Abstract
Introduction:
National Institute of Health (NIH) stated in their strategic plan that a diverse research workforce is an important goal for the advancement of health care science; however, there is little evidence to show funding goes to National Institute of Nursing Research (NINR) minority nurse scientists. The study’s aim was to determine NINR grant recipients’ race/ethnicity, gender, and licensed nurse status.
Methods:
A descriptive research design was used with NIH providing NINR award recipients’ names and employing organizations. An online survey with questions about their gender, race, ethnicity, and being a licensed nurse was sent to 619 award recipients.
Results:
Survey responses were collected from 135 NINR recipients receiving awards. Almost 50% NINR grant recipients were non-nurses. With licensed nurse recipients, White female was the dominate race and gender. Hispanic licensed nurses were 6.8% of the NINR grant recipients over the 3-year period. In addition, Asians and Blacks were the lowest race categories at 4.1% award percentage over the 3-year period.
Conclusions:
NIH strategic plan is for a diverse research workforce in order to advance health care science. NINR must lead the efforts to grow a diverse nursing workforce including Hispanic and underrepresented nurses in order to successfully compete in NINR grants and funding.
The National Institute of Health (NIH) is a federally funded agency that operates as a part of the U.S. Department of Health and Human Services. “NIH is the largest biomedical research agency in the world” (para 1), according to the website (NIH, 2019a). The NIH agency consists of 27 institutes and centers for health research. In 1985, the Public Law 99-158 Health Research Extension Act went into effect that established the National Center for Nursing Research. This Act provided federal funding for health care focused on nurse scientists (Public Law 99-185, 1985). The institution’s strategic plan espouses the goal of providing a scientific workforce that is innovative, multidisciplinary, and diverse (National Institute of Nursing Research [NINR], 2016). Since the initial start, the institute refined its foci to “build the scientific foundation of clinical practice, prevent disease and disability, manage and eliminate symptoms caused by illness, and enhance end-of-life and palliative care” (NINR, 2019, para 1). The institute has funded nursing science that supports evidence-based practice and innovation. This was a landmark achievement for nursing as a profession to receive government recognition as an essential component of health care and research (Grady, 2018). These grant awards are a catalyst for science and innovation in many disciplines (Forscher et al., 2019; Grady, 2018), and nursing is no exception.
In recent years, questions have surfaced about the distribution of these dollars from NIH and NINR. Over the past decade, scientists have investigated gender differences in award recipients of various NIH grants. Jagsi et al. (2009) investigated physician scientist career development grant recipients for K08 and K23 training awardees. The authors reviewed 2,784 NIH awardees over a 10-year time period. The findings were women were less likely to receive funding than men. Additional analysis showed women’s 10-year K08 award rate was 31.4% compared to men’s at 68.4% and the K23 women’s rate was 43.7% compared to men’s at 56.3%. Ginther et al. (2011) were one of the first to report NIH award differences according to race and ethnicity. They studied 83,188 NIH R01 applications from 2000 to 2006 for self-identified race and ethnicity. The authors reported Black applicants were 13% less likely to receive NIH funding compared to Whites. In addition, Asians were 4% less likely to receive NIH funding compared to Whites.
Spurred by these study findings, the NIH formed an advisory committee on diversity. The NIH advisory committee concluded that attaining diversity in the biomedical and behavioral research workforce should be a national priority. More specifically, they recommended a goal be set to grow the number of underrepresented scientists to reflect the demographics in the U.S. population (NIH, 2012). In recent times, some new findings identified changes were occurring in eliminating racial/ethnic funding gaps across all grant recipients (NIH, 2020).
Status of Nursing Scientists
According to the facts page on the ninr.nih.gov website, the NINR is focused on nursing research to build the scientific foundation for clinical practice, prevent disease and disability, manage and eliminate symptoms caused by illness, and enhance end-of-life and palliative care. To build this scientific foundation, nursing scientists must be available to conduct research. Many research opportunities exist for nursing scientists in health care facilities and institutions of higher learning across the United States in greater numbers than ever before. However, many of these vacancies go unfilled.
Purpose
The American Association of Colleges of Nursing (AACN) has reported the number of graduates pursuing research-based doctorates is in decline. Since 2014, enrollment in research-based programs has declined by 9.6% (AACN, 2018). This decline in the nursing scientific workforce has led to questioning the NINR grant distributions. The aim of the study was to investigate funding patterns for race, gender, and licensure status in a sample of NINR grant recipients since the decline in nursing seeking research-based doctorate education.
Method
The request for this information began with contacting NIH. The Freedom of Information Act allowed for requests of public information from NINR. At the time of the study, the most currently available NINR research project grant (RO1) recipient data were from the years 2014 through 2016. Most recent recipient data were provided by NIH in these years. The R01 grant was selected because it was the original and historically the oldest grant mechanism used by NIH (2019b). Grant recipient data included the principle investigator (PI) contact email address. The result of the request was the summary for NINR award recipients that included gender (male/female, unknown) and race/ethnicity (American Indian/Alaskan Native, Asian, Black/African American, Hispanic/Latino, Native Hawaiian/other Pacific Islander, White, more than one race reported, or Hispanic or Latino). In the summary report, less than 11 recipients represented the majority of the race/ethnicity categories for the 3-year period.
Additional data that included contact information were found on the NIH’s Award by Location and Organization (NIH, 2018) website. At this site, the researchers searched awardee by names and organization. This search in the publicly available source for the 3-year period of 2014, 2015, and 2016 resulted in a sample of n = 211, n = 209, and n = 199 subjects, respectively. Email addresses were included in the available contact information. With the viable email contacts, the subjects (n = 619) were asked to participate in the study through an email. The researchers explained the study’s purpose, and the implied informed consent was obtained when the award recipients completed the questionnaire. The questionnaire included self-identified gender (male/female); race/ethnicity (Hispanic, American Indian/Alaskan Native, Asian, Black or African American, Native Hawaiian/other Pacific Islander, and White); and licensure as a registered nurse (RN) reported as yes/no. Prior to the investigation, the university’s institutional review board approved the study. All the data were coded and stored securely. Excel was the software program used for data analysis. The analysis of demographic variables was expressed in frequencies and percentages.
Results
Survey responses were collected from 135 NINR recipients receiving awards between 2014 and 2016. The response rate was 21.8%. Results from the award recipients’ surveys showed females were the dominant recipients. The 3-year average for female award recipients was 71%. Likewise, women dominated the licensed nurse NINR recipients with 92% self-identifying in this category.
In the race/ethnicity categories, the percentage of award recipients was dominated by Whites ranging from 87.5% to 91% for the 3-year period with an average of 80.4%. Asians and Blacks were significantly less with an average of 8.8% and 2.7%, respectively. Hispanic recipients accounted for a little over 6% of the 3-year total. Whites again dominated the RN NINR recipients with a 3-year average of 83.5%. In addition, Asians and Blacks were a distant second and third with 4.1% over the 3-year period. Hispanic licensed nurses were 6.8% of the NINR grants recipients over the 3-year period.
Those reporting “no” as a RN and recorded as nonnurses showed an increase in receiving awards in the same 3-year period. For the total 3-year period, almost one half of the NINR grant recipients were nonnurses (47.6%).
Discussion
For the purposes of the study, the demographics of those receiving NINR awards was compared to national nursing organizations’ demographic profiles. Using the existing nursing workforce for comparison is one way to determine diversity goal achievement. The National Council of State Boards of Nursing (NCSBN) and AACN provide reports that include the demographics of the general RN population in the United States. The NCSBN reported 4.5 million plus RN licenses held in the latest biennial national survey (Smiley et al., 2018). The NCSBN found the overall RN workforce to be dominated by women (90.1%) primarily from the White (80.7%) race. There is similarity with the RN NINR study findings of White and female being the leading demographic descriptors of award recipients receiving NINR funding.
Another national nursing organization to compare gender and racial/ethnicity distributions is the AACN full-time faculty reports. For licensed nurse NINR grant recipients, the percentage of females and males (91.1% and 5%) respectfully receiving awards aligned closely with the gender distributions provided in the AACN reports. In addition, White was the predominant race in the study’s findings which mirrors the AACN full-time faculty race/ethnicity reports. The finding of White females dominating the award distributions can be expected since the majority of full-time nursing faculty are reported as White female (AACN, 2018a).
The overall findings of this study indicate that NINR is at the forefront of funding males and minority races/ethnicities at a greater percentage when compared to the population of full-time nursing faculty across the United States. Findings also indicate this cannot be said for those licensed nurses receiving awards. The percentage of those funded in the licensed nurse category closely resembled the gender and race/ethnicity distributions of the AACN full-time faculty across the United States.
The overall summary of NINR distributions according to gender and race/ethnicity in the 3-year analysis dispels the claims of unfair bias in award distributions; however, these percentages may reveal an inclination toward the majority categories of female and White. The progressive decline in female award recipients is inconsistent with the percentage of the population of full-time faculty. Female faculty percentage has remained relatively consistent over the last decade at approximately 94%. The percentage of male award recipients averaged 29% over the 3-year period as reported in the survey findings. These percentages were inconsistent when considering award recipients identified as licensed nurses when the distributions were compared with the AACN annual reports. In a similar study, scientists examined R01 critiques and scoring for differences due to principal investigator (PI) gender in a sample of NIH applications from those in academic medicine. The authors concluded that subtle gender bias might continue in the NIH review format that holds males and females to different standards (Kaatz et al., 2016). Gender was found to be a significant predictor of R01 award attainment with men receiving the majority of funding in a 2009 study that sampled grant applicants from academic medicine (Jagsi et al., 2009). Other work investigating gender and race bias in a sample of 48 R01 applications representing a broad spectrum of NIH-funded sciences revealed little or no bias in the review process for awarding grants (Forscher et al. 2019).
It appears that bias for males to receive awards may be present in the aggregate analysis of all NINR recipients. This study reported findings that many of the funds targeted for nursing scientists were awarded to PIs in other health-related disciplines and a larger percentage of these PIs were males compared to licensed nurse grantees. One reason for this distribution could be the decreasing number of nurses pursuing research doctorates (AACN, 2018a). Another reason could be that licensed nurses were included as members of an interdisciplinary team and not submitting applications as the PI.
There are several limitations to this exploratory analysis. One is the limited number of responses from those award recipients for the 3-year period. A greater sample size and more years of NINR grant recipients would add value to the findings and assist in the generalizability of the findings. In the comparison to full-time faculty across the United States, it is an assumption that the majority of award recipients are employed by institutions of higher learning. Differentiating the university type such as health care science and research intensive could be beneficial.
Future research could include investigating the nonfunded grant applicants for their demographic profile. A comparison of funded and nonfunded applicants regarding race, gender, and licensure status could give information if a difference exists between those two groups. Another future investigation could be nurses applying for other NIH agencies monies and determining the demographic characteristics of the recipients.
Conclusion
NIH stated in their strategic plan that a diverse research workforce is an important goal for the advancement of health care science. Of great importance in the diversity goal is to obtain racial and ethnic composition of scientists. Other demographic factors to consider in the diverse workforce is gender, socioeconomic status, geographic location, and disability status (NIH, 2015). The nursing workforce nor the nursing faculty reflects the U.S. population for sex, race, or Hispanic origin. One half of the U.S. population is male, 13% Black, and 18% Hispanic (U.S. Census Bureau, 2018). As stated previously, nursing is dominated by White females. The NINR-funded nurse scientists are similar to the general nursing workforce demographics. NINR needs to actively plan and lead the development of a new generation of students with interest in nursing science and mirroring the diversity of our society. The Advisory Committee to the NIH recommended the pipeline of diverse students in elementary, secondary, and college be involved with NIH-specific activities to foster intellectual stimulation in the biomedical sciences (NIH, 2012). NINR needs to lead the plans and efforts to grow a diverse nursing workforce in which future nurses will successfully compete in NINR grants and funding.
A part of the NINR’s (2016) strategic plan is the continued focus on innovative strategies to attract nurses into research careers. Licensed nurses serving as primary investigators (PIs) and receiving awards from NINR seem to be in decline and many awards seem to be granted to PIs outside of nursing. This result could be impacted by the diminishing number of nurses seeking research doctorates. The competition to attract students into the variety of career choices available to nurses has exacerbated the decline in research-focused doctoral programs. Academic nursing programs have risen to the task of preparing advanced practice nurses to care for patients. Conceivably, this goal has inadvertently directed potential nurse scientists to other careers. Nursing students should be made aware of the opportunities available to them as nursing scientists and the importance of this work to improve health care across the globe.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
