The Value of Small Beginnings

Meneses, Karen PhD, RN, FAAN

doi: 10.1097/NCC.0b013e3182278709

Author Affiliation: Center for Nursing Research, School of Nursing, University of Alabama at Birmingham.

Correspondence: Karen Meneses, PhD, RN, FAAN, University of Alabama at Birmingham, 1530 3rd Ave S, Birmingham, AL 35294 (

The author has no funding or conflicts of interest to disclose.

The first grant that I received was to better understand how young cancer survivors made decisions to become pregnant after treatment. The year was 1989. The Office of Cancer Survivorship at the National Cancer Institute in the United States had not yet been established. The term cancer survivor was yet to be part of our collective vernacular. The amount of funding was $1000, and I was thrilled. The thousand dollars felt more like a million dollar award. Surely, I thought, this is what it was like to strike gold.

In the intervening 2 decades, I have received sustained funding, both large and small, to support our research team's work in cancer survivorship. But I still hold dear what it felt like to receive my first small award, and what the value of small beginnings meant to me, and I try to convey the value of these insights to others.

I have worked with young and eager doctoral students who are anxious to seek any amount of funding to support their work. I have also mentored some faculty who are less eager about small funds. They scoff at securing initial pilot funds. "What can you do with such a little amount of money?" they ask. "I want the big bucks," they say. Next, they get that dreamy faraway look in their eyes, seeing 1 letter and 2 numbers (read: R01) twinkling after their names.

I understand the big picture and where they want to go. I sit back and think the phrase, "haste makes waste," has not yet become a learned strategy. In the haste to get large funding, they waste time in overlooking the value of small funds. They do not connect how small funds can lead to a meaningful difference in their patients' and families' lives. So when they are ready to listen after a less than successful grant submission, we start with the value of small beginnings.

The steps in small beginnings are not embedded in rocket science; they are the basics. We carefully construct a pilot project to address the questions that will lead to the next step. We carry out the small pilot in a small amount of time with a small number of research questions. We focus on the "answerable questions." Most importantly, we keep our eyes on the horizon to where we are going. We take the lessons learned from pilot results to move to the next vital question, which, in turn, will move them to the next level. The focus is not on the funding, per se, but on the learning and understanding of the outcome. Small funding with good results can beget larger funding. Larger funding can bring its share of challenges.

Today, the word sustainable takes on even greater meaning. Maintaining sustained external support is increasingly difficult given that funding levels are being cut, and the available funding mechanisms are being reduced. And, with more researchers seeking small pilots, the value of small beginnings takes on larger significance.

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