THE EMPHASIS on evidence-based practice (EBP) in the past 2 decades and the introduction of the doctor of nursing practice (DNP) has elevated opportunities to participate in scholarship for clinical nursing staff. As a result, now more than ever, practicing nurses are making the connection between research and improved clinical outcomes. Moreover, nurses who are educated about EBP recognize the lack of evidence for many nursing practices and their potential role in generating and investigating essential research questions and creating new knowledge to build the evidence to support nursing practice. To retain nurses equipped with EBP knowledge and achieve top-tier clinical outcomes, health care organizations must provide a culture that inspires continuous reflection and improvement in nursing practice with opportunities to showcase and build nursing science internally and externally.
As nursing science has evolved in tandem with increased overall education of the nursing workforce, nurses and nurse leaders in the practice setting recognize the value of employing PhD-prepared nurse scientists in the practice setting. Several trends/initiatives/events have driven increased interest in employing PhD-prepared nurse scientists: (1) Magnet recognition program, (2) Institute of Medicine's call for increasing doctorally prepared nurses, (3) burgeoning academic-practice partnerships, and (4) an overall higher level of education among clinical nursing staff including increasing numbers of baccalaureate, masters, and doctor of clinical nursing practice (DNP)-prepared nurses.1,2 The nurse scientist, embedded in the hospital organization, can collaborate with the clinical staff to facilitate the identification of crucial practice-generated research questions that align with the organization's strategic priorities.3 As the nursing workforce struggles to recover from the COVID-19 pandemic, more than ever, hospital-based nurse scientists (HBNSs) have the opportunity to collaborate with nurse leaders to explore and test innovative nursing care delivery systems. Furthermore, nurse leaders and nurse scientists working as a dyad must be at the national forefront of discussions to address the Institute of Medicine's Quintuple Aims: improving patient experience, improving the health of populations, reducing health care costs, promoting the clinician's well-being, and advancing health equity.4 The purpose of this article is to provide practical recommendations for nurse leaders to introduce an HBNS into an organization as an essential building block to reduce the “research to practice gap” and elevate nursing science for practicing clinicians.
DATA AND EVIDENCE REGARDING THE HOSPITAL-BASED NURSE SCIENTIST ROLE
The most recent tracking data of doctorally prepared nurses from the 2020 National Nursing Workforce Survey (inclusive of all doctorate education) demonstrated that only 2.2% (PhD comprising 0.7%, DNP comprising 1.4%, and other doctoral degrees comprising 0.1%) of the registered nurses (RNs) in the United States obtained a doctorate-level education.5 The American Association of Colleges of Nursing (AACN) reported that, among the 733 PhD graduates in 2021, only 9.3% anticipated working in either hospital nursing service research or a clinical position.6 Thus, the pool of nurse scientists pursuing careers in clinical practice remains relatively low, despite increasing opportunities for employment of PhD-prepared nurses in clinical settings.
Literature addressing the role of the HBNS dates to the 1980s.1,7,8 Briefly, the role of the HBNS includes shaping the culture of inquiry for an organization, facilitating research and conducting independent research, enacting key processes and activities (mentoring, professional development, supporting the Magnet recognition program, and interdisciplinary collaboration), and providing structural support (clinical-academic connection). HBNS activities vary depending upon the maturity of the health care organization, designation of Magnet status, and presence of an academic-clinical partnership.1 However, the 20 studies in a scoping review indicate that the HBNS's primary role responsibilities are active leadership, mentorship, and research productivity.1
IMPLEMENTATION SCIENCE AND THE HOSPITAL-BASED NURSE SCIENTIST
The AACN made a call to action for nurse scientists to pioneer innovation in system redesign, EBP, informatics and technology, competency-based education, learning technologies, public policy, and academic-practice partnerships.9 Additionally, HBNSs have a burgeoning opportunity to be leaders in advancing implementation science in their organizations. Implementation science helps people address common barriers to change using a systematic approach to evaluate the adoption and uptake of evidence into practice,10 including rigorous testing and evaluation of implementation strategies and equity.11
Because HBNSs understand contextual barriers in practice, they can facilitate buy-in and serve as opinion leaders to support implementation.12 Implementation science may be most successful in nursing when a nurse scientist collaborates with a DNP-prepared nurse to blend their knowledge and skills, and these partnerships can generate knowledge about implementation science and provide skilled expertise for knowledge application in clinical settings.13 Supporting opportunities for EBP/research teams and other multidisciplinary colleagues to attend training workshops and webinars can help build implementation science capacity within the organization.14 Armed with implementation science knowledge, the HBNS can mentor staff to address common barriers to practice changes using a systematic approach to adopt new evidence into practice.10 This approach will support the organization's earlier investments in nursing research and EBP, reducing the “research to practice gap.”
LEADERSHIP SCIENCE AND THE HOSPITAL-BASED NURSE SCIENTIST
The COVID-19 pandemic has illuminated many nursing workforce challenges, particularly those related to disaster preparedness. With significant workforce shortages and financial challenges, nurse leaders are being called upon to continue delivering high-quality patient outcomes with fewer resources. These leadership challenges provide opportunities for HBNSs and nurse leaders to collaborate and advance nursing leadership science. Nursing leadership science provides nursing leaders with the empirical evidence to make decisions related to nursing care services and the delivery of quality outcomes across all health care settings.15 The American Organization of Nursing Leadership (AONL) and the Association for Leadership Science in Nursing (ALSN) identified priority areas for nursing leadership science through an AONL-ALSN Delphi study, which include: “1) nurses' health, well-being, resiliency, and safety in the workplace; 2) developing and managing a nursing workforce to meet current and future healthcare needs; 3) healthy work/practice environments for direct care nurses; 4) healthy work/practice environments for nurse leaders; 5) quantification of nursing's value across the healthcare delivery system, and 6) nurse leader development and essential competencies.”16(p436)
RECRUITMENT OF HOSPITAL-BASED NURSE SCIENTISTS
The HBNS is a complex role and differs significantly from the traditional academic PhD pathway. Most PhD programs prepare nurse scientists for an academic research career focused on a specific research program, securing federal research funding, and obtaining tenure. Moreover, many PhD programs do not include curriculum or real-world opportunities to explore alternative PhD career paths. As a result, many PhD students are neither exposed to/nor well informed about opportunities outside of the academic setting, making recruitment of HBNS a challenging endeavor.
Before recruiting an HBNS, the organization must create a job description that is very specific and outlines responsibilities. A scoping review found that role expectations (ie, authoritative directives) of clinically based nurse scientists are not well described.1 The organization's leadership must consider whether the nurse scientist will serve and lead the enterprise in EBP, or exclusively focus on research. A scoping review found that most clinical nurse scientists (15 out of 20 articles) were involved in and leading EBP or quality improvement science projects.1
Once the decision has been made to hire an HBNS, it is crucial to have a recruitment plan in place. The current workforce market among PhD-prepared nurses will likely determine the recruitment strategy. For organizations closely aligned with colleges of nursing (CON), a cost-effective approach is to explore within the CON if potential graduating students and current or retiring faculty are interested in the position. If local talent is not available, advertising on the job board of a professional organization is an option. Social media avenues have also been shown to be an effective nursing recruitment strategy.17 Alternatively, a more costly approach is to hire a health care recruitment firm.
Attracting and hiring the right candidate is critical. This individual will shape the culture of clinical inquiry and scholarship, leading and driving efforts to close the gap between knowledge and practice. Given the complexity of the position and the many different types of nursing and interprofessional staff that the nurse scientist must work and interact with, it is worthwhile to form a search committee that includes potential stakeholders such as staff RNs, advance practice RNs, nurse leaders, Magnet directors, faculty from an affiliated CON, interprofessional colleagues, members of the administrative research infrastructure of the organization (eg, institutional review board administrators), and other interprofessional researchers to provide hiring input.
Organizations may consider recruiting an HBNS that maintains a clinical appointment. Clinician-scientists are health care professionals such as nurses, physicians, and physical and occupational therapists who are experts in both research and clinical practice.18 An HBNS may have maintained an active clinical practice and may not want to give up this piece of their professional trajectory. In this case, another approach for recruitment is to consider offering a shared clinical position between a select clinical specialty area and the department in which the nurse scientist reports. For example, the HBNS might maintain a 1-day week practice in a clinic as a nurse practitioner.
IDEAL CHARACTERISTICS FOR HOSPITAL-BASED NURSE SCIENTISTS
Identifying and selecting the ideal candidate can be challenging. Given the national shortage in the PhD-prepared nurse scientist talent pool, the organization must prioritize a priori the “hard and soft” qualifications of this individual. This position involves intensive interactions with frontline clinical practitioners; therefore, this candidate must have a solid clinical nursing background and speak “the language” of clinicians. They must also generate excitement and enthusiasm for nursing research.1 Ideal candidates should have a general broad-based knowledge of clinical practice and feel comfortable engaging with clinicians in all areas of clinical specialty, given the widespread reach across multiple clinical specialties that the role requires.
Leaders embedded in clinical operations are responsible for planning, conducting safe patient care, and maintaining data quality focused on quality and safety, patient care experience, risk, care delivery, informatics, business management, and data analytics.19 Nurse scientists can help connect research and clinical operations teams,19 so the HBNS must be knowledgeable regarding hospital operations, including strategic planning processes, budget planning, and compliance issues. In clinical research, the HBNS will extract data from numerous databases and organizational tracking systems use. Hence, familiarity with the electronic health record, hospital scorecards, and other common clinical and quality databases is beneficial.
The HBNS may be the only PhD-prepared nurse in the organization and thus must have a robust repertoire of research skills. Depending on the organization's affiliation with universities/colleges, they may have limited access to experts for consultation. Unlike the nurse scientist working in a traditional academic setting, the HBNS will write proposals and mentor staff in multiple clinical areas using various research design methodologies. The American Nurses Credentialing Center Research Council found that 96% of nursing research departments are engaged in research proposal writing.20 Thus, the HBNS must demonstrate competencies in various research design approaches.3 Additionally, many hospitals have limited budgets for statistical support, so the HBNS must also be competent with statistical computer software and data analysis.
Mentorship of clinical nurses is an ongoing component of the responsibility of the HBNS.1,3,21 Mentorship differs from formal teaching experience. The HBNS candidate should be able to distinguish and articulate these differences. Mentorship by the HBNS will occur in many different settings, such as one-on-one sessions with clinical nurses or while guiding a nursing research council. The HBNS should be sensitive to and seek out “mentoring moments.” Experiences with successful mentoring relationships will significantly benefit the transition to this new role. In addition to mentoring, the HBNS is often tasked with formal educational programs in classroom settings, fellowship programs aimed at developing EBP or research experts, leading grand rounds, and organizing internal and external conferences. Therefore, a track record of demonstrated success in developing and leading professional development programs is essential.
The HBNS must be at the pulse of current nursing and health care issues related to all aspects of the nursing profession, including but not limited to clinical innovations and workforce challenges. Involvement in nursing organizations at the national level is essential and provides the HBNS with an external network of HBNS colleagues and other nurse scientists. These connections allow the HBNS to engage in multisite studies and bring outside perspectives to the organization.
Perhaps the most challenging attributes to assess when recruiting an HBNS are the “softer” qualities such as communication style, personality, and temperament. The HBNS must effectively communicate in one-on-one, formal, informal group settings, and written communications. As a mentor and advisor throughout the lifecycle of a research project, the HBNS provides ongoing and iterative feedback. Failed projects are often the result of poor communication among the research team. Thus, the HBNS must communicate feedback and project direction with clarity in a straightforward, timely, and sensitive manner.
The ability to inspire and motivate frontline clinicians is critical to success in the HBNS role. Most nurse clinicians are not required by their job description to engage in research. Clinicians may feel intimidated to engage with a researcher voluntarily. Successful HBNSs are described as “approachable,” and the relationship between the HBNS and clinicians must be viewed as an equal and collaborative partnership. The HBNS must have the disposition necessary to create a milieu in which the staff members feel comfortable and excited to share their ideas.
THE ROLE OF THE HOSPITAL-BASED NURSE SCIENTIST ON THE NURSING EXECUTIVE TEAM
The reporting structure for the HBNS and position in the organization chart of the nursing team varies across health care systems. Some organizations elect to have a self-contained nursing research department, often led by one senior HBNS, and this senior HBNS reports to the chief nursing officer. These organizations generally have more than one HBNS employed and may include other research infrastructure-support personnel such as statisticians and research coordinators.21 In other organizations, the HBNS may be embedded in a nursing division such as a Center for Nursing Excellence. This division may include other clinical support nursing professionals such as the Magnet program director, nursing professional development specialists (nurse educators), quality improvement specialists, and EBP experts, and there is generally one senior leader who has oversight and reports to the chief nursing officer.
Hospital leadership must position the HBNS in a prominent role within the organizational chart, so colleagues respect the role of the HBNS as a senior nurse leader, well-read scholar, and advisor in contemporary nursing issues. Participation as a member of the senior leadership team provides the forum and synergy for other senior nurse leaders to engage with and utilize the expertise of the HBNS. The nurse executive team should feel comfortable asking the HBNS to explore a new area of interest/innovation resulting from discussions at leadership meetings. Moreover, because current and pressing nursing issues are often discussed at senior leadership meetings, the HBNS can identify current administrative and clinical challenges that may be worthy of further investigation and parlay these discussions into important leadership science research projects. As the number of DNP and PhD-prepared nurse executives increase, opportunities to build nursing leadership science and impact the emerging leadership challenges have increased exponentially.
MEASURING AND DEFINING OUTCOMES FOR THE HOSPITAL-BASED NURSE SCIENTIST
A clear trajectory for HBNS performance expectations and success requires planning. Nursing leaders may align HBNS performance expectations with their organization's strategic priorities, such as Magnet program expectations for EBP and research. For example, the 2023 Magnet manual requires (1) the organization to describe the infrastructure that supports nursing research and (2) have 2 completed nursing research studies and 1 ongoing study at the time of application submission. Additionally, the requirements include 2 examples of clinical nurses disseminating the study findings internally and 1 study externally.22
Outcome measures and metrics of the HBNS include quantifying the number of publications, presentations, and research.1,21,23 Specific to research, nurse leaders may be interested in the size and scope (multisite studies) of ongoing research projects and the number of clinical nurses involved in nursing research. Other metrics are productive and engaged research councils, formal and informal educational programming, the number of staff included in publications, interdisciplinary research collaborations, and overall visibility of nursing research within the institution. Institutions that provide more infrastructure support (editorial, statistical, and administrative support) have greater productivity in measurable outcomes (number of publications and completed studies).1 As organizations gain expertise in implementation science, nurse leaders may consider the sustainability of new practice initiatives generated from research as an outcome metric.
In the last 10 years, the number of PhD graduates in nursing ranged from 601 (in 2011) to 733 (in 2021)24 While the nursing profession has slowly increased the number of PhD-prepared nurse scientists in the last decade, there is also a nursing faculty shortage exacerbated by climbing faculty age and impending retirement.25 As the HBNSs age and retire, nurse leaders must consider succession planning for the HBNS, with fewer faculty to replace retirees.
Many hospitals support associate-prepared nurses to pursue the BSN by providing tuition reimbursement, scholarships, and schedule flexibility. Interestingly, it is rare for a hospital to provide financial support for a clinically based nurse to pursue a PhD. A nurse leader interested in succession planning may want to look inward at nurse “superstars” within the organization. Do any of these individuals possess the characteristics to become future nurse scientists? If so, the nurse leader may consider offering a competitive full-time scholarship for PhD studies, with an obligation to work for the organization for several years. The PhD student could conduct the dissertation within the organization, which is convenient and beneficial for the organization to support endeavors such as Magnet designation. The Mayo Clinic, as an example, has built interest in the HBNS through 2 programs: (1) the Clinical Nurse Scholar program provides selected clinical nurses release time to work with a nursing research mentor for up to 2 years and, (2) the Nurse Scholar Program provides selected nurses either enrolled in a PhD program or who have recently completed a PhD program mentorship with an internal HBNS.26
Nurse leaders who employ an HBNS can ask the scientist to develop a succession plan for nursing research at the organization. Because a PhD program takes at least 4 years to complete, nurse leaders must create a succession plan early. For example, a nurse leader can hire a PhD student on a contingent basis to work alongside the experienced HBNS, gaining valuable research skills and mentorship. Nurse leaders and the HBNS can recruit PhD students by explaining the benefits of the HBNS position, which may offer less pressure for federal grant funding and less stress associated with the academic tenure track career path. Additionally, nurse leaders may increase the likelihood of hiring a new PhD graduate by offering benefits such as administrative support, a research assistant for data collection or other delegable duties, and funding for statistical analysis. Savvy nurse leaders will provide the infrastructure to support research activities to retain a satisfied and productive HBNS.
Hallmark characteristics of hospitals with top-tier clinical outcomes and Magnet designation are a nursing workforce engaged in nursing scholarship with a commitment to EBP. Nursing leaders considering recruiting and hiring an HBNS must plan strategically given the shortage of PhD-prepared nurse scientists. The ideal HBNS will demonstrate a wide array of research and scholarship skills to facilitate the mentorship of staff. However, communication, mentorship, leadership skills, and an approachable demeanor are equally crucial to this role's success. HBNSs have advanced nursing science through tangible outcomes such as publications and presentations, and nursing leaders may also consider nursing engagement and satisfaction in research activities as measures of success. Nursing leaders are in a prime position to support the HBNS role by quantifying their value for nursing career advancement and retention. Moreover, creating HBNS-nurse leader research collaborations provides a powerful platform to address many of the emerging challenges brought on by the COVID-19 pandemic.
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