During the golden age of ‘60s soul music, one of Otis Redding’s most popular songs was “I’ve Been Loving You Too Long (To Stop Now).” In this plaintive ballad, Otis sings about how his significant other’s love for him is fading away and is almost gone, yet his love for her continues to grow. How will he be able to carry on when she finally leaves him? “You’ve become a habit with me,” he laments. “With you my life has been so wonderful. I don’t want to stop now.”
Any nurse who has ever received a grant to fund a research project, nursing education program, minority nurse recruitment program or other important initiative can relate to what Otis was talking about. Few events rival the thrill of learning that your grant proposal has been funded. Suddenly, hundreds of thousands, perhaps even millions, of dollars will be supporting your dream. Your project will have proper staffing and good equipment. . .at least for a few years.
But what happens at the end of the grant? Will you be able to sustain your program after the original funding runs out? Or will you find yourself in the same situation as Otis, as he implores, “Please don’t make me stop now”?
The good news is that many programs that initially get their start through a grant award do find ways to continue. Some are able to find new funding sources to keep the program going. Others continue to receive money from the original source. For instance, Head Start began in 1965 as a pilot program in President Lyndon Johnson’s War on Poverty. More than 40 years later, community-based organizations throughout the country are still receiving Head Start funds from the Department of Health and Human Services.
Capitalizing on Success
One example of a federally funded project that doesn’t intend to call it quits after its grant period ends is the BCC/HCA Specialty Nurse Training Program in southeast Florida. The program, a collaboration between Hospital Corporation of America (HCA) and Broward Community College (BCC) in Fort Lauderdale, provides specialty training in emergency and critical care nursing for RNs who are employees of local HCA hospitals.
The project, which began in 2005, was funded by a $2 million grant awarded through the President’s High Growth Job Training Initiative. (HCA actually received $4 million, which was divided between its Florida and Texas divisions.) Because of the area’s diverse population, the Florida program has succeeded in training a large number of minority nurses to become critical care or emergency nursing specialists. One third of the nurses who have completed the training are African American and another third are Hispanic.
The two-year grant ended on June 30, 2007. As this issue of Minority Nurse went to press, program administrators were awaiting word on their application for a grant extension. Regardless of whether or not this happens, they say, the specialty training will still go on.
“Once this grant started, we contacted [participating HCA] hospitals for feedback,” explains Alicia Hinton, BSN, RN, MBA, emergency department project manager at BCC. “They gave us input as to what they thought was needed and they saw how the students were doing on the floor. The hospitals looked at their resources and decided this program should continue.”
Some of the hospitals are now providing money to fund adjunct faculty for clinical training conducted in the hospitals. BCC continues to provide classroom instruction, T1 lines and college credit. Funds are still being sought for hiring a program secretary and a computer technician. The students’ tuition will be paid through the hospitals’ tuition reimbursement program.
The most likely factor in the continuation of this program is its success. The grant called for 88 nurses to be trained. Actually, 133 completed the training—an impressive 166% of the required enrollment. Then, grant administrators started surveying hospitals outside the HCA East Florida system.
“Hospital CEOs liked the program and they wanted it to continue. Students wanted the program to continue. With all that data to back it up, we were able to secure local funding [to help replace the federal funding],” says Charlene Ingwell, MSN, RN, workforce and organizational training director for HCA East Florida.
Hinton believes Broward Community College’s strong relationships with its clinical training partners were what made the difference. “Develop a close relationship with your hospital partners,” she advises. “Work with them in trying to determine the costs and needs of a program. Have an open dialogue at the very beginning so that you’ve got the hospitals’ buy-in at the end of the grant.”
Plan from Day One
One experienced grant reviewer agrees that the key to creating sustainability is to start planning for it at the very beginning, perhaps even before the grant is awarded.
“As people craft their applications, they need to consider how the program will continue after grant funding,” says Janice M. Phillips, PhD, RN, FAAN, a nurse researcher at the University of Chicago Hospitals. Prior to accepting her current position, Phillips was a grant program director at the National Institute of Nursing Research (NINR), where she reviewed grant applications for programs such as the Mentored Research Scientist Development Award for Minority Investigators (also known as the Minority K01 grant).
Phillips encourages grant seekers to consider a contingency plan when writing the grant proposal. Determine possible community partners and then involve those partners in program assessment. Clinical advisory boards are good places to start. You can find other partners by closely examining who will ultimately benefit from the research or services that will be made possible by the grant funding.
Being knowledgeable about funding sources is another important factor in keeping the money coming when the initial grant ends. If you haven’t already done so, become familiar with online resources like the Federal Register Web site and Grants.gov, which publish announcements of competitive grants funded by federal agencies. (See “Where the Money Is” sidebar.)
Networking with other grant writers in your field is another good way to learn about new funding opportunities. When attending conferences, listen closely to presentations and begin keeping a list of agencies that have funded programs and the type of programs funded. Then visit those agencies’ Web sites and sign up to receive requests for proposals (RFPs).
“Funds are so competitive now,” Phillips emphasizes. “You have to be constantly searching for new funding sources. The federal government’s resources may be limited and agencies may change their primary focus. That challenges everyone to be open to other sources.”
Flexibility Could Mean Funding
If you’re a nurse scientist whose grant is ending, would you be willing to alter your research goal slightly in order to find new funding sources that could keep your project going? For example, instead of spending 100% of your time investigating nursing interventions for Hispanic heart patients, could you spend part of your time assisting a pharmaceutical company in testing new drugs designed to prevent second heart attacks?
Where the Money Is: Online Resources for Finding FundingThe Federal Register Online
http://www.gpoaccess.gov/fr/index.html
The Federal Register includes announcements of grant opportunities available through federal agencies, along with information on legislation and regulations concerning grants and awards.
Grants.gov
http://www.grants.gov
A more user-friendly alternative to the Federal Register, this site includes an easily searchable database of over 1,000 grant programs offered by all federal grant-making agencies. You can also sign up for email announcements about newly available grant opportunities.
Health Resources and Services Administration
http://www.hrsa.gov/grants/ and http://bhpr.hrsa.gov/nursing/grantprograms.htm
This federal agency funds many grants each year, in areas such as HIV/AIDS research, rural health, maternal/child health and others. HRSA’s Bureau of Health Professions (BHPR), Division of Nursing offers several grant programs for schools of nursing, including Nursing Workforce Diversity grants and Nurse Education, Practice and Retention grants.
Robert Wood Johnson Foundation
http://www.rwjf.org/applications/
This private charitable foundation gave out $400 million in health care-related grants last year. Its Web site issues calls for proposals (CFPs) and offers details on the application process.
The Centers for Disease Control and Prevention
http://www.cdc.gov/od/science/PHResearch/
This page within the CDC Web site offers information for public health researchers, including Funding Opportunities Available (FOA).
National Institute of Nursing Research
http://www.ninr.nih.gov
NINR, one of the National Institutes of Health, provides funding to support clinical and basic research on health and illness across the lifespan, including health promotion/disease prevention and health disparities. Funding opportunities are announced through Requests for Applications (RFAs) or Program Announcements (PAs).
Flexibility can often make the difference between keeping doors open and having them close on you when the grant money is gone, according to Phillips. “You may have to rethink your research. People who are committed can juggle research with a little creativity,” she says. “Some drug companies might offer research funds depending on what they’re investigating. Specialty nursing organizations, such as the American Association of Critical-Care Nurses, may be able to provide small pools of funding, and sometimes larger [grants in support of research or clinical projects].”
Phillips also recommends checking with large national philanthropic organizations. Private foundations, such as the Robert Wood Johnson Foundation, offer grants to support research, training programs and other projects in a broad range of areas related to health care, such as improving the health of vulnerable populations and increasing diversity in the health care workforce.
Sometimes flexibility is forced by the outcomes of a project. HIV/AIDS researcher Sheldon Fields, PhD, APRN, BC, FNP, AACRN, FNAP, FAANP, RN, is halfway through a federal grant that will run out in 2009, and he says he will be adjusting calls for new funding in accordance with the results of his work. Fields, who is an assistant professor and co-director of the Family Nurse Practitioner Program at the University of Rochester School of Nursing in Rochester, N.Y., was awarded a five-year Special Projects of National Significance grant from HRSA’s HIV/AIDS Bureau to fund Project YEAH (Youth Empowerment Around HIV), an initiative designed to increase HIV testing and treatment among young men of color who have sex with men.
“This is a research grant that has a community-based program and whether it keeps going or not depends on whether the community wants it. It’s still too early to know what will happen,” Fields says.
He adds that it’s very possible some aspects of the project will find a way to continue while others may not. “This project has many parts. Some are working well and what actually works is what needs to be sustained. When you have outcome-based research, it’s hard to plan if you don’t know what the major outcomes will be until year three or four.”
Fields hopes that HRSA will offer follow-up funding for elements of the project that are working. Those elements include a group-level prevention intervention and an Internet outreach program. If additional HRSA funds don’t materialize, he may seek funding from the Centers for Disease Control and Prevention or the New York State Department of Health’s AIDS Institute.
Collaborate, Collaborate, Collaborate
Phillips reminds researchers that grant-funded projects don’t have to be isolated in one ivory tower. She recommends partnering with researchers at other institutions to share resources.
“Multi-site studies allow you to pool expenses,” she says, “and they also give you a chance to collaborate. You may have a piece of the population [being studied], say an urban area, while another person may have systems support or access to labs.”
Phillips, whose current research specialty is breast cancer in African Americans, believes a collaborative effort may also make a study more comprehensive. “I may be [based in] Chicago, but I want to know about rural women. That’s one of the advantages of multi-site partnerships.”
She suggests looking for fellow researchers with common ideas and interests.
“Starting out with a multi-site or multi-organization project may be a little much until you get acclimated to research. More seasoned researchers are open to this because if they have a particular methodology, they want other people to use their work. It gives more credibility.”
Issues like intellectual property and authorship should be discussed early in the process so that everyone is clear about these arrangements before the research even begins, Phillips adds.
Look Within
Making friends within your organization can pay dividends if a program finds itself in a financial crunch when the grant money runs out, says nursing educator Jacque Dolberry, RN, MS. She is director of the RN/BSN program at Salish Kootenai College, a tribal college located in Pablo, Mont., on the Flathead Indian Reservation.
“This college has been very supportive of the Nursing Department. We have had a couple of years where the administration had to pick up some recruitment and retention [staff] salaries so we could get another grant funded,” she recalls.
How do you approach your institution’s president or chancellor about gaining funding support when resources are scarce? Dolberry recommends focusing on the bottom line. “You always need to constantly justify the cost and the need for a [good] faculty/student ratio. Be able to talk about [issues like] the need for more technology. It’s a process of continuing to educate the college administration.
“Part of it is being able to show them what kind of impact the lack of a [faculty] position might have,” she continues. “How will the number of degrees your program hands out affect the count across campus? You have to justify that you need a certain number of faculty in certain specialty areas to meet accreditation standards. Even if you decrease the student numbers, you still have to have the specialized faculty.”
Dolberry also notes that it’s easier to get buy-in from administration if the grant is closely in line with your organization’s mission and target audience. That may seem obvious, but some grant seekers can’t pass up any chance for money, regardless of whether or not the grant is a good match for their particular institution.
“You have to choose the ones that offer a good fit between the aim of the grant and the needs of your program,” she says. “You have to have support from all parts of the campus. That’s so much better than just writing for more money.”
Be Creative
The BCC/HCA Specialty Nurse Training Program grant is somewhat unusual in that it is a job skills training grant from the Department of Labor’s Employment & Training Administration (ETA), not a health-focused or nursing-specific grant from a health agency like HRSA. In other words, thinking outside the box can yield big results.
Dolberry has seen some nursing programs fill funding gaps by putting students and faculty members into practice. “[Our program] hasn’t gotten to this point yet, but I do know of one school that developed clinical sites to serve special populations. That enabled the school to secure funding for a faculty position,” she says. “I also know of academic health centers where nursing students do clinicals that serve the student population. The program receives reimbursement through private pay or Medicaid.”
What started as one grant then expanded to include other mental health professional associations, including the American Nurses Association, American Psychology Association, and American Psychiatric Association. The Minority Fellowship Program became a place where racially diverse mental health professionals could go to get support to pursue doctoral and postdoctoral study.
Today, through funding from the U.S. Department of Health and Human Services’ Substance Abuse & Mental Health Services Administration (SAMHSA), the American Nurses Association is able to offer the Minority Fellowship Program (MFP). It looks to encourage doctoral and post-doctoral training of minority nurses to help them become leaders in research, clinical practice, and academia. Fellows of the program have gone on to improve culturally competent mental health and substance abuse care across the United States.
“I think it’s extremely important to give encouragement to go into doctoral study,” says Willa Marlene Doswell, Ph.D., R.N., F.A.A.N., Chair of the MFP Advisory Committee and a member of the first class of fellows in 1975. Many minority nurses can’t or don’t know how to reach the inside track for research and publication at their home institutions, she says. The SAMHSA Minority Fellowship Program at the American Nurses Association provides the support they need to get ahead.
Over the years, the MFP has supported over 200 minority nurses while they look toward a doctoral education and beyond. Here are just a few of these inspiring nurses’ stories.
Marife C. Aczon-Armstrong, Ph.D., R.N.
A retired nurse from the Peace Corps convinced Marife she should pursue a career in nursing. She started by applying for the Associate Degree in Nursing program at a nearby community college. “I was placed on a wait list,” she says. “It was taking too long, so I decided to try the L.P.N. route.”
This strategy worked, as she was accepted right away. When she completed the program, Marife passed the NCLEX-PN exam. “Unlike my colleagues, I went straight into the B.S.N. program at Hawaii Pacific University instead of working as an LPN,” she says. “It paid off! By the time I completed the B.S.N. program, most nursing certification started requiring a B.S.N. degree as a criterion.”
After graduation, Marife went on to earn her Master of Science in Counseling Psychology at Chaminade University of Honolulu and a Master of Science in Nursing and doctorate in nursing at the University of Hawaii at Manoa. To complement her education, Marife was a member of the American Psychiatric Nurses Association and the Asian American Pacific Islander Nurses Association. Recently, she accepted a position at the University of Hawaii’s School of Nursing and will be a full time assistant professor in the fall.
With expertise in counseling, mental health, case management and utilization management, health insurance, diabetes education, medical/surgical nursing, and oncology nursing, Marife works to create a healthier, more compassionate community. She is an RN Case Manager in the Emergency Department and Clinical Decision Unit at the Queen’s Medical Center in Honolulu, Hawaii.
Marife is currently researching alcohol and substance abuse among patients with chronic illnesses. She started her work in substance abuse because she was tired of treating patients only for immediate problems. “We’re always rushing to get the patients in for triage and rushing to get them discharged,” she says. “I would like to fi nd a process to efficiently help them.” Marife sees substance abuse as an array of addictions, not only alcohol and illicit drugs. “It is about a human being trapped in a revolving door with nowhere to go.”
Her work has not only helped her grow academically, but as a nurse as well. Marife’s diverse spectrum of patients has allowed her to learn when to be gentle and when to give tough love, but she says her job has taught her to be nonjudgmental and to treat people equally. “I take care of the patient who has insurance the same way I take care of the homeless patient with no insurance,” she explains. Her greatest joy is seeing patients’ smiling faces as they wave goodbye, thanking her and her colleagues for taking good care of them.
Giving advice to nurses interested in helping mental health and substance abuse patients, Marife says, “Always be true to yourself and treat your patients with respect and dignity. This population knows if you are sincere. They are most likely willing to open up and receive help and assistance if you are sincere.”
Doris Hill, Ph.D., R.N., C.N.O.R.
Doris Hill has always enjoyed the sciences and working with a variety of people. She started out working at a bank, but after talking to people at her church who were in nursing, she realized it was the fi eld for her. When she and her husband relocated from the West Coast to the Midwest for his job, Doris saw the perfect opportunity to switch careers. She graduated from nursing school and began her work in the OR.
While working toward her B.S.N., Doris was encouraged by her professors to pursue a master’s degree. Not only did she get her M.S.N., but she followed it up with a doctorate in nursing from the University of Minnesota in 2005. Of her studies, Doris says, “I really felt a lot of pull toward diverse populations, minority populations.” Her dissertation was titled “Sense of Belonging as Connectedness to Selected Areas of Health and Traditional Practices in American Indians.”
Doris has a long-standing commitment to the health of minority populations, especially American Indian and Latino patients. Overall, Doris says she’d “like to see a decrease in health disparities,” and increased services for mental health patients and their families. She says nurses and other health care providers must learn and consider historical roots of trauma and the cultural needs of their patients. She stresses the importance of advocating and joining committees. “Take what you learn and use that to benefit the health of minority populations,” she says. “Be a voice.”
For her post-doctoral fellowship, Doris worked with her mentor, Dr. Barbara Elliott, at the University of Minnesota, Duluth, in the School of Medicine specializing in the health of ethnic minority populations, violence, and mental health. Doris says her fellowship has an impact on everything she does. It has given her an awareness of minority health issues, helped her get involved, and allowed her to make a larger impact. “It’s such a great experience, it’s hard to put into words,” she says. She advocates the program’s support, mentoring, networking, and focus on the “bigger picture”—expanding mental health from a local to a national level.
For future fellowship participants, she has a few words of advice. “It’s such a positive experience. Enjoy it, learn all you can, and take advantage of the networking,” she says. “When they leave the fellowship, they’re given the skills and support to really impact those health disparities.”
Robert Pope, Ph.D., R.N., M.S.N.
Robert Pope started as a hospital orderly, trying to work his way through the ranks. Then a colleague introduced him to a 20/20 program: work and school for 20 hours each, every week. Determined and serious about his studies, Robert was able to jumpstart his career in nursing.
Robert trained in gerontology at one of the largest hospitals in California and eventually delved into substance abuse and home-based patient care while working at a VA hospital. He noticed that a large population of the older veterans had histories of substance abuse. At one point, he had fi ve patients living in squalor, addicted to crack cocaine. “It appalled me. It shocked me,” he says. “I didn’t know that this existed at the time.”
His experiences at the VA hospital led him to SAMHSA and substance abuse study. “I had taken my experience and my background and used those experiences to gain entry into areas not previously examined,” he says. When he started his doctoral studies, Robert focused on the social processes surrounding illegal drug use among older African American men (his dissertation: “Older African Americans and Illicit Drug Use: A Qualitative Study”).
Not only did the Minority Fellowship Program help him complete his doctoral work at the University of California, San Francisco (UCSF), but Robert is continuing his work as a post-doctoral fellow as well. He recently accepted a one-year SAMHSA post-doctoral fellowship studying perceived control and psychosocial/ physiological functioning in substance abusing older African Americans.
Outside the program, Robert has become internationally renowned for his work in substance abuse in older African Americans, presenting at conferences across the globe. The Journal of Transcultural Nursing recently published an article that Robert co-authored, “The Social Determinants of Substance Abuse in African American Baby Boomers: Effects of Family, Media Images, and Environment.” Recently, he was appointed to serve on the Board of Directors of Mental Health America (MHA), in Alexandria, Virginia.
Robert says the MFP opened his eyes to many of the disparities minorities face working in health care, which he experienced firsthand. While attending his first class at UCSF, Robert looked around the auditorium. “The one glaring thing to me was there were no other African Americans,” he says. “I was it.” Robert felt a sense of isolation and loneliness. He struggled to relate to his peers. During one class, they discussed money-saving strategies that included decreasing spending on end-stage renal disease, which affects a large number of African Americans and other minorities. At another lecture, they talked about raising funds for osteoporosis, a disease that predominately affects older white women. These instances showed Robert the difficulties of being the only minority in a health science training program and motivated him to help try to change the health care landscape so minorities could see nursing and other health care professions as obtainable careers.
As a strong advocate for the MFP, Robert believes it’s important to increase minority nurse numbers through mentoring and speaking out. He says the program has helped him immeasurably and is “an excellent model of success for minority students.” He credits the program, Executive Consultant Dr. Faye Gary, Program Manager Janet Jackson, and their personal support for his success today.
Robert’s advice for potential fellows? Don’t be reluctant or hesitate. He was uncertain at fi rst, but a peer at UCSF convinced him to apply, and he hasn’t looked back. Future candidates should not compare their accomplishments to the existing fellows’ impressive résumés and feel they can’t measure up, he says.
Currently, Robert promotes nursing among minorities and recruits across the country. For young people who want to pursue the program and nursing in general, he suggests not only applying for the MFP, but also reaching out to those who have already found success in their fields. He says fellows are ready and available to help–students just have to ask. Robert invites nurses in need of career guidance to contact him. He can be reached at [email protected].
At three years old, Mayola knew that she wanted to get involved in health care from watching her mother, a Red Cross volunteer. “I always, always wanted to be a nurse,” she says. “That’s all I’ve ever wanted to do.”
While at the University of Southern Indiana School of Nursing, Mayola completed a rotation in the mental health program and “fell in love with it.” She remembers her instructor saying that the discipline was an area where nurses have to rely on their knowledge and compassion and not as much on machines. “It stuck with me,” she says.
For 24 years, Mayola has been working in various clinical settings with a focus on psychiatric/ mental health nursing. She completed her dissertation, “Predictors of Depressive Symptoms and Obesity in African American Women Transitioning from Welfare to Work,” at the University of Tennessee Health Science Center in Memphis. Mayola is also the first known nurse to earn both a Ph.D. and a D.N.P.
Of her patients, Mayola says they “are some of the most vulnerable.” Mental health care requires a very different mindset from physical health, and many people don’t want to be around mental health patients. “They’re the forgotten population,” she says. “But they’re still people and they still deserve care.”
Mental health care is a difficult field, she explains, and nurses must call upon all their faculties when aiding those with psychological concerns. (Mayola prefers the word “concern” over “illness” because of the stigma associated with the latter.) “You have to have compassion,” she says. You are working with patients that may never get better, and many times it’s an uphill battle against chronic progressive diseases. It is hard to leave her practice at the end of the day, and it sometimes occupies her thoughts into the evenings. However, Mayola stresses that the skills involved in mental health nursing are not unique to the practice; they’re transferable and needed across all health care disciplines.
Despite the hardships, there are many benefits to working in mental health. “I am thankful that I have the opportunity to serve these people,” she says. “I think that it has made me a better person.” Mayola cares deeply about her patients’ welfare and says they truly make a contribution to society. “Every day that I go to practice, I ask God to guide me and help me practice safely,” she says, “and I try to give it all that I can.”
Regarding the MFP, Mayola is in reverence. “I wouldn’t be where I am if it weren’t for that program and Dr. Faye Gary and Janet Jackson,” she says. Of Dr. Gary, Mayola says, “She truly believes that her fellows will make a difference.” Dr. Gary pushes the fellows, knowing they will contribute to nursing science and research.
The MFP provides the foundation fellows need, and Mayola recommends that those passionate about mental health apply for the program–just be ready to articulate and demonstrate your enthusiasm for helping those with serious and persistent mental illnesses.
Rosa M. Gonzalez-Guarda, Ph.D., M.P.H., R.N.
When she was in high school, Rosa Gonzalez-Guarda went on a service mission to the Dominican Republic. There she saw very poor communities, with limited education and health care resources. “The thing that struck me most,” she says, “were the great disparities [between the United States and the Dominican Republic] that existed in terms of health.”
When she left high school for Georgetown University in Washington, D.C., Rosa wasn’t exactly certain of what she wanted to study. She thought about nutrition, but there weren’t many programs available at the time, so she decided on nursing and a minor in international health so she could be more exposed to public health issues.
After earning her B.S.N., Rosa began working with communities in the United States. “I realized I saw the same disparities that struck me abroad existed here.” She refocused her studies on local issues, especially intimate partner violence (IPV), domestic violence, substance abuse, and risky sexual behavior.
Rosa decided to pursue master’s degrees in public health and nursing (M.P.H. and M.S.N.) at Johns Hopkins University in Baltimore, Maryland. She worked with world renowned researcher Jackie Campbell, who specializes in domestic violence and has published more than 150 articles and seven books on the subject. They developed a violence prevention program at a predominantly African American inner-city middle school. It was a wonderful experience for Rosa, as she learned more about IPV. It was then that she decided to focus on domestic violence among Hispanics.
For her doctoral study at the University of Miami, Rosa drew from three different disciplines: nursing, epidemiology, and psychology. Her dissertation focused on the intersection of substance abuse, IPV, and risky sexual behavior among Hispanic women, and she developed a model for understanding and addressing the co-occurrence of these conditions. “In reality, when you look at a lot of the factors that lead to these conditions, they’re the same thing,” she says. Rather than focusing and treating a single ailment, Rosa believes that such issues should be treated together. There are many changes she’d like to see, especially the categorical way the health system is funded.
Rosa says the MFP and its fellows improve communities through research and granting more opportunities for nurses. She believes they can also help with the nursing shortage. The lack of nursing faculty, who tend to need Ph.D.s to teach, has forced nursing schools to turn away students. With the program, more nurses can earn their Ph.D. on the way to becoming professors.
Rosa suggests potential candidates think about the things they’d like to research as a doctoral candidate and build a career trajectory around them. She explains that being a nurse researcher doesn’t mean being isolated from patients, sitting at a desk crunching numbers. Research nurses can really make a difference in the field. And her last piece of advice for potential MFP candidates? “Stay true to the communities that you are trying to serve.”
A final note
As nurses look toward the future and an aging American population, the opportunities to make an impact in the mental health and substance abuse field will continue to expand. The MFP affords minority nurses the chance to participate in that growth. When asked what advice she has for candidates considering the MFP, Willa Marlene Doswell says, “They should apply! [The SAMHSA Minority Fellowship Program at the American Nurses Association] opens up doors and it opens up opportunities to help the minority community.” For more information on SAMHSA’s Minority Fellowship Program at the American Nurses Association, visit the MFP online at www.emfp.org.
What is social capital and can social capital play a role in better asthma outcomes in children residing in homeless shelters? These were some of the questions that guided a research proposal for the Research Infrastructure in Minority Institutions—Career Opportunities in Research (RIMI-COR) grant at Mercy College. Funding for this study was made possible in part by a grant from the National Institute on Minority Health and Health Disparities.
A pilot study was undertaken from October 2008 through August 2009 to quantify if social capital structures existed in three homeless shelters in New York City and if shelter residents were aware of these structures, and to examine parental perceptions about their child’s asthma (controlled/uncontrolled and mild/moderate/severe) and clinician concordance of parental assessment.
Five Mercy College nursing students assisted the researcher in this study with literature reviews and data collection. Engaging nursing students in research is an important venue because it gives students opportunities to examine health issues that are outside of their purview. Further, the students participating in data collection learned about social contributors to health disparities.
Additionally, this research is also being undertaken at a transitional homeless shelter in San Francisco, California. A medical student from University of California, San Francisco has assisted with data collection (anticipated completion in August 2012). To date, 13 parents have participated in the study.
Putnam defined social capital as social relationships (interpersonal trust, norms of reciprocity, and civic responsibilities) within communities that act as resources for individuals and facilitate collective action for mutual benefit.1 Social capital structures are systems of networks, norms, and trust relationships, which allow communities to address common problems.2
Social capital and health linkages are paltry, but research has shown that higher levels of social capital lead to better health outcomes and lower mortality rates in adults and children.3 Asthma prevalence in the United States is about 8.9% and affects more than 6.8 million children and adolescents.4 Asthma is overrepresented in children living in poverty and asthma rates in homeless children are six times the national average.5,6
Social capital in homeless shelters refers to those structures that facilitate social relationships, interpersonal trust, social engagement, and civic responsibilities. Social capital resources were viewed as case managers, onsite medical clinics, educational programs, and shelter governance meetings.
If we consider that homeless shelters might function as a community, structural features that can stimulate social capital may improve childhood asthma outcomes. Further, engaging homeless families in the tenets of social capital may be the means to facilitate participation in community events when they become permanently housed. Active community participation is essential to bring about the social and physical resources necessary to reduce the detrimental environmental exposures in lower income communities.
Self-rated health and psychological well-being are higher in individuals who reported increased levels of community trust and less political participation such as voting has been associated with poorer self-rated health.7,8,9 Therefore, if homeless shelters provided onsite medical clinics (a social capital resource) would parents rate their children’s asthma as controlled? Encouraging patterns of social engagement with the onsite medical clinic would reduce visits to the emergency room. Further, understanding how social capital interacts with the homeless shelter environments (physical and social) could influence how parents understand or perceive their child’s asthma.
The three shelters were identified by an organization that provides onsite medical services at family shelters. Nineteen parents who had asthmatic children (aged six or older) completed a questionnaire adapted from the American Academy of Pediatrics (v. 3.1; 6/02). The questions covered the child’s health, child’s activities, information about the parent, and information about the shelter. The questionnaire was also translated into Spanish. The questionnaire was read to most of the parents because literacy was a problem.
The researcher, a family nurse practitioner, used the National Heart and Lung Institute’s Guidelines for the Diagnosis and Management of Asthma to determine if the child’s asthma was controlled or uncontrolled and the severity of the child’s asthma (mild, moderate, and severe). The social capital indicators examined were voting patterns and if the shelter had case managers, onsite medical clinic, educational programs, town hall meetings, and governance meetings for the shelter residents.
Self-reported demographic characteristics of the study sample can be found in the images accompanying this article. The questionnaire asked about gender, socioeconomic status indicators (income, education, and occupation), insurance information, and if this was their first time living in a homeless shelter.
All of the homeless shelters had case managers, onsite medical clinics, education programs such as GED preparation, town hall meetings, and shelter governance meetings. Respondents were asked if they were aware of these social capital structures and if they voted and if not, their reasons. About 58% of respondents indicated their awareness of town hall meetings; 21% indicated they did not know about these meetings, and 21% answered don’t know. Most parents knew their case managers (90%), 5% indicated they did not know them, and 5% answered don’t know. Most parents knew about the onsite medical clinic (95%) and only 5% responded don’t know. Parents used the medical clinic (32%) for asthma problems and 58% chose not to use the onsite clinic because the clinic was closed; they brought their child to the ER or to their private clinician. Few parents were aware of educational programs (16%); 47% specified no and 37% responded don’t know. A minority of parents were aware of shelter governance meetings (37%); 26% were unaware of these meetings and 37% answered don’t know. Most respondents voted (68%) whereas 32% indicated they did not vote. Reasons given for not voting were (1) not registered, (2) did not know where to vote, (3) did not know about a particular election, and (4) did not want to vote.
Parents were asked to subjectively assess if their child’s asthma was controlled or uncontrolled and to rate if their child’s asthma was mild, moderate, or severe. Mild was defined as not too bad, moderate was considered bad, and severe was considered very bad. Assessment of the child’s asthma by the researcher was based on the parent’s answers about medication usage and types of medication the child had been prescribed. Cross-tabulations were performed to examine clinician and parental concordance of asthma perceptions and asthma severity.
The clinician and the parent agreed at a 91% rate that the child’s asthma was controlled and 25% that the child’s asthma was uncontrolled. The clinician-parent concordance for asthma severity was 70% for mild, 14.3% for moderate, and 50% for severe.
This small-scale exploratory study was able to quantify that social capital structures existed in family homeless shelters in New York City; however, respondents were more aware of some of these structures than others. Additionally, this study investigated parental perceptions about their child’s asthma because data suggested that social capital may be a determinant in self-rated health and thus could potentially be extended to perceptions about a child’s health status. Further, if the parent sought treatment at the onsite medical clinic, did the parent gain a better understanding of asthma triggers and medications leading to decreased visits to an emergency room?
Theoretically, social capital can broadly examine the structural inequalities that contribute to health disparities. Additionally, social capital may increase our understanding of the associations of homelessness and health problems because linking social capital and health may enable homeless shelters to address cultural norms that are detrimental to health, ensure the adequate provision of health care, and collectively build infrastructures that are conducive to better health outcomes.
References
R.D. Putnam, “Bowling alone: America’s declining social capital,” Journal of Democracy 6 (1995):65-78.
P.M. Pronyk, et al., “Is social capital associated with HIV risk in rural South Africa?” Social Science & Medicine 66(2008): 1999-2010.
I. Kawachi, B.P. Kennedy, and R. Glass, “Social capital and self-rated health: A contextual analysis,” American Journal of Public Health 89 (1999): 1187-1193.
E. Forno and J.C. Celedon, “Asthma and ethnic minorities: Socioeconomic status and beyond,” Current Opinion in Allergy and Clinical Immunology 9 (2009): 154-160.
J.J. Cutuli, J.E. Herbers, M. Rinaldi, A.S. Masten, and C.N. Oberg, “Asthma and behavior in homeless 4- to 7-year-olds,” Pediatrics 125 (2010): 145-151.
D. McLean, S. Bowen, K. Drezner, A. Rowe, P. Sherman, S. Schroeder, K. Redlener, and I. Redlener, “Asthma among homeless children: Undercounting and undertreating the underserved,” Archives of Pediatric and Adolescent Medicine 158: (2004):244-249.
T. Nieminen, T. Martelin, S. Koskinen, H. Aro, E. Alanen, and M.T. Hyyppa, “Social capital as a determinant of self-rated health and psychological well-being,” International Journal of Public Health (2010): doi: 10.1007/s00038-010-0138-3.
S.V. Subramanian, D.J. Kim, I. Kawachi, “Social trust and self-rated health in US communities: A multilevel analysis,” Journal of Urban Health 79(2002): S21-S34.
T.A. Blakely, B.P. Kennedy, and I. Kawachi, “Socioeconomic inequality in voting participation and self-rated health,” American Journal of Public Health, 91(2001): 99-104.
Imagine getting a grant that would relieve you of your teaching duties for up to three years so that you can spend most of your time doing research. Now imagine that this grant would also offer a mentorship to help guide your research and would cover additional training to further your career development. Sound too good to be true?
The National Institute of Nursing Research (NINR), one of the National Institutes of Health (NIH), doesn’t think so. That’s why it offers the NINR Mentored Research Scientist Development Award for Minority Investigators, also known as the Minority K01 grant. This award provides up to three consecutive 12-month appointments to pursue a mentored research experience and specialized study in nursing research that are tailored to the faculty member’s individual needs. The NINR provides recipients with salary up to a maximum of $50,000 plus fringe benefits per year, plus up to $20,000 per year in funds to carry out a research project.
The Minority K01 grant program is designed to:
foster the development of independent investigators in nursing research on the faculties of traditionally minority-based institutions and majority academic institutions;
stimulate nursing research and nursing research training at these institutions, and
encourage the development of qualified minority nurse investigators in academic research settings who can become effective role models for minority students.
Faculty members who have received Minority K01 awards agree that it’s a one-of-a-kind grant that offers a host of benefits, foremost being the time to conduct their research. “Minority nurse researchers will never have another opportunity that enables them to buy out their time in terms of teaching responsibilities, have access to a mentorship and pursue specialized training. That kind of experience just can’t be replicated anywhere else that I’m aware of,” says Christopher Coleman, PhD, ACRN, CS, assistant professor at Virginia Commonwealth University in Richmond, Va., who received a grant for his research focusing on determinants of sexual behavior among African-American men infected with AIDS and HIV.
In addition to facilitating time and mentorship, the Minority K01 award also gives Coleman the valuable experience of serving as a principal investigator on a federal grant. “That’s a huge plus because that shows the National Institutes of Health that I can manage a grant as a principal investigator,” he explains. “If I’m successful, the likelihood of me getting another grant goes up even higher.”
Researchers with a Mission
What types of research does the Minority K01 grant program fund? The NINR encourages minority nurse investigators to pursue areas of research that involve underserved minority populations and are relevant to priority areas of NINR’s scientific research mission, particularly its Strategic Plan on Reducing Health Disparities.
For More InformationComplete information about the NINR Mentored Research Scientist Development Award for Minority Investigators, including downloadable application forms, is available on the NINR Web site at http://www.nih.gov/ninr/. Click on “Research Funding and Programs,” then “Diversity Programs and Resources.” For information on the amount of Minority K01 grant funding available in fiscal year 2004, look for the Request for Applications under the “What’s New” section of the site.
“The NINR wants investigators to be funded for the area of science that they are committed to as long as that area fits within our mission,” says Program Director Janice Phillips, RN, PhD, FAAN, who is African American. Areas of research consistent with this mission include chronic illness and long-term care; health promotion in diverse populations; cardiopulmonary health and critical care; neurofunction and sensory conditions; immune responses and oncology; reproductive and child health, and end-of-life care.
Grant recipients must be willing to devote at least 75% of their professional effort to conducting research during the award period. The remaining 25% should focus on other research-related activities and/or teaching or clinical pursuits consistent with the award’s objectives.
Who exactly is eligible for these grants? In order to pursue a Minority K01 award, candidates must meet the following criteria:
Have a research or health-professional doctorate (e.g., PhD, DNSc) or its equivalent
Have demonstrated the capacity or potential for a productive independent research career
Have a Registered Nurse license
Have secured the commitment of an appropriate research mentor actively involved in research relevant to NINR’s mission.
Preparing Your Application
Not surprisingly, Minority K01 grants are very competitive, and putting together a successful application requires time, effort and care. According to Phillips, the NINR is looking for individuals who show a commitment to a nursing career in biomedical or behavioral research and the potential to develop into an independent nurse investigator. Applicants must submit both a research plan and a research career development plan outlining their immediate and long-term objectives and how the award will contribute to obtaining them.
Christopher Coleman, PhD, ACRN, CS
Phillips advises applicants to highlight prior scientific training and experience, building on their previous research experience. You should also show your involvement in professional activities. This may include membership in professional organizations; attendance at interdisciplinary conferences, journal clubs and other professional meetings; and scholarly activities, such as publication in peer-reviewed journals. Candidates must also include a minimum of three letters of recommendation addressing their potential for an independent research career.
In explaining their career development plan, candidates should “describe a systematic plan to obtain any necessary biomedical or behavioral science background and research experience to launch or reinitiate an independent nursing research career.” They must also “describe plans to receive instruction in the responsible conduct of research.”
For example, Coleman made the case that he needed additional training to prepare him to conduct large population-based studies. Consequently, he pursued additional public health coursework at Johns Hopkins University in Baltimore under this grant. The career development goals should be cast in a realistic timeline to ensure they are achievable within the grant’s three-year duration. “Sometimes applicants can be overambitious and list too many goals in the allotted timeframe,” Phillips cautions.
As for the research plan, it should focus on the use of a basic or clinical approach to a biomedical or behavioral problem. Specifically, the applicant should describe the research project’s aims, background and significance, progress report/preliminary studies, research design and methods.
The NINR is looking for a sound research plan that is consistent with the candidate’s career development plan and existing research skills, says Phillips. NINR grant reviewers will judge the scientific and technical merit of the research question, design and methodology within the context of the applicant’s previous training and experience and the relevance to his or her career objectives.
When human subjects are involved, the research plan should include minorities, both genders and children (if appropriate). NINR reviewers will also evaluate the applicant’s plans for the recruitment and retention of subjects.
Choosing Your Research Team
Given that the Minority K01 award is a mentored research experience, choosing the right mentor–or mentors–is critical. The mentor should have:
research qualifications consistent with the applicant’s research plan;
a commitment to supervising and guiding the candidate throughout the award period;
previous experience in fostering the development of independent nurse investigators, and
a history of research productivity and support.
The mentor must also write a letter of support showing his or her willingness to provide the necessary assistance to the candidate.
In putting together their research team, applicants should not only carefully select mentors who have a record of independent funded research in a relevant area of science but also consultants who bring expertise to the table that will assist in the applicant’s development, says Phillips. For example, if a candidate proposes to include instrumentation as a major part of the research, he or she should consider including a psychometrician on the research team. “Individuals from multiple disciplines help to ensure a well-rounded learning experience ,” Phillips adds.
Veronica Clarke-Tasker, RN, PhD, MBA, MPH
It’s important to keep in mind that your mentor does not necessarily have to be a nurse. When Veronica Clarke-Tasker, RN, PhD, MBA, MPH, assistant professor in the College of Pharmacy, Nursing and Allied Health Sciences at Howard University in Washington, D.C. applied for the grant, she chose an epidemiologist with expertise in cancer for a mentor. This helped broaden Clarke-Tasker’s perspective of her research in prostate cancer education and screening for African-American men. “You need to identify who has expertise in your area of interest and would be willing to mentor you through this process,” she says.
Similarly, Eunice Choi Lee, RN, DNSc, assistant professor at the University of Illinois at Chicago College of Nursing, has one mentor from the nursing school and two mentors from outside nursing–one in public health and one from the medical school faculty. Lee, who is Korean American, feels that working with co-mentors from other disciplines has broadened her understanding of her research, which focuses on breast and cervical cancer screening in Korean-American women. Plus, research based in community health requires multidisciplinary work, she adds.
June Strickland, RN, PhD, associate professor at the University of Washington School of Nursing in Seattle and president-elect of the National Alaska Native American Indian Nurses Association (NANAINA), chose a consultant with experience working in the American Indian community and a mentor with expertise in mental health and intervention design. “It’s important to find a good mentor who has resources that you need and it’s also important to have consultants,” says Strickland, who recently completed her research on suicide in the young male population in three Indian communities.
“Applicants must be mindful to carefully outline the respective contributions and/or expertise of any mentors and/or sponsors as well as a plan for interacting with each of them,” notes Phillips. The latter should include the level, frequency and type of research training supervision that the mentor and applicant feel is necessary to achieve the objectives.
Phillips recommends selecting mentors who are geographically nearby to enhance the mentored experience. If the mentors are geographically distant from the candidate, he or she must provide a detailed communication plan to document the relationship and level of commitment for implementing and completing the research goals.
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Clarke-Tasker considers herself fortunate that her mentor is both internationally known and local. “Because there are so few minority research experts out there, the person you want as a mentor may not be available because he or she may already be mentoring three other people,” she points out.
Often, when one individual has too full a plate to be your mentor, he or she will recommend someone else. That’s what happened in Coleman’s case, and he ended up with co-mentors who had worked together on previous HIV research projects, a point that he believes strengthened his application. Rounding out his team is a population consultant with expertise on the adult male African-American population.
Getting Your University’s Support
Just as the mentors must document their willingness to assist the applicant, the sponsoring academic institution must likewise provide a statement of commitment to the faculty member’s development into an independent investigator. This includes releasing the applicant from academic duties to accomplish his or her research and career goals during the award period.
Program Director Janice Phillips, RN, PhD, FAAN
The NINR reviewers are looking for the institution’s commitment to the applicant’s scientific development as well as assurance that it intends the candidate to be an integral part of the school’s research program. They also want to ensure that the institution offers adequate research facilities and training opportunities, a quality environment for scientific and professional development, and a willingness to provide an appropriate balance of research, teaching and administrative responsibilities for the candidate.
As Coleman notes, “You can propose the best science, but if your university doesn’t carry the resources, you won’t be awarded the funding.” He not only had his dean write a letter of support but also had the department chair do the same. “There’s no limit to how many letters you can send with your application,” he says, “and you want to show that your institution is standing behind you.”
Then there’s the subject of money. As with any grant application, you can be sure that your proposed budget will be reviewed thoroughly. Applicants can request any amount up to the $50,000 annual salary cap and $20,000 annual research expenses cap. The NINR reviewers are looking for justification of the budget request in relation to the research goals, aims and plans. It should also be consistent with available funds. Information about funding levels for fiscal year 2004 is available on the NINR Web site (see “For More Information”).
Your Moment of Truth: The Reviewers Respond
After submitting an application, all candidates receive a written critique, also known as the summary statement. In many cases, the NINR reviewers may request additional information or ask for clarifications. The statement should be reviewed very carefully and comments addressed in any subsequent application, says Phillips. In fact, she encourages applicants to contact the appropriate program director to review the statement and discuss any aspects of the proposal that need clarification. They should also meet with their mentors and consultants for recommendations in drafting a revised application.
The Minority K01 CountdownNINR’s Minority K01 grants are awarded once a year. The timeline for fiscal year 2004 is:
Send Letter of Intent by [November TBA], 2003
Send Application by [December TBA], 2003
Peer Review completed by [February 2004]
Council Review completed by [May 2004]
Grant awarded by [TBA, 2004]
If an applicant doesn’t get funded, Phillips suggests that he or she consider resubmitting the application for the next call for the Minority K01 award. “Applicants must remember that many investigators do not get funded the first time around,” she emphasizes. “Success may only come after careful revisions.”
Coleman followed the suggestions he received from the NINR reviewers to improve his application. “There are people at the NINR who will look at your ideas and provide good advice. They really try to help you be successful in getting the grant,” says Coleman, who was funded after submitting a second application.
Clarke-Tasker, who received her grant on the first try, credits her research team that had her “working around the clock. They made sure what I wrote made sense and that I had the correct measures,” she recalls. “I was so close to the material, I couldn’t always see when something I thought made sense didn’t.” For example, Clarke-Tasker wrote that she would be using the Health Belief Model, which she didn’t see a need to explain because it is so well known in the research arena. But she was asked to explain it and clarify a few other points before getting the grant.
“Don’t get discouraged if you don’t get funded the first time,” she says. “The process is there to help us. We have to take advantage of it.”
In working with many applicants over the years, Phillips has noted that successful candidates share several common characteristics. She has come to call them “the Power of the Ps”–a passion for what they’re doing, persistence in pursuing the grant, people who support them along the way and productivity evidenced by the dissemination of their research results.
Robert Wood Johnson Foundation P.O. Box 2316 College Road East and Route 1 Princeton, N.J. 08543-2316 (888) 631-9989 www.rwjf.org
The foundation began after its namesake, the man behind the Johnson & Johnson medical empire, left the majority of his estate to begin what would become the nation’s largest philanthropy devoted exclusively to improving the health and health care of Americans. Working with a variety of organizations and individuals, the foundation funds research, education and other efforts at hospitals; medical, nursing and public schools; hospices; professional associations; research organizations; government agencies and community organizations.
Reducing Disparities in Health Care
Among the foundation’s key areas of focus are addressing disparities and public health issues and building human capital in the health care workplace. Last fall, the foundation announced three national initiatives—and dedicated $23 million—aimed at eliminating racial and ethnic disparities in health care treatment. Their goal is to reduce disparities in the next three years by examining patient care and current health systems and by making suggestions for improved care.
Researchers at George Washington University, the University of Chicago and Harvard University are leading the three programs. They will focus on cardiac care received by minority patients and fund various organizations to focus on disparities in health plans, hospitals and community clinics. They will also collect and analyze results from other research on disparities to inform efforts at improving care and technical processes in health systems.
Among other reports, the foundation’s health research publications dealt with covered care at big-city hospitals, the effects of anthrax on those exposed, how federal health dollars are being spent in the states, and protecting public health in the face of bioterrorism.
Building Human Capital
Not all of the foundation’s work is research-related, however. One area allied health students and professionals should keep an eye on is the foundation’s focus on building human capital. Robert Wood Johnson funds training and education programs for doctors, nurses and other health care workers. In 2005, the foundation hosted a series of one-day informational workshops, Frontline Workforce Development: Promoting Partnerships and Emerging Practices in Health and Health Care, to share research and tips for the advancement of the allied health workforce.
The foundation has particularly focused on those professionals who receive the smallest compensation, such as nurse aides, home health aides, psychiatric technicians, and others because, according to the Robert Wood Johnson Foundation Web site, these health care workers are “often the first and most frequent point of contact for patients and clients. Despite their importance, these essential workers are often poorly paid and have limited opportunities for training, advancement and reward.”
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One of the programs in this area aims to train workers in hospitals and other facilities so that employees at all levels—from housekeeping to nurses—can receive continuing education to encourage their advancement.
Addressing Needs
Like many organizations and schools interested in addressing both health disparities among their patients, as well as career advancement and adequate pay for their allied health care workers, the Robert Wood Johnson Foundation also values assisting their minority students and professionals to receive the training they need to be successful in the field of allied health.
“The biggest challenge is the anti-affirmative action climate in this country,” says Contance Pechura, senior program officer at the Robert Wood Johnson Foundation. “Because of the Supreme Court decisions in the Michigan cases, it puts any program that’s based on selection by ethnicity or race in very murky legal territory.” As a result, the foundation has expanded its criteria for some programs to include economically disadvantaged rural areas.
The Basics
The Robert Wood Johnson foundation maintains an informative and up-to-date Web site (www.rwjf.org) that you can check out for interesting developments in research and current health care and public health trends. Visit the site to stay informed or to check its “Job Opportunities” section under “About Us.”
