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.
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.”
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.”
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?
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.
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.
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.”
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.”