Date: Thu, 28 Mar 2024 15:52:00 -0400 (EDT) Message-ID: <1005890555.185.1711655520482@odprdoirapp.od.nih.gov> Subject: Exported From Confluence MIME-Version: 1.0 Content-Type: multipart/related; boundary="----=_Part_184_1518080586.1711655520389" ------=_Part_184_1518080586.1711655520389 Content-Type: text/html; charset=UTF-8 Content-Transfer-Encoding: quoted-printable Content-Location: file:///C:/exported.html
Download the PDF: Woods_Nancy_Oral_History_2008 (PDF 129 kB)
National Institute of Nursi= ng Research Oral History Project
Telephone Interview with Na= ncy Woods Conducted on March 24, 2008, by Philip Cantelon
PC: I'm speaking with Nancy Woods.
NW: That's true.
PC: On March the 24th, 2008, and I have your permission to record the call?
NW: Sure.
PC: Thank you. Just a bit of ba= ckground with your relationship to the National Center for Nursing Research= .
NW: Uh-huh.
PC: How did you come upon that?=
NW: Well, it was a long =E2=80=93 it = was a long journey. I started out actually working with the American Nurses= Association. It was at that time called the Cabinet on Nursing Research, w= hich was a committee that was asked to look at research activity and resear= ch resources for nursing in the U.S. at that time.
PC: And this was what year?
NW: This was probably around 1980.
PC: Uh-huh.
NW: And during the course of my work = with that committee, spent a lot of time, I was on a subcommittee that focu= sed on NIH. And so along with Joanne Stevenson, who is the other committee = member assigned to look at the relationships with NIH, she and I made a ser= ies of regular visits to the institute directors at NIH to talk with them a= bout nursing research activities and their institutes, and to talk about th= e need for funding to support the kind of research that nurses did, and to = try to help them understand what that was actually, because there was not a= very clear vision on the part of people outside of nursing, and to some ex= tent, there was a developing vision inside nursing about what the appropria= te focus should be for nursing research.
And over the course of several years, we made a series of visits to the = NIH director, who, at that time, was Jim Weingarten, and to many of the oth= er institute directors, and to people in their offices about what the resea= rch agenda of their institutes looked like. Certainly, we were trying to le= arn. We did our homework. There wasn't anything =E2=80=93 there wasn't the = Internet availability at that time. Nobody had web pages in 1980, and so we= started out looking in the NIH phone book, and studying things like org. c= harts to figure out where there might be a match for the kinds of research = that nurses did, and whether there would be places where we could look to f= ind the kind of support we needed for nursing research, and sort of to= ok it from there. We looked at places in the NIH where we thought there wou= ld be a good fit with the contributions that nurse scientists could make to= the work, and try to do some consciousness raising about that, as we talke= d with the institute directors.
Then one thing led to another, and as often happens, one looks for momen= ts of opportunity. It was becoming more and more clear that it would be unl= ikely that there would be a line item in anybody's budget that would focus = on some of the work that really needed to be done to inform nursing practic= e. And we began thinking about well, what would a center on nursing researc= h that would be, you know, located in the office of the director, would tha= t be the right structure? Would an institute be the right structure? We kne= w the congressional bias was not to create any more institutes than already= existed. And we had a political opportunity that the American Nurse'= s Association helped us work with to introduce the legislation for what was= the National Center for Nursing Research. And the legislation passed becau= se we had very good congressional support.
PC: As I recall, the first time= it got vetoed in 19 =E2=80=93 probably '83, the Health Research Extension = Act.
NW: Yes. When it was =E2=80=93 are yo= u thinking of the occasion when it was first introduced?
PC: Yes.
NW: I'm trying to remember that parti= cular detail, and I'll have to honestly say, I'd have to probably go back i= n history and dig around.
PC: Okay. No, my understanding = is that it got pocket vetoed, and then it came back in the next session. It= was really put in as an institute, then it came back as a center.
NW: That sounds correct.
PC: And it got passed, and veto= ed again, and then passed over the veto.
NW: I'll have to admit to not remembe= ring that piece of history as well as you do.
PC: Well, I've been trying to d= o that. But that was in 1985. But let me ask, when you were =E2=80=93 you s= ay you were working with the ANA. You were hired by the ANA to do this advo= cacy at NIH?
NW: Actually, not hired. This was a v= olunteer committee through the American Nurses Association. It was a labor = of love.
PC: And you were with whom at t= he time?
NW: I was on the faculty of the Unive= rsity of Washington.
PC: Okay. So you came in from S= eattle to =E2=80=93
NW: Yes. This is sort of my community= service as it were.
PC: [Laughter]. What did you do= wrong, huh?
NW: [Laughter]. Oh, yes.
PC: And the =E2=80=93 had you h= ad any input at all with the study going on with the Institute of Medicine = between '81 and '83 was looking at the same issue in nursing, and indeed, i= n '83 when its report came out, recommended an institute?
NW: I was not part of that study. And= I suspect possibly Ada Sue Henshaw might have been at that time.
PC: The nursing community itsel= f, when you are pushing for nursing research within institutes at NIH, was = it entirely united behind all of this?
NW: Oh, not at all. I remember making= a presentation along with Joanne Stevenson at a meeting where we heard a l= ot of worry being expressed about were we to move out of the
=E2=80=93 out of HRSA, the Health Resources and Services Administration,= where much of the =E2=80=93 what money existed to support nursing research= existed within the Health Resources and Services Administration, whose mis= sion was quite different. It was only focused on manpower research at = the time. There was a great deal of worry that we would lose control of the= little money that we had, that if we moved research into NIH, we would be = risking everything, and the possibility existed that we would be putting al= l of our resources at risk.
PC: And this included the Divis= ion of Nursing, which was funding these programs at that point.
NW: Yes.
PC: And these were the manpower= programs, basically, studying manpower.
NW: Yes, yes. You know, there was a little bit of what = we might call clinical research that was part of the Division of Nursing at= that time, but really, not very much of it. There was very little, very, v= ery little money =E2=80=93 probably a couple million dollars =E2=80=93 at t= he time.
PC: And their whole budget was,= what, around 10 or 11?
NW: I think so.
PC: Okay.
NW: Yeah. My recollection is there mi= ght have been around $2 million for what was considered research at that ti= me.
PC: And what about the attitude= within the education, nursing education community, School of Nursing? Were= they all behind it?
NW: Probably not because nursin= g education has stakeholders who are employed in all sorts of schools of nu= rsing. Some are in community colleges where the sole mission is teaching. I= can't say that the profession was, you know, uniformly supportive because = the mission of their institutions was quite different, and I'm sure that th= ere was a bit of worry that we were making such a big issue out of an area = within nursing research that was not going to benefit everybody in every sc= hool. And that some people saw it as a competition for scarce resourc= es. For example, competition for funding that could otherwise be going to s= upport enhancements in nursing education.
PC: And by that, you mean schol= arship money, or recruitment for more nurses at a community college level r= ather than baccalaureate?
NW: I don't think it would've =E2=80= =93 I don't think it would've been that kind of funding as much as health r= esources. You know, what was seen was potential competition for money that = would fund other programs within the Health Resources and Services Administ= ration. So largely at that time, the support would have been for bachelor's= programs.
PC: These are bachelor of scien= ce and nursing?
NW: Yes. Probably DSN and master's pr= ograms. But, in fact, that wasn't what happened. What happened w= as that the funding was from =E2=80=93 the funding was =E2=80=93 the only f= unding that moved out of HRSA was about a million and a half to $2 million = worth of funding that had supported the manpower research that was being do= ne by =E2=80=93 or funded by HRSA at that time.
PC: So it was the manpower mone= y that came out when it got transferred to the center?
NW: Yes. It was the money that funded= that kind of research, which was really the only research that was being f= unded by HRSA.
PC: I'm sorry, I guess =E2=80= =93 I thought I understood that the 2 million had gone to clinical research= .
NW: I'm sorry. I misspoke. There was =E2=80=93 it was m= ostly funding for manpower research that existed within HRSA, but HRSA actu= ally also did fund some clinical research, but not very much of it.
PC: So when we say not much, no= t less than 20 percent would've been clinical.
NW: You know, I don't know that I cou= ld give you a precise estimate at this time.
PC: Okay.
NW: It's just too long ago for me.
PC: Oh, that's all right.
NW: It's a great question, but my sen= se is that to start with, there wasn't very much money in HRSA, and to go b= eyond that, the little bit of money that was in HRSA at the time was divide= d =E2=80=93 I guess the most accurate thing you could say is that the money= that was in HRSA at that time was divided between research about manpower.= So do we have enough nurses, in other words, versus studying clinical prob= lems, like how do you provide optimal care for a patient with diabetes.
PC: What was the situation that= promoted, or what's the history that promoted this change in attitude in t= he nursing profession in the, I suppose, late 70's and early 80's towards a= more clinical research?
NW: I think probably what prompted th= at was the development of the Ph.D. programs in nursing where for the first= time, we began to articulate what the knowledge was that we needed as foun= dational to practice. I think that was probably the most =E2=80=93 probably= the most significant force. When we found ourselves faced with the need to= work with these =E2=80=93 work with graduate students and develop the Ph.D= . programs in nursing, it was very important that we had the opportuni= ty for schools across the country, faculties across the country to rea= lly be thinking seriously about what it was that should be on the scientifi= c agenda that would support the profession and the practice of nursing, so = how would we inform our ability to practice.
PC: &nbs= p; Had the medical profession itself gotten more complex and deman= ded this of the nurses as well?
NW: I think I wouldn't say just medic= ine, I would say probably all of health care had become much more complex, = both in terms of the populations needing care, the kinds of health problems= people had, as well as the need for expanding or thinking differently abou= t the systems that would deliver services to people. And that had =E2=80=93= you know, that had all sort of gotten, I think, stimulated during the 70's= , kind of following the Hill-Burton Act, which builds hospitals across the = U.S., and then the need to staff those hospitals in the 1970's, there was a= fair amount of attention paid to the education of nurses, and then as we b= egan looking at preparing people better as practitioners, I think we learn = that we probably had underused or underestimated the capacity within nursin= g to provide for the health care needs of the population, and we found ours= elves moving into an era in which we needed good science to undergird what = we were doing in delivering care to people.
PC: So that, basically, it all = came back on the schools of nursing.
NW: A lot of it was coming back on th= e schools of nursing to look at =E2=80=93 to look at ways of providing bett= er prepared clinicians. We had to be more sophisticated in thinking about&n= bsp;the services we were delivering to people, about understanding the outc= omes, and really owning the responsibility for the services that we provide= d.
PC: And let me =E2=80=93 when y= ou went around NIH talking to people, what kind of response did you get?
NW: Well, initially, I think we were = tolerated and people were polite, but not thrilled to have us appear on the= ir calendars. And because there was a fair amount of legislative support fo= r nursing, I think that =E2=80=93 I know the people we met with felt compel= led to listen to us, though not necessarily to be thrilled with what we wer= e telling them. I think we did find some kindred spirits in a number of the= institutes who said "Hey, you know, if you would like to really see this k= ind of programming in NIH, here's what needs to happen." Or "If you would l= ike to see this kind of programming, here's what needs to happen in your do= ctoral programs. These are the kinds of people that NIH needs to have on bo= ard to do this kind of work. If you want to be able to compete for extramur= al funding, here are the changes that you need to make in your Ph.D. progra= ms."
So we were getting a lot of feedback about what the profession needed to= do, what the discipline needed to do to position ourselves to engage in th= e kind of research that other disciplines were doing. But at the same= time, Joanne and I, I think, provided a lot of education to some of the in= stitutes about what were the kinds of things that nurses and nursing scienc= e could really be contributing. And so some examples of that were we = were able to talk about how in our literature, one would find things that w= ere just not on the NIH agenda anywhere else. For example, if we were meeti= ng with the director of NHLBI, we could talk about how there were peop= le in our discipline at that time who had studied, you know, what is the ex= perience of having a heart attack? What was that like for a person to go th= rough? What were the demands that were placed on that individual by having = that diagnosis? What were the =E2=80=93 what were the kinds of adaptations = that families had to make to have a family member in their household living= with heart disease, and then what were the =E2=80=93 what were the therape= utics, what were the therapeutic measures or the therapeutic programs that = nurses provided to people with heart disease? And we could easily point out= where some of those things were not being well addressed as part of the = =E2=80=93 NIH's current research agendas.
PC: Were some institutes more a= cceptable, open and acceptable than others?
NW: Oh, definitely. And, in fact, the= re was =E2=80=93 I'm trying to think of the name of the =E2=80=93 the names= of a few of the people who were really most open. There was a person by th= e
name of Eileen Hassmiller, who was at the National Institute for Child H= ealth and Human Development, who spent a great deal of time with Joanne Ste= venson and me talking about the kinds of research that NICHD would fund, an= d where there was really good fit, for example, with some of the research n= urses did on caring for premature infants and their development. And within= the National Cancer Institute =E2=80=93 oh, this is bad, I can see the wom= an's face and I'm having trouble remembering her name, but there was a pers= on who looked at the cancer =E2=80=93 National Cancer Institutes prevention= agenda, who was very, very interested in the work that nurses were doing a= round cancer screening. For example, working with women on studies of breas= t exams, and facilitating women's having mammography, which at that ti= me was still quite new, and was a screening test that was just becoming mor= e and more available to women, but where there wasn't a lot of public infor= mation available.
PC: May I ask you to spell Eile= en's last name? I heard it, but I'm not sure I can spell it.
NW: I think it =E2=80=93 I think it w= as H-A-S-S-M-I-L-L-E-R.
PC: Okay. Hassmiller.
NW: It's either Hassmiller or Hasselm= eyer.
PC: Okay.
NW: And I'd have to go back, and I do= n't know if I can even find it, but I'll have to go back in my old files, i= f I still have some of them. And then I'll try to see if I can remember the= name of the woman from the National Cancer Institute. But those are two th= at stand out in my mind where actually what they said was "Oh, we need peop= le to do this kind of work, you know, we don't have people who are sort of = taking his holistic view of, you know, people with cancer, or we don't have= a science that takes a holistic view of premature infants and their famili= es."
PC: Uh-huh. And did the basic s= cientists at NIH give this a lot of credit generally?
NW: I'm not so sure that we talked wi= th many of them because we ended up probably talking with people who were i= nstitute directors who tended to have a little bit broader view than only b= asic science. Now I think what we've seen, you know, several years down the= road, 20 years later, we certainly see a great deal of interest in collabo= ration with basic scientists because they're now able to see the value of n= ursing in a lot of the translational work that we need to do as teams or pa= rts of scientific teams.
PC: Not an attitude that existe= d in 1980.
NW: No. [Laughter]. No. The attitude = in 1980 was, you know, probably to still be quite convinced that basic scie= nce trumped everything else, and that, you know, grudgingly, there had to b= e a little bit of clinical research that NIH did. So I think, frankly, in s= ome instances, we were very useful to the institutes because there weren't = many people who were interested in trying to do clinical research, and that= was what we did.
PC: Well, I've always been intr= igued with the fact that only two institutes have research in their name, a= nd neither were part of the sort of basic science approach or theory. I don= 't know whether you'd want to comment on that or not. I just find it intere= sting that the NIDR and NINR are the only two.
NW: Yes, yes. It's dental and nursing= .
PC: Uh-huh.
NW: Well, you know, it's interesting.= I suppose we would be inclined to use that in a title whereas other instit= utes might not because those two institutes have the name 'profession' as p= art of the institute name. And yet what's important is the work that we do.= For example, NINR funds research that is being conducted by physicians and= , you know, many other investigators, people who are educated in other disc= iplines. So it's not just a place to go if you want your research funded an= d you're a nurse, as much as it is this is a place to go if you want resear= ch funding to do work of a certain nature.
PC: You mentioned political iss= ues.
NW: Uh-huh.
PC: Representative Madigan =E2= =80=93
NW: Yes.
PC: =E2=80=94 was, I suspect, t= he largest supporter of this?
NW: Well, he was the primary sponsor,= which was somewhat unusual because we had had many other friends on the hi= ll who had helped us with trying to move this initiative forward that he fo= und himself in a reelection campaign, and he was facing a gender gap, = and he had very strong alliances with nursing in his home state. I believe = it was Indiana. And when he =E2=80=93 when, I guess, the American Nurses As= sociation health policy staff on the Hill worked with Madigan's staff, it b= ecame clear that he was somebody who would be willing to try to advance the= National =E2=80=93 it was the National Center at that time. And I think th= at, although people in nursing might have been surprised at that alliance, = I think we were very pleased that there was somebody who was willing to adv= ocate for a center or an institute.
PC: You did not expect that?
NW: I think that there wasn't a longs= tanding relationship between him and the people who were working on this is= sue in nursing, so it probably was a bit of a surprise, but I don't think i= t was =E2=80=93 I think everyone might have anticipated that Senator Kenned= y would have taken the lead on this, or Senator Inoway, both of whom had be= en very longstanding supporters of nursing and nursing research.
PC: But they didn't.
NW: For this particular, at this part= icular moment, it was Madigan who stepped up to do it.
PC: And somewhat to Jim Weingar= ten's surprise?
NW: Oh, I think probably everybody at= NIH was surprised [laughter] by this, but I'm sure Jim Weingarten more tha= n anyone.
PC: Because he didn't expect it= , even though people had been talking about it?
NW: Well, I think one could safely sa= y that the =E2=80=93 that the NIH administration, at the director level and= the institute director, would never have been thrilled by the thought of h= aving anybody on the Hill create or elaborate more of an institute structur= e. They would have seen that coming out of their own recommendations. So th= ey would have been telling people on the Hill what they wanted, and they wo= uld have probably hoped that what would happen is that the funding would be= supplied to create the funding for the institute structure that the NIH di= rectors would have wanted to have seen put in place for the institute direc= tors, as opposed to having the, having the community outside NIH =E2=80=93 = I mean what was probably really unique about this is to have a group of sta= keholders across the country be able to stimulate a groundswell of support = for this. That caught the attention of people on the Hill.
PC: And that's lobbying through= the ANA or =E2=80=93
NW: Well, not just the ANA. What had = actually happened was we had created a network across the U.S. with nurses = Ada Sue Henshaw and her leadership =E2=80=93 Joanne Stevenson and I were wo= rking with the Executive Branch. We were working with the NIH institute dir= ectors and the director =E2=80=93 people in the director's office. And Ada = Sue and a group working with her was actually focusing on seeing if th= ey could create a legislative network around the country that would be able= to take the initiative to rally support within the state. So we had a very= elaborate telephone tree at that time. And again, remembering there was no= Internet, and you couldn't get things done quickly, except by phone. So we= had organized a rather elaborate telephone tree of nurses in each of the s= tates who was willing to give some time and support and advocacy for this i= ssue.
PC: And that was through the AM= A, or Tri-Council or =E2=80=93
NW: It was the American Nurses Associ= ation at that time.
PC: Okay.
NW: This was before the Tri-Council d= ays.
PC: Ah, okay. And once it was e= stablished in 1986, did you still stay involved with that and the appointme= nt of Doris Merit?
NW: I was not directly involved in th= at as much as I was involved fairly early on as a member of the National Ad= visory Council for Nursing Research, and came on board, I think within a fe= w years. I don't remember if I was on the very first council. I think I mig= ht have come on during the second few years of the life of the institute or= of the center.
PC: That would have been 1986 = =E2=80=93 was it after Merit left?
NW: I came on after Ada Sue Henshaw w= as named the first permanent director.
PC: Okay.
NW: And by that time, there had been = some work with the PEP panels, the Priority Expert Panels, to set what the = agenda should be for nursing research in the country, and we had identified= several areas of study that were seen as very high priority, so one I reme= mber very well was focusing on pre-term infants or pre-term birth. Another = focused on HIV/AIDS, and there were a couple of rounds of the priority sett= ing that involved creating very thoughtful position papers on work that nee= ded to be done in fleshing out what a research agenda in those areas would = look like.
PC: And then they would then ta= rget these for funding through NINR?
NW: Yes, yes. Eventually then what ha= ppened was the National Institute for Nursing Research would publish a set = of requests for applications for research proposals that would be responsiv= e to these areas of priority.
PC: And in a large =E2=80=93 we= ll, I hate to use the word bureaucracy =E2=80=93
NW: [Laughter]. It is.
PC: It's always the people who = are more interesting.
NW: Yeah.
PC: Could you give me some char= acter snapshots of the people that you thought were important in driving fo= rces behind all of this?
NW: Oh, goodness. Yes. Well, probably= , going back in history, there were =E2=80=93 there were a number. And the = person who was really the engine behind positioning this cabinet to do some= of the really important work was Carolyn Williams. She was the chair of th= e ANA Cabinet on Nursing Research back in the very early 80's when I became= involved with it. And I think it was her very thoughtful leadership and he= r very strategic thinking about deploying us in small sub-communities to ad= dress how we moved policy ahead on the hill, but at the same time making su= re that NIH knew that we existed, and that we were going to be trying to ar= ticulate the need for nursing research and funding for nursing research. Ca= rolyn got us deployed to the NIH as well as the Hill. Carolyn was also prob= ably one of the people who would've been on the IOM committee to look at th= e need for nursing research, and I suspect Ada Jay Cox before Carolyn's lea= dership with the same ANA Cabinet for Nursing Research. I didn't work direc= tly with Ada, but I have heard that she was quite involved in leading the c= abinet before I became a member.
PC: When you say the cabinet, e= xplain to me exactly what the cabinet is.
NW: That was the committee out of ANA= that I served on. The Cabinet on Nursing Research was basically a committe= e that took on the responsibility for helping to envision a national center= for nursing research and to =E2=80=93 or eventually, a national institute = on nursing research, which was what we really wanted in the first place. An= d then it was this committee which ANA called a Cabinet on Nursing Research= . It's just ANA's term at that time.
PC: Okay. So cabinet is just a = word for the =E2=80=93 was it an ad hoc committee or just a regular committ= ee at the =E2=80=93
NW: At that time, it was part of the = government structure of the American Nurse's Association.
PC: Okay. Uh-huh.
NW: So we were the group that was cha= rged with looking at nursing research for the country, and sort of envision= ing what we needed, and at the same time, proposing the kind of resources t= hat we needed to get there.
PC: And this was =E2=80=93 the = cabinet was consisted of how many people?
NW: Oh, I'm thinking six to eight. So= Carolyn Williams, Ada Sue =E2=80=93 Boris Strickland was one of the people= who served on it, Joanne Stevenson and I, and I think =E2=80=93 though I'm= not sure,
Nola Pendra may have been one of the members of that cabinet, but I may = be =E2=80=93 I may be imagining some of these other folks who worked with m= e on other committees over the years. I'm sure about Ada Sue, I'm sure abou= t Carolyn Williams, Joanne Stevenson and myself, and I think Boris Strickla= nd was on that cabinet with us as well.
PC: I know Ada Sue is still ali= ve.
NW: Oh, yeah.
PC: And the others?
NW: I'm sure, I'm sure all the others= are.
PC: Okay.
NW: But that's a good question, given= our =E2=80=93 well, I guess we're not so old [laughter].
PC: No, no, you're not. You're = not. No, you're not [laughter].
NW: Well, we're all sort of 60's. I m= ean I was probably one of the younger people on that group at the time.
PC: I've talked to Jessie Scott= .
NW: Oh. Wow. [Laughter].
PC: That's when we're getting u= p there.
NW: Yeah. Oh, my gosh, yes. Jessie an= d =E2=80=93 I'm trying to remember the person who was the director of = HRSA at the Division of Nursing at that time. I think it was Jo-Eleanor&nbs= p;Elliott. I remember these people because there were a lot of people in th= e country who were not all that happy with us. [Laughter]. I do remember ha= ving a few tense meetings.
PC: With Elliott or Scott?
NW: Well, I think Jo-Eleanor was worr= ied that we would undermine HRSA in the Division of Nursing. And, of course= , none of us really wanted to do that. But what we did want is there to be = research support available to the National Institutes of Health for Nursing= Research, much as it was for any other kind of health sciences research at= the time.
PC: Now did =E2=80=93 it's Jo-E= leanor Elliott? Is that the way =E2=80=93
NW: Uh-huh. Yes.
PC: Okay. And did she take =E2= =80=93 well, Scott headed the division of nursing, but Scott told me she ha= d left by =E2=80=93 she retired by 1979.
NW: Yes. And so Jo-Eleanor Elliott wa= s the Director of the Division of Nursing at the time that we were working = on this.
PC: So she replaced Scott.
NW: She did.
PC: Okay. And so your meetings = were with her and trying to explain what you were doing, and not trying to = vulcanize the nursing profession.
NW: Yes, that's correct. And she actu= ally was, you know, she actually was friendly to the idea. I think she was = doing her job and expressing some concern that, you know, that there might = be an anticipated consequence for the division. And, you know, that was som= ething that we worried about also.
PC: Uh-huh. But it didn't happe= n.
NW: It didn't happen. In fact, the di= vision grew [laughter] and got =E2=80=93 they ended up getting more support= , probably because we were then able to make very clear what the contributi= ons are that, you know =E2=80=93 were that we were making, and so the divis= ion got funding to help support doctoral programs and nursing education. An= d that was a good thing.
PC: You mean the division did.<= /p>
NW: Yes.
PC: So they got the funding for= doctoral programs in nursing education.
NW: Yes. They funded what are called = training grants, which were grants that were given out to universities to h= elp their faculty develop Ph.D. programs.
PC: Okay. Did you know Doris Me= rit?
NW: I knew her a bit. In fact, I was = invited to give a lecture that's named for her at Indiana University last y= ear.
PC: Did she come?
NW: Oh, yes. Yes, she did. Yes, she w= as there.
PC: And had you known her befor= e when she first took over the national center?
NW: I got to know her briefly in that= role, and probably I would have known her a little bit better, but living = on the West Coast always makes it a bit harder for us since we have to = ;go all the way across the country to see people. And so I got to know her = just a bit, but not deeply.
PC: And was =E2=80=93 is she a = surprise in that appointment? What was the reaction?
NW: Oh, I think the initial reaction = was "What?" You know, "The first institute director is a physician." And my= response was "This is a wonderful gift to us because we have an experience= d and seasoned administrator for the institute who's an insider." And had t= he first institute director been an outsider to NIH, we would probably stil= l be writing the job descriptions 20 years later. You know, how important, = what a gift it was to have a seasoned scientific administrator from NIH ass= igned to be the first, the first director. That was a wonderful = thing for us.
PC: And that selection came abo= ut how? Do you know?
NW: Well, I'm sure that that was the = NIH director's prerogative.
PC: But here's a guy who didn't= really want the center there in the first place.
NW: Uh-huh.
PC: But was it an attitude of "= Well, I've got it. I've got to deal with it. I might as well do the best I = can with it rather than let it die"?
NW: I think that probably was the cas= e. And I think, by appointing somebody like Doris, you know, in the very be= st intentions, and I'm pretty certain it would have been Jim Weingarten who= would have appointed her, he made an appointment of somebody who was going= to safeguard the quality of the science. So, you know, if this was going t= o be a weak institute with work that really didn't pass muster, he wouldn't= have had to see that happen on his watch as NIH director. And Doris had be= en tapped to do other work as a senior administrator within NIH before= she had =E2=80=93 she worked closely with Ruth Kursteen, who is, I think, = maybe still at NIH.
PC: Yes.
NW: A very, very senior, very seasone= d person. And she and Ruth actually worked together on writing the fi= rst task force report on women's health for the entire public health servic= e years before there was an Office of Women's Health Research. So here was = somebody who was not only sensitive to the needs and issues of research and= research training, and who could certainly be entrusted with developing th= is new institute. But here was somebody who had an unassailable reputation = as far as her work with =E2=80=93 on behalf of women and women's health. An= d I think that there was some wisdom in that assignment with respect to wor= king with this group of largely women researchers.
PC: And how did you break that = down? I mean I suspect you don't want to be caught in that all the time jus= t as a single-gender nursing issue, do you?
NW: No, no. Not at all.
PC: And how did that get broken= down, or did the funding priorities tend to break it down?
NW: I'm not sure I understand your qu= estion. Can you try me one more time?
PC: Well, I just wondered if yo= u were trying to get away from seeing nursing as a gender-oriented, you kno= w, for women =E2=80=93
NW: Uh-huh.
PC: And as a more, you know, th= e broader professional issues, did the priorities set by the advisory counc= il try to do that, or was it =E2=80=93 and also, with the education program= s? Did they attract more men into nursing at a higher level?
NW: I don't know that gender was much= of an issue around the time of the establishment of the institute. But if = you're asking was it sort of a closed shop for men, oh, no. It has never be= en.
PC: No, I knew that. I just =E2= =80=93
NW: But I guess I don't know how to a= nswer your question really, as much as to say given that the dominant membe= rship in the discipline with women, and nursing has for all of our history = a dominant =E2=80=93 predominantly a woman's discipline, that selection of = Doris, who had the sensitivity to some of the challenges that women faced i= n science and in the health sciences in particular, and also in the health = professions, that that choice was probably a really smart one.
PC: Let me go back. You mention= ed some of these people =E2=80=93 for example, could you describe Nola Pend= ra for me? Just character and description.
NW: Nola's work had been focused on h= ealth promotion and prevention, and she had worked very hard to create a re= search agenda around =E2=80=93 instead of managing disease and illness, had= worked very hard on trying to help develop a research agenda and her own r= esearch around promoting health.
PC: You mean wellness?
NW: I'm sorry?
PC: Wellness? When you say =E2= =80=93
NW: Yes, yes.
PC: =E2=80=94 promoting health?=
NW: Health and wellness.
PC: Uh-huh. And how would you d= escribe yourself in that regard?
NW: My =E2=80=93 most of what I have = done has focused on women's health. I actually started out my career focusi= ng on more traditional in-patient care issues. My master's thesis was focus= ed on sleep problems that patients had in critical care units after they ha= d had open heart surgery. And I was headed to continue that work, but as it= happened, I ended up taking care of somebody with a really serious head in= jury who had been almost beaten to death by her husband, and discovered dom= estic violence as a problem. And then sort of from there got involved in a = couple of other projects with women, and sort of stood back and realized th= at we didn't really have much in the way of formal understanding of a uniqu= e need of women in the health care system. Now we probably didn't have a go= od understanding for men either, but you know, it was a period in history w= here there wasn't much understanding of women aside from obstetrics and iss= ues around birthing.
So I really got caught up in thinking about why is heart disease differe= nt for women than men? You know, why does our health care system not have b= etter ways of interfacing with social services around domestic violence? Wh= y do we have treatments for breast cancer that are quite ineffective? This = was back in the 70's. And really found myself getting more engaged there.= p>
PC: And has this carried throug= h in what NINR has been doing more and more in these areas as well?
NW: To some extent, yes. I think you = know we had the first NINR funded =E2=80=93 one of the first NINR-funded ce= nters for research in the country, and we had the first NIH-funded center f= or women's health research in the country, which NINR actually supported ba= ck in 1989, which was before there was even an Office of Women's Health Res= earch at NIH.
PC: But that wasn't a formal = =E2=80=93 I wouldn't say women's health was ever a formal priority for NINR= .
PC: But it did fill a gap that = nobody else was doing.
NW: Yes.
PC: Are there other issues that= you think are important that I have omitted?
NW: You know, at the moment, this has= been like a trip down memory lane for me, and I would have to think about = that some more.
PC: Okay.
NW: You really started me on a trip t= hinking about things that I worked on a very long time ago. I guess it isn'= t that long ago, but it sure feels like it.
PC: A lot of changes since then= .
NW: Yes. Yeah.
PC: In the profession, and beca= use of what happened then. I think a final question would be how would you = evaluate those probably five, or maybe a decade of ferment in the professio= n? Let's say 1978 to '88.
NW: Yeah. Oh, yes. Well, I would say = it was a transformative kind of change in that had we never created the pol= icy change that created the institute, there would be a lot missing from th= e fabric of health research in this country, and it would be largely the in= tegrative approach to health. So looking beyond just a biomedical approach = to caring for people and understanding their health problems, it would have= been =E2=80=93 there would be some areas of research that probably would n= ot have had the liftoff it has had. So some of the work on end-of-life care= that's even being done now in other disciplines probably would not have go= tten such a strong start: the work with low birth weight infants, some of t= he work on HIV/AIDS where there was fast uptake, probably faster than we sa= w in the biomedical world, the work on symptom management, pain management,= management of other symptoms, much of that came out of nursing.
PC: Okay.
NW: So if you follow the intellectual= roots back in time =E2=80=93
PC: Yeah. I knew someone at NIH= who was in pain management, but I never knew what institute she was with. = I just never asked her. I will the next time I see her.
NW: Yeah.
PC: And was this =E2=80=93 well= , you called it a transformation or evolution or revolution, whatever, led = by mostly younger people?
NW: I'm trying to remember if I was e= ver really a younger person.
PC: [Laughter]. Twenty years ag= o, you were much younger, 20 years younger.
NW: Yeah. That's true.
PC: Or 30 =E2=80=93
NW: In my early 40's, yeah.
PC: Or 30 years ago, yeah.
NW: Well, actually, looking back on i= t, I think there was =E2=80=93 probably the generation was different than t= he age. We were all of =E2=80=93 the first generation of nurses who got doc= toral preparation did it in education because that was open to people in nu= rsing, it was accessible to women, and I'm of the second generation. We got= =E2=80=93 we studied for a doctorate in a related skill, so I'm of a gener= ation that got doctoral education in physiology, sociology, psychology. My = degree is in epidemiology. So we were an inherently interdisciplinary group= . We went off and studied in all these other fields, and then came back and= worked in nursing. And I thin it was that =E2=80=93 we got really solid re= search training. And I think we were in a better position to lead this beca= use of that.
PC: Interesting. And that =E2= =80=93
NW: And then, of course, there's this= next generation which is educated within our discipline, so their view of = the world is a little different than ours, as it should be.
PC: And this group that you had= talked about on the advisory council, Stevenson and Henshaw and you and Pe= ndra =E2=80=93 go back and lose a name, I know it began with S, but Strickl= and, all came out of that, and Carolyn Williams all came out of that Ph.D. = group.
NW: Yes.
PC: And they were all in =E2=80= =93 they got it in =E2=80=93 well, what did we say? Interdisciplinary field= s, but not nursing itself.
NW: Uh-huh.
PC: And I suppose Jan Heinrich = would be in the same crew.
NW: Yes. Jan had a doctorate in publi= c health.
PC: Yeah. So that's =E2=80=93 b= ut that's not an educational thing, but it would be interdisciplinary?
NW: Well, I think the critical featur= e was not only the interdisciplinary, though that was certainly part of it,= but it was a strong education of scientists.
PC: Okay. Uh-huh.
NW: And so because we had that, we co= uld see the need, and we could articulate what that need was.
PC: Does that also mean the lea= dership in the ANA was changing as well?
NW: Probably, though I think that may= have been =E2=80=93 you know, there at least was tolerance for what we wer= e doing.
PC: Uh-huh.
NW: You know, I don't know that I rem= ember clearly enough who was behind what we were trying to achieve with NIN= R at that time from ANA, but at the very least, people were not obstructing= it.
PC: Sometimes that's the most p= ositive response you can get.
NW: Yeah, yeah. And we probably could= not have hoped that things would have been better, you know, than just not= getting in the way.
PC: Well, I want to thank you v= ery, very much.
NW: Oh, you're welcome.
PC: I've enjoyed the conversati= on, and want to take advantage of following-up with you, if I may, when I h= ave additional questions.
NW: Sure. Sure. I would be very happy to talk with you = more. And you really, as I said, you sort of have led me on a trip down mem= ory lane, so I'm going to have to think a little bit more about some of the= questions you asked me and se what I can reconstruct.
PC: Well, I'll give you a buzz = sometime in a month or so.
NW: I'd like that.
PC: Okay, great. Thank you very= much.
NW: Oh, you're welcome. I'm looking f= orward to reading what you =E2=80=93 what you write.
PC: So am I [laughter].
NW: [Laughter]. I understand that.
PC: Thanks again.
NW: You're welcome.
PC: Bye-bye.
NW: Bye.
[End of Interview]