The Problem: Nurses comprise the largest health professional group and play a critical role in providing care at the bedside in hospitals and in clinics. They are the largest constituency other than patients in the health care system. While nurses engage in basic science research and randomized clinical trials, they are less likely to conduct research that directly informs health policy. Nurses, however, have a direct care perspective that is valuable to policy decisions. Although nurses may not be aware of funding opportunities in health policy research, the Robert Wood Johnson Foundation's Investigator Awards in Health Policy Research encourages nurse researchers to apply to the program.
The Proposal: The Investigator Awards in Health Policy Research, a national program of RWJF, funds an array of researchers whose broad scope and innovative projects have policy relevance. In 2007, 15 investigators received $3.4 million in support for 12 new research projects.
In the 15 years since RWJF inaugurated the Investigator Awards program, more than 160 investigators from the nation's leading private and state universities, and other nonprofit organizations have received funding. Researchers have explored the determinants of health disparities among population groups, public health policy, health care reform and financing, medical technology, patient safety and quality of care, and the patient-provider relationship, among other policy issues. During that time, only two nurse researchers received awards.
Now, with the addition in 2006 of Marilyn Chow, R.N., D.N.Sc., vice president, patient care service, Kaiser Permanente, to the program's national advisory committee, nurses likely will be getting get more attention. “I think the leadership of the Investigators program recognized that nursing can make a difference, and we would like to see more nurses receive awards,” she says. “The challenge is for nurse researchers to broaden the area for which they are seeking research funding.”
Grantee Perspective: Julie Fairman, Ph.D., R.N, University of Pennsylvania School of Nursing, received an Investigator Award in 2006 and exemplifies the health policy nurse researcher. Fairman decided to apply for the program after receiving a postcard announcing the Investigator Awards program's request for proposals. She also knew Linda Aiken, Ph.D., R.N., a professor at Penn's Nursing School, and, until Fairman, was the only other nurse to receive an Investigator Award (in 1998). Fairman's first attempt for funding did not receive approval, but she persevered. Her project, “Practice Politics: The History of Nurse Practitioners, 1975 to Present,” will culminate in a book to be published by Rutgers University Press later this year.
Becoming an Investigator was, to Fairman, “a pretty natural fit, given RWJF's interest in history and healthy policy,” she said. Her mentor, Rosemary A. Stevens, Ph.D., M.P.H., used her 1997 Investigator Award to start research on a book, History and Health Policy in the United States: Putting the Past Back In (Rutgers University Press, 2006).
The questions Fairman hopes to answer with her research shed some light on the intersection of nursing and health policy. In general, she will try to address the overarching question of how do we, as a society, decide who provides health care at what time and where. “That is where the politics of gender, race and class really play a key role,” says Fairman. ”I am arguing that what occurs at the grassroots level highly influences health policy.”
More specifically, she will:
- Examine state health care reform, including in Pennsylvania, where a new initiative seeks to develop 24-hour clinics—alternatives to hospital emergency departments—staffed by nurse practitioners to increase access to health care services while decreasing costs.
- Explore why nurse practitioners provide care in underserved areas where doctors are scarce but create controversy when they treat middle-income clients at walk-in clinics in Wal-Mart stores.
- Examine how state practice acts requiring sometimes stringent physician supervision of nurse practitioners present barriers to practice.
Chow says nursing research such as Fairman's is important because “nurses who do research do it from a public policy perspective, a care delivery perspective, and a patient and family perspective. It is a different lens on the health care world.”
RWJF Perspective: “One of the important criteria for selecting investigators is the likelihood that their work will inform health policy,” says Lori Melichar, Ph.D., RWJF director.
“Equally important to being selected is the promise of the investigator's proposal to rejuvenate the field of health policy research by asking innovative questions, applying innovative frameworks and using innovative methods. Nursing researchers have important contributions to make to health policy. Both as observers and actors, nurses offer a unique perspective of local and national health policy challenges—without which, innovative opportunities for improvement surely will be missed."
The deadline for letters of intent for the 2008 round of Investigator Awards is March 26. Visit the Investigator Awards Web site for more information and an application. Approximately 10 awards will be made of up to $335,000 each.
The Investigator Awards in Health Policy Research national program office is at the Institute for Health, Health Care Policy and Aging Research at Rutgers the State University of New Jersey. David Mechanic, Ph.D., is the director, and Lynn Rogut, M.C.R.P., the deputy director.