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The 2019 National Nursing Research Roundtable “The Value and Importance of PhD Research Scientists to Health Outcomes”

March 8-9, 2019

The 2019 National Nursing Research Roundtable (NNRR) was co-sponsored by the Eastern Nursing Research Society (ENRS) and the National Institute of Nursing Research (NINR), part of the National Institutes of Health. Representatives from over a dozen professional nursing societies met to discuss the critical importance of the PhD pipeline, implications of the decline in the number of nurse scientists seeking a PhD, and strategies that might be implemented to sustain the pipeline.

The meeting began with welcoming remarks by Dr. Ann Cashion, Acting Director of the National Institute of Nursing Research and Dr. Victoria Dickson, President of the Eastern Nursing Research Society. Following those remarks, the keynote address was provided by Dr. Suzanne Miyamoto, Chief Executive Officer of the American Academy of Nursing. Dr. Miyamoto’s theme was "Nursing Science’s Value Proposition: Discovery, Innovation, Health." Her remarks began with a recounting of the historic milestones that have led nursing science to its present status (founding of the first doctoral program in nursing at Columbia University’s Teacher’s College in 1920; authorization of the Division of Nursing Resources to conduct and support research in 1944; publication of "Better Patient Care Through Nursing Research" by Dr. Faye Abdellah in 1965; publication of an Institute of Medicine (IOM) report recommending 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 [1983]; the establishment in 1986 of the National Center for Nursing Research and, in 1993, the elevation of the Center for Nursing Research to Institute status at the National Institutes of Health.

Dr. Miyamoto next addressed the importance of reframing the public’s perception of nursing from a purely clinical discipline to one that views nurses as both clinicians and scientists. Such a perception is critical not only for the general public but also for the recruitment of the most talented individuals into nursing science. Dr. Miyamoto identified four elements as necessary for encouraging these individuals to pursue nursing science: beginning identification of potential students at an early age, providing "frames" that are most likely to attract students to nursing science, the critical role of strong mentors in developing young scientists, and the central role of funding. Concomitant with these strategies is the recognition of the obstacles to the growth of PhD-trained nurse scientists (the advanced age of current nursing PhD faculty; the general absence of training in "big data"; the length and cost of PhD programs; and the declining rate of researchers obtaining tenure). Dr. Miyamoto concluded her remarks by stressing the innovative nature of nursing science through its fundamentally multidisciplinary approach to problem-solving.

The second day of the roundtable began with an update on NINR by Dr. Cashion. In her remarks, Dr. Cashion provided examples of NINR-funded early career investigators in each of the Institute’s four primary research areas (symptom science, wellness, self-management, and end-of-life/palliative care). Dr. Cashion noted that such work is illustrative of the high quality of science being done by junior investigators funded by NINR and the importance of supporting and nurturing such researchers to the maximum degree possible. These remarks were followed by scientific presentations by Drs. J Nicholas Dionne-Odom, Dawn Aycock, and Ansley Stanfill, each of whom discussed their own research and career experiences from their respective positions as early career investigators.

Dr. Dionne-Odom, Assistant Professor at the School of Nursing, University of Alabama at Birmingham, addressed "Developing Palliative Care Support for Serious Illness Family Caregivers: Perspectives from an Early Career Nurse Researcher." He began by describing the origins of his research interests and why he believes research into family caregiving is a priority, emphasizing that families are typically out of their element when attempting to address the caregiving of loved ones. Early in his career, Dr. Dionne-Odom’s work involved identification of pivotal moments in family caregivers’ experience within the ICU, finding that families were poorly prepared to be decision makers, leading him to conclude that preparation for this role needed to occur earlier in the process of serious illness. This research resulted in further interest in the question of the caregiving role and how it impacts caregivers’ mental and physical health.

Additional research by the speaker among 300 caregivers found high levels of anxiety, depression and neglecting of self-care – issues that will grow in importance with increasing reliance on family caregivers. In part, as a reflection of these and similar findings, new clinical guidelines state that palliative care is important for both patients and families, and that families should begin preparation for caregiving at the patient’s initial diagnosis.

Dr. Dionne-Odom highlighted the point that the traditional model of curative care, followed by palliative care, followed by death should be replaced by an approach that, over time, combines increasing levels of palliative care with decreasing levels of disease-modifying or curative care, followed by bereavement care for the deceased individual’s loved ones. He concluded his scientific remarks with three messages: 1) Support for serious illness family caregivers is urgently needed 2) Palliative care can meet this need and 3) Leadership skills are necessary for early-career nurse scientists to conduct trials that develop and disseminate these models of care.

In discussing his own career path, Dr. Dionne-Odom cited the important influence of his mentors, identifying six critical roles necessary for a successful mentor: being a teacher, cheerleader, social agent, administrative advocate, counselor and opportunity agent. In addition, he credited NINR support, the importance of learning leadership skills, implementing the results of one’s research in real world settings, and developing collaborative relationships (e.g., within the Palliative Care Research Cooperative (PCRC)) as being critical to his career success. Additional factors cited included having an abundance of curiosity and empathy. Lastly, Dr. Dionne-Odom emphasized the development of a career development plan and the importance of strict accountability as to how a junior investigator’s protected time is spent.

The next speaker, Dr. Dawn Aycock, Associate Professor at Georgia State University, traced the course of her transition from student nurse to nurse scientist. Dr. Aycock noted that she was first exposed to nursing research during her bachelor’s program at Prairie View A&M University College of Nursing, an HBCU in Houston, followed by work in the private sector as a clinical research nurse testing analgesics. Her next position involved graduate research experience with Dr. Patricia Clark at Emory University. Dr. Aycock discussed how she developed her research interests – in her case, her clinical experience with stroke determined that she would investigate that area – and emphasized the central importance of a strong mentor-student relationship as the driving force behind her success, as well as the additional experience gained through her work with other NINR-supported scientists who similarly encouraged her to obtain a PhD. Because of a number of factors, the encouragement she received from her mentors, her experiences working with stroke survivors and caregivers, an interest in conducting her own research, and the financial support she received (a grant from Georgia State University and a K award from NINR), Dr. Aycock elected to pursue a PhD at the University of Alabama. Following receipt of her PhD, Dr. Aycock participated in various post-doc training opportunities which helped to develop and refine the next steps in her research path.

The remainder of Dr. Aycock’s remarks dealt with her specific area of research – knowledge of stroke risk factors among African Americans, culminating in her most recent work involving the "Development and Outcomes of the Stroke COunseling for Risk REduction (SCORRE) Intervention." Dr. Aycock identified five components to the intervention: a brochure, a video, the American Heart Association’s (AHA) "Life’s Simple 7® Program," a risk-reduction diary and motivational text messages. When asked what aspects of her clinical research experience led her specifically to nursing science, Dr. Aycock replied that research allowed her the opportunity to be creative and to be on the cutting edge in the development of new knowledge. Dr. Aycock concluded by noting that her work on the SCORRE Intervention has achieved three objectives: preventing or delaying stroke and its life-changing outcomes among young African Americans, increasing the accuracy of perceived stroke risk and competence in the ability to live a healthy lifestyle and confirming the utility of the AHA’s "Life’s Simple 7® Cardiovascular Health Metric" to effectively communicate stroke risk.

The final speaker, Dr. Ansley Stanfill, Assistant Professor at the University of Tennessee Health Science Center, began by noting that her research career was triggered by her interest in neuroscience and genetics as an undergraduate at Vanderbilt University. This work led her to focus on clinical research, where the need for clinical training and a clinical degree became apparent. To accomplish this goal, she completed an accelerated BSN program at St. Louis University, followed by various clinical nursing positions. However, her interest in research never waned and she subsequently sought and obtained a PhD at the University of Tennessee, working with Drs. Ann Cashion and Donna Hathaway. In addition to her formal academic training, Dr. Stanfill cited NINR’s Summer Genetics Institute, which she attended, and subsequent involvement in ISONG, as being pivotal elements in her career development.

Dr. Stanfill’s research centers on the contributions of dopaminergic genetics to weight gain following kidney transplant. In order to pursue this interest, she obtained an F31 fellowship which provided further opportunity for learning and course work in genetics. In addition, Dr. Stanfill assembled a team of five mentors to enhance her genetics background. As a result of her research, Dr. Stanfill found that the expression of dopamine genes was inversely related to weight gain at six months. Following completion of her PhD program, she did a post-doc in dopamine neurogenetics at the University of Pittsburgh under Dr. Yvette Conley’s T32 award, examining outcomes of survivors of subarachnoid hemorrhage. Following her post-doc, Dr. Stanfill became a faculty member at the University of Tennessee, focusing on expanding the diversity of the stroke research population with a particular emphasis on African Americans and their attendant poorer outcomes. This work, entitled "Integrating Multifaceted Data into a Multidisciplinary Prediction Model of Disability Post-Subarachnoid Hemorrhage" was the focus of Dr. Stanfill’s Roundtable presentation. The primary finding of this research was that African American sub-arachnoid hemorrhage patients experience increased mortality at an earlier age as compared to Caucasians, both nationwide and in the midsouth region. This research led to two follow up questions which are currently being studied: 1) What is the quality of life for patients post-stroke? and 2) Why is there such a marked disparity in outcomes for African Americans?

Following the three individual presentations, a panel discussion among the speakers, moderated by Dr. Dionne-Odom, addressed three topics, all linked to the importance of mentoring: 1. "The Role of and Value of Mentorship in Successful Research Careers" 2. "Successful Research Mentorship; Defining Characteristics and Measurable Outcomes" and 3. "Attracting Young Emerging Talent to The Field of Nursing Science in Today’s Competitive Environment; Importance of Successful Scientists as Role Models."

Six overriding themes emerged from this discussion:

1) THE NEED TO DEVELOP STRATEGIES TO ADDRESS THE DECLINE IN THE PHD PIPELINE. Proposed strategies included increasing awareness of the role of nursing science; starting on a research trajectory earlier in one’s career; earlier identification of promising nursing science researchers, and enhancing the role of mentorship.

2) THE GROWTH IN THE NUMBER OF DNP PROGRAMS AT THE EXPENSE OF PHD ENROLLMENT. Issues discussed under this topic included the shorter time period required of DNP as contrasted with PhD students; the possibility of targeting promising DNP students for PhD programs, and potential collaboration between DNP and PhD programs.

3) STRATEGIES DESIGNED TO NURTURE THE CAREERS OF NURSE SCIENTISTS included striking the right balance between research and administrative activities and nurturing the individual’s development throughout their academic careers.

4) STRATEGIES TO ENGAGE PROFESSIONAL ORGANIZATIONS IN RESOLVING THE PHD PIPELINE ISSUE. Strategies discussed involved engaging community partners to stimulate local bedside nurses in research; providing support for PhD students and others to attend national meetings and conferences, and partnering among different organizations (e.g., American Cancer Society and hospice organizations) to build networks and relationships.

5) THE CRITICAL ROLE OF THE MENTOR. The importance of mentoring was repeatedly emphasized during the discussion, along with the qualities that make for a good mentor, including being available and offering simple encouragement and feedback.

6) THE RESEARCHER’S RESPONSIBILITY IN MAKING A DIFFERENCE IN CLINICAL PRACTICE. Some of the ideas offered were keeping the "so what" in mind; collaborating with DNPs in translating to practice, and the critical role of relationship-building in implementation science.

Following the panel discussion among the speakers, an open discussion occurred between panelists and all Roundtable attendees. In that conversation, the following points were made:

  • Nurses in the clinical settings get "mad" when they see things that aren’t working. That "anger" should be channeled into encouraging people to pursue research to create real change, and bedside nurses can be engaged in this effort.
  • Career days for elementary schools and middle schools could generate interest among future nurse scientists, along with summer camps for middle-schoolers.
  • Clinical care nurses should be exposed to PhD nurses to spark interest in science.
  • Partnering with local science museums could be useful in educating children and communities as to the importance of nursing science.
     

In the afternoon, attendees broke into small groups to discuss potential strategies constituent organizations might implement to sustain the pipeline through attracting young emerging talent to the field of nursing. Themes and suggestions that emerged from that discussion included encouragement of students as early as possible in their careers – perhaps through an Emerging Scholars Program; increased financial support and mentorship; formation of PhD-DNP teams; dual appointments between clinical and research departments; better integration of nursing into STEM programs; enhanced media campaign(s) to attract students to nursing research; and an emphasis on the flexibility and diversity inherent in a nursing research career.

Closing thoughts were provided by Drs. Dickson and Cashion. In her remarks, Dr. Dickson emphasized the need for better data to characterize the pipeline issue; increased mentorship, including the development of future mentors; improved messaging both within and outside the nursing community, including young students; enhanced funding from national sources and seed funding within organizations; and lastly, to simply emphasize that a research career is "fun."

In her closing remarks, Dr. Cashion highlighted the importance of team science in advancing research, and emphasized the point that nurses are capable of leading teams. As a corollary, she noted that it is important to provide leadership training to students in order to broaden their skill sets. She pointed out that NIH is examining its intramural programs and its leadership roles, in light of the fact that most leadership roles are held by men. She stated that differing management styles between men and women in science is a topic worthy of further investigation, particularly because nursing science is currently a woman-dominated profession.

The 2019 Roundtable concluded by noting that the 2020 Roundtable will be held March 5-6 and will be co-sponsored by National Association for Pediatric Nurse Practitioners. The date for the 2021 has not yet been confirmed but the co-sponsor will be the Western Institute of Nursing.

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