Say "nursing science" to many nurses and they'll roll their eyes, remembering the seemingly useless theory and research courses they've sat through. And it's true: Theory and research have too often been irrelevant to the daily practice of nurses. So who, other than researchers and academics, should care about the state of our science?
In September in Washington, DC, the State of the Science Congress provided reasons for every nurse to care. In a superb presentation, University of Pennsylvania professor and nurse researcher Linda Aiken argued that nursing's influence on patient outcomes has been neglected by researchers. Aiken pointed out that although researchers have sought to explain the documented relationship between high volume of cases or procedures and lower mortality rates for hospitals, none have looked to nursing care as a variable.
It's almost laughable-outstanding research that ignores nursing care as a factor in outcomes. Unfortunately, nurses who've been affected by reengineering and the downsizing of nursing departments aren't laughing, and neither are their patients. Consultants have received exorbitant fees to advise hospitals on how to reduce expenses and boost income. They were smart to propose cutting nursing budgets, which would result in the quickest short-term financial gains. If asked for data, the consultants could always argue that there was no evidence that a professional nursing staff was cost effective.
But no more. Nurse researchers are putting nursing back into the equation. Aiken has undertaken a series of studies examining hospital organization of AIDS care (designated units versus scattered AIDS beds), as well as AIDS care in magnet hospitals-facilities that have no difficulty recruiting and retaining nurses because of their commitment to such things as primary nursing, autonomy, and control of nursing practice. She found that magnet hospitals have a 60% decrease in mortality rates as compared with non-magnet hospitals, even though the volume of patients with certain diagnoses or procedures may be lower in magnet hospitals. She also found that adding just one registered nurse per patient day results in a more than 50% decreased chance of death for a patient with AIDS.
Aiken has also begun to include in her research a variable referred to as "failure rate," or deaths from complications. When too few nurses are available to monitor patients, complications are less likely to be detected early enough to prevent death. Aiken believes that this failure rate reveals the role nurses play as the hospital's surveillance system.
She's one of several nurse researchers examining nursing as the intervention. Her work has been published in leading medical and nursing journals and presented at national and international multidisciplinary research conferences. Aiken's visibility could have enormous influence on researchers who are beginning to consider nursing care as a variable in studying health care outcomes.
There is power in this kind of research. Aiken can now obtain data on Pennsylvania hospitals from public databases, and she can go directly to nurses for their perceptions on how much, or how little, their hospitals are supporting progressive nursing practice. She no longer needs the hospitals' approval to collect her data, and word has it that there are some very nervous hospitals in Pennsylvania. Imagine how the public might react if her research reveals that hospitals don't support autonomous, professional nursing practice, or that inadequate professional nurse staffing is associated with poor patient outcomes.
The State of the Science Congress illustrated that our science is indeed improving. Other nurses at the conference presented research on fatigue, nausea, pain, pressure ulcers, medication management, stress, relaxation, incontinence, depression, and other clinical topics. The work of these nurses is impressive. But we're not there yet. Research makes no difference if its results don't reach clinicians.
AJN enters the new millennium-and our 100th-anniversary year-as the bridge between research and practice. We will move nursing science forward by keeping readers informed of important research findings that can change the care we deliver and how we deliver it. This includes findings on the impact nurses have on the outcomes of care; armed with such data, nurses will be better equipped to discuss how to cut costs and improve care. In January, the journal will have a new look and a new attitude, and we'll introduce some new departments and features throughout the year that will reflect our belief that the art and science of nursing are intertwined.
AJN is committed to demonstrating that we care about the state of nursing science. Because if nurses don't, who will?