The National Institute of Nursing Research may not be a common topic of conversation on most hospital units, but behind the scenes the NINR has become a change-engine that is quietly — but profoundly — shaping the delivery of healthcare.

Case in point: The NINR funded research studies that developed and tested the effectiveness of a method of improving health outcomes among at-risk, chronically ill elderly patients. The method, known as the Transitional Care Model, involves a program of home visits and telephone support for patients after discharge. Nurse scientist Mary Naylor, RN, PhD, FAAN, a professor at the University of Pennsylvania School of Nursing, published her studies in 1994, 1999, and 2004 and testified before Congress in April 2009 that a TCM benefit could translate to improved outcomes for millions of older Americans and achieve substantial healthcare savings for the Medicare program. The Patient Protection and Affordable Care Act now includes provisions for coverage of pilot programs and demonstration projects that will further explore services such as transitional care.

The NINR is one of the 27 institutes and centers within the National Institutes of Health, which are dedicated to improving the health of the nation through the funding of research, but the NINR’s mission takes a slightly different approach to advancing healthcare.

“Much of what the NIH funds is more basic science research that focuses on a specific disease,” says Patricia A. Grady, RN, PhD, director of the NINR. “We focus primarily on funding clinical research that crosses a spectrum of diseases. Our investigators study disease prevention, symptom management and end-of-life and palliative care.”

The organizations says the research is person-centered and point-of-care focused. “Nursing science focuses on improving health outcomes and quality-of-life for individuals, families and communities in real world settings,” Grady says. “Our research encompasses every discipline and every stage of life — from genomic research in the laboratory, to family health practice in the community, to health policy formation in the legislature.

As the trend toward disease prevention and quality of life increases, Grady believes the NINR is positioned perfectly to make an even greater impact in the coming years.
“It is really exciting right now because there has never been such a need for nurses and nursing research,” she says. “As people develop chronic illnesses and continue to live longer, there is so much potential to improve the quality of life with the aging population. People are more savvy now about prevention and want to take care of themselves and be healthy, so we have an audience that is receptive to what we are trying to say.”

Origins of the NINR

The organization’s first chapter began in 1986 when the Department of Health and Human Services announced the establishment of the National Center for Nursing Research at the NIH. The impetus for creating a nursing research organization came from findings in two federal studies. Three years earlier the Institute of Medicine recommended that nursing research be included in the mainstream of biomedical and behavioral science, and then in 1984 an NIH task force study found that nursing research was relevant to the NIH mission and should be expanded.

In the beginning, the organization was allotted a budget of close to $5 million and a staff of less than 20 who were “borrowed” from other agencies. Then in 1993, Congress approved legislation that would elevate the center’s status to being an NIH institute. “This meant we were now a national presence within the scientific community,” says Mary E. Kerr, RN, PhD, deputy director of the NINR.

The NINR now has an annual budget of $148 million and funds about 300 research projects per year. Funding amounts vary widely, but for FY 2010, the average cost of a Research Project Grant was about $400,000. The majority of that money is dedicated to funding nurse scientists who are faculty at academic institutions. About 4% of the budget is directed to intramural research, such as the development of clinical applications to more accurately measure pain from gastrointestinal symptoms and assess the acute status of stroke patients, improving understanding of the role of genetics among factors that influence pain perception and building collaborations to explore the feasibility of using gene expression profiling in traumatic brain injury to predict outcomes and identify targets for novel therapeutics.

The NINR also has a significant focus on supporting doctoral nursing students through fellowships. The organization dedicates more than 6% of its annual budget — the second highest percentage of all the NIH entities — to fellowships that go to students or trainees.

“We feel that supporting doctoral students is important because they are the pipeline for developing faculty, and one of the best ways to help the shortage of nurses is to create more faculty to teach those students,” Kerr says. “Our young scientists are also future researchers who will provide the basis for clinical practice.”

Bringing Science to Life

This year the organization is celebrating its 25th anniversary, and reflecting on the past two decades offers ample evidence that nursing science is in fact paving the way to improve the nation’s health.

The NINR, for example, has continually funded the research of Linda Aiken, RN, PhD, FAAN, FRCN, a professor at the University of Pennsylvania School of Nursing. Aiken is well known for research that documents the relationship between nurse staffing and patient outcomes. Aiken says her 2002 paper on staffing and mortality was referenced in the ongoing debate to support the five patients per nurse ratio in med/surg nursing that was eventually implemented in California. Her most recent study, published in the April 9, 2010, issue of Health Services Research, suggested lower patient-to-nurse staffing ratios in med/surg units in California were associated with significantly lower patient mortality rates when compared to hospitals in Pennsylvania and New Jersey, where there are no mandated staffing ratios.

These papers have been referenced in ongoing policy debates in a number of states now considering mandated ratios, according to Aiken. More than 20 states now have legislation enacted or pending on nurse staffing, she says.

In the coming year, the NINR is ramping up efforts to focus on end-of-life and palliative care. The organization foresees the needs of an aging population with more complex diseases and multiple symptoms, and consequently created the OEPC (Office of Research on End-of-Life Science and Palliative Care, Investigator Training, and Education). The office is identifying research projects along these lines and spreading the message that this type of work is needed.

Kerr encourages nurses to consider research because they have skills that are critical for research investigators. “Nurses are already trained to make clinical observations and to evaluate patients, and this is the basis for research,” Kerr says. “Some researchers who have never seen a patient are interested in the science but not the applications. Nurse scientists want to improve outcomes and help patients, and they can do that through research.”