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IMPLEMENTATION OF PROGRAM PRIORITIES 

The purpose of developing a long-range plan for nursing research is to focus a portion of the 

resources for such research into areas of study that target critical issues confronting society, health 

care, and nursing. The priority setting component, the National Nursing Research Agenda (NNRA), 

is designed to guide decisions about resource allocation to promote depth in research in the chosen 

areas. The priorities developed through the NNRA, elaborated by the recommendations of the 

Priority Expert Panels (PEPs), are implemented through the extramural program of the National 

Center for Nursing Research (NCNR), the intramural program, or both. 

To understand the implementation of the priority recommendations, it is necessary to understand the 

organization of the NCNR and its programs, the mechanisms of extramural and intramural support 

used by it, methods of information dissemination to potential applicants about NCNR's areas of 

special research interest, and the system of grant application review. 

Organization of NCNR Programs 

The scientific program of the NCNR has two major components, namely, the extramural program 

and the intramural program. 

Extramural Program 

The extramural program, which supports investigations by scientists outside of NIH, is organized 

into three research emphasis branches: Health Promotion and Disease Prevention, Acute and Chronic 

Illness, and Nursing Systems. The nature of these three branches reflects nursing's orientation toward 

health promotion and disease prevention, the care of individuals and their families who are 

experiencing acute and chronic illness, and the impact of the system within which nurses function on 

the quality of care nurses provide. The branches are deliberately broad to encompass the breadth of 

content in research grant applications that may be submitted by the extramural community. The 

NCNR does not wish to prematurely limit nursing's areas of science. 

Health Promotion and Disease Prevention. Health promotion research focuses on nursing 

approaches to improving the general health of individuals, families, and communities. Health 

Promotion includes ways to promote wellness and to decrease the vulnerability of individuals and 

families to illness and disability. Disease prevention research, on the other hand, focuses on a 

particular illness, injury, or disability and on ways to intercept the onset of such problems. 

Acute and Chronic Illness. This program supports research on the human responses to acute and 

chronic illness, injury, and disability. It addresses biological and behavioral factors that contribute to 

these conditions, as well as their interrelationships; ways to improve, mitigate, or remedy these 

conditions; and ways to assist individuals to live with and cope with such conditions. 

Nursing Systems. Research in this area examines: the clinical practice environment in which health 

care is provided; factors underlying the process of nursing care; relationships among aspects of 

clinical practice; and the influence of that practice on outcomes of care. It includes such diverse 

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investigations as promising approaches to strengthening quality of care, nursing informatics, 

structuring nursing care delivery, technology assessment, and ethical issues in clinical practice. 

Intramural Program 

The intramural program supports investigations by nurse scientists on the NCNR staff. This 

program, which is relatively new, focuses in its initial phase on one of the priorities identified by the 

NNRA: HIV Infection--Prevention and Care. Although the program is still small, it has enhanced its 

resources and the significance of its work through collaboration with several other NIH intramural 

programs, namely the National Institute on Allergy and Infectious Diseases, the National Heart, 

Lung, and Blood Institute, and the National Institute on Aging. Several studies are in progress, 

including studies of nutritional requirements of HIV/AIDS patients, health-related quality of life in 

HIV/AIDS patients, and myopathy in HIV/AIDS patients. 

The recommendations of several of the PEPs are expected to influence significantly the future 

development of the intramural program. For example, the recommendations of the Symptom 

Management Subpanel on Pain will be highly relevant to the intramural program. 

Mechanisms of Extramural Support 

To enhance and accelerate the development and maintenance of a community of nurse researchers 

committed to scientific excellence, the NCNR supports individuals who are beginning research 

training, as well as those continuing their research career development. 

The NCNR believes that achieving excellence in science requires a commitment to research training 

and career development across the entire career of a nurse scientist. For that reason, the NCNR's 

research training, career development, and research awards are designed to form a continuum of 

support that potentially covers a large portion of an individual's research career. The order in which 

individuals apply for these awards is purposely flexible, depending on each person's needs, 

qualifications, and stage of career development. At junctures along the scientific career path, an 

investigator can choose from various research training, career development, and research support 

options, as described below. This pattern is designed to augment an individual's skills and to enhance 

an individual's qualifications for funding in the highly competi- tive biomedical and behavioral 

research world. To implement the NNRA and other NCNR priorities, virtually any funding 

mechanism can be used. 

Research Training: National Research Service Awards 

National Research Service Awards (NRSA) enable scientists to be trained to conduct independent 

nursing research and to collaborate in interdisciplinary research through individual and institutional 

fellowships. There are four mechanisms of support. 

Individual NRSA Predoctoral Fellowship (F31). These awards are available to registered nurses for 

supervised research training by a sponsor while the nurse is enrolled in a program leading to a 

doctoral degree in areas related to the NCNR mission. 

Individual NRSA Postdoctoral Fellowship (F32). Postdoctoral fellowships support training in areas 

related to the NCNR mission for individuals with a Ph.D. or equivalent degree. Applicants must have 

a sponsor and must identify a research project for full-time study. 

Institutional NRSA (T32). These research training grants are awarded to domestic schools of 

nursing to provide full-time predoctoral and/or postdoctoral research training in a specified area of 

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research. Recipient schools must show training potential, that is, an established research record and 

demonstrated interdisciplinary linkages. 

NRSA Senior Fellowship (F33). These awards support nurse investigators generally with at least 

seven years of relevant research experience beyond the doctoral degree. These awards enable 

investigators to take time from regular professional activities to make major changes in the direction 

of their research careers, to broaden their scientific backgrounds, to acquire new research 

capabilities, and to expand their command of an allied research field. 

Career Development Awards 

Career development awards allow nurse scientists to enhance their research career through additional 

research experience under the guidance of a sponsor. Such awards allow investigators to increase 

research time while reducing, for a few years, the responsibilities of teaching and clinical practice. 

Two mechanisms are in place. 

Academic Investigator Award (AIA) - Nursing (K07). These three-to-five-year awards are designed 

for junior faculty members, generally four to six years beyond the doctorate, who have demonstrated 

research potential. They allow promising nursing faculty to take time from administrative and 

teaching duties to establish research programs and mature into independent investigators. 

Clinical Investigator Award (CIA) - Nursing (K08). These awards enable nurses with a doctoral 

degree and with a strong clinical practice background to become independent scientists. Awardees 

work under a sponsor at an NIH-supported Center program or in a General Clinical Research Center 

(GCRC) funded by the NIH National Center for Research Resources (NCRR). 

Extramural Research 

NIH has developed different mechanisms to allow investigators to apply for funds for different types 

of research projects. Each mechanism embodies a specific purpose or is directed to a specific group 

of potential applicants. For example, there are grants for small and large projects, for experienced 

and inexperienced investigators, for individuals in nonprofit institutions and in small business, and 

for single studies and multiple studies around a single theme. 

Applicants interested in submitting a research grant application, either unsolicited or in response to 

an announced priority area, must decide what mechanism is most suitable for their particular 

situation. Mechanisms used by NCNR are briefly described below. 

Research Project Grant (Traditional) (R01). These grants are made to an institution, on behalf of an 

experienced principal investigator, for research focused on a single scientific objective in the 

investigator's area of interest and competence. 

Small Grant (R03). These awards provide support for empirically-based small-scale or feasibility 

studies or pilot projects, but to date NCNR has allowed use of this mechanism only for studies in 

bioethics and clinical decision making and for studies at the interface of nursing and biology. These 

awards are generally made only in response to a specific announcement. 

Academic Research Enhancement Award (AREA) (R15). These awards are intended to stimulate 

research by faculty members in educational institutions that have not been major participants in NIH 

programs. They are designed to support feasibility studies and other small-scale research projects. 

First Independent Research Support and Transition Award (FIRST) (R29). These grants are 

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intended to support the first independent investigative efforts of an individual and are designed to 

facilitate the transition to the traditional NIH research project grant (R01). 

Small Business Innovation Research Award (SBIR) (R43/R44). These grants are for small 

businesses with the technological expertise to contribute to the NIH research and development 

mission. Proposed research must have the potential to lead to commercial products or services. 

Program Project Grant (PO1). These grants support a broad, multidisciplinary research program 

with a specific major objective or theme. They are designed to add depth to the science base. A 

program director oversees the efforts of a number of investigators who conduct discrete research 

subprojects contributing to the overall research objective. The component research projects must be 

at the level of R01s. 

Cooperative Agreement (U01). These awards are available only when a request for application 

(RFA) in the NIH Guide for Grants and Contracts, a weekly NIH publication, cites the cooperative 

agreement mechanism. The cooperative agreement differs from a traditional research grant in that it 

provides for more extensive federal program staff participation in project activities than does the 

traditional research grant. Federal program staff may provide advice, coordination, and other 

program action, but may not dominate the relationship. The RFA indicates a specific area of research 

needed and describes the nature of the partnership between NIH and the awardee. 

Research Centers. NCNR presently funds two types of Research Centers, but applications are 

accepted only when a call for such applications is specifically announced. 

Exploratory Center (P20). These grants are designed to enable institutions with a small 

amount of ongoing research to strengthen their research capabilities, increase productivity, and 

generate new research through formal interdisciplinary collaborative efforts. They support 

pilot or feasibility studies, core or shared resources, and integration of activities with other 

relevant research endeavors. The intent is to increase significantly the research momentum of 

the grantee institution. 

Specialized Center (P50). These grants support the creation of an interdisciplinary 

collaborative research program among established investigators in a specific area of basic 

and/or clinical nursing research. They provide for the integration of a group of related projects 

and encourage the development of new research projects. They enhance the environment for 

research training and career development, as well as the depth of the science in the specified 

area. 

Contracts. Although contracts are a mechanism for funding some types of research, the NCNR does 

not now use this mechanism. 

Methods of Dissemination of Extramural Research Initiatives 

The NCNR disseminates information about the NNRA priorities and PEP panel recommendations to 

a number of audiences both inside and beyond NIH. In addition to members of the nursing 

profession, non-nurse scientists, government officials, and the general public are interested in, and 

need to know about, nursing research. Information about the research initiatives to implement the 

NNRA priorities is disseminated in both formal and informal ways. 

Formal Methods 

On the formal level, all new initiatives at the NIH, including those of the NCNR, are announced in 

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the NIH Guide for Grants and Contracts. Two types of announcements in this weekly NIH 

publication, namely requests for applications (RFAs) and program announcements (PAs), are 

relevant. 

RFAs. An RFA is an invitation to submit an 

application for a research grant or cooperative 

agreement in response to an initiative in a welldefined scientific area. There is a single 

designated submission date for a one-time 

competition, with specific funds set aside. 

PAs. A PA describes a new initiative or updates 

an ongoing research interest. No funds are set 

aside for applications invited in response to such 

announcements, but the significance of such 

research is underscored by the formal program 

announcement. 

Informal Methods 

On the informal level, NCNR staff interact and communicate with investigators as a natural and 

ongoing part of their daily activities. Through such informal interactions, as well as through more 

structured presentations at professional meetings-- such as speeches, symposia, and exhibits--

information about the NCNR's programs, priorities, and related announcements is given wide 

circulation. 

Dissemination of NNRA Information 

Staff of the NCNR develop announcements (PAs and RFAs) to implement a PEP's recommendation

(s) based on the PEP's draft or final report. The announcement not only will describe the area of 

interest and its relevance to the PEP recommendation but also will specify the type of award 

anticipated, such as training, small grant, or research center. In many cases, such announcements 

may be jointly sponsored and developed in collaboration with staff of other interested NIH institutes 

or centers or with staff from other interested government research programs. 

In developing such an announcement, staff have to make thoughtful choices among the multiple 

recommendations usually embedded in the PEP's report. Should the call for applications be broad or 

narrow? Should it cover an entire report chapter or a single recommendation? For example, should 

the announcement cover all recommendations about the physiological aspects of nursing care for 

HIV/AIDS patients reported by that panel? Or should it cover only a single recommendation, such as 

the recommendation which deals with "... strategies to effectively manage physical symptoms 

associated with HIV infection .... ?" 

Furthermore, staff have to make judgments, either with or without PEP guidance, regarding the 

adequacy of the cadre of nurse researchers who are sufficiently well prepared in the area under 

consideration to respond by submitting high-quality applications. If the cadre of nurse scientists is 

seen to be inadequate, it may be necessary to stimulate research training in the area, for example by 

soliciting applications for National Research Service Awards. 

Publication of NNRA information in guest editorials and staff papers in professional journals is 

another useful mode of dissemination. 

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Grant Application Review Procedures 

All competing applications are received by the NIH Division of Research Grants (DRG), whose staff 

refer applications for two crucial review functions. 

The first referral is to an appropriate initial review group or IRG (also called a study section) for 

scientific and technical merit review. IRGs have 15 to 20 primarily nonfederal senior scientists 

chosen for their expertise in the IRG's area of interest who meet three times a year to review 

applications. 

The second referral is to an institute or center for second-level review by their National Advisory 

Council, and for staff follow-up and funding as indicated. The Council review focuses on policy and 

program relevance of applications judged to be highly meritorious by the initial review group. 

Members of National Advisory Councils are also primarily nonfederal research experts, but include 

other prominent health professionals and members of the public with interest in the ICD's area of 

concern. There are three possible paths from submission of an application to final recommendation. 

Applications submitted in response to a PA enter the usual peer review process with all other 

competing research grant applications submitted at regular intervals three times a year. Similarly, 

applications for research training enter the training review process, also three times a year. 

Applications submitted in response to an RFA enter a special review process for only that RFA. 

The first level of review of nursing research grant applications is usually carried out by the Nursing 

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Research Study Section, administratively located in the DRG. 

For most applications, the second level of review is by the NACNR. In making recommendations for 

funding to the NCNR Director, both the peer IRG and the advisory council consider the priorities 

and initiatives specified by the NCNR, including the initiatives resulting from the NNRA effort. The 

initial review of applications submitted in response to an RFA is by an NCNR review committee that 

is specially constituted for the expertise needed for the particular RFA. The second level of review is 

the same as for all other nursing research grant applications, namely, the NACNR. 

Applications to support research training and career development are reviewed by the NCNR's 

Nursing Science Review Committee, which has a composition similar to the IRG for nursing 

research. The second level of review is by the Advisory Council, except for individual fellowship 

applications, which are reviewed by NCNR's Executive Review Group. The latter differs from the 

Advisory Council in that members are usually senior government nurse scientists. 

Summary 

Research funded by the NCNR in both its extramural and intramural programs reflects both its longrange plan and the creativity of scientists engaged in nursing research. The processes described here 

for implementation of the NNRA support interaction between NCNR staff and the research 

community to do significant research on the critical issues confronting society, health care, and 

nursing. 

Given the complexity of nursing practice, multidisciplinary perspectives are required in nursing 

research, and, therefore, one of the major initiatives of the NCNR is collaboration. In fact, multiple 

opportunities for collaboration are generated by interacting with colleagues in diverse disciplines 

engaged in various types of basic and clinical research. NCNR staff actively seek out such 

collaboration. Furthermore, as described in Chapter 2, each PEP is deliberately structured to include 

scientists from disciplines other than nursing, as well as representatives from other government 

research programs that have interests in issues addressed by the PEP in question. 

 

TABLE OF CONTENTS CHAPTER 4

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