Adams, Jeffrey M. PhD, RN
ADAMS: Dr Havens, I really appreciate you speaking with me today. Can I start by asking you to share a little about yourself and especially your research trajectory?
HAVENS: I am very appreciative of this opportunity to speak with you and the JONA readers. I can say, I’ve always been interested in promoting good nursing practice and patient care. I was influenced by the work of pioneers in our field whose wisdom I admired: Joyce Clifford, Myrtle Aydelotte, Linda Aiken, and Ada Jacox. Early on, I was drawn to literature focusing on sociology of the professions, professional nursing practice, and organizational studies. This helped me to craft what remains my passion today—studying and enhancing professional nursing practice environments. Over the years, my work evolved from describing and measuring the features of professional nursing practice to working with nurse administrators and staff to create, develop, and foster quality environments for care. This approach has merged the methods of participatory action research and implementation science.
ADAMS: To that end, nursing administration, leadership, and work environment research are not very well funded through traditional research mechanisms. How have you crafted a career in this work and set up longstanding relationships?
HAVENS: You are correct. Unfortunately, this type of work doesn’t seem to be on the National Institute of Nursing Research/National Institute of Health’s radar. The Health Resource and Services Administration (HRSA) division of nursing has issued calls for proposals promoting nurse retention and quality care framed by the literature on professional nursing practice. This presented an opportunity to shape 2 successful proposals over a period of 10 years that built on my earlier work. Through these 2 projects, we were able to collaborate with 11 hospitals to enhance staff nurse decisional involvement and improve communication and collaboration. I recently submitted another proposal to HRSA that involves partnering with hospital teams to implement nurse-led interprofessional collaborative practice, a proposal that grew from what we learned from these first 2 projects.
ADAMS: HRSA is not a traditional “research” funding mechanism. How does that work?
HAVENS: I wouldn’t minimize the contribution of HRSA to the broader body of knowledge. HRSA aims to improve equity through optimization of access to quality care, the workforce, and innovative programs. My interests align very well, and most if not all HRSA funding requires a robust evaluation component. We’ve approached our HRSA programs both to advance the body of knowledge as well as improve the practice environment and patient outcomes.
ADAMS: How might the practitioner/administrator/executive readers of JONA access a researcher like you to collaborate? How did those 11 hospital relationships come to be?
HAVENS: Initially, I contacted the nurse executive at each of the hospitals. We recruited organizations based on state nurse workforce data, identification of those that had an appetite for change, and hospital leadership support to engage in our projects. But I have to say, I think that there is a natural skepticism about researchers. For the 1st project, we worked with the hospital association in the state in which our hospitals were located. We had an established bond with this person who communicates regularly with nurse execs throughout the state. She created an entrée for us, helping to establish our credibility. I believe that, as a researcher, you need to earn the trust of those that you are working with. It is crucial to do more than talk about partnership—both sides need to truly enact it. For instance, from the beginning, we drew the nurse leaders in to talk about the project, to find out what would work for them, and establish their needs. It was clear that the hospitals that joined were our partners and not mere research subjects. We had opportunities to learn a lot from each other. From these experiences, I learned the true meaning of and the powerful potential for partnership with practice. A lesson that became apparent was that it was not about “doing to” it was about “doing with.” That approach really was key to enhancing the practice environments in those organizations. Two partner hospitals gained enough confidence to pursue the American Nurses Credentialing Center’s (ANCC) Pathway to Excellence® status; a couple more are currently working on this designation and 1 is on the Magnet® journey. These outcomes were possible because the projects helped the hospital teams to build capacity and become empowered.
ADAMS: Speaking of ANCC, I know you are also very involved in the work of the professional roles outside of UNC, serving as a member of the ANCC Magnet Commission, the chairperson of the AONE Foundation Research committee, and as the chair-elect of the American Academy of Nursing’s (Academy) Building Health Care System Excellence Expert Panel. Can you talk a little bit about this work and why those roles are important to you, how other nurse leaders could serve in similar type of roles, and why they should?
HAVENS: Involvement, for me, presents opportunities to use research findings to influence policy, nursing’s future, and meet colleagues. I have set my professional goal as “shaping systems to promote desired outcomes.” Participation in these professional leadership roles presents avenues to contribute my voice to help shape systems to promote desired outcomes. Professional organizations are eager to have members become involved.
ADAMS: I couldn’t help but notice the tagline on your e-mail is “spiraling upward for nurse retention and quality care.” Can you talk a little bit about spiraling upward?
HAVENS: “Spiraling Upward for Nurse Retention and Quality Care” is the name of our 2nd HRSA-funded study. We made the deliberate decision to focus on positive perspectives, for example, exploring nurse work engagement as opposed to burnout. This purposeful focus emerges from my growing interest in the discipline of Positive Organizational Scholarship, which is about focusing on what’s right, not only looking for what’s wrong. We framed our project strategies according to the positive organizational perspective. We don’t look for the source of problems, we look for the source of success—those things that an organization can identify that they do well, that might serve as a foundation for change. We’ve published on this subject in both JONA1 and AONE’s Nurse Leader.2 It has been pretty fulfilling to help our partner hospitals to spiral upward.
ADAMS: In addition to Spiraling Upward, you also have done quite a bit with the concept of decisional involvement and have developed the Decisional Involvement Scale (DIS).3 What is DIS?
HAVENS: The DIS was developed as part of my dissertation, which was a study of the implementation of features of professional nursing practice. A few years after completing the dissertation, I discovered that many people were using the DIS to gauge levels of staff nurse decisional involvement, plan for implementing shared governance, and evaluate shared governance. DIS has been adapted for use in ambulatory care and translated for use in at least 8 countries.
ADAMS: Your implementation-based research differs from how many think of nursing/health services research. You’re seeing what direct care nurses and nurse leaders at the frontlines are doing. Can you speak about how this works with your students and impacts your perspective?
HAVENS: Undoubtedly, these experiences have given me and the students who’ve worked with me valuable insights into real-world day-to-day issues faced by nurse leaders. These experiences have provided opportunities to use research and theory to impact the problems that the leaders and the staff are facing on a daily basis.
ADAMS: How do you think we can infuse systems thinking into nursing and prepare the next generation of nurses to advance the profession?
HAVENS: There are several foci that I would like to be addressed in programs preparing healthcare leaders. We need to have the right people teaching this content. Faculty need to be grounded in research and practice. I encourage the use of educational modalities that foster real-world systems oriented experiences, learning, and critical thinking. I would encourage paradigm change to emphasize positive organizational scholarship and interprofessional education for courses at the graduate level to challenge traditional mechanisms and contribute to the future of nursing and healthcare. I believe we can do a better job in educating and mentoring nurses. The American Academy of Nursing (AAN) Expert Panel on Building Healthcare Systems of Excellence has discussed that all professional nurses in all nursing roles should be leaders and what will make this happen. All nurses, both today and into the future, need to learn to be effective, influential leaders. I hope that we can help them develop the confidence to use their voices to share the right messages in powerful ways.
ADAMS: Can you share an experience that has helped mold your current insights on nursing leadership?
There have been many. I had the opportunity to study with Dr Linda Aiken for a few years and she taught me the importance of telling the right stories, in powerful ways, to the correct audience. For this reason, I continuously strive to improve this skill personally and help others to foster this capacity. Through partnerships and collaboration with good leaders, I have gained valuable insights that influence my personal leadership goals and behaviors. Finally, I had the wonderful opportunity to spend much of last year on sabbatical as a visiting professor at the Florence Nightingale School of Nursing and Midwifery at King’s College, London. During that time, I met with executives from professional nursing organizations such as the Royal College of Nursing and nurse executives and direct care nurses from most London hospitals. I came away with the understanding that, globally, we face similar issues and have common aspirations for nursing education and practice. Universally, there is an interest in developing capacity to shape research-based practice environments.
ADAMS: Dr Havens, thank you so much for speaking with us today. I hope we can all spiral upward.
HAVENS: Jeff, it has been my pleasure. Thank you to you and JONA for the opportunity to share.