NINR NATIONAL INSTITUTE OF NURSING RESEARCH PHILIP L. CANTELON, PhD NINR: Bringing Science To Life National Institute of Nursing Research (NINR) with Philip L. Cantelon National Institute of Nursing Research National Institutes of Health Publication date: September 2010 NIH Publication No. 10-7502 Library of Congress Control Number 2010929886 ISBN 978-0-9728874-8-9 Printed and bound in the United States of America TABLE OF CONTENTS Preface The National Institute of Nursing Research at NIH: Celebrating Twenty-five Years of Nursing Science .........................................v Acknowledgments ..................................................................................................ix Chapter One Origins of the National Institute of Nursing Research .................................1 Chapter Two Launching Nursing Science at NIH ..............................................................39 Chapter Three From Center to Institute: Nursing Research Comes of Age .....................65 Chapter Four From Nursing Research to Nursing Science ............................................. 113 Chapter Five Speaking the Language of Science ............................................................... 163 Epilogue The Transformation of Nursing Science ..................................................... 209 Appendices A. Oral History Interviews .......................................................................... 237 B. Photo Credits ........................................................................................... 239 C. National Advisory Council for Nursing Research Member List ....... 241 Index ..................................................................................................................... 247 Preface The National Institute of Nursing Research at NIH: Celebrating Twenty-five Years of Nursing Science At no time has the nursing profession been transformed more dra­ matically than in the past thirty years. Behind that revolution, liter­ ally millions of nurses have constituted a team of committed actors: clinicians, professional nursing organizations, schools of nursing, and the National Institute of Nursing Research (NINR). Their creativity and cooperation, coupled with the strong support of Congress, fash­ ioned a different nursing profession and moved it beyond procedure to promise, beyond implementation to innovation, and into the main­ stream science at the National Institutes of Health (NIH). Nursing research became part of NIH twenty-five years ago. After several years of promising starts and frustrating stops, Congress char­ tered the National Center for Nursing Research (NCNR) in the fall of 1985. There were sharp divisions about creating such an entity at NIH. The Reagan administration opposed a center as an addition to administrative costs at NIH. Many NIH officials rejected the notion of nursing research, which they viewed as neither disease- nor basic science-oriented, as part of the NIH medical community. Nurses, vi Bringing Science to Life too, were divided over a presence at NIH. Several deans of nursing graduate schools feared that there would not be an environment that could understand or support nursing research at America’s premier medical research institution. But nurse researchers at the American Nurses Association found vigorous allies in Congressman Edward R. Madigan and Senator Orrin G. Hatch. Recognizing the potential of an institute, the nursing community put aside its differences and seized the opportunity of a supportive Congress for nursing research to take, as Senator Hatch said at the time, “its rightful place in those NIH halls of ivy.” Since 1986, the NINR and its predecessor, the NCNR, have served as the nucleus for the advancement of nursing science, providing the profession with national leadership on the federal level and financial support for research initiatives throughout the country. From the beginning, nursing’s national research agenda retained its orientation to patient care. But over the years, nursing science directed at critical health outcomes has grown and developed a sophistication that is enabling our profession to translate scientific research and data into policy that helps shape the nation’s health care system. As this history demonstrates, nursing research at NIH has both provided for and partnered with nurse educators in the recruitment, preparation, nurturing, and continued support of nurse scientists. Twenty-five years ago, only a small number of nurse researchers in the United States could claim advanced degrees in science. Today, there is an entire sector of the nursing profession populated with highly trained, innovative nurse scientists. Their growing body of work, often in tandem with other scientific disciplines, has altered the way Americans approach many health care issues. Three decades ago, we worried about nursing shortages, recognizing the facts without fully understanding the impacts on nurses, patients, and health care costs. Today, because of nursing research, we possess the hard clinical data to understand the physical, psychological, and financial impacts—as well as health outcomes on patients—caused by inadequate nurse staffing. Preface vii Similar research over the past two decades has led to parallel advances in community-based health care, which addresses crucial health issues for minorities and other hard-to-reach or underserved groups. NINR-sponsored research has discovered factors to enhance health relationships and has developed community-based intervention programs that changed dangerous behavior patterns for at-risk groups, thereby promoting wellness and mitigating or preventing disease. Other policies, informed and shaped by the research data of nurse sci­ entists, have shortened hospital stays, decreased patient complications, increased patient satisfaction, and eased the transition to home care. Perhaps most significantly, especially in tough economic times and for the future of health care reform, these new policies, by emphasiz­ ing prevention and continuity, can save millions—if not hundreds of millions—of dollars annually. As the current debate over health care reform continues, nursing science, as it has in the past, will be at the forefront of designing programs that promote wellness, prevention, and, not coincidentally, lower health care costs. The story of the NINR recounts the development and use of science to form new constructs of nursing practice—from observation to translation, from nursing care to nursing science, from procedure to practice to policy. The NINR’s accomplishments stand on the foundations laid by those who came before us—from the early nurse scientists to the current growing cadre of talented scientists. Preserving that history and applying its lessons are essential for nurse scientists and health care policy makers, both now and in the future. I am personally grati­ fied to be a part of the success of the NINR, for what it has provided to the nursing science community and to the direction of health care in the United States over the past quarter of a century. Far less would have been accomplished over that short period without the backing and vigorous commitment of elected officials, the biomedical commu­ nity, nursing educators, and the thousands of talented young women and men who discovered their destinies in nursing science and forever viii Bringing Science to Life altered the nursing profession. A tribute goes also to the millions of practicing nurses who support the ideas research entails and incorpo­ rate new science into their practices. Nurse scientists will always be a key wellspring of the information required so that evidence-based practice and policy can prevail and ensure the delivery of high-quality health care. I am confident that a continuing flow of fresh ideas and innovative science from nurse investigators will help reform and trans­ form the American health care system in the twenty-first century. I also believe that the NINR is a tribute to the amazing things the nursing profession can accomplish when it unifies behind an idea—may we continue to do so. Patricia A. Grady, PhD, RN, FAAN Director, National Institute of Nursing Research Bethesda, Maryland September 1, 2010 Acknowledgments The preparation of this book was accomplished through the efforts of many individuals. Over the course of researching and writing the history of the National Institute of Nursing Research (NINR), an array of nurse scientists and historians were involved. They all made the work much easier during the course of delving through primary records and conducting a wide range of oral history interviews of those who worked to create the National Center for Nursing Research and advance it to the status of a full institute at the National Institutes of Health (NIH). For more than a quarter of a century, the NINR built steadily upon the fundamental work of the professional nursing orga­ nizations, nurse educators, members of Congress, nurse scientists, and NINR administrators. Each group and many individuals played important parts in the conception, development, and growth of the NINR. In supporting research that brings nursing science into the lives of all Americans, the NINR has become the nursing profession’s leader and patron. The oral history interviews with the first acting director, Dr. Doris Merritt, and the Institute’s two directors, Dr. Ada Sue Hinshaw and Dr. Patricia A. Grady, were compelling and informative. The success of the NINR was due in large part to their