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 dramatically than in the past thirty years. Behind that revolution, literally 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, fashioned a different nursing profession and moved it beyond procedure 

to promise, beyond implementation to innovation, and into the mainstream 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 chartered 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 scientists, 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 emphasizing 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 gratified 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 community, 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 incorporate 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 transform 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 organizations, 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 knowledge, commitment, 

perseverance, and staff selections, which helped shape and expand the 

Institute. The other interviewees, listed on page 237, were also most 

helpful, especially those of Dr. Patricia Moritz of the University of 

Colorado School of Nursing; Dr. Janet Heinrich, now at the Health 

Resources and Services Administration; Dr. Kathleen Dracup of 
x Bringing Science to Life 

the University of California, San Francisco, School of Nursing; 

Dr. Geraldene Felton, emeritus of the University of Iowa School of 

Nursing; and Dr. Nancy Fugate Woods of the University of Washington 

School of Nursing, all of whom helped when the writing became 

most challenging. The insights, suggestions, and corrections from 

the members of the NINR History Advisory Committee, all of whom 

generously donated their time to this endeavor—Drs. Moritz, Dracup, 

and Felton—were most thoughtful and perceptive. Consultants Ms. 

Mary Miers, Dr. Patricia O’Brien D’Antonio, and Dr. Victoria Harden 

provided invaluable expertise and guidance. 

Finally, a thank you is extended to Ms. Eileen McGuckian, who 

read and commented on the manuscript through several drafts and 

learned the lasting value and great promise of nursing science. 

Philip L. Cantelon, PhD National Institute of Nursing Research 

Rockville, Maryland Bethesda, Maryland 

The National Institutes of Health, Building 1. 
Origins of the National 1
 Chapter 1 

Institute of Nursing Research 

Just before Christmas 1985, Dr. Doris H. Merritt had a telephone call 

from the director’s secretary. “Doris,” she said, “can you get down here? 

Jim needs to see you.” Merritt walked down a flight of stairs and over 

to the other side of Building 1. National Institutes of Health (NIH) 

Director James B. Wyngaarden sat alone in his big corner office. “You 

probably know they passed the Center for Nursing Research over the 

President’s veto,” he began. “Yes,” Merritt replied. “Well, I want you 

to make it happen.” Wyngaarden was not happy about having nursing 

research at NIH. Like most scientists around NIH, he believed nursing 

research was an oxymoron and now “it was going to be foisted on the 

absolute pinnacle of research in the nation.” But the law was the law. 

If NIH was going to have a Center for Nursing Research, Wyngaarden 

wanted it done and done right—to NIH standards. Would Merritt get 

it up and running? Merritt, an experienced senior NIH administrator, 

said no.1 

It was not an auspicious beginning. 

Wyngaarden’s meeting with Merritt does not begin to reveal the 

long and bumpy road that the nursing profession and its allies had 

traveled so that a nursing research center might reside at the NIH. 

Nursing science was a relatively new member of the U.S. scientific 

community, beginning as an occupation in a hospital setting, not as 
2 Bringing Science to Life 

an academic discipline. For nearly a century, nursing had followed 

the path of Florence Nightingale, advancing the science of nursing by 

observation. Teacher’s College at Columbia University established the 

first doctoral program in nursing in the early 1920s, but however large 

its influence, the numbers of graduates remained small. World War II 

marked the beginning of a change in the approach to nursing research. 

The war had demonstrated the necessary nexus between science 

and nursing care and the growing demands on the profession. The 

Public Health Service Act of 1944 authorized the Division of Nursing 

Resources in the Bureau of Medical Services to conduct and support 

research, but Congress did not appropriate any funds for it. In 1948 

Esther Lucille Brown argued in Nursing for the Future that to become 

fully professional, nursing required a knowledge base supported by 

research. But it was not until 1955 that the division initiated a small 

program for extramural support, the Nursing Research Grants and 

Fellowship Program. By that time the curricula of nursing schools had 

begun to change. The “three years under a hospital roof ” education 

was giving way to associate degree and baccalaureate programs that 

followed “the pattern of those established for other professions.”2 

Early nurse advocates and educators (from left): Lavinia Dock, Isabel Stewart, Lillian Wald, 

Annie Goodrich, Mary Adelaide Nutting. 
Origins of the National Institute of Nursing Research 3 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Dr. Faye G. Abdellah, an early advocate of nursing research 

and the author of Better Patient Care Through Nursing Research 

(1965), developed the first federal nurse specialist training program 

for the preparation of nurse researchers. In California, the state 

Board of Regents also recommended the introduction of graduate 

programs in nursing to prepare clinical specialists, administrators, 

nursing instructors, and directors of nursing education. The newly 

formed Council of Baccalaureate and Higher Degree Programs of 

the National League for Nursing applauded these goals. Over the 

next fifteen years, graduate studies “focused almost entirely on the 

role of the nurse, nursing theory, and nursing education,” according 

to one nurse commentator. “Because few nurses were prepared to 

do nursing research, much of the funding was channeled into supporting advanced education for nurses.” However, by the mid-l960s, 

some master’s degree programs had not only expanded but also 

switched from concentrating on functional skills such as teaching, 

supervision, and administration, to clinical knowledge and skills in 

cardio-pulmonary, medical-surgical, maternal-child, psychiatric, 

and community health nursing.3 

By 1960 the Division of Nursing Resources merged with the 

Division of Public Health Nursing to become the Division of Nursing 

in the Health Resources Administration (later the Health Resources 

and Services Administration [HRSA]), but the impact on research was 

minimal. In 1963 the Surgeon General’s Consultant Group on Nursing 

reported that nursing research suffered from a lack of funding and 

argued for more research fellowships and financial support of research 

projects. The report also advocated additional funds for graduate-level 

training, with a separate recommendation to give greater emphasis to 

support for those seeking doctoral degrees. In response to the Surgeon 

General’s report and to Great Society legislation in the mid-1960s, particularly Medicare and Medicaid, the Division of Nursing sponsored 

research conferences and boosted funding for the development of 

research in nursing institutions.4 
4 Bringing Science to Life 

Nursing scholars in the 1960s became increasingly aware of the 

need for the discipline’s knowledge base to be theoretically grounded. 

Two U.S. Public Health Service initiatives, the Faculty Research 

Development Grants in 1959 and the Nurse Scientist Training Grants 

in 1962, “were instrumental in both stimulating nursing faculty 

research activities and expanding the numbers of doctorally prepared 

nurse scientists.” Nursing research became more theoretical, often 

using conceptual models drawn from other disciplines including psychology, physiology, and sociology. With the expansion of doctoral 

programs in the 1960s and 1970s, according to an article in the Journal 

of the New York State Nurses Association, “research mentorship made a 

profound impact on the development of nurse researchers,” who often 

investigated questions from a qualitative perspective.5 

Jessie M. Scott, the highly regarded director of the Division of 

Nursing in HRSA and a two-star admiral in the Commissioned 

Corps of the U.S. Public Health Service, recognized that nursing was 

becoming more sophisticated and encouraged nurses to become more 

involved in the research process. She entered the Public Health Service 

in 1955 after a first career as an infirmary nurse at the University of 

Pennsylvania, where she received her bachelor’s degree. She taught at 

Pioneers of nursing research (from left): Dr. Myrtle Aydelotte, Dr. Virginia Henderson, 

Dr. Harriet Werley, Jessie M. Scott, Dr. Faye G. Abdellah. 
Origins of the National Institute of Nursing Research 5 

Jefferson Medical College in Philadelphia and became an organization executive with the Pennsylvania Nurses Association. By 1957 she 

became deputy chief of the service; seven years later Surgeon General 

Luther Terry appointed her the second director of nursing. Her testimony to Congress on the need for better nursing training led to the 

passage of the 1964 Nurse Training Act, the first major legislation to 

provide federal support for nurse education during peacetime. “I’m 

convinced that nursing is the linchpin in the delivery of health care in 

this country,” she told Congress. With the clout to carry through on 

her vision of expanding nursing education at the baccalaureate level, 

she laid the groundwork for more scientific research into nursing care. 

“As more nurses sought higher education,” one observer noted, “the 

level of interest and expertise in research grew.” While the primary 

focus of the division’s funding remained on nursing education, clinical 

nursing, and ways to alleviate a series of real or anticipated nursing 

shortages, Scott’s basic support of educational growth was fundamental to the future of nursing research. “The money that Jessie Scott and 

HRSA invested in nursing in the 1970s expanded nursing programs 

in colleges and universities,” said one early nurse researcher. “For 

those programs to be sustained, their faculty had to do research like all 

other faculty in academic institutions,” thereby laying the foundation 

for more sophisticated nursing science and gradually moving research 

designs from being primarily observational to more experimental.6 

As Scott’s government program built a base for future nurse scientists, other funding came from professional nursing groups and private 

foundations, including Sigma Theta Tau International (STTI), the 

nursing honorary society; the American Nurses Foundation (ANF); 

and the Cunningham, Avalon, Russell Sage, Rockefeller, Robert Wood 

Johnson, and W. K. Kellogg Foundations. Nevertheless, between 1955 

and 1968, the Division of Nursing, STTI, and ANF funded a total of 

only 226 research projects. No one kept count of the grants issued by 

other private funding bodies, but they were not numerous. Small as 

the programs were, however, they did begin to have a positive impact 
6 Bringing Science to Life 

on nursing research, with a growing emphasis on interdisciplinary 

methods and the application of findings to all practice fields.7 

In the early 1970s, under the leadership of Virginia Cleland, the 

American Nurses Association’s (ANA) Commission (later Cabinet) on 

Nursing Research focused its attention on gaining support for nursing 

research at the federal level in both Congress and the executive branch. 

“We were discouraged from such activities by those within and outside 

of ANA, who said that the commission should concern itself with such 

things as establishing a philosophy and priorities for nursing research 

and leave the politics to others,” recalled one nurse scientist a decade 

later. The nine members of the commission thought otherwise. They 

moved the commission’s meeting to Washington, D.C., so that the 

major activity on its agenda would be visiting various federal agencies 

and members of Congress. They soon realized that to make a significant impact the lobbying effort would need to be expanded. In 1975 

they approached the ANA Council of Nurse Researchers for assistance 

and began to coordinate lobbying activities. They also included political and legislative programs in the council’s meetings. As a result of 

these actions, according to Ada Jacox in Nursing Outlook, by the mid1980s “nurse researchers [became] much more sophisticated in their 

ability to interpret nursing research to members of Congress and to 

lobby effectively for support for nursing research.”8 

The lack of a vigorous nursing research program, many nurses 

believed, stemmed from the fact that federal programs were scattered 

among several agencies. To be successful, nursing leaders advocated 

centralizing nursing research in one agency that would focus on 

funding research. Many agreed that the most logical place for such 

an entity was the organization that had successfully sponsored it in 

the past: the Division of Nursing at HRSA. Scott had championed 

the cause that nursing education, research, and practice were interconnected and needed to function together. As a result, the Division of 

Nursing harbored all of these components. When, in the mid-1970s, 

the Bureau of Health Resources Development (BHRD) of the Public 
Origins of the National Institute of Nursing Research 7 

Health Service looked at the transfer of nursing research project grants 

to one federal agency, Scott was prepared. She met with Dr. Gerald 

Rosenthal, the director of BHRD, and Dr. Kenneth M. Endicott, the 

administrator of HRSA, to discuss where best to place nurse training 

and nursing research grants. They agreed that “research directly 

related to nursing education and the more clinical aspects of nursing 

research was probably not appropriate for BHRD and that the bureau’s 

emphasis would be primarily on the manpower aspects of nursing 

services.” Scott convinced them that the Division of Nursing was the 

natural location for such grants. The transfer occurred, but Scott was 

able to effect little change in the political visibility of nursing research 

or the level of funding received by nurse scientists, many of whom 

were becoming increasingly disillusioned with the situation.9 

Nurse scientists believed they had good reason to be frustrated. 

The growth in nursing research had been painfully slow. Although an 

NIH task force reported that there were approximately 4,000 nurses 

with doctoral degrees in 1980 and more than half of them held PhDs, 

only 6 percent of those reported their primary function as research. 

The low research figure was understandable. Limited funding was 

available, schools of nursing did not promote faculty on the basis of 

their research, and most of the biomedical community—including, 

most importantly, NIH, the country’s premier research institution and 

funder—neither understood nor appreciated nursing research.10 

That the nursing community in the 1980s was divided on the definition of nursing research contributed to the biomedical community’s 

disdain. Nurse investigators struggled to define their work to make 

it more identifiable as a clinical and basic science. Still, many in the 

nursing profession viewed research in observational and behavioral 

terms pertaining to clinical practice. Far fewer in numbers, but more 

on the cutting edge, were those who began to define nursing research 

as a part of a larger world of medical research. By the late 1970s, a 

small group of nurses from the ANA’s Commission on Nursing 

Research, including Joanne S. Stevenson, Nola J. Pender, Ada Jacox, 
8 Bringing Science to Life 

Ora Strickland, Ada Sue Hinshaw, Carolyn Williams, and Nancy 

Fugate Woods, all of whom held doctoral degrees, began a campaign 

to expand the vision of nursing research. They lobbied within the professional nursing associations, on Capitol Hill, and at NIH for greater 

recognition of and funding for nursing research.11 

A small group of persistent and energetic nurse researchers turned activist in the late 1970s 

and early 1980s. Their years of engaged effort produced the pivotal publication “Directions 

for Nursing Research: Toward the Twenty-First Century” and helped guide the creation of the 

National Center for Nursing Research (NCNR). 
Origins of the National Institute of Nursing Research 9 

Stevenson was a good example of the group of nurse research 

activists emerging in the 1970s. From 1969 to 1972 she had been a 

beneficiary of a predoctoral fellowship at NIH sponsored by HRSA. 

Subsequently, she was elected as fellow of the American Academy of 

Nursing in 1978 and had been a key participant at a conference sponsored by the Division of Nursing in 1979 called “Future Directions 

for Nursing Research.” Stevenson and Jacox, then president of the 

ANA, were making regular visits to congressional staffers, stressing 

the need for more funding for nursing research. At the same time, 

Stevenson and Woods, a faculty member of the School of Nursing at 

the University of Washington, carried a similar message to the institute directors at NIH. Every time she and Woods came to Bethesda, 

they made regular visits to specific directors. “We were trying to learn. 

We did our homework. We started out looking in the NIH phone 

book and studying org[anizational] charts to figure out where there 

might be a match for the kind of research that nurses did and whether 

there would be places where we could look to find the kind of support 

we needed.” They explained that some nursing research was already 

occurring in many NIH institutes and that more funding was needed 

to support the kind of research nurses did, “trying to help them understand...the appropriate focus for nursing research,” Woods recalled. 

The women were careful in conveying their message. There were many 

in the profession who were very happy with nursing research in the 

Division of Nursing, and the ANA had taken no formal position on 

making any changes. However, within the ANA, the Commission, 

later the Cabinet on Nursing Research, criticized the stagnant status of 

nursing research, saying that it needed to be more closely allied with 

other scientists in other disciplines.12 

A major breakthrough occurred in 1983 with the publication of 

an Institute of Medicine (IOM) report that recommended that nursing 

research be placed in the mainstream of scientific investigation by establishing a separate federal entity that would foster nursing research and 

develop more nurse scientists. The congressionally mandated report, 
10 Bringing Science to Life 

Nursing and Nursing Education: Public Policies and Private Actions, had 

been two years in the making and reflected many of the views advanced 

by the nursing research activists. “Despite the fact that nurses represent the largest single group of professionals in the provision of health 

services,” it stated, “there is a dearth of research in nursing practice. 

The lack of adequate funding for research and the resulting scarcity of 

talented nurse researchers have inhibited the development of nursing 

investigation. The government’s specific nursing research initiative 

[approximately $5 million in grants administered by the Division of 

Nursing in HRSA] is not at a level of organizational visibility and scientific prestige to encourage professionals to pursue careers in nursing 

research,” the report said. In addition, nurse investigators suffered from 

a number of competitive disadvantages in pursuing grants, including a 

lack of representation on peer review committees and “subject matter 

that may not be of prime interest to other reviewers.” Greater, more 

focused federal support for nursing research, the report argued, would 

better “inform nursing and other health care practice.” The information stemming from such research “could lead to a reduction in the 

federal health care bill by lessening the length of hospital stay, minimizing the need for additional treatment, and preventing unnecessary 

or premature institutionalization in long-term care facilities.”13 

The report stopped short of identifying a specific federal agency 

to become the organizational base for nursing research, recommending that it should be “at a high level in the federal government to be 

a focal point for promoting the growth of quality nursing research.” 

Without directly saying so, the report implied that the current funding 

organization was lacking in terms of what was required to attack the 

problem. As committee members were split on the best location for 

such a federal entity, they hoped that an internal NIH review of its 

research structure might provide guidance on nursing, as well as biomedical, research. Some committee members favored an institute at 

NIH, the report acknowledged, while others “question the wisdom of 

adding new units to NIH. However, all agreed that the goal should 
Origins of the National Institute of Nursing Research 11 

 

 

 

 

be an entity for nursing research at a level of scientific credibility that 

would provide impetus toward the initiation, coordination, monitoring, and dissemination of clinical and operational research in academic 

and other research centers throughout the United States.”14 

The IOM report on nursing dramatically intensified the debate 

over the nature of funding for nursing research and what government 

entity should be that funder. As the report stated, not all could agree on 

an institute at NIH. There were more than a few in the profession who 

saw these proposed changes not as an elixir for nursing but as a divisive 

witch’s brew. Opponents believed that the drive for a separate, NIHbased institute would severely damage the Division of Nursing and 

only achieve a balkanization of the profession. Dr. Geraldene Felton, 

dean of the University of Iowa School of Nursing, was particularly sensitive to a diminution of the Division of Nursing. Years before, she 

had received a postdoctoral research grant from the division and had 

served on a number of its review panels. She warmly remembered the 

professional importance of that first grant and became a good friend 

of the division’s head, Jo Eleanor Elliott, who had succeeded Scott. Not 

surprisingly, she opposed any action that might reduce the division’s 

importance in the profession.15 

She was not alone. A number of deans within the American 

Association of Colleges of Nursing (AACN) remained cool to or 

outright opposed the idea. One questioned the wisdom of creating an 

institute when there were so few nurse scientists, calling an institute 

“premature.” Dr. Ruby Wilson, dean of the Duke University School of 

Nursing, a committee member on the IOM report, and a strong force in 

the national nursing community, was initially outspoken in her opposition of a separate entity. Her opposition contributed to the report’s 

vagueness on naming a specific place for nursing research funding.16 

Another who worried about a nursing institute and preached 

caution in embracing a new entity at NIH was Dr. Rhetaugh Dumas, 

dean of the University of Michigan’s School of Nursing. One of the 

foremost African-Americans in the profession, Dumas had worked 
12 

 

 

 

 

 

 

 

 

 

 

 

 

 

Bringing Science to Life 

at the National Institute of Mental Health, where she served as 

deputy director of the Alcohol, Drug Abuse, and Mental Health 

Administration from 1979-1981, the first woman and first nurse to 

hold that position. Prior to that, she was chief of the Psychiatric 

Nursing Education Branch of the Division of Manpower and Training 

Programs. Dumas was investigating the connections among mental 

health, psychiatry, psychology, and psychosocial issues in nursing 

care. According to a friend, “she had tried to find ways of integrating that body of research into NIH and had been frustrated by those 

efforts. From her perspective, she had [experienced] some basic 

reality on which to base her belief that nursing research, part of 

which is psychosocial concepts, would not be welcome, that it would 

not be a good fit at NIH.”17 

Moreover, there was considerable opposition within NIH regarding a nursing institute. Reagan administration and NIH officials 

opposed the creation of any other new institutes. They viewed nursing 

as far removed from NIH’s biomedical mission. “Nursing research was 

not seen as bench science or hard science. It represented a soft science” 

not appropriate to NIH’s mission, according to one nurse activist. Put 

another way, NIH believed in “cure research,” one congressman commented, and nursing research was “care research” and therefore not 

part of NIH’s mission. NIH Director James Wyngaarden expressed his 

frustration with the possibility of a nursing institute and reflected the 

attitude of most of his colleagues when he stated that nursing research 

did not fit into the biomedical research program at NIH. In response 

to the IOM report and increasing political pressure to create a nursing 

research institute, Wyngaarden commissioned an internal study of 

nursing research at NIH. In doing so, he hoped to derail the creation 

of a new nursing research institute by proving that NIH was already 

active in this area. Nonetheless, “the fact that nursing research itself is 

not exactly at the heart of the kind of research NIH feels most comfortable about,” observed Science, “only makes matters worse.”18 

Additional opposition came from the medical community, 
Origins of the National Institute of Nursing Research 13 

NIH Director James B. Wyngaarden and President Ronald Reagan at NIH in 1987. The NCNR 

was created over President Reagan’s veto just two years earlier. 

particularly the American Medical Association and the Association 

of American Medical Colleges (AAMC). They vigorously opposed all 

new institutes, calling the proposed addition of two new institutes— 

one for Nursing and one for Arthritis and Musculoskeletal and Skin 

Diseases—a “disease-of-the-month” mentality. The AAMC deplored 

the increasing congressional role in changing the nature of NIH as 

“administratively costly and scientifically ineffective.” The organization argued to keep NIH the way it was, taking an “if it ain’t broke, 

don’t fix it” posture. The editor of the American Journal of Nursing 
14 Bringing Science to Life 

was particularly irked by the attitude that “nursing research uses rather 

than generates information,” a view she laid at the door of the medical 

organizations.19 

Aside from the opposition to an institute within NIH and the 

Reagan administration, the central issue, according to Science, remained 

the definition of nursing research. “Just what is nursing research? The 

short answer is ‘ill-defined.’ It spans a wide range of activities that 

includes the prevention of bed sores, the education of patients with 

special dietary needs, and the emotional support of the chronically ill 

and their families.” Badly needed was a definition that the public and 

the biomedical community could grasp. The ANA took the lead in 

the nursing community to provide this definition. The organization 

suggested an example of cost-effective nursing research with a clearly 

biomedical side: a study of premature infants to determine criteria for 

early hospital discharge. Doubters were hardly convinced. Moreover, 

the issue became a Catch-22 situation: because nursing research lacked 

a clear definition, it was impossible to categorize within the NIH mainstream; therefore, it was inappropriate to be part of the NIH research 

world. It was a frustrating dilemma. “If you look at the other institutes,” explained one advocate, “you see that having an institute in itself 

helps develop research.”20 

The ANA launched a campaign to explain and sell nursing research. 

The network of nurse scientists pulled together a series of examples that 

would make sense to politicians, government bureaucrats, and the biomedical community. One example that proved exceptionally effective 

was how nursing research had led to advances to control nausea and 

vomiting that occurred as side effects of chemotherapy drugs. Another 

emphasized the effectiveness of informing patients beforehand about a 

procedure. The result, nursing research had proven, was that prepared 

patients were far less anxious or distraught about a procedure than 

those who were not informed, and they recovered more quickly. “We 

wanted to win people over by giving examples of nursing research that 

made a difference in practice...and to provide examples that fit nicely 
Origins of the National Institute of Nursing Research 15 

within the concept of NIH,” according to Dr. Jan Heinrich, who helped 

organize the campaign. The group drafted blueprints for a nursing 

institute within NIH, drew up a proposed organization chart, and even 

selected the Cloisters, a former nunnery of the Sisters of Visitation and 

a prime historical property on the NIH campus, as the location for the 

new institute.21 

Staunch supporters, including several members of Congress, 

seized the report’s recommendation on creating an institute and 

quickly received the backing of the Tri-Council for Nursing, a group 

Representative Edward R. Madigan (R-Illinois) was a vocal supporter and welcome ally of a 

nursing research institute. 
16 Bringing Science to Life 

consisting of representatives of the American Nurses Association, 

which represented registered nurses, the National League for Nursing, 

which termed itself the “voice for nursing education,” and the American 

Association of Colleges of Nursing, which promoted baccalaureate 

and higher degree nursing education programs. The ANA’s considerable lobbying machine went into action. Though based in Kansas City, 

Missouri, the ANA maintained a staff of about ten people at its governmental affairs office in Washington, D.C., and it tirelessly worked the 

halls of the Senate and the House to convince members of Congress of 

the need for a national institute for nursing research.22 

The most enthusiastic supporter of a nursing research institute 

was Rep. Edward R. Madigan, an Illinois Republican who had just 

been re-elected to a sixth term from his district in the central part of 

the state. Madigan hailed from Lincoln, Illinois, a small town whose 

claim to fame was that it was the only place named for Abraham 

Lincoln before he became President. While Lincoln had practiced law 

there in the 1850s, perhaps its most famous native son was the poet 

Langston Hughes. Ed Madigan was a businessman turned politician. 

By 1983 he was the ranking minority member of the Subcommittee on 

Health and the Environment of the House Committee on Energy and 

Commerce. Leonard E. Heller, a Robert Wood Johnson Fellow assigned 

to Madigan’s staff, had brought the IOM report to the congressman’s 

attention about the time Madigan was looking for a legislative hook 

on which to conduct his next campaign. The wife of his presumptive opponent was a nurse. For Madigan, the idea for greater federal 

support for nursing research was a delicious irony with which he could 

stifle his opponent’s attacks. He seized the opportunity. Even in the 

face of opposition from a Republican White House, Madigan was convinced of the necessity for an institute. With Madigan’s support, the 

possibility of a nursing institute within NIH took on a fresh life.23 

There was a dose of political sophistry in Madigan’s espousing a 

nursing institute. He and fellow Republican James T. Broyhill of Virginia 

had blocked a Democratic reauthorization bill sponsored by Henry A. 
Origins of the National Institute of Nursing Research 17 

 

 

 

 

 

 

Waxman of California, which called for NIH to initiate research into 

specific items such as diet therapy for kidney failure, spinal cord regeneration, sudden infant death syndrome, and Alzheimer’s disease. In 

demanding these requirements among many others, the Democrats 

were forcing congressional control over NIH, the Republicans claimed. 

They said that NIH administrators “are far better qualified than those 

of us on the House floor to make the determination as to where NIH 

dollars go.” The Republicans wanted to authorize the same funding 

levels for NIH as the Democrats—they just wanted fewer strings 

attached. The irony was not lost on Science, however, which noted that 

“although Madigan has become a staunch supporter of the idea that 

NIH should be relatively unencumbered by congressional mandates,” 

it was worth noting he was sponsoring an amendment for the creation 

of a new national institute for nursing research.24 

As the IOM report had stirred debate in the nursing community 

regarding a separate entity at NIH, so too did Madigan’s proposed 

amendment. The ANA held a conference call in late June 1983 to review 

short- and long-range goals relating to the idea of a National Institute 

of Nursing. In a report to the Tri-Council representatives of the ANA, 

the conference participants noted that it would be important to push 

for more “visibility and credibility with the other research communities 

and with the nursing profession.” This could best be accomplished by 

moving nursing research to the NIH, while at the same time supporting “manpower production” through the Nurse Training Act at HRSA. 

The position taken by the ANA in the summer of 1983 demonstrated 

the influence of the association’s Cabinet on Nursing Research, which 

strongly supported the NIH institute.25 

Nonetheless, there was wide recognition that the various constituencies of the Tri-Council were not united on a specific policy. 

Just after Labor Day, the Virginia-Carolinas Doctoral Consortium in 

Nursing, a group consisting largely of academics and academic administrators, including Drs. Ruby Wilson and Rhetaugh Dumas, met at 

George Mason University in Fairfax, Virginia. The group made every 
18 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Bringing Science to Life 

attempt to air out all opinions. Dr. Linda Amos, the president-elect 

of the AACN, Jo Eleanor Elliott, director of the Division of Nursing, 

Dr. Nola Pender, chair of the ANA’s Cabinet on Nursing Research, and 

Jessie Scott also participated. The meeting was important because the 

issues and concerns expressed by the participants at that time would 

remain much the same for the next two years. Was the intent to form 

a center as the National League for Nursing (NLN) had suggested, 

or was it an institute as proposed in the amendment? How stable 

would a new nursing entity be at NIH? Why had there been insufficient time and opportunity for input on the desirability and direction 

of the amendment? Why was nursing not proactive in developing 

its own legislation rather than being reactive to Madigan’s proposal? 

Was this the best way to take advantage of the current federal political and administrative interest in nursing? What kind of negotiating 

power would nurses have under another placement within the federal 

government? What would be the impact of the amendment on the 

Division of Nursing?26 

While the Tri-Council strongly believed that riding on the tail of 

the Madigan amendment was the best way to enhance nursing’s position 

in the federal government through an institute at NIH, the larger group 

preferred a less ambitious strategy. They suggested an agency within 

the Public Health Service, parallel with NIH, “not within it.” The idea 

was to have something comparable to the Centers for Disease Control or 

the Food and Drug Administration. Other preferences were for bureau 

status for nursing within the Division of Nursing or a National Institute 

of Nursing with the Division of Nursing as the nucleus. The minutes 

of the meeting reflected both the divisions and the places of agreement 

among the groups. “An overriding concern across all the suggested 

options was that immediate efforts be taken to strengthen the Division 

of Nursing [emphasis in original], especially in reference to the Nurse 

Training Act of 1964. Under no circumstance, the participants agreed, 

should the research, education, and practice elements of nursing be separated, as each derived strength from the other.”27 
Origins of the National Institute of Nursing Research 19 

The idea of separating the three legs of the stool of nursing gnawed 

at those participants who believed that the Tri-Council had first placed 

and then pushed nursing research above other aspects of the profession. 

Jo Eleanor Elliott reminded the group that “two of the three organizations within the Tri-Council favored an Institute for Nursing Research, 

not an Institute for Nursing, which encompassed research, education, 

and practice.” Echoing Elliott’s concerns, several others commented 

that “nursing research had a small constituency and that constituency 

was not large enough to support legislation for an institute focused on 

research.” “The Tri-Council,” these participants cautioned, “ought to 

be aware of other important constituencies within nursing from whom 

they needed support to successfully pass legislation, namely educators 

and nurses in practice.”28 

Whatever the differences within the group, the participants chose 

to take the debate to their boards—the ANA, AACN, and NLN— 

rather than take the divisions public by relaying them to Madigan’s 

office. The participants agreed to hold additional meetings, listen to 

the nurse scientists, and continue the discussions of the issues related 

to placement of nursing within the federal government. The decision 

to raise concerns to the various boards maintained the idea of a unified 

nursing community. In reality, the decision was a victory for the institute’s supporters, as the legislation was on track for a vote before most 

of the boards would meet to express an official opinion.29 

In November, H.R. 2350, the Health Research Extension Act of 

1983—legislation reauthorizing the appropriations for NIH—made 

its way through the House. Madigan, as expected, attached a floor 

amendment to create a National Institute for Nursing Research at NIH. 

He later recalled that the IOM report convinced him that there was a 

“remarkable absence of funding for research into nursing practice... 

which resulted in a critical shortage of nursing leadership in faculties 

of colleges of nursing and in clinical practice.” To solve the problem, 

he said, the federal government needed “to establish a more visible 

research activity for nurses.” The new institute would give nurses 
20 

 

 

 

 

 

 

 

 

 

 

 

 

 

Bringing Science to Life 

“unprecedented visibility, prestige, and esteem,” he told reporters. 

Quoting almost directly from the IOM report, Madigan told his colleagues that “this is a straightforward amendment that seeks to put 

nursing research into the mainstream of scientific investigation.”30 

The amendment passed on a voice vote as part of a bipartisan compromise between Waxman, who chaired the subcommittee 

that had jurisdiction over NIH, and Madigan to get the entire bill 

enacted. Waxman’s support was crucial because he brought along 

those undecided representatives inclined to follow the lead of a major 

subcommittee chair. When the amendment came to a floor vote on 

November 17, 1983, legislators were reluctant to speak against what 

many viewed as a “mom and apple pie” issue. The amendment passed 

overwhelmingly. Moreover, in the meantime Congress had appropriated $9 million for nursing research for fiscal year 1984, nearly 

doubling the previous year’s appropriation. The increase indicated the 

federal government’s growing interest in nursing research. Nursing 

also responded. The Division of Nursing, which received the funding, 

reported a dramatic increase in the number of applications for nursing 

research grants.31 

Science commented that the nursing institute amendment passed 

the House with “remarkable alacrity by political standards. Despite the 

fact that some nursing groups have been pushing for greater status in 

the federal government for some time,” the journal said, “the institute’s 

passage took people by surprise.” The Senate, however, took a more 

cautious approach. “We’re willing to hold hearings, but not to have 

this thing sail through on the wings of the gender gap,” a Senate staffer 

told Science. But neither Utah Republican Orrin G. Hatch, chair of the 

Senate’s Labor and Human Resource Committee, nor Massachusetts 

Senator Edward M. Kennedy, the ranking committee Democrat, “were 

likely to go along with a nursing institute now,” the journal believed. 

Nonetheless, Science was mightily impressed with what had been accomplished. “Whatever the outcome of this round, thanks to Madigan, 

nurses have won Congress’s attention as never before.”32 
Origins of the National Institute of Nursing Research 21 

The corollary was also true: the Madigan amendment energized the nursing community. Over the summer of 1983, before the 

amendment hit the floor of the House, the big three nursing organizations—the AACN, the ANA, and the NLN—held a series of meetings 

to discuss the situation. “Many of nursing’s strongest legislative supporters found themselves,” an observer wrote later, “in a very difficult 

position. While not wanting to oppose a nursing initiative, they were 

also on record as being against the formation of any new institutes at 

NIH.” The professional nursing organizations consulted with others 

who stood on all sides of the issue, including Jessie Scott and Jo Eleanor 

Elliott from the Division of Nursing, who were cool to the idea, and 

Drs. Ada Jacox and Nola Pender, who strongly supported greater 

federal aid outside of HRSA. Those interested in the amendment 

believed that the happy coincidence of the IOM recommendation and 

reauthorization of NIH “provided a most expedient method of accomplishing a highly visible organizational entity for nursing research in 

a fairly simple” and straightforward way. “Input and concerns have 

been heard, considered, and pondered,” one participant from the 

AACN wrote. “Clearly not all consultants have favored the amendment to establish an institute within NIH; others have strongly favored 

the idea.” Not all of the AACN board members favored the idea either, 

but a majority believed that the “benefits outweighed the risks and 

there were at least as many risks involved in doing nothing or taking 

no position.” By mid-July, representatives from the three nursing organizations, working with Heller in Madigan’s office, “hammered out the 

final wording for the amendment and all voiced their support for it.”33 

The Division of Nursing, understandably fearful of how the 

Madigan amendment might alter its own future, fought back. In 

August 1983 Dr. Doris Bloch released a report explaining all that the 

Division of Nursing had accomplished for nursing research since the 

inception of federal support programs in 1955. “There has been tremendous growth and development in all aspects of the nursing research 

effort,” she wrote. “There are more nurses with doctoral degrees, more 
22 Bringing Science to Life 

nurses engaged in research, and more schools of nursing educating 

nurse researchers.” She noted the increase in sophistication of nursing 

research, the growing number of nursing research journals, and the 

expansion in the dissemination of research findings through refereed 

journals and professional conferences. Judging from the number of 

articles cited, the most prevalent source of funding for nursing research 

in 1981 was the Division of Nursing, she reported. In 1972 Scott wrote 

that she wanted the Division of Nursing to increase scientific knowledge by “fostering on a nationwide basis, high-quality research of 

value to nursing.” Scott’s vision, in Bloch’s view, had been reached. 

The Division of Nursing was doing the best job possible, she believed. 

There was no reason to make any changes.34 

Others in the nursing community agreed. The AACN divided 

over the idea of an institute. A number of deans feared that changes 

in the system would upset the current situation, which, while not 

perfect, was one with which they were comfortable and that worked 

tolerably well. They envisioned losing control over the use of funds 

“to a director and an advisory committee not friendly to nursing.” 

The AACN’s board was suspicious of NIH and believed nursing organizations would lose influence over the type or focus of research in 

a situation where only biomedical-related research projects would 

be funded. A major risk, some believed, would be an erosion in the 

number and amount of grants awarded by the Division of Nursing, a 

long-time source of funds for nursing schools. An institute at NIH 

would separate “research from manpower and training programs, 

making it more likely to remove further functions from the Division 

and ‘divide and conquer.’”35 

The central concern for many nursing deans was the uncertainty that would surely arise in changing the structure of funding for 

nursing. They raised the same issues that had been discussed at the 

conference at George Mason University the year before. For those in 

the academy, the Division of Nursing was an old and trusted friend. 

It might not have the wherewithal to give you everything you wanted, 
Origins of the National Institute of Nursing Research 23 

but it was reliable and had a track record of support for the profession. 

Many recalled all that Jessie Scott had done and personally liked her 

successor, Jo Eleanor Elliott, and they sought to guard the interests of 

the division. Alarmed that the Tri-Council had backed the Madigan 

amendment with too little discussion beyond a few officials representing the three nursing organizations, Dumas and Felton published an 

article outlining their concerns in Nursing Outlook in early 1984 before 

the Senate took action on the House bill. The article “Should There 

Be a National Institute of Nursing?” stressed the interdependence of 

nursing education, nursing practice, and nursing research and asked 

for a “thoughtful examination of the proposed amendment by a wider 

nursing constituency.” Nursing had embraced the Madigan proposal 

of a new institute too hastily, they cautioned. The “growing eagerness 

to implement” the IOM’s recommendation had prompted the TriCouncil to support Madigan’s plan and eschew full discussion of its 

merits, they wrote. Yet “many prominent nurse leaders believe that it 

would be unwise at this stage in the development of nursing science 

to locate support programs for nursing research and those for nursing 

education and practice in separate agencies,” which the Madigan 

amendment would do.36 

The two deans appealed to the profession to consider other alternatives to an institute. While there was “little disagreement among 

nurses that an adequately funded organizational entity is needed at a 

high level in federal government to foster the development of nursing 

research,” there needed to be further consideration of where it could 

best be located. Placing it within NIH, the authors feared, would “give 

other institutes greater influence in the review of nursing research 

grants, in decisions to approve or disapprove them, and in matters 

pertaining to their oversight and management.” Dumas and Felton 

believed it crucial to “maintain linkages among nursing research, 

education, and practice.” They concluded that placing the new entity 

within the Division of Nursing—which had long understood, supported, and advanced the needs of the nursing community—was best. 
24 Bringing Science to Life 

Such placement would give the Division of Nursing more visibility and 

greater support. “No other organizational unit has had the experience in the affairs of our discipline that the Division of Nursing has 

had. Furthermore, up to this time, no others have appreciated our 

actual and potential contributions in health care delivery and scientific 

inquiry.” Therefore, the nursing community “might have a good deal 

more to gain and less to lose by establishing the new nursing entity 

within a stronger, more viable Division of Nursing.”37 

However, other deans saw fresh opportunities in an NIH institute of nursing. It would provide a prominent, highly visible entity 

for nursing research, something that didn’t exist in HRSA. They also 

anticipated that a new institute would increase credibility and status 

for nursing research and provide “far greater opportunities for postdoctoral research training and research fellowships.” They stressed 

that it was only after “painstaking deliberations that the AACN Board 

decided to support the amendment in order to make it as strong as 

possible.”38 

Over the spring and summer of 1984, House and Senate conferees shaped the legislation with the assistance of a united Tri-Council. 

Any differences within the Tri-Council were hammered out behind 

closed doors so the nurses could present a united front in favor of an 

institute. “This cohesiveness was very important in promoting the 

bill,” an NLN analyst believed. The key person in the Senate was Orrin 

Hatch, who chaired the committee that dealt with health matters. 

Hatch opposed a nursing institute, but did want to pass some legislation that would respond to the recommendations of the IOM report. 

In May, Hatch proposed promoting nursing research by elevating the 

Division of Nursing to bureau status, an initiative proposed earlier 

by the Tri-Council to ensure the continued strength of the existing 

nursing support agency. However, Hatch proposed creating within 

the bureau a Center for Nursing Studies and Research, which would 

coordinate all nursing research sponsored by all of the various federal 

agencies and eliminate the need for a new institute. The Tri-Council 
Origins of the National Institute of Nursing Research 25 

did not support Hatch’s proposed alternative to an institute of nursing, 

arguing that a center should be considered as a step toward the establishment of an institute, not an excuse to kill it. Nevertheless, with 

Hatch’s opposition to a nursing institute, Senate support appeared 

lukewarm at best. At that point, Senator Daniel K. Inouye (D-Hawaii) 

took up the torch for an institute, circulating a “Dear Colleague” letter 

to drum up support. As a result, several senators came out in support 

of the institute, including Republicans Paula Hawkins from Florida 

and Robert T. Stafford of Vermont. Spark M. Matsunaga, Hawaii’s 

junior Democratic senator, also came aboard. Importantly, all three 

were members of Hatch’s committee and took independent positions 

in opposing him on this issue.39 

Congressional support was critical to the NCNR’s creation. Pictured is Senator Orrin Hatch’s 

(R-Utah) letter of support for HR 2409. 

In addition, one health care issue beyond a nursing institute 

held up the bill. The legislation also contained a highly controversial 

section on fetal research, which the Reagan administration vehemently opposed. After several months, House and Senate conferees 

finally reached agreement, leaving only the nursing institute remaining 
26 Bringing Science to Life 

on the table. Madigan and Waxman held firm on a nursing institute, 

and Senator Hatch finally relented. By October 1984 the two houses 

agreed on the language of the NIH reauthorization bill, now labeled 

S. 540, which included the provision to establish a National Institute 

of Nursing. The new bill would “provide a focal point for promoting growth and quality of nursing research, to provide leadership in 

expanding the pool of researchers, and to promote interaction with 

other bases of health care research.” The conferees intended that 

nursing research activities conducted by the Division of Nursing in 

HRSA would be transferred to a new entity in NIH. Still opposed to a 

new institute, President Reagan allowed the bill to die through a pocket 

veto after Congress adjourned in October 1984.40 

A number of nurses blamed themselves for Reagan’s veto. Some 

argued that the ANA’s endorsement of Democratic candidates Walter 

Mondale and Geraldine Ferraro was the reason. Others believed it was 

the inclusion of the nursing institute. But in retrospect, according to a 

political analyst for the NLN, there was no “one particular issue that was 

the final cause. There was a strong likelihood that the bill would have 

been vetoed regardless of the ANA’s endorsement.” The administration had opposed other provisions of the bill “that specified the degree 

to which Congress would have jurisdiction over NIH activities,” the 

same reasoning that Madigan and other Republicans had used to block 

Democratic initiatives. While emphasizing his support for biomedical 

research, in his veto message the President said that “creating unnecessary, expensive new organizational entities,” such as the arthritis and 

nursing institutes, would impede health research. “This reorganization of NIH is premature in light of a study of the NIH organizational 

structure to be released in a few weeks by the IOM.”41 

Therefore, it surprised no one that the IOM report mentioned in 

Reagan’s veto message, “Responding to Health Needs and Scientific 

Opportunity: The Organizational Structure of the National Institutes of 

Health,” rejected the idea of creating new institutes. The study had two 

principal objectives in reviewing the organization of NIH. One was to 
Origins of the National Institute of Nursing Research 27 

be responsive to health needs and to capitalize on scientific opportunities. The second was to “promote basic science and maintain standards 

of scientific excellence.” While nursing research was most pertinent to 

the first objective, NIH’s traditional attachment to basic science would 

serve to block a nursing institute altogether. According to the IOM 

report, “there should be a presumption against any additions at the 

institute level, because changes would fragment the scientific effort, 

add to administrative costs, and diminish effective communication 

between institutes.” But the report did not eliminate every possibility. A new institute could be created if it were “demonstrable that the 

research area of a new institute or other major organizational entity... 

is not already receiving adequate or appropriate attention.” That criterion, all of the nursing organizations agreed, could be applied to nursing 

and “can contribute to the arguments in favor of nursing research at 

NIH.” In addition, the report recommended that the director of NIH 

be given more authority and that a new board be established within 

the Department of Health and Human Services (HHS) to determine 

oversight for the research organizations of the Public Health Service 

(PHS). “Nursing’s input to both the director’s office and the board... 

are [sic] critical,” an NLN analyst wrote. And nursing still had many 

friends in Congress.42 

On the heels of the release of the IOM study, the NIH Task Force on 

Nursing Research issued its report. Appearing in December 1984, the 

internal task force reiterated Wyngaarden’s view that no new institute 

was needed but emphasized the potential for a greater role for nursing 

research at NIH. This was no accident. Wyngaarden had selected 

the task force from among those NIH officials who had worked with 

nurses and better understood the importance of nursing research. The 

director of the National Institute on Aging, Dr. T. Franklin Williams, 

chaired the task force, which consisted of directors, deputy directors, 

and assistant directors from the Office of the Director, the National 

Cancer Institute, and the Division of Research Grants, among others. 

Moreover, the ANA suggested a number of people who would be 
28 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Bringing Science to Life 

valuable in helping the task force understand nursing research. These 

included people who held differing opinions but all of whom wanted 

more nursing research. Ruby Wilson, Rhetaugh Dumas, Joanne 

Stevenson, and Edyth H. Schoenrich, a dean at the Johns Hopkins 

School of Public Health, were among those recommended by the ANA. 

Before meeting with the task force, the ANA staff invited the women 

to lunch. “Here is an opportunity to inform all of the institutes at NIH 

about nursing research,” Heinrich recalled telling them. “Our plea was 

‘stick to the issue of what is nursing research and stay away from where 

it should be housed.’”43 

The ANA strategy worked. All focused on nursing research and 

what it could do for public health. No one mentioned whether something should be located in HRSA or NIH. In a series of three meetings, 

the group examined the definition of nursing research and the existing 

nursing research activities within NIH. In its conclusions, the task force 

recommended ways to expand them within the current administrative 

structure. The nursing research environment at NIH could be enhanced 

by “fostering the awareness of nursing research” and by “encouraging 

more collaborative and interdisciplinary research and training within 

the extramural and intramural programs,” it stated. Again, the report 

helped the nursing community define policy priorities as a new Congress 

returned in 1985. In addition, the nurses’ testimony opened a few eyes at 

NIH, Heinrich believed. The nurses were “very, very well received,” she 

recalled. “People began to say, ‘Oh, now I know what to look for in our 

own research portfolios at NIH.’”44 

While the Tri-Council continued to support the creation of a 

national institute of nursing (NIN) at NIH, the larger nursing community was still divided. “Many nursing leaders oppose the NIN and 

made their view heard in public,” wrote a government affairs analyst 

for the NLN. “Nursing needs to hold open forums to discuss the institute so that, as much as possible, we iron out these differences among 

ourselves.” Yet those who believed that an NIN remained the strongest 

means to promote nursing research needed “to have stronger arguments 
Origins of the National Institute of Nursing Research 29 

for the NIN than merely its ability to project nursing research into the 

mainstream and increase nursing visibility. Legislators need to hear 

more about the advantages and cost-effectiveness of nursing research 

for patients and other voters in their district. We may not reach a 

consensus,” the NLN analyst concluded, “but the need for greater discussion on the ramifications of a National Institute of Nursing and 

on the decision-making process for this and other issues confronting 

nursing is critical.” In any case, the increased attention that nursing 

research received in the previous two years greatly raised the expectations of the nursing community. And that community was determined 

to get something accomplished.45 

The Division of Nursing at HRSA was determined to keep its 

central role as the “go to” federal agency for nursing research. With 

the encouragement of Dr. Robert Graham, the director of HRSA, 

Dr. Edward Brandt, the assistant secretary for health, commissioned 

Lewin and Associates, Inc., a D.C.-based consulting company, to 

conduct a study to determine ways to “augment nursing research activities within PHS.” Deliberately timed for release before the NIH Task 

Force and House-Senate conference reports, the Lewin Report, they 

believed, would receive administration backing and take the wind out 

of the sails of Congress’s effort to establish an institute of nursing at 

NIH. Again, the ANA recommended nurse scientists as resources for 

the Lewin team. The ANA strategy was to voice its strong support for 

a federal focus for nursing research, something that HRSA’s Graham 

also backed. The Lewin Report offered several options, all including 

a strong federal focus for nursing research. The preferred option was 

to establish a center for nursing research in the Division of Nursing— 

something, the report noted, that could be done without passing new 

legislation and without impact on the Division of Nursing. Thus, the 

report could respond favorably to the recommendation of the IOM 

report and mesh with administration policy. With the backing of HHS 

Secretary Margaret Heckler, HRSA established a center for nursing 

research within the Division of Nursing in 1985.46 
30 Bringing Science to Life 

The “Lewin Report” offered several options for nursing research at the federal level. 

Because Congress could not override Reagan’s pocket veto in the 

fall of 1984, the legislation introduced in the next Congress, H.R. 2409, 

the Health Research Extension Act of 1985, was substantially the same, 

including the provision for the nursing institute. Again, the House and 
Origins of the National Institute of Nursing Research 31 

Senate conferees agreed on the concept of improving federal support 

for nursing research. But the bill that finally emerged in October 1985 

called for the establishment of a national center for nursing research, 

similar to the Fogarty International Center on the NIH campus, rather 

than an institute. While the nursing community viewed the center as a 

necessary compromise, the ANA and other professional groups worked 

with Madigan and his supporters to ensure that the center would have 

the same authorities as an institute. The bill passed unanimously in the 

Senate and by a 395 to 10 vote in the House. Once again, the White 

House and Congress were at odds over NIH legislation. On November 

8 President Reagan vetoed the bill, saying it imposed congressional 

“micromanagement” on NIH and was “overloaded with objectionable 

provisions that seriously undermine and threaten the ability of NIH to 

manage itself and is therefore unacceptable.” The President also took a 

direct swipe at nursing research in his veto message. “I do not believe 

that the establishment of a nursing research center at NIH is appropriate, for a very basic reason—there is a lack of comparability between 

the mission of such a center and the mission of NIH.” Reagan, following the lead of NIH, believed that nursing research was not sufficiently 

scientifically oriented to merit an institute. Both House and Senate 

leaders, who viewed NIH as an organization for promoting health 

rather than a “National Institute of Diseases,” disagreed and moved 

quickly to override the veto.47 

All of the major nursing organizations encouraged their members 

throughout the country to contact their members of Congress and 

sent their Washington lobbyists up to Capitol Hill to urge the override. 

On November 12, the House, as expected, voted 380 to 32 to do just 

that. About a week later, Senators Hatch, Kennedy, and Connecticut 

Republican Lowell P. Weicker, Jr., urged their colleagues to follow 

the House example. Hatch was particularly annoyed with the veto 

message and the dismissive attitude of NIH toward nursing research. 

The missions of NIH and a center for nursing research were not 

incompatible, as Reagan had suggested, he said. According to the 
32 Bringing Science to Life 

Utah Republican, “the truth lies closer to a comment attributed to an 

NIH scientist: ‘Nurses are not a disease, and at NIH we do disease 

research.’” The notion that the $5 million for nursing research within 

NIH’s $5.5 billion budget was “too much,” Hatch said, was “preposterous. A proposal for nursing research to have one one-thousandth of 

the NIH budget is too much? My fellow Senators, don’t you believe it,” 

he admonished. “It is high time that nursing research took its rightful 

place in those NIH halls of ivy.” Most senators agreed. They voted to 

override the veto, 89 to 7.48 
Origins of the National Institute of Nursing Research 33 

Chapter 1 Endnotes 

1	 Doris Merritt, telephone interview by Philip L. Cantelon, April 28, 2008, 12-13, 

31 (hereafter Merritt Oral History); author’s conversation with Doris Merritt, 

October 31, 2008. 

2	 Patricia A. Grady, “A Model for Government-Sponsored Nursing Science, 

Enferm Clin 16, no. 4, 172; Georgia K. Miller, et al., “What Is Nursing Research: 

Evolving Approaches to Methods and Content,” Journal of the New York State 

Nurses Association 23, no. 3 (September 1992): 5; Barbara Bronson Gray, “A Brief 

History of Nursing Research,” n.d., NINR Records, Box A. 

3	 Marilyn E. Flood, Promise on Parnassus: The First Century of the UCSF School of 

Nursing (San Francisco, CA: UCSF Nursing Press, 2007), 77-78, 93; “The History 

of the National Institute of Nursing Research,” n.d., NINR Records, Box 5; Gray, 

“A Brief History of Nursing Research”; NIH Task Force on Nursing Research: 

Report to the Director (Bethesda, MD: National Institutes of Health, 1984), 9. On 

the application of funds for graduate nursing education in California, see Flood, 

Promise on Parnassus, 90-91. 

4	 NIH Task Force on Nursing Research, 9; “Federal Support for Nursing Research,” 

August 18, 1983, NINR Records, Box 11, Folder: Nursing Research: NIH or 

HRSA?; NIH Task Force on Nursing Research, 9. 

5	 Miller, et al., “What Is Nursing Research,” 5. 

6	 Obituary for Jessie M. Scott, The Washington Post, October 30, 2009. Scott 

received the Distinguished Service Medal from the Department of Health, 

Education and Welfare in 1973 and, some years later, the American Academy 

of Nursing named her a “Living Legend.” Patricia Moritz, telephone interview 

by Philip L. Cantelon, March 13, 2008, 7 (hereafter Moritz Oral History); Linda 

Aiken, telephone interview by Philip L. Cantelon, June 10, 2008, 11 (hereafter 

Aiken Oral History); Miller, et al., “What Is Nursing Research,” 6. 

7	 Gray, “A Brief History of Nursing Research,” 9. 

8	 Ada Jacox, “The Coming Age of Nursing Research,” Nursing Outlook 34, no. 6 

(November/December 1986): 277-78. 

9	 Gerald Rosenthal, Memorandum to the Record, September 23, 1974, NINR 

Records, Box 11, Folder: Nursing Research: NIH or HRSA?; Susan R. Gortner, 

“Issues in Proposed Transfer of Nursing Research Project Grants to Health 

Services,” November 4, 1974, NINR Records, Box 11, Folder: Nursing Research: 

NIH or HRSA? 

10	 NIH Task Force on Nursing Research, 9. 

11	 Janet Heinrich, telephone interview by Philip L. Cantelon, March 21, 2008, 1-4 

(hereafter Heinrich Oral History March 21, 2008). 
34 Bringing Science to Life 

12	 Ibid.; Stevenson c.v., http://www.con.ohio-state.edu/ (accessed July 15, 2008); 

Nancy Fugate Woods, telephone interview by Philip L. Cantelon, March 24, 2008, 

20-21, 1-3 (hereafter Woods Oral History). 

13	 Institute of Medicine, Nursing and Nursing Education: Public Policies and Private 

Actions (Washington, D.C.: National Academy of Sciences, January 1983), 

215-17. 

14	 Ibid., 216-17. 

15	 Geraldene Felton, telephone interview by Philip L. Cantelon, June 30, 2008, 6-7, 

17. 

16 Heinrich Oral History March 21, 2008, 6. 

17 Ibid., 6, 9-11; Barbara J. Culliton, “A Nursing Institute for NIH?” Science 222 

(December 23, 1983): 1310; biography of Rhetaugh Dumas, www.nursing.umich. 

edu/dumas/bio.html (accessed July 15, 2008). 

18	 Culliton, “A Nursing Institute for NIH?” 1310-11; see NIH Task Force on Nursing 

Research, 1, 5. 

19	 Barbara J. Culliton, “Study of NIH Gets Under Way,” Science 222 (October 21, 

1983): 306; Mary B. Malison, “A Toast: To Overriding a Presidential Veto,” 

American Journal of Nursing, January 1986, 9. 

20	 Culliton, “A Nursing Institute for NIH?” 1310-11. 

21	 Heinrich Oral History March 21, 2008, 12-16; “The History of the National 

Institute of Nursing Research,” n.d., NINR Records, Box 5. The Howard Hughes 

Medical Institute later purchased the Cloisters. 

22	 Geraldine (Polly) Bednash, telephone interview by Philip L. Cantelon, June 3, 

2008 (hereafter Bednash Oral History), 11; Heinrich Oral History March 6, 

2008, 7. 

23	 Information on Madigan from his entry in Wikipedia, June 22, 2008; Heinrich 

Oral History March 21, 2008, 17. 

24	 Barbara J. Culliton, “House Battles over NIH Legislation,” Science 221 (August 29, 

1983): 726-27. 

25	 Patricia Jones and Rose Boroch to Tri-Council Representatives, Memorandum 

on National Institute of Nursing, July 15, 1983, ANA Library, Folder: NINR, 

passim. 

26	 Nola Pender to Eunice Cole, et al., Memorandum, “Report of Proceedings, Work 

Group Conference to Define the Federal Focus of Nursing,” September 11, 1983, 

1-2. 

27 Ibid., 4-5. 

28 Ibid., 5. 
Origins of the National Institute of Nursing Research 35 

29	 Ibid., 6. 

30	 Culliton, “A Nursing Institute for NIH?” 1310; Edward R. Madigan, “Nursing 

Research to Take Its Rightful Place,” January [1986], 3, NINR Records, Box 17, 

Folder: Articles on NINR. 

31	 Sally B. Solomon, “The Fate of the National Institute of Nursing,” Legislative 

Challenges for Nursing in the 80s, National League for Nursing Publication 

#19-1981 (New York: National League for Nursing, 1985), 4. 

32	 Culliton, “A Nursing Institute for NIH?” 1312. 

33	 Pat Scearse to Colleagues Interested in the Amendment to Create a National 

Institute of Nursing, Memorandum, July 21, 1983, ANA Library (hereafter 

Scearse Memo); Solomon, “The Fate of the National Institute of Nursing,” 4. 

34	 Doris Bloch, “Federal Support for Nursing Research,” August 18, 1983, NINR 

Records, Box 11, Folder: Nursing Research: NIH or HRSA? 

35	 Scearse Memo. 

36	 Rhetaugh G. Dumas and Geraldene Felton, “Should There Be a National Institute 

of Nursing,” Nursing Outlook 32, no. 1 (January/February, 1984): 16, 18. 

37	 Dumas and Felton, “Should There Be a National Institute of Nursing,” 18-20. 

38	 Ibid., 21. Some years later Felton regretted writing this article, listing it under 

the category of “Famous Miscalls” in a paper titled “History and Development of 

Nursing as a True Academic Discipline,” presented to the 32nd Annual Meeting 

of the American Association of Nurses in November 2005, presentation in 

Geraldene Felton Folder, NINR History Files. 

39	 Solomon, “The Fate of the National Institute of Nursing,” 4-5. 

40	 Ibid., 6; “Annotated (and simplified) Legislative Chronology,” National Center for 

Nursing Research, December 10, 1985, 1-2, NINR Records. 

41	 Solomon, “The Fate of the National Institute of Nursing,” 6. NIH did receive 

across-the-board funding increases for 1985 of some $5.1 billion, approved by 

the Reagan administration. Nursing research received an increase of $400,000 in 

1985, for a total of $9.4 million (ibid., 7). 

42	 Solomon, “The Fate of the National Institute of Nursing,” 7-8. 

43	 NIH Task Force on Nursing Research, 3; Heinrich Oral History April 11, 2008. 

44	 Solomon, “The Fate of the National Institute of Nursing,” 10; Heinrich Oral 

History April 11, 2008, 7. 

45	 Heinrich Oral History April 11, 2008, 10. In August 1985, Jo Eleanor Elliott 

made a final pitch to a group of nursing consultants to place a Center for Nursing 

Research in the Division of Nursing and HRSA. It was a good planning idea 

depending on the political winds of the pending legislation. See Donna Diers, 
36 Bringing Science to Life 

“Report of an Ad Hoc Advisory Committee: Center for Nursing Research,” 

September 3, 1985, passim, NINR Records, Box 11, Folder: Nursing Research: 

NIH or HRSA? 

46	 Heinrich Oral History April 11, 2008, 10-13; Lewin and Associates, “Assessment 

of the Organizational Locus of the Public Health Service Nursing Research 

Activities,” Contract Number 282-83-0072, September 7, 1984, copy in NINR 

Records, Box 11, Folder: Nursing Research: NIH or HRSA? 

47	 Washington Post, November 9, 1985; Bonnie Bullough, “Public Policy: National 

The Center for Nursing Research,” Journal of Professional Nursing, SeptemberOctober 1986, 270; Angela Barron McBride, “Nursing Research: Coming of Age,” 

Grants Magazine 11, no. 2 (June 1988): 62-63. 

48	 McBride, “Nursing Research: Coming of Age,” 62-63; The Washington Post, 

December 29, 1985; Congressional Record, November 20, 1985. Colman 

McCarthy wrote in The Washington Post that “the nurses lobby had been 

sophisticated in making the case that a research center was needed.” See The 

Washington Post, December 29, 1985. 

The NCNR shared space in Lister Hill Center’s basement with NIH’s 

Division of Computer Research and Technology, whose technicians 

made this punch-paper sign, held by Doris Merritt and Geraldine “Polly” 

Bednash, to make the nurses feel welcome. 
 

 

 

 

Science at NIH 

2

Chapter 2 

Launching Nursing 

A legislative mandate, even one passed over a presidential veto, did not 

translate into a functioning center for nursing research. There were the 

obvious hurdles to clear—funding, staffing, and space. There were also 

more subtle barriers to establishing the Center, those lurking in the 

attitudes of individuals who ran the National Institutes of Health (NIH) 

and had opposed the creation of any new competitor on the campus, 

especially one that they believed lacked the credentials of basic science. 

In addition, there was a built-in gender bias. Nearly all NIH leaders 

were men. To those at NIH who looked down their noses at women in 

science—and there were many—the new nursing research center was 

an interloper in a world run by men. There were numerous bureaucratic potholes available to delay, if not halt, the Center’s progress. By 

no means could nurse scientists rest assured that their new creation 

would succeed. There was a good deal of hard swimming ahead before 

the National Center for Nursing Research (NCNR) could enter the 

mainstream of the NIH research community. 

Creating the NCNR took more than five months, due largely to 

those bureaucratic potholes. Under the new law, the House and Senate 

conferees intended for the research and training activities supported by 

the Health Resources and Services Administration’s (HRSA) Division of 
40 

 

   

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Bringing Science to Life 

Nursing to be moved to NIH. Until the NCNR was established under 

the NIH aegis, however, Jo Eleanor Elliott retained those activities in the 

Center for Nursing Research at the Division of Nursing. While Elliott 

agreed to provide program supervision, merit reviews, and grants management and to “preserve the status quo for as long as necessary,” she 

wanted the activities moved to NIH and the NCNR “as soon as possible.” 

Nonetheless, there were delays stemming from budget battles with the 

Office of Management and Budget (OMB), which had not requested 

funds for the new center, and in Congress, which was struggling with the 

requirements of the Gramm-Rudman-Hollings Balanced Budget Act. 

With that as a background, it boiled down to how soon Wyngaarden 

could establish the Center on the NIH campus.1 

For many nurse scientists across the country, the establishment of 

the NCNR at NIH marked a rite of passage for their profession into the 

scientificcommunity. Inthe1970s,nursesattheVeteransAdministration 

discovered that nursing research was classified in a list of diseases, placed 

alphabetically between multiple sclerosis and periodontal disease. A list 

of areas of scientific expertise published by NIH had pages of categories 

dealing with biological aspects of disease, but nursing was mentioned 

only under “Health Sciences and Health Services Delivery,” specifically 

“Nurse/Midwifery” and “Nursing Education and Training.” With such 

long-held attitudes pushing against the full acceptance of nurse scientists, Dr. Ada Jacox, a leading advocate of nursing research, wondered if 

it ever would be possible for nurses to “fully contribute their perspective, 

knowledge, and talent to the development of the science of health.” She 

noted that nursing’s “emphasis on combining behavioral and biological 

aspects of health does not reflect the dominant values in the scientific 

community,” which paid but minimal attention to health promotion, 

patient education strategies, and the behavioral aspects of health and 

illness. Jacox was outraged that, for years, NIH had no way to identify 

nursing research. “Not only have we not been integrated into the scientific community, very often we have not even been acknowledged by it 

except in superficial and misleading ways.”2 
Launching Nursing Science at NIH 41 

 

Jacox’s frustration stemmed from her lobbying activities on 

behalf of a National Institute of Nursing Research (NINR). Most 

people had no idea that nurses did something called nursing research. 

“We encountered a common assumption that nursing research is concerned only with determining how many of what kinds of nurses are 

needed in various work settings. The fact that nurses do research on 

clinical problems still comes as a surprise to many.” Added to this was 

a general skepticism in federal agencies and in the medical community 

that there was anything “worth researching in nursing” or that “nurses 

had the capacity to do science.” Later, she said, “the surprise and skepticism gave way in some cases to an attitude of paternalism: that is, if 

you are interested in joining us, let us speak for you.” As female professionals coming of age in a period of active feminism, Jacox and her 

colleagues considered such a position anathema.3 

Moreover, nurse scientists faced another barrier to joining the 

scientific community: money. Scientists at NIH and elsewhere wanted 

to keep the status quo in both science and research dollars. “Any 

encroachments,” Jacox wrote, “including but not limited to nurses, into 

what they [scientists] define as their turf, are apt to be met by suspiciousness, hostility, and resistance.” She concluded that nurses “must 

not make the mistake of thinking that, because we have achieved legislation for a national center for nursing research at NIH, we will now be 

welcomed there.” Therefore, she believed that “much work needs to be 

done to integrate nursing research into the scientific community.”4 

Whatever his previous opinions about creating a new center 

at NIH, Wyngaarden did not hesitate to get it launched. Soon after 

Congress approved the law over President Reagan’s veto, Doris Merritt 

received Wyngaarden’s call. She believed she had good reason to turn 

him down, even though Wyngaarden was an old friend of hers and her 

husband’s from their days together at Duke University Medical School, 

where Wyngaarden chaired the Department of Internal Medicine and 

her husband was chief resident. Nurse scientists, she realized from her 

NIH experience, would be strangers in a strange land.5 
42 Bringing Science to Life 

Merritt grew up in New York City and in 1944 graduated from 

Hunter College, then an all-women’s school, where she majored in 

English literature and philosophy. An only child, she was eager to 

get out of New York and away from home. Faced with a manpower 

shortage during World War II, the Navy was recruiting graduates in 

the upper 10 percent of their class for officers’ training school. With 

approval from her parents, Merritt signed on. Just short of her twentyfirst birthday, she received her commission and was stationed in 

Washington, D.C. For the next two and a half years, she worked in 

the Code Room in one of the long rows of “temporary” buildings on 

the Mall, rickety relics from World War I plopped down alongside the 

Reflecting Pool between the Washington Monument and the Lincoln 

Memorial. Her job was to take incoming radio transmissions, have a 

machine decipher them, and distribute them to the right people. As 

exciting as she found D.C. during the war, the Code Room and the 

Navy were not part of her future.6 

When the war ended and the nation demobilized, Merritt knew 

she wanted neither to teach nor to go into sales. Unmarried and 

determinedly independent, she decided on a career in medicine. She 

looked over the catalogs from The George Washington University and 

was somewhat appalled by the science requirements, since her science 

in college had been astronomy and photography. She asked the dean 

of admissions of the medical school if it was really necessary to take all 

those physics and chemistry classes. “He must have been completely 

entertained by this naïveté,” she later recalled, but “he was very courteous. He told me to go away and take some of the prerequisites and 

come back in six months. I kept seeing him every six months [until] I 

was admitted.”7 

After graduation, one of two women in her class, Merritt headed 

to Duke University for an internship in pediatrics. She married Dr. 

Donald Merritt, an internist, had a baby, and then moved to Bethesda, 

Maryland, in the mid-1950s when he took a position as an investigator at NIH. After a month home with the baby, Merritt, who had 
Launching Nursing Science at NIH 43 

 

 

held one job or another since she was sixteen, “was climbing the walls.” 

Because of her medical degree, she landed a job as a senior administrator in the Division of Research Grants, responsible for selecting the 

group that reviewed applications for support at NIH. Her Navy luck 

held. At that time the entire extramural program staff for all of NIH 

was housed in one temporary building. Importantly, the people there 

formed a tight-knit group consisting of everyone who worked in the 

review process, including associate directors. As a result, Merritt came 

to know many of the individuals in the various institutes, something 

that would become very helpful later.8 

In 1961 the Merritts left NIH for Indiana University, where she 

became the director of grants in the dean’s office and the following 

Dr. Doris Merritt, the first acting director of the NCNR. 
44 

 

 

 

 

 

 

 

 

 

 

 

 

  

 

Bringing Science to Life 

year became an assistant dean. She also had an appointment in 

pediatrics, building both administrative and academic credentials. 

When the presidents of Indiana and Purdue created a new school 

in Indianapolis, Indiana University–Purdue University–Indianapolis 

(IUPUI), Merritt came in to run the school’s grants and contracts 

office, becoming dean for research and sponsored programs for the 

entire campus. In the meantime, her husband, Donald Merritt, had 

started a department of medical genetics at the Medical School at 

IUPUI, the third such program in the country. In 1978 he had an 

opportunity to return to NIH as a medical officer of the National 

Library of Medicine, which was developing a genetics database. For 

the next seven years, Doris Merritt served first as a special assistant to 

Dr. Donald Frederickson, the director of NIH, and then as research 

training officer and research resources officer for NIH.9 

Then came the call from Wyngaarden’s office. Merritt knew the 

score when she declined Wyngaarden’s offer. “These nurses are not 

going to be happy if you put a physician in charge of them when they 

have been spending the last thirty years trying to get out from under 

that yoke,” she told him. Further, she fully understood the low level 

of respect in which most NIH researchers held nursing research. The 

research scientists and medical doctors had made no secret of their 

contempt during the debate over a nursing research entity at NIH. 

Moreover, no new institute or center had been established for more 

than ten years, since the National Institute on Aging was created in 

1974. The new institute authorized in the 1985 legislation, the National 

Institute of Arthritis and Musculoskeletal and Skin Diseases, had been 

split off from the existing National Institute of Arthritis, Diabetes, and 

Digestive and Kidney Diseases. The two institutes split their staffs, 

each experienced in the cultural landscape of NIH. Nurses would not 

have that luxury. NIH would be alien territory. Furthermore, no one 

had experience in setting up a new center and there was no template 

for doing so, Merritt said. But Wyngaarden was insistent. He would 

give Merritt all the support she requested, whatever she needed, except 
Launching Nursing Science at NIH 45 

for one thing: people. There was a hiring freeze, so she would have 

to make do with whatever or whomever she could beg or borrow. He 

told Merritt to get it launched. In spite of his opposition to the Center, 

“I want you to do a good job of it,” he said. “Just get it done and don’t 

bother me with it. Do it, please,” he asked. Caught between an appeal 

and an order, Merritt decided to do it.10 

Whatever Wyngaarden’s animosity toward nursing research or a 

new entity at NIH, his selection of Merritt to implement the Center 

was inspired. He was confident of her abilities. An experienced and 

seasoned manager familiar with the back roads, secret byways, and 

idiosyncrasies of the NIH bureaucracy, Merritt knew and had earned 

the respect of the people who could get things done at NIH. While she 

admitted her ignorance about nursing research and her own prejudice 

about it, she had a job to do. As a pediatrician, she had often worked 

with nurses and had learned a good deal from them. “I was generously 

received by a community that had every reason to resent my being 

put there to direct them,” she recalled later. She read the Institute of 

Medicine report on nursing and the legislation creating the Center. 

She read the discussions held within the nursing community about it. 

“I was open to learning. I had to be.”11 

Once the legislation passed and it was clear that NIH would get 

the NCNR, the health-related agencies that had previously opposed 

it now lined up to get it going. Wyngaarden’s appointment of Merritt 

was an indication of his attitude. In Dr. Jan Heinrich’s view, once the 

Center was coming to NIH, Wyngaarden decided that “we’re going to 

be good and we’re going to be smart, and what we put out is going to 

be up to NIH standards.” The Division of Nursing realized it had lost 

the political battle and agreed to make the transfer of personnel and 

funding as smooth as possible. By January 1986 Merritt was hard at 

work organizing the Center.12 

Merritt travelled to San Diego in early January to attend a 

meeting of the Council of Nurse Researchers. The session provided 

her with an opportunity to discuss nursing research and hear about 
46 

 

 

 

 

 

 

 

 

 

Bringing Science to Life 

different examples of what nurse scientists were doing. Soon after the 

meeting, Dr. Ada Sue Hinshaw, then the chair of the American Nurses 

Association (ANA) Cabinet on Nursing Research, wrote Merritt to say 

how pleased the members of the cabinet were with her selection to 

establish the Center for Nursing Research and to offer their assistance. 

Hinshaw suggested that Merritt review the Tri-Council for Nursing’s 

resolution concerning the mission of the NCNR and the cabinet’s 

“latest policy statement outlining the priorities for the profession’s scientific endeavors for the coming decade.”13 

Merritt turned to the nursing community for assistance, knowing 

their participation and “buy-in” would create a group of solid support, 

something especially important to a non-nurse. In mid-February 

she reassured Heinrich at the ANA that in spite of President Reagan’s 

rescission of the Center’s budget in fiscal year (FY) 1987, all the work 

and documentation necessary to establish the Center for Nursing 

Research would continue. Heinrich and her political allies, of course, 

were already at work to ensure future funding. But Merritt needed 

more help. Would the professional nursing organizations help her find 

a permanent director? She wanted the nursing community to have a 

central role in shaping the guidelines for the individual’s qualifications 

and identifying a pool of “the best possible candidates.” The Center 

would be best served by a highly qualified nurse researcher who could 

relate to and have the respect of the NIH biomedical community. “We 

want to be sure we don’t miss anything,” she told Heinrich.14 

Merritt faced two more pressing problems: personnel and space. 

Elliott agreed to move nine people to the new Center—six professionals, a grants manager, and two clerks. They would become the 

core of the Center’s staff. But would they be the right people? The 

grant-making culture at the Division of Nursing was far different 

from that at NIH. At HRSA, Merritt learned, “the staff sought the 

grants, advised people how to write them, ran the reviews and then 

managed them after they were awarded.” There was “no separation 

of church and state,” an NIH staffer reported. “Each professional is 
Launching Nursing Science at NIH 47 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

lawyer, judge, and jury for her own programs.” That arrangement was 

diametrically opposite of that at NIH, which separated the review 

and award functions from the managing of grants. HRSA’s staff had 

to be brought into the NIH way of doing business. By February 1986 

the Division of Research Grants at NIH would review all applications 

for nursing research. Wyngaarden’s office moved to create a separate 

advisory council to evaluate them as well. And space was a permanent nightmare. When asked about the physical resources available 

for the Center, the facilities man for the director of NIH replied, 

“Pathetic.” He had visited the HRSA offices with Merritt. People 

were jammed into small spaces partitioned by a maze of file cabinets 

and old desks. When the office became very busy, case officers had to 

use the pay phones in the hall. He concluded that “even a windowless suite with adequate elbow room would be an upgrading of their 

present quarters.” He also suggested using NIH’s discarded office 

equipment. “It would still be better than what they [the Division of 

Nursing] have.”15 

Merritt overcame these problems with help from several places. 

One was the Division of Nursing at HRSA; the other, officials at NIH. 

To get started, Merritt needed a staff familiar with nursing issues. As 

promised, Elliott, who had rightfully worried about the impact of the 

Center on her own agency, arranged to transfer her grants staff to 

the new Center. They were ready to go within a week of Merritt’s 

appointment. The NIH people were appalled at the Division of 

Nursing’s offices in the Parklawn Building, a ten-story office building 

housing mazes of offices in Rockville, Maryland—a testament to government frugality in leasing office space. Merritt rejected the notion 

of running a bifurcated office, one part on the NIH campus and the 

other two miles north up Rockville Pike. She brought down nine 

people from the Division of Nursing, including Dr. Doris Bloch, Dr. 

Patricia McCormick, Dr. Deidre Blank, Dr. Adele Woods, and Harriet 

D. “Bunny” Carroll, to handle grant applications coming into the 

Center. Crucial to adapting to the NIH culture and grant-making 
48 

 

 

 

 

 

Bringing Science to Life 

environment, Bloch, McCormick, Blank, and Woods held doctorates 

and Carroll had previously worked on the Bethesda campus. The 

following year, Merritt hired another nurse scientist from HRSA, 

Dr. Patricia M. Moritz, who had been with the Advanced Nursing 

Resources Branch of the Division of Nursing.16 

Merritt also received assistance from other parts of NIH. Because 

of a hiring freeze, she had to beg and borrow from those already on the 

NIH payroll. “I went around the NIH to directors with whom I was 

friends and I asked if they could possibly lend me any personnel on a 

short-term assignment to help me get this off the ground.” The director 

of the Division of Research Resources provided a much-needed executive officer, and the central budget office gave her a legislative assistant. 

Dr. Ruth Kirschstein, the director of the National Institute of General 

Medical Sciences, lent Merritt a full-time grants officer who could run 

the awards process until the Center was fully operational. Wyngaarden, 

good to his word, approved the space, the temporary assignments, and 

all the transfers.17 

Cajoling some office space for her new team was Merritt’s first 

miracle. One of the medical world’s worst-kept secrets is how fierce 

the battle can be to capture a location on the NIH campus in Bethesda. 

So even if Congress mandated a new entity, that organization was 

destined to get space that others either shunned or abandoned. One 

of these spaces was a small suite in the basement of the Lister Hill 

Center, home to the Division of Computer Research and Technology, 

NIH’s information technology operations. Merritt convinced Dr. 

Donald Lindberg, head of the National Library of Medicine, to let the 

Center use it. The division tended to the large mainframe computers 

that churned out miles of Teletype-size sheets of paper. In April they 

learned that the new NCNR would be joining them. They didn’t know 

what that was exactly, but the information technology staff was excited 

to have company in their basement. On the day the Center’s personnel 

moved in, the Division hung up a huge banner of perforated computer 

paper reading, “Welcome Nurses.”18 
Launching Nursing Science at NIH 49 

The Lister Hill Center. The NCNR’s first home was in its basement. 
50 

 

 

   

 

 

 

 

 

 

Bringing Science to Life 

On April 18, 1986, Dr. Otis R. Bowen, Secretary of the Department 

of Health and Human Services, announced the creation of the National 

Center for Nursing Research under Public Law 99-158 and the appointment of Dr. Doris H. Merritt as acting director. The announcement 

ended more than two years of efforts by professional groups to achieve 

a national focus for nursing research. Bowen and the nurses recognized 

the important efforts of Hatch and Madigan in guiding the legislation 

authorizing the Center. A week later, on April 28, the NCNR was open 

for business in its temporary quarters in the basement of the Lister Hill 

Center (Building 38A) on the NIH campus. At last, nurses were part of 

NIH.19 

With a staff in place and ready to operate, Merritt received a 

further jolt—a bureaucratic squabble over funding. The Public Health 

Service tried to transfer some $7 million in nursing funds to the NCNR 

but found it impossible because the new Center had no appropriation symbol or account number. Attempts to solve the problems hit 

snags in OMB. Then the union, Local 41 of the American Federation 

of Government Employees, wanted written assurances that the transferred personnel were being treated equitably. OMB, Merritt recalled, 

was in no hurry to assign an account number “because their tactic was 

if you don’t have the money, you can’t spend it.” In order to function, 

the NCNR borrowed funds from HRSA to meet expenses for travel and 

the installation of computer equipment. An interagency agreement 

allowed HRSA to continue making awards on continuation grants 

and to pay personnel. Only when Wyngaarden approved a spending 

shortcut could the Center purchase supplies that it badly needed. The 

financial snafus made it very difficult, if not impossible, to use the $5 

million carried over from FY 1985 to establish the Center or to prepare 

budgets for FY 1987 and FY 1988. In addition, the situation hampered 

Merritt’s ability to meet current commitments, hire new personnel, 

procure needed items, track obligations, make new grants, or conduct 

a search for a permanent director.20 

In Merritt’s view, a third group was also crucial to her getting 
Launching Nursing Science at NIH 51 

through these difficulties. Three weeks after Merritt’s appointment, 

a delegation of four nurses representing the ANA, the American 

Association of Colleges of Nursing, the National League of Nursing, 

and Sigma Theta Tau International, the nursing honor society, came 

to see her. “They had really done their homework to find out what I 

was like,” Merritt remembered. “They probably knew what I ate for 

breakfast.” She got straight to the point. Confessing how little she 

knew about nursing, Merritt asked the delegation to help structure 

the Center into three branches—one for prevention, one for chronic 

diseases, and one more loosely defined as nursing services. The delegation offered advice on establishing a national advisory group. “I can’t 

tell you how generous they were with their time and their information, 

supplying lists of names from around the country that I could appoint 

as reviewers,” Merritt later recalled.21 

Working with borrowed people on borrowed money in borrowed 

space, Merritt pushed hard for the Center to become fully operational. 

HRSA, Merritt said, had told the Division of Nursing that there was 

no point in reviewing grant applications as they came in because there 

was no money to fund even those that had been previously approved. 

“The whole program was stymied,” she recalled, “which was one of the 

reasons that the research nurses were so eager to get out from HRSA.” 

She set her transfer nurses to work reviewing grants. “If we get money,” 

she told them, “we’re going to be ready.” It was not the first clash 

between the HRSA and NIH cultures, but Merritt was determined to 

establish an NIH culture at the Center. “They were not very happy 

with me. I kept saying, ‘But this is the way we do it at NIH,’ and they 

would say, ‘But we’ve never done it that way.’” In addition, NIH based 

its awards on priority scores, “not on a first come, first served whowas-waiting-the-longest basis,” as she described the HRSA system. 

Again, the Division of Nursing transfers pushed against the change. 

But Merritt’s husband had just been diagnosed with terminal cancer. 

With additional worries at home, she had little patience or sympathy 

for any foot-dragging at the office.22 
52 Bringing Science to Life 

Merritt fully knew OMB’s penchant for releasing appropriated 

funds that it didn’t want spent at the very last minute of the fiscal year 

“in hope that the system could not react quickly enough to get all the 

grants awarded.” If that happened, she said, the funds went back to 

the U.S. Treasury and “it’s an absolute cardinal sin at NIH to send 

money back.” HRSA, she understood, was not always prepared for 

OMB’s funding process and subsequently lost the funds. Therefore, 

she made it a high priority to get all the grant applications reviewed 

and scored and approved by a council borrowed from the Division of 

Nursing. Three weeks before the end of the fiscal year, all the paperwork was in place. True to form, in mid-September, OMB released 

the funds, and the Center for Nursing Research made approximately 

$6 million worth of awards in two weeks. Both awards were institutional grants continuing work already underway—one was in the 

Acute and Chronic Illness Branch, the second in the Nursing Systems 

and Special Projects Branch.23 

Out of necessity, the early NCNR staff learned how to navigate the complex world of the NIH 

grants process. 

The success of grant-making during the Center’s initial year was 

crucial to establishing its reputation within the nation’s nursing community and at NIH. It was no coincidence, as Merritt carefully steered 
Launching Nursing Science at NIH 53 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

the Center toward the mainstream of NIH research. “I am inclined 

to treat the RN/PhD investigator population how we treat MD/PhD 

investigators,” she told the Cancer Nursing Letter in June 1986. She 

wanted the Center to “integrate nursing research activities into ongoing 

NIH programs while establishing the nurse investigator as a colleague 

rather than a coordinator working under an NIH investigator.” The 

goal of the Center was to improve nursing care by expanding the scientific base for nursing practice. NCNR programs, she stressed, would 

complement other NIH biomedical research programs and seek more 

collaboration with them.24 

The Center’s professional staff initially came from HRSA’s Nursing 

Research Branch of the Division of Nursing. Doris Bloch led the transfer 

of nursing research and training programs from the Division of Nursing. 

A native of Berlin, Germany, Bloch escaped Nazi persecution during 

WorldWarIIbyhidingwithfamiliesintheDutchcountryside. Sheimmigrated to the United States after finishing high school in the Netherlands 

and graduated from Mount Holyoke College with a BA in zoology. She 

earned a master’s degree in nursing from Yale University and a doctorate in public health from the University of California, Berkeley. As the 

leader of the Nursing Research Branch, Bloch “contributed significantly 

to nursing research by categorizing nursing terminology and clarifying concepts, such as defining goals and objectives for nursing research 

centers.” As a result of her work over the years, the “quiet and unassuming” Bloch became “a legend” among nurse scientists and a mentor to 

many of nursing’s future leaders. As interim extramural director and 

branch chief, she assumed primary responsibility for program planning 

and evaluation before completing her career as special assistant to the 

director of the National Institute of Nursing Research (NINR). The 

Center’s Division of Extramural Programs, initially headed by Bloch, 

developed three program target areas, two concerning biological and 

behavioral factors on health and the third, recovery from illness.25 

In addition to the Division of Extramural Programs, the NCNR 

created three other branches, much as Merritt had recommended to the 
54 Bringing Science to Life 

Dr. Doris Bloch was among Division of Nursing staff members who moved to the Lister Hill 

Center to assist with the grants process. 

professional nursing organizations. The Health Promotion and Disease 

Prevention Branch was headed by Deidre M. Blank, who had worked 

in the Nursing Research Branch of the Division of Nursing before 

moving to the NCNR. Her division funded studies that addressed 

the general health of the population and were not directed toward 

any one disease or disability. Studies to promote health might include 

nutritional requirements adjusted to the various phases of one’s life 
Launching Nursing Science at NIH 55 

or the relationship between biomedical and behavioral dimensions of 

human health. The branch also took interest in studies that enhanced 

the ability of individuals and families to respond to actual or potential 

health problems. The Acute and Chronic Illness Branch, headed by 

Patricia McCormick, who also worked in the Nursing Research Branch, 

considered technological developments in rehabilitation therapies, epidemiological factors in disease and disability, nursing interventions, 

and biomedical, cognitive, and perceptual responses to illness or disability. The third branch was the Research Development and Review 

Branch under Adele Woods. Her responsibility was to ensure an 

adequate cadre of well-trained nurse investigators to meet the nursing 

research needs of the future. New research directions for the NCNR 

included an increasing emphasis on predoctoral and postdoctoral 

fellowships for research. The branch also launched two career development awards: the Academic Investigator Award, a five-year award 

for nursing faculty “to establish their research programs and mature 

into independent investigators,” and the Clinical Investigator Award, 

a three-year postdoctoral program for nurse investigators working in 

general clinical support centers. The Division of Research Resources 

of NIH, which Merritt directed before becoming acting director of the 

NCNR, funded this program.26 

Other key people who came to the NCNR from the Division of 

Nursing were Gertrude K. “Trudy” McFarland and Bunny Carroll. 

McFarland had worked in the special projects program in the Division 

of Nursing and was the first scientific review administrator for nursing 

research at NIH. She and her staff worked at the NIH Center for 

Scientific Review to ensure “rigorous and timely processing of nursing 

research grant applications.” Carroll initially ran the Nursing Systems 

and Special Programs Branch, which investigated the environment in 

which nursing management and care were delivered. For example, the 

branch sponsored studies comparing the outcomes of home care, longterm care, and hospital care to identify the mechanisms responsible 

for different outcomes and thereby improving nursing care. Patricia 
56 Bringing Science to Life 

Moritz moved from HRSA to become branch chief of the Nursing 

Systems Branch in mid-1987.27 

By the spring of 1987 Merritt’s staff worked out of three separate 

buildings on the NIH campus. The program and grants management 

staff occupied some 1,400 square feet in the Lister Hill Center; the 

administrative, budget, and planning offices were in Building 31; and 

Merritt and her secretary remained in Building 1. Merritt had already 

staked out about 2,700 square feet of space in Building 31 so all of the 

NCNR would be consolidated in one spot. Her schedule was to move 

everyone into the new area in early 1988.28 

Merritt had also assembled an NCNR National Advisory Council 

by the beginning of 1987. The National Advisory Council met in midFebruary of that year to review new program development initiatives 

and become familiar with the NIH review procedures that the NCNR 

had adopted. The council consisted of individuals from throughout 

the country and included nurse scientists and educators, such as Drs. 

Nola Pender, Ann W. Burgess, and Dyanne D. Affonso, health experts 

like Dr. Leonard Heller, formerly of Congressman Madigan’s staff, and 

public citizens including Frederick C. Matthaei, Jr., president of ARCO 

Industries Corporation, and Elaine W. Conway, an interior decorator. 

That first council expressed a special interest in two areas: the ethics 

of decision making, in which the nurse played an important role, and 

the need for research initiatives that focused on the patient’s perception of what makes for a healing hospital stay. An additional role of 

the council was to assist the NCNR staff in developing the Center’s 

long-range plans.29 

Most critical to the Center’s long-range plans and goals was the 

development of more nurse scientists. Echoing a refrain often heard 

in nursing circles, Merritt saw opportunity for nursing in the emerging 

AIDS epidemic. Testifying to the House Appropriations subcommittee 

that oversaw the NCNR’s funding, Merritt admitted that “the nursing 

profession does not yet have a cadre of well-trained nurse scientists 

with sufficient postdoctoral training to become successful independent 
Launching Nursing Science at NIH 57 

investigators.” The Center sought applications for several awards in 

the area of AIDS, she said, an Academic Investigator Award (KO7), 

a Clinical Investigator Award (KO8), and an Institutional National 

Research Service Award (T32). These awards, she said, “should help 

correct these deficiencies.”30 

Just as Merritt integrated the National Advisory Council into the 

culture of NIH, so did she seek to integrate the NCNR into the NIH 

community. One ready method of doing this was to collaborate in 

research projects with other NIH institutes and centers so that they 

might get a deeper understanding of nurse scientists. The NCNR 

invested heavily in this approach. Some $1.5 million, nearly 10 percent 

of the Center’s entire budget in 1986, was invested in these collaborative efforts. Most important were three projects with the National 

Institute on Aging, two projects with the National Institute of Child 

Health and Human Development, and four projects with the National 

Heart, Lung, and Blood Institute. Other partners included the National 

Library of Medicine, which co-funded a project for the “Development 

of New Techniques for the Retrieval and Delivery of Problem-Specific 

Information,” and the National Institute of Mental Health, whose 

project of “Social Competence Risk Assessment—Mother–Child 

Factors” was reassigned to the NCNR.31 

Collaboration was most cost effective at a time when funding was 

limited and the Center was trying to establish a basis for its annual 

budget. But in addition, the Center had to rethink the grant review 

process. The peer review system for research proposals developed 

at the Division of Nursing ran by a different set of rules from that at 

NIH. In the 1970s Jessie Scott had warned the Nursing Research and 

Education Advisory Committee that it was “being too hard...and that 

the disapproval rate [75-80 percent] was too high,” though the aim was 

to fund nearly all the approved proposals. At that time, Ada Jacox 

recalled, “our response typically was to insist that we were not going to 

compromise our standards and that nursing research proposals had to 

be as good as any other proposals.” Nurses learned that the approval 
58 Bringing Science to Life 

rate in other federal agencies was closer to 80 percent. The review 

groups at NIH, for example, would know a cut-off point for funding 

“but made generous use of the approval system for other proposals 

that will not be funded. The large number of approved but unfunded 

proposals then is used as an argument for increasing the appropriation 

for the next year.” The dichotomy between the two approaches led 

people to cite the high disapproval rate as evidence of the poor quality 

of nursing research proposals. To merge into the mainstream NIH 

culture, the NCNR would need to be both alert and adaptive to the 

nuances of the institution’s traditional practices.32 

Merritt was someone who connected the dots, who could gather 

disparate facts and link them together. She used this talent to begin 

the process of integrating nurses into the NIH culture. “By this time I 

was learning a bit about behavioral sciences and saw how the effects of 

Among the NCNR’s accomplishments of the first year was the creation of the Nursing Research 

Study Section within the Division of Research, which reviewed individual and institutional 

training grants. (Front row, from left): Marilyn T. Oberst, RN, EdD, FAAN; Kathleen A. 

O’Connell, RN, PhD; Thelma J. Wells, RN, PhD, FAAN, FRCN; Sister Callista Roy, RN, PhD, 

FAAN; Geraldene Felton, RN, EdD, FAAN, chairperson; Gertrude K. McFarland, RN, DNSc, 

FAAN, health scientist administrator; Mi Ja Kim, RN, PhD, FAAN; Joyce Roberts, RN, CNM, 

PhD, FAAN; Melanie C. Dreher, RN, PhD; Susan L. Jones, RN, PhD; Betty L. Chang, RN, 

DNSc. (Back row, from left): Sandra G. Funk, PhD; Sharol F. Jacobson, RN, PhD; Linda R. 

Cronenwett, RN, PhD; Ivo Abraham, RN, PhD; Marie Cowan, RN, PhD, FAAN; Darlene Wood, 

PhD; Carolyn J. Walker, grants technical assistant. 
Launching Nursing Science at NIH 59 

nursing research could expand or add to the effects of clinical research 

in cancer.” Patient compliance—whether patients did what they were 

supposed to do, such as take their drugs or stick to their therapy— 

applied to a number of institutes. “It just seemed to me that there were 

so many ways that nurses could...serve on institute committees.” She 

convinced institutes to incorporate nurses into their programs, believing that both could profit from the experience and exchange of ideas. 

“The word got around that these people [nurses] were pretty good. 

A certain amount of collegiality began to form where there was none 

before, or where they would have been actually ostracized or ignored.” 

Nurses, Merritt hoped, would eventually fit into NIH.33 

Within a year the Center, under Merritt’s leadership, had chartered 

a nursing research study section to review individual and institutional 

training grants, had formed a national advisory council, was making 

its own grants, was getting its own budget, and was conducting a 

search for a permanent director. By the end of September 1986, the 

NCNR had obligated its entire FY 1986 appropriations and made 109 

research and 165 training awards. The Search and Screen Committee 

was beginning its hunt for a director and planned to review candidates for the job within weeks. Notably, Merritt had put the stamp of 

NIH culture on nursing research. The structure of the Center paralleled that of the various NIH institutes, giving nurses greater access to 

a range of opportunities at NIH. Within a year of her appointment, 

Doris Merritt, pediatrician, had been the mother, midwife, and parent 

to the NCNR.34 

The development of a more aggressive approach to nursing 

research, which led to the creation of the NCNR at NIH, was the result 

of the investment that Jessie Scott, the Division of Nursing, and, to a 

lesser extent, private foundations had made in nursing education over 

the years. That investment stimulated the growth of nursing education 

and the number of nurse researchers. By the late 1970s, the expansion of 

undergraduate and graduate education programs in schools of nursing 

had produced a critical mass of young professionals eager to advance 
60 Bringing Science to Life 

both their own careers and the discipline of nursing. Impatient with the 

static funding and slow advances achieved by the Division of Nursing 

and ever mindful of the expanding dollars going into basic research at 

NIH, nurse researchers seized leadership of the profession. Operating 

largely from bases in Washington, D.C., they finally convinced their 

nursing colleagues and their members of Congress that the time for 

nursing research to enter the mainstream of medical science had 

arrived. They had no intention of denigrating the Division of Nursing 

or what it had achieved in the past; they had every intention of redefining and changing the profession’s future. Congressman Madigan 

provided the legislative vehicle to crash through the old barriers and 

onto the NIH campus. The establishment of the NCNR was a milestone in the history of nursing research. It raised the standing of the 

profession and greatly improved its ability to get the funding necessary 

to conduct significant research. 

Any doubts that nursing activists held about NIH biomedical 

snobbery were dissipated with Wyngaarden’s appointment of Doris 

Merritt. In retrospect, it is hard to imagine a better choice. A skilled 

administrator and savvy in the ways of NIH, she deftly maneuvered 

through or around every snarl and snag. Within a year she successfully 

launched the new Center with a $16 million budget, more than three 

times the funding available from HRSA. She stretched those dollars 

even further by pushing collaborative programs for nurse researchers 

with other institutes. “The NCNR is expected to thrive as it carries out 

its mission to augment the nursing science base that underlies effective 

patient care and the efficient delivery of nursing services, which benefit 

every individual in the United States at some time in his or her life,” 

Merritt wrote in August 1986. Hers was a virtuoso performance.35 
Launching Nursing Science at NIH 61 

Chapter 2 Endnotes 

1	 “National Center for Nursing Research, Outline Memorandum,” February 4, 

1986, NINR Records, Box 11, Folder: NCNR Achieved. 

2	 Ada Jacox, “The Coming of Age of Nursing Research,” Nursing Outlook 34, no. 6 

(November/December 1986): 277, 276. 

3	 Ibid., 278. 

4	 Ibid., 280-81. 

5	 Doris Merritt, telephone interview by Philip L. Cantelon, April 28, 2008 (hereafter Merritt Oral History), 17-18, 43. 

6	 Ibid., 1-3. 

7	 Ibid., 3-4. 

8	 Ibid., 5-7. Building T-6 had a “temporary” life of some twenty years and was 

then torn down to become a parking lot for Building 31. 

9	 Ibid., 8-10. 

10	 Ibid., 14, 13. 

11	 Ibid., 13-14. 

12	 Janet Heinrich, telephone interview by Philip L. Cantelon, March 6, 2008 (hereafter Heinrich Oral History March 6, 2008), 12. 

13	 Ada Sue Hinshaw to Doris Merritt, January 14, 1986, copy in ANA Library. 

14	 Doris H. Merritt to Jan Heinrich, February 19, 1986, copy in ANA Library. 

15	 Merritt Oral History, 15-17; National Center for Nursing Research, Staff Memo, 

February 4, 1986, NINR Records, Box 11, Folder: NCNR Archives; see also 

Richard Mandel, A Half Century of Peer Review, 1946-1999 (Bethesda, MD: 

National Institutes of Health, Division of Research Grants, 1996). 

16	 Merritt Oral History, 17-21. 

17	 Ibid., 20-21. Merritt had co-chaired with Kirschstein a task force studying 

the status of research into women’s health issues a few years before. Ruth L. 

Kirschstein, telephone interview by Philip L. Cantelon, January 17, 2008, 2, 8 

(hereafter Kirschstein Oral History). 

18	 Geraldine (Polly) Bednash, telephone interview by Philip L. Cantelon, June 3, 

2008 (hereafter Bednash Oral History), 17-18; Merritt Oral History, 18. 

19	 The NIH Record 28, no. 9, NINR Records, Box 6, Folder: NCNR Archives; ANA 

News, Press Release, April 18, 1986, ANA Library, Folder: NINR. 

20	 National Center for Nursing Research, Fact Sheet, n.d., NINR Records, Box A, 

Folder: Notebook Prepared by Gerry Pollen; Merritt Oral History, 23; Daniel K. 
62 Bringing Science to Life 

Inouye to James B. Wyngaarden, May 14, 1986, copy in ANA Library, Folder: 

NINR. See also, John H. Kelso and James B. Wyngaarden to Donald Ian 

McDonald, April 14, 1986, Memorandum, “Establishment of the National Center 

for Nursing Research, NIH,” April 14, 1986, NINR Records, Box A, Folder: 

Notebook Prepared by Gerry Pollen. 

21	 Merritt Oral History, 15; Heinrich Oral History March 6, 2008, 3. 

22	 Merritt Oral History, 23-24. 

23	 Ibid., 26-27; Merritt Testimony, “Hearings,” Subcommittee on Appropriations, 

House of Representatives, March 17, 1987, 710. 

24	 The Cancer Nursing Letter, June 1986, 3-4, copy in ANA Library, Folder: NINR; 

National Center for Nursing Research in National Institutes of Health Fact Sheet, 

n.d., NINR Records, Box B, Folder: NIH History (hereafter NCNR Fact Sheet). 

25	 NCNR Fact Sheet, passim; Doris Bloch obituary, NIH Record, September 9, 

2003; Deidre M. Blank and Patricia Moritz, “Encouraging Service Through 

Collaboration,” Reflections on Nursing Leadership, Fourth Quarter 2006, passim. 

26	 NCNR Fact Sheet, passim; Blank and Moritz “Encouraging Service Through 

Collaboration,” passim. 

27	 NCNR Fact Sheet, passim; Blank and Moritz, “Encouraging Service Through 

Collaboration,” passim; Patricia Moritz, resume, NINR files. 

28	 Merritt Testimony, “Hearings,” Subcommittee on Appropriations, House of 

Representatives, March 17, 1987, 710. 

29	 Ibid., 711. 

30	 Ibid., 713. 

31	 Ibid., 711-12. 

32	 Jacox, “The Coming of Age of Nursing Research,” 279. 

33	 Merritt Oral History, 41. 

34	 Ibid.; see also, Angela Barron McBride, “Nursing Research: Coming of Age,” 

Grants Magazine 11, no. 2 (June 1988): 64; Merritt Testimony, “Hearings,” 

Subcommittee on Appropriations, House of Representatives, March 17, 1987, 

679. The central NIH Office of Research Grants reviewed the Center’s research 

applications. Note from Patricia Moritz, August 2008. 

35	 Doris Merritt, “The National Center for Nursing Research,” August 1986, 8, 

NINR Records, Box A, Folder: Notebook Prepared by Gerry Pollen. 

As the leadership changed, Ada Sue Hinshaw, right, recognized Doris 

Merritt and her staff for their “remarkable” accomplishments “during 

the ‘start-up days.’” 
 

 

 

 

 

 

Nursing Research Comes of Age 3

Chapter 3 

From Center to Institute: 

When Doris Merritt agreed to become the acting director of the 

National Center for Nursing Research (NCNR), her job was to get the 

new Center solidly organized within the National Institutes of Health 

(NIH). But she was not a nurse, and there was wide agreement that 

a nursing professional should direct the Center. The director of NIH, 

Dr. James B. Wyngaarden, had insisted that Merritt initiate a search 

for a permanent director. Whatever the derogatory comments about 

nursing science from the NIH biomedical community, Merritt and the 

nursing community were determined to bring the new Center fully 

into the NIH orbit and earn nursing research the respect of other institutes on the Bethesda, Maryland campus. Finding the right person to 

become director was crucial to the future success of the Center and to 

the scientific opportunities of the nursing profession.1 

In September 1986 Wyngaarden, with Merritt’s assistance, 

selected a search committee, headed by Dr. T. Franklin Williams, 

director of the National Institute on Aging. Williams, considered 

by many to be the father of geriatrics in the United States, had long 

been interested in the care of the elderly and had publicly recognized 

nursing’s critical role in delivering this care. Over the years he had 

proved himself a good friend of nursing science and had supported 
66 

 

 

 

 

 

 

 

 

 

 

 

 

 

   

Bringing Science to Life 

an institute for nursing within NIH. Consequently, Williams’s selection pleased Merritt, the American Nursing Association (ANA), and 

many others within the nursing community. The committee drafted 

specifications for the job and began a nationwide search for qualified candidates in the fall of 1986. Merritt, Wyngaarden, and the 

search committee interviewed the finalists. After those discussions, 

one candidate emerged, Merritt recalled later, who was “head and 

shoulders above anybody else.” In her mid-March testimony, Merritt 

told Congress that a nomination had been forwarded to Secretary 

of Health and Human Services Dr. Otis Bowen. She estimated that 

the new person might be on board by May. Congressman Carl 

Pursell (R-MI) wanted to know who it would be. “That is Ada Sue 

Hinshaw?” he asked. “Yes,” Merritt replied, but, understanding the 

politics of the appointment, quickly added, “she has been nominated 

by Dr. Wyngaarden along with other candidates for Secretary Bowen’s 

consideration.”2 

Merritt was overly optimistic by a month. Bowen announced the 

selection in June, and Wyngaarden swore in Dr. Ada Sue Hinshaw as 

the first NCNR director in the auditorium of NIH on June 24, 1987.3 

Hinshaw possessed all the credentials to head the NCNR. She 

held a dual appointment as professor and director of research at the 

University of Arizona College of Nursing. She had received four major 

research grants from the Division of Nursing and was project director 

of the Biomedical Research Support Grant awarded to the university’s 

Medical Center. She had Washington experience, including actively 

lobbying for the establishment of the NCNR. Hinshaw was a member of 

the ANA Cabinet on Nursing Research from 1980 to 1984 and chaired 

the cabinet from 1984 to 1986 as the Madigan amendment wound its 

way through Congress. She was a member of the National Institute 

of Mental Health Task Force on Nursing Research and the governing 

council of the American Academy of Nursing, as well as a registered 

nurse and a Fellow of the American Academy of Nursing. The nursing 

community held Hinshaw in the highest regard. In December 1985 
From Center to Institute: Nursing Research Comes of Age 67 

she received the first Nurse Scientist of the Year Award from the ANA’s 

Council of Nurse Researchers.4 

Nursing was in her blood. The daughter of a nurse, Hinshaw was 

born and raised in small towns in southeastern Kansas. Following her 

mother’s example, she went to the University of Kansas in Lawrence 

for two years and then to the Medical Center in Kansas City to earn a 

bachelor of science degree in nursing from the University of Kansas. 

At graduation, she was “capped” with her mother’s nurse’s cap. As 

she recalled, “it was always a foregone conclusion that I would do 

nursing.” But unlike her mother, Hinshaw did not go to work in a 

hospital. Rather, she saw her career in higher education and entered 

the master’s program at Yale University in 1965 because it offered 

strong clinical programs. At the time it never entered her mind to 

study nursing research, she said, but at Yale she had the opportunity 

to study with some of the early nurse researchers in the country, such 

as Drs. Rhetaugh Dumas and Jane Johnson. She also studied with two 

sociologists, Robert C. Leonard and Dr. Powhatan J. Wooldridge, who 

were teaching nurses interdisciplinary research techniques in behavioral science and social practice and applying them to nursing theory. 

Nursing science was just emerging, and Yale was one of the first in the 

country to offer nursing research, Hinshaw later recalled. “We were so 

new at this,” she later observed, “we didn’t have our own people or our 

own faculty.”5 

The pioneering program at Yale was, in the beginning, focused 

on the sociological, psychological, or psychiatric aspects of improving patient care. Leonard and Wooldridge were medical sociologists 

newly arrived in New Haven. Both were interested in health care 

delivery and began developing research agendas for nursing. Leonard 

had co-edited a book, Social Interaction and Patient Care, published 

soon after Hinshaw arrived at Yale. Wooldridge and Leonard would 

later publish a noted book, Behavioral Science and Nursing Theory. 

Dumas had been a psychiatric nurse for some time and later joined 

the Yale faculty as a research associate. She had earned “quite a bit of 
68 Bringing Science to Life 

credibility as a scholar and a scientist in the psychiatric world,” according to Hinshaw, and was doing a study that investigated the impact 

of preoperative teaching on postoperative stress. Dumas’s research, 

Hinshaw recalled, was “one of the first experimental studies ever done 

by nursing.” Hinshaw embraced the research courses and the whole 

process of entering a world of new scientific discovery.6 

After finishing her master of science degree in nursing at Yale, 

Hinshaw returned to teach at the University of Kansas. After a year at 

her alma mater, she moved west to teach maternal/child nursing at the 

University of California, San Francisco. She also conducted educational 

research with Dr. Marlene Kramer, whose work focused on biculturalism and socialization for nursing. Hinshaw considered Kramer one 

of the strongest nurse research mentors in the country. Inspired by 

Kramer, Hinshaw realized that she could not rise in the research community without a PhD. In 1971 she moved to the University of Arizona 

in Tucson, attracted by its nurse scientist programs. Funded by the 

Division of Nursing at Health Resources and Services Administration 

(HRSA), the program at Arizona was one of nine in the country established in the early 1970s to train nurse scientists who would be capable 

of building nursing research programs elsewhere. After graduate 

school she focused on satisfaction modeling, integrating the processes 

of theory construction, research methodology, and statistical analysis 

with medical sociology and their applications to professionals and 

large organizations. In her dissertation she developed an anticipated 

turnover study to predict when nurses were going to leave a work 

environment because of bad circumstances. Working with Dr. Jan 

Atwood, she studied job stress, job satisfaction, group cohesion, clinical 

autonomy, and control over nursing practice, interviewing more than 

1,000 nurses in urban and rural hospitals throughout Arizona to 

evaluate the impact of work environments on patient outcomes.7 

To earn her PhD, Hinshaw changed her field of study to sociology. As an undergraduate she had taken one sociology course. To 

make up her deficiencies in the field, she enrolled in basic courses 
From Center to Institute: Nursing Research Comes of Age 69 

 

 

while pursuing a master’s degree. Completing an MA in sociology in 

1973, Hinshaw was accepted into the PhD program. Her dissertation 

dealt with professionals in organizations and how they made complex 

decisions, something she considered a good combination of sociology 

and nursing and that reinforced the importance of the application of 

nursing research to nursing practice.8 

After receiving her PhD in 1975, Hinshaw accepted a joint 

appointment at the University of Arizona between the College of 

Nursing and the University Medical Center. She wanted to continue 

her research, and having an appointment in the Medical Center was 

critical to its application. Later, she assessed how the dual appointment 

affected her career. “That was my laboratory. I was director of research 

for the College of Nursing and associate director for research over in 

the Medical Center. It was the twelve years that I spent in that dual 

position that made me think about how to focus and set up programs 

at the NCNR so that very tight, theory-driven research would have a 

practical application.”9 

From her base in Tucson, Hinshaw moved to the forefront of 

the push for more resources for nurse scientists. She worked extensively with the Council of Nurse Researchers and the Western Society 

of Nursing Research, and then ran successfully for a seat on the 

Commission on Nursing Research, the ANA’s major policy group for 

nursing research in the country. In that capacity she made frequent 

trips to D.C. to lobby on behalf of nursing research and was among 

the leaders who pushed for an institute at NIH. Once the legislation 

for a national center passed, however, Hinshaw retreated from the 

national scene to concentrate on heading a large institutional research 

training grant at the University of Arizona. When she first learned that 

the National Center for Nursing Research was seeking a permanent 

director, Hinshaw was not interested. She said she loved her research 

and “didn’t want much to leave it.”10 

Initially, Hinshaw did not apply for the opening. Nevertheless, 

her colleagues convinced her to apply. “They felt like NIH needed to 
70 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Bringing Science to Life 

know the caliber of people that were out there,” she said. She agreed 

that she would “take a look at it,” but told her friends that “I don’t 

really want to leave and I don’t really intend to take it, so this is just 

to increase the pool.” She sent in her application, and the committee 

invited her to NIH for an interview. That went well, as did a followup interview with Doris Merritt. Her interview with Wyngaarden, 

however, was awkward, “as cool and formal as the furnishings in his 

corner office,” she remembered. Even though she had lobbied at NIH 

for a nursing research institute, Hinshaw had never met Wyngaarden. 

She did, however, have a sense of his research interests. To break the 

ice, she asked about his work on the biological mechanisms of gout but 

“received a very sharp answer” as though she should not have asked. 

Moreover, Hinshaw was nervous about the interview. “I was stilted 

because I wasn’t sure what I was doing there and didn’t expect to take 

anything if I was successful,” she recalled. “I went home thinking, 

well, that’s the end of it.”11 

A couple of weeks later, Hinshaw’s phone rang. Wyngaarden was 

calling to offer the job. She was dumbstruck, recalling her perplexing 

interview with him. After a long pause, she told the NIH director that 

“I didn’t expect you to call me and I didn’t think I’d be interested in considering this.” Wyngaarden laughed and told her to think about it and 

that he would call her back in a couple of days to discuss it. The casual 

manner of the phone conversation, so different from the interview, 

trumped the misgivings from the awkward first meeting. She spoke 

with her children, friends, and colleagues about the job and decided to 

take it. “It’s probably the biggest risk I’ve ever taken in my career,” she 

said in retrospect. “We knew we had a lot of people and organizations 

who really didn’t want us out there [at NIH]. I knew it was going to be 

a huge amount of work to show what nursing research was, and yet for 

all the risk it was such an exciting challenge and opportunity. I had so 

much invested in it, it was worth doing. I finally just couldn’t say no.”12 

In selecting Hinshaw, Wyngaarden had picked an individual who 

believed passionately in the idea that nursing science could shape 
From Center to Institute: Nursing Research Comes of Age 71 

NIH Director James B. Wyngaarden swore in Ada Sue Hinshaw as the NCNR’s first director on 

June 24, 1987. 

regional and national health policy. “Accurate information is basic to 

the ability to make knowledgeable and effective clinical and administrative decisions,” Hinshaw told an audience at the National Forum on 

Doctoral Education soon after she had accepted the NCNR directorship. She stressed that nursing research could provide this information 

through collaborating with clinicians or administrators and presenting 

these findings to policy makers. Nurse scientists needed “to synthesize 

research with societal needs and professional imperatives to influence 

health care policy,” she said. To do this, the profession had to identify 

“areas of nursing research that could be legitimately funded under the 

goals and objectives of existing federal programs.” She warned that in 

one study that examined the proposals submitted by nurse scientists 

to NIH, only approximately half of these matched the scientific interests of any of the national institutes. Nursing research proposals had 

to “become part of the current mainstream of health care research,” 

she said. “Our challenge is to develop strategies based on the growing 

body of knowledge in health care policy that relates to nursing science 
72 Bringing Science to Life 

and research.” Now Hinshaw had a “bully pulpit” to inspire a new generation to meet those challenges.13 

Since the early 1980s, nurse scientists had argued that their 

research would help shape health care agendas and policy over the 

coming decade. In 1981 the Commission on Nursing Research of 

the ANA recognized that “the full potential of nursing’s contribution 

to health care is contingent on a scientific basis for clinical practice.” 

Moreover, it noted that “increasing attention is being directed to 

generating new knowledge through research and to providing mechanisms for ensuring its use in practice.” The Commission observed that 

“nurses are assuming increased decision-making responsibility for 

the delivery of health care and they can be expected to continue to 

assume greater responsibility in the future. Nursing research directed 

to clinical needs can contribute in a significant way to the development 

of these solutions.” The Commission emphasized that there was a symbiotic relationship between nursing science and biomedical research. 

“Biomedical advances,” the position paper argued, had led to greater 

numbers of those who required nursing care, “such as the frail elderly, 

the chronically ill, and the terminally ill,” and observed that nursing 

had to keep pace.14 

Therefore, the Commission argued, nurses should give priority 

to clinical “nursing research that would generate knowledge to guide 

practice in promoting health, well-being, and competency for personal 

care among all age groups.” Nursing science could prevent health 

problems throughout life, decrease the negative impact on individuals’ ability to cope with health issues, develop appropriate strategies 

to meet the care requirements of particularly vulnerable groups, and 

design and develop health care systems that were cost effective in 

meeting the nursing needs of the population.15 

While it continued to wrestle with an adequate definition for 

nursing research, the Commission could offer solid examples of 

research consistent with its priorities. Health care could profit from 

the “identification of determinants of wellness and health functioning 
From Center to Institute: Nursing Research Comes of Age 73 

in individuals and families such as the avoidance of abusive behaviors including alcoholism and drug use, successful adaptation to 

chronic illness, and coping with the last days of life.” Nursing practice 

might also be better informed through studies analyzing the impact 

of anorexia, diarrhea, sleep deprivation, infection, diet, and chemical 

imbalance on the course of recovery. The Commission cited other 

areas for nurse scientists such as reducing stress from surgical procedures and intrusive medical examination and monitoring devices, 

providing more effective care to high-risk populations, especially 

mothers and infants, and enhanced care of “clients culturally different 

from the majority,” such as African-Americans, Mexican-Americans, 

and Native Americans. Other areas ripe for nursing research were 

those populations with special problems, such as teenagers, prisoners, 

and the mentally ill, and the underserved, such as the elderly, the poor, 

and rural residents. Finally, the Commission placed a high priority on 

the design and assessment of models for delivering nursing care strategies found to be effective in clinical studies.16 

When the Commission on Nursing Research published its report 

on research priorities in 1981, its vice chair was Ada Sue Hinshaw. Not 

surprisingly, the new NCNR director’s top priority six years later was 

to set a national agenda for nursing. 

Hinshaw used the occasion of her swearing-in ceremony to 

explain publicly her goals for the Center and how critical NIH would 

be in helping nursing accomplish them. Her audience was ideal 

for outlining her vision for the Center. Timed to coincide with the 

meeting of the Center’s scientific review panel, the ceremony included 

not only the entire review panel, but also several directors from other 

NIH institutes, including supporters Dr. Franklin Williams from aging, 

Dr. Anthony Fauci from infectious diseases, Dr. Ruth Kirschstein from 

general medical sciences, and Dr. Murray Goldstein from neurology. Hinshaw explained that the NCNR’s “union with the National 

Institutes of Health...allows for nursing research to be developed 

[and] conducted in collaboration with the other scientific disciplines 
74 Bringing Science to Life 

in a complementary manner. In this environment, nurse investigators 

will be able to capitalize on NIH’s tradition of scientific excellence and 

numerous alternatives for research support.” With adequate collaborative and interdisciplinary support, she said, nurses would “continue to 

build a solid, high-quality body of nursing science.”17 

Hinshaw then turned from NIH to the vital role the nursing community itself would serve in incorporating nursing research into the 

broader base of health care science. The NCNR’s National Advisory 

Council had recommended several program initiatives, she said. 

Importantly, the Center’s first initiative—the development of a national 

nursing research agenda—came from those recommendations. With 

extensive input from the nursing community, the NCNR would assess 

the major health needs of society and the current state of the discipline 

and then outline priorities for investigators. From this assessment, the 

nurse scientists envisioned a five-year plan identifying the programs to 

be developed and the resources needed for their implementation.18 

A second initiative Hinshaw announced that day involved increasing the research training opportunities “for nurses who are committed 

to careers as scientists.” The NCNR, Hinshaw vowed, “would emphasize 

funding for postdoctoral and predoctoral fellowships and institutional 

HRSA awards.” The aim, she stated, was eventual growth in the career 

development award programs.19 

Another major priority, Hinshaw said, would be increased collaboration with the other institutes, divisions, and centers within NIH. 

Using the speech to clarify the nature and activities of nursing science 

at NIH, she explained how nurse investigators synthesized knowledge 

across disciplines. “The scientific networks within the Institutes offer 

innumerable opportunities for collaboration in research of mutual 

concern,” she stated. Hinshaw cited a successful cooperative program 

on incontinence that the Center had done with the National Institute on 

Aging as “an excellent example of inter-institute collaboration involving a major ‘care’ problem of concern to the elderly in our society.” Her 

comment was both a public appreciation for institute director Franklin 
From Center to Institute: Nursing Research Comes of Age 75 

 

 

 

 

 

 

 

 

 

 

Williams and his longtime support for nursing at NIH and an appeal 

to other institute directors to bring in nurse scientists and stretch their 

research program dollars.20 

Hinshaw’s swearing-in remarks not only outlined for her new 

NIH colleagues the aspirations of nursing, but also how nursing 

science was an integral part of the NIH mission. She recognized Doris 

Merritt and her staff for their “remarkable” accomplishments “during 

the ‘start-up days.’” Merritt’s leadership and “commitment to excellence” had already brought the NCNR considerable stature within 

NIH. “You have my pledge of commitment to facilitate the efforts of 

our discipline’s scientific endeavors,” Hinshaw told the gathered NIH 

leadership and the nursing community, “through the investment of 

intellectual and leadership capabilities in promoting the continued 

development of the NCNR...and to realize our profession’s vision of 

bringing nursing science into the mainstream of health care research 

at NIH.”21 

Hinshaw quickly settled into her new job. She moved into a 

house on the NIH campus, near her office in Building 31. In one 

sense, living on campus near others in leadership roles symbolized 

her intent to integrate nursing science into NIH. It gave her access 

to this group outside of official duties and, she hoped, would make 

nursing science more acceptable to the biomedical scientists that had 

opposed the Center. On her first day she met with Merritt, Doris 

Bloch, Adele Woods, Patricia Moritz, Harriet Carroll, and others to 

get a sense of the issues. “It was not a huge day,” she recalled, “but I 

was very excited.” Within a few months, she knew she had made the 

right decision.22 

As she tried to integrate the NCNR more fully into the NIH 

network, Hinshaw believed it was essential that the Center provide 

leadership within the nursing community. She discussed this at length 

with Williams, Merritt, and Kirschstein. They told her they doubted 

that nursing science could emerge from individual studies by nurse 

investigators. Hinshaw agreed. Such studies lacked a central purpose, 
76 Bringing Science to Life 

something nursing science needed to develop if it were to be an integral 

part of NIH. She queried them about setting agendas to build nursing 

science. That must be done, they said. In addition, they advised 

that the Center would eventually need to show Congress what it was 

achieving. Focusing resources on a few priorities would provide those 

outcomes. At the time, nurses were “well-educated and prepared, but 

had relatively little [research] experience,” she recalled. “We needed 

to focus our endeavors.” As long as nursing research followed the 

interests of the individual researcher—a “shotgun” approach—the profession could not build science over time. Groups of studies needed 

to be validated in order to build, one upon the other. What nursing 

needed, Hinshaw determined, was a national agenda, and the NCNR 

would provide the vehicle to draft the priorities for that agenda.23 

In the fall of 1987, the NCNR announced its intention of setting a 

national nursing research agenda. Hinshaw envisioned it as a five-year 

plan, expanding the numbers of nursing scientists and focusing on 

nursing research priorities until the end of 1992. Working with Doris 

Bloch, she mapped out a two-year planning process that would define 

“initiatives to provide a structure for selecting scientific opportunities 

and a knowledge base for nursing practice and to give direction and 

momentum to research within the nursing discipline.” None of this 

could be accomplished, she believed, without the full involvement of 

the nursing community, which had to participate fully in setting the 

agenda. She invited the top sixty research scientists in the nursing profession—“seasoned investigators,” Hinshaw called them—representing 

as many fields and methodologies as possible, pointedly moving away 

from those in nurses’ training toward those in nursing education and 

research training. Early in 1988, the NCNR brought them to Bethesda 

under the auspices of the first Conference on Nursing Research 

Priorities and installed them at the Hyatt Hotel with the goal of developing a national nursing research agenda “to provide structure for 

selecting opportunities and initiatives and to promote depth in developing the knowledge base for nursing practice.”24 
From Center to Institute: Nursing Research Comes of Age 77 

Working in conference rooms in the basement of the hotel, the 

nurse scientists broke into small groups, first according to specialty 

areas, and then in groups that crossed specialty lines. For two and a 

half days, the conferees focused on identifying research priorities and, 

at the same time, defining the direction of nursing science. The Center 

established three major criteria for setting those priorities. First, the 

agenda had to focus on a critical public health problem in the country. 

Second, the nursing research had to be applicable and make a difference. And third, the nursing profession had to have the investigators 

able to conduct appropriate studies. “We were a little thin in places,” 

Hinshaw said of that period. “A lot thin in some places.” During the 

conference, the participants met in groups representing various combinations and permutations of interests to rank research priorities, 

establish an agenda for nursing that focused on science, and devise 

programs for beefing up those thin spots.25 

According to Hinshaw, in addition to formulating a national 

nursing research agenda, one other important professional change 

emerged from these discussions. For years nurses had talked about 

issues for research but had stalled in debates over whether qualitative 

or quantitative research was better. As more research funding became 

available, Hinshaw believed that nursing could ill afford to be mired in 

this controversy. It had to embrace more quantitative research. She 

knew that NIH had long advocated Lord Kelvin’s statement that “when 

you measure something and express it in numbers, you know something about it.” Hinshaw translated this to nurses “have got to focus 

on science.” She told the group to “get over [the debate] and move 

on.” She was relieved with the ease in which the nurses accepted her 

suggestion. “They did it beautifully,” she recalled. Nursing came to 

embrace a more quantitative approach to research as a result of the 

meeting. “It was very important for us to focus to both build science 

and to explain nursing science to NIH. As we began to define areas of 

research, we told NIH who we were and what nursing research was. 

So the agenda emerging from the meeting served to educate as well 
78 Bringing Science to Life 

and, I think, make people at NIH and the Congress feel much more 

comfortable.” The ultimate value of nursing research, most agreed, was 

to “create knowledge about the relationships and interactions between 

persons and their environments, which results in recognizable changes 

in health status.”26 

The broad priorities coming out of the Bethesda conference went 

to a subcommittee of the National Advisory Council for Nursing 

Research for further consideration and development. From there, 

expert panels consisting of scientists from nursing and related disciplines refined and elaborated on the priority areas that might give 

nursing the greatest impact in improving health care and therefore 

merited research funding. The National Advisory Council then sent 

its recommendations to Hinshaw.27 

The priority-setting process moved on a very fast track, taking less 

than five months. The National Nursing Research Agenda identified 

seven priority areas for nursing science, most cutting across areas of 

nursing research to integrate behavioral and physiological measures. 

The NCNR announced its interest in receiving proposals for studies that 

identified health risk factors, designed educational and intervention 

strategies to reduce health risks, and determined the efficacy and cost 

effectiveness of health prevention methodology. The Center urged that 

proposals focus on the seven priority areas: (1) low birthweight infants 

and their mothers; (2) HIV positive patients, partners, and families; 

(3) long-term health care for the elderly; (4) symptom management, 

such as intervention strategies for pain and other symptoms associated with acute and chronic illness; (5) health promotion to modify 

behavior for reducing risk factors; (6) family adaptation to chronic 

illness; and (7) improving the quality of life during chronic illness. The 

nursing community agreed that all of these areas demanded additional 

study by nurse scientists. Soon after establishing the research agenda, 

the NCNR called for proposals in those areas of science, allocating 

about 35 percent of the Center’s funds to two of the priority areas in 

the first year. The two target areas recommended by the Center were 
From Center to Institute: Nursing Research Comes of Age 79 

the psychological and physiological aspects of care and caregiving for 

patients with HIV positive conditions and their families and the prevention and care of low birthweight infants.28 

Even as the National Nursing Research Agenda evolved over the 

next year, the NCNR needed to demonstrate to Congress the value of 

its activities. Budget appropriations were the lifeline that nourished the 

Center’s development, and the appropriators demanded evidence of 

leadership, progress, and accomplishment to sustain and strengthen its 

support. The Center’s budget request for the following fiscal year (FY) 

1989, depended in part on presenting convincing proof of the Center’s 

achievements. For a new entity just initiating funding for multiyear 

projects, however, it was easier to explain how nursing science was 

meeting current challenges and working toward specific goals than to 

outline specific accomplishments. 

Hinshaw traveled to Capitol Hill with her staff and Wyngaarden 

to testify for the first time before Congress in the spring of 1988. The 

room was packed with proud nurse scientists, “probably the only 

people in the room,” Hinshaw recalled, “because we had everybody 

else crowded out.” Although she faced a very friendly and solicitous 

subcommittee on health, headed by Democrat William H. Natcher of 

Kentucky, she recognized the importance of making a strong, positive 

impression. Natcher’s subcommittee was the first line in appropriating funds for NIH and the subcommittee largely viewed its role as an 

advocate for the institutes, so few of the questions came as a surprise. 

No one wanted to make the new director’s maiden voyage before 

Congress a rough one.29 

Hinshaw thanked the committee for its “vigorous support of 

nursing research” and outlined current challenges facing the nursing 

community and how the NCNR planned to tackle them. The Center 

had started “a strenuous formal and national process of identifying research priorities for nursing science,” she said, referring to the 

National Nursing Research Agenda. In addition, the Center was 

expanding the cadre of nurse scientists committed to research careers 
80 Bringing Science to Life 

and developing programs to “increase the physiologic and biomedical 

content of the research.” To accomplish this, the NCNR publicized its 

goals and initiatives to the nursing community. She highlighted three 

promising scientific developments emerging from NCNR-supported 

research. One was a study of pressure sores, commonly known as 

bed sores, in hospitals, nursing homes, and the home. The research, 

she explained, found a significantly higher incidence among elderly 

residents with lower intakes of protein, calories, iron, zinc, and folic 

acid. “The long-term significance of this research,” she said, “will be 

its contribution toward accurately predicting elderly persons at risk for 

developing pressure sores, and aiding in the development of preventative nursing therapies.”30 

The second study involved insomnia and other sleep disorders, 

which impaired tissue healing and immune function and increased the 

susceptibility to lesion formation. The incidence of insomnia was as 

high as 35 percent in adults, Hinshaw explained, and occurred more 

frequently in women as they grew older. Nurse scientists learned 

that emotional upheaval, more than hormone changes, may affect 

sleep patterns in women approaching menopause. This was just one 

example, Hinshaw said, of the “kind of study that will assist health professionals to identify specific factors responsible for sleep disorders.”31 

The third focused on urinary incontinence, which health care professionals considered a major problem, especially in nursing homes. 

Incontinence, normally associated with aging, was the principal cause 

of nursing home admissions. Incontinent elderly persons tended to 

withdraw from social activities and increase the burden on those who 

provided care, Hinshaw told the committee. Moreover, incontinence 

was one of the most disruptive and costly conditions that affect nursing 

home patients. The NCNR was supporting research to develop treatment, technologies, and procedures with the potential for reducing 

the incidence and complications of incontinence, thereby reducing the 

cost of managing those patients and alleviating the personal and social 

consequences of the condition. One technology the nurse scientists 
From Center to Institute: Nursing Research Comes of Age 81 

were assessing was a noninvasive electronic device to establish a 

patient’s pattern of voiding. “This pattern is then used as a basis for an 

individual continence training program,” she said.32 

Nonetheless, even by 1988, some members of Congress remained 

confused by the changes nursing science had brought to the profession. 

They were still unclear about the differences between the programs 

of the NCNR and the Health Resources and Services Administration 

(HRSA). Clarification was critical for the new Center to establish its 

own identity both on Capitol Hill and in the biomedical community. 

HRSA, Hinshaw carefully explained, funded the education of nurses. 

The NCNR had responsibility for the conduct, support, and dissemination of research and research training associated with patient care. 

The Center’s programs focused on “health promotion and disease prevention, understanding and mitigating the effects of acute and chronic 

illnesses and disabilities, and the delivery of nursing services. Nursing 

research,” she continued, “examines the biomedical and behavioral 

processes that underlie health and the environment in which health 

care is delivered.”33 

The most vocal supporter for nursing on the subcommittee was Carl 

D. Pursell, who represented Michigan’s Second District, which included 

the Detroit suburbs and Ann Arbor, and was the ranking Republican 

on the House Labor-Health and Human Services (HHS) appropriations 

subcommittee. Described as “rumpled, chatty, usually inclined to seek 

consensus but ready to speak out when aroused,” he became a leader 

of the “Gypsy Moths,” a group of moderate Republicans who opposed 

the Reagan administration’s budget cuts for social programs. Pursell 

had long been an advocate for NIH and, more recently, Madigan’s ally 

in first calling for a National Institute of Nursing Research (NINR) 

and later in establishing the NCNR. He called the institutes “The 

Untouchables” when it came to funding from the appropriations subcommittee and emphasized to Wyngaarden how proud he was of the 

development of the Nursing Center at the University of Michigan. He 

saw himself as close to the nursing community and understanding of 
82 Bringing Science to Life 

Ada Sue Hinshaw and Representative Carl Pursell (R-Michigan) amid stacks of grant applications at the NCNR offices. 

its needs. Pursell also realized how far a single legislator could push 

his own agenda through pointed questioning at budget time.34 

Indeed, Pursell claimed some ownership or direct paternity for 

the Center’s birth, referring to it when speaking with Hinshaw as “our 

center.” The NCNR represented an area of interest to him, and the 

nursing groups helped him to prepare for the hearings. He phrased 

his questions in part to highlight the value of nursing science and in 

part to anticipate the Center’s funding needs to carry out its developing five-year plan. He worried that the Center might not be able to 

meet the desired number of nursing research trainees in 1988—the 

National Academy of Sciences recommended 320—and still maintain 

a high-quality performance. Prepared for the question, Hinshaw 

explained that the NCNR was, “first of all, committed to funding good 

science and excellent applicants.” As a result, the Center was funding 

fewer nurse scientists than the National Academy had proposed but 
From Center to Institute: Nursing Research Comes of Age 83 

planned to reach the recommended level in 1991, pending available 

funding. Hinshaw explained that “we are obviously trying to balance 

the training endeavor in relation to research grant support.” Satisfied 

with the response, Pursell moved to another, somewhat controversial, 

topic—intramural research.35 

The underpinning of basic science at NIH was its reputation for 

pioneering intramural research programs within the institutes and 

centers. Such programs allowed experts to devote full time to their 

research, unencumbered by teaching or other duties. Intramural 

research programs defined many institutes’ standings in the biomedical 

world—the higher the quality of the program, the greater the reputation 

of the institute, or so it was perceived by many. The NCNR, however, 

had no intramural program in the years following its creation. Pursell 

asked Wyngaarden if he would support an intramural program for 

nursing so that it might be on par with entities at NIH. Wyngaarden 

demurred, instead praising the Center for its “very soundly planned” 

extramural program. “I think the center has come along very, very 

well, both during the period when we had a temporary director, and 

since Dr. Hinshaw has arrived.” Since the NCNR’s programs placed 

“a heavy emphasis on developing collaborative work with other institutes,” Wyngaarden said, “I think the extramural program...can grow 

over the years, resources permitting.” But, he continued, as a result, 

the “NCNR does not need as large a staff as some of the other centers 

that have laboratories since much of this is collaborative.” In effect, he 

told Pursell, any intramural program for nursing was not a priority and 

would need to wait.36 

As Kirschstein, Merritt, and others had warned Hinshaw, she 

would need to demonstrate to Congress the accomplishments of the 

Center. FY 1987 was the first year that all new grant proposals were 

received, reviewed, and awarded under the auspices of the NCNR and 

NIH, rather than HRSA, though the Center continued to fund awards 

originally made by HRSA. And though it was premature to identify 

specific scientific accomplishments made possible by the Center’s 
84 Bringing Science to Life 

grants, Hinshaw did outline the areas in which the Center was working—areas of research in the nursing community and areas that spoke 

to the interests of the subcommittee members.37 

One research area involved cancer. The medical community 

had long recognized that a diagnosis of cancer created an immediate 

crisis for patients and their families. As patients underwent radiation 

therapy, used in some 50 percent of cancer patients, they experienced 

side effects, depression, and anxiety, frequently becoming preoccupied 

with fears of disability and possible death. Nonetheless, little scientific 

research had been done to see how the problem might be mitigated. 

Under an NCNR program, researchers developed a three-tape video 

program that presented information about radiation therapy, common 

side effects and approaches to management, and hospital and community resources. Nurses ran the first tape prior to treatment, the 

second during the second week of treatment before the onset of side 

effects, and the third during the final week. “An assessment of patients’ 

comprehension has shown a high level of understanding of all these 

programs and has documented the usefulness of the program as an 

effective educational intervention,” Hinshaw told the subcommittee. 

The NCNR, she maintained, was also seeing progress in programs 

relating to health care for elderly in nursing homes, insomnia in 

women, and health-compromising behaviors such as early sexual 

activity, cigarette smoking, drug and alcohol use, and excessive food 

and caffeine consumption.38 

Finally, Hinshaw explained that the NCNR vigorously supported 

research activities related to HIV/AIDS, a scourge that held wide 

attention in the late 1980s as a major public health concern. In 1988 

the Centers for Disease Control reported some 42,000 AIDS cases in 

the United States. The number of deaths from this group was almost 

25,000, leading to “conservative estimates” that between 2 million and 

4 million Americans would be infected with HIV by 1991, she said. 

Unlike cancer patients, who experienced a steadily declining illness 

trajectory, the disease trajectory for AIDS patients tended to be up 
From Center to Institute: Nursing Research Comes of Age 85 

and down, up and down, throughout its downward trend. Nurses, one 

expert said in a presentation to nurse researchers in 1988, needed to 

learn more about how to “help persons cope with the affective stages 

of AIDS, denial, depression, anxiety, and ultimate death.” With an 

AIDS epidemic on the minds of many Americans, nursing science 

was moving to respond. The NCNR encouraged investigator-initiated 

research that addressed AIDS as it related to nursing and would make 

its first grant awards for this in FY 1988. The Center also collaborated 

with the National Institute of Allergy and Infectious Diseases (NIAID) 

to sponsor a national outreach conference for health care practitioners, 

including nurses and social workers, to provide “accurate, relevant, 

and timely information on issues associated with AIDS and the care of 

AIDS patients and their families.”39 

Each of the programs sponsored by the NCNR provided an 

example of the direction in which nursing science was moving— 

symptom management. Researchers had studied pain or fatigue or 

some other area, Hinshaw recalled, “but had not clustered them in the 

sense of symptom management. That was, essentially, a new kind of 

cluster of studies that nursing began to evolve. Symptom management 

was a term that we pretty much coined and worked with, but it was 

not a well-used term like it is today.” Rather than focusing on cancer 

or a type of cancer, nursing looked at how one assesses and manages 

symptoms, such as how patients could better deal with pain, fatigue, 

hair loss, and the like. The same was true for the care of HIV/AIDS 

patients. “If you’re talking about care of,” Hinshaw said, “then you’re 

talking symptom management. That goes across any field.”40 

Hinshaw requested a budget of $24,400,000 for the Center’s 

activities in FY 1989, an increase of $1,530,000 from the previous year. 

The fund obligated for nursing research would be $22,257,000, which 

would fund forty-five competing and eighty-four noncompeting 

research project grants, a number of career training awards, nearly 200 

research fellows, and institutional training grants for fifty-nine individuals. The balance of the money, about $2,000,000, a bit less than 
86 

 

 

 

 

 

 

 

 

Bringing Science to Life 

10 percent of the amount targeted for research, would go to research 

management of the extramural programs and additional administrative support, approximately the same percentage as for all of NIH. 

Funding for AIDS research, a priority area for the NCNR, totaled an 

additional $700,000 and was to come out of a general NIH appropriation request for AIDS of $1.3 billion.41 

Hinshaw was pleased with the Center’s accomplishments in its 

first years and its potential to shape the future of nursing science at 

NIH. The nursing community had united behind the Center and established a national research agenda. True to predictions, the creation of 

the NCNR had raised the profile of nursing science, introduced the 

concept to the biomedical world of NIH, and attracted more funding 

and underwrote more grants than ever before. The results were a testament to Merritt’s administrative savvy, Hinshaw’s leadership, and the 

enthusiastic response of the nursing community to create a focused 

agenda for nursing science. 

Over the next five years the National Nursing Research Agenda 

set the guidelines for nursing science, and Congress supplied the funds 

to achieve those goals. At times the NCNR tweaked the agenda to 

meet the immediate health concerns of a member of Congress, but the 

agenda was broad enough to accommodate these changes, even if they 

spread the Center’s funding more thinly in other areas. Nevertheless, 

when it came to the National Agenda, the professional nursing organizations and their congressional allies continued to be effective lobbyists 

for additional money for scientific studies. 

The congressional budget hearings in the spring of 1990 provided 

an opportunity for the NCNR to demonstrate clearly the impact and 

effectiveness of the National Nursing Research Agenda and the development of an expanded knowledge base for nursing practice. These 

hearings were especially important, as the budget for the following 

year was essentially flat. Hinshaw related the “considerable advances” 

that the Center had made between 1989 and 1990. In particular, she 

noted the completion of the reports of the first two priority expert 
From Center to Institute: Nursing Research Comes of Age 87 

 

 

 

 

 

 

 

 

panels for nursing’s national research agenda and the development 

of research initiatives in both areas. The first major nursing initiative had concentrated on the prevention and care of low birthweight 

infants, including preconception care, prenatal care, hospital care, and 

follow-up care of the infant and mother after discharge. The studies 

were testing the “effectiveness of prenatal and postpartum nurse home 

visitation services as a means of enhancing the health and well-being 

of unwed poor women and their first-born children” in urban and 

rural areas.42 

Hinshaw was especially proud of the research that the NCNR had 

sponsored in the area of very low birthweight infants (VLBWI). The 

NCNR “probably put more money into low birthweight...in the first 

several years. That was a major public health problem for the country 

at that time. We tried to get better programs by which people could 

prevent low birthweight infancy or care for low birthweight infants.” 

In response to an anticipated change in the federal payment system 

enacted in 1983 that encouraged early hospital discharges to save 

health dollars, nurse scientists led by Dr. Dorothy Brooten, then at the 

University of Pennsylvania, recognized that the early discharge of vulnerable patients, such as VLBWI, posed health risks and the potential 

for increased health care costs due to complications and readmissions. 

Brooten and her colleagues developed a transitional care model that 

demonstrated the cost effectiveness of a comprehensive intervention 

program that included counseling of parents and home follow-up 

by nurse specialists, thereby creating a “feasible model of care and a 

new role for master’s-prepared advanced practice nurses.” The results 

were remarkable. The program improved the infant’s environment, 

was safe and effective, and “saved approximately $18,560 per infant in 

hospital and physician costs.” A later study funded by the NCNR built 

on Brooten’s work. Another researcher, Hinshaw said, “got drastic difference between low birthweight infancy rates for women who had 

continuous telephone call contact and ones who did not,” thereby 

establishing that patients could go home faster and cheaper from the 
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Improving the care of low birthweight infants and their mothers was one of seven priority areas 

identified by the National Nursing Research Agenda in 1988. 

hospital “as long as you had advanced practice nurses who made one 

home visit and then all the rest were phone calls.”43 

The second major program initiative was AIDS. In 1988 the 

Center had established a new collaborative intramural research 

program on symptom management for AIDS patients with NIAID 

and the NIH Clinical Center Department of Nursing. This initiative, 

set up along cooperative lines suggested by Wyngaarden in 1988, 

marked the first time that the NCNR would test the waters of intramural research at NIH. The AIDS collaboration was ideal for initiating 

an intramural research program for nurses because many Americans 

considered the AIDS epidemic as one of the major health challenges 

facing the country. “We are strongly committed to research on the 

physical, psychosocial, and ethical problems central to prevention of 

HIV infection,” she said. Hinshaw explained that the NCNR nurse 

scientists would “quantify changes in nutritional status and then 

develop nursing interventions to minimize the nutritional problems 

such as anorexia, nausea, and weight loss.” As AIDS patients lived 
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longer, she said, nursing research was critical to “discover ways to 

decrease the morbidity, and to diminish the economic and personal 

costs of this infection and to promote an optimal quality of life.” This 

early intramural program, conducted out of the Office of the Director 

of NINR, provided the foundation for the Clinical Therapeutics 

Laboratory.44 

The NCNR could boast of other accomplishments beyond the 

major priorities. In 1988 the Center established four centers for nursing 

research, a program pushed by Pursell. Two were specialized centers for 

nursing research, each funded at a level of about a half-million dollars; 

the other two were called exploratory centers, which were funded at 

a much lower level, a bit more than $100,000 per year. The first specialized center, established at the University of Washington, supported 

research with an emphasis on women’s health. The NCNR funded a 

second specialized center in 1989 at the University of Pennsylvania, 

which concentrated on behavioral research on patient care. One promising study at Penn that was in the center, Hinshaw told the members 

of Congress, emphasized the depressive signs and symptoms experienced by stroke patients. The results, she said, “should give nurses 

the ability, through the development of a new instrument for detecting 

depression, to make timely referrals for treatment.”45 

The research centers program attracted considerable attention 

from the nursing community, and competition for funding was fierce. 

The NCNR received eleven applications for specialized centers and 

awarded two; of the thirty-two applications for exploratory centers, the 

NCNR selected only two—one located at the University of Pittsburgh, 

which concentrated on critical care nursing, and the second at the 

University of Minnesota, which specialized in long-term care of the 

elderly, “particularly factors that influence the autonomy and independent functioning of older persons.” The National Advisory Council 

on Nursing Research recommended that the number of centers be 

increased over the next five years to eight specialized centers and 

eleven exploratory centers.46 
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One central element of the NCNR’s research initiatives was 

training new investigators. Since the idea of a nursing research institute 

gained traction in the early 1980s, the advocates of scientific nursing 

research had worried that the profession had too few scientists to be 

readily accepted by NIH. Rhetaugh Dumas and Geraldene Felton had 

advanced that argument in opposition to a proposed national institute 

for nursing research. The nursing community and its allies in Congress 

saw the NCNR as the leader in developing new investigators in nursing 

science. The Center emphasized increasing the number of trainees, 

building postdoctoral programs, and encouraging more minority 

nurse scientists. In its first year of operation, the NCNR supported 171 

trainees. The following year, FY 1988, the Center funded 194 trainees 

through National Research Service Award fellowships and institutional training grants. In 1989 the Center supported 228 trainees. By 

1990, though, the lack of funding forced the Center to cut its research 

training goal from 270 to 257, still well below the 320 nursing research 

trainees recommended in 1985 by the National Academy of Sciences. 

Hinshaw said that the NCNR planned to increase the proportion of 

postdoctoral trainees under a new Nurse Scientist Program. Similar to 

the Physician Scientist and Dental Scientist award programs of other 

NIH institutes, the Center intended to build a “cadre of clinical nurse 

researchers with a background of rigorous scientific training.”47 

Over its first few years of operation, the bulk of the NCNR’s 

funding went into research on health and behavior, which had always 

been a strong interest for nurse scientists for whom public health applications had long been an important focus. Forty-seven percent of the 

Center’s extramural funds were targeted for this research. The area held 

great promise for improving health and preventing disease, since many 

current public health concerns were the result of lifestyle choices and 

behaviors. To Hinshaw, nursing science was “very family and community oriented, so from our disciplinary perspective, we roll those two 

together very easily.” The Center supported research studies to prevent 

and lower the risk of illness and strategies to manage the symptoms of 
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diseases and their treatment. One major longitudinal study examined 

risk-taking behaviors relative to overeating, drug use, early sexual 

activity, and smoking in rural adolescents. Congress had allocated an 

additional $600,000 for rural health care the year before, and Hinshaw 

emphasized the importance of developing and evaluating communitybased rural nursing practices for underserved populations. With the 

more limited funding for these types of projects anticipated for 1991, 

Hinshaw encouraged the Center to partner with the Division of Nursing 

in HRSA and the newly created Agency for Healthcare Research and 

Quality to fund two or three proposals on rural health care.48 

The most notable impact of the flat administration budget was 

the decline in competing research grants, or newly funded research 

initiatives. In its first year, 1987, the Center awarded forty-eight such 

grants. The number increased to fifty-two in 1988 and then dropped 

to fifty the following year. In 1990 the Center awarded forty-five 

grants, but in 1991, Hinshaw said, the number would drop by a third, 

to approximately thirty-three competing grants. The award rate for 

nursing grants, that is, the number of awards versus the number of 

applications, was 12 percent, less than half of the award rate for the rest 

of NIH. To achieve parity with the other institutes, the NCNR would 

require an additional $10.3 million over the President’s budget request 

for FY 1991. “Being a young program, we have been supporting a 

rapidly growing number of outstanding scientists who are now receiving noncompeting continuations,” or previously funded multiyear 

projects, Hinshaw explained, making a case for the importance of new, 

emerging work. As a result, she noted, “we are using an increasing 

portion of our research project grant funds to support the noncompeting portion of our portfolio.”49 

If additional funding were available, Hinshaw allowed, the NCNR 

would increase the number of competing research project grants to 

match the NIH-wide award rate, add three specialized centers and 

four exploratory centers, increase the number of trainees and research 

career awards, initiate a collaborative program with the NIH Clinical 
92 Bringing Science to Life 

Center for nursing research with HIV-positive patients, and expand the 

Center’s staff to handle the increased administrative responsibilities, 

which had been kept below authorized staffing levels to offset some of 

the costs associated with starting the Center. Hinshaw estimated that 

the NCNR would need to phase in over three years an annual budget 

of $132 million to “facilitate the rapid momentum of the nursing 

research community and to handle the backlog of questions that need 

to be addressed to improve nursing practice.” According to Hinshaw, 

“this would enable [the NCNR] to attain a funding level close to that of 

some of the smaller research institutes at NIH.”50 

Hinshaw’s comment drew quick attention from Representative 

Pursell. While all members of the subcommittee supported the 

programs of the NCNR, Pursell was nursing’s constant champion. 

He embraced the role as the major financial advocate for the NCNR, 

and his position on the HHS appropriations subcommittee put him 

in the right place to be effective. In the spring of 1990, Pursell began 

a campaign to garner above-average annual increases in the NCNR’s 

appropriation to “jump-start” funding for nursing science. He had 

learned from Rhetaugh Dumas, the dean of the University of Michigan 

School of Nursing, that “excellent proposals were overwhelming the 

dollars available.” She briefed him on the newly funded projects at the 

School of Nursing and followed up with a tour to meet the nurse scientists. Pursell mulled over what he had learned. Looking at a ranked 

order of the various NIH budgets, he noticed that the two organizations ranked above the NCNR were the newly organized Division 

of Research Resources and the new National Institute of Deafness 

and Communicative Disorders, both of which were funded at $122 

million per year. The NCNR’s budget for FY 1990 was $33 million. He 

believed that nursing should have budget parity, or at least closer levels 

of funding, with those organizations. The question was whether the 

Center could handle any additional funding.51 

Pursell put this issue to Hinshaw when she appeared before 

the committee. He was proud of the NCNR’s accomplishments and 
From Center to Institute: Nursing Research Comes of Age 93 

The NCNR’s staff was very proud of the Center’s accomplishments in its first five years. 
94 

 

   

 

 

 

 

 

 

 

 

 

 

Bringing Science to Life 

particularly fond of a photograph showing him among high stacks 

of applications. “What level of funding do you need to be at three 

years from now...to be brought up-to-par with the more established institutions?” he asked. She said that the NCNR could spend 

$50.3 million on quality research in FY 1991. She had learned during 

the struggle to establish the Center that “when you have an opportunity in Washington, you jump.” Following that principle, Hinshaw told 

the subcommittee that an estimated $132 million might be an appropriate funding level for FY 1994.52 

Not all nurses agreed with Hinshaw’s optimistic vision of nursing’s research capabilities. While all agreed that the quality of research 

proposals meriting funding warranted such appropriations, the reality 

was that the nurses did not have a long-term strategy other than to 

expand existing programs to absorb such elevated funding. The 

Council of Nurse Researchers thought that the NCNR could handle an 

appropriation of a little more than $41 million, what it termed an “eyebrow raising” increase of 20 percent in comparison with other NIH 

units. Nonetheless, the Council estimated that even at $41 million, less 

than one-fifth of the approved grants would actually be funded.53 

Pursell worked hard to guarantee that “his” center would succeed. 

He pushed Dr. William Raub, then the acting director of NIH, for more 

research dollars for the NCNR. His staff urged nursing groups throughout the country to convince their representatives to learn more about 

nursing research, to tour local nursing research projects, and to learn 

how nursing applied to public policy concerns and the cost savings that 

would accrue from the research. They asked nurse scientists to use their 

universities’ public relations staffs to get their research covered in the 

national media. The Council of Nurse Researchers backed Pursell’s 

efforts to expand legislative interest in major funding increases for the 

NCNR with an additional lobbying effort of its own through nursing 

political action committees in most congressional districts.54 

While the NCNR could not lobby, it could demonstrate to policy 

makers and others the value of its sponsored research. As nurse 
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scientists began to get substantiated findings from their research, 

the NCNR and the professional nursing organizations began to use 

those accomplishments in testimony to Congress, rather than tell the 

members what the next year’s plans would be. The Center circulated 

the results widely in publications and other local and national media 

outlets. The effort, Hinshaw later said, paid off. The NCNR was able 

to establish “this area of important education of other colleagues [and 

the public] as to what nursing research was about.”55 

Never far from Pursell’s mind was the future of the Center 

becoming an NIH institute as Madigan originally planned. Pursell 

recognized that to maximize resources for nursing science, the Center 

would need to obtain institute status at NIH. He introduced legislation assuring that institute status was contained in the National 

Health Revitalization Act of 1991. Although President George H. W. 

Bush vetoed the bill for reasons unrelated to the NCNR, Pursell’s bill 

rejuvenated the campaign to promote the designation of the Center 

to an institute, a goal never far from thought for Pursell or the nursing 

lobby. Hinshaw, too, continued to advocate for a nursing institute. 

Since the establishment of the NCNR, the budget for nursing research 

had tripled. She believed that this extensive growth had occurred 

in large part because nursing science was part of NIH. If nursing 

could achieve institute status, she thought, nursing’s funding potential could increase even more. Writing in the summer of 1992 to 

Charles A. Meyer, an editor of the American Journal of Nursing, she 

noted that “obtaining institute status will have a significant impact on 

[funding].” Further, she explained that there were occasions when 

it was detrimental not to have institute status. “A recent example of 

the difficulty associated with being designated as a Center occurred 

when the NIH Director was allowed to request transfer authority 

of funds appropriated for cancer research and Alzheimer’s disease 

research to those research institutes of the NIH that had meritorious 

scientific proposals for research in those areas.” Although the Center 

had an approved proposal for Alzheimer’s research, she noted, the 
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Bringing Science to Life 

“NCNR was unable to receive any of the funds since it was a ‘center’ 

and not a ‘research institute.’”56 

Even as nurse scientists chafed at the delays blocking the NCNR 

from becoming a full-fledged institute at NIH, there was no doubt that 

nursing research was taking enormous strides. In two decades the 

number of nurse scientists had grown from 500 to more than 5,000. 

At the beginning of 1978 there was but one nursing research journal in 

the United States, Nursing Research, which began publication in 1952; 

by 1992 there were more than seven. This growth in the number of 

research journals was critical to the profession. They not only published 

scholarly investigations, but also influenced society via their editorials 

and essays. For the nursing community, the creation of the NCNR 

marked public and professional recognition of the utility, diversity, and 

credibility of nursing science. Since the inception of the NCNR in 

1986, funding for nursing research had increased from $16 million to 

more than $48 million, a threefold increase, by 1992. Moreover, the 

politics surrounding health care in Washington had changed considerably. Congress gave budget increases for the NCNR only grudgingly 

during the Reagan and Bush administrations. The Clinton administration, which took office in January 1993, gave a new impetus to health 

care research. Not unimportantly for the nursing profession, whose 

members were 95 percent female, President Clinton appointed women 

to the two top health roles in the country: Dr. Donna E. Shalala was 

confirmed as Secretary of HHS and Dr. Joycelyn Elders, a physician 

and former nurse’s assistant, was appointed Surgeon General, the first 

African-American to hold that position.57 

Internally, the NCNR had moved to more closely align its operations with the NIH institutes in order to demonstrate the quality of 

its science. While the Center had successfully built an extramural 

program, funding research projects at institutions throughout the 

country, it had shied away from developing an intramural program. 

But in 1991, Hinshaw decided to start an intramural research program 

within the NCNR. Such a program, she hoped, would demonstrate 
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that nurse scientists, like other investigators at NIH, could conduct 

serious quantitative research on the Bethesda campus. The program 

would also send a strong message to the new generation of nurse scientists coming out of graduate school that nursing research had entered 

the mainstream of science at NIH. Nonetheless, the decision carried 

two potential challenges. First, the initiative would pull some of the 

Center’s money out of the extramural budget, where all agreed it was 

badly needed. Hinshaw feared this move might generate opposition 

within the nursing community, but she believed that the science at 

the NCNR was “strong enough to do it and [the Center] had enough 

money to do both.” She proved right on this count, and no nurses 

protested the intramural program. The second issue, which she did 

not expect but quickly discovered, concerned the other institutes at 

NIH. In the early 1990s the scientific directors of the intramural 

research laboratories at many of the other institutes did not approve 

of nurse researchers on campus. “For them, nurse researchers were 

not two words that went together,” Hinshaw later recalled. “The whole 

concept of nurse and researcher just didn’t go together.” Nonetheless, 

Hinshaw launched the intramural program with a budget of about 

$300,000, bringing in Dr. Carolyn Murdaugh to build the program. 

Murdaugh was a highly regarded scientist and nurse whose assignment was to plan and conduct a new portion of the Honolulu-Asia 

Aging Study in Hawaii to examine the impact on the caregivers, 

usually female family members, of dementia occurring in aging men. 

The goal of the NCNR study was to improve understanding of the 

burdens that caregivers experience and the effect of caregiving on the 

quality of the caregiver’s life.58 

By 1992, the NCNR created the Division of Intramural Research 

to develop and conduct research programs relevant to nursing practice 

and health care apart from collaborations with other institutes. Both 

the Clinical Therapeutics Laboratory and the Laboratory for the Study 

of Human Responses to Health and Illness ran separate research 

programs addressing the interaction of biological and behavioral 
98 Bringing Science to Life 

Nurse scientist Dr. Carolyn Murdaugh came to the NCNR to build its new intramural program. 

aspects of health and disease. At the same time, the labs presented 

research training opportunities to develop nurse scientists while 

extending the depth of the science in research programs.59 

President Clinton’s victory in the fall of 1992 sparked considerable discussion about health care reform as part of the administration’s 

agenda. During its first months, his administration focused much of 

its energies on health care reform, but for a variety of reasons—both 

internal and external—the effort failed. Nevertheless, the concept of 

health care delivery shifted from a medical model emphasizing individuals and their particular afflictions to a health model that encompassed 

the patient, the family, and the community. For the nursing profession, 
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which had long recognized that illness affects families and communities, not just the individual, it was a change that ensured nursing would 

have an important role to play in whatever health care reform might 

emerge in the future.60 

The manifestation of the change in health care delivery for the 

nursing community came in November 1992, when the NCNR 

convened the second Conference on Nursing Research Priorities. As 

it had done almost five years earlier in 1987, the NCNR invited nurse 

scientists from across the country to meet in Bethesda to develop a 

new five-year agenda for nursing research priorities. For three days, 

more than fifty top nurse scientists from across the country met to 

debate and ultimately select a new list of nursing’s most urgent issues. 

“We voted with little voting machines on the priorities for nursing 

research,” Hinshaw later recalled. The voting resulted in the selection 

of five research priorities that were phased into the National Nursing 

Research Agenda and guided a portion of research funding between 

1995 and 1999.61 

The five priorities coming out of the second Conference on Nursing 

Research Priorities reflected the changes being discussed among health 

care professionals. Nurses now placed an emphasis on developing and 

testing community-based nursing models for rural and other underserved populations and patients and families living with chronic illness. 

They also began to move away from behavioral programs to investigate 

more intensively biobehavioral interventions, that is, interdisciplinary research that examined the interaction of psychological, biological, 

social, medical, and nursing factors on health care issues. The basic 

premise was to move the research results to clinical and community 

applications. Three of the five new priorities focused on biobehavioral 

nursing interventions in HIV/AIDS, cognitive impairment, and immunocompetence. The program fit well into the health care reform ideas 

circulating in the Clinton administration and garnered the support of 

Clinton’s HHS secretary, Donna Shalala.62 

Neither the nurses nor their allies in Congress had forgotten the 
100 Bringing Science to Life 

In 1992, nurse scientists from across the county met in Bethesda, Maryland, to establish nursing 

research priorities. Here, participants use handheld voting machines as part of the process. 

disappointment of becoming a center rather than an NIH institute. 

The professional nursing organizations had worked with Congress to 

keep the idea alive and found strong bipartisan support from Pursell 

and Senators Daniel K. Inouye of Hawaii and Tom Harkin of Iowa, 

then chair of the appropriations subcommittee overseeing health 

care funding. The Center stressed that a conversion to an institute 

would require no modification to the existing infrastructure and that 

the designation was “budget neutral,” as the established programs and 

administration would be largely unchanged. Dr. Bernadine Healy, 

then the director of NIH, also favored an institute for nursing. In 
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the summer of 1992, Pursell resubmitted language to create an NINR 

in the NIH reauthorization bill of 1993, which would come before a 

new administration and Congress after the November 1992 elections. 

Hinshaw met with Healy to let her know what Pursell was doing so 

she and NIH would not be caught by surprise. Hinshaw, as a federal 

official in the executive branch, could not endorse the change without 

approval from any new administration. She told Healy about the congressional effort for redesignation to an institute. “I need to know 

whether we can support that or not,” she asked. Healy replied, “I think 

that’s a good idea. Do you think you’re ready for that?” Hinshaw 

explained that the Center had a good array of programs in place. She 

thought the staff and the nursing community could do it. Since legislation was not always passed, as had happened to Pursell’s redesignation 

effort two years before, Healy thought that an executive order might 

work and asked her staff to draw one up.63 

Following Hinshaw’s conversation with Healy, but before the 

presidential election in the fall of 1992, HRSA held a reception 

and dinner for leaders of the health care community. At that event 

Hinshaw and Healy questioned then-HHS Secretary Louis Sullivan 

and Assistant Secretary for Health, Dr. James Mason, about the institute. Given the long-term opposition from the medical community 

to institute status for nursing at NIH, Healy needed to know the 

position of the Bush administration on the change. Mason asked if 

the Center was ready. Healy replied, “Absolutely. It’s time to go for 

it.” Mason simply said, “Okay,” and turned to an aide and said, “Note 

that down.” It was the night the administration said yes. Someone 

nearby who overheard the exchange said to Hinshaw, “What a coup.” 

The support “neutralized opposition from the medical community so 

quickly,” Hinshaw recalled, “[this time] we never heard from them.” 

Healy instructed her office to file the paperwork to begin the process 

of redesignation through executive channels. This time, however, the 

legislation passed, even as the executive redesignation order came 

to the desk of Shalala, who had replaced Sullivan as the Secretary 
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Bringing Science to Life 

of HHS in the new Clinton administration. In June 1993, Shalala 

signed the papers creating the NINR.64 

The creation of NINR realized the dreams of many in the nursing 

In June 1993, HHS Secretary Donna Shalala and NCNR Director Ada Sue Hinshaw marked the 

Center’s attainment of institute status. 

community. For Hinshaw, however, it marked the end of “a really fun 

adventure.” In 1993 she was named “Health Leader of the Year.” She 

saw herself as a builder, and the institute was becoming an agency 

requiring more maintenance than building. She was tired of the bureaucracy. “Now the science had to build, and that’s a job of many, many 

years. I knew that and didn’t want to stay there for years and years.” 

She toyed with the idea of returning to a university setting but turned 

down opportunities to become a vice president for research because 

she wanted to stay in nursing. A school of nursing deanship, however, 

especially at a research-intensive university, looked far more attractive. She knew that Rhetaugh Dumas was stepping down as dean at the 

University of Michigan. Hinshaw had spent a short time in Ann Arbor 

just before taking over the NCNR. “I liked it a lot. It [was] a strong 

school, still a lot of growth to be done, a lot of openness, [and] a good 

faculty.” In the summer of 1994, Hinshaw left the NINR to become 

dean of the School of Nursing at the University of Michigan.65 

Looking back at the impact of the creation of a nursing entity at 
From Center to Institute: Nursing Research Comes of Age 103 

NIH, Hinshaw emphasized the “excitement of building the science, a 

science that had both a strong clinical and a strong scholarly orientation.” The NCNR had accomplished this, she believed, by involving 

the nursing “community in what we did, so we were able to keep the 

flavor and commitment of nursing to the science. The other piece was 

the early and consistent involvement of the other disciplines through 

the other institutes. Our science is much richer for that.” She was very 

proud of the redesignation to an institute, “because all of us worked 

Ada Sue Hinshaw celebrated with the newly named NINR staff. Her work largely complete, 

Hinshaw left the NINR the following summer. 
104 Bringing Science to Life 

very hard on that.” By the time she left for Michigan, she recalled, 

“we no longer had NIH fighting us, but with us, as we moved for 

something.”66 

In retrospect, Hinshaw considered the NCNR’s centers program to 

have had the greatest influence on nursing science because they “grow 

and raise more scientists at the same time they produce more science. 

Centers do double duty—they produce very fine scientists and also 

much research.” When the NCNR began, Hinshaw recalled, nursing 

had but a handful of postdoctoral students; when she left the institute, 

there was a “whole cadre of postdocs, people who really do know how 

to do research and were well underway with research programs. Their 

mentors, by running these centers and producing [new scientists] at 

the same time, have really added to the science in many ways.” In 

particular, Hinshaw cited Dr. Linda Aiken, whose studies to determine adequate nurse staffing and patient outcomes became the basis 

for establishing policy guidelines for nursing practice. Aiken, working 

with NINR funding, determined that inadequate staffing increased 

mortality and morbidity. She argued that facilities needed to carry a 

staffing ratio of no higher than four- or five-to-one in terms of patients 

to nurses. Failure to do so, her studies indicated, meant that for every 

increase in the patient load by one, the death rate for that patient thirty 

days from discharge increased by 7 percent. The results, published in 

the Journal of the American Medical Association, changed state laws to 

require staffing levels set by Aiken’s research in California and elsewhere. “So there’s some real impact there that’s made a difference,” 

Hinshaw concluded, especially for a small and very young agency with 

money available to fund limited research. “And yet, it began to make 

some huge policy impacts very quickly.”67 

After seven years as the director of the NCNR, Hinshaw was 

proud of the vibrant research program nurse scientists had established. 

She could point to the advances made in transitional care with low 

birthweight infants and research breakthroughs in the area of women’s 

health, including a greater understanding of menopausal symptoms 
From Center to Institute: Nursing Research Comes of Age 105 

in midlife women. She noted the success of community-based health 

prevention studies, such as one in which nurse scientists were able to 

reduce the prevalence of cardiovascular risk factors in rural children 

through a specially designed education program taught in the schools. 

Another source of pride was the development of a pediatric pain tool, 

the “OUCHER scale”, that used graphic facial expressions to help 

children communicate how much pain they felt. Originally developed 

The “OUCHER scale” uses graphic facial expressions to help measure the location, intensity, 

and quality of pain in children. 
106 Bringing Science to Life 

in 1983 by Dr. Judith E. Beyer at the University of Missouri–Kansas 

City School of Nursing, the scale proved to be reliable in measuring the 

location, intensity, and quality of pain in children and adolescents. The 

NINR sponsored additional programs of research in the assessment 

and treatment of pain for minorities, including studies done by Beyer 

and by Dr. Mary J. Denyes at the Wayne State University School of 

Nursing. “We at the NCNR,” Hinshaw told a group of senators in 1993, 

“believe the intellectual rigor and resulting interventions of nursing 

research can make an impressive, cost-effective difference. It provides 

essential scientific substantiation for innovative available, high-quality 

health care for all Americans.” Although Hinshaw would leave in a 

year, her comments captured the essence of what she believed the new 

agency had achieved.68 
From Center to Institute: Nursing Research Comes of Age 107 

Chapter 3 Endnotes 

1	 Doris Merritt, telephone interview by Philip L. Cantelon, April 28, 2008, 45 

(hereafter Merritt Oral History); testimony of Dr. James B. Wyngaarden, March 

17, 1987, 694, NINR Records, Box 6, Folder: Legislation for NCNR. 

2 Merritt Oral History, 45; testimony of Dr. Doris Merritt, March 17, 1987, 679, 

690, NINR Records, Box 6, Folder: Legislation for NCNR. The list sent to Bowen 

contained three names with Hinshaw at the top. Ada Sue Hinshaw, telephone 

interview by Philip L. Cantelon, August 20, 2008, 44 (hereafter Hinshaw Oral 

History August 20, 2008). 

3	 “Hinshaw Heads NCNR,” AACN Newsletter, July 1987, NINR Records, Box 11, 

Folder: NCNR Achieved. 

4	 Ada Sue Hinshaw, Resume, Box A, NINR Records; Legislative Network For 

Nurses, “NCNR Director Nominated,” n.d., NINR Records, Box 11, Folder: 

NCNR Achieved. 

5 Hinshaw Oral History August 20, 2008, 2-3. The nursing or nurse’s cap, derived 

from a nun’s habit and introduced into nursing by Florence Nightingale in the 

mid-1850s, fell out of favor in the 1980s as more men entered the nursing profession and scrubs were adopted as a unisex uniform for nurses. 

6 See Powhatan J. Wooldridge, Robert C. Leonard, James K. Skipper, and 

Madeleine H. Schmitt, Behavioral Science and Nursing Theory (St. Louis: Mosby, 

1983) and James K. Skipper and Robert C. Leonard, ed., Social Interaction and 

Patient Care (Philadelphia: J. B. Lippincott, 1965); Hinshaw Oral History August 

20, 2008, 4-5. 

7	 Hinshaw Oral History August 8, 2008, 6-7; Ada Sue Hinshaw, telephone interview by Philip L. Cantelon, April 22, 2009, 3-5 (hereafter Hinshaw Oral History 

April 22, 2009). Kramer’s landmark book, Reality Shock: Why Nurses Leave 

Nursing, was published in 1974. 

8	 Hinshaw Oral History August 20, 2008, 8-9. 

9	 Ibid., 9-10. 

10	 Ibid., 11, 16, 42. 

11	 Ibid., 42-43; Hinshaw Oral History August 28, 2008. 

12	 Hinshaw Oral History August 20, 2008, 43, 47. 

13	 Ada Sue Hinshaw, “Using Research to Shape Health Policy,” Nursing Outlook 36, 

no. 1 (January/February 1988): 21-24. 

14	 Commission on Nursing Research, “Research Priorities for the 1980s: 

Generating a Scientific Basis for Nursing Practice” (Kansas City: American 

Nurses Association, 1981), passim. 
108 

 

Bringing Science to Life 

15 Ibid.
 

16 Ibid.
 

17 “Hinshaw Heads NCNR,” AACN Newsletter 13, no. 6 (July 1987), NINR Records, 


Box 11, Folder: NCNR Achieved; Hinshaw Oral History August 28, 2008, 7-8. 

18	 “Hinshaw Heads NCNR.” 

19	 Ibid. 

20	 Ibid. 

21	 Ibid. 

22	 Hinshaw Oral History August 20, 2008, 48-49. 

23	 Hinshaw Oral History August 28, 2008, 10-11, 14-15. 

24	 Hinshaw testimony to the House Subcommittee of the Committee on 

Appropriations, 100th Cong., 2d sess., March 10, 1988, 1017 (hereafter Hinshaw 

Testimony); Hinshaw Oral History August 28, 2008, 13-14; National Nursing 

Research Agenda, “Setting Nursing Research Priorities,” September 13, 1993, 1, 

NINR Records, Box 5; Patricia Moritz, telephone interview by Philip L. Cantelon, 

March 13, 2008, 24, 26 (hereafter Moritz Oral History). The conference was later 

known as CORP I. 

25	 Hinshaw Oral History August 28, 2008, 13-14; Hinshaw Testimony, 1020. 

26	 Hinshaw Oral History August 28, 2008, 14-16; Georgia K. Miller, et al., “What Is 

Nursing Research: Evolving Approaches to Methods and Content,” Journal of the 

New York State Nurses Association 23, no. 3 (September 1992): 5. 

27	 See Hinshaw Testimony, 1020; National Center for Nursing Research, “National 

Nursing Research Agenda,” March 13, 1992, 1, NINR Records, Box 22. 

28	 Presentation of Dr. Marie Cowan, Task Force on Nursing Research, November 

28, 1988, 78-90, NINR Records, Box A, Folder: Excerpts (hereafter Cowan 

Presentation); Hinshaw Oral History August 28, 2008, 16; Hinshaw Testimony, 

1014. 

29	 Hinshaw Oral History August 28, 2008, 56; Hinshaw Testimony, 1011. 

30	 Hinshaw Testimony, 1012-13. 

31	 Ibid. 

32	 Ibid., 1013. 

33	 Ibid., 1044. 

34	 Ibid., 1022; The Washington Post, June 13, 2009. 

35	 Hinshaw Testimony, 1022. 

36	 Ibid., 1023. 
From Center to Institute: Nursing Research Comes of Age 109 

37 Ibid., 1066.
 

38 Ibid., 1067.
 

39 Ibid., 1067-68; Cowan Presentation, 80-81. The downward trajectory was 


reversed in 1996 with the introduction of Highly Active Anti-Viral Therapy, 

which kept patients on a steady or upward trajectory. See A. B. Williams, “New 

Horizons: Antiretroviral Therapy in 1997,” Journal of the Association of Nurses in 

AIDS Care 8, no. 4 (July-August 1997): 26-38. 

40	 Hinshaw Oral History April 22, 2009, 10. 

41	 Hinshaw Testimony, 1064-65, 1069, 1078-79. 

42	 Ibid., 791-92. 

43	 Sue K. Donaldson, “Breakthroughs in Scientific Research: The Discipline 

of Nursing, 1960-1999,” Annual Review of Nursing Research 18 (2000): 

261; Hearings, Senate Subcommittee of the Committee on Appropriations, 

101st  Cong., 1st sess., May 1, 1989, 1228; Hinshaw Oral History April 22, 2009, 

10-11. 

44	 Hinshaw Testimony, 792; NINR, Division of Intramural Research, Annual 

Report for FY 1995, 8. 

45	 Hinshaw Testimony, 793, 829, 816. 

46	 Ibid., 817. 

47	 Ibid., 817-18. 

48	 Ibid., 819-20; Hinshaw Oral History April 22, 2009, 15. 

49	 Hinshaw Testimony, 821-22. 

50	 Ibid., 832-33, 841-42. 

51	 “Jump-starting Funding for NCNR,” CNR News 17, no. 3 (1990): 4, NINR 

Records, Box A, Folder: Publications. 

52	 Ibid.; Hinshaw in “Advancing Health Through Science: Building Knowledge 

for Patient Care,” 15th Anniversary Symposium, October 24, 2001, 14, NINR 

Records (hereafter 15th Anniversary Symposium); Hinshaw quoted in Charles 

Meyer, “Nursing on the Political Front,” American Journal of Nursing, October 

1992, 59. 

53	 “Jump-starting Funding for NCNR,” 4. NCNR received more than $43 million in 

FY 1992, up about 10 percent from the previous year. See William K. Russ to Dr. 

Peter Reineke, October 28, 1991, NINR Records, Box 11, Folder: From Center to 

Institute. 

54	 “Jump-starting Funding for NCNR,” 4. 

55	 Hinshaw, 15th Anniversary Symposium, 12, 14-15. 
110 Bringing Science to Life 

56	 Celebration of Establishment of a National Institute of Nursing, November 17, 

1993, 13, NINR Records, Box 5; Hinshaw to Meyer, August 28, 1992, NINR 

Records, Box 6, Folder: Legislation for NCNR. 

57	 Talking Points for Donna E. Shalala, November 1993, 1, NINR Records, Box 5. 

For Joycelyn Elders, see http://www.military.com/Careers/Content1?file=trans_ 

joycelyn_elders.htm&area=Content. Other specialty journals also published 

nursing research in neonatal and critical care, as well as oncology, to name a 

few fields, but nurse scientists were just emerging as a conceptualized discipline 

of their own. See Donaldson, “Breakthroughs in Scientific Research,” 248. For 

a listing of nursing research periodicals, see Miller, et al., “What Is Nursing 

Research,” 6. 

58	 Hinshaw Oral History August 28, 2008, 47-49; Hinshaw Oral History April 22, 

2009, 2-3, 13-14; Hearings of the Subcommittee of the House Committee on 

Appropriations, 100th Cong., 2d sess., March 25, 1992, 550. 

59	 NINR, Division of Intramural Research, Annual Report for FY 1995, 8. 

60	 Talking Points for Donna E. Shalala, November 1993, 3, NINR Records, Box 5. 

61	 “Setting Nursing Research Priorities,” September 23, 1993, 1, NINR Records, Box 

9, Folder: Priority Setting–NINR; Celebration of Establishment of a National 

Institute of Nursing, November 17, 1993, 15, NINR Records, Box 5. 

62	 “Setting Nursing Research Priorities,” September 23, 1993, 2, NINR Records, Box 

9, Folder: Priority Setting–NINR; Talking Points for Donna E. Shalala, November 

1993, 3-4, NINR Records, Box 5. 

63	 Hinshaw Oral History August 28, 2008, 38; William K. Russ to Peter Reinecke, 

October 28, 1991, NINR Records, Box 11, Folder: From Center to Institute. 

64	 Hinshaw, 15th Anniversary Symposium, 17, 19; Hinshaw Oral History August 

28, 2008, 41-42; Hinshaw Speech, November 13, 1993, NINR Records, Box 5. 

Days after the establishment of NINR, NIH Director Bernadine Healy, who was 

so critical to the redesignation, left NIH. 

65	 Hinshaw Oral History August 28, 2008, 45. 

66	 Ibid., 55-56. 

67	 Hinshaw Oral History April 22, 2009, 23-24, 26-28. 

68	 Hearings, Senate Subcommittee of the Committee on Appropriations, 103d 

Cong., 1st sess., May 26, 1993, 680-82; author’s correspondence with Antonia M. 

Villarruel, March 8, 2010; see also, Judith E. Beyer, Mary J. Denyes, and Antonia 

M. Villarruel, “The Creation, Validation, and Continuing Development of the 

OUCHER: A Measure of Pain Intensity in Children,” Journal of Pediatric Nursing 

7, no. 5 (October 1992): 335-46. 

Dr. Suzanne Hurd, right, served as NINR acting director after Dr. Hinshaw’s 

departure in 1994. On April 3, 1995, Dr. Patricia A. Grady, left, became the 

NINR’s second director. 
4

Chapter 4 

From Nursing Research 

to Nursing Science 

When Ada Sue Hinshaw departed for Ann Arbor and the deanship of 

the University of Michigan School of Nursing in 1994, she left behind a 

very different nursing entity than she had taken over eight years earlier. 

The National Center for Nursing Research (NCNR) had gained institute status, funding levels for research were more than three times 

what they had been in 1986, graduate schools were educating greater 

numbers of nurse scientists, and, as if to validate the National Institute 

of Nursing Research’s (NINR) acceptance into NIH, nursing had initiated its own intramural program. None of this had been easy or 

the automatic result of being part of NIH. The staff of the NINR, the 

professional nursing associations, and nurse scientists throughout the 

country had planned, justified, prodded, and advocated for the growth 

and development of nursing science. Despite their successes, however, 

these were but first steps in the evolution of the NINR. It remained 

a small institute, still laboring under the perception that nurses did 

only clinical research, not the more basic science that led to clinical 

research as in other NIH institutes. While most nurses agreed that 

Hinshaw had done an “outstanding job to build the research program 

base for the NINR,” they also realized that much remained to be done. 

To some, the NINR was still a stepchild at NIH.1 
114 Bringing Science to Life 

In July 1994, a month after Hinshaw’s departure, NIH Director 

Harold E. Varmus appointed Dr. Suzanne S. Hurd acting director of 

the NINR, a position she held in addition to her job as the director of 

the Division of Lung Diseases at the National Heart, Lung, and Blood 

Institute (NHLBI). A graduate of Bates College in Maine, she earned 

her advanced degrees at the University of Washington. After postdoctoral studies at the University of California, Berkeley, Hurd came 

to NIH in 1969. Though she had concentrated her research interests 

on chronic obstructive pulmonary diseases, she built her career at the 

NHLBI in health science administration.2 

One of Hurd’s administrative strengths was building a solid 

program management infrastructure for the funding of grants for 

research projects. Although she expected her term at the NINR to be 

short, she believed that her long experience with program development at NIH could benefit the Institute until a permanent director was 

found. She began a review of the Institute’s budget history to uncover 

its previous funding patterns, program balance, success rates, plans for 

future research directions, and mechanisms for program planning in 

order to provide recommendations for future growth. Hurd concluded 

that “the future success of the NINR will be tested based on the ability 

of individual researchers to develop and submit an increasing number 

of innovative, high-quality nursing research proposals related to NIH 

basic and clinical research goals.” In other words, Hurd believed that 

bringing the NINR more in line with the programs of other NIH institutes during a period of tight resources would pay handsome dividends 

for nurse scientists.3 

Hurd became acting director of the NINR at a time of considerable 

uncertainty. Off-year elections in November 1994 during President 

Clinton’s first term had brought stunning change to the political landscape in Washington. For the first time since 1954, the Republican 

Party captured both houses of Congress. Led by Congressman Newt 

Gingrich of Georgia and his conservative Contract with America, the 

Republican victory was a reaction—in part—to the failure of Clinton’s 
From Nursing Research to Nursing Science 115 

In 2001 the NINR celebrated fifteen years of nursing research at NIH. 

attempt to reform the nation’s health care system. Although there had 

been substantial support for the NINR from Republicans in the past, 

the new leadership’s position was unclear. Committee and subcommittee chairs would change in the 104th Congress. Familiar ties were 

weakened, if not broken altogether. With much change came much 

uncertainty, especially in the level of medical research funding.4 

The new chair of the appropriations subcommittee was John 

Edward Porter, who represented the suburban “silk stocking” district 

north of Chicago on the shore of Lake Michigan. A strong supporter 

of medical research, Porter nonetheless questioned Hurd closely in 

budget appropriations hearings about areas in which the NINR could 
116 Bringing Science to Life 

cut costs. Porter realized that while all institutes had to share in 

cutting personnel, a small institute like the NINR had less flexibility 

to downsize its staff. Hurd explained that the NINR was developing 

management teams and job sharing to achieve workload balances 

with fewer employees. In addition, NIH was reducing the number 

of required reports and amount of paperwork and streamlining the 

grant application process. All of this would result in better efficiency 

to effectively use the scarce resources, she assured him, and preserve 

the work of nurse scientists.5 

If so, Porter asked, why did the NINR have “the dubious distinction of having the lowest projected success rate on campus in 1996 of 

about 12 percent?” It was a question that referred to the number of 

funded applications divided by the number of applications received, 

U.S. Representative John E. Porter (R-Illinois), chair of the appropriations subcommittee and a strong supporter of medical research. 
From Nursing Research to Nursing Science 117 

 

 

and one that the subcommittee had pondered earlier with Hinshaw. 

Since her first day as acting director, Hurd replied, she had wrestled 

with this question. “Indeed, it would appear overall that the success 

rate is significantly lower than the other institutes,” she said. “However, 

if you separate out the applications that are investigator-initiated 

applications,” she said, “the success rate is similar to the success rates 

throughout NIH.” The difference, she explained, was the large number 

of applications that the NINR received in response to the solicitations, 

i.e., Requests for Applications (RFAs), which modified the success rate. 

Her solution was to encourage more nurse-initiated applications. The 

issue needed close attention, she concluded, “but it is not the same 

magnitude that has been presented in the past.”6 

Hurd had already begun the process of inviting more innovative 

proposals. In a series of articles in early 1995, she attempted to put 

into perspective for nurse scientists the problems facing the NINR. 

For the near future, Hurd observed, budgets at NIH and the NINR 

would do well to keep up with inflation. “The likely diminution of 

future resources,” she wrote, would be “especially hard on a developing 

institute with a small base, such as the NINR.” Because the Institute 

had the lowest success rate at NIH, it needed to attract more research 

proposals, particularly those from individual investigators. However, 

she noted, “we are receiving fewer applications now, a worrisome trend 

that must be reversed to preserve and enhance the Institute’s stature 

and effectiveness.”7 

Hurd praised the two conferences on research priorities (CORP I 

in 1988 and CORP II in 1992). This method of identifying areas of high 

scientific emphasis was “an outstanding means to develop new and 

innovative approaches to specific areas of interest and to meet federal 

program objectives,” she wrote. Because the RFA programs were 

“very broad in scope,” they generated a large number of applications 

and, therefore, a lower success rate. Of all of the NINR’s extramural 

funding, more than 80 percent went to these research project grants. 

In addition, because of the NINR’s small funding base, “the presence or 
118 Bringing Science to Life 

absence of even small numbers of grant applications can exert considerable influence on the NINR success rate.” The solution, she argued, 

was to build an increasing number of multidisciplinary “innovative 

investigator-initiated research projects (R01 and R29 applications), 

thereby demonstrating the enormous potential of nursing research.”8 

From her analysis of the NINR over the previous three years, Hurd 

believed she understood both the strengths and weaknesses of the 

Institute. Her purpose was to bring the NINR more in line with other 

NIH institutes and increase the scientific merit of its research. She recommended that the NINR continue to work with the nursing research 

community—a strength—while “carefully balancing support” for RFAs 

with the individual investigators for whom she urged greater funding. 

Based on her experience in the NHLBI, Hurd believed that greater 

scientific merit could be found in the work of innovative individuals. 

Moreover, she urged the Institute to evaluate carefully the progress of 

the RFA programs and to identify and evaluate specific topic areas that 

could be implemented through special initiatives. Finally, the NINR 

should “publish the results of nursing research projects in the broad 

scientific literature to establish the impact of scientific findings.”9 

Hurd’s review of the NINR carried the message of a friendly, wellmeaning, but stern aunt inclined to tell youngsters how to emulate 

successful adult behavior. Her articles were not quite sermons or 

lectures, but rather instructions on self improvement, as well as sharp 

guidelines to improve the NINR’s basic science for Hinshaw’s eventual 

successor. Her message to the nurses was: You’ve started out on the 

right path, but you’ll need to advance the quality of the science of your 

research to become something more than a stepchild institute at NIH. 

Hurd’s message was important. It was a call to nurses to alter their 

thinking about research and become more proactive. She encouraged 

nurse researchers to think of themselves as nurse scientists—to move 

beyond observation to initiating innovative research programs. 

Varmus agreed with Hurd. The co-recipient with J. Michael Bishop 

of the Nobel Prize in Medicine in 1989 for his research on the cellular 
From Nursing Research to Nursing Science 119 

origin of retroviral oncogenes, Varmus, as NIH director, was pushing for 

more and better research at NIH, urging Congress to increase funding 

for basic science. His choice of Hurd as interim director reflected his 

emphasis on basic research and his interest that it should be ramped 

up at the NINR. After Hinshaw left for Ann Arbor, a rumor circulated 

among staffers on Capitol Hill that the NINR might be redesignated as 

a center. No one knew what currency Varmus gave these whispers, if 

indeed he had heard them. But like Wyngaarden before him, whatever 

Dr. Harold E. Varmus, NIH director from 1993 to 1999. 
120 Bringing Science to Life 

his opinion about an institute of nursing at NIH, he wanted the NINR 

to represent the very best science. In any case, improving the Institute’s 

scientific reputation would guarantee its survival. To help assure his 

vision of a refocused NINR, Varmus selected someone with whom he 

had worked and whom he considered to have the proper credentials, 

credibility, and capability to implement that vision. He would encourage her to apply for the Institute’s directorship. Unfortunately, his 

candidate, Dr. Patricia A. Grady, had already been proposed as chair of 

the NINR Director Search Committee.10 

In the spring of 1995, Grady was just completing a stint as the 

acting director of the National Institute of Neurological Disorders and 

Stroke (NINDS). An internationally recognized stroke researcher specializing in cerebral blood flow, metabolism, and function, Grady had 

come to the NINDS in 1988 as a program administrator. Four years 

later she assumed the responsibilities of assistant director. In 1993 she 

became the deputy director. Nine months later, when the institute’s 

long-time director, Murray Goldstein, retired, Secretary of Health and 

Human Services Donna Shalala appointed Grady acting director of the 

NINDS. After Goldstein’s successor was selected, Grady returned to 

her position as deputy director and agreed to chair the NINR selection 

committee.11 

When Varmus saw Grady’s name on the selection committee list, 

he may have asked why it was there. “Because she’s a nurse” would 

have been the logical reply. It also meant that Grady was not considering the position. She was at a meeting in Dallas when Varmus 

tracked her down. “You know,” he began, “I’d really like to keep you 

on my team. I wonder if you’d be willing to compete for the [NINR] 

job. I can’t promise it, but I really think you’d be very competitive 

and do a great job if you were selected and took it.” The conversation 

overturned Grady’s plans to chair the committee and return to her old 

position at the NINDS, where “life would be back to normal.”12 

Grady thought about Varmus’s suggestion. She had not planned 

to take on anything new. She knew she could do the deputy job at the 
From Nursing Research to Nursing Science 121 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NINDS. Moreover, staying in her area of science carried additional 

advantages and comfort. The more she thought about the challenge, 

however, the more reasons she raised for possibly remaining on 

Varmus’s team and moving to the NINR. Like many at NIH, Grady 

viewed the NINR as more of an institute on paper than a full-fledged 

member of the NIH community. She believed the NINR directorship 

would be a good opportunity to pull together her nursing training, 

her scientific background, and her NIH administrative experience to 

benefit the Institute. On the other hand, she realized that she was not 

as well known in the nursing community as other potential candidates. 

In addition, Grady was uncertain whether nurses would consider her a 

viable candidate. “It boiled down to doing something that I really liked 

doing, which was being the deputy, or taking something on that I really 

thought I would like and thought maybe I could make a difference and 

do something new. So I opted for the new challenge.”13 

Grady was raised in Delray Beach, then a small town on Florida’s 

east coast south of Palm Beach. Her parents were from Connecticut, 

so when Grady graduated from high school, she decided to return 

north for college. She excelled in science and was interested in health, 

so like many similarly inclined women at that time, she decided on a 

career in nursing “because it gave you flexibility and the potential to 

carry out the profession in any number of settings and variety of lifestyles.” She settled on the St. Francis School of Nursing in Hartford, 

close to a number of her extended family. Nurse training at St. Francis 

consisted of a three-year diploma program, after which Grady transferred to Georgetown University School of Nursing to complete her 

bachelor of science degree. Because Georgetown accepted her St. 

Francis nursing credits, she was able to take many liberal arts and 

science courses with a few upper-level nursing classes sprinkled 

into the mix. When she graduated in 1967 with a BS in nursing, she 

received the equivalent of an undeclared minor in philosophy, a byproduct of Georgetown’s Jesuit education. After Georgetown, Grady 

also served as an instructor at the Washington Hospital Center’s 
122 

 

 

 

 

Bringing Science to Life 

School of Nursing, teaching in the newborn division of the Maternal 

and Child Health Department and supervising the clinical experience for student nurses.14 

The following year Grady moved to Baltimore to pursue a master’s 

degree at the University of Maryland School of Nursing. Completing 

the degree in 1968, she accepted a job at the university, teaching courses 

on critical care nursing and leadership and management in the clinical 

setting. In her second year Grady became the director of the newly 

created Neurological and Neurosurgical division. There she discovered her special research interest in stroke and related problems. She 

returned to school full time in 1973, entering the doctoral program at 

Maryland’s School of Medicine. She received her PhD in physiology in 

1977 and continued her research while teaching advanced courses to 

medical and doctoral students. By 1980 Grady held a primary appointment as research assistant professor in the School of Medicine, where 

she directed a Cerebrovascular Physiology Research Laboratory, and 

a joint appointment as assistant professor in the School of Nursing. 

While there, her research proposals won NIH funding for independent 

projects in stroke.15 She also received funding from the Office of Naval 

Research for an interdisciplinary study on brain function. 

In the course of her research work, Grady presented her scientific findings in a number of national and international scientific 

meetings, including symposia at NIH. In 1988 the NINDS recruited 

her to become an administrator, first in the area of head injury and 

soon after in the area of stroke. “The only job I would have liked better 

than the one I took,” she recalled later, “was the one that they gave me 

after I arrived, so it worked out quite nicely.” For the next three years, 

she served as health scientist administrator for the Division of Stroke 

and Trauma, as well as taking on more NIH-wide duties on behalf 

of the NINDS. Among these was serving as her institute’s liaison to 

the National Center for Nursing Research (NCNR). She rose quickly 

through the administrative structure, becoming assistant director of the 

NINDS in 1992, deputy director the following year, and acting director 
From Nursing Research to Nursing Science 123 

The NINR directorship allowed Dr. Patricia A. Grady to employ her nursing training, her scientific background, and her NIH administrative experience. 

in 1994. During that time Grady developed NINDS policies, priorities, and program activities. She coordinated all research activities in 

neurological disorders and stroke, overseeing the institute’s budget of 

about $700 million and a staff of approximately 1,000. By 1993 she 

had become the chief advisor to Varmus on neurological research and 

science policy.16 

By the time Grady decided to apply for the directorship of the 

NINR, she was somewhat familiar with the workings of the Institute. 
124 Bringing Science to Life 

While on the University of Maryland faculty, she had worked with Ada 

Sue Hinshaw when they were both consultants to the doctoral program 

at the School of Nursing. She dealt with Hinshaw again when the latter 

was the NINR director. She made another point to speak with her 

when she was considering the directorship. “I knew about the science, 

but I talked with her about what the issues were. I came to know pretty 

much what you would know about your neighbors, what’s going on in 

the [NINR] neighborhood,” she recalled. She also spoke with Hurd, 

several longtime veterans of NIH, and institute directors, including Anthony Fauci of the National Institute of Allergy and Infectious 

Diseases (NIAID), Duane Alexander of the National Institute of Child 

Health and Human Development, and Claude Lenfant of the NHLBI, 

who was looking forward to getting Hurd back to her position as 

director of the Division of Lung Diseases. All encouraged Grady, especially Hurd. “I think you should do this,” Hurd said, in part because 

her background was similar to Grady’s—a basic scientist—and she had 

found working at the NINR an enjoyable experience.17 

The selection committee, co-chaired by Dr. Richard J. Hodes, 

director of the National Institute on Aging (NIA), and Kathy 

Montgomery, director of the Clinical Center Nursing Department, 

began its work. Soon Grady’s name circulated as a potential director, 

and a number of nurses’ organizations, such as the American Nursing 

Association and the American Academy of Nursing, called her to 

support her candidacy. “Others didn’t call,” she later joked, “because 

they didn’t want to encourage me.” Publicly, deans of nursing schools 

stayed neutral because one or two of them were also candidates for the 

job. The selection process, which was to be quiet in the sense that no 

one openly campaigned for it, was rife with rumors. When the search 

deliberations were over, Varmus called Grady in mid-March to say that 

the job was hers. Shortly thereafter, on April 3, 1995, Secretary Shalala 

made the appointment official.18 

In announcing Grady’s appointment to the NIH community, 

Varmus praised her experience. “The breadth of Dr. Grady’s scientific 
From Nursing Research to Nursing Science 125 

and management expertise,” he said, “meshes well with the leadership 

requirements of an institute that has a broad mandate. Her experience in conducting and managing neurological research makes her the 

ideal leader to carry out the NINR mission that includes linking biological and behavioral research programs to benefit people’s health.” 

Grady, whose career began with clinical neurological and neurosurgical nursing, said that she was assuming her position at a time when the 

nation’s health care system was undergoing a science-based evolution. 

To meet this challenge, she intended to expand the scientific base for 

nursing. “Scientific research for nurses,” she stated, “is more crucial 

than ever before.”19 

Even before becoming director of the NINR, Grady had been a 

leader at NIH in supporting the advances of women in science. In 

the spring of 1995, while still deputy director at the NINDS, she 

demonstrated her enthusiasm for the changes female scientists were 

bringing to NIH. Writing in the AWIS Magazine, the quarterly journal 

of the Association for Women in Science, Grady noted that in 1985 

few women held positions on review boards, study sections, advisory 

boards, or tenured posts in laboratories at NIH. But a decade later, she 

said, while women were still not well represented in senior positions, 

“no clinical trial, review board, or tenured group is complete without 

them.” The difference, she explained, was that more women had successfully entered professional scientific careers, “despite structural and 

informal barriers, despite different socialization patterns for boys and 

girls, despite ‘glass ceilings,’ long hours, editorships, review committees, faculty meetings, motherhood, and ‘old boy networks.’” One in 

five independent investigators supported by NIH was a woman scientist. In addition, the number of women submitting applications to 

NIH was rising while the number of men was declining. “The success 

of women scientists in the NIH system,” she wrote, “suggests they will 

remain competitive and important contributors to the health of the 

Nation in the 21st century.” The NINR appointment provided an ideal 

platform to continue her message.20 
126 Bringing Science to Life 

From her experience as the acting director of an institute with 

more than 1,000 employees, Grady recognized that size mattered when 

it came to slicing up the NIH pie. That there was a pecking order 

at NIH was an unacknowledged reality. Institutes outranked centers, 

and big institutes carried more importance than smaller ones. When 

nursing research was a center, even a freestanding center with all the 

rights and privileges of an institute, it was recognized that such a 

situation did not carry the stature of an institute. When competing 

for pooled funds, centers and small institutes received less than the 

larger entities. In reviewing the history of the NINR, Grady learned 

that even as an institute, the NINR struggled for parity. Coming from 

outside the nursing community, she saw what the nurses were able to 

accomplish and what, in her opinion, remained to be achieved. The 

year that Hinshaw had served as an institute director was too short 

to accomplish parity or improve status within NIH. Hurd, as acting 

director, was unable to do much more than keep the new institute 

in a holding pattern. Grady envisioned funding better science and, 

by doing so, improving the NINR’s competitiveness in relation to 

other institutes, which would garner it more respect within the NIH 

community. Varmus had praised Grady’s credentials as a nurse academician, clinician, and researcher. Her experience at NIH, he said in 

announcing her appointment, would “be invaluable in building on the 

NINR’s already impressive record of collaborative efforts with other 

NIH institutes and Public Health Service agencies.” While not abandoning collaborative research, Grady’s long-term strategic goal was to 

move the NINR from a campus collaborator to a campus leader.21 

Varmus’s confidence in his new NINR director was not misplaced. 

Having served as an acting institute director, Grady fully understood 

the importance of congressional support. She also had the credentials 

and the self-assurance to explain the NINR’s role within NIH as she 

viewed it. In testimony before the House Appropriations subcommittee, she said that the goals of the NINR were twofold: improving health 

and reducing costs. She indicated that “while scientific research must 
From Nursing Research to Nursing Science 127 

continue to seek cures, it must also find ways to ease the symptoms 

of disease and modify problems arising from treatment.” Secondary 

symptoms, such as those associated with cancer or AIDS, she noted, 

could be as life threatening as the disease itself. “Nursing research 

findings, once envisioned to affect nursing practice alone,” she said, 

“are now understood to be relevant to the work of all health care 

practitioners.”22 

During the mid-1990s, the entire nursing profession was under 

pressure from congressional efforts to balance the federal budget. To 

accomplish this, the budget committees of both houses called for deep 

cuts in social programs, including funding for nursing programs, education, and research. Although appropriations for the NINR were 

relatively secure because of the assurance of NIH funding, the TriCouncil for Nursing pushed for a $10 million increase in the NINR’s 

budget in order to fund a higher percentage of nursing research 

grants. The Tri-Council prodded nurses to begin a grassroots lobbying 

campaign to write their members of Congress and explain both the 

importance of nursing education and nursing research—and the health 

care savings that research produced.23 

The most prominent examples of the NINR’s ability to save health 

care dollars came in areas in which it had been working for some 

years—low birthweight babies and the elderly. Health care costs for a 

low birthweight baby could be in excess of $20,000, versus an average 

just below $3,000 for children of normal birthweight. While low birthweight infants accounted for only 7 percent of all U.S. births, their care 

amounted to more than 50 percent of costs for all newborns, according 

to the NINR. Therefore, prevention of low birthweight could result 

in significantly reduced neonatal health care costs. In one program 

with low-income African-American women, NINR-supported investigators had reduced the number of low birthweight deliveries by 

36 percent, which made a remarkable contribution toward reducing 

both short-term and long-term costs to the health care system. 

“Describe how research funded by [the NINR] has helped nurses 
128 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Bringing Science to Life 

discharge low birthweight babies from hospitals sooner, and therefore 

less expensively,” the Tri-Council urged. When compared to control 

groups, according to the NINR, cost savings of 29 percent were achieved 

with women who had caesarean births and savings of 38 percent were 

realized for diabetic mothers with newborns. Moreover, women had 

fewer postnatal rehospitalizations and expressed greater satisfaction 

with their care. In addition, each nurse should let Congress know how 

nursing research programs had prevented injuries from falls among 

the elderly, the Tri-Council suggested, “injuries that account for a significant portion of the expense for caring for the elderly and prevent 

costly complications in critically ill patients.”24 

The campaign had some effect. The idea that scientific research 

could produce cost savings seemed to be a given by the spring of 

1996. Fresh initiatives, especially in the glitzy world of genetics, 

captured more of this interest. Although Congressman Porter, then 

in the second year of his chairmanship, changed the format of the 

subcommittee’s hearings, bringing representatives from several institutes at a time to talk about specific heath care themes, such as the 

role of genetic information, risk factors, or pain, rather than specific 

institute programs, he remained a staunch supporter of NIH. The 

purpose of Porter’s panel format was to find ways for the institutes 

to coordinate research and prevent duplication of effort in order to 

save money. Each institute had an opportunity to mention its successful programs in each area of Porter’s interest. Grady believed 

that the approach achieved the goal of showcasing areas of mutual 

interest, collaboration, and individual perspectives on research 

problems—and the special missions and priorities of each institute. 

She explained the NINR’s new clinical ethics program focusing on 

decision making and participation in genetic studies and clinical 

trials. She explained the Institute’s concentration “on the aspects of 

being tested or not being tested.” In collaboration with the Clinical 

Center, its ethics department, and the Genome Center, the NINR, 

she said, was “planning to be a part of this long-term process and 
From Nursing Research to Nursing Science 129 

 

 

 

 

 

 

 

 

 

 

to guide patients in these very difficult decisions, as the information 

unfolds from the genetic discoveries.”25 

Nevertheless, one immediate impact of the more conservative and 

budget-conscious Congress was a change in the process by which the 

NINR set its research agenda. In times of fiscal constraint, Grady told 

Porter, the Institute had simplified its planning process. Rather than 

bring experts for multiday sessions in Bethesda, Maryland, “what we 

are looking at now,” she said, “is having smaller work groups convene 

at national meetings, and also using our council more actively.” Two 

initiatives, she reported, were new workgroups: one studying nursing 

issues in the environment and the second examining nursing in 

genetics. Grady’s objective was to keep the level of funding for the 

NINR as close to the previous year as possible while still continuing 

successful research projects and allowing additional funds to sponsor 

new investigations. Her request—in keeping with the President’s budget—for nearly $52 million was basically flat.26 

While all of NIH was concerned with funding after the 1994 elections, health concerns proved to be one of the few common grounds 

on which both parties could agree. The NINR received its requested 

appropriation. With the re-election of President Clinton in 1996, 

the first Democrat to serve two full terms since Franklin Roosevelt 

sixty years before, the emergence of a federal budget surplus, and 

the anticipated funds from settlement with the tobacco companies, 

funding for health research would increase dramatically over the 

next decade. 

In 1996 the NINR celebrated the tenth anniversary of nursing 

research at NIH. More than 400 nurse scientists, deans of nursing 

schools, graduate and undergraduate nursing students, and many 

others filled the Masur Auditorium in Building 10 on the Bethesda 

campus for a day-long symposium in September in recognition of the 

Institute’s first decade. Opening the meeting, NIH director Varmus 

congratulated the NINR on its contributions and praised the “broad 

and interactive nature of nursing research,” particularly in the areas 
130 Bringing Science to Life 

In 1996 the NINR celebrated the tenth anniversary of nursing research at NIH with a day-long 

symposium in Bethesda. (Front row, from left): Nancy Fugate Woods, RN, PhD, FAAN; Loretta 

Sweet Jemmott, RN, PhD, FAAN; Dr. Patricia Grady, RN, PhD, FAAN; Barbara Therrien, RN, 

PhD, FAAN; Dorothy Brooten, RN, PhD, FAAN. (Back row, from left): Gayle Page, RN, DNSc; 

Sue Donaldson, RN, PhD, FAAN; Gary Morrow, PhD; Kathleen Buckwalter, RN, PhD, FAAN; 

Dyanne Affonso, RN, PhD, FAAN. 

of genetic counseling, prevention research, and pain and cognitive research. The symposium, entitled “Advancing Health Through 

Science: The Human Dimension,” featured presentations by nine distinguished nurse scientists on current research topics from improving 

pregnancy outcomes to pain and its immunological implications. The 

keynote presentation by Dr. Sue Donaldson of The Johns Hopkins 

University School of Nursing on translating basic science into clinical 

care carried several of the themes—such as the influence of gender or 

ethnicity on the effectiveness of nursing interventions—underscored 

in other papers. The final presentation, by Dr. Nancy Fugate Woods 

of the University of Washington, highlighted some of the issues that 

would be important to nurse scientists in the near future, including 

access to data, ethical issues surrounding genetic indicators of disease, 

and the challenges presented by emerging diseases. The anniversary 

celebration, which had included a day of poster sessions on Capitol 
From Nursing Research to Nursing Science 131 

Hill the day before the symposium, ended with a “Nightingala” reception and banquet honoring distinguished nurse scientists.27 

Grady, who had recognized the value of history since her days at 

Georgetown, continued to use the anniversary to review the Institute’s 

accomplishments. Her analysis, Grady told the readers of Image: 

Journal of Nursing Scholarship, a publication of international nursing 

honorary society Sigma Theta Tau, “reinforced the view that we can 

take pride in so much progress over such a short period.” The budget 

had increased from $16 million to more than $50 million, supporting 

an intramural program with three laboratories and a growing extramural program that included six research and training centers. “The 

attainment of institute status in 1993,” she wrote, “enhanced national 

and international recognition for nursing research. We view this 

impressive progress as a beginning and eagerly await future opportunities to achieve much more.”28 

Grady’s advice to young nurse scholars blended an acknowledgment of past accomplishments with recognition of the changes in 

nursing science yet to come. She praised the research priority areas 

established by the nursing community over the previous decade, but 

as “important as these designated priority areas are,” she said, “from 

the beginning, the NINR has always given emphasis to the knowledge, 

creativity, energy, and dedication of its individual scientific investigators. These scientists strive to evaluate the effectiveness of different 

interventions. They seek the twin goals of health care effectiveness 

and cost effectiveness. In sum, these scientists form the backbone of 

the Nation’s nursing research activities.” Grady believed that nurse scientists, among all the researchers in health care, were special. They 

were changing the landscape of scientific research not only by asking 

the right questions, but by asking unique ones—questions raised by 

their interactions with patients and their families. She encouraged 

young nurse scientists to link basic, clinical, and behavioral research 

in addressing health problems. “Ten years ago,” she stated, “nursing 

research was not investigating problems at the molecular level. But 
132 Bringing Science to Life 

today we can be important contributors to issues surrounding genetic 

screening and genetic therapy.” She outlined the work to be done in 

managing symptoms resulting from diseases and medical therapies, 

increasing awareness of prevention, and the importance of adherence 

to treatments. Nursing research was more than just bench science. 

In Grady’s view, the NINR’s research emphasis brought a “consistent, patient-oriented perspective to biomedical research that extends 

beyond the traditional research continuum.” Nursing’s scientific 

agenda had a human face, she said, “one that is directly relevant to 

improving the nation’s health.”29 

Grady crusaded for more nurse investigators and, by inference, 

more grant applications for the NINR to sponsor. She also emphasized the scientific leadership provided by the NINR. The Institute 

had “taken a lead in a major NIH-wide initiative to explore the biologic 

and behavioral aspects of pain,” she explained in Nursing Outlook. 

According to Grady, the NINR would “explore neurochemical influences on pain perception; controlling transmission of pain to the 

brain; and interactions of molecular mechanisms of pain with such 

variables as gender, genetic differences, and cultural background.” The 

field of genetics had also pushed its way into the foreground of nursing 

science in order to develop counseling strategies to help nurses deal 

with “issues surrounding genetic environments and pinpoint which 

people should be tested.” Whether nurse investigators would deal with 

managing chronic wounds, treatment side effects, genetic advances, 

cognitive impairment in the elderly, or other targeted health problems, 

Grady stressed that “investigator-initiated research is at the heart of 

scientific progress.”30 

Drawing on her own experiences and using her post at the NINR, 

Grady became a combination of advocate, teacher, counselor, and 

cheerleader for nursing science. She believed that nursing’s primary 

challenge was to translate research findings into clinical practice. She 

urged nurses to involve themselves in the research process, to understand the culture of research, to “have a healthy sense of curiosity, [to] 
From Nursing Research to Nursing Science 133 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ask questions about what’s going on around you and be curious about 

why things are done a certain way.” In short, she encouraged young 

nurses to think like independent investigators, like the next generation 

of nurse scientists. Grady also stressed the value of student research 

teams that combined undergraduates and graduates to collect data, 

which would take some of the mystery and intimidation out of research. 

The profession needed to “figure out how to excite the imagination of 

young minds and how to keep these minds excited. When specific 

research isn’t going the way you want,” she said, “it’s this excitement 

that sustains you. It is really important to have a passion for research. 

We need to foster that passion and develop any research interests in 

our youth.” Grady believed that virtually anyone could—and should— 

play a role in the research process. “We are in a time of great change,” 

she explained, “and times of change often produce uncertainty and 

anxiety, but they also produce unexpected opportunities.”31 

Grady was correct about change. Nursing research was becoming 

more active in different areas of science, such as pathophysiology and 

immunology, and entering into fields that had not existed for nurse investigators a decade earlier. As greater numbers of nurse PhDs trained in 

the biological sciences emerged from graduate school, nursing’s research 

agenda moved with them. In certain traditional research areas, such as 

rehabilitation to restore lost function and improve quality of life for the 

elderly, nursing science blended both the physiological and psychological aspects of rehabilitation. And while many researchers maintained 

their interest in the Institute’s long-time specialties—low birthweight, 

HIV/AIDS, elder care, women’s health, and symptom management— 

other nurse scientists, pushed by the NINR, moved into emerging areas 

of scientific investigation. Genetics and Grady’s own research area of 

neuroscience were two fields that marked new directions for nurse 

investigators. Environmental science was a third. As before, this new 

critical mass of nurse scientists would build on the foundations of the 

NINR’s earlier programs and policies, such as the centers program and 

increasing sponsorship of individual nurse investigators.32 
134 Bringing Science to Life 

In December 1995 NIH released its “Report and Recommendations of the Panel to Assess the NIH Investment in Research on Gene 

Therapy.” The document called for more basic genetic research to 

“understand the pathophysiology of disease and the action of gene 

transfer vectors.” The panel participants emphasized the need for 

rapid incorporation of new findings into valid and reliable psychosocial interventions. Nurse scientists recognized that a major gap in 

genetics research was its lack of integration with behavioral sciences, 

an area in which nurse scientists were major participants. The NIH 

panel acknowledged the special position nurses occupied to translate 

genetic research to patients and families and encouraged the NINR 

to collaborate with other agencies to discuss how genetic information 

might be incorporated into behavioral studies to develop improved 

strategies for health care management and policies.33 

Following the NIH lead, the NINR began to publicize the opportunities for nurse scientists in genetics research in 1996. In mid-April the 

NINR hosted a workshop covering areas for science research, critical 

research directions, and training and development opportunities in 

genetics. The Genetics Research Workgroup consisted of nurse scientists from schools of nursing and research facilities around the nation. 

“The initiation of studies that blend genetics bench research with the 

behavioral sciences is critical for the transfer of laboratory findings 

into clinical practice,” the panel announced. The group identified gaps 

in genetics research where nurse scientists could make significant contributions, in such areas as gene-environment-behavioral interface, 

biological, psychosocial, and neuroimmunological markers, and basic 

research, among others. Obesity and cardiac arrhythmia, for example, 

offered nurse investigators an opportunity to examine the complex 

interplay between genetics, behavior, and environment in a patient’s 

condition. For nurse scientists the goal was to identify and isolate 

disease markers and risk factors for persons with genetic conditions 

and in individuals and families at risk of developing genetic conditions. Progress in this area of research, the group believed, would 
From Nursing Research to Nursing Science 135 

enable clinicians to tailor prevention strategies for at-risk persons and 

test interventions for treating persons with genetic illnesses.34 

Once again, nurses faced ethical issues associated with genetic 

health. Nurse scientists had already explored individual attitudes 

toward genetic testing. Therefore, the NIH panel noted, researchers 

should continue to “play an important role in describing, characterizing, and explaining the responses of individuals and families to genetic 

testing and test results.” Nurses needed to perform additional studies 

to clarify the impact of the timing and the conveying of genetic information, especially as it pertained to children, and to develop models 

for health care providers to use in presenting to patients the risk of 

developing a genetic illness. Further research, the panel hoped, would 

“clarify issues critical to the genetic testing of children, such as the 

age at which testing is appropriate, informed consent issues in genetic 

testing, and how understanding the implications of results can be 

monitored in children.” These same ethical issues carried over to the 

health care delivery use of any genetic information. “The vast literature developed by nurse researchers on grief and grieving,” the panel 

suggested, “may also be applicable to understanding the outcomes of 

genetic testing and counseling.”35 

In a series of articles in professional nursing publications, the 

NINR used the report of the Genetics Workgroup to emphasize 

new directions for a brave new world of genetics research, which the 

panel believed related to all areas of nursing science. Nurses who had 

examined issues of health care delivery using populations and community approaches would need to shift focus from studying health 

issues across populations to studying specific phenotype, or marker, 

variations. Nurse scientists would now “need to give special attention 

to multipurpose intervention studies, development of family models 

that allow for different definitions of family, and multifactorial studies 

in which cohorts are followed over a long period of time.” In addition, 

integrated research, that included “both descriptive and intervention 

studies, [was] especially needed for groups...at high risk, including 
136 Bringing Science to Life 

minorities, populations with special care needs, and families currently 

underserved by the health care system.”36 

As a relatively new area of study for nurse investigators, genetics 

also offered special opportunities to initiate multidisciplinary projects. 

The workgroup participants urged nurse scientists to stimulate genetics 

research by “piggybacking” nursing research components onto existing 

or new studies and sharing expertise on various aspects of genetics 

research at scientific gatherings. According to the report, “nurse 

researchers can take leadership roles and contribute to basic genetic 

studies with their biological, environmental, and behavioral linkages” 

and were “especially well positioned for fostering the necessary connections between basic and applied studies through the development and 

implementation of improved strategies for preventing and managing 

genetic disease.” Nurses, in effect, were ideally placed to guide patients 

and families in the use of genetic information to make health-related 

and ethical decisions and guide therapeutic approaches to ensure the 

safety and efficacy of treatments. Moreover, the NINR, Grady and her 

staff announced, would invest its extramural funds to advance such 

research and to develop a cadre of nurse scientists trained in genetics 

research to translate those findings into clinical practice.37 

A notable success of the NINR’s program to develop young scientists was the Summer Genetics Institute (SGI). Conceptualized 

in 1999, the SGI provided a two-month, full-time research training 

program on the NIH campus targeted at faculty, graduate students, 

and advance practice nurses to develop and expand genetic research 

capacity and to furnish a basis for clinical practice in genetics. Since 

the program began, more than 80 percent of its graduates have published peer-reviewed papers and presented their research findings 

at numerous national and international conferences. Moreover, the 

SGI experience often served as a springboard to additional research 

training and education.38 

The NINR followed a similar path in promoting the incorporation 

of nursing research into the environmental sciences. In September 1995 
From Nursing Research to Nursing Science 137 

The NINR’s Summer Genetics Institute provides intensive research training on the NIH campus. 

the Institute of Medicine released a report, “Nursing, Health, and the 

Environment,” that stressed the need to enhance the occupational and 

environmental health content in the practice of nursing, nursing education, and research training. In the next year, the NINR convened an 

Environmental Health Sciences Working Group to identify the gaps in 

the knowledge base of environmental health science, to discuss promising research opportunities for nurse scientists, and to recommend 

research areas that could be explored through investigator-initiated 

research. A major attraction of environmental research for nurses 

lay in its public health aspect—the rich potential to expand from the 

laboratory into the community and, from there, to clinical studies. As 

Grady and her staff wrote in Nursing Outlook, “a compelling illustration of gaps in scientific knowledge regarding target populations and 

target research areas is evident in research literature, suggesting certain 

disadvantaged populations and communities may be at greater risk for 

environmentally induced diseases or health problems.”39 

Moreover, the nature of environmental research meshed perfectly 
138 

 

 

 

 

 

Bringing Science to Life 

with the concept of interdisciplinary and multidisciplinary collaboration, ensuring that budget dollars could be stretched further. The 

NINR stressed that such coordinated efforts would be essential if 

nursing research were to have an impact on environmental health 

challenges. Grady and her coauthors pointed to existing partnerships 

that the NINR had with other parts of NIH in this area. One, with 

the National Institute of Environmental Health Sciences (NIEHS), 

sponsored programs for predoctoral and postdoctoral training in environmental health sciences. A second collaboration, with the NIEHS 

and NIH Office of Behavioral and Social Sciences Research, underwrote 

programs for community-based prevention intervention research. The 

NINR viewed this initiative as a model “for collaborating agencies to 

use in the science base needed by clinicians, target populations, policy 

makers, bioethicists, and decision makers to address environmental 

health issues.”40 

According to the Environmental Health Sciences Working Group, 

promising areas for the future ran the gamut of community-based 

nursing research approaches for investigator-initiated clinical studies. 

Among these were surveillance studies to identify populations at risk 

from exposure to work-site chemicals and radiation and investigations of the impact of pesticide behavior among migrant and seasonal 

farm workers. Other recommendations included cohort studies to tie 

health effects and exposure to environmental hazards, such as investigations to study the impact of pesticide exposure on reproductive 

functions and the consequent neurological functioning in children. 

The research examples, Grady and her team noted, “provide a mere 

starting point because the challenges in environmental health sciences 

for nurse researchers appear to be unlimited.”41 

The annual increases in the NIH and NINR budgets for research 

funding during the second half of the 1990s, anticipated from the tobacco 

settlement and the federal budget surplus, gave some financial underpinning to the opportunities Grady envisioned. The Institute’s highest 

priority was to fund research project grants, with some 70 percent of 
From Nursing Research to Nursing Science 139 

 

 

 

 

 

 

 

 

 

 

 

 

 

its appropriations targeted to support them, including both competing and noncompeting awards. As the NINR’s funding rose, however, 

the trend in awards changed. In its initial years on the NIH campus, 

nursing research funded a higher percentage of new grants because there 

were few continuing projects. Over time, however, nurse investigators 

became more successful in getting longer-term grants, which committed 

funds for several years. Moreover, many projects in the NINR portfolio involved clinical research, which was more expensive. Coupled with 

the increasing average cost of grants, there was less funding available 

for new competing grants, despite higher appropriations. This situation 

made the need for collaborative agreements and partnerships with other 

institutes even more critical to stretch research dollars and maintain a 

growing pool of nurse scientists.42 

During these years the NINR also began to compete successfully 

for funds from the Office of the NIH Director. Two of these were particularly innovative: Shannon Awards provided discretionary funding 

to support scientists whose grant applications just missed the cut 

in any given major grant application cycle, and Academic Research 

Enhancement Awards supported smaller projects not covered by 

major NIH research grants. The NINR also competed effectively for 

funding from the Office of Research on Women’s Health and the Office 

of Research on Minority Health. 

With the support of the NIH director, the NINR had taken a leadership role within NIH for research on end-of-life (EOL) care. In the 

fall of 1997, the NINR co-sponsored a workshop to discuss managing 

symptoms in terminal illness. As a result, NIH provided the Institute 

with additional funding to support research in this area. In doing so, 

Varmus provided the NINR with both a challenge and an opportunity. 

It was up to nurse investigators to respond. Speaking at a conference 

of the American Association of Colleges of Nursing, Grady urged the 

nursing community to submit proposals for EOL care research. A 

year later Grady termed the response to the EOL research initiative 

“excellent” and looked forward to the scientific advances that would 
140 Bringing Science to Life 

emerge from that work. The EOL program was unique also because of 

its interdisciplinary nature. 

By the late 1990s, increased funding allowed the NINR to expand 

its research and centers programs as well as its professional outreach. 

The future for nursing science looked bright, according to Grady. She 

encouraged nurse scientists, especially young professionals, to take 

advantage of all the possibilities. The NIH campus offered research 

opportunities for nurse scintists that “would be difficult or impossible 

elsewhere,” Grady said. “The enormous breadth of expertise across 

disciplines and diseases, a unique mix of intellectual and physical 

resources, and the proximity of clinical and basic researchers,” she 

noted, “create a rich environment for training and mentoring of young 

investigators.”43 

By the end of the twentieth century, the traditional paths of 

inquiry in nursing science—low birthweight, pain, chronic illness, 

and care for the elderly—were growing in significance as public health 

problems, influenced by demographic shifts, scientific and technological advances, and epidemiological trends. The aging of the population, 

the rise in chronic conditions, and the proliferation of treatment-resistant strains of known pathogens would alter the future of health care, 

Grady told a gathering at the Joint Center for Nursing Research and the 

School of Nursing at the Vanderbilt University Medical Center in 1999. 

So, too, would knowledge about human genetics result in new technologies that would improve the ability to diagnose and treat people. 

In addition, shifting population patterns would lead to an emerging 

majority of people of different cultures who were once in the minority. 

As a result, “health care team roles and functions will become more 

responsive,” she predicted.44 

Over the first two decades of the twenty-first century, the population cohort known as the “baby boomers” would enter the time of 

life when chronic illness was more common. The size of the generation was likely to overwhelm traditional systems, Grady believed. 

Because chronic conditions were the leading cause of illness, disability, 
From Nursing Research to Nursing Science 141 

The NINR works to eliminate health disparities. Here, Dr. Grady poses with (left) Dr. Clifton 

Poodry, director of the National Institute of General Medical Sciences’ Minority Opportunities 

in Research Programs, (right) Dr. John Ruffin, director of the National Center on Minority 

Health and Health Disparities and (far right) Dr. Betty Smith Williams, president of the 

National Coalition of Ethnic Minority Nurse Associations. 

and death in the United States, health care costs required to meet this 

demographic shift would increase dramatically. As nursing research 

had long focused on efforts to understand and manage the symptoms 

associated with chronic illness and the prevention of related complications and disability, Grady saw the shift as a rich opportunity for nurse 

investigators. The same was true for genetic advances. As researchers 

closed in on completing the mapping of the human genome, scientific 

knowledge about predisposition to disease would rapidly accelerate. 

However, as new knowledge about genetics was absorbed into health 

care practice, people would face hard decisions about being tested 

for genetic diseases. Grady believed that, because nursing offered 

a patient-oriented rather than disease-oriented perspective, nurse 

scientists had an especially important role to play in the genetics of 

symptom management. As a result, the NINR began offering postdoctoral fellowships that linked training in nursing research and genetics 

and encouraged currently funded investigators to add a genetic component to their research projects.45 

The NINR also recognized the importance of the ethnic and 

cultural changes occurring in the country. Waves of immigration 
142 Bringing Science to Life 

from Latin America and Asia had a profound impact on the traditional 

delivery of health care in the country. Nurse investigators recognized 

that certain community-based health programs had failed to reach 

immigrant and other vulnerable populations. When they brought 

greater cultural sensitivity to the programs, including Spanish language 

assessment questionnaires, and targeted health behaviors that placed 

ethnic groups at risk, they became much more successful. The NINR 

began another initiative in self-management strategies for diabetics 

that included cultural, ethnic, and age-related factors. The Institute also 

responded by enhancing its outreach activities to underserved groups 

in collaboration with the National Coalition of Ethnic and Minority 

Nursing Associations. The NINR was instrumental in forming the 

coalition whose membership consisted of the major minority nursing 

organizations. Out of this partnership, the NINR sponsored a major 

conference, “Minority Health Research Development,” in the summer 

of 2000 to identify minority research plans and assist career development of minority nurse researchers.46 

The graying of the United States gave greater impetus to the 

NINR’s leadership role within NIH for EOL research initiatives. The 

goal was to establish additional empirical evidence to improve care for 

those approaching death. In 1996 the National Advisory Council for 

Nursing Research (NACNR) identified EOL research as a key initiative. 

NIH appointed the NINR as the lead institute the following year, in 

large part, due to its extensive research activities in pain management, 

clinical bioethics, and symptom management, all of which served as a 

foundation for EOL studies.47 

Of all the institutes at NIH, the NINR focused most intently on 

symptom management research. Many patients at the end of life experienced the same symptoms regardless of their underlying medical 

condition. Pain, difficulty breathing, episodes of confusion and loss 

of concentration, loss of appetite and muscle wasting, nausea, fatigue, 

and depression were the most common symptoms, adding significantly 

to the suffering of patients and the burden on their families. Nurse 
From Nursing Research to Nursing Science 143 

 

scientists demonstrated that in many cases these symptoms could be 

treated or prevented and health care costs decreased.48 

For more than half a decade, the NINR had conducted research on 

symptom management through its Division of Intramural Research. It 

also funded a number of extramural programs on managing symptoms 

of AIDS patients and the aged. In the early 1990s, nurse scientists led 

by Dr. Mary Ropka from the Institute’s Clinical Therapeutic Laboratory 

(CTL), in cooperation with the NIAID and the NIH Clinical Center, 

initiated the first intramural study at the NINR to develop and test 

methods of managing HIV symptoms and side effects. In collaboration 

with the NIA, the CTL also studied incontinence and the prevalence of 

postoperative complications from hip fractures. The NINR’s participation in the Honolulu Heart Program and the Aging Asian Study, in 

collaboration with the NHLBI, expanded intramural research into the 

field of aging.49 

Extramural researchers also studied symptom management for 

While the NINR has moved into new research areas over the years, it has remained faithful to 

its longtime priorities, including HIV/AIDS research, as reported by Dr. Antonia M. Villarruel, 

PhD, FAAN, at the NINR’s twentieth anniversary symposium. 
144 

 

 

 

 

 

 

 

 

Bringing Science to Life 

patients at the end of life. Dr. Virginia Tilden of the University of 

Oregon examined how families reached decisions about withdrawing life support and the effects of the attitudes and behavior of health 

care professionals on the patient’s family. Tilden’s work provided 

clear guidelines for helpful behavior on the part of clinicians, an 

outcome extremely important for the state of Oregon, which was 

on the cutting edge of EOL care and death-with-dignity legislation. 

Other NINR studies revealed the need for more emphasis on advance 

directives.50 

NINR extramural researchers also worked on three other critical 

areas of terminal illnesses—pain management, breathing difficulties 

(dyspnea), and loss of appetite and muscle wasting (cachexia)—and 

the results of their research began to have an impact. Nurse scientists 

at the University of Wisconsin in Madison developed an educational 

intervention to provide patients with information about analgesic side 

effects and opioid use to improve patients’ appropriate use of pain 

medication. Dr. Jon D. Levine and Dr. Christine Miaskowski of the 

University of California, San Francisco, established that gender played 

a key role in pain relief, with women obtaining satisfactory relief from 

kappa-opioid drugs, which had fewer side effects than more typically 

used morphine-like opioids. Another researcher studied rats with 

cancerous tumors to test treatment interventions for loss of appetite 

in an effort to see if caloric intake could be improved by increasing the 

caloric content of the rats’ diet. Instead, the results indicated that the 

rats adjusted their food intake by eating less to maintain a steady caloric 

balance. A study on dyspnea conducted at the University of California, 

San Francisco, found that people with chronic obstructive pulmonary 

disease could differentiate between the distress and anxiety associated 

with difficult breathing and symptoms associated with other stressors, 

leading to more specific treatments to manage the symptom.51 

Most nurse investigators acknowledged that there was much 

research yet to be done on EOL care. At an NINR-sponsored Terminal 

Illness Workshop, participants recommended collecting better 
From Nursing Research to Nursing Science 145 

epidemiological data on the incidence and co-occurrence of symptoms 

for EOL patients; conducting basic research on the mechanisms and 

interactions of these symptoms and on pharmacologic interventions, particularly opioid receptors; and increasing clinical research 

into drug therapies as well as mobilizing psychosocial and spiritual 

resources to mediate the perception and interpretation of symptoms. 

Research methods for EOL inquiry needed standardization. “There are 

pressing needs to better define key concepts, identify and test appropriate measures, and devise methods for complex data analysis,” Grady 

explained to a group at the Institute of Medicine. “In addition to basic 

research into the epidemiology and pathophysiology of symptoms 

and the mechanisms of symptom relief,” she said, “the foundation for 

improved care at the end of life requires social, behavioral, and health 

services research.” She also indicated that more needed to be “understood about the emotional, social, cultural, and spiritual experiences of 

people who are dying and about the attitudinal, organizational, legal, 

cultural and other factors which influence the care of those persons.” 

In light of its contributions to the knowledge base underlying the interaction of human biology and behavior, the NINR, Grady assured the 

meeting, would be an effective leader for the nine institutes, centers, 

and agencies co-sponsoring EOL research.52 

In addition to the challenges provided by changes in demographics, genetics, and environmental issues in the 1990s, some 

believed—though many disagreed—that nursing research faced a 

potential threat from the trend to managed care. With its emphasis 

on price controls, managed care was changing the practice of medicine 

and influencing the conduct of biomedical research. By the mid1990s, many health professionals believed that managed care had 

caused a paradigm shift in health care and its long-range implications 

for science. At an NIH conference titled “Managed Care: Crisis and 

Opportunity for Biomedical Research” and coordinated by the NINR 

and the nursing department at the Clinical Center, Grady noted several 

concerns with the new developments, especially as they pertained to 
146 Bringing Science to Life 

clinical trials. She wondered if patients in managed care would be 

available for clinical trials or if research dollars would become more 

scarce as managed care organizations (MCOs) sought to reduce or 

eliminate payments for activities that did not immediately benefit the 

patient. It was a critical issue for nurses, Grady said, as “the success of 

clinical research, particularly clinical trials, is often dependent upon 

”53 nurses.

The complexities of the shift in health practices that managed care 

caused were just beginning to be understood. A study conducted at the 

Vanderbilt School of Nursing noted some of these changes. According 

to the school’s dean, Dr. Colleen Conway-Welch, if there were to be a 

trial including managed care patients, any MCO would want to be part 

of the planning, not simply presented with an already designed trial. 

Their databases were designed for business needs, not for research, she 

explained. Moreover, MCOs were interested in quick answers. An 

eighteen-month study, for example, would be seriously disrupted by 

patients leaving the study by switching MCOs at the annual window 

for changing providers, thereby damaging data designed for a full 

study and the possibility of follow-up.54 

Nevertheless, Conway-Welch noted that there were significant 

mutual interests between MCOs and nursing research. MCOs, she 

said, “value prevention, patient education, screening, early detection, 

and comprehensive treatment plans—all of which mesh well with 

nurses’ values.” Lowering costs was another area of mutual interest, 

added Dr. Dorothy Brooten of the Frances Payne Bolton School of 

Nursing at Case Western Reserve University. She presented several 

examples of how nurse-directed transitional care of women with highrisk pregnancies had fewer rehospitalizations and low birthweight 

infants, reducing hospital charges by 40 percent. “These sorts of 

numbers make bookkeepers sit up and take notice,” she said. “Nursing 

research is one of the best investments managed care can make.” The 

key, she emphasized, was to get the word out about the value of nursing 

research to the MCOs. Both women agreed that representatives of 
From Nursing Research to Nursing Science 147 

managed health care companies needed to be included in nursing 

conferences, that nurse researchers needed to write op-ed pieces, and 

that the profession needed to do a better job of highlighting its successes to Congress and the public. “We should try to get published in 

USA Today,” Conway-Welch suggested. “Nurse investigators who are 

proactive and tenacious and who aggressively market their studies will 

be the most likely to thrive.” Grady moved to include MCOs in the 

NINR’s planning by naming Jean R. Marshall, the corporate vice president of Meridian Health Systems, to the NACNR in 1998.55 

Near the end of the twentieth century, Grady reflected on the 

achievements of research in advancing health care. She cited improvements in imaging techniques, molecular biology, and genomic 

mapping as factors changing the way health care would be delivered 

in the future. While the NINR had accomplished much as a small 

and very new institute, Grady believed that few understood those 

accomplishments. “One of my goals,” she said, “is that within five 

In 1998 Dr. Grady welcomed five new members to the National Advisory Council for Nursing 

Research. Reflecting Dr. Grady’s desire to include current concepts of health care in the NINR’s 

planning was the appointment of Jean R. Marshall (2nd from left), corporate vice president of 

Meridian Health Systems. Also pictured (from left): Gene A. Blumenreich, Sarah J. Sanford, Dr. 

Grady, Dr. Kathleen Buckwalter, and Dr. Curtis L. Patton. 
148 Bringing Science to Life 

Dr. Loretta Sweet Jemmott, one of the foremost researchers on behavioral interventions for 

HIV/AIDS, particularly among African-American adolescents and adult women. At right, 

Dr. Monique Howard, of the New Jersey Women and AIDS Network, looks on. 

years, everyone will be able to cite examples of how nursing research is 

making a difference.” To achieve this, nursing research translated into 

clinical practice—“from bench to bedside”—needed to be the focus for 

nurse scientists, she argued. The NINR’s goal in this equation was to 

encourage and sponsor the science that would “bring life to research 

and research to life.”56 

As part of the program to broadcast the accomplishments of 

NINR-sponsored research, Grady praised the work of selected nurse 
From Nursing Research to Nursing Science 149 

 

 

  

 

 

 

 

 

 

 

investigators whose pioneering work led to new understandings of 

the impact of nursing research on patient care, the health care environment, and clinical practice. She cited the work of Dr. David Olds, 

whose studies in Elmira, New York, and elsewhere established that 

home visits by registered nurses significantly lowered mothers’ high 

blood pressure during pregnancy. He also determined that the visits 

reduced abuse and neglect of the children. Olds’s Nurse-Family 

Partnership demonstrated that nurse-visited mothers were more likely 

to enter the workforce and had fewer pregnancies before the first child’s 

second birthday. Children in the program also demonstrated better 

language and behavior skills than nonparticipants. Another NINR 

pioneer investigator was Dr. Loretta Sweet Jemmott of the University 

of Pennsylvania School of Nursing. One of the foremost researchers on behavioral interventions for HIV/AIDS, her development of 

gender-appropriate, culturally sensitive programs for hard-to-reach, 

vulnerable populations reduced sexual risk behaviors for HIV, particularly among adolescent male African-Americans. Subsequently, the 

Centers for Disease Control and Prevention distributed her program, 

“Be Proud! Be Responsible!” throughout the nation. Along similar 

lines, the research of Dr. Martha Hill of The Johns Hopkins School of 

Nursing, using multidisciplinary health teams, successfully developed 

and tested strategies to improve hypertension control in young, inner 

city African-American males.57 

The NINR also targeted health disparities as a major research focus, 

which required community-based interventions that would teach selfmanagement and other techniques to improve health behaviors. Dr. Kate 

Lorig, a senior researcher at the Stanford School of Medicine, applied a 

culturally sensitive self-management program at the community level 

for Spanish-speaking Hispanics suffering from chronic diseases such as 

heart disease, arthritis, type-2 diabetes, and lung disease. She found that 

participants in the program had improved health and energy, required 

fewer emergency room and physician visits, and were better able to 

manage their disease and to improve the quality of their lives.58 
150 Bringing Science to Life 

Dr. Kate Lorig found that Spanish-speaking Hispanics with arthritis, diabetes, or lung disease 

were better able to manage their disease when she applied a culturally sensitive self-management program at the community level. 
From Nursing Research to Nursing Science 151 

 

 

 

 

 

 

 

 

 

 

 

 

   

 

 

 

 

 

 

 

 

Of critical interest to nurses nationwide was the impact of staffing 

levels and working conditions on patient care. In a series of studies 

funded by the NINR, Dr. Linda Aiken, a professor of nursing and sociology at the University of Pennsylvania, demonstrated that hospital 

working conditions and the adequacy of nurse staffing per patient 

could significantly affect patient recovery. In hospitals where nurses 

had lower patient workloads, she found that patients had substantially 

lower mortality rates.59 

Aiken’s research, as well as that of others, was applicable to efforts 

to improve the health care, and consequently lower the health care 

costs, of the elderly. For example, in 2003 the American Hospital 

Association estimated that the total direct health care expenditure 

for elders with heart failure exceeded $24 billion annually. Since 

1989 Dr. Mary Naylor, a professor of gerontology at the University of 

Pennsylvania School of Nursing, had conducted three NINR-funded 

clinical trials focusing on discharge planning and follow-up of highrisk elders by advanced practice nurses. Naylor’s research aimed 

at reducing health care costs while improving health outcomes. 

She learned that customized intervention for the experimental 

group dropped costs by one-third when compared to routine care 

and improved outcomes by nearly 15 percent—results that helped 

change nursing practices for the elderly. Similarly, nursing homes 

and hospitals nationwide adopted the work of Dr. Nancy Bergstrom 

of the University of Texas School of Nursing. Bergstrom tested the 

Braden scale for predicting risk of pressure sores and found it to be 

quite accurate. As a result of her work, the Agency for Healthcare 

Research and Quality incorporated the scale into its Clinical Practice 

Guidelines. Since then, nursing homes and hospitals have used the 

guidelines to identify patients susceptible to pressure sores.60 

One of the most complicated issues nurses face is how to care 

for patients who are chronically critically ill. In a three-year, NINRsupported study at Case Western Reserve University, Dr. Barbara Daly 

and her team studied an intervention designed to reduce health care 
152 Bringing Science to Life 

Among other things, Dr. Linda Aiken demonstrated that working conditions and nurse staffing 

levels could significantly affect patient recovery and mortality rates. 

costs and improve outcomes for the chronically critically ill who are 

released from hospitals. Daly learned that the best way to care for these 

patients was to treat them in an environment that is designed for longterm care. The most important element for a chronic patient’s physical 
From Nursing Research to Nursing Science 153 

Dr. Mary Naylor’s research 

focused on reducing costs while 

improving outcomes for highrisk elders. Below, advanced 

practice nurses working on Dr. 

Naylor’s NINR-funded heart 

failure study. 

Left to right: JoAnne Konick-McMahan, M. Brian Bixby, Catherine McKenna. 
154 Bringing Science to Life 

and emotional well-being was continuity of nursing staff support. For 

these patients, Daly said, “it’s not the therapy, it’s the nurses.”61 

The Center for Research in Chronic Disorders at the University of 

Pittsburgh School of Nursing is studying another significant element 

in examining the management and self-management of the treatment 

of chronic disorders. Headed by the school’s dean, Dr.  Jacqueline 

Dunbar-Jacob, the NINR-funded center has focused on a combination of variables in chronic disorders, including the level of adherence 

to treatment in both patient and provider, management of treatment 

regimens, quality of life, functional status, and co-morbid conditions, 

and the central role that adherence plays in clinical outcomes. In 

addition to its research, the center provides mentorship and support 

for new and seasoned investigators and the dissemination of new 

knowledge about the care and treatment of persons experiencing 

chronic disorders.62 

Through such research initiatives, Grady said, NINR-funded 

investigators were reducing the impact of illness, improving the quality 

of life for the chronically ill, reducing health care costs, and changing 

both the clinical practice of nursing and the delivery of health care. 

“We are,” she proudly told a gathering of nurse scientists, “making a 

difference.”63 

In 2006, twenty years after the creation of the NCNR at NIH, the 

NINR developed a new five-year strategic plan “to advance nursing 

science through research.” A long-standing leader in integrating biological and behavioral science, the NINR believed that the field of 

biobehavioral research—the study of the interactions among biological, 

behavioral, and social factors and their effects on outcomes—distinguished nursing science from other NIH institutes. According to the 

plan, the NINR intended to remain a leader in applying the results 

of this interdisciplinary research and in expanding and improving nursing science methods. The Institute also planned for nurses 

to stay at the forefront of new technologies, especially for screening, 

symptom monitoring, and detection and delivery of interventions, 
From Nursing Research to Nursing Science 155 

such as the applications of telehealth. To assure a solid foundation 

for future research, a critical mission for the NINR was to prepare the 

next generation of nurse scientists and nursing faculty and to increase 

the number of them holding PhDs. Moreover, the NINR would not 

only make research opportunities more available, Grady announced, 

but also make the activities and events at the Institute, the findings of 

its investigators, and general information about nursing science more 

available through the Internet via an updated Web site and podcasts.64 

The differences in the training of Hinshaw and Grady accentuated the changes that had occurred at the NINR since its inception. 

Hinshaw, a nurse whose graduate training was in sociology, represented the first steps in advancing nursing science. In contrast, Grady 

was trained in neurology, a basic “bench” science better understood 

and, accordingly, accepted than sociology by other scientists at NIH. 

Grady led the NINR in a harder science direction, something Hinshaw 

could not have accomplished because, in part, the nursing profession had not yet created enough trained investigators to conduct the 

research. Nevertheless, the careers of both women reflected the evolution of nursing science, each building on the accomplishments of those 

nurse scientists who came before them. For years, graduate schools 

of nursing had encouraged researchers to get clinical experience after 

their bachelor’s and master’s degrees. As a result, most nurse scientists did not earn their doctorates until they were in their mid-forties, 

thereby delaying their research careers and limiting the length of time 

they had to actually do research. The training of younger nurse scientists took time. Both leaders saw the need to create a sufficient cadre 

of nurse investigators who would build careers around their program 

of research. The NINR spent more than twice the percent of its overall 

budget on training as compared to the NIH average for pre-doctoral 

and postdoctoral students. The policy paid off. Applicants for NINR 

grants increased more proportionally than those for all other institutes. By the end of the century, graduate schools, through research 

opportunities largely funded by the NINR, had increased the number 
156 Bringing Science to Life 

of “fast-track” nurse scientists and thereby steered nursing science into 

the mainstream of NIH research.65 

Grady was the embodiment of what many had in mind in the 1980s 

when they pushed for nursing research to become part of the mainstream of biomedical and behavioral science at NIH. She approached 

her job the same way a scientist approached a problem, she told The 

NIH Record in late 2000. “Collect the data, analyze it, look for the 

best possible approaches and solutions, weigh them and then make a 

decision.” Grady pushed nursing research, while respecting its core, to 

be more like research at other institutes—both an integral part of and a 

vital partner to the work done throughout NIH. “Interrelationships of 

mind and body—between biological and behavioral—are increasingly 

under study at NIH,” she wrote in a survey of the nursing profession 

published in 2001, “and nursing research has long been active in this 

area of inquiry. NIH scientific activities in prevention also benefit from 

nursing contributions,” she continued, and suggested that “together, 

NIH and NINR emphases coincide with national health concerns, 

such as prevention of low birthweight, reduction of cardiovascular 

disease and cancer, reduction of obesity, and issues surrounding endof-life and palliative care.” Whatever changes were shaped by scientific 

breakthroughs, changing economic and demographic trends, or new 

health care theories, Grady believed that health research, health care, 

and health choices were increasingly interdependent and insisted 

that the NINR be fully responsive to those changes in order to meet 

future health care issues head on. “If nurses think they’re interested 

in research,” Grady said, “they should just jump in.” And the NINR 

would provide the support to make it happen.66 
From Nursing Research to Nursing Science 157 

Chapter 4 Endnotes 

1	 See Patricia Moritz, telephone interview by Philip L. Cantelon, March 13, 2008, 

18-19; Suzanne S. Hurd, “The National Institute of Nursing Research of the 

National Institutes of Health,” Nursing Outlook 43, no. 2 (March/April 1995): 89. 

2	 Marquis Who’s Who in America, 2009. 

3	 Suzanne S. Hurd, “RX for a Healthy NINR,” Nursing Research 44, no. 1 (JanuaryFebruary 1995): 3. 

4	 See Patricia A. Grady, “A Brief History of Nursing Research,” September 11, 1996, 

NINR Records, Grady Folder. 

5	 Hurd testimony to the House Subcommittee of the Committee on 

Appropriations, 104th Cong., 1st sess., part 4 (March 22, 1995), 982-83. 

6	 Ibid., 983. 

7	 Hurd, “RX for a Healthy NINR,” 3. 

8	 Hurd, “The National Institute of Nursing Research,” 92; Hurd, “RX for a Healthy 

NINR,” 1, 3. For an explanation of grant activity codes, see http://grants.nih.gov/ 

grants/funding/ac_search_results.htm. 

9	 Hurd, “The National Institute of Nursing Research,” 91-92. 

10	 Patricia A. Grady, telephone interview by Philip L. Cantelon, January 26, 2009, 

19, 15 (hereafter Grady Oral History). 

11	 Grady curriculum vitae, January 2009; Grady Oral History, 12-14, 16. 

12	 Grady Oral History, 15-17. 

13	 Ibid., 18-19. 

14	 Grady curriculum vitae, January 2009; Grady Oral History, 1-4. 

15	 Grady curriculum vitae, January 2009; Grady Oral History, 9. 

16	 Grady Oral History, 9-10; Grady curriculum vitae, January 2009. 

17	 Grady Oral History, 21. 

18	 Ibid., 22-23, 25-26. 

19	 “The NINDS’ Patricia Grady to Lead Nursing Institute,” The NIH Record 47, no. 7 

(March 28, 1995): 1, 4. 

20	 Patricia A. Grady, “Support for Women Scientists,” AWIS Magazine 24, no. 3 

(May/June 1995): 24-25. 

21	 Ibid., 28-30; NIH News, n.d., Press Release on Patricia A. Grady Appointment, 

NINR Records, Box A, Folder: NINR Resources. 

22	 Grady testimony to the House Subcommittee of the Committee on 

Appropriations, 104th Cong., 2nd sess. (March 1996), part 4, 1866, 1868, 1889 

(hereafter Grady Testimony). 
158 Bringing Science to Life 

23	 Lynn Holladay Avery, “Nurse Education Act and National Institute for Nursing 

Research Funding in Jeopardy,” AORN Journal 62, no. 2 (August 1995): 279. 

24	 NINR, “Economic Benefits of Research,” September 7, 1995, 1-3, NINR Records, 

Box 17, Folder: Misc. Clips. This document was written by the Office of Public 

Affairs and Education in May 1995 and released in the fall. Avery, “Nurse 

Education Act,” 281. 

25	 Biographical Directory of the United States Congress, 1774-1989 (Washington, 

D.C.: Government Printing Office, 1989), 1662; Grady Testimony, 1902. The 

Genome Center became an institute in 1997. 

26	 Grady Testimony, 1898, 1867. It is important to keep in mind that, as a member 

of the executive branch, the director’s request must mirror the request of the 

President. 

27	 Marianne Glass Duffy, “Hundreds Celebrate NINR’s Tenth Anniversary,” The 

NIH Record 48, no. 24 (November 19, 1996). 

28	 Patricia A. Grady, “Landmark Anniversary for Nursing Research at the National 

Institute of Health,” Image: Journal of Nursing Scholarship 28, no. 1 (Spring 1996): 

4. 

29 Ibid., 5; Patricia A. Grady, “NINR and the Nursing Research Community: The 

Next 10 Years...The Next Century,” Nursing Outlook 45, no. 1 (January/February 

1997): 43. 

30 Grady, “NINR and the Nursing Research Community”; see also Grady 

Testimony, 1866. About this time, leadership in the NIH pain research initiative was shifting from the National Institute of Dental Research (now National 

Institute of Dental and Craniofacial Research) to the NINR and the National 

Institute of Neurological Disorders and Stroke. See http://www.history.nih.gov/ 

exhibits/pain/docs/page_13.html. 

31 Grady quoted in Mary de Chesnay, “National Institute for Nursing Research 

Update: Interview with Dr. Patricia Grady,” Advanced Practice Nursing Quarterly, 

Winter 1996, 22. 

32	 NINR, Fact Sheet, August 31, 1995, passim, NINR Records, Box A (no folder). 

33	 Hilary D. Sigmon, Patricia A. Grady, and Lynn M. Amende, “The National 

Institute of Nursing Research Explores Opportunities in Genetics Research,” 

Nursing Outlook 45, no. 5 (September/October 1997): 215-16. 

34	 Ibid. 

35	 Ibid., 216-17. 

36	 Ibid., 217. 

37	 Ibid., 217-19; see also, Hilary D. Sigmon, “Linking Critical Care Nursing and 

Genetics with Research Funding Opportunities,” AACN Clinical Issues 9, no. 4 

(November 1998): 569-73. 
From Nursing Research to Nursing Science 159 

38	 Patricia A. Grady, “Intramural Research and Training at NINR,” Nursing Outlook 

55, no. 4 (July/August 2007): 209. 

39	 Patricia A. Grady, J. Taylor Harden, Patricia Moritz, and Lynn M. Amende, 

“Incorporating Environmental Sciences and Nursing Research: An NINR 

Initiative,” Nursing Outlook 45, no. 2 (March/April 1997): 73-74. 

40	 Ibid., 74. 

41	 Ibid., 75. 

42	 NINR Update, March 13, 1998, passim, NINR Records, Box H, Folder: Speeches, 

Vol. 3. 

43	 Ibid. 

44	 Patricia A. Grady, “Future Trends for Nursing and Nursing Research,” speech at 

the Vanderbilt University Medical Center, February 2, 1999, NINR Records, Box 

H, Folder: Speeches, Vol. 4. 

45	 Ibid. 

46	 Ibid.; Patricia A. Grady, “National Institute of Nursing Research: Director’s 

Update,” speech to the American Association of Colleges of Nursing, October 

16-19, 1999, NINR Records, Box H, Binder: Speeches – Office of Science 

Planning and Public Liaison; Patricia A. Grady, “Future Directions in Outcomes 

Research: A National Perspective,” speech to the Ann May Center for Nursing, 

November 12, 1999, NINR Records, Box H, Binder: Speeches, Vol. 5. 

47	 Patricia A. Grady, “End-of-Life Research: Directions for the Future,” speech to 

Institute of Medicine, National Academy of Sciences, April 9, 1999, 1-4, NINR 

Records, Box 18, Folder: Long Range Plan. 

48	 Ibid., 8-9. 

49	 NINR, Annual Report for Fiscal Year 1994, 7-8, 11; Grady, “End-of-Life 

Research,” 8-9. 

50	 Robert Wood Johnson Foundation, “Researchers Study End-of-Life Care in 

Oregon,” September 1, 2006, http://www.rwjf.org/pr/productjsp?id=17099. 

51	 Patricia A. Grady, “NINR: The First 20 Years,” speech to the 20th Annual Pacific 

Nursing Research Conference, March 22, 2007; Grady, “End-of-Life Research,” 

4-5. 

52	 Grady, “End-of-Life Research,” 10-15. 

53	 Lisa Esposito and Cynthia Saver, “Will Research Survive Managed Care?” (n.d. 

[1997]), NINR Records, Box 19; The NIH Record, March 25, 1997. 

54	 The NIH Record, March 25, 1997. 

55	 Conway-Welch and Brooten quoted in Grady speech, “NINR: The First 20 Years”; 

The NIH Record, August 11, 1998. 
160 Bringing Science to Life 

56	 Patricia A. Grady, “Bringing Research to Life,” Applied Nursing Research 11, no. 1 

(February 1998): 1; Robert Bock, “NINR’s Grady Manages Science with Science,” 

The NIH Record, November 28, 2000. 

57	 Grady speech, “NINR: The First 20 Years”; Andy Goodman, “The Story of David 

Olds and the Nurse Home Visiting Program,” Robert Wood Johnson Foundation 

(July 2006), 14. Dr. Martha Hill was the first non-physician to serve as president 

of the American Heart Association. 

58	 Kate R. Lorig, et al., “Hispanic Chronic Disease Self-management: A 

Randomized Community-based Outcome Trial,” Nursing Research 52, no. 6 

(November-December 2003): 361. 

59	 Grady speech, “NINR: The First 20 Years.” 

60	 Ibid. 

61	 Barbara Daly, “Chronic Critically Ill Patients Pose Special Challenges,” AACN 

News 18, no. 1 (August 2001). 

62 University of Pittsburgh School of Nursing, “Faculty Interests: Jacqueline 

Dunbar-Jacob,” www.pitt.edu/~nursing/biosketches/dunbar_jacobbio.html. 

63	 Ibid. 

64	 Grady speech, “NINR: The First 20 Years.” 

65	 Bock, “NINR’s Grady Manages Science with Science”; Megan Flaherty, “Making 

Its Mark: Institute of Nursing Research Gaining Clout at the NIH,” Nurse Week/ 

Health Week, May 6, 1999, copy in NINR Records, Box G, Folder: NINR in the 

News, May 1999. 

66	 Bock, “NINR’s Grady Manages Science with Science”; Patricia A. Grady, “The 

Future of Nursing,” in Norma L. Chaska, ed., The Nursing Profession: Tomorrow 

and Beyond (Thousand Oaks, CA: Sage Publications, Inc., 2001), 894, 902. 

The NINR’s early support of cost effectiveness research led to a 

program that saved $18,560 per infant in hospital and physician costs 

while improving the neonatal environment. 
Speaking the 

Language of Science5

Chapter 5 

For the past twenty-five years, from its earliest days as the National 

Center for Nursing Research (NCNR) until today, the National Institute 

of Nursing Research (NINR) has steadfastly supported both basic and 

clinical science, the training of nurse scientists, and the development 

of individual, community, and public health strategies to improve the 

health of the nation. In the spring of 1987, NCNR acting director 

Dr. Doris Merritt explained the multidisciplinary nature of nursing. 

She noted that nursing research broadly encompassed “studies relevant 

to individual responsibility for wellness and the diagnosis, treatment, 

and prevention of disease” and included “both the scientific inquiry 

into fundamental biomedical and behavioral processes relevant to 

nursing and study of the applications of nursing interventions in 

patient care.” Merritt also highlighted the NCNR’s efforts to “enrich 

the research training of top caliber nurse scientists” and “assure that 

properly prepared nurse investigators will continue to contribute their 

unique point of view to health care.” Such efforts included emphasis 

on individual postdoctoral training opportunities in established 

National Institutes of Health (NIH)-funded research centers, as well 

as NCNR-initiated career development awards for nurse scientists and 

NCNR-provided institutional research training opportunities for both 
164 Bringing Science to Life 

pre- and postdoctoral trainees. It was the NCNR’s intention, Merritt 

emphasized, to ensure “that the nurse scientists of the future will be 

adequate in number and extremely well qualified.” For the first time, 

nursing science would have the funding and the flexibility to tackle the 

broad demands of the nation’s health care issues.1 

But the challenges for nursing science became far more complex 

than professional leaders might have imagined. By the 1980s, public 

officials faced new sets of public health questions on a scale largely 

unanticipated by previous generations. As America’s population aged, 

officials focused on treating chronic and degenerative diseases such 

as Alzheimer’s disease and dementia, pain management, and end-oflife (EOL) care. The spread of highly infectious and mutating viruses 

presented fresh challenges to affected communities and caretakers. In 

each case, questions arose regarding a patient’s symptoms and quality 

of life, the long-term costs of treating the diseases, and the impact on 

families and communities. New genetic technologies opened previously unimagined research paths. The NCNR/NINR’s efforts to fund 

basic and clinical scientific inquiry and train nurse scientists put it in 

the vanguard of contemporary public health concerns. The NINR’s 

mission was simple and direct: “To strengthen nursing practice to 

promote health, prevent disease, and ameliorate the effects of illness 

and disability through the support and conduct of research, research 

training, and dissemination of research results.” NINR director 

Dr. Patricia A. Grady emphasized this responsibility, noting the NINR’s 

goal of advancing “nursing science by integrating biological and behavioral science for better health, adopting, adapting, and generating 

technologies for better health care, improving research methods, and 

developing nurse scientists for today and tomorrow.” Reflecting on 

NINR’s history, Grady characterized the Institute’s role in the advancement of nursing research in the United States as “a journey,” the result 

of which “is not only the advancement of nursing science but also the 

improvement in the health and well-being of millions of Americans 

and countless numbers worldwide.”2 
Speaking the Language of Science 165 

A key factor in the NINR’s advancement of nursing science has 

been its role in developing the National Nursing Research Agenda to 

establish funding priorities for investigators in the faculties of nursing 

schools and the nursing community. By the late 1980s, a few important 

developments made this possible. The Health Resource and Services 

Administration Division of Nursing had developed an initial cadre of 

nurse investigators within academic/clinical research positions, but 

the total number was small and the growth of nursing science frustratingly slow in the opinion of most nurse scientists. Nonetheless, these 

nurse investigators, products of an earlier focus on the preparation of 

researchers, provided an important foundation on which the NCNR 

could build. Only with large-scale federal funding could doctoral 

programs at schools of nursing prepare more scientists who recognized the importance of research to the profession, who conducted 

research in their own disciplines, and who possessed the skills to apply 

the research findings in practice. The establishment of the NCNR in 

1987 accelerated this shift in education from focusing primarily on the 

preparation of nurse scientists to mentoring graduate and postgraduate scientists in the more sophisticated research required to address 

current societal health care issues. The NCNR’s resources, though 

puny by NIH standards, provided nurse investigators with a stable 

source of funding and allowed the Center to set national priorities in 

the field.3 

NCNR officials determined that setting nursing research priorities was an important part of establishing excellence in nursing 

science, reasoning that research programs for nurse investigators that 

included series of studies in one common area, with one phase built on 

the results of the prior phase, would develop depth in the area of study 

and produce better science. As studies expanded knowledge through 

dialogue and critique among investigators, the logic went, the findings 

of the multiple studies would provide substantiated results that could 

be transferred into nursing practice. Setting research priorities as 

part of strategic planning for the discipline’s scientific programs thus 
166 Bringing Science to Life 

allowed the nursing community to establish specific directions for 

nursing research.4 

In early 1988, the NCNR and the National Advisory Council for 

Nursing Research launched the first of a series of national research 

agendas. Nurse scientists and policy makers agreed that the research 

priorities had to address major critical public health problems and 

contribute to improving clinical practices. The NINR and its advisors 

ultimately identified a number of research priorities over the next two 

decades including, to name but a few, symptom management, preventive health measures, health disparities, and the value of nursing care. 

Nurse investigators later seized on new research opportunities, such as 

those offered by the emerging field of genetics. These research priorities shaped nursing’s research agenda, producing scientific studies that 

contributed greatly to the development of nursing science and, in the 

process, produced several landmark studies that would change both 

nursing practice and people’s lives. Nurse investigators not only spoke 

the language of science, they also translated it into practical use.5 

Good science demanded good scientists, and the nursing profession had struggled to produce the number of highly trained 

PhD investigators needed to conduct advanced studies. Therefore, 

graduate training of nurse scientists was an immediate and critical 

priority. From the beginning, every director believed that the additional training opportunities offered by the NINR held great promise 

for the nursing community. Each highlighted the difference between 

the traditional course of nurse scientists and those involved in the NIH 

system. Experience with PhDs and MDs in the NIH system suggested 

that at least two to three years of postdoctoral research and training 

were necessary to produce a highly sophisticated, very capable, and 

competitive investigator. One director noted, however, that nurses 

typically began “their research careers later in life following extensive 

clinical practice.” Even if they went straight through to their terminal 

degree, nurse scientists traditionally received their PhD, DSN, or DNS 

and began teaching without engaging first in postdoctoral research 
Speaking the Language of Science 167 

The NINR has a long history of training nurse scientists for today and tomorrow. 

training. Moreover, the median age at which nurses completed the 

PhD work bore out the distinction of delayed terminal degrees. “Of 

those doctoral students who receive federal training funds, nurses 

complete[d] the PhD by median age 41 years as compared to age 30 

for basic biomedical PhDs, and age 32 for behavioral and social scientists.” The reason was simple. Nurses often pursued research careers 

only after obtaining advanced practice credentials and several years 

of clinical experience. Although nurses with advanced clinical backgrounds brought “vital questions and skills to the research arena from 

their practical experience in clinical and community settings,” when 

competing according to NIH standards, postdoctoral training was 

essential. For the first time, the Institute was not only “making it available, [it was] emphasizing it.”6 

To implement the policy, the NINR intensified efforts “to provide 

diverse training and career development programs that meet the 

needs of individuals along a continuum of academic and clinical 

backgrounds.” Officials believed that increasing the number of rigorously trained nurse scientists was “essential to the continued growth 
168 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Bringing Science to Life 

of nursing research programs.” The length of time needed to train 

nursing researchers, coupled with the later start of their studies, meant 

that trained researchers had fewer years to actually conduct research. 

By 2006, the Institute’s Strategic Plan included its commitment to 

programs offering not only high-quality training, but also innovative ways to address the disincentives to early and productive research 

careers. The NINR aimed to increase the pool of investigators and 

shorten the period from baccalaureate to the doctoral degree.7 

Over the years, the NINR developed a variety of tools to 

emphasize training for nurse scientists. By the mid-1990s, the cornerstone of the Institute’s research training program, the National 

Research Service Award (NRSA)—the authority under which NIH 

supported preparation of individuals for careers in biomedical and 

behavioral research through institutional grants and individual 

fellowships—had surpassed $4 million annually. NINR-sponsored 

NRSAs included individual predoctoral fellowships (F31s), individual postdoctoral fellowships (F32s), senior fellowships (F33s), 

institutional training awards (T32s), and minority training supplements. The NINR also utilized Academic Investigator Awards (K07) 

and Clinical Investigator Awards (K08) to provide opportunities for 

sponsored research beyond the NRSA program. In 1995, the NINR 

replaced such K07 and K08 awards with the revised K01 mechanism, 

the Mentored Research Scientist Development Award–Nursing, to 

provide scientists with a period of sponsored research in which to 

gain expertise in new research areas or areas that would enhance 

their careers.8 

The Institute also took advantage of partnerships with other NIH 

groups to train nurse scientists. Designed for postdoctoral students, 

the Nurse Scientist Training Program provided information regarding NIH resources, techniques in “grantsmanship,” and practical 

skills for building and advancing scientific careers. Early returns on 

the program proved positive; by the year 2000, 40 percent of the 181 

participants submitted applications. The NINR utilized its intramural 
Speaking the Language of Science 169 

program to sponsor interdisciplinary research training to exploit 

unique opportunities offered by the NIH campus, such as the National 

Cancer Institute Division of Cancer Epidemiology and Genetics’ 

invitation to postdoctoral nurse scientists to work alongside its intramural investigators. Addressing the gap in postdoctoral research 

training between medical and nursing scientists, the Institute offered 

Intramural Research Training Awards to postdoctoral nurse scientists 

in the early stages of their careers. Likewise, the Institute initiated a 

Career Transition Award (K22) to provide intramural training experiences to help postdoctoral students embark on research careers. These 

K22 awards combined support for research training in an NINR or 

other NIH intramural laboratory, with subsequent resources for independent research in an extramural institution. After completing such 

training, the NINR expected individuals to obtain a research project 

grant (R01) to continue their investigations.9 

Beyond expanding and restructuring its own training programs, 

the NINR also worked to coordinate and collaborate with underrepresented nursing groups and other governmental agencies concerned 

with nurse training. The Institute’s intensified focus on attracting 

nurses from underrepresented groups to biomedical and behavioral 

research careers played a key role in this effort, including work with 

the National Black Nurses Association and the National Association 

of Hispanic Nurses to inform their communities about NINR research 

and research training opportunities. In 2000 the NINR organized 

the Minority Health Research Development for Nurse Investigators 

Conference with more than thirty representatives from major ethnic 

and minority nursing associations. The two-day conference addressed 

health disparities and career development for nurses and resulted in 

a partnership between the NINR, the National Coalition of Ethnic 

Minority Nurse Associations, and the NIH Center on Minority Health 

and Health Disparities aimed at developing recommendations for the 

nursing agenda for minority health issues and nurse scientists. Further, 

the NINR collaborated with the NIH Center on Minority Health on 
170 Bringing Science to Life 

partnerships between schools of nursing at historically black universities and more research-intensive universities.10 

Since the first National Nursing Research Agenda, the NINR had 

for most of its history made symptom management a priority. The 

Institute urged investigators to develop effective assessment measures 

and intervention strategies for pain and other symptoms associated 

with acute and chronic illness, with an emphasis on bio-psycho-social 

parameters. This pain-related research fit well with the NINR’s goal 

of developing basic and clinical research, epidemiological studies, 

and training, all of which would address individual and community 

health issues. Early studies, for example, included an examination 

of the clusters of clues nurses used in assessing pain in children, the 

type of care they selected, and the evaluation strategies they used to 

determine the effectiveness of treatment. Center-funded studies also 

included research regarding the prevention of pressure sores through 

using an evaluation scale to predict bed sore risk in varied populations 

and settings and the effectiveness of transcutaneous electrical nerve 

stimulations—the application of low-voltage electrical current to the 

skin—in the healing process.11 

Characterizing pain as “a costly, critical health concern,” the 

Institute suggested that beyond the suffering it caused, pain might 

adversely affect immune function and be related to increased tumor 

growth. Beyond its traditional focus on managing the symptoms of 

pain, the NINR affirmed its desire for improved assessment measures 

and biobehavioral interventions to assist patients. The NINR supported both basic and clinical research on pain in close collaboration 

with many institutes, including the National Cancer Institute (NCI) 

and the National Institute of Dental Research. Drs. Jon Levine and 

Christine Miaskowski of the University of California at San Francisco 

conducted a study on postoperative pain management following dental 

surgery. They found that two kappa-opioids, nalbuphine and butorphanol, produced “significantly greater pain relief in women than in men, 

even though the women reported higher amounts of pain initially.” 
Speaking the Language of Science 171 

Understanding and managing pain is another of the NINR’s longtime priorities. Here, nurse 

scientists aim to gauge a youngster’s level of pain using an “OUCHER scale.” 

The results contradicted previous research indicating that kappa-opioids were not very effective in pain management. Unexpectedly, their 

findings stimulated advancements in the field of gender-based biology. 

The study suggested that the discrepancy in findings could be based on 

the previous studies’ recruitment of male subjects rather than women. 

This methodological bias obscured evidence that kappa-opioids could 

be a good analgesic choice for treating women’s pain, while a low dose 

actually intensified pain in men. The identification of this discrepancy 

and such implications underscored the value nursing science could 

provide in treating individual patients, as well as the science’s contributions to medical understanding of public health questions.12 

By the time Grady became director of the NINR, the Institute 

had taken the lead in a major research initiative on pain involving 

nine other NIH institutes. Grady’s leadership catalyzed the NINR’s 

interest in the phenomenon of pain at all levels, from the genetic and 

molecular, to the cell and organ, to the whole person. She noted that 

the NINR’s focus would be “to understand the physical and behavioral 
172 Bringing Science to Life 

mechanisms that compromise recovery and quality of life.” NINR 

researchers explored mechanisms for controlling pain, including 

genetic differences and changes in the brain’s control of hormones and 

immune response. Investigators examined how to prevent permanent 

establishment of neural pathways for pain that perpetuate the discomfort after the removal of the pain’s cause. Beyond that, the NINR 

provided resources for other pain-related research, including a collaboration with the National Institute of Arthritis and Musculoskeletal 

and Skin Diseases (NIAMS) regarding exercise programs for elderly 

with arthritis, as well as research suggesting that the use of antianxiety medications, such as Valium, to sedate patients before surgery 

blocked the effectiveness of the morphine to reduce pain after surgery. 

In keeping with its broader mission of supporting research to reduce 

health disparities, the Institute funded research for education, medication, behavioral change, and other protocols in treating sickle cell 

related pain.13 

The NINR’s pain research portfolio also included funding to 

study perioperative pain, or the pain experienced during the patient’s 

time under anesthesia, during the operation, and in the recovery 

room. Dr. Gayle Page’s work at Ohio State University and later at Johns 

Hopkins University examined the impact that painful stress from 

surgery could have upon immune function and in promoting tumor 

metastasis. Page used an animal model to assess the specific role of 

local, peripheral, and central pain mechanisms as well as the role of the 

brain’s control of hormones as a consequence of surgery. Specifically, 

Page investigated the impact of pain associated with surgery on natural 

killer cells, a subset of lymphocytes (a type of white blood cell) and 

the development of metastasis. She sought to determine whether pain 

relief would affect surgical suppression of the proliferation of lymphocytes and natural killer cell activity. Page’s research found that “surgery 

compromised the animal immune system’s ability to resist metastasis” 

and that providing morphine before and after surgery significantly 

decreased the “observed metastatic-enhancing effects of surgery.” As 
Speaking the Language of Science 173 

Grady noted, the study demonstrated “that management of pain is a 

physiologic necessity” requiring further research.14 

HIV and AIDS represented another high-priority research area 

for nurse investigators, an area where nurses’ clinical experience 

proved particularly advantageous. By the mid-1980s, health officials 

characterized HIV/AIDS as an epidemic and Congress prepared to 

fund a broad array of research projects to combat it. Countless editorials and public health officials pointed out the crucial role that 

federal health planning and research funding could play in battling 

the disease. At the time, Merritt emphasized that AIDS research was 

“an area of major importance to which nursing research can make a 

major contribution in the essential areas of prevention, education, 

acute and chronic care, and support of individual families coping with 

personal disaster.” Recognizing this importance, she noted that the 

NCNR was “encouraging research that assesses the health effects of 

various nursing interventions at different stages of the illness and in 

various settings” and “the cost-effectiveness of these interventions.” In 

addition, the NCNR invited research proposals that identified predictive factors, ethical issues related to diagnosis and treatment strategies, 

and public policy questions concerning AIDS and AIDS patients.15 

The NCNR used HIV/AIDS research to implement the Center’s 

broader goals of expanding programs at university research centers 

and with other institutes at NIH. A major focus was on the physiological aspects of HIV/AIDS and caregiving for patients with HIV-positive 

conditions, their partners, and their families. The NCNR budgeted 

$510,000 for AIDS research in fiscal year (FY) 1988 and requested 

$707,000 for the following year. By the end of 1988, the Center funded 

four multiyear AIDS-related studies, two at Johns Hopkins University, 

one at Case Western University, and a fourth at Rush University Medical 

Center in Chicago. As part of the Center’s effort to educate other NIH 

institutes about nurse scientists and to familiarize nurse investigators 

with other disciplines, the NCNR also held technology transfer conferences with the National Institute of Allergy and Infectious Diseases 
174 Bringing Science to Life 

(NIAID) targeted to nurses and social workers providing services to 

HIV-infected individuals. In addition, the NCNR worked with the 

NCI and the NIAID to develop and test protocols for the nursing care 

of patients with aberrant immune systems. Moreover, the Center 

contributed to decision making regarding AIDS policy through its participation in the NIH AIDS Executive Committee, the Public Health 

Service Executive Task Force on AIDS, and the National Institute of 

Mental Health (NIMH) AIDS Policy Subcommittee.16 

The NCNR underscored its sharpened focus on investigatorinitiated research that addressed the multiple dimensions of AIDS 

relevant to nursing practice. The Center planned an increased research 

emphasis for educational strategies to prevent and contain AIDS infection, ethical and public policy issues related to nursing and AIDS, and 

factors relating to nursing care of persons with AIDS and their families 

or partners. Center director Dr. Ada Sue Hinshaw stressed the importance of direct efforts toward “decreasing morbidity and increasing the 

individual’s ability to cope with symptoms from the disease in order to 

maximize the quality of life and diminish both economic and personal 

cost.” Each of these approaches fit within nurses’ experience in clinical 

research settings. Using science, they served the dual public health 

goals of the discipline: treating individual patients and improving 

health within the community at large.17 

The NCNR continued to stress the importance of AIDS research 

over the next few years. By the early 1990s, minority health, health 

disparities, and high-risk behaviors had become important public 

health issues; consequently, these topics received regular congressional 

scrutiny. The Center began seeking applications, in conjunction with 

the Agency for International Development, the National Institute on 

Aging (NIA), and the National Institute of Child Health and Human 

Development, for basic research to provide information concerning 

high-risk behaviors and behavioral changes related to the transmission 

of HIV throughout a person’s lifetime. The NCNR funded efforts to 

develop individualized, effective educational programs regarding safe 
Speaking the Language of Science 175 

 

 

 

 

 

 

 

 

 

sexual behavior for adolescents. Further, the Center sponsored extramural studies focusing on culturally sensitive prevention strategies for 

high-risk populations.18 

Intervention-based research continued throughout the late 1990s 

and early 2000s. As observed by Dr. June Lunney, an oncology nurse 

critical in establishing the NINR’s HIV/AIDS research program and 

portfolio, the shifting profile of HIV-infected persons from “a group 

of highly educated and motivated gay men to a very vulnerable 

population”—including disproportionate numbers of minorities and 

increasing numbers of women—required the identification of prevention methods targeted to different populations. By the end of the 

1990s, the NINR supported studies identifying or testing interventions 

to improve adherence to treatment regimens, including a communitybased project testing the impact of self-efficacy-based intervention 

that stressed patients’ ability and confidence to control symptoms 

and disabilities associated with the illness. Another study examined a 

phone-based intervention testing the benefits of a program of twelve 

independent sessions designed to improve patients’ daily drug-taking 

habits through the development of self-assessment and problem-solving skills. The NINR also provided resources for symptom management 

research, including information and communication skills-building 

programs to improve pain management in AIDS patients, programs 

to reduce high-risk behaviors, and studies of the effect of exercise on 

symptoms of HIV infections.19 

Research funding for the NINR’s HIV/AIDS portfolio also continued to increase. By FY 1999, NINR support for HIV research 

increased to $6.3 million. By FY 2006, the total was $12.3 million 

and included studies of risk reduction in vulnerable populations, 

management of symptoms and complications, treatment adherence, 

methodologies, ethics and decision making, and EOL care. The NINR 

continued to sponsor conferences and discussions regarding HIV/ 

AIDS, including the “Cultural Dynamics in HIV/AIDS Biobehavioral 

Research: Focus on Young People” workshop in September 2005, 
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Bringing Science to Life 

which examined how best to understand and integrate cultural 

dynamics within the context of HIV/AIDS biobehavioral research 

focused on methodology and intervention development. Stressing 

the importance that research on culture and the intersection between 

history and culture could have for the health of population subgroups, 

workshop attendees emphasized the need for investigators to disseminate and sustain interventions, use methods that achieved cultural 

sensitivity, develop and test new measurements and interventions in 

a variety of settings, develop more provider-based interventions for 

prevention, pay attention to subpopulations, use meta-analysis to 

find commonalities and patterns among diverse cultural groups, and 

ensure “community buy-in.”20 

This emphasis on targeting interventions to distinct cultures 

matched the ongoing public health concern for, and congressional 

interest in, health disparities among ethnic groups. In response to this 

continuing concern, the Institute funded research focused on developing programs for different populations. The NINR’s support continued 

to result in significant research findings, including development of 

programs addressing the behavior patterns of distinct sets of the population. For example, Dr. Nilda Peragallo completed a study she began 

at the University of Illinois in Chicago examining HIV knowledge and 

prevention. Her study showed that an intervention provided by bilingual counselors and designed to decrease risky sexual behaviors among 

low-income Latina women resulted in improved HIV knowledge and 

communication skills among participants after six months. The NINR’s 

successful research programs thus demonstrated an ability to replicate 

and augment previous research findings, build upon the science, and 

provide real-world treatment for individuals and communities.21 

In the late 1980s, a growing enthusiasm emerged within the 

nursing community for basic science research—a response, in part, to 

participating in the broader research trends at NIH. Acknowledging 

the need to support more biological and biobehavioral research, the 

NCNR convened the Biological Sciences Task Force in March 1990. 
Speaking the Language of Science 177 

Dr. Nilda Peragallo, right, demonstrated that bilingual counselors could improve HIV knowledge among Latina women. At Jackson Memorial Hospital, August 10, 2004 (from left to right): 

Zehra Madhany, Jimmy Heredia, Teresa M. Rodriguez. 

The task force reported “an increased need to develop nurse scientists 

who can use biological theory and measurement as the underpinning 

of nursing science” and the need “to increase research collaboration 

among nurse and biological scientists who conduct basic research.”22 

The meeting led to a ten-year plan to increase the use of biological 

theory and measurement in the conduct of nursing research. A 1991 

report indicated that “few of the biological measurements currently in 
178 Bringing Science to Life 

use in nursing research are state-of-the-science” and highlighted the 

need for the NCNR to propose “research, training, and career development mechanisms” to facilitate the “use of ‘cutting-edge’ biological 

techniques by researchers in nursing.” In addition, the report advocated combining biological theory, measurements, and techniques 

within all priority areas of nursing research. In a 1993 article regarding the training of researchers, Dr. Marie J. Cowan of the University of 

Washington, along with Dr. Janet Heinrich of the American Academy 

of Nursing, Dr. Mary Lucas and Dr. Hillary Sigmon at the NINR, and 

then-director Hinshaw, suggested the need to increase not only the 

number of biologically based studies, but also the quality of measurements used in these studies. The NCNR expected that application of 

such skills to nursing would expand the understanding of both the 

relationship among biological, behavioral, and social factors in the 

manifestation of symptoms and how to manage those factors during 

illness and recovery.23 

Against this background, in November 1992 nurse scientists 

selected another set of research priorities, including cognitive impairment, to guide research funding between 1995 and 1999. These 

research priorities and the new emphasis on biological research would 

shape the development of nursing science in coming years. In 1995, 

NINR acting director Dr. Suzanne Hurd identified the linkage of biological findings from medical research with behavioral application 

as a major theme of the Institute’s research programs. When Grady 

assumed the directorship a year later, she pressed the importance of 

the NINR’s cognitive impairment research, which she characterized 

as “a national health care problem” accompanying “many disorders, 

including the dementias, AIDS, and stroke.”24 

The call for research to develop and test both biological and behavioral treatments for cognitive impairment fit well with the NINR’s goals 

of developing science to address individual and community needs. In 

the context of the country’s aging population, such research reflected 

the growing public health concern for EOL issues. Beyond its clear 
Speaking the Language of Science 179 

benefits for individual patients and caregivers, research on decreased 

mental functioning also represented an opportunity to serve the community’s need for lower health care costs. Citing an estimate in a 1995 

report of the Advisory Panel on Alzheimer’s Disease, the NINR noted 

that the financial burden of dementia, including costs of direct care 

and lost productivity, was approximately $100 billion annually. The 

Institute acknowledged that effective therapies remained elusive and 

made a case for addressing symptoms in the best way possible. The 

NINR suggested that until the physical causes of impairment could be 

treated, the “greatest hope” for delaying or relieving symptoms lay in 

effectively managing the behavioral, physical, and functional problems 

associated with cognitive impairment, including wandering, falls, sleep 

disturbances, and inadequate nutrition. Noting that cognitive failures 

“rob people of their minds and deplete their material resources,” Grady 

said the NINR’s research aimed to prevent or delay such deterioration. 

She also underlined NINR-sponsored research to find non-pharmacological ways to manage the symptoms that accompanied cognitive 

A participant in an NINR-funded study meets “Pearl,” a humanoid from the Nursebot Project, 

in which nurse scientists aimed to learn how older adults would respond to navigational 

guidance offered by a mobile robot. 
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impairment as well as methods to help family caregivers deal with 

these problems.25 

The Institute grasped the implications—for patients, caregivers, 

and the nation—of estimates that more than 6 million individuals in 

the United States would have Alzheimer’s disease or related dementia 

(ADRD) by 2040. The NINR emphasized the critical need for interventions to reduce patients’ secondary symptoms and preserve optimal 

functioning and supported studies focused on behavioral interventions and the environmental context of care. The Institute also funded 

research into the harmful effects that caring for cognitively impaired 

individuals had for the caregivers’ immune function, well-being, and 

productivity. By 1994, the NINR had begun funding a significant 

number of studies with the NIA that examined symptom management with Alzheimer’s disease patients and aimed at helping families 

to handle eating and dressing problems, confusion, and wandering 

behavior. Preliminary investigations into wandering, disturbed sleep, 

and agitation served to establish a strong scientific base for large-scale 

clinical trials addressing behavioral, environmental, social, and organizational interventions to deal with ADRD symptoms.26 

Building a broad base of cognitive impairment research, the NINR 

sponsored projects, such as Dr. Mary Ann Matteson’s early 1990s work 

at The University of Texas Health Science Center in San Antonio, examining the use of behavioral and environmental modifications along with 

the reduced use of psychotropic medications in nursing home ADRD 

patients. Moreover, the NINR funded studies regarding decreased sleep 

disruption in ADRD patients and their caregivers, as well as the effects 

of a walking and conversational treatment on the communication ability 

of ADRD patients. Other studies examined the development of effective models for the family caregivers’ role as part of the management 

team. The NINR research programs examined the relationship between 

behaviors and the advancing neurological damage that ADRD patients 

experienced, as well as neurological and motor changes that contributed 

to important health problems, like urinary incontinence.27 
Speaking the Language of Science 181 

Nurse scientist Dr. Kathleen Buckwalter, second from right, at a Capitol Hill Breakfast Briefing 

on Women’s Health and Chronic Illness in 1997. Also pictured are (left to right): Dr. Joan 

Shaver, Dr. Patricia A. Grady, Honorable Louis Stokes, and Dr. May Wykle. 

Such efforts and research expansion continued throughout the 

mid-1990s. By FY 1996, the NINR requested $3,370,000 for research 

on Alzheimer’s disease, approximately 6.7 percent of the Institute’s total 

1996 budget. The NINR’s research on disruptive behaviors accompanying ADRD included Dr. Kathleen Buckwalter’s efforts at the University 

of Iowa to build upon and extend the Progressively Lower Stress 

Threshold model she developed with Iowa’s Dr. Geri Hall. According 

to Grady, such studies demonstrated that family caregivers could use 

cognitive stimulation exercises in the home to decrease behavioral 

problems, improve overall mental functioning, and reduce stress 

for all concerned. With improvements lasting “up to nine months,” 

patients were able to remain at home longer, with greater patient and 

caregiver satisfaction. Grady explained that research into the basic 

biology of Alzheimer’s disease—including a “remarkable series of 

genetic discoveries”—contributed to “major advances” in understanding the disease. Together with the results of epidemiologic studies, 

such findings led to the identification of risk factors and of potential 
182 Bringing Science to Life 

protective interventions for Alzheimer’s disease. For example, a study 

of elderly U.S. nuns found that the coexistence of Alzheimer’s disease 

with vascular disease resulted in more severe dementia than expected 

on the basis of Alzheimer’s alone. The study suggested that prevention 

or treatment of vascular disease could delay or reduce the development of symptoms in many Alzheimer’s disease patients.28 

In addition, the NINR’s focus on cognitive impairment included 

research involving the role of sleep in neurological functioning, including studies at the University of California, San Francisco, by Dr. Glenna 

A. Dowling that addressed the management of sleep in Alzheimer’s 

patients and the use of bright light exposure and melatonin to improve 

outcomes for sleep disorders in patients with Parkinson’s disease. In 

another study, Dr. Kathy Richards, then at the University of Arkansas 

for Medical Sciences, examined the effects of nonpharmacological 

interventions such as social activities and exercise to improve sleep 

patterns and disorders in dementia patients. Her work was soon 

Dr. David Dinges points to one of several video monitors showing volunteers in his Sleep 

and Chronobiology Laboratory in the Hospital of the University of Pennsylvania. The lower 

monitors show the physiological recordings of the sleeping subjects. 
Speaking the Language of Science 183 

translated into clinical practice in many nursing homes. By FY 1995, 

the NINR had also begun supporting interdisciplinary research at the 

University of Pennsylvania in the neurobehavioral effects of chronic 

sleep deprivation. Dr. David Dinges and colleagues studied the 

function of the nervous system, hormone profiles, core body temperature, and sleep/waking polysomnography—a diagnostic test recording 

physical variables—for various times of chronic sleep restriction to 

assess increased levels of sleep deprivation. The team also looked at 

the effects of sleep recovery when measurements were made during 

the day instead of nocturnally. Using both subjective and objective 

measures to record their findings, the researchers demonstrated a “significant decline” over time in behavioral alertness and memory, with 

the group with the greatest deprivation showing the greatest declines 

in performance. Given the important implications of chronic sleep 

deprivation for certain workers, the team’s researchers acted as experts 

for a variety of regulatory agencies on the risks of chronic sleep loss, 

including the Department of Transportation, National Aeronautics and 

Space Administration, Department of Justice, National Transportation 

Safety Board, and Association of American Medical Colleges.29 

In the new century, the NINR continued to sponsor research 

regarding symptom management for degenerative diseases. The 

Institute provided resources for researchers studying the effectiveness of a nighttime alarm system to monitor wandering in Alzheimer’s 

disease patients as well as the efficacy of individual daytime activities 

to replace napping and improve sleep at night. The NINR also funded 

studies to improve functional ability in nursing home residents with 

dementia, with particular emphasis on dressing and bathing. The 

Institute supported, in collaboration with the NIA, the Advanced 

Cognitive Training for Independent and Vital Elderly (ACTIVE). In 

2008, ACTIVE researchers showed that older adults with pre-existing 

mild memory impairment benefited from certain forms of cognitive 

training that did not rely on memorization as much as adults with 

normal memory function.30 
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Another focus of NINR-sponsored research was improving experiences for caregivers dealing with degenerative cognitive diseases. By 

2001, an NINR-funded intervention study including selected information and behavior management skill training for caregivers of patients 

with dementia showed reduced caregiver depression scores among those 

who were initially depressed, fewer negative responses to the patient’s 

disruptive behaviors, and a moderate decrease in perceived caregiver 

burden. In a related study, caregivers involved in community-trainingbased programs that focused on reducing the negative effects of stress by 

developing knowledge, skills, and beliefs regarding the caregiving role 

showed a 16 percent improvement in depression and feelings of burden 

and a 28 percent improvement in distress caused by behavior problems. 

In addition, the study showed a 9 percent increase in the number of study 

participants expressing a balanced assessment of their caregiving role.31 

Collaborative research efforts with other institutes have become 

the hallmark of many NINR projects, stressing the interdisciplinary 

and cross-cutting science that is becoming the norm for cutting-edge 

nurse investigators. Such a strategy provides nurse scientists with fresh 

interdisciplinary perspectives and stretches available funding due to 

the cost-sharing arrangements between institutes. The NINR and the 

National Heart, Lung, and Blood Institute teamed to sponsor research 

seeking to improve self-care behavior and outcomes in rural patients 

with heart failure. Led by Dr. Kathleen A. Dracup of the University of 

California, San Francisco, the research scientists, using a controlled 

multisite clinical trial with 700 patients living in rural areas, are testing 

the effects of an educational intervention focused on fluid management on hospital readmissions and mortality. The study is being 

conducted by an interdisciplinary group of researchers from nursing 

and medicine, disciplines that usually work as a team to care for this 

population. Investigators also will calculate cost effectiveness based on 

the net cost per hospitalization averted or year of life saved. If effective, 

the study will be broadly applicable and lend valuable insight about 

treatment of heart failure in rural settings.32 
Speaking the Language of Science 185 

In another collaborative project, the NINR supported the 

Resources for Enhancing Alzheimer’s Caregiver Health initiative 

with the NIA. This study consisted of six sites across the country 

and addressed family caregiving for Alzheimer’s disease patients, 

with special emphasis on underrepresented populations. At one site, 

NINR scientists focused on African-American and Caucasian caregivers’ ability to cope with daily stress and to manage the behavioral 

problems of Alzheimer’s patients. Despite differences in psychological 

distress, physical health, and cultural and socioeconomic conditions, 

the researchers designed responses to the common needs of both populations. The NINR also sponsored Alzheimer’s research by Dr. Louis 

Burgio of the University of Alabama at Birmingham. Through interviews, Burgio found that African-American caregivers reported more 

positive aspects to caregiving than did Caucasians, as well as lower 

levels of anxiety. As a result, these findings suggested that health care 

professionals should promote such strategies to all family caregivers, 

regardless of race. Such NINR-funded results highlighted the partnership among nursing science, individuals, and community health. 

Addressing the biological bases, behavioral problems, and caregiver 

impact of cognitive impairment, the NINR’s research again investigated 

and mitigated the physical, emotional, and financial impact of such 

diseases and disorders on individuals and the community at large.33 

By 1996, the NINR had entered the final years of its second National 

Nursing Research Agenda. The landscape of nursing science had 

changed in the intervening five years, such that the Institute convened 

new panels to discuss future research directions. One such panel at 

the cutting edge of science was the Work Group on Opportunities in 

Genetics Research. The emerging field of genetics offered fresh opportunities for nursing research, including basic biologic and behavioral 

investigations as well as clinical and population studies. Nurse scientists, 

the work group believed, could take leadership roles and contribute to 

basic genetic studies with their biological, environmental, and behavioral linkages. The work group also emphasized opportunities in 
186 Bringing Science to Life 

genetic determination of physical responses and applied studies aimed 

at translating basic science findings into interventions to solve clinical 

problems.34 

Early NINR-supported genetic research, such as the work of 

Dr. Janet Meininger from the University of Pennsylvania, explored these 

avenues of inquiry. Meininger examined genetic variation and specific 

risk factors for cardiovascular disease in identical/fraternal twins, 

underscoring the implications that genetics could have for individual 

patient treatment. She argued that understanding the role of genetic 

factors in hypertension would revolutionize the ability to prevent and 

effectively manage that widespread problem. Such information, she 

demonstrated, could lead informed practitioners and clinical researchers to successfully apply the rapidly expanding knowledge of human 

genetics. At the same time, the NINR began funding research training 

and career development programs focusing on genetic research, such 

as a predoctoral award to investigate the interplay between cognition 

and the Apolipoprotein E genotype in late-onset Alzheimer’s disease. 

The Institute sponsored senior fellowship grants, such as a research 

grant aimed at developing effective genetic educational interventions 

for teaching at-risk populations about hereditary cancers. The NINR 

also funded career development awards for genetics research, including the potential of gene therapy to treat cachexia, which is the loss of 

weight and muscle mass caused by disease.35 

In the spring of 1998, Grady explained to Congress the importance 

of genetics in the future of nursing research. Anticipating a great deal 

of activity in that area, she stressed the potential impact of the NINR’s 

study of genetics on disease risk factors and the development of an 

ethical decision-making model for testing. As its early training awards 

suggested, the Institute recognized that beyond the clear opportunities genetics held for nursing researchers, the field also presented them 

with a set of distinct training challenges that would require innovative 

solutions reaching a larger number of nurse scientists and clinicians. 

The NINR, she said, needed to build a robust nurse training program 
Speaking the Language of Science 187 

and boost the ranks of nurse scientists and nursing school faculty 

prepared to incorporate genetics into their studies.36 

Genetic research’s cornucopia of opportunities—and concomitant 

training challenges—merged with the NINR’s long-standing efforts to 

provide training for nurse scientists. As Grady noted, scientific breakthroughs like genetics continued to “reshape” the way health care was 

provided, requiring nurses to “translate new technology into health 

care at the personal level—to the healthy and ill in communities, hospitals, and residences.” Almost simultaneously, the ability to identify 

individuals at risk for heritable disease “rapidly outdistanced the 

ability to counsel them about what to do with that knowledge.” This 

widening gap created a significant research path for nurse scientists, 

but it required that they be trained in genetics. By 1999, “a time when 

the topic was rarely seen in nursing curricula,” according to Dr. Pamela 

Hinds of the Children’s National Medical Center in Washington, D.C., 

the Institute had begun developing plans for an intensive training 

course in genetics for nurse scientists, and in 2000 the NINR launched 

the Summer Genetics Institute (SGI) for extramural researchers. An 

eight-week training course, the SGI emphasized genetics in clinical 

practice, in the research laboratory, and in nursing curricula. As 

the NINR’s intramural training director Dr. Mindy Tinkle noted, the 

program enabled “graduate students and faculty to develop or expand 

their research capacity” and enabled “advanced practice nurses to 

develop and expand their clinical practice in genetics.” By 2008, SGI 

students discussed clinical case studies and attended lectures and 

seminars focused on a range of ethical, social, legal, and public policy 

issues. They spent approximately 100 hours in the laboratory, learning 

basic techniques used in molecular biology to promote their understanding of the technology of genetic testing.37 

Building the growing cadre of nurse scientists equipped to conduct 

genomic-based research, the SGI produced graduates who developed 

research grant applications and published papers applicable to clinical 

practice and research. These NINR-supported scientists facilitated the 
188 Bringing Science to Life 

integration of genetic content into the curricula of nursing schools. 

In its first ten years, the program graduated 182 people from across 

the country and produced more than 130 peer-reviewed papers. More 

than one-third went on to receive federal funding for their research 

projects. Through 2009, SGI graduates had won twenty-one predoctoral fellowships and eight postdoctoral fellowships, among other 

awards. As a measure of the program’s success, the SGI shaped the 

careers of former graduates as they continued their education and 

career development. Many graduates of the SGI and the Graduate 

Partnerships Program in Biobehavioral Research continued to pursue 

genetic and hereditary health research questions. Meeting expectations, the SGI proved to be a springboard for nurse scientists to join 

the ranks of genomic researchers and an important foundation for 

their careers. Before the SGI, Hinds observed, “nurses at all levels of 

preparation were not being exposed to genetics, the role of genetics 

in health, and the role of nursing in genetics. But that has changed at 

amazing rates since the NINR created the Institute and began funding 

very important research related to genetics.”38 

The completion of the Human Genome Project in 2003 and subsequent research efforts led to major changes in the clinical practice 

of nursing. By focusing on health rather than disease, nurses were 

central to using information about the function, structure, and interactions of genes with the goal of improved outcomes. In a key article 

in the Journal of Nursing Scholarship, Dr. Jean Jenkins, a senior clinical 

advisor, Dr. Francis S. Collins, then director of the National Human 

Genome Research Institute, and Grady emphasized that the science of 

genomics was “creating important and profound changes in nursing 

education, practice, policy, and research. The vision of researchers and 

clinicians in genomic health care contains three themes,” they wrote, 

“genomes to biology, genomes to health, and genomes to society.” They 

encouraged nurses to become literate in the field, to “assimilate and 

integrate this burgeoning genetic and genomic science.” They concluded, “Nurses, with their long tradition of being educators, and with 
Speaking the Language of Science 189 

sensitivity to emotional and psychological issues and advocacy, are 

ideally suited to address the emerging needs of patients, families, and 

communities. Through education, research, and clinical applications, 

nurses can accelerate the pace of integrating genomics into options for 

care, thereby contributing significantly to reshaping and optimizing 

health care.” More than ever, nurses needed to speak and translate the 

language of a new science. 39 

As the century ended, the NINR increased its collaboration with 

other institutes and cemented its place within NIH. Grady’s vision 

for the NINR was to “demonstrate the essential nature of our science 

in every institute and center across the campus—that we could tie the 

science more closely to NIH programs.” Noting that nurse scientists 

were new players on the scientific research campus with the advantage 

of starting out when the climate was becoming more collaborative, 

Grady observed that the “days of scientists in their little closet doing an 

experiment were over.” The nature of research questions, she argued, 

now required a more collaborative effort in many more cases than 

earlier eras. The ability to collaborate with other institutes also fit well 

with the ethos of nursing research, since it was not disease specific, 

nor was it dedicated to a particular age group or population. Instead, 

nursing research asked questions that probed “the very core of patients’ 

and families’ personal encounters with illness or its avoidance, perhaps 

to a more immediate, intense extent than other disciplines of science.” 

Given the NINR’s breadth of research, it was critical that the Institute 

continue to collaborate across the spectrum at NIH, including work 

with the NIAMS, the NCI, and the NIA, as well as the NIAID. The 

NINR’s ability to collaborate across age and disease spectra proved 

essential as the Institute assumed a new and important leadership role 

within NIH with EOL issues.40 

A 1997 Institute of Medicine report, Approaching Death: 

Improving Care at the End of Life, found “widespread dissatisfaction 

with EOL care and many gaps in scientific knowledge about the topic.” 

Recognizing the need for greater cohesion for EOL research and the 
190 Bringing Science to Life 

The NINR is the lead institute at NIH for end-of-life research. 
Speaking the Language of Science 191 

NINR’s emphasis on symptom management, NIH director Dr. Harold 

Varmus designated the NINR as the lead NIH institute for EOL research. 

Grady also believed the NINR was the logical lead for EOL research, 

explaining that the Institute’s research encompassed “people at all ages, 

from all populations, and who die from many different causes.” After 

its designation, the NINR helped frame the fundamental issues and 

spur research in this relatively new area. In 1999, the Institute received 

more than 100 responses to its request for applications on EOL care. 

By 2001, the NINR funded twenty-two studies and seven training and 

career development awards.41 

As the lead institute for EOL research, the NINR’s portfolio 

focused on the physiological and psychosocial components of symptom 

management, communication, ethics and clinical decision making, 

caregiver support, care delivery, and quality of life. For example, 

studies found that only 20 to 30 percent of patients completed advance 

directives and that families making decisions to halt care of terminally 

ill patients without the benefit of such directives from the patient experienced a high level of stress that often continued for months after the 

patient’s death. Moreover, in acute care settings, advance directives 

“significantly” relieved the high level of family stress associated with 

decision making related to terminal care. Other prominent studies 

included focus on EOL care ethics, such as nurse scientist Dr. Sharon 

L. Tennstedt’s work at New England Research Institutes, Inc., examining the prevalence, nature, and progression of symptoms in patients 

with congestive heart failure and chronic obstructive pulmonary 

disease, as well as the impact such symptoms have on quality of life and 

their effects on health care costs and utilization. Similarly, Dr. Marie 

T. Nolan’s study at Johns Hopkins University modeled EOL decision 

making to focus on the preferences of terminally ill patients. Dr. Mark 

Rubert from the University of Miami examined the use of “Tele-Care” 

as psychosocial support for elderly caregivers of terminally ill cancer 

patients, and Dr. Dana Mukamel at the University of Rochester studied 

the utilization of medical resources and place of death for individuals 
192 Bringing Science to Life 

In March 2000 the Institute co-sponsored “An Evening of W;t and Wisdom: The Science of Care 

and Compassion at the End of Life.” Actress Judith Light starred in the play W;t as a woman 

with ovarian cancer. 

enrolled in a managed care program, including related costs and 

quality of life and death. Addressing ethics, quality of life, and health 

care costs, these early studies provided an important base upon which 

the NINR built its EOL research program.42 

The NINR’s efforts to provide scientific leadership for EOL 

research at NIH included funding for NIH-wide symposia and events 

to spur discussion of EOL issues. In March 2000, the Institute cosponsored An Evening of W;t and Wisdom: The Science of Care and 

Compassion at the End of Life, which included a performance of this 

Pulitzer Prize-winning play detailing a patient’s EOL experiences 

along with a pre-play reception and a post-play question-and-answer 

forum. Later that year, the NINR also helped form the NIH End-ofLife Special Interest Group to address issues relating to research in 

this area. That group held a forum entitled “The End of Our Lives: 

Guiding the Research Agenda” to discuss ethnic and cultural dimensions of EOL issues, the role of palliative care, ethical issues, and the 

role of technology during the final phase of life.43 

To collect a wide array of information and ideas from across other 

disciplines, the NINR sponsored similar meetings and workshops 
Speaking the Language of Science 193 

regarding EOL issues, including the “Integrative Workshop on Endof-Life Research: Focus on Older Populations” in October 2001; 

“Ethical Challenges in End-of-Life” in September 2002; “Moving 

the Research Agenda Forward for Children with Cancer” in August 

2003; and “Developing the Capacity for End-of-Life and Palliative 

Care Research” in August 2004. In addition, the NINR spearheaded 

the Department of Health and Human Services-wide End-of-Life 

Scientific Interest Group, which united agencies both internal and 

external to NIH. The group was the conduit through which the NINR 

coordinated EOL scientific activities, as well as activities to raise the 

profile of EOL research, including lectures regarding developments in 

palliative care and research approaches to meaning and spirituality in 

EOL care. The NINR also worked with the American Association of 

Colleges of Nursing and the Association of Academic Health Centers 

to videotape six one-hour continuing education programs for nurses 

on end of life that were broadcast to 700 hospitals.44 

To improve EOL care by “fostering excellence in EOL research and 

evidence-based practice,” the NINR co-sponsored, with NIH’s Office 

of Medical Applications of Research, a conference to discuss the state 

of the science of EOL care. The conference’s panel of experts drafted 

a statement examining five key issues: the definition of the transition 

to the end of life; outcome variables that are important indicators of 

the quality of the EOL experiences of the dying persons and for the 

surviving loved ones; patient, family, and health care system factors 

associated with improved or worsened outcomes; processes and interventions associated with improved or worsened outcomes; and future 

directions for improving EOL care. Reporting that many patients 

and their family members still struggled with a lack of continuity of 

care and poor communication between health care practitioners, the 

panel indicated that ambiguity surrounding the definition of end of life 

hindered the development of science, delivery of care, and communication between patients and providers.45 

The panel also called for “rapid development of research 
194 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Bringing Science to Life 

infrastructure” to improve understanding of what approaches were 

most effective for different groups of patients and recommended 

enhanced resources to deliver quality care to patients and their families 

at the end of life. The panel observed that although a growing body of 

research existed covering a wide range of issues, in many ways, rigorous 

testing and evaluation of models of care, in terms of patient and family 

outcomes as well as resource utilization, were still in their “infancy.” 

Emphasizing the need for research to understand patient, caregiver, and 

health care system influences on these outcomes, the panel detailed the 

need for research regarding conceptual models, infrastructure, methodologic issues, ethical issues, treatment, outcomes, and policy.46 

Beyond the various conferences and symposia that the NINR sponsored to raise the profile of EOL research and discuss its practice and 

implications, the Institute played an important role in funding ongoing 

research. Between FY 2001 and FY 2006, the NINR supported fiftyone grants, while an NINR review of EOL scholarship noted fifty-eight 

peer-reviewed publications between 1997 and 2000. In each case, the 

data showed an increasing number of funded EOL studies and publications over time, suggesting a growing science. The Institute also issued 

Program Announcements and Requests for Application in three distinct 

areas of end of life—quality of life, decision making, and care for dying 

children—as well as research regarding symptom clusters in cancer and 

immune disorders. For example, the NINR funded research examining 

EOL care outcomes of the Program for All-inclusive Care for the Elderly, 

a community-based managed care program for Medicare recipients aged 

fifty-five and older, aimed to promote continuity and communication 

between providers and recipients of care and enhance personal control 

in care at the end of life. Researchers found that the program helped 

elders both to develop an advance directive and maintain a continuity 

of care, thereby “increasing the likelihood” that their wishes would be 

followed.47 

More recent studies also began to address the 2004 panel’s observations regarding the breakdown of communication between providers, 
Speaking the Language of Science 195 

patients, and families. Dr. Sharon Kaufman’s study at the University 

of California, San Francisco, regarding inconsistent communication 

in discussing EOL issues, for example, found that nurses were seen 

as more available and more willing to share information with family 

members than doctors. Her study further suggested that most family 

members wanted doctors and nurses to offer hope, but stick to the 

truth and help them prepare for the worst. Similarly, Dr. J. Randall 

Curtis’ work at the University of Washington examining communication with families regarding withdrawal of life support found that 

clinicians in intensive care units often missed opportunities for communication when addressing the concerns of family members while 

discussing withdrawal of treatment.48 

The NINR also continued to ensure exposure and funding for EOL 

issues. Grady reinforced the Institute’s leadership for these issues with 

an August 2005 presentation to the NIH Institute and Center Directors’ 

Meeting entitled “Symptom Management: Chronic Disease and End of 

Life,” which focused on research addressing hard-to-reach populations, 

successful strategies, quality-of-life issues, and interventions that had 

been incorporated into practice. NINR planning documents for FY 

2007-FY 2011 called for increasing the number of studies and publications and targeted self-management as an area of EOL research. These 

documents recommended that the Institute issue requests for research 

for EOL health disparities and for improving AIDS care at the end of 

life. The NINR’s plans also suggested developing biobehavioral studies 

at the end of life, with research focusing primarily on intervention. 

The Institute sought to develop and increase EOL research capacity 

through targeted training opportunities and to collaborate with NIH 

institutes and centers, including those that had not traditionally collaborated with the NINR on EOL research, like the NIAID.49 

From its beginnings, the NINR proved an effective champion of 

the value and necessity of nursing science, an essential bulwark for 

the nascent but critical discipline, and the leading voice in defining 

its research priorities and training its future researchers. The NINR’s 
196 Bringing Science to Life 

early agenda-setting work provided a basis for HIV/AIDS research, 

which fit well with the clinical experience of nurses. This work also 

developed education and behavior modification programs, interventions, and treatment for symptoms on which the Institute continues to 

build today. As nurse scientists recognized the need for expanded biological and biobehavioral research, the NINR’s emphasis on cognitive 

impairment provided a hard science base upon which later neuroscience, sleep studies, behavioral management, and caregiver research 

would build. The Institute’s funding for pain management research 

also built upon its basic science goals and made strides in understanding differences between the way men and women experience pain 

and in identifying the ways pain could adversely affect an individual’s 

health. With the growing importance of genetic research, the NINR 

also appreciated the importance of training nurses for the future. The 

Institute revised training mechanisms and awards, partnered with other 

nursing agencies to create new training opportunities, and developed 

the summer genetics program for nurse scientists. After its appointment as NIH’s lead institute for EOL issues, the NINR focused its 

portfolio on symptom management, communication, ethical decision 

making, and quality-of-life issues. The Institute also led NIH discussions regarding EOL issues in symposia and conferences. 

Speaking the language of science since its earliest days, the 

NINR made possible the long-held, but difficult to implement, vision 

that nurses need to be scientifically informed, socially experienced, 

and technically expert. The Institute matched its desire to advance 

nursing science with the discipline’s emphasis on study and preparation. Aligning the nation’s nursing agenda and research in support 

of basic and clinical science, discovering new treatments and creating 

prevention programs, and producing highly trained nurse scientists 

for the future all proved key touchstones for evolving science. As the 

NINR grew, it did so within the context of a rapidly changing public 

health landscape. Genetic research provided novel opportunities and 

challenges. At the same time, an aging society became increasingly 
Speaking the Language of Science 197 

concerned with the treatment and costs associated with chronic 

disease. Throughout its history, the NINR’s leadership and the nursing 

community have responded, staying at the forefront of these emerging 

public health questions while maintaining nursing’s traditional focus 

on individual and community health concerns. 
198 Bringing Science to Life 

Chapter 5 Endnotes 

1	 Senate Committee on Appropriations, Hearings Before a Subcommittee of the 

Committee on Appropriations, Department of Education; Department of Health 

and Human Services, 100th Cong., 1st sess., H.R. 3058 (Washington, D.C.: U.S. 

Government Printing Office, 1987), 444, 466. 

2	 “National Center for Nursing Research: Long-Range Plan,” NINR Records, Box 

22; “A Model for Government-Sponsored Nursing Science: The National Institute 

of Nursing Research,” Enferm. Clin. 16, no. 4 (2006): 172-73. 

3	 Ada Sue Hinshaw, “Priorities in Nursing Science in the United States,” at Nordic 

Symposium “Perspectives on Priorities in Nursing Science,” Vadstena, Sweden, 

October 23-24, 1995, http://www.vardal.se/rapport/dll/1-97.pdf, 18-19. 

4	 Ibid., 16-17. 

5	 House Committee on Appropriations, Hearings Before a Subcommittee of the 

Committee on Appropriations, Departments of Labor, Health and Human Services, 

Education, and Related Agencies, 100th Cong., 2d sess., Part 4B (Washington, 

D.C.: U.S. Government Printing Office, 1988), 1013; Hinshaw, “Priorities in 

Nursing Science in the United States,” 20, and “National Nursing Research 

Agenda: Setting Nursing Research Priorities,” September 23, 1993, NINR 

Records, Box 9, Folder: Priority Setting—NINR; “Changing Practice, Changing 

Lives: 10 Landmark Nursing Research Studies,” http://www.ninr.nih.gov/. 

6	 Ellen Rudy and Patricia Grady, “Biological Researchers: Building Nursing 

Science,” Nursing Outlook 53, no. 2 (March/April 2005): 89; House Committee 

on Appropriations, Hearings Before a Subcommittee of the Committee on 

Appropriations, Department of Education; Department of Health and Human 

Services, 100th Cong., 1st sess., H.R. 3058 (Washington, D.C.: U.S. Government 

Printing Office, 1987), 688; “Briefing Document on the Nursing Shortage: 

Strategies for the National Institute of Nursing Research (NINR),” March 2001; 

House Committee on Appropriations, Hearings Before a Subcommittee of the 

Committee on Appropriations, Departments of Labor, Health and Human Services, 

Education, and Related Agencies, 106th Cong., 2d sess. (Washington, D.C.: U.S. 

Government Printing Office, 2000), 41. 

7	 House Committee on Appropriations, Hearings Before a Subcommittee of the 

Committee on Appropriations, Departments of Labor, Health and Human Services, 

Education, and Related Agencies, 106th Cong., 2d sess. (U.S. Government 

Printing Office, 2000), 35, 41; Robert Bock, “NINR’s Grady Manages Science 

With Science,” NIH Record 52, no. 24 (November 28, 2000); NINR, “Changing 

Practice, Changing Lives: NINR Strategic Plan,” October 2006, 13; House 

Committee on Appropriations, Hearings Before a Subcommittee of the Committee 

on Appropriations, Departments of Labor, Health and Human Services, Education, 
Speaking the Language of Science 199 

and Related Agencies, 106th Cong., 2d sess. (Washington, D.C.: U.S. Government 

Printing Office, 2000), 35, 41. 

8	 “Direction in Nursing Research Training,” Office of Planning, Analysis, 

Evaluation, NINR, 1995, 1-4, NINR Records, Box 8; House Committee 

on Appropriations, Hearings Before a Subcommittee of the Committee on 

Appropriations, Departments of Labor, Health and Human Services, Education, 

and Related Agencies, 106th Cong., 2d sess. (Washington, D.C.: U.S. Government 

Printing Office, 2000), 42. The Mentored Research Scientist Awards also received 

partial support from the Office of Research on Minority Health. 

9	 Dr. Patricia Grady, Speech Transcript, “National Institute of Nursing Research: 

A Celebration of Fifteen Years at the National Institutes of Health,” September 

20-21, 2001, 9, NINR Records, Box E, Speeches, Vol. 9 (hereafter Grady Speech); 

House Committee on Appropriations, Hearings Before a Subcommittee of the 

Committee on Appropriations, Departments of Labor, Health and Human Services, 

Education, and Related Agencies, 106th Cong., 2d sess. (Washington, D.C.: U.S. 

Government Printing Office, 2000), 42. 

10	 “NINR Reaches Out to Minority Nurses,” NIH Record 49, no. 1 (January 14, 

1997); Grady Speech, 17; House Committee on Appropriations, Hearings Before a 

Subcommittee of the Committee on Appropriations, Departments of Labor, Health 

and Human Services, Education, and Related Agencies, 107th Cong., 2d sess., Part 

4B (Washington, D.C.: U.S. Government Printing Office, 2002), 995. 

11	 “Priorities Resulting from Second Conference on Research Priorities in Nursing 

Practice,” NINR, March 24, 1993, NINR Records, Box 22; House Committee 

on Appropriations, Hearings Before a Subcommittee of the Committee on 

Appropriations, Departments of Labor, Health and Human Services, Education 

and Related Agencies, 101st Cong., 1st sess., Part 4B (Washington, D.C.: U.S. 

Government Printing Office, 1989), 955; House Committee on Appropriations, 

Hearings Before a Subcommittee of the Committee on Appropriations, Departments 

of Labor, Health and Human Services, Education, and Related Agencies, 103rd 

Cong., 2d sess. (Washington, D.C.: U.S. Government Printing Office, 1994), 1907. 

12	 Changing Practice, Changing Lives: 10 Landmark Nursing Research Studies, 

NIH Publication 06-6094 (2006), 15-16. See also, Biennial Report of the 

Director, National Institutes of Health, 1995-1996, 193; House Committee 

on Appropriations, Hearings Before a Subcommittee of the Committee on 

Appropriations, Departments of Labor, Health and Human Services, Education, 

and Related Agencies, 103rd Cong., 2d sess. (Washington, D.C.: U.S. Government 

Printing Office, 1994), 1907; Patricia Grady, “Future of Nursing Research,” in 

Creating Nursing’s Future Issues, Opportunities, and Challenges, E. J. Sullivan, ed. 

(Chicago: Mosby, 1999), 267-68. 
200 

 

Bringing Science to Life 

13	 House Committee on Appropriations, Hearings Before a Subcommittee of 

the Committee on Appropriations, Departments of Labor, Health and Human 

Services, Education, and Related Agencies, 104th Cong., 2d sess. (Washington, 

D.C.: U.S. Government Printing Office, 1996), 1869-70, 1881; Senate Committee 

on Appropriations, Hearings Before a Subcommittee of the Committee on 

Appropriations, 105th Cong., 2d sess., H.R. 4274/S. 2440 (Washington, D.C.: U.S. 

Government Printing Office, 1999), 250; House Committee on Appropriations, 

Hearings Before a Subcommittee of the Committee on Appropriations, Departments 

of Labor, Health and Human Services, Education, and Related Agencies, 105th 

Cong., 2d sess. (Washington, D.C.: U.S. Government Printing Office, 1998), 1700. 

14	 CRISP Database, http://crisp.cit.nih.gov/; House Committee on Appropriations, 

Hearings Before a Subcommittee of the Committee on Appropriations, Departments 

of Labor, Health and Human Services, Education, and Related Agencies, 105th 

Cong., 2d sess. (Washington, D.C.: U.S. Government Printing Office, 1998), 

1700; “Summary of the Capitol Hill Breakfast Briefing on Pain Management,” 

May 7, 1997, 2, http://www.ninr.nih.gov/NR/rdonlyres/ F6F9F0CC-5CD8-4601­

9EA3-C5B8D75EB6AA/4796/571997.pdf; House Committee on Appropriations, 

Hearings Before a Subcommittee of the Committee on Appropriations, Departments 

of Labor, Health and Human Services, Education, and Related Agencies, 105th 

Cong., 2d sess. (Washington, D.C.: U.S. Government Printing Office, 1998), 1700. 

15	 Lawrence K. Altman, “Medicine May Learn From the Tragedy of AIDS,” The 

New York Times, May 10, 1983, C2; House Committee on Appropriations, 

Hearings Before a Subcommittee of the Committee on Appropriations, Department 

of Education; Department of Health and Human Services, on H.R. 3058, 100th 

Cong., 1st sess. (Washington, D.C.: U.S. Government Printing Office, 1987), 682. 

16	 House Committee on Appropriations, Hearings Before a Subcommittee of the 

Committee on Appropriations, Departments of Labor, Health and Human Services, 

Education, and Related Agencies, 100th Cong., 2d sess., Part 4B (Washington, 

D.C.: U.S. Government Printing Office, 1988), 1014. According to Hinshaw, 

the Advisory Council also recommended that prevention and care for low 

birthweight infants be an area initially developed. See also: House Committee 

on Appropriations, Hearings Before a Subcommittee of the Committee on 

Appropriations, Departments of Labor, Health and Human Services, Education, 

and Related Agencies, 100th Cong., 2d sess., Part 4B (Washington, D.C.: U.S. 

Government Printing Office, 1988), 1038, 1068; CRISP Database, http://crisp.cit. 

nih.gov/; House Committee on Appropriations, Hearings Before a Subcommittee 

of the Committee on Appropriations, Departments of Labor, Health and Human 

Services, Education, and Related Agencies, 100th Cong., 1st sess., H.R. 2990/H.R. 

3566 Part 2 (Washington, D.C.: U.S. Government Printing Office, 1988), 1230. 

17	 Ibid. 
Speaking the Language of Science 201 

18	 House Committee on Appropriations, Hearings Before a Subcommittee of the 

Committee on Appropriations, Departments of Labor, Health and Human Services, 

Education and Related Agencies, 101st Cong., 1st sess., Part 4B (Washington, 

D.C.: U.S. Government Printing Office, 1989), 917; House Committee 

on Appropriations, Hearings Before a Subcommittee of the Committee on 

Appropriations, Departments of Labor, Health and Human Services, Education 

and Related Agencies, 101st Cong., 2d sess., Part 4B (Washington, D.C.: U.S. 

Government Printing Office, 1991), 831; and Biennial Report of the Director, 

National Institutes of Health, 1989-1990, 135. 

19	 Minutes of the National Advisory Council for Nursing Research, September 14, 

1999, 6, http://www.ninr.nih.gov/aboutninr/NACNR; Minutes of the National 

Advisory Council for Nursing Research, January 20-21, 1999, 9-10, http://www. 

ninr.nih.gov/aboutninr/NACNR. 

20	 Minutes of the National Advisory Council for Nursing Research, September 14, 

1999, 6, http://www.ninr.nih.gov/aboutninr/NACNR, 15-16, 23. 

21	 “NINR Focus: An Overview,” NINR Records, Box 5. 

22	 “National Center for Nursing Research: National Nursing Research Agenda,” 

March 13, 1992, NINR Records, Box 22; Marie Cowan, Jan Heinrich, Mary 

Lucas, Hillary Sigmon, and Ada Sue Hinshaw, “Nursing Research Interface with 

the Biological Sciences: 1991 Report on Mechanisms to Enhance Biology in 

Nursing Research,” NINR Records, Box 22, Folder: Nursing Research Interface 

with the Biological Sciences, 1991. 

23	 Biennial Report of the Director, National Institutes of Health, Vol. I: 1993-1994, 

136; Cowan et al., “Nursing Research Interface with the Biological Sciences”; 

Nancy Burns and Susan K. Grove, The Practice of Nursing Research: Conduct, 

Critique, and Utilization (St. Louis, MO: Elsevier, 2004), 387-88; Cowan, 

Heinrich, Lucas, Sigmon, and Hinshaw, “Integration of Biological and Nursing 

Sciences: A 10-year Plan to Enhance Research and Training,”  Research in Nursing 

& Health 16, no. 1 (1993): 3-9. 

24	 “National Nursing Research Agenda: Setting Nursing Research Priorities,” 

September 23, 1993, NINR Records, Box 9, Folder: Priority Setting—NINR. 

Other priorities included community-based nursing models, the effectiveness of nursing interventions in HIV/AIDS, living with chronic illness, and 

biobehavioral factors related to immunocompetence. House Committee 

on Appropriations, Hearings Before a Subcommittee of the Committee on 

Appropriations, Departments of Labor, Health and Human Services, Education, 

and Related Agencies, 104th Cong., 1st sess. (Washington, D.C.: U.S. Government 

Printing Office, 1995), 970; House Committee on Appropriations, Hearings 

Before a Subcommittee of the Committee on Appropriations, Departments of Labor, 

Health and Human Services, Education, and Related Agencies, 104th Cong., 2d 

sess. (Washington, D.C.: U.S. Government Printing Office, 1996), 1866. 
202 Bringing Science to Life 

25	 “Priorities Resulting From Second Conference on Research Priorities in Nursing 

Practice: National Center for Nursing Research; National Institutes of Health; 

Bethesda, Maryland; February 1993,” revised March 24, 1993, NINR Records, 

Box 22; Biennial Report of the Director, National Institutes of Health, Vol. I: 1995­

1996, 196; House Committee on Appropriations, Hearings Before a Subcommittee 

of the Committee on Appropriations, Departments of Labor, Health and Human 

Services, Education, and Related Agencies, 104th Cong., 2d sess. (Washington, 

D.C.: U.S. Government Printing Office, 1996), 1866. 

26	 Biennial Report of the Director, National Institutes of Health, 1995-1996, 196; 

House Committee on Appropriations, Hearings Before a Subcommittee of the 

Committee on Appropriations, Departments of Labor, Health and Human Services, 

Education, and Related Agencies, 103rd Cong., 2d sess. (Washington, D.C.: U.S. 

Government Printing Office, 1994), 1907; Senate Committee on Appropriations, 

Hearings Before a Subcommittee of the Committee on Appropriations, Departments 

of Labor, Health and Human Services, and Education, and Related Agencies, 103rd 

Cong., 2d sess., H.R. 4606, Part 2 (Washington, D.C.: U.S. Government Printing 

Office, 1994), 402. 

27	 House Committee on Appropriations, Hearings Before a Subcommittee of the 

Committee on Appropriations, Departments of Labor, Health and Human Services, 

Education, and Related Agencies, 103rd Cong., 2d sess. (Washington, D.C.: U.S. 

Government Printing Office, 1994), 1907; House Committee on Appropriations, 

Hearings Before a Subcommittee of the Committee on Appropriations, Departments 

of Labor, Health and Human Services, Education, and Related Agencies, 104th 

Cong., 1st sess. (Washington, D.C.: U.S. Government Printing Office, 1995), 973. 

28	 House Committee on Appropriations, Hearings Before a Subcommittee of the 

Committee on Appropriations, Departments of Labor, Health and Human Services, 

Education, and Related Agencies, 104th Cong., 1st sess. (Washington, D.C.: U.S. 

Government Printing Office, 1995), 990; House Committee on Appropriations, 

Hearings Before a Subcommittee of the Committee on Appropriations, 105th 

Cong., 1st sess., H.R. 2264/S. 1061 (Washington, D.C.: U.S. Government Printing 

Office, 1998), 213-14; CRISP Database, http://crisp.cit.nih.gov/. Dr. Buckwalter 

also participated in the NINR’s 10th anniversary symposium, “Advancing Health 

Through Science: The Human Dimension,” in which she described “how testing 

and refining conceptual models of caring for people with dementia has led to 

developing interventions that benefit not only the patient but also the caregiver.” 

See Marianne Duffy, “Hundreds Celebrate NINR’s Tenth Anniversary,” NIH 

Record 48, no. 24 (November 19, 1996); Sue K. Donaldson, “Breakthroughs in 

Scientific Research: The Discipline of Nursing, 1960-1999,” chap. 10 in Annual 

Review of Nursing Research, vol. 19, Focus on Chronic Illness (New York: Springer 

Publishing Company, Inc., 2000), 259. 
Speaking the Language of Science 203 

29	 National Institutes of Nursing Research, “Making a Difference: Part Two–NINR 

Research Results,” 28-29, NINR Records; Minutes of the National Advisory 

Council for Nursing Research, May 22-23, 2001, 16-17, http://www.ninr.nih.gov/ 

aboutninr/NACNR. On Richards’ work, see http://abramsoncenter.org/pri/staff/ 

richards.htm. Dowling later continued her research at the Goldman Institute on 

Aging in San Francisco, California. 

30	 Minutes of the National Advisory Council for Nursing Research, May 22-23, 

2001, 14, http://www.ninr.nih.gov/aboutninr/NACNR; House Committee 

on Appropriations, Hearings Before a Subcommittee of the Committee on 

Appropriations, Departments of Labor, Health and Human Services, Education, 

and Related Agencies, 107th Cong., 1st sess., Part 4B (Washington, D.C.: U.S. 

Government Printing Office, 2001), 1057; “Cognitive Training Helps Older 

Adults Who Have Some Memory Loss,” NIH Record 60, no. 1 (January 11, 2008). 

31	 House Committee on Appropriations, Hearings Before a Subcommittee of the 

Committee on Appropriations, Departments of Labor, Health and Human Services, 

Education, and Related Agencies, 106th Cong., 2d sess. (Washington, D.C.: U.S. 

Government Printing Office, 2000), 37; House Committee on Appropriations, 

Hearings Before a Subcommittee of the Committee on Appropriations, Departments 

of Labor, Health and Human Services, Education, and Related Agencies, 107th 

Cong., 2d sess., Part 4B (Washington, D.C.: U.S. Government Printing Office, 

2002), 992. For additional details regarding skill programs developed for caregivers of people with dementia, see also House Committee on Appropriations, 

Hearings Before a Subcommittee of the Committee on Appropriations, Departments 

of Labor, Health and Human Services, Education, and Related Agencies, 108th 

Cong., 1st sess., Part 4B (Washington, D.C.: U.S. Government Printing Office, 

2003), 381. 

32	 Author’s correspondence with Dr. Kathleen A. Dracup, April 7, 2010. 

33	 House Committee on Appropriations, Hearings Before a Subcommittee of the 

Committee on Appropriations, Departments of Labor, Health and Human Services, 

Education, and Related Agencies, 107th Cong., 1st sess., Part 4A (Washington, 

D.C.: U.S. Government Printing Office, 2001), 236; NINR Focus: An Overview, 

NINR Records, Box 5; House Committee on Appropriations, Hearings Before 

a Subcommittee of the Committee on Appropriations, Departments of Labor, 

Health and Human Services, Education, and Related Agencies, 107th Cong., 2d 

sess., Part 4B (Washington, D.C.: U.S. Government Printing Office, 2002), 992. 

According to the NINR’s budget justification, researchers found that “spirituality 

was the major coping mechanism used by African-American caregivers,” while 

“problem solving was the coping method used most often by Caucasian caregivers.” In terms of managing behavioral problems in care recipients, the study 

“identified more similarities than differences between African-American and 

Caucasian care providers.” 
204 Bringing Science to Life 

34	 Hilary D. Sigmon, Patricia A. Grady, and Lynn M. Amende, “The National 

Institute of Nursing Research Explores Opportunities in Genetics Research,” 

Nursing Outlook, September/October 1997, 215-19; House Committee 

on Appropriations, Hearings Before a Subcommittee of the Committee on 

Appropriations, Departments of Labor, Health and Human Services, Education, 

and Related Agencies, 104th Cong., 2d sess. (Washington, D.C.: U.S. Government 

Printing Office, 1996), 1898. 

35	 Minutes of the National Advisory Council for Nursing Research, September 14, 

1999, 10-11, http://www.ninr.nih.gov/aboutninr/NACNR. For Meininger, see 

http://health.usf.edu/nocms/nursing/ ResearchCenters/distinguishedLec_arch. 

html. 

36	 House Committee on Appropriations, Hearings Before a Subcommittee of the 

Committee on Appropriations, Departments of Labor, Health and Human Services, 

Education, and Related Agencies, 105th Cong., 2d sess. (Washington, D.C.: U.S. 

Government Printing Office, 1998), 1694; House Committee on Appropriations, 

Hearings Before a Subcommittee of the Committee on Appropriations, Departments 

of Labor, Health and Human Services, Education, and Related Agencies, 106th 

Cong., 1st sess. (Washington, D.C.: U.S. Government Printing Office, 1999), 16. 

37	 House Committee on Appropriations, Hearings Before a Subcommittee of the 

Committee on Appropriations, Departments of Labor, Health and Human Services, 

Education, and Related Agencies, 105th Cong., 2d sess. (Washington, D.C.: U.S. 

Government Printing Office, 1998), 1712; House Committee on Appropriations, 

Hearings Before a Subcommittee of the Committee on Appropriations, Departments 

of Labor, Health and Human Services, Education, and Related Agencies, 106th 

Cong., 2d sess. (Washington, D.C.: U.S. Government Printing Office, 2000), 3, 10, 

41; House Committee on Appropriations, Hearings Before a Subcommittee of the 

Committee on Appropriations, Departments of Labor, Health and Human Services, 

Education, and Related Agencies, 106th Cong., 1st sess. (Washington, D.C.: U.S. 

Government Printing Office, 1999), 17; “NINR Summer Program Graduates 18,” 

NIH Record 56, no. 18 (August 31, 2004); Ray Bingham, “NINR Completes Ninth 

Summer Genetics Institute,” NIH Record 60, no. 20 (October 3, 2008). Dr. Tinkle 

eventually moved on to become a scientific review officer for NIH. 

38	 Yvette P. Conley and Mindy B. Tinkle, “The Future of Genomic Growth,” 

Journal of Nursing Scholarship, First Quarter 2007, 17; Dr. Pamela Hinds, 

telephone interview by Philip L. Cantelon, August 23, 2009, 6 (hereafter 

Hinds Oral History); House Committee on Appropriations, Hearings Before a 

Subcommittee of the Committee on Appropriations, Departments of Labor, Health 

and Human Services, Education, and Related Agencies, 108th Cong., 1st sess. 

(Washington, D.C.: U.S. Government Printing Office, 2003), 384; Bingham, 

“NINR Completes Ninth Summer Genetics Institute”; NINR Web site, SGI 

Graduates Federally Funded Research, http://www.ninr.nih.gov/ Training/ 
Speaking the Language of Science 205 

TrainingOpportunitiesIntramural/SummerGeneticsInstitute/SGIStudentPage/; 

Hinds Oral History, 6; Ray Bingham, “NINR Celebrates First Graduates of 

Graduate Partnerships Program,” NIH Record 61, no. 4 (February 20, 2009). One 

of the graduates, Dr. Katy Meilleur, credits SGI with helping to spur her interest 

in research, observing “I wanted to combine genetics with nursing because I saw 

the future importance and impact of this combination.” 

39	 Jean Jenkins, Patricia A. Grady, and Francis S. Collins, “Nurses and the Genomic 

Revolution,” Journal of Nursing Scholarship 32, no. 2 (Second Quarter 2005): 

98-99, 101. 

40	 “NINR Celebrates 15th Anniversary,” NIH Record 54, no. 1 (January 8, 2002); 

House Committee on Appropriations, Hearings Before a Subcommittee of the 

Committee on Appropriations, Departments of Labor, Health and Human Services, 

Education, and Related Agencies, 104th Cong., 2d sess. (Washington, D.C.: 

U.S. Government Printing Office, 1996), 1874, 1877, 1882; Senate Committee 

on Appropriations, Hearings Before a Subcommittee of the Committee on 

Appropriations, 105th Cong., 2d sess., H.R. 4274/S. 2440 (Washington, D.C.: U.S. 

Government Printing Office, 1999), 248. 

41	 Harrison Wein, “The Science of End-of-Life Care,” NIH Record 58, no. 5 (March 

10, 2006); “Draft Text for Handout on End-of-Life,” NINR Records, Box 16, 

Folder: Fact Sheets—May 2006; Senate Committee on Appropriations, Hearings 

Before a Subcommittee of the Committee on Appropriations, 105th Cong., 2d sess., 

H.R. 4274/S. 2440 (Washington, D.C.: U.S. Government Printing Office, 1999), 

249; “Symposium Marks Start of NINR’s 20th Anniversary,” NIH Record 57, no. 

23; House Committee on Appropriations, Hearings Before a Subcommittee of the 

Committee on Appropriations, Departments of Labor, Health and Human Services, 

Education, and Related Agencies, 106th Cong., 2d sess. (Washington, D.C.: U.S. 

Government Printing Office, 2000), 8; House Committee on Appropriations, 

Hearings Before a Subcommittee of the Committee on Appropriations, Departments 

of Labor, Health and Human Services, Education, and Related Agencies, 107th 

Cong., 1st sess., Part 4A (Washington, D.C.: U.S. Government Printing Office, 

2001), 237. 

42	 Untitled Blue Folder, “National Institute of Nursing Research,” n.d., NINR 

Records, Box B; NINR, “Current Research Perspectives, 1996-2001,” September 

2001, 17, NINR Records, Box A; House Committee on Appropriations, Hearings 

Before a Subcommittee of the Committee on Appropriations, Departments of Labor, 

Health and Human Services, Education, and Related Agencies, 107th Cong., 1st 

sess., Part 4B (Washington, D.C.: U.S. Government Printing Office, 2001), 1057; 

and CRISP Database, http://crisp.cit.nih.gov. 
206 Bringing Science to Life 

43	 “Play Raises End-of-Life Issues,” NIH Record 52, no. 7 (April 4, 2000); “Forum 

on End-of-Life Issues,” NIH Record 52, no. 22 (October 31, 2000). Members of 

the group included the NINR, NIA, National Center for Complementary and 

Alternative Medicine, and NCI. The distinctive spelling of the play’s title references the play’s dialogue about the difference punctuation can make in interpreting poetry. 

44	 Drs. Alexis Bakos and Barbara Smothers, “NINR End-of-Life Portfolio Analysis 

and Recommendations,” December 2006 Retreat, September 1, 2006, NINR 

Records, Box 16, Folder: NINR; Grady Speech, 9; see also, “Symposium Explores 

Dying on One’s Own Terms,” NIH Record 53, no. 2 (January 23, 2001). 

45	 “Improving End-of-Life Care,” NIH Consens State Sci Statements 21, no. 3 

(December 6-8, 2004): 1-28; “NINR Examines Care at the End of Life,” NIH 

Record 57, no. 6 (March 15, 2005). The National Institute for Nursing Research 

and the Office of Medical Applications of Research were the primary sponsors. 

In addition, the Centers for Disease Control, Centers for Medicare and Medicaid 

Services, National Cancer Institute, National Center for Complementary and 

Alternative Medicine, NIMH, and NIA were also co-sponsors, while the Agency 

for Health Care Research and Quality supported the conference. See also, “NINR 

End-of-Life Portfolio Analysis and Recommendations.” 

46	 “Improving End-of-Life Care,” NIH Consens State Sci Statements 21, no. 3 

(December 6-8, 2004): 1-28. 

47	 Bakos and Smothers, “NINR End-of-Life Portfolio Analysis and 

Recommendations.” 

48	 Fact Sheets—May 2006, “Draft Text for Handout on End-of-Life,” NINR Records, 

Box 16, Folder: Minutes of the National Advisory Council for Nursing Research, 

Sept. 13-14, 2005; “NINR Focus: An Overview,” NINR Records, Box 5; http:// 

www.ninr.nih.gov/aboutninr/NACNR. 

49	 Bakos and Smothers, “NINR End-of-Life Portfolio Analysis and 

Recommendations.” 

As a changing public health landscape creates novel opportunities 

and challenges, NINR has made producing a new generation of highly 

trained nurse scientists a priority. 
Epilogue
 

The Transformation 


of Nursing Science
 

Soon after the end of World War II, in February 1946, the American 

Journal of Nursing held a festive luncheon at the Waldorf-Astoria Hotel 

in New York City to honor “Tomorrow’s Nurse,” Annie Warburton 

Goodrich. More than 500 stylishly dressed guests filled the ballroom, 

including top officials from all of nursing’s professional associations. 

President Harry S. Truman and New York Governor Thomas E. Dewey 

sent tributes for the occasion. To be hailed as the nurse of the future by 

one of the profession’s top journals was all the more remarkable in that 

Miss Goodrich had just celebrated her eightieth birthday.1 

Indeed, Goodrich’s active days in nursing were largely over, but 

her work during more than fifty years in the profession was the stuff of 

nursing legend. In 1906 she was elected president of the National League 

of Nursing Education. She had been instrumental in the founding of 

the U.S. Army School of Nursing during World War I and had served 

as director of the Henry Street Visiting Nurse Service, a pioneer in 

community-based health. She was president of the American Nurses 

Association from 1915 to 1918. By 1923 she had founded the Yale 

School of Nursing and become its first dean. She was the first president 

of the Association of Collegiate Schools of Nursing. Goodrich, according to her close friend and colleague Adelaide Nutting, was a “resolute 
210 Bringing Science to Life 

Annie Warburton Goodrich was active in nursing affairs at every level. Among many other 

things, she developed and, in 1924, became dean of the first nursing program at Yale University. 

She was responsible for developing the program into the Yale School of Nursing ten years later. 
Epilogue: The Transformation of Nursing Science 211 

and adventurous [nursing] pioneer. She has no fear of treading any 

new path.” Nurses, Goodrich often emphasized, should be “scientifically informed, socially experienced, and technically expert.” But most 

of all, she declared, they must be “prepared to speak the language of 

science and put the findings fully to use.” In 1929 she did something 

no other dean had done—she set aside funds in the school’s budget specifically for nursing research. Annie Goodrich was nursing’s visionary 

for much of the twentieth century.2 

Nevertheless, after her death in 1954, the fulfillment of Goodrich’s 

vision came slowly. One speaker at the Waldorf-Astoria luncheon 

noted that more than twenty-five years after the first funding of nursing 

research at Yale in 1929, “the full attainment of this ideal awaits larger 

resources than those now available.” Not for another three decades, 

when nursing research became part of the National Institutes of Health 

(NIH) in 1986 and significantly more resources for nurse investigators 

became available, did nursing science become more integrated into 

the broader scientific community and begin to speak the language of 

science. Throughout the development of nursing science, leading practitioners, theorists, educators, and policy makers undertook critical 

studies, educated high-quality nurses, and developed new methods to 

provide the scientific support for the distinct and crucial role nurses 

play in the health of individuals and their communities. They blazed 

new paths in nursing research. They are the heirs of Annie Goodrich’s 

vision.3 

The celebration of the National Institute of Nursing Research’s 

twenty-fifth anniversary in 2011 commemorates the creation and 

growth of the Institute, its impact on nursing science, and its effect on 

health. In twenty-five years, the NINR has brought nursing science 

into the mainstream of research at NIH. During that time, the NINR 

has fundamentally altered the nature of nursing research by providing funding for increasingly more sophisticated and complex research 

projects to match the increased complexities of health care needs in 

America. Although it takes decades to build a strong base for further 
212 Bringing Science to Life 

research, the NINR can boast of any number of innovations and 

achievements over its brief history. But as for any twenty-five year 

old, there remains much to learn and accomplish. The challenge, of 

course, is how effectively the succeeding generation of nurse scientists 

will tackle nursing’s next research agenda. 

Future scientists will benefit from the vision of pioneering nurse 

scientists who advocated for a place for nursing research at NIH, 

helped it take root, pushed for its broader acceptance in the NIH 

community, and pressed their students and protégés to do innovative research. Mostly in their forties when the movement to establish 

nursing research at NIH caught traction in the early 1980s, this first 

generation of activists, educators, and scientists is reaching retirement 

age. Marking the transition of this legacy of nursing research and 

science, the torch is being passed to the new generation of nurse scientists they have trained. Throughout its history, the NINR has funded 

talented and dedicated nurse investigators who provided the functional knowledge for clinical practice for the largest professional group 

in the nation’s health care delivery system. The measure of success for 

nursing research over the next twenty-five years will be how well this 

new generation meets the challenges of a world in which health care 

will be defined not solely by finding cures for disease, but increasingly 

by promoting the health of the nation—the central focus of nursing. 

Nursing science in the future will investigate patient, family, and community health requirements, utilizing interdisciplinary techniques 

drawn from ever more complex technologies. This is the direction in 

which the NINR has channeled its resources and science over the past 

quarter-century. With a solid base of nurse investigators, the future 

looks bright for nursing science. 

Since nursing research became part of NIH nearly twenty-five 

years ago, the nation’s health care system has changed dramatically. 

The population has grown, aged, and diversified. Diseases that were 

once acute and life threatening, such as heart disease, diabetes, and 

HIV, are now treatable, long-term chronic conditions. At the same 
Epilogue: The Transformation of Nursing Science 213 

 

 

 

 

 

time, the world has become smaller. In an increasingly interconnected 

and mobile world, global health threats such as tuberculosis, SARS, 

Ebola, and influenza, among others, can spread at the speed of a jet 

plane. The World Health Organization (WHO) reports that emerging 

public health risks “will require enhanced international cooperation 

and transparency.” Factoring all these changes into data-based effective 

health care systems will be a part of the NINR’s long-range planning 

for the second decade of the twenty-first century.4 

From an initial annual budget in 1986 of $16 million, the 

NINR’s appropriation has grown to more than $145 million, nearly 

three-quarters of which goes to research project grants and another 

approximately 20 percent to other research and training initiatives. 

Institute director Dr. Patricia A. Grady believes the country “is experiencing a convergence of factors that offer nursing research the chance 

to expand the already substantial impact it has had on the health of the 

public.” She notes that as the population ages, it increases the need to 

manage the normal aging process as well as the long-term impact of 

chronic illness. In addition, the nation’s increasing diversity requires 

health care professionals to have greater multicultural knowledge and 

sensitivity. Of significant importance is the shift from patient cure to 

patient care—the shift from acute illness to chronic conditions and 

from disease treatment to disease prevention. For the past decade, 

there has been an increased reliance on technology in health care 

delivery and a renewed call to translate successful nursing research 

into clinical practice. To continue to confront and overcome these 

challenges, Grady believes that the NINR must expand new research 

opportunities while providing for the future development of nurses, 

nursing faculty, and scientists.5 

In the future, nursing science may integrate the knowledge of 

complex systems into personalized self-management in order to 

maximize and improve overall health. As in any brave new world, the 

future brings new challenges that nurse investigators, in partnership with 

other health care professionals, must be willing and prepared to tackle.6 
214 Bringing Science to Life 

Dr. Pamela Hinds, director of nursing research at Children’s National 

Medical Center in Washington, D.C. 

In 2006 the NINR developed a strategic plan that outlined four 

areas in which the Institute and nurse investigators aimed to elevate 

nursing science’s contributions to clinical research over the following 

five years. The plan sought to “further the integration of the biological 

and behavioral sciences, promote the design and use of new patient 

care technologies, improve nursing science methods, and commit to 

the ongoing development of new nurse investigators.” To accomplish 

this blueprint for action, the NINR focused its research priorities on 

health promotion and disease prevention, improving the quality of life 

through symptom management and caregiving, eliminating health 

disparities, and leading end-of-life (EOL)-research. In formulating the 

strategic plan, the NINR sought to apply its resources to the areas of 

public health that had the greatest need and in which nursing science 

could have the greatest impact.7 
Epilogue: The Transformation of Nursing Science 215 

 

   

 

 

 

 

 

At regular five-year intervals, the NINR has reflected on its past 

achievements to measure the success of its strategies and their effectiveness. In anticipation of its twenty-fifth anniversary celebration, the 

Institute queried grantees on their assessment of its impact on nursing 

research. In the past, the NINR marked its accomplishments by the 

results of the research projects and centers it funded. The importance of these achievements cannot be overestimated. But the broader 

outlook of more than two decades provided an opportunity to look at 

the NINR with a fresh perspective, according to Dr. Pamela Hinds, the 

director of nursing research at Children’s National Medical Center in 

Washington, D.C. Hinds believed that the NINR changed the attitude 

and the altitude of nurse investigators. As to attitude, the NINR, as 

the leader in nursing science, has “been inspirational, and that inspiration and the financial support that came with it has led to a huge 

incremental increase in the number of nurses prepared to do research. 

The NINR has improved the sophistication of the research [nurses] 

conducted, such as more interventional and multisite trials, and more 

interdisciplinary studies. This occurred as a result of the expansive 

viewpoint of the NINR with its priorities, its collaborative nature on 

the NIH campus, and its resources distributed to investigators.” As to 

altitude, or raising the level of nursing research, Hinds asserted that 

the NINR, as an integral part of NIH, gave nursing science legitimacy. 

Many nursing professions agree that the NINR has worked hard to 

become a positive force for health care and health care research, not 

just on the NIH campus, but across the nation. And that, in itself, has 

been no small accomplishment.8 

Others applauded the catalytic role that the NINR assumed over 

the years. Dr. Kathleen A. Dracup, dean of the University of California, 

San Francisco, School of Nursing, whose work has centered on cardiology, disease management, and EOL issues, believed that the NINR 

“contributed more than any other institute to clarify these issues for the 

medical system.” She remarked that nursing research lacked a strong 

scientific base twenty-five years ago. “It didn’t have a lot of doctorally 
216 

 

 

 

 

 

 

Bringing Science to Life 

prepared scientists within its ranks, and it was hard to encourage people 

to conduct research because funding was difficult to obtain from other 

institutes.” Now the NINR “is the catalyst for predoctoral training, 

postdoctoral training, new investigator funding, thereby opening the 

way for an academic career. The NINR has made a huge difference in 

people’s lives in terms of research and academic success.”9 

Nearly all nurse scientists agreed on one particular achievement: 

the importance of locating the NINR at NIH. Dr. Elaine L. Larson, a 

professor and associate dean of research at the Columbia University 

School of Nursing, said that just being on the NIH campus brought 

nursing research to the larger scientific table. Before 1986, “there was 

essentially no presence at NIH of nurse scientists. Nursing was pretty 

invisible, and it wasn’t because anybody was trying to hide anything. It 

was because the other institutes didn’t consider nursing to have a body 

of research.” The NINR changed much of that, though not always to 

the extent that many nurses hoped.10 

Nursing research at NIH turned out to be a two-way street. Not 

only did other scientists learn about the value of nursing’s behavioral 

research, but at the same time, nurse investigators integrated more 

biological and basic science methodologies into their own studies, 

creating new interdisciplinary programs of research. The NIH 

Roadmap in 2004 provided opportunities for scientists to go beyond 

the tried and true, “to color outside the lines.” The Roadmap was the 

way for “off-road” vehicles to escape the well-traveled paths of traditional research and support innovative, high-risk science. One area 

ripe for such an approach emerging from the advances in science over 

the previous decade was genetics. By merging the study of human 

biology with behavior, the Roadmap sought to detour around the traditional highways of health research and follow paths leading to more 

creative interdisciplinary inquiry. Investigators assembled teams of 

scientists to build bridges across the biological, behavioral, and social 

sciences while training scientists to cultivate and integrate interdisciplinary approaches to complex health problems. The effect of the 
Epilogue: The Transformation of Nursing Science 217 

The NIH Roadmap for Medical Research was launched in September 2004 to address roadblocks to research and to transform the way biomedical research is conducted. NIH director 

Dr. Elias Zerhouni (right) spoke at the kickoff event. 

Roadmap, in which the NINR took a leadership role, was to increase 

the number of nurse scientists working with peers from another discipline. “The NINR has been very actively involved and supportive of 

the whole idea of translational and interdisciplinary research,” Larson 

said. The formula was simple and it has been successful, she asserted. 

“You do better research when you have different perspectives.”11 

The trend toward more interdisciplinary research allowed nursing 

research to “be more scaled up and become more mainstream,” according to Dr. Linda H. Aiken, a noted investigator and the director of the 

Center for Health Outcomes and Policy Research at the University of 

Pennsylvania School of Nursing. Because of the NINR’s support, she 

said, “nursing research is being published in interdisciplinary journals 

and adding to the cumulative interdisciplinary knowledge base on a 

number of issues. I think we are going to see more scientists viewing 

clinical problems through the lens of nursing and more nurse scientists leading interdisciplinary research teams to solve these problems,” 

she concluded.12 
218 Bringing Science to Life 

Dr. Lauren S. Aaronson, a leading nurse scientist and former senior 

advisor to the director of the NINR, agreed but argued that nursing 

should be considered a pioneer in melding the work of several research 

fields. “There was no one discipline that has all that is needed to address 

the complexities of today’s health problems,” she said. Aaronson, a 

professor at the University of Kansas School of Nursing, was particularly impressed with the idea of scientists working collaboratively and 

across disciplines to the point of developing “additional sciences that 

are a blending of the work coming from different disciplines.”13 

In a twist of fate, or at least one of the unintended consequences 

of the paucity of nursing research three decades ago, it was this lack 

of doctoral programs that created one of the profession’s strengths, 

Aaronson reflected. “When we first started this research enterprise,” 

she said, “there were very few doctoral programs in nursing, so most 

of us got our doctorates in other disciplines, so we became experts 

in those disciplines. When we came back to nursing, our charge was 

to figure out how to take that knowledge and apply it to nursing and 

make it relevant for nursing.” Trained as a nurse and then a sociologist, Aaronson recalled that she had inherent advantages over her 

classmates who came out of undergraduate programs in sociology. “In 

studying medical sociology—health services, delivery systems, and 

such—it became very clear that, because I was a nurse and had different life experience and professional experience, I could relate to that 

content very differently than my colleagues in sociology.”14 

Nevertheless, while Aaronson saw great potential in the interdisciplinary orientation of nursing science, she believed that the very 

youthfulness of nursing research was a two-edged sword. “In the 

research domain,” Aaronson said, “we are a young discipline. While 

we have done a tremendous job of preparing more nurse scientists in 

a short period if you compare us with our colleagues in other fields, 

we did not have a very large pool to select from initially.” As a result, 

there were fewer nurses to join multidisciplinary research teams, and 

“there is a tendency among nurses not to be particularly assertive in 
Epilogue: The Transformation of Nursing Science 219 

 

 

 

 

 

 

 

 

 

interdisciplinary groups, and that’s unfortunate. The knowledge we 

have gained from the research funded by the NINR has led to significant improvements in practice and the health of people. But it has been 

a quiet success. We need to raise nursing’s visibility in the research 

community.”15 

Dr. Margaret Grey, the dean and Annie Goodrich Professor at the 

Yale School of Nursing, was more optimistic. Grey, whose research 

has focused on pediatric diabetes, including behavioral interventions 

that improve metabolic control of diabetes and the quality of life in 

young people and their parents, as well as preventing type 2 diabetes 

in high-risk youth, believed that the NINR had changed the face of 

nursing science. She recalled that “when I first started doing science, 

studies were relatively...simple, though that is too pejorative a term. 

Our science was at a point where we weren’t doing studies that really 

tested complex models or involved many disciplinary teams.” More 

recently, however, nursing science has tackled more complex studies, 

testing models rather than “the simple question of if you do this intervention, then you’ll get this outcome.” The degree of complexity in 

nursing research “is the primary thing that’s changed over the past 

twenty years,” Grey said. “We’re seeing many more larger, multisite 

clinical trials that allow us to really test models. I feel very fortunate 

to have come up as a scientist at a time when nursing came into NIH. 

The NINR created an environment that allowed us, as junior scientists, 

to get funded and flourish as researchers.”16 

Grey noticed other changes as a result of the NINR. In 1970, when 

she graduated from the University of Pittsburgh, she recalled, “We didn’t 

even have a course in research. It was not a component of the curriculum. 

Now research is included in every undergraduate program in nursing.” 

When Grey finished her doctoral program in 1985, “good science was 

to conduct survey research. But the NINR made it clear that the goal 

was always to be able to do research that would change nursing practice. 

Ours is an applied discipline. We needed to move from what may be 

basic descriptive work to what we can do to fix this clinical problem.” 
220 

 

 

 

 

 

 

 

 

 

 

 

Bringing Science to Life 

Dr. Margaret Grey, right, with research scientist Dr. Sarah Jaser. Dr. Grey is dean and Annie 

Goodrich Professor at the Yale School of Nursing. 

From 1991 through 1997, Grey was a member, then chair, of the Nursing 

Science Review Committee, the panel that reviews training applications. 

“It was an era where there was a real burgeoning of PhD programs in 

nursing,” she recalled. “We were getting a lot of applications, but many 

of them were very weak in terms of research design, methodology, and 

faculty mentoring. But over the course of six years, we began to see 

an increase in sophistication of the research proposals—not only from 

the students, but from the faculty as well. Our methods and statistics 

courses are much more challenging. We are now looking at far more 

complicated models. Things are just night and day from what they were 

when I was in school. It’s just a whole different world.”17 

While the NINR catalyzed many of the major changes in nursing 
Epilogue: The Transformation of Nursing Science 221 

 

science over the past twenty-five years, it has not always been able to 

achieve other goals that deans of nursing schools held dear. The NINR 

sought to bring parity for nurse scientists to NIH. One noticeable difference between nurse investigators and those in other fields at NIH 

was the age of nurses with PhDs. While other scientists were finishing 

their doctorates around the age of thirty, nurse scientists were encouraged to leave school and work clinically. Nurse scientists were in their 

mid-forties by the time they received their doctorates. To remedy this, 

the NINR pushed for young nurse scientists to go through graduate 

education earlier, straight from the baccalaureate to the PhD, and it set 

aside funding to make this possible. A recent analysis by the National 

Academy of Sciences indicated that there had been little change, despite 

the NINR’s initiative. “Those data are not pretty for nursing,” Grey 

declared. Even today, she observed, many faculty members advise their 

students to work in clinical settings for a few years after their bachelor’s 

degree and again after the master’s degree before pursuing the PhD. “I 

started graduate school three years out of my undergraduate program, 

and everybody told me not to do it. I was too young, I didn’t know 

enough about nursing. And faculty are still giving the same message 

today. It’s awful. We are educating twenty-first century students using 

eighteenth century pedagogy.” Future change, she believes, cannot 

depend on the initiatives of the NINR. “What it’s really going to take is 

the game-changing view of the world by the older nurse faculty.”18 

Other needed changes in educating nurse scientists can be made 

by the NINR, according to Larson of Columbia University. “The 

research workforce is aging,” she emphasized. “We’re losing a lot of 

researchers who are in their sixties and ready to retire. In addition, 

we have failed to attract enough new people with a passion for nursing 

research into the discipline.” Larson recounted examples of nurse scientists seeing the hurdles of following an academic career and getting 

scared off. She faults the regulatory and funding systems that scientists 

face. “They’re so daunting, many just give up,” she said. “It’s really hard 

for new scientists to independently write a grant that is of the level that 
222 Bringing Science to Life 

In an NINR-funded study, Dr. Elaine Larson (left) evaluated the effect of antibacterial home 

cleaning and handwashing products on infectious disease symptoms. She meets with project 

coordinator Delmy Miranda (right) in a storeroom containing a year’s worth of supplies. 

passes review. I think it’s a good idea that the NIH gives priority to 

new investigators. I do not want to lose grants myself, but we have to 

make room for a new generation of scientists.”19 

To build this cadre of “new passionate investigators,” Larson 

believes that there should be closer collaboration among the NINR, 

other funding groups, and the schools of nursing. “The schools need to 

be on top of what needs to happen,” she argues, “which is more interdisciplinary training, more translational training, and more faculty willing 

and able to mentor new people.” Like others, she stresses the urgency 

of nurse scientists pursuing their degrees at an earlier age. “You spend 

most of your career getting your own research funding; you are not in 

a position to provide the mentoring for new people coming along. So 

we have to mature faculty earlier in their careers so that they have the 

time, energy, and willingness to mentor new people.”20 

Aiken sees the same trend at the University of Pennsylvania, which 
Epilogue: The Transformation of Nursing Science 223 

is trying to attract students earlier to scientific research as undergraduates and “then promote these expedited BSN to PhD programs so that 

we have more nurses begin their research careers at a much earlier age, 

more comparable to the ages of people in other fields.” To accomplish 

this, Pennsylvania is developing a fast research track for freshmen and 

placing them in one of the university’s six research centers so they 

can “actually start working on and understanding NINR research.” 

But Aiken does not believe that the cadre of young nurse scientists is 

shrinking. “What gives us that perception that there are not enough 

nurse PhDs,” she explains, “is that because of the growth of demand for 

nurses with doctoral degrees, we have so much greater need.”21 

The basic ingredient for successful nursing science has been, 

and remains, funding. The NINR and its funding levels gave nursing 

research both a symbolic and significant impact on nursing science. 

The Institute fostered the growth of the interdisciplinary nature of 

nursing research, according to Aiken. Interdisciplinary journals now 

publish the work of nurse investigators, “adding to the cumulative 

interdisciplinary knowledge base on a number of issues. The NINR 

made that possible.” But, she warned, “a lot of nursing research, especially funded by the NINR, is still small [scale].” Now, she said, skilled 

investigators are doing larger multisite trials, and these larger initiatives require greater funding. “So either the NINR must have a larger 

budget or nurses have to become more influential in other institutes” 

to get such trials funded.22 

Nevertheless, Aiken, whose role in the creation of the NINR goes 

back to the 1983 Institute of Medicine report, recalls that funding has 

long been a limiting factor. “The funding has never been as great as we 

imagined. For example, some of the agenda items that it has selected— 

like end-of-life care and management of chronic care, are different from 

curing diseases—there are no other institutes that really devote their 

attention to management of symptoms.” When her group made the 

recommendation about nursing research at NIH, she said, “We were 

anticipating that the NINR would be the institute that would establish 
224 

 

 

 

 

 

 

 

 

 

 

 

Bringing Science to Life 

the science base of clinical care and fund any investigator of any discipline that had a good idea.” Unfortunately, the NINR has never had 

the resources to meet that ideal. One way to accomplish this goal, 

she believes, is for the NINR-funded scientists “to play a larger role 

in policy than they have played to date.” She believes that in addition 

to clinical research, when higher funding levels become available, the 

NINR should place a greater priority on studies examining the basis 

for science in health services, research, and policy.23 

But what of the future? There is widespread agreement that the 

NINR has been the impetus for enormous changes in the science of 

nursing research over the past twenty-five years. “It has transformed 

our science,” declared one nurse investigator. The NINR’s presence 

at NIH has given nursing science unmatched visibility and a reliable 

source of funding unknown to nurse investigators before the 1980s. 

Making progress on finding a cure for a disease has made NIH world 

famous. Meanwhile, the NINR has, in a sense, widened the NIH 

mission, giving credibility to maximizing the health and quality of life 

of patients and families even when afflicted with an acute or chronic 

disease. Over the past quarter-century, both the cure and the health 

promotion tracks have moved closer together as biomedical science 

and biobehavioral science have learned the value of—and come to 

respect—the other’s research approaches.24 

The idea that any one profession holds the key to solving the world’s 

health problems was and is “insanity” in the opinion of Dean Grey of 

Yale University. Just two decades ago, nurses would collaborate, often as 

part of a clinical team, but not as equal members of the research group, 

according to Grey. That is no longer the case, she claims. “We are recognized as part of a broader team trying to solve complicated problems.” 

Now, she says, “‘interdisciplinarity’ is the name of the game.” Society’s 

problems, Grey believes, are “way too complicated to even think about 

trying to solve using single disciplinary strategies. So I think we’re going 

to see nursing science become increasingly involved in transdisciplinary 

research training, and transdisciplinary research teams.”25 
Epilogue: The Transformation of Nursing Science 225 

Others agree with Grey’s assessment. Moreover, they recognize 

not only the myriad of health care problems faced by society, but also 

the technological complexities arrayed against them, all of which nurse 

scientists must absorb if they are to be well prepared for the future. 

Larson of Columbia University sees a richer mixing of the biological and social sciences, where researchers from those disciplines have 

crossed over to develop more credible qualitative methodologies. 

Dracup, the dean of the University of California, San Francisco, School 

of Nursing, thinks the integration of technology will be a major trend 

in the future of nursing research and that the NINR will take the lead 

in this area. “It’s so hard to imagine that we did not even have e-mail 

in the late eighties. Isn’t that stunning?” She uses the example of her 

colleague, Dr. Yoshimi Fukuoka, who is developing an intervention to 

support exercise in older sedentary women using a cell phone. Such 

handheld devices, Dracup says, have the potential to reach patients 

and families and to support behaviors that keep people healthy and out 

of the hospital—and, not incidentally, at significant cost savings.26 

There are other technological advances that are rich with potential for nurse scientists. With the advent of inexpensive and fast 

DNA sequencing in the past five years, genetic studies have become a 

powerful way to uncover genes that make contributions—along with 

environmental influences and personal choice—in a person’s overall 

risk for such chronic ailments as diabetes and coronary heart disease. 

In 2010, as technology has lowered the cost of decoding a genome 

to less than $50,000 and the cost of sequencing is expected to drop 

to $5,000 or less in two or three years, the understanding of diseases 

and patients’ suffering will open a plethora of opportunities for nurse 

scientists.27 

Such work has momentous implications for nursing science, 

according to Dracup. She views the use of biomarkers of phenotypes 

for the surveillance and management of symptoms as an example of the 

evolving and complex strategies that are being incorporated by nurse 

scientists. The impediment to greater understanding of genomes will 
226 Bringing Science to Life 

not be technology, but the ability to understand and interpret what the 

technology reveals and how this is translated to patients and families. 

Nurse investigators will need to identify which biomarkers are important indicators of disease progression and which are diagnostic of 

either symptoms or disease, and then integrate them more fully into 

their research and practice. Disease management, she believes, especially for the nation’s population that is aging and obese, will become 

the next big issue for the NINR. The challenges are many, she warns. 

“How do you get a sixty-five-year-old obese person to exercise more?” 

she asks. “People have been asking that question for decades. We have 

to figure out if technology will be the answer. Are there other things 

we should be measuring that we haven’t been able to measure well that 

might be clues to how we could intervene in behavior?” In addition to 

technology, biomarkers, EOL care, and disease management, Dracup 

adds, the research will also have to demonstrate cost effectiveness. She 

sees this as a requisite for all of NIH, not solely the NINR. “Is there an 

institute that will look at a clinical trial that does not have a cost effectiveness analysis? It’s just too hot a topic in health care right now.”28 

The health care debate of 2010 swirled around no single topic 

with more passion and bluster than EOL care. Whatever the outcome 

of that debate, nurse scientists will be central to those decisions, as 

EOL care has long been a specialty for nurses and nursing research. 

For years, nurse clinicians have understood the importance of establishing advance directives in EOL care. Yet studies done by nurse 

scientists have demonstrated low rates of completing those directives 

among the critically ill. Even when in place, living wills and other 

advance directives are often seen as vague and difficult to interpret. 

Moreover, in the absence of any advance directives, neither family 

members nor clinicians have been able to predict accurately the health 

decisions of critically ill patients. Using new technology, a group of 

NINR researchers developed an innovative multimedia decision aid, 

“Making Your Wishes Known: Planning Your Medical Future,” to 

translate preferences into a specific plan that can be implemented by 
Epilogue: The Transformation of Nursing Science 227 

 

 

 

 

 

 

 

 

 

 

a health care team. Not only were the results of the program overwhelmingly embraced by the patients involved, the peace of mind for 

patients and families as well as the long-term cost savings to be gained 

from the widespread implementation of such programs seemed readily 

apparent.29 

In the spring of 2009, Hinds, the head of nursing research at The 

Children’s National Medical Center, served as the facilitator for a focus 

group of investigators and nursing leaders from across the country 

to suggest to the NINR where EOL science, including palliative care, 

stood and where it needed to go. “The NINR is leading the charge for 

palliative and EOL research on the NIH campus. I am thrilled that 

the NINR has gone after that area of science and how to benefit it,” 

she said. Hinds complimented the NINR on the amount of thought 

that went into assembling the group, which included advocates, nurses 

and non-nurses, and individuals who had never been funded before 

“but represented very important voices in terms of palliative and EOL 

research,” as well as funded investigators. “There was a tremendous 

cross-cutting of interests so that it just wasn’t your senior funded 

investigator. The feedback sessions were a kind of informed grassroots 

interaction with NINR leadership.”30 

For Hinds, the diverse panel represented the future of the NINR 

in setting priorities for nursing science. Echoing others who praised 

the trend for interdisciplinary research, she stressed the importance of 

such an array of fields being brought together in EOL care. “The inclusiveness of the panels has gone way beyond our own discipline. I think 

that’s quite an evolution of the process, and a maturation sign as well. I 

have been impressed with how skillfully the NINR and attendees learn 

where the science needs to go and subsequently develop content areas 

for formalizing, galvanizing, and then funding efforts in those areas. 

We are going to learn the most where the NINR puts its resources.”31 

Nonetheless, as the NINR approaches its twenty-fifth anniversary, 

some issues remain. For many nurse scientists, the size of the Institute’s 

budget has not matched the level of its achievements. Continuation 
228 Bringing Science to Life 

of this trend, they believe, will hinder future research. For example, 

Hinds observes that nurse scientists have “demonstrated very exciting 

research at the practical bedside, the science needed to provide excellent care to a patient; but that has yet to be translated into an equally 

impressive increase in budget. My concern for the future is being able 

to grow the program in a way that is reflected by the budget.” She 

sees the future of nursing research in developing more low-cost interventions, including developing more international research programs 

with selected partners for “low-resource countries.” According to 

Hinds, these partners “have tackled some of the same issues we are 

tackling, and because of limited resources, they may well have identified low-cost interventions that will assist us in reassessing how we 

are giving care in the same area.” She points to several countries in 

South America that have developed low-cost care interventions related 

to how premature babies maintain body temperature. “The more we 

can learn from our international partners about what the mechanism 

of these actions can do, the better our perspective will be. They will 

provide new eyes to look at possibilities we might not otherwise have 

considered.”32 

Dracup also sees budgetary issues as a hindrance to the NINR’s 

future. Like many nurse investigators, she looks at the gains of the 

NINR through the larger lens of NIH. “We’ve been really lucky with 

the directors we have had in both Ada Sue Hinshaw and Patricia Grady. 

They both had tremendous credibility on the NIH campus for different reasons. Ada Sue was an outsider who quickly gained credibility. 

Patricia brought even more credibility because of her familiarity with 

NIH and other institutes and her own research portfolio, the kind 

of portfolio familiar to NIH.” But, she added, “at the end of the day, 

budgets talk, and compared to other institutes, I would say we are still 

struggling for our place.” While both Hinshaw and Grady advocated 

collaboration with other institutes to increase funding possibilities for 

nurse scientists, Grady also emphasized working with other institutes 

in co-funding research that would meet the strategic priorities of the 
Epilogue: The Transformation of Nursing Science 229 

Dr. Ada Sue Hinshaw, NIH Director Elias Zerhouni, and Dr. Patricia A. Grady marked NINR’s 

20th anniversary. 

NINR. While this strategy has expanded nursing science, Dracup 

maintains that one of the main difficulties lies in the nature of nursing 

research itself. “The NINR has provided a place for scientists who 

are interested in the priority issues stemming from coping and stress, 

disease prevention, and EOL care. It is research that affects the quality 

of every day of patients’ lives. It’s what makes people feel better or worse 

in their day if they have cancer or some other debilitating disease. But 

fortunately or unfortunately for society, quality of life is not what is 

publicized as hot New York Times science advances, like a new vaccine 

or the discovery of the AIDS virus. I think that’s a stumbling block for 

the NINR. That’s always the challenge for the NINR director, because 

when she goes to Congress [for appropriations], they are looking for 

dramatic findings.”33 

Aiken registers the same concern. “The funding has never been 

as great as we imagined it could be, and so the overall funding is a 

constraining factor in terms of the ability of the NINR to really make 
230 Bringing Science to Life 

significant progress.” The NINR agenda, she notes, has selected EOL 

care and chronic care coordination to establish a science base for patient 

care as other institutes did for cure. “As a result, progress in terms of 

nursing research on policy-relevant issues has not grown as rapidly 

as it could grow with greater resources. So for nursing to really come 

into its own, it’s got to utilize more fully its knowledgeable and highly 

skilled investigators and scale up with larger multisite trials. To do 

this, the NINR must have a budget comparable to the other Institutes 

or nurse scientists have to continue to be more creative in raising the 

money elsewhere.” She recommends placing a greater emphasis on the 

significance of research itself, especially as it applies to policy makers 

and legislators.34 

And what will be the future of nursing science in the next twentyfive years? With the spectacular advances in technology accompanied 

by lower costs, no one can know for certain, but a reasonable guess 

would be that technology and science will continue to evolve, creating 

an ever more complex mix of interdisciplinary concepts, while at the 

same time driving down the costs of technology and making its application more widespread. Arguably, these new combinations will, by 

the very nature of their complexities, become part of a broad systems 

approach to health care management. For nursing science, this will 

particularly include information science and its application into largescale clinical trials, as well as mining and combining previous, smaller 

trials to reconfigure data with new approaches or perspectives. In 

addition, e-mail and electronic journals have expanded the flow and 

increased the speed of exchanging ideas and information in nursing 

science. This is especially important for drawing on the results of nurse 

investigators throughout the world. Already, electronic submissions of 

manuscripts from nurse investigators around the globe have changed 

the content of and internationalized nursing science, according to the 

editor of one national journal. As this trend continues, then, nursing 

science will increasingly enhance its international perspective, or, as 

one nurse scientist says, “expand its scope of voices.”35 
Epilogue: The Transformation of Nursing Science 231 

In reviewing the NINR’s 2006 Strategic Plan, Director Patricia A. 

Grady wrote that “the time is right for the NINR to become a leader in 

addressing some of the most important health care issues facing our 

society. For the NINR, and for all of nursing science, the possibilities 

are endless.” Grady, who became head of the Institute in 1995, brought 

a decade of historical perspective to her observation. Her words still 

ring true, but in the interim the NINR has assumed that leadership 

role in several of the areas anticipated in that strategic plan. The 

Institute’s commitment to eliminating health disparities and its focus 

on health promotion and disease prevention have positioned it as a 

leader in strategic planning on health outcomes for underserved populations. In addition, the NINR has played a critical role within NIH in 

developing a research infrastructure in minority-serving institutions 

and making research findings and methods more widely accessible in 

those communities.36 

The NINR leadership has emerged most noticeably in the area of 

EOL and palliative care science. Many are surprised to learn that even 

though civilization has coped with death throughout history, research 

into EOL care is still in its infancy in terms of rigorous testing and 

evaluation of models of care, of patient and family outcomes, and of 

resource utilization. NINR initiatives have expanded EOL research 

through research training, interdisciplinary programs, supplemental awards, and targeted grants. As part of this research effort, the 

Institute has funded the Center for End-of-Life Transition Research 

at the University of Illinois at Chicago. The focus of the center and 

other NINR-supported research is to identify factors that influence 

and develop strategies to improve decision making and treatment at 

the end of life. For example, a recent study examined the decision 

to remove patients in an intensive care unit (ICU) from life support. 

The investigators found that the life support withdrawal process from 

feeding tubes, intravenous fluids, ventilators, or medications, though 

relatively common, was often sequential as clinicians sought to balance 

the complex needs of the patient and the patient’s family. Of particular 
232 Bringing Science to Life 

interest was the finding that families of patients who had experienced 

a longer ICU stay tended to prefer the more extended, sequential 

withdrawal process. Another study indicated that improved communication between ICU staff and families to provide them with accurate 

information on which to base decisions and prepare them emotionally 

for the eventual loss of a loved one greatly reduced feelings of stress 

and depression in family members.37 

The NINR has evolved with the country’s changing demographics and increasing diversity as the nation’s population ages. By 2020, 

more than 20 percent of the population will be age sixty-five or older. 

Longer life expectancy of individuals with chronic and acute conditions will challenge the health care system’s ability to provide efficient 

and effective continuing care. Increases in the diversity of the population will continue to affect access to care, morbidity, and mortality 

among underserved population groups. Nurse training and nursing 

science must keep up with these changes, adapting emerging digital 

technologies and genomic advances to clinical diagnosis and treatment. Nurses of the future will need to be as knowledgeable about 

health promotion as disease prevention and to demonstrate management skills in epidemiology, biostatistics, and behavioral science. 

They will need to collaborate with ever-shifting teams of nurses, physicians, social workers, pharmacists, and other health care providers 

to explore fully the wide range of knowledge and skill necessary to 

manage and resolve patient needs. Over the past quarter-century, 

nursing science has become an integral part of improving the nation’s 

health as nursing research continues to build an independent body 

of knowledge. Nevertheless, the challenges incumbent with shifting 

demographics, expanding technology, and the globalization of health 

care will continue to demand the latest and most original approaches 

from nursing science.38 

As the NINR celebrates its twenty-fifth anniversary and looks to 

the future, the lessons of the past are particularly pertinent to nurse 

investigators: to sift the evidence and study problems from all sides 
Epilogue: The Transformation of Nursing Science 233 

and angles, to challenge old methodologies, to reveal new patterns of 

inquiry, and to apply fresh strategies to nursing science. As the country’s health care system expands, the demand for nurses will be even 

higher. Schools of nursing will need to find the nurse scientists to 

become the faculty to teach this anticipated influx of new students. 

Never have the opportunities for nurse scientists been so promising 

in terms of training, research, and outcomes. Never have resources 

been more available. Fortunately, for a quarter of a century, nurse 

scientists funded by the NINR have been preparing for such challenges and opportunities. Working in tandem with, and in support 

of, nurse educators and scientists, the NINR has developed the conceptual frameworks to guide a full range of systematic research for 

its programs, integrating emerging technologies, collaborating with 

diverse disciplines, and tackling both widely recognized and understudied societal needs to strengthen nursing science and the nation’s 

health care system. As the Institute’s research portfolio evolves, so too 

must nurse scientists continue to question old assumptions, initiate 

new research approaches, and embrace unexpected opportunities. For 

twenty-five years the NINR, with planning, resources, and leadership, 

has held the door open for nurse investigators, let the future in, and 

changed the face of nursing science. With that foundation, the next 

quarter-century for the NINR and nursing research promises to be 

even more stimulating, significant, and accomplished.39 
234 Bringing Science to Life 

Epilogue Endnotes 

1	 “Annie W. Goodrich: Representing ‘Tomorrow’s Nurse,” American Journal of 

Nursing 46, no. 4 (April 1946): 215. 

2	 Ibid., 215-16. 

3	 Ibid., 216. 

4	 World Health Organization, A Safer Future: Global Public Health Security in the 

21st Century (Geneva, Switzerland: World Health Organization Press, 2007). 

5	 NINR Strategic Plan, 2006-2011, “Prologue from the NINR Director,” October 

2006, n.p. 

6	 NINR: An Overview, August 2006, http://www.ninr.nih.gov/ 

NewsAndInformation/NINRPublications/. 

7	 NINR Strategic Plan, 2006-2011, “Prologue from the NINR Director,” October 

2006, n.p. 

8	 Dr. Pamela Hinds, telephone interview by Philip L. Cantelon, August 23, 2009, 5, 

9 (hereafter Hinds Oral History). 

9	 Dr. Kathleen A. Dracup, telephone interview by Philip L. Cantelon, September 2, 

2009, 4-6 (hereafter Dracup Oral History). 

10	 Dr. Elaine L. Larson, telephone interview by Philip L. Cantelon, August 19, 2009, 

18-19 (hereafter Larson Oral History). 

11	 NIH Roadmap for Medical Research, http://nihroadmap.nih.gov/interdisciplinary/; “NIH Roadmap in Gear for 3rd Year,” NIH Record 58, no. 12 (June 16, 

2006); Larson Oral History, 4. 

12	 Linda H. Aiken, telephone interview by Philip L. Cantelon, August 17, 2009, 

11-12 (hereafter Aiken Oral History). 

13	 Lauren S. Aaronson, telephone interview by Philip L. Cantelon, September 4, 

2009, 5 (hereafter Aaronson Oral History). 

14	 Ibid., 5-6. 

15	 Ibid., 11-13. 

16	 Margaret Grey, telephone interview by Philip L. Cantelon, August 14, 2009, 2 

(hereafter Grey Oral History). 

17	 Ibid., 4-5, 7-8. 

18	 Ibid., 8-9, 11. 

19	 Larson Oral History, 20. 

20	 Ibid., 21. 

21	 Aiken Oral History, 7-8. 
Epilogue: The Transformation of Nursing Science 235 

22 Ibid., 10-12.
 

23 Ibid., 10-11.
 

24 Grey Oral History, 18.
 

25 Ibid., 13-14.
 

26 Larson Oral History, 4-5; Dracup Oral History, 9.
 

27 The Washington Post, September 7, 2009; The New York Times, August 11, 


2009. The pursuit to sequence a genome for $1,000, “as cheap as the price of a 

Broadway ticket,” according to The New York Times, is the goal of a global race 

toward an era of personalized medicine that would offer significant improvements in diagnosis and treatment. See The New York Times, October 6, 2009. 

28	 Dracup Oral History, 10-11. 

29	 “Interactive Computer Program Demonstrates Improvements in the Advance 

Care Planning Process at the End of Life,” Monthly Summaries of Nursing 

Research: April 2009, http://www.medscape.com/viewarticle/702792. 

30	 Hinds Oral History, 6-8. 

31	 Ibid., 9, 10-11. 

32	 Ibid., 10, 14-15. 

33	 Dracup Oral History, 7-8. 

34	 Aiken Oral History, 10-12, 15. 

35	 Larson Oral History, 26-27, 25; Hinds Oral History, 16. Larson also calls on 

nurse scientists in the United States to collaborate more with nurse researchers in 

Europe and Asia. 

36	 NINR Strategic Plan, 2006-2011, “Prologue from the NINR Director,” October 

2006, n.p.; ibid., “Eliminating Health Disparities,” n.p. 

37	 “Prolonging the Withdrawal of Life Support in the ICU Affects Family 

Satisfaction with Care,” NIH News, October 15, 2008; “Improving 

Communication in the ICU about End-of-Life Care in the ICU Reduces 

Symptoms of Stress, Anxiety, and Depression in Family Members,” NIH News, 

February 1, 2007. 

38	 See Barbara R. Heller, et al., “The Future of Nursing Education: Ten Trends to 

Watch,” Nursing and Health Care Perspectives 21, no. 1 (January-February 2000): 

9-13. 

39	 The Washington Post, November 6, 2009. 

Appendices 237 

Appendix A 

National Institute of Nursing Research 

Oral History Interviews 

Conducted by Dr. Philip L. Cantelon 

Aaronson, Dr. Lauren, September 4, 2009 

Aiken, Dr. Linda, June 10, 2008, and August 17, 2009 

Bednash, Dr. Geraldine “Polly,” June 3, 2008 

Bulger, Dr. Roger, March 10, 2008 

Dracup, Dr. Kathleen, September 2, 2009 

Elliott, Jo Eleanor, May 1, 2008 

Felton, Dr. Geraldene, June 30, 2008 

Grady, Dr. Patricia A., January 26 and February 4, 2009 

Grey, Dr. Margaret, August 14, 2009 

Heinrich, Dr. Janet, March 6, March 21, and April 11, 2008 

Hinds, Dr. Pamela S., August 23, 2009 

Hinshaw, Dr. Ada Sue, August 20 and 28, 2008, and April 22, 2009 

Kirschstein, Dr. Ruth L., January 17, 2008 

Larson, Dr. Elaine, August 19, 2009 

Merritt, Dr. Doris, April 28, 2008 

Moritz, Dr. Patricia, March 13, 2008 

Raub, Dr. William F., May 21, 2008 

Rudy, Dr. Ellen, June 16, 2008 

Woods, Dr. Nancy Fugate, March 24, 2008 

Appendices 239 

Appendix B 

Photo Credits 

National Institute of Nursing Research 

xii, 2, 4, 8, 15, 25, 30, 38, 49, 54, 58, 64, 82, 88, 93, 100, 103, 112, 115, 116, 119, 

130, 137, 143, 162, 167, 171, 190, 192, 208, 229 

Wikimedia Commons 

13, 52 

NIH Record 

43, 71, 98, 102, 123, 141, 147, 217 

www.oucher.org 

105 

Dr. Loretta Sweet Jemmott 

148 

Dr. Kate Lorig 

150 

Dr. Linda Aiken 

152 

ADVANCE Newsmagazines 

The photograph on page 152 has been reprinted with permission from 

ADVANCE Newsmagazines. 

Dr. Mary Naylor 

153 

Dr. Nilda Peragallo 

177 

Dr. Judith Matthews 

179 

Dr. Kathleen Buckwalter 

181 

Dr. David Dinges 

182 

Yale University School of Nursing 

210 

Dr. Pamela Hinds 

214 

Dr. Margaret Grey (Michael Marsland photographer) 

220 

Dr. Elaine Larson 

222 

Appendices 241 

Name Date of Service Institution/Organization (State) 

Abdellah, Faye G.* 02/1987-08/1989 U.S. Public Health Service (MD) 

Affonso, Dyanne D. 02/1987-09/1988 University of California, San Francisco (CA) 

Alt-White, Anna* 01/2004-present Department of Veteran Affairs (DC) 

Archbold, Patricia G. 06/1990-01/1994 Oregon Health Sciences University 

(OR) 

Austin, Joan K. 02-2004-01/2008 Indiana University (IN) 

Baun, Mara M. 06/1990-02/1992 University of Nebraska (NE) 

Beck, Cornelia M. 02/1994-01/1998 University of Arkansas for Medical 

Sciences (AR) 

Behrman, Richard E. 02/1998-01/2001 Center for the Future for Children, 

The David and Lucile Packard Foundation (CA) 

Berman, Richard A. 06/1991-01/1995 Howe-Lewis International (NY) 

Berning, Randall K. 02/1994-01/1998 Health Care Attorney & Consultant 

(CA) 

Blumenreich, Gene A., 02/1998-01/2002 Nutter, McClennen & Fish, LLP 

(MA) 

Broome, Marion 02/2008-01/2012 Indiana University (IN) 

Brooten, Dorothy 02/1997-01/2001 Case Western Reserve University 

(OH) 

Bryant L. Edward, Jr. 06/1990-01/1994 Gardner, Carton and Douglas (IL) 

Buckwalter, Kathleen C. 06/1997-01/2002 The University of Iowa (IA) 

Buehler, Meta E. 06/1993-01/1997 Medical College of Virginia (VA) 

Buerhaus, Peter 02/2002-01/2006 Vanderbilt University (TN) 

Burgess, Ann W. 02/1987-09/1998 University of Pennsylvania (PA) 

Appendix C 

National Advisory Council for 

Nursing Research Member List 

*Ex-officio members 
242 

Name Date of Service Institution/Organization (State) 

Burgio, Louis 02/2002-01/2006 University of Alabama (AL) 

Cammermeyer, Margarethe 02/2001-01/2003 Lecturer/Consultant (WA) 

Conway, Elaine W. 02/1987-09/1998 Community Leader (NY) 

Conway-Welch, Colleen 06/1989-02/1993 Vanderbilt University (TN) 

Cordes, Donald W. 02/1987-09/1990 Cordes & Associates, Inc. (IA) 

Counte, Michael A. 03/2005-04/2009 St. Louis University (MO) 

Cournoyer, Paulette R.* 02/1987-05/2003 VA Boston Healthcare System (MA) 

Cowan, Marie J. 06/1993-01/1997 University of Washington (WA) 

Crisp, Rosemary B. 03/2003-02/2007 Consultant (IL) 

Cronenwett, Linda R. 06/1992-01/1996 Dartmouth Hitchcock Medical 

Center (NH) 

Cupples, Sandra A.* 02/1987-02/1990 Washington Hospital Center (DC) 

Curtis, J. Randall 06/2006-01/2010 University of Washington (WA) 

Damus, Karla H. 02/1987-02/1990 Albert Einstein College of Medicine 

(NY) 

Dinges, David F. 08/2005-02/2009 University of Pennsylvania (PA) 

Dowling, Glenna A. 02/2010-01/2014 University of California–San Francisco (CA) 

Dracup, Kathleen A. 02/2004-01/2008 University of California, San Francisco (CA) 

Dunbar-Jacob, Jacqueline M. 02/2001-01/2005 University of Pittsburgh (PA) 

Elliott, Jo Eleanor* 02/1987-05/1989 Department of Health and Human 

Services (MD) 

Felton, Geraldene 06/1991-01/1998 University of Iowa (IA) 

Ferguson, Stephanie 02/2002-01/2005 George Mason University (VA) 

Ferrell, Betty R. 06/1997-01/2000 City of Hope National Medical 

Center (CA) 

Fife, Rose S. 06/1991-01/1995 Indiana University (IN) 

Finkelstein, Stanley 02/2008-01/2012 University of Minnesota (MN) 

Bringing Science to Life 

*Ex-officio members 
Appendices 243 

Name Date of Service Institution/Organization (State) 

Finkler, Steven A. 06/1997-01/2001 New York University (NY) 

Fralic, Maryann F. 06/1991-01/1995 Robert Wood Johnson University 

Hospital (NJ) 

Freeman, Everette J. 02/2010-01/2014 Albany State University (GA) 

Frick, Kevin 02/2007-01/2011 Johns Hopkins Bloomberg School of 

Public Health (MD) 

Geolot, Denise* 06/1990-01/1991 Department of Health and Human 

Services (MD) 

Giger, Joyce N. 03/2003-02/2007 University of Alabama (AL) 

Gioiella, Evelynn 02/1994-01/1998 Hunter Bellevue School of Nursing 

(NY) 

Grey, Margaret J. 02/2000-01/2004 Yale University (CT) 

Guthrie, Barbara 02/2009-01/2013 Yale University (CT) 

Hagey, Antoinette* 02/1990-01/1991 Office of the Assistant Secretary of 

Defense for Health Affairs (DC) 

Hanley, Daniel F. 02/2000-01/2004 Johns Hopkins Medical Institutions 

(MD) 

Harrigan, Rosanne C. 02/2000-01/2004 University of Hawaii School of Nursing and Dental Hygiene (HI) 

Heller, Leonard E. 02/1987-02/1990 University of Kentucky Chandler 

Medical Center (KY) 

Hernandez, Gloria* 02/1987-09/1988 Office of the Assistant Secretary of 

Defense for Health Affairs (DC) 

Hodge, Felicia Schanche 05/2005-02/2009 UCLA School of Nursing (CA) 

Howell, Doris A. 02/1987-02/1992 University of California, San Diego 

Medical Center (CA) 

Jemmott, Loretta S. 06/1993-01/1997 Rutgers, the State University of New 

Jersey College of Nursing (NJ) 

Jennings, Bonnie L.* 09/1991-01/1995 Office of the Assistant Secretary of 

Defense for Health Affairs (VA) 

Kennedy-Scott, Patricia 09/1994-02/1995 Michigan Health Center (MI) 

Kim, Hesook Suzie 06/1990-01/1994 University of Rhode Island College 

of Nursing (RI) 

*Ex-officio members 
244 

Name Date of Service Institution/Organization (State) 

Kim, Mi Ja 06/1997-01/2000 The University of Illinois at Chicago 

(IL) 

Kinney, Marguerite R. 06/1992-01/1996 University of Alabama (AL) 

Kirchoff, Karin T. 02/1987-02/1992 University of Utah (UT) 

Kjervik, Diane K. 02/1987-02/1992 University of Texas (TX) 

Lake, Diana E. 02/2008-01/2012 Memorial Sloan Kettering Cancer 

Center (NY) 

Lancaster, Joan 02/2008-01/2010 Community and Government Relations (TN) 

LaRosa, Judith H. 06/1997-01/2001 Tulane University School of Public 

Health and Tropical Medicine (LA) 

Larson, Elaine 02/2010-01/2014 Columbia University (NY) 

Lindsey, Ada M. 06/1997-01/2001 University of Nebraska 

Linn, James W. 09/2005-01/2009 Lewis, Longman & Walker (FL) 

Lum, Jean L. J. 06/1990-02/1993 University of Hawaii at Manoa (HI) 

MacDonald, Elizabeth A.* 02/1989-09/1989 Office of the Assistant Secretary of 

Defense for Health Affairs (DC) 

Marshall, Jean R. 06/1997-01/2000 Meridian Health System (NJ) 

Matthaei, Frederick C., Jr. 02/1987-09/1990 ARCO Industries Corporation (MI) 

McSweeney, Jean C. 02/2007-01/2011 University of Arkansas for Medical 

Sciences (AR) 

Merritt, Doris H.* 12/1986-10/1999 Indiana University Medical Center 

(IN) 

Miller, Karen L. 06/1997-01/2000 School of Allied Health (KS) 

Millon-Underwood, Sandra 

M. 

02/2004-04/2008 University of Wisconsin Milwaukee 

(WI) 

Morrow, Gary 02/2004-06/2008 University of Rochester Medical 

Center (NY) 

Munet-Vilaro, Frances 02/2003-02/2007 University of Washington (WA) 

Murray, John S.* 09/2005-01/2008 National Capital Area Military 

Health System (MD) 

Bringing Science to Life 

*Ex-officio members 
Appendices 245 

Name Date of Service Institution/Organization (State) 

Naylor, Mary 02/2001-09/2005 University of Pennsylvania (PA) 

Oakley, Debora J. 06/1993-01/1997 University of Michigan (MI) 

Patton, Curtis L. 03/1998-01/2002 Yale University (CT) 

Pender, Nola J. 02/1987-02/1990 Northern Illinois University (MI) 

Potempa, Kathleen 02/2009-01/2013 University of Michigan (MI) 

Portillo, Carmen J. 01/1999-09/2003 University of California (CA) 

Powell, Dorothy L. 02/2000-01/2004 Howard University (DC) 

Reardon, Judy E. 06/1995-01/1996 New Hampshire Public Affairs 

Director (NH) 

Reinhard, Susan C. 02/2010-01/2014 AARP (DC) 

Richard, Maggie L.* 01/2009-Present Department of the Navy (MD) 

Rudy, Ellen B. 06/1997-01/2000 University of Pittsburgh (PA) 

Rutledge, Everard O. 06/1991-09/1992 St Like’s Lutheran Healthcare Corporation (MD) 

Salmon, Marla E.* 06/1991-09/1998 Department of Health and Human 

Services (MD) 

Salmon, Marla E. 02/2008-Present University of Washington (WA) 

Sands, Delores 02/2001-01/2005 University of Texas at Austin (TX) 

Sanford, Sarah J. 03/1998-01/2002 American Association of Critical 

Care Nurses (CA) 

Schempp, Catherine M. 02/1987-05/2005 Tripler Army Medical Center (HI) 

Shaver, Joan 02/2001-01/2005 University of Illinois at Chicago (IL) 

Siantz, Mary De Leon 06/1997-01/2000 University of Washington/Indiana 

University (WA) 

Smith-Williams, Betty 01/1999-01/2003 California State University Long 

Beach (CA) 

Strickland, Ora L. 06/1989-02/1993 Emory University (GA) 

Stuart, Gail 02/2009-01/2013 Medical University of South Carolina 

(SC) 

Tennstedt, Sharon L. 03/2005-02/2009 New England Research Institutes 

(MA) 

*Ex-officio members 
246 

Name Date of Service Institution/Organization (State) 

Trevino, Fernando 09/1995-06/1997 American Public Health Association 

(DC) 

Trofino, Joan 02/1987-09/1990 Riverview Medical Center (NJ) 

Udall, King S. 02/2007-01/2011 Family Practice (UT) 

Ward, David 05/2001-01/2005 Medical University of South Carolina 

(SC) 

Weinert, Clarann 07/2006-01/2010 Montana State University Bozeman 

(MT) 

Williams, Betty Smith 09/2000-01/2003 California State University Long 

Beach (CA) 

Williams, Janet K. 02/2009-01/2013 University of Iowa (IA) 

Woerner, Louise 06/1990-01/1994 Home Care of Rochester (NY) 

Woods, Nancy A. F. 06/1989-02/1993 University of Washington (WA) 

Zeller, Janice M. 06/1992-01/1996 Rush University (IL) 

Bringing Science to Life 

*Ex-officio members 
Index 247 

Index 

Note: Boldface page numbers indicate illustrations. 

A 

Aaronson, Lauren, 237
 

nursing research of, 218–219
 

Abdellah, Faye G., 4, 241
 

development of federal nurse 


specialist training program by, 3
 

Abraham, Ivo, 58
 

Academic Investigator Award, launch 


of, 55
 

Academic Research Enhancement 


Awards (AREA), 139
 

acute illness. See also National Center 


for Nursing Research (NCNR) Acute 


and Chronic Illness Branch
 

National Center for Nursing 


Research (NCNR) on, 52, 55, 81
 

symptoms associated with, 78, 170
 

Advanced Cognitive Training for 


Independent and Vital Elderly 


(ACTIVE), 183
 

Advisory Panel on Alzheimer’s Disease, 


179
 

Affonso, Dyanne D., 130, 241
 

as member of National Advisory 


Council, 56
 

Agency for Healthcare Research and 


Quality (AHRQ), 91
 

Clinical Practice Guidelines of, 151
 

Agency for International Development 


(AID), 174
 

Aging Asian Study, National Institute 


of Nursing Research (NINR) 


participation in, 143
 

aging population, 179. See also
 

demographics; elder care
 

AIDS. See HIV/AIDS
 

Aiken, Linda H., 237
 

nursing research of, 104–105, 151, 


152, 217, 222–224, 229–230
 

Alcohol, Drug Abuse, and Mental 


Health Administration (ADMHA), 12
 

alcohol use, National Center for 


Nursing Research (NCNR) research 


on, 84
 

Alexander, Duane, support for Grady 


as candidate for director of National 


Institute of Nursing Research 


(NINR), 124
 

Alt-White, Anna, 241
 

Alzheimer’s disease. See also Cognitive 

diseases 

National Institute of Nursing 


Research (NINR) research on, 


180–182, 185
 

National Institutes of Heath (NIH) 


research on, 17
 

Alzheimer’s disease or related 


dementias (ADRD), 180
 

American Academy of Nursing (AAN)
 

Hinshaw as fellow of and member 


of the governing council of, 66
 

support for Grady as candidate for 


director of National Institute of 


Nursing Research (NINR), 124
 

American Association of Colleges of 


Nursing (AACN), 11
 

assistance from, in structuring 


National Center for Nursing 


Research (NCNR) into branches, 


51
 

on creation of nursing research 


institute, 21, 22
 

on end-of-life (EOL) research, 193
 

Grady as speaker at, 139–140
 

promotion of nursing education 


programs, 16
 

American Journal of Nursing, honoring 


of Goodrich, Annie Warburton, as 

248 Bringing Science to Life 

“Tomorrow’s Nurse,” 209, 210, 211
 

American Medical Association (AMA), 


opposition to nursing institute, 12–13
 

American Nurses Association (ANA)
 

assistance from, in structuring 


National Center for Nursing 


Research (NCNR) into branches, 


51
 

on creation of nursing research 


institute, 17, 21, 27–28
 

on defining nursing research, 14–15
 

endorsement of, by Mondale and 


Ferraro, 26
 

Goodrich, Annie Warburton, as 


president of, 209
 

nurse researchers at, vi
 

support for Grady as candidate for 


director of National Institute of 


Nursing Research (NINR), 124
 

American Nurses Association (ANA) 


Cabinet on Nursing Research
 

campaign for nursing research and, 


7–8
 

Hinshaw as member of, 66
 

American Nurses Association (ANA) 


Commission (later Cabinet), on 


nursing research, 6
 

American Nurses Association (ANA) 


Council of Nurse Researchers, 


lobbying activities for nursing 


research, 6
 

American Nurses Foundation (ANF), 


nursing research funding by, 5
 

Amos, Linda, nursing research of, 18
 

antiretroviral therapy, 109
 

Approaching Death: Improving Care at 


the End of Life (report), 189
 

Archbold, Patricia G., 241
 

arthritis. See also National Institute of 

Arthritis and Musculoskeletal and 

Skin Diseases (NIAMS) 

exercise and, 172
 

health disparities and, 149, 150
 

in Hispanics, 149
 

proposed new institute for, 13, 27, 


44
 

Association of Academic Health 


Centers (AAHC), end-of-life (EOL) 


research and, 193
 

Association of American Medical 

Colleges (AAMC), opposition to 

nursing institute, 12–13 

Association of Collegiate Schools 


of Nursing, Goodrich, Annie 


Warburton, as president of, 209
 

Atwood, Jan, research of, 68
 

Austin, Joan K., 241
 

Avalon Foundation, nursing research 


funding by, 5
 

AWIS Magazine (journal), 125
 

Aydelotte, Myrtle, 4
 

B 

Baby Boomers, 140–141
 

basic research on pain, 170
 

basic science
 

at National Institute of Nursing 


Research (NINR), 118, 163, 177
 

at National Institutes of Health 


(NIH), 83, 113, 119
 

promoting, 27
 

transcending into clinical care, 130
 

Baun, Mara M., 241
 

Beck, Cornelia M., 241
 

Bednash, Geraldine “Polly,” 237
 

behavioral research
 

defined, 154
 

National Institute of Nursing 


Research (NINR) interest in, 89, 


154, 176, 216
 

National Institutes of Health (NIH) 

support for careers in, 168–169 

Behavioral Science and Nursing Theory 

(Wooldridge and Leonard), 67
 

Behrman, Richard E., 241
 
Index 249 

 

“bench to bedside,” 148
 

Bergstrom, Nancy, 151
 

Berman, Richard A., 241
 

Berning, Randall K., 241
 

Better Patient Care Through Nursing 


Research (Abdellah), 3
 

Beyer, Judith E. See also Pain
 

development of OUCHER scale 


and, 106
 

biomedical research
 

National Institutes of Health (NIH) 


support for careers in, 168–169, 


188
 

patient-oriented perspective to, 132
 

Bishop, J. Michael, as recipient of Nobel 


Prize in Medicine, 118
 

Bixby, M. Brian, 153
 

Blank, Deidre M.
 

at Health Promotion and Disease 

Prevention Branch at National 

Center for Nursing Research 

(NCNR), 54–55 

at National Center for Nursing 

Research (NCNR), 47–48 

Bloch, Doris, 54
 

Division of Nursing and, 75, 76
 

Madigan amendment and, 75
 

at National Center for Nursing 


Research (NCNR), 47–48, 53
 

on nursing research, 21–22
 

Blumenreich, Gene A., 147, 241
 

Bowen, Otis R., 50
 

as Secretary of Health and Human 


Services, 66
 

Braden scale, 151
 

Brandt, Edward, 29
 

Broome, Marion, 241
 

Brooten, Dorothy, 130, 241
 

nursing research of, 87, 146–147
 

Brown, Esther Lucille, 2
 

Broyhill, James T., blocking of bill 


calling for National Institutes of 


Health (NIH) to initiate research, 


16–17
 

Bryant, L. Edward, Jr., 241
 

Buckwalter, Kathleen C., 130, 147, 181,
 

241
 

research of, 181
 

Buehler, Meta E., 241
 

Buerhaus, Peter, 241
 

Bulger, Roger, 237
 

Bureau of Health Resources 

Development (BHRD), nursing 

research and, 6–7 

Bureau of Medical Services, Division of 


Nursing Resources in, 2
 

merger of, with Division of Public 


Health Nursing, 3
 

in nursing research funding, 20
 

Burgess, Ann W., 241
 

as member of National Advisory 


Council, 56
 

Burgio, Louis, 242
 

Alzheimer’s research by, 185
 

Bush, George H. W., veto of National 


Health Revitalization Act (1991), 95
 

C 

Cabinet on Nursing Research, support 


for nursing research, 9, 17
 

cachexia, National Institute of Nursing 


Research (NINR) on, 144, 186
 

caffeine consumption, National Center 


for Nursing Research (NCNR) 


research on, 84
 

California, graduate programs in 


nursing in, 3
 

Cammermeyer, Margarethe, 242
 

cancer. See also National Cancer 


Institute (NCI)
 

end-of-life (EOL) care and, 192, 193
 

National Center for Nursing 


Research (NCNR) on, 84
 
250 Bringing Science to Life 

National Institute of Nursing 

Research (NINR) on, 144, 156
 

nursing research on, 59, 95–96, 127
 

symptom clusters in, 194
 

teaching at-risk populations about 


hereditary, 186
 

cardiovascular disease. See also heart 


disease
 

research on risk factors of, 105, 156, 


186
 

Carroll, Harriet D. “Bunny,” 75
 

as head of Nursing Systems and 


Special Programs Branch, 55
 

position of, at National Center 


for Nursing Research (NCNR), 


47–48
 

Center for End-of-Life Transition 


Research, National Institute of 


Nursing Research (NINR) funding 


for, 231
 

Center for Research in Chronic 


Disorders at University of Pittsburgh 


School of Nursing, 154
 

Centers for Disease Control and 


Prevention (CDC), 18
 

distribution of “Be Proud! Be 


Responsible!” by, 149
 

report on AIDS cases, 84
 

Chang, Betty L., 58
 

children
 

diabetes in, 219
 

pain assessment in, 170
 

reducing prevalence of risk factors 


for cardiovascular disease in 


rural, 105
 

chronic illness
 

family adaptation to, 78
 

in Hispanics, 149
 

as leading cause of disabilities, 141
 

long-term impact of, 213
 

National Center for Nursing 


Research (NCNR) on, 52, 55, 81
 

patient care and, 151–154
 

as public health problem, 140
 

research on, 225
 

successful adaptation to, 73
 

symptoms associated with, 78, 141, 


170
 

treating, 164
 

chronic obstructive pulmonary diseases 


(COPD), research on, 114, 144, 191
 

chronic wounds, nursing research on, 


132
 

cigarette smoking
 

longitudinal study on, 91
 

National Center for Nursing 


Research (NCNR) on, 84
 

Cleland, Virginia, nursing research 


and, 6
 

clinical bioethics, National Institute 


of Nursing Research (NINR) as lead 


institute in investigating, 142
 

clinical ethics, 128–129
 

Clinical Investigator Award, launch of, 


55
 

clinical research, 99–100
 

Bureau of Health Resources 


Development (BHRD) and, 6–7
 

into cancer, 59
 

dissemination of, in academic and 


other research centers, 10–11
 

into drug therapies, 145
 

into genetics, 136
 

investigator-initiated, 138
 

at the National Institute of Nursing 


Research, 139–140, 149, 151, 


163–164
 

nurse involvement in, 19, 41, 59, 


72–73, 90, 104, 113–114, 131, 


148, 155, 174, 214, 224
 

into pain, 170
 

public health aspects of, 137
 

success of, 146
 

Clinical Therapeutics Laboratory, 97
 

foundation of, 89
 

clinical trials, 146
 

into Alzheimer’s disease or related 


dementia (ADRD), 180
 
Index 251 

clinical ethics and, 128–129
 

large-scale, 230
 

managed care and, 146
 

at the National Institute of Nursing 


Research (NINR), 151
 

testing models in, 219
 

Clinton, William (Bill)
 

administration of, 98–99
 

in election of 1992, 98
 

in election of 1996, 129
 

health care and, 96, 114
 

cognitive diseases. See also Alzheimer’s 


disease
 

National Institute of Nursing 


Research (NINR) on research on, 


179–185, 196
 

Collins, Francis S., as director of 


National Human Genome Research 


Institute, 188
 

Commissioned Corps of U.S. Public 


Health Service, Scott as two-star 


admiral in, 4
 

Commission (later Council) on Nursing 

Research, shaping of health care 

agendas and policy at, 72–73 

community-based health care, nursing 


research and advances in, vii
 

compliance, research on patient, 59
 

Conference on Nursing Research 


Priorities, 99–100, 100
 

development of national nursing 


research agenda of, 76–78
 

National Center for Nursing 


Research (NCNR) convening of 


second, 99–100, 100
 

Congestive heart failure. See Heart 


failure
 

Contract with America, 114
 

Conway, Elaine W., 242
 

as member of National Advisory 


Council, 56
 

Conway-Welch, Colleen, 146–147, 242
 

Cordes, Donald W., 242
 

Coronary heart disease. See 

cardiovascular disease; heart disease 

CORP I, 117
 

CORP II, 117
 

Council of Baccalaureate and Higher 


Degree Programs of National League 


for Nursing, support for nursing 


research, 3
 

Council of Nurse Researchers, 69
 

lobbying efforts of, 94–95
 

Merritt attendance of meeting at, 


45–46
 

on National Center for Nursing 


Research (NCNR), 94
 

Counte, Michael A., 242
 

Cournoyer, Paulette R., 242
 

Cowan, Marie J., 58, 242
 

nursing research of, 178
 

Crisp, Rosemary B., 242
 

Cronenwett, Linda R., 58, 242
 

Cunningham Foundation, funding for 


nursing research and, 5
 

Cupples, Sandra A., 242
 

Curtis, J. Randall, 242
 

end-of-life (EOL) research of, 195
 

D 

Daly, Barbara, research on chronically 

critically ill, 151–154 

Damus, Karla H., 242
 

degenerative diseases
 

National Institute of Nursing 


Research (NINR) research on, 


184
 

nursing research on symptom 


management for, 183
 

treating, 164
 

dementia
 

coexistence of Alzheimer’s disease 


with vascular disease and, 182
 

financial burden of, 179
 

in Honolulu-Asia Aging Study, 97
 
252 Bringing Science to Life 

National Institute of Nursing 


Research (NINR) research on, 


178, 184
 

nursing research on, 164
 

demographics, challenges provided by 


changes in, 145, 232
 

Denyes, Mary J., 106
 

Dewey, Thomas E., 209
 

diabetes
 

health disparities and, 149, 150
 

pediatric, 219
 

research on, 219, 225
 

risk for, 225
 

as treatable, 212
 

Dinges, David F., 182, 242
 

research of, 182-183
 

disability
 

chronic illness as leading cause of, 


141
 

fears of, 84
 

National Institute of Nursing 


Research (NINR) mission on, 164
 

disease management, research on, 215, 


226
 

disease-oriented perspective, 141
 

disease prevention
 

National Center for Research 


(NCNR) focus on, 81
 

National Institute of Nursing 


Research (NINR) focus on, 214, 


229, 231, 232
 

shift to, 213
 

Division of Nursing. See under
 

Health Resources and Services 


Administration (HRSA)
 

Division of Research Resources, 92
 

Dock, Lavinia, 2
 

Donaldson, Sue, 130, 130
 

Dowling, Glenna A., 242
 

research of, 182
 

Dracup, Kathleen A., 237, 242
 

on budgetary issues as hindrance 


to National Institute of Nursing 


Research (NINR) future, 228–229
 

on disease management, 226
 

nursing research and, 184–185, 


215–216, 225–226
 

Dreher, Melanie C., 58
 

drugs
 

clinical research on, 145
 

National Canter for Nursing 


Research (NCNR) on, 84
 

Dumas, Rhetaugh
 

concerns on nursing research, 23, 


28, 67–68
 

as dean of University of Michigan 


School of Nursing, 11, 92, 102
 

at National Institute of Mental 


Health, 11–12
 

opposition to proposed National 


Institute for Nursing Research, 90
 

at Virginia-Carolinas Doctoral 


Consortium in Nursing, 17–18
 

Dunbar-Jacob, Jacqueline M., 154, 242
 

E 

elder care. See also aging population
 

National Center for Nursing 


Research (NCNR) research on, 84
 

National Institute of Nursing 


Research (NINR) research on, 


133
 

as public health problem, 140
 

Elders, Joycelyn, 96
 

Elliott, Jo Eleanor, 237, 242
 

on nursing research, 11, 18, 40
 

on nursing research institute, 19, 21
 

as successor to Scott, Jessie, 23
 

emerging diseases, challenges presented 


by, 130
 

Endicott, Kenneth M., nursing research 


and, 7
 

end-of-life (EOL) care
 

Association of Academic Health 


Centers research on, 193
 

Curtis, J. Randall, on, 195
 
Index 253 

in health care debate of 2010, 

226–227
 

Kaufman, Sharon, on, 195
 

National Advisory Council for 


Nursing Research on, 142
 

National Institute of Nursing 


Research (NINR) leadership role 


on research on, 139–140, 142, 


144–145, 175, 191–197
 

as public health concern, 178
 

research on, 164, 231
 

Tennstedt, Sharon L., on, 191–192
 

Environmental Health Sciences 


Working Group, 137, 138
 

environmental sciences
 

incorporation of nursing research 


into, 136–137
 

nature of research on, 137–138
 

epidemiology
 

basic research into, 145
 

need for management skills in, 232
 

ethics 

clinical, 128–129 

end-of-life, 191–192 

ethnic groups, health disparity among, 


176
 

An Evening of W;t and Wisdom: The 

Science of Care and Compassion at 

the End of Life, National Institute 

of Nursing Research (NINR) cosponsorship of, 192, 192–193 

F 

Faculty Research Development Grants, 


4
 

Fauci, Anthony, 73
 

support for Grady as candidate for 


director of National Institute of 


Nursing Research (NINR), 124
 

Felton, Geraldene, 58, 237, 242
 

on nursing research, 11, 23
 

opposition to proposed National 


Institute for Nursing Research 

(NINR), 90
 

Ferguson, Stephanie, 242
 

Ferraro, Geraldine, American Nurses 

Association (ANA) endorsement by, 


26
 

Ferrell, Betty R., 242
 

Fife, Rose S., 242
 

Finkelstein, Stanley, 242
 

Finkler, Steven A., 243
 

Fogarty International Center, 31
 

Food and Drug Administration (FDA), 


18
 

food consumption
 

longitudinal study on, 84
 

National Center for Nursing 


Research (NCNR) research on 


excess, 84
 

Fralic, Maryann F., 243
 

Frederickson, Donald, 44
 

Freeman, Everette J., 243
 

Frick, Kevin, 243
 

Fukuoka, Yoshimi, nursing research of, 


225
 

Funk, Sandra G., 58
 

G 

gender
 

bias in establishing nursing research 


institute, 39
 

as factor in pain, 144, 171, 196
 

gene therapy, research on, 134, 186
 

genetic counseling, National Institute 


of Nursing Research (NINR) 


contributions to, 129-130
 

genetic research, 225
 

as emerging field, 166, 196–197
 

ethical issues associated with, 135
 

Meininger, Janet, on, 186
 

National Institute of Nursing 


Research (NINR) support for, 


134–136, 186–189
 
254 

 

Bringing Science to Life 

need for basic, 134
 

Genetics Research Workgroup, 134–135
 

genetic therapy, research on, 131-132
 

Geolot, Denise, 243
 

George Mason University, conference 


at, 22
 

Giger, Joyce N., 243
 

Gingrich, Newt, 114
 

Gioiella, Evelynn, 243
 

Goldstein, Murray, 73
 

retirement of, 120
 

Goodrich, Annie Warburton, 2
 

as director of Henry Street Visiting 


Nurse Service, 209
 

in founding of U.S. Army School of 


Nursing, 209
 

in founding of Yale School of 


Nursing, 209
 

honoring of, as “Tomorrow’s 


Nurse,” 209, 210, 211
 

as president of American Nurses 


Association (ANA), 209
 

as president of Association of 


Collegiate Schools of Nursing, 


209
 

as president of National League of 


Nursing Education (NLN), 209
 

Graduate Partnerships Program (GPP) 


in Biobehavioral Research, 188
 

Grady, Patricia A., 130, 141, 181, 237
 

academic studies of, 122
 

accomplishments of, as director 


of National Institute of Nursing 


Research (NINR), 112, 125–156, 


178, 187, 228–229
 

as acting director of the National 


Institute of Neurological 


Disorders and Stroke (NINDS), 


120, 122, 123
 

advice to young nurse scholars, 


131–132
 

application for directorship, 


123–124
 

as chair of National Institute 


of Nursing Research (NINR) 

Director Search Committee, 120
 

as combination of advocate, teacher, 

counselor, and cheerleader for 

nursing science, 132–133 

confidence in, by Varmus, Harold 

E., 126–127 

development of National Institute 

of Neurological Disorders 

and Stroke (NINDS) policies, 

priorities, and program activities, 

122–123 

early career and credentials of, 


121–123, 126
 

goal of, in advancing nursing 

science, 164–165 

leadership skills of, 171–172 

long-term strategic goal of, 126–127 

at National Institute of Nursing 


Research (NINR) 20th 


anniversary, 229
 

on National Institute of Nursing 

Research (NINR) clinical ethics 

program, 128–129 

on National Institute of Nursing 

Research (NINR) logical lead 

for end-of-life (EOL) research, 

191–197 

on National Institute of Nursing 


Research (NINR) research, 132, 


179, 181–182, 231
 

philosophy of, 213
 

recognition of value of history, 131
 

research work of, 122–123, 133
 

scientific and management 

expertise of, 124–125 

as speaker at American Association 

of Colleges of Nursing (AACN), 

139–140 

stress of, on value of student 


research, 133
 

training of, 155
 

Varmus encouragement to compete 

for director, 120–121 

vision for National Institute of 


Nursing Research (NINR), 189, 

Index 255 

29 

191
 

writings of, 125
 

Graham, Robert, on nursing research, 


Gramm-Rudman-Hollings Balanced 


Budget Act, 40
 

Great Society, 3
 

Grey, Dean, nursing research and, 


224–225
 

Grey, Margaret J., 237, 243
 

nursing research of, 220, 219–220
 

Guthrie, Barbara, 243
 

Gypsy Moths, 81
 

H 

Hagey, Antoinette, 243
 

Hall, Geri, 181
 

Hanley, Daniel F., 243
 

Harkin, Tom, support for National 


Center for Nursing Research (NCNR) 


as institute, 100
 

Harrigan, Rosanne C., 243
 

Hatch, Orrin G.
 

on nursing research, 24–25, 31–32
 

role of, in creation of National 


Institute of Nursing Research 


(NINR), vi, 20, 25, 26
 

Hawkins, Paula, support for nursing 


research institute, 25
 

head injury, research on, 122
 

Health and Health Services, U.S. 


Department of, National Institute 


of Nursing Research (NINR) 


spearheading of End-of-Life Scientific 


Interest Group, 193
 

health care reform
 

under Clinton, 114-115
 

current debate over, vii
 

end-of-life care in, 226–227
 

health care system, dramatic changes in, 


212–213
 

health disparities
 

among ethnic groups, 176
 

efforts to eliminate, 214, 231
 

end-of-life research (EOL) and, 195
 

Minority Health Research 


Development for Nurse 


Investigators Conference on, 169
 

as public health issue, 174, 176
 

as research focus at the National 


Institute of Nursing Research 


(NINR), 141, 148–149, 166, 169, 


172, 174
 

health promotion
 

National Center for Nursing 


Research (NCNR) focus on, 81
 

National Institute of Nursing 


Research (NINR) focus on, 214, 


231–232
 

Health Research Extension Act (1983), 


19
 

Health Research Extension Act (1985), 


30–31
 

Reagan veto of, 31
 

override of, 32
 

Health Resources and Services 


Administration (HRSA), 3, 81
 

Division of Nursing in, 3
 

Advanced Nursing Resources 


Branch of, 48
 

Center for Nursing Research 


at
 

establishment of, 1, 


23–24, 29, 40
 

mission of, 31
 

grant-making culture at, 46
 

as location for research 


grants, 7
 

Madigan amendment and, 


21–23
 

nurse investigators under, 165
 

peer review system for 


research proposals 


developed at, 57
 

Scott as director of, 4
 

Healy, Bernadine
 
256 Bringing Science to Life 

as director of National Institutes of 


Health (NIH), 100-101
 

Hinshaw and, 101
 

heart disease. See also cardiovascular 


disease
 

in Hispanics, 149
 

risk for, 225
 

as treatable, 212
 

heart failure
 

congestive, 191
 

health care expenditures on, 151
 

National Institute of Nursing 


Research (NINR) research on, 


151
 

research on, in rural areas, 184, 185
 

Heckler, Margaret, establishment of 


center for nursing research within 


Division of Nursing, 29
 

Heinrich, Janet, 45, 237
 

on nursing research, 14–15, 178
 

Heller, Leonard E., 16, 243
 

as member of National Advisory 


Council, 56
 

Henderson, Virginia, 4
 

Henry Street Visiting Nurse Service, 


Goodrich, Annie Warburton, as 


director of, 209
 

Heredia, Jimmy, 177
 

Hernandez, Gloria, 243
 

Highly Active Anti-Viral Therapy 


(HAART), 109n39
 

high-risk behaviors, as public health 


issue, 174
 

Hill, Martha, research of, using 


multidisciplinary health teams, 149
 

Hinds, Pamela S., 237
 

as director of nursing research at 


The Children’s National Medical 


Center in Washington, 187–188, 


214, 215, 227–228
 

Hinshaw, Ada Sue, 64, 102, 237
 

accomplishments of, as director 


of National Center for Nursing 


Research (NCNR), 66–106, 113, 


174, 228–229 

application of, for director, 69–70 

avocation of nursing institute, 

95–96 

campaign for nursing research 


and, 8
 

as chair of American Nurses 


Association (ANA) Cabinet on 


Nursing Research, 46
 

credentials of, 66–67 

as dean of School of Nursing at 

University of Michigan, 102–103 

departure from National Center 


for Nursing Research (NCNR), 


102–103, 103, 113, 119
 

education and early career of, 67–69 

as Fellow of American Academy of 


Nursing, 66
 

goals of, for National Center for 

Nursing Research (NCNR), 

73–75 

grant applications at National 


Center for Nursing Research 


(NCNR) offices and, 82
 

as Health Leader of the Year, 102
 

Healy, Bernadine, and, 101
 

interview with Merritt, Doris, 70
 

interview with Wyngaarden, 70
 

as member of American Nurses 


Association (ANA) Cabinet on 


Nursing Research, 66
 

as member of governing council of 


American Academy of Nursing, 


66
 

as member of National Institute 


of Mental Health Task Force on 


Nursing Research, 66
 

on National Center for Nursing 

Research (NCNR) centers 

program, 104–105 

at National Institute of Nursing 


Research (NINR) 20th 


anniversary, 229
 

on nursing research, 71–72, 94
 

on nursing science as family and 
Index 257 

community orientation, 90–91
 

push for more resources for nurse 


scientists, 69
 

as recipient of Nurse Scientist of the 


Year Award, 66–67
 

selection of, by Wyngaarden, James 


B., 70–71
 

starting of intramural research 

program within National Center 

for Nursing Research (NCNR), 

97–98 

swearing in of, as National Center 

for Nursing Research (NCNR) 

director, 71, 73–75 

testimony before Congress, 79–80
 

training of, 155
 

as vice chair of Commission on 


Nursing Research, 73
 

HIV/AIDS
 

health disparities and, 176
 

National Center for Nursing 


Research (NCNR) on research in, 


84–85, 88–89, 127, 173–178, 196
 

National Institute of Nursing 


Research (NINR) research on, 


133
 

as public health concern, 84, 174
 

research on, 133
 

Hodes, Richard J., 124
 

Hodge, Felicia Schanche, 243
 

Honolulu Heart Program, National 

Institute of Nursing Research (NINR) 


participation in, 143
 

Howard, Monique, 148
 

Howell, Doris A., 243
 

human genome, mapping of, 141
 

Human Genome Project (HGP), 141
 

completion of, 188–189
 

Hurd, Suzanne S.
 

as acting director of National 


Institute of Nursing Research 


(NINR), 112, 114–119, 178
 

administrative strengths of, 114
 

budget appropriations hearings 

and, 115–116
 

credentials of, 115
 

interest in more innovative research 


proposals, 117
 

on linkage of biological findings 


from medical research with 


biological research, 178
 

praise for conferences on research 


priorities, 117
 

on strengths and weaknesses of the 


Institute, 118
 

I
 

Image: Journal of Nursing Scholarship 

(publication), 131
 

immune disorders, symptom clusters 


in, 194
 

immunology, nursing research on, 133
 

Indiana University-Purdue University-


Indianapolis (IUPUI), 44
 

information science, nursing science 


and, 230
 

Inouye, Daniel K., support for nursing 


research, 25, 100
 

insomnia, National Center for Nursing 


Research (NCNR) research on, 80, 84
 

Institute of Medicine (IOM) report 


(1983), 16, 19, 45, 223
 

on nursing research, 9–11, 17
 

in Reagan’s veto message, 26–27
 

Interdisciplinary journals, publication 


of work of nurse investigators in, 223
 

interdisciplinary research, National 


Institute of Nursing Research (NINR) 


support for, 217
 

interdisciplinary training, 222
 

“it’s not the therapy, it’s the nurses” 


(Daly quote), 154
 

J 

Jacobson, Sharol F., 58
 

Jacox, Ada
 
258 Bringing Science to Life 

as advocate of nursing research, 6, 


7–8, 9, 40–41, 57
 

position of, on nursing research 


institute, 21
 

as president of the American 


Nurses Association (ANA), 9
 

Jaser, Sarah, 220
 

Jemmott, Loretta Sweet, 130, 148, 243
 

research of, on behavioral 


interventions, 149
 

Jenkins, Jean, as senior clinical advisor, 


189
 

Jennings, Bonnie L., 243
 

Johnson, Jane, 67
 

Jones, Susan L., 58
 

K 

Kaufman, Sharon, end-of-life (EOL) 


research of, 195
 

Kellogg, W. K., Foundation, funding for 


nursing research and, 5
 

Kennedy, Edward M., on nursing 


research, 20, 31–32
 

Kennedy-Scott, Patricia, 243
 

kidney failure, research on diet therapy 


for, 17
 

Kim, Hesook Suzie, 243
 

Kim, Mi Ja, 58, 244
 

Kinney, Marguerite R., 244
 

Kirchoff, Karin T., 244
 

Kirschstein, Ruth L., 237
 

as director of National Institute of 


General Medical Sciences, 48, 73, 


75–76
 

Kjervik, Diane K., 244
 

Konick-McMahan, JoAnne, 153
 

Kramer, Marlene, nursing research of, 


68
 

L 

Laboratory for the Study of Human 


Responses to Health and Illness, 97
 

Lake, Diana E., 244
 

Lancaster, Joan, 244
 

LaRosa, Judith H., 244
 

Larson, Elaine L., 222, 237
 

on educating nurse scientists, 221, 


225
 

on nursing research, 216, 217, 


221–222, 244
 

Lenfant, Claude, support for Grady as 


candidate for director of National 


Institute of Nursing Research 


(NINR), 124
 

Leonard, Robert C., 67
 

Levine, Jon D., research on pain relief, 


144, 170–171
 

“Lewin Report” on nursing research, 


29, 30
 

Light, Judith, 192
 

Lindberg, Donald, location of National 


Center for Nursing Research (NCNR) 


and, 48, 49
 

Lindsey, Ada M., 244
 

Linn, James W., 244
 

Lister Hill Center, location of National 


Center for Nursing Research (NCNR) 


offices in, 48, 56
 

Local 41 of American Federation of 


Government Employees (AFGE), 50
 

Lorig, Kate, 150
 

research of, 149-150
 

low birthweight infants
 

National Center for Nursing 


Research (NCNR) research on, 


78, 79, 87–88, 88
 

National Institute of Nursing 


Research (NINR) research on, 


127–128, 133
 

nurse-directed transitional care 


and, 146
 
Index 259 

prevention of, 156 

as public health problem, 140 

transitional care with, 104 

Lucas, Mary, research of, 178 

Lum, Jean L. J., 244 

lung disease, health disparities and, 

149–150 

Lunney, June, 175 

M 

MacDonald, Elizabeth A., 244 

Madhany, Zehra, 177 

Madigan, Edward R. 

amendment, 66 

in emerging nursing 

community, 21 

Tri-Council for Nursing 

backing of, 23 

role of, in creation of National 

Institute of Nursing Research 

(NINR), vi, 15, 16, 18, 19–20, 23, 

25–26, 31 

managed care, National Institute of 

Nursing Research (NINR) research 

on, 145–146 

managed care organizations (MCOs), 

nursing research and, 146–147 

Marshall, Jean R., 147, 244 

Mason, James, 101 

Matsunaga, Spark M., 25 

Matteson, Mary Ann, research of, 180 

Matthaei, Frederick C., Jr., 244 

as member of National Advisory 

Council, 56 

McCormick, Patricia 

as head of Acute and Chronic 

Illness Branch at National Center 

for Nursing Research (NCNR), 55 

position of, at National Center 

for Nursing Research (NCNR), 

47–48 

McFarland, Gertrude K. “Trudy,” 55, 58 

McKenna, Catherine, 153 

McSweeney, Jean C., 244 

medical community, opposition to 

institute status for nursing at National 

Institutes of Health (NIH), 101–102 

Meininger, Janet, genetic research of, 

186 

Merritt, Donald, 42, 44 

diagnosis of terminal cancer, 51 

Merritt, Doris H., 64, 237, 244 

as acting director of National 

Center for Nursing Research 

(NCNR), 1, 41–42, 43, 44–47, 50, 

56, 60, 65, 163–164 

appointment of, by Wyngaarden, 

James B, 44–45, 60 

attendance at Council of Nurse 

Researchers meetings, 45–46 

early career of, 42–44 

education of, 42 

efforts to integrate National Center 

for Nursing Research (NCNR) 

into National Institute of Health 

(NIH), 57–59, 75–76 

on HIV/AIDS research, 56–57, 173 

on integration of National Advisory 

Council into National Institutes 

of Health (NIH), 57–59 

on multidisciplinary nature of 

nursing, 163–164 

recognition of, for start-up work, 75 

on staffing of institute, 47–48 

Meyer, Charles A., 95 

Miaskowski, Christine, research of, 

170–171 

on pain relief, 144 

Miller, Karen L., 244 

Millon-Underwood, Sandra M., 244 

minorities 

health of, as public health issue, 174 

pain in, 106 

Minority Health Research Development 

for Nurse Investigators Conference, 

142, 169–170 
260 

26 

Bringing Science to Life 

Mondale, Walter, American Nurses 

Association (ANA) endorsement by, 

Montgomery, Kathy, 124
 

Moritz, Patricia M., 75, 237
 

as branch chief of Nursing Systems 


Branch, 55–56
 

position at National Center for 


Nursing Research (NCNR), 48
 

Morrow, Gary, 130, 244
 

Mukamel, Dana, 191
 

multiple sclerosis, 40
 

Munet-Vilaro, Frances, 244
 

Murdaugh, Carolyn, 97
 

intramural program under, 98
 

Murray, John S., 244
 

N 

Natcher, William H., 79
 

National Advisory Council for Nursing 


Research (NACNR), 59, 147
 

on end-of-life (EOL) research, 142
 

integration of, into culture of 


National Institutes of Health 


(NIH), 57–58
 

priorities for nursing research and, 


78, 166
 

recommendations of, on centers for 


nursing research, 89–90
 

National advisory group, establishment 


of, for National Center for Nursing 


Research (NCNR), 51
 

National Association of Hispanic 


Nurses (NAHN), 169
 

National Black Nurses Association 


(NBNA), 169
 

National Cancer Institute (NCI), 27
 

collaboration between National 


Institute of Nursing Research 


(NINR) and, 170, 189
 

Division of Cancer Epidemiology 


and Genetics at, 169
 

National Center for Nursing Research 

(NCNR) 

accomplishments of, 59–60, 94–95 

Acute and Chronic Illness Branch 

at, 52, 55
 

acute illness research at, 52, 55, 81
 

alcohol use research at, 84
 

alignment of operations with 


National Institutes of Health 


(NIH) institutes, 96–97
 

attainment of institute status, 102,
 

102–103, 103
 

Biological Sciences Task Force at, 


176-177
 

biological theory research and, 


177–178
 

budget of, 59, 60, 79, 85–87, 92, 


94, 96
 

bureaucratic problems in creation 


of, 39–40
 

cancer research at, 84
 

chartering of, v
 

cigarette smoking research by, 84
 

collaboration with other groups, 


57–58, 85
 

commitment to funding good 


science, 82–83
 

convening of second Conference 


on Nursing Research Priorities, 


99–100, 100
 

creation of “Directions for Nursing 


Research Toward the Twenty-


First Century,” 8
 

creation of Division of Intramural 

Research, 97–98
 

on disease prevention, 81
 

Division of Extramural Programs 


at, 53
 

drug use research at, 84
 

elder care research at, 84
 

establishment of centers for nursing 


research, 89–90 

establishment of national advisory 

group for, 51
 

focus of, on disease prevention, 81
 

food consumption research at, 84
 
Index 261 

funding for nursing research at, 50, 


90–92, 96, 113
 

funding of behavioral research, 89
 

goal of, 53
 

grant making by, 52, 52–53 

health and behavior research at, 

90–91 

on health promotion, 81
 

Health Promotion and Disease 


Prevention Branch of, 54–55, 81
 

Hinshaw as director of, 66–106, 71,
 

113, 174, 228–229
 

HIV/AIDS research at, 84–85, 

88–89, 173–177 

identification of research priorities 

for nursing science, 79–81 

inability to lobby, 95
 

on insomnia, 80, 84
 

integration of, into National 


Institutes of Health (NIH) 


network, 73–75, 113
 

intention of setting national nursing 

research agenda, 76–77 

intervention-based research under, 


175
 

intramural program of, 83, 97–98, 


113
 

on investigator-initiated research, 


174
 

launch of national research agenda 


by, 166
 

location of, in Lister Hill Center, 48, 


49, 50
 

long range plans and goals of, 

56–57 

under Merritt as acting director, 1, 


41–42, 43, 44–47, 50–51, 56, 60, 


65, 163–164
 

National Advisory Council for 


Nursing Research (NACNR) at, 


56, 57–58, 59, 74
 

navigating National Institutes of 


Health (NIH) grants process, 52
 

Nursing Research Study Section 


at, 59
 

Nursing Systems and Special 

Projects Branch at, 52, 56
 

physical space for, 56
 

professional staff for, 53–56
 

on public health, 90, 197, 214
 

on quality of life, 78
 

Reagan opposition to, v
 

Research Development and Review 


Branch of, 55
 

research on cancer, 84
 

research on chronic illness, 52, 81
 

as rite of passage, 40
 

search for permanent director, 59, 


65–66
 

on setting nursing research 


priorities, 165–166
 

on sexual activity, 84
 

on sleep disorders, 80
 

structuring of, into branches, 51
 

symptom management research at, 


78, 85, 88
 

technology transfer conferences 


between National Institute of 


Allergy and Infectious Diseases 


and, 173
 

in training of investigators, 90
 

very low birthweight infants 


research at, 87–88, 88
 

on women’s health, 89
 

National Coalition of Ethnic and 


Minority Nursing Associations 


(NCEMNA), 142, 169
 

National Forum on Doctoral Education, 


71
 

National Health Revitalization Act 


(1991), 95
 

Bush’s veto of, 95
 

National Heart Lung and Blood 


Institute (NHLBI)
 

collaboration between National 

Institute of Nursing Research 

(NINR) and, 184–185 

collaboration of National Center 


for Nursing Research (NCNR) 


with, 57
 

National Human Genome Research 
262 Bringing Science to Life 

Institute (NHGRI), 188-189
 

National Institute of Aging, 


collaboration of National Center for 


Nursing Research (NCNR) with, 57
 

National Institute of Allergy and 


Infectious Diseases (NIAID), 174
 

collaboration with, 85
 

National Institute of Nursing 


Research (NINR) collaboration 


with, 191
 

technology transfer conferences 


between National Center for 


Nursing Research (NCNR) and, 


173
 

National Institute of Arthritis, Diabetes, 


and Digestive and Kidney Diseases, 


44
 

National Institute of Arthritis and 


Musculoskeletal and Skin Diseases 


(NIAMS)
 

creation of, 44
 

National Institute of Nursing 


Research (NINR) collaboration 


with, 172, 191
 

National Institute of Child Health and 


Human Development (NICHD), 174
 

collaboration of National Center 


for Nursing Research (NCNR) 


with, 57
 

National Institute of Deafness and 


Communicative Disorders (NIDCD), 


92
 

National Institute of Dental Research 


(NIDR), National Institute of Nursing 


Research (NINR) collaboration with, 


170
 

National Institute of Environmental 


Health Sciences (NIEHS), 138
 

National Institute of Health (NIH)
 

spinal cord regeneration research 


at, 17
 

sudden infant death syndrome 


(SIDS) research at, 17
 

National Institute of Mental Health 


(NIMH) 

collaboration of National Center 


for Nursing Research (NCNR) 


with, 57
 

Hinshaw as member of Task Force 


on Nursing Research at, 66
 

National Institute of Neurological 


Disorders and Stroke (NINDS), 120, 


122, 125
 

National Institute of Nursing Research 


(NINR), 19
 

ability to save health care dollars, 


127–128
 

Academic Investigator Awards, 168
 

accomplishments of, vii–viii, 131, 


148–149
 

advancement of nursing science 


and, vi, 164–165
 

Aging Asian Study participation 


of, 143
 

basic science at, 176-177
 

behavioral research at, 154, 176­

178, 216
 

breadth of research of, 191
 

budget for, 41, 115–116, 127, 138, 


155–156, 227–228
 

on cachexia, 144, 186
 

on cancer, 144, 156
 

cancer research at, 144, 156
 

Career Transition Award, 169
 

catalyzation of changes in nursing 


science and, 220–221
 

celebrating fifteen years of nursing 


research at National Institutes of 


Health (NIH), 115
 

celebration of tenth anniversary 


of nursing research at National 


Institutes of Health (NIH), 129–
 

131, 130
 

Clinical Investigator Awards, 168
 

clinical research and, 139
 

Clinical Therapeutic Laboratory 


(CTL) at, 143
 

on cognitive impairment research, 


179–185, 196
 
Index 263 

collaborative research efforts with 


other institutes, 18–185, 170, 172, 


189, 191
 

co-sponsorship of An Evening of 

W;t and Wisdom: The Science of 

Care and Compassion at the End 

of Life, 192, 192–193 

creation of, 102, 102, 103
 

degenerative disease research at, 


183–184
 

on dementia, 178, 184
 

development of “Making Your 


Wishes Known,” 226–227
 

on disability, 164
 

Division of Intramural Research 


(DIR) at, 143
 

efforts to eliminate health 


disparities, 141
 

efforts to improve scientific 


reputation, 120
 

end-of-life (EOL) care research at, 


139–140, 142, 189-197
 

Environmental Health Sciences 


Working Group, 137, 138
 

evolution of, with country’s 


changing demographics, 232
 

extramural funding and, 117–118
 

focus on attracting nurses from 


underrepresented groups, 169
 

focus on disease prevention, 214, 


229, 231, 232
 

focus on research priorities on 


health promotion and disease 


prevention, 214
 

focus on symptom management 

research, 142–144
 

on functional ability in, 183–184
 

funding for, 129, 139, 196
 

genetics research at, 134–136, 


186–189
 

Genetics Workgroup at, 134–135
 

goals of, 126, 178–179
 

under Grady, 125–156, 189, 191
 

on health disparities, 166
 

health disparities as research focus 


at, 149-150
 

on health promotion, 214, 231, 232
 

HIV/AIDS research at, 195-196
 

Honolulu Heart Program 


participation of, 143
 

under Hurd as acting director of, 


112, 114–119, 178
 

improvement of sophistication of 


research, 215
 

initiative in self-management 


strategies for diabetics, 142
 

initiative of, on self-management, 


142, 149
 

interdisciplinary and 


multidisciplinary collaboration 


and, 138, 168–169, 217
 

Intramural Research Training 


Awards at, 169
 

issuance of Program 

Announcements and Requests for 

Application (RFAs), 194–195 

as leader in nursing science, 215
 

leadership in, 231–232 

as lead institute in clinical bioethics, 


142
 

as lead institute of National 


Institutes of Health (NIH), 190
 

low birthweight delivery research 

at, 127–128 

Madigan’s role in establishment 


of, 81
 

managed care research at, 145–146 

Mentored Research Scientist 


Development Award-Nursing, 


168
 

National Institute of Dental 


Research (NIDR) collaboration 


with, 170
 

National Nursing Research Agendas 

of, 170, 185–186 

new clinical ethics program of, 

128–129 

on nurse scientists training, 167,
 

166–169
 

Nurse Scientist Training Program, 


168
 

offering of post doctoral fellowships 
264 Bringing Science to Life 

that linked training in nursing 

research and genetics, 141
 

organization of Minority Health 

Research Development for 

Nurse Investigators Conference, 

169–170 

origins of, 1–32 

on pain research, 170–173, 196
 

partnerships with other National 

Institutes of Health (NIH) groups 

in training nurse scientists, 

168–169 

planning process at, 129
 

on preventive health, 166
 

priority in funding research project 

grants, 138–139 

promotion of incorporation 

of nursing research into 

environmental sciences, 136–137 

recognition of importance of ethnic 

and cultural changes, 141–142 

reflection of, on past achievements, 


215
 

research agenda of, 129, 132, 224
 

in setting priorities for nursing 


science, 227
 

spearheading of DHHS-wide Endof-Life (EOL) Scientific Interest 


Group, 193
 

sponsorship of “Minority Health 


Research Development” 


conference, 142
 

sponsorship of Terminal Illness 

Workshop, 144–145 

strategic planning by, 154–155, 168, 


214, 231
 

strengths and weaknesses of, 118
 

strengths of, for parity in National 


Institutes of Health (NIH), 126
 

success rate of, 116–117 

Summer Genetics Institute (SGI) at, 


136, 137, 187–188
 

support for basic and clinical 

science, 163, 170–171 

support for Program for Allinclusive Care for the Elderly 

(PACE), 194
 

support for Resources for 


Enhancing Alzheimer’s Caregiver 


Health (REACH), 185
 

support for translational research, 


217
 

support of cost effectiveness 


research, 162
 

on symptom management, 78, 85, 


133, 141, 142–143, 166, 170, 175, 


180, 183, 191, 196, 214
 

terminal illness research at, 144–
 

145
 

twenty-fifth anniversary of, v–viii, 


211–212, 232–233
 

on women’s health, 133
 

National Institute of Nursing Research 


(NINR), on value of nursing care, 166
 

National Institute on Aging (NIA), 27, 


124, 174
 

collaboration with National 


Institute of Nursing Research 


(NINR) and, 185, 189
 

creation of, 44
 

National Institutes of Health (NIH), 

facing page 1
 

AIDS Executive Committee, 174
 

basic research at, 83, 113, 119
 

Center for Scientific Review, 55
 

Center on Minority Health and 


Health Disparities, 169–170 

early opposition to nursing 

institute, 12, 14
 

launching nursing science at, 39–63
 

mission of, 31
 

National Center for Nursing 


Research (NCNR) alignment of 

operations with, 73–74, 96–97 

National Institute of Nursing 


Research (NINR) role in forming 


End-of-Life Special Interest 


Group, 192
 

nursing research at, v–vii, 28, 


216–217
 

Office of Behavioral and Social 

Index 265 

Sciences Research (OBSSR) at, 


138
 

Office of Medical Applications of 


Research on end-of-life (EOL) 


care, 193–194
 

pecking order at, 126
 

Reagan veto of reauthorization bill, 


26
 

reputation for pioneering 


intramural research programs, 83
 

research budgets of, 138
 

Roadmap of, 216–217, 217
 

support for careers in biomedical 


research, 168, 188
 

Task Force on Nursing Research, 


report on need for nursing 


research, 27
 

National Institutes of Mental Health 


(NIMH), 12, 57
 

AIDS Policy Subcommittee, 174
 

Task Force on Nursing Research 


at, 66
 

National League for Nursing (NLN)
 

assistance from, in structuring 


National Center for Nursing 


Research (NCNR) into branches, 


51
 

on creation of nursing research 


institute, 21
 

as voice for nursing education, 16
 

National League of Nursing Education, 


Goodrich as president of, 209
 

National Library of Medicine (NLM), 


collaboration of National Center for 


Nursing Research (NCNR) with, 57
 

National Nursing Research Agendas
 

development of, 74, 76–79, 185–186
 

identification of priority areas for 


nursing research, 78–79
 

impact and effectiveness of, 86
 

low birthweight infants and 


mothers identified as priority of, 


88
 

research priorities phases into, 99
 

setting guidelines for nursing 


science, 86
 

National Research Service Award 


(NRSA), 168
 

Naylor, Mary, 153, 245
 

research of, 151
 

neurology, 73, 155
 

Nolan, Marie T., 191
 

Nurse-Family Partnership, 149
 

nurse scientists, research careers for, 80, 


155, 166, 167, 168, 221-223
 

Nurse Scientist Training Grants, 4
 

nurse training, 121
 

National Institute on Nursing 


Research (NINR) on, 169, 186, 


232
 

research grants on, 7
 

Nurse Training Act (1964), 5, 17, 18
 

Nursing and Nursing Education: Public 


Policies and Private Actions (report), 


9–11
 

Nursing for the Future (Brown), 2
 

Nursing home residents, 183
 

Nursing Outlook, 6, 132, 137
 

concerns on nursing research, 23
 

nursing profession, pressure on, to help 


balance federal budget, 127
 

nursing research
 

American Journal of Nursing and, 13
 

attitude on use versus generation of 


information, 13–14
 

on cancer, 84, 95–96, 127
 

on cognitive diseases, 179–185, 196
 

defined, 14
 

on degenerative diseases, 183–184
 

division of nursing community on, 


7–8
 

on end-of-life (EOL) care, 139–140, 


142, 191
 

establishing priorities in, using 


handheld voting machines, 100
 

funding for, 96
 

genetics in, 134–136, 166, 185–188
 

on HIV/AIDS, 84–85, 88–89, 173–
 
266 Bringing Science to Life 

177, 195-196
 

incorporation of, into 


environmental sciences, 136–137
 

on insomnia, 80
 

on managed care, 145–147
 

National Institutes of Health (NIH) 


researchers’ position on, 44
 

on pain, 170–173, 196
 

on patient care, vi
 

pioneers of, 4
 

on pressure sores, 80
 

Reagan’s opposition to, 31
 

on sleep disorders, 80
 

on symptom management, 85, 142­

143, 170, 183, 191
 

on urinary incontinence, 80–81
 

on very low birthweight infants 


(VLBWI), 87–88, 88
 

World War II changing of approach 


to, 2
 

Nursing Research (journal), 96
 

Nursing Research and Education 


Advisory Committee, 57
 

Nursing Research Grants and 


Fellowship Program, establishment 


of, 2
 

nursing schools, early changes in 


curricula at, 2
 

nursing science 

future of, 164, 213–214, 230–231 

launching of, at National Institutes 

of Health (NIH), 39–63 

as new member of scientific 

community, 1–2 

transformation of, 209–233
 

Nursing Science Review Committee, 


Grey as member and chair, 220
 

Nursing Systems and Special Programs 


Branch, Carroll, Bunny, as head of, 55
 

Nutting, Mary Adelaide, 2, 209
 

O 

Oakley, Debora J., 245
 

Oberst, Marilyn T., 58
 

obesity, basic research on, 134, 156
 

O’Connell, Kathleen A., 58
 

Office of Management and Budget 


(OMB), funding for National Center 


for Nursing Research (NCNR) and, 


50, 52
 

Office of Research on Minority Health, 


139
 

Office of Research on Women’s Health, 


139
 

Olds, David, 149
 

OUCHER scale, 105, 106, 171. See also
 

Pain
 

ovarian cancer, 192
 

P 

Page, Gayle, 130
 

research on pain, 172–173
 

pain
 

assessment of, in children, 170
 

basic and clinical research on, 170
 

biological and behavioral aspects 


of, 132
 

gender as factor in, 144, 171, 196
 

immunological implications of, 130
 

Levine, Jon D., on relief from, 144, 


170–171
 

medication for, 144
 

in minorities, 106
 

National Institute of Nursing 


Research (NINR) leadership on 


research on, 130, 142, 144, 164, 


170–173, 196
 

OUCHER scale on, 105, 106, 171
 

as public health problem, 140
 

symptom management and, 78, 85
 

palliative care science. See End-of-life 

(EOL) care 

Parkinson’s disease, sleep disorders in, 


182
 

pathophysiology, nursing research on, 


133–134, 145
 
Index 267 

patient care
 

chronically critically ill and, 


151–153
 

nursing research and, vi
 

patient-oriented perspective
 

in biomedical research, 132
 

in nursing, 141
 

Patton, Curtis L., 147, 245
 

Pender, Nola J., 245
 

campaign for nursing research and, 


7–8, 21
 

as member of National Advisory 


Council, 56
 

Peragallo, Nilda, HIV research of, 176,
 

177
 

periodontal disease, 40
 

personalized medicine, 235–27
 

pesticide exposure, impact on 


reproductive functions, 138
 

Physician Scientist and Dental Scientist 


award programs, 90
 

Poodry, Clifton, 141
 

Porter, John Edward
 

as chair of appropriations 


subcommittee, 115–116, 116
 

as supporter of medical research, 


116
 

as supporter of National Institutes 


of Health (NIH), 128
 

Portillo, Carmen J., 245
 

postdoctoral students, research careers 


for, 169
 

Potempa, Kathleen, 245
 

Powell, Dorothy L., 245
 

pressure sores, nursing research on, 80, 


151, 170
 

prevention. See disease prevention
 

preventive health, National Institute of 


Nursing Research (NINR) on, 166
 

Program Announcements and Requests 


for Application (RFAs), National 


Institute of Nursing Research (NINR) 


issuance of, 194–195
 

Program for All-inclusive Care for the 


Elderly (PACE), National Institute of 


Nursing Research (NINR) support 


for, 194
 

Progressively Lower Stress Threshold 


(PLST) model, 181
 

Psychiatric Nursing Education Branch 


of the Division of Manpower and 


Training Programs, 12
 

public health, 77
 

American Nurses Association 


strategy on, 28
 

contemporary concerns on, 164
 

development of strategies in, 


163–164
 

emerging risks in, 213
 

end-of-life (EOL) issues and, 179
 

environmental research and, 137
 

health disparities and, 177
 

HIV/AIDS as major concern in, 


84, 174
 

medical understanding of questions 


in, 171
 

National Center for Nursing 


Research (NCNR) on, 90, 197, 


214
 

research agenda on, 166, 173
 

traditional paths of inquiry in 


nursing science and, 140
 

very low birthweight infants 


(VLBWI) as problem in, 87
 

Public Health Nursing, Division of, 


Division of Nursing Resources 


merger and, 3
 

Public Health Service, U.S.
 

funding for nursing research and, 


50
 

initiatives at, in stimulating nursing 


research, 4
 

Public Health Service Act (1944), 2
 

Public Health Service Executive Task 


Force on AIDS, 174
 

Pursell, Carl D., 66, 81–82, 83
 
268 Bringing Science to Life 

on creation of National Institute 


of Nursing Research (NINR) 


in National Institutes of Health 


(NIH) reauthorization bill, 101
 

grant applications at National 


Center for Nursing Research 


(NCNR) offices and, 82
 

legislation introduced by, 95
 

as nursing constant champion, 92
 

pushing of nursing research 


program by, 89
 

support for National Center for 


Nursing Research (NCNR) as 


institute, 94–95, 100
 

Q 

quality of life, 191-196
 

HIV/AIDS and, 89
 

National Center for Nursing 


Research (NCNR) on, 78
 

symptom management and, 214
 

R 

radiation therapy, 84
 

Raub, William F., 237
 

as acting director of National 


Institutes of Health (NIH), 94
 

Reagan, Ronald, 13
 

budget cuts under, for social 


programs, 81
 

opposition to fetal research, 25
 

opposition to National Center for 


Nursing Research (NCNR), v, 


12, 14
 

vetos of, 26–27, 31, 41
 

Reardon, Judy E., 245
 

Reinhard, Susan C., 245
 

research careers
 

biomedical and behavioral, 169
 

for nurse scientists, 80, 155, 166, 


167, 168, 223
 

for postdoctoral students, 168-169
 

Resources for Enhancing Alzheimer’s 


Caregiver Health (REACH), National 


Institute of Nursing Research (NINR) 


support for, 185
 

Richard, Maggie L., 245
 

Richards, Kathy, research of, 182
 

Roberts, Joyce, 58
 

Robert Wood Johnson Foundation, 


funding for nursing research and, 5
 

Rockefeller Foundation, funding for 


nursing research and, 5
 

Rodriguez, Teresa M., 177
 

Ropka, Mary, 143
 

Rosenthal, Gerald, nursing research 


and, 7
 

Roy, Sister Callista, 58
 

Rubert, Mark, 191
 

Rudy, Ellen B., 237, 245
 

Ruffin, John, 141
 

Russell Sage Foundation, funding for 


nursing research and, 5
 

Rutledge, Everard O., 245
 

S 

Salmon, Marla E., 245
 

Sands, Delores, 245
 

Sanford, Sarah J., 147, 245
 

Schempp, Catherine M., 245
 

Schoenrich, Edyth H., on nursing 


research, 28
 

Science on nursing institute 


amendment, 20
 

Scott, Jessie M., 4, 59
 

on creation of Division of Nursing 


as location for research grants, 7
 

education of, 4–5
 

on nursing research, 4–6, 18, 21, 22
 

successor of, 23
 

warning to Nursing Research and 


Education Advisory Committee, 


57
 

self-management, 149-150
 
Index 269 

in chronic disorders, 154
 

in end-of-life (EOL) research, 195
 

in maximizing and improving 


overall health, 213
 

sexual activity
 

longitudinal study on, 91
 

National Center for Nursing 


Research (NCNR) on, 84
 

sexual behavior
 

among low-income Latina women, 


176
 

research on adolescent, 175
 

Shalala, Donna E.
 

creation of National Institute of 


Nursing Research (NINR), 102, 


102
 

executive redesignation order and, 


102
 

making of Grady’s appointment 


official, 124
 

as Secretary of Health and Human 


Services, 96, 100, 102, 102, 120
 

Shannon Awards, 139
 

Shaver, Joan, 181, 245
 

Siantz, Mary De Leon, 245
 

sickle cell disease, art therapy protocols 


in dealing with pain in, 172
 

Sigma Theta Tau International (STTI), 


131
 

assistance from, in structuring 


National Center for Nursing 


Research (NCNR) into branches, 


51
 

funding for nursing research and, 5
 

Sigmon, Hillary, research of, 178
 

sleep disorders
 

National Center for Nursing 

Research (NCNR) on, 80
 

nursing research on, 80
 

in patients with Parkinson’s disease, 


182
 

Smith-Williams, Betty, 245
 

Social Interaction and Patient Care 

(Leonard), 67
 

spinal cord regeneration, National 


Institutes of Health (NIH) research 


on, 17
 

staffing levels, impact of, on patient 


care, 151
 

Stafford, Robert T., support for nursing 


research institute, 25
 

Stevenson, Joanne S., campaign of, for 


nursing research and, 7–8, 9, 28
 

Stewart, Isabel, 2
 

Stokes, Louis, 181
 

Strickland, Ora L., 245
 

campaign for nursing research 


and, 8
 

strokes
 

depressive signs and symptoms in 


patients, 89
 

research on, 122–123, 178
 

Stuart, Gail, 245
 

sudden infant death syndrome (SIDS), 


National Institutes of Health (NIH) 


research on, 17
 

Sullivan, Louis, 101
 

Shalala, Donna E., as replacement 


for, 102
 

Summer Genetics Institute (SGI), 136, 


137
 

National Institute of Nursing 

Research (NINR) launch of, 

187–188 

Surgeon General’s Consultant Group 


on Nursing on need for funding for 


nursing research, 3
 

symptom clusters, research on, in 


cancer and immune disorders, 194
 

symptom management
 

for degenerative diseases, 183
 

extramural research on, 144
 

National Center for Nursing 


Research (NCNR) on, 78, 85, 88
 

National Institute of Nursing 


Research (NINR) on, 78, 85, 133, 


141–143, 166, 170, 175, 180, 183, 

270 Bringing Science to Life 

191, 196, 214
 

“Symptom Management: Chronic 


Disease and End of Life” (NIH 


Institute and Center Directors’ 


meeting), 195
 

symptom monitoring. See symptom 


management
 

T 

Teacher’s College at Columbia 


University, doctoral program in 


nursing at, 2
 

telehealth, applications of, 155
 

Tennstedt, Sharon L., 245
 

research on end-of-life (EOL) care 


ethics, 191–192
 

terminal illness. See also end-of-life 


(EOL) care
 

research into critical areas of, 144
 

Terminal Illness Workshop, National 


Institute of Nursing Research (NINR) 


sponsorship of, 144–145 

Terry, Luther, 5
 

therapy. See specific 

Therrien, Barbara, 130
 

Tilden, Virginia, 144
 

Tinkle, Mindy, as National Institute of 


Nursing Research (NINR) intramural 


training director, 187
 

translational research, National Institute 


of Nursing Research (NINR) support 


for, 217
 

translational training, 222
 

Trevino, Fernando, 246
 

Tri-Council for Nursing
 

backing of Madigan amendment, 23
 

on budget for National Institute 

of Nursing Research (NINR), 

127–128 

lack of support for Hatch 

alternative, 24–25 

support for creation of National 

Institute of Nursing (NIN) at 


National Institutes of Health 


(NIH), 15–19, 46
 

Trofino, Joan, 246
 

Truman, Harry S, 209
 

U 

Udall, King S., 246
 

U.S. Army School of Nursing, founding 


of, by Goodrich, Annie Warburton, 


209
 

urinary incontinence, nursing research 

on, 80–81 

V
 

Varmus, Harold E.
 

appointment of Hurd as acting 


director of National Institute of 


Nursing Research (NINR), 114, 


119
 

confidence in Grady, 120–121, 124, 


126–127
 

as National Institutes of Health 


(NIH) director, 118–120, 119,
 

129, 191
 

as recipient of Nobel Prize in 


Medicine, 118
 

vascular disease, coexistence of 


Alzheimer’s disease and, 182
 

very low birthweight infants (VLBWI). 


See also low birthweight infants
 

National Center for Nursing 


Research (NCNR) research on, 


87–88, 88
 

Villarruel, Antonia M., 143
 

Virginia-Carolinas Doctoral 

Consortium in Nursing, 17–18 

W 

Wald, Lillian, 2
 

Walker, Carolyn J., 58
 
Index 271 

Ward, David, 246 

Waxman, Henry A. 

sponsorship of Democratic 

reauthorization bill, 16–17 

support for creation of nursing 

research institute, 20, 25–26 

Weicker, Lowell P., Jr., on nursing 

research, 31
 

Weinert, Clarann, 246
 

Wells, Thelma J., 58
 

Werley, Harriet, 4
 

Western Society of Nursing Research 


(WSNR), 69
 

Williams, Betty Smith, 141, 246
 

Williams, Carolyn, 75–76
 

campaign for nursing research 


and, 8
 

Williams, Janet K., 246
 

Williams, T. Franklin, 73, 75
 

as chair of task force on nursing 


research, 27
 

as director of National Institute on 


Aging (NIA), 65
 

as head of committee for search for 


permanent director, 65–66
 

Wilson, Ruby
 

on nursing research, 11, 28
 

at Virginia-Carolinas’ Doctoral 


Consortium in Nursing, 17–18
 

Woerner, Louise, 246
 

women’s health
 

National Center for Nursing 


Research (NCNR) on, 89, 106
 

National Institute of Nursing 


Research (NINR) research on, 


133
 

research on, 106
 

Wood, Darlene, 58
 

Woods, Adele, 75
 

as head of Research Development 


and Review Branch at National 


Center for Nursing Research 


(NCNR), 55
 

position of, at National Center 

for Nursing Research (NCNR), 

47–48 

Woods, Nancy Fugate, 130, 237, 246
 

campaign for nursing research and, 


8, 9
 

on nurse scientists, 130
 

Wooldridge, Powhatan J., 67
 

Workgroup on Opportunities in 


Genetics Research, 185
 

working conditions, impact of, on 


patient care, 151
 

World Health Organization (WHO), on 


emerging public health risks, 213
 

Wykle, May, 181
 

Wyngaarden, James B. (director of 


NIH), 1, 13, 81–82, 119
 

appointment of Merritt by, 44–45, 


60
 

congressional testimony of, 79
 

creation of Advisory Council by, 47
 

creation of National Institute of 


Nursing Research (NINR) and, 1, 

12, 40, 41
 

on nursing research, 1, 27, 45
 

on search for permanent director, 


65
 

selection of Hinshaw by, 66, 70–71, 


71
 

set up of National Center for 


Nursing Research (NCNR) and, 


48, 88
 

on support for intramural 


programs, 83
 

testimony before Congress, 79–80
 

Y 

Yale School of Nursing
 

Goodrich, Annie Warburton, 


founding of, 209
 

nursing research at, 67
 
272 Bringing Science to Life 

Z 

Zeller, Janice M., 246 

Zerhouni, Elias, 217 

at National Institute of Nursing 

Research (NINR) twentieth 

anniversary, 229