for the training, skills and experiences acquired by their non-nurse peers. This begs the question as to whether this short-term fix has long-term consequences for the development of nurse scientists.
Another key to successful preparation of nurse scientists is post-doctoral education. Effective postdoctoral programs build on foundational skills and knowledge acquired through pre-doctoral studies, and provide newly prepared PhDs with concentrated time, resources, and support required to advance research skills and launch and sustain independent research careers (Conn, 2005; Wood, 2002; Wysocki, 1998). Evidence of the effectiveness of postdoctoral training was provided by NINR, which reported that nurses who complete an NINR-supported postdoctoral program are more successful in obtaining future research grant funding than peers who apply but do not complete such training (Sigmon & Grady, 2001). Similarly, receiving a postdoctoral training resulted in approximately one additional publication over the next five years as compared to peers who did not receive post-doctoral training (Jacob & Lefgren, 2011). Despite the effectiveness of postdoctoral training in building a pipeline of successful nurse scientists, only a small minority of nurse PhD program graduates obtain post-doctoral training. In 2018, there were 802 PhD graduates and only 112 enrolled in post-doctoral training.(American Association of Colleges of Nursing (AACN), 2019) By comparison in 2017, there were 796 PhD graduates and 120 enrolled in post-doctoral training (American Association of Colleges of Nursing (AACN), 2018). Of the small cadre of nurse PhD graduates each year approximately 15% enroll in a post-doctoral training program. Findings on the low rates of post-doctoral training among doctorally prepared nurses coupled with the staggeringly high rates of non-nurse led NIH studies in the School of Nursing point to the need for new models for encouraging nurse PHD graduates to obtain additional training so that they can successfully build their own program of research. Preparing a cadre of nurse scientists who can generate new knowledge to advance our health care is critical to the success of our profession and to ensuring the health of the people for whom we provide care.
Limitations
All data were extracted from NIH reporter and assumed to be accurate based on government reporting standards. Second, if a multiple PI (MPI) grant exists, the contact PI institution will be credited for the NIH award. So, in the case of a MPI plan where the contact PI is not in a School of Nursing, the entire award appears to be credited to the contact PI Institution and Department. The analysis was also limited by PIs reporting of their degree status. In reviewing CVs and online profiles, there was an assumption that anyone who listed a RN license or BSN or MSN degree to be accurate and degree and licensure verification through the State licensing boards or the degree granting institutions did not occur. Another limitation is that this study was limited to Schools of Nursing and there are several nurse scientists who are the PI of NIH awards in Schools and Departments outside of Nursing. Further study is warranted to understand how the profiles of these nurse scientists compare to those in Schools of Nursing. Finally, this analysis did not include a comparative group of another applied science, predominated by females, to help shed light on patterns and trends in the academic research environment.
Conclusion
Academic nursing is at a pivotal moment in our discipline as retirements soar, the number of nurses who enter PhD programs remains flat and the funding environment becomes increasingly competitive. These findings highlight the current funding streams for Schools of Nursing as well as opportunities for expansion. There are implications from these findings for identifying the educational and training need of nurse scientists to ensure the sustainability of our disciplines’ science. Careful attention should be paid to the gaps in our emerging scientists’ knowledge and training to ensure that our future nurse scientists can make important contributions to the delivery of healthcare and improving patient outcomes.
Highlights.
Nearly 50% of the National Institute of Nursing Research’s (NINR) extramural budget is awarded through grants to Schools of Nursing in the US.
NINR funds 80% of training grants and >70% of Center grants, which support the education and infrastructure for research, respectively, at Schools of Nursing.
Among top ranked research-intensive Nursing Schools, awards to non-nurse Principal Investigators averaged 34.5% across all years.
The percentage of NIH funds awarded to non-nurse Principal Investigators ranged from 0% at 3 Schools to as high as 97% at 1 School of Nursing.
Acknowledgments
The author thanks Drs. Nancy Reame, Suzanne Bakken, Jacqueline Merril and Elaine Larson for their critical review of versions of this manuscript.
Disclosures. The author declares no perceived or actual conflict of interest. The author is currently the recipient of the following grant awards from the National Institute of Health (K24NR018621, U01MD011279, R01MH118151, R01NR01573704S1, R01NR015737) and the Agency for Healthcare Research and Quality (R01HS025071). The content is solely the responsibility of the author and does not necessarily represent the official views of the National Institutes of Health or the Agency for Healthcare Research and Quality.
Footnotes
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