NurseWeek: Making its Mark: Institute of Nursing Research gaining clout at NIH

The National Institute of Nursing Research (NINR) is still the new kid on the block compared with most other parts of the National Institutes of Health. But it’s quickly grown into a productive member of the NIH family, earning respect for funding and conducting studies directly applicable to patients, caregivers, and health professionals.

"Nursing research is a younger field and there are fewer of us," said NINR Director Patricia A. Grady, PhD, RN, FAAN. "We’re expanding our mission and increasing our ranks at a time when [other scientific research disciplines] are already quite large."

The NINR—with a staff of 40 and a 1999 budget of $70 million—is the smallest of the NIH’s 18 components. The next-smallest institute, the National Institute of Dental and Craniofacial Research, has 134 employees and almost four times the NINR’s budget, said Daniel O’Neal III, MA, RN, chief of the office of science policy and public liaison at the NINR. The biggest and oldest institute, the National Cancer Institute, employs 2,260, operates on a $2.9 billion budget, and has been around since 1937, when the NIH campus was built.

Historical snapshot

The federal government has supported nursing research through several programs and agencies since the 1940s. But the establishment of the National Center for Nursing Research at the NIH in 1986 meant a higher level of funding was consistently dedicated to the cause.

The center was established after years of lobbying by the National League for Nursing, the American Nurses Association, Sigma Theta Tau, nursing schools, and other nursing groups, O’Neal said. A 1983 study by the Institute of Medicine showing the need for nursing research was a big factor in the creation of the center also, O’Neal said.

The center was elevated to institute status in 1993. This move gave it slightly more autonomy in issuing grants, O’Neal said. Grady, a stroke researcher and former nursing and medical school professor, took the helm at the NINR in 1995.

Nurse research matters

Nursing research is often more directly applicable to people’s lives and health care than other types of scientific investigation, Grady believes. One recent NINR-funded pain study that grabbed national media attention showed gender differences in response to analgesics. The study, conducted by UCSF, showed that seldom used kappa-opioid drugs provide women satisfactory pain relief with few side effects but have little or no effect on men.

Increased life spans and the aging of America are trends shaping current nursing research, Grady said. Because today’s patients who have arthritis, osteoporosis, or other chronic illnesses are living to 75 instead of 55, the level of their disabilities is more severe. The need to address quality-of-life issues for these populations is likewise greater, Grady said.

Several nursing studies on how to help patients with Alzheimer’s disease and their families are under way as well. One study is determining whether "white noise"—such as the background noise of a television—has a soothing effect on Alzheimer’s patients. This study was prompted by a clinical nurse’s observation that Alzheimer’s’ patients who were aggressive and disruptive relaxed when sitting under the hair dryer at a beauty parlor, Grady said. "Nurses who are engaged in clinical activities and patient care may not see themselves as researchers," Grady said. "But I think all nurses are researchers. They just haven’t realized it yet."

Nurses with many different educational levels can be involved in research, although an advanced degree is necessary to become a principal investigator or the leader of a team, Grady said. "If nurses think they’re interested in research, they should just jump in," she said.

Stimulating interest

Besides funding and conducting studies, the NINR seeks to stimulate more interest in nursing research. But it’s easier connecting with the nursing research community than with staff nurses, O’Neal said. "We need to make more of an effort to make staff nurses aware of what we do and what we’re about."

The NINR spends more than twice the average of other institutes to fund research training for predoctoral and postdoctoral students, O’Neal said. Also, the NINR maintains close ties with the 70 or so doctoral nursing programs in the country, he said.

The close coordination with students, schools, and researchers has paid off. Applications for NINR grants have increased more proportionally than those for all other institutes, O’Neal said.

However, the money appropriated to the NINR hasn’t kept pace with the applications, O’Neal said. A budget increase of 5 percent amounts to much less for the NINR than for big-budget institutes, he noted. "Of course, in our professional judgment, we could use another $20 million," he said. "As our science matures, we need to be able to give larger grants that will cover multisite studies and last for more years."