In-house nurse researcher
In this model, the nurse scientist is a direct employee of the healthcare institution. Organizational structures may vary depending on funding or need. Nurse scientist positions may be centralized, reporting directly to the institutional governance; decentralized, reporting as nursing staff; or may report to a specialty division, such as orthopedics or oncology. Personnel are selected due to their research expertise and experiences, as well as their fit with the institution's vision and mission.
The priority for the nurse scientist is to conduct a program of original research on a relevant clinical issue. Individuals functioning in this role are deftly positioned to meld clinical inquiry opportunities with clinical practice questions. Studies should be of significance to the home institution, but with findings that are generalizable beyond its borders. Collaboration with other scientists working in similar areas results in a body of knowledge used by professional organizations and policy institutes to ultimately change standards of practice. Examples of nursing research programs that have significantly changed practice include symptom management, transition planning, and family participation in care.
The nurse researcher often functions within a larger university-based multidisciplinary team. Although the work may not be very visible to nursing staff, opportunities are created to mentor selected nurses who are interested in the study, want to learn research skills, or are considering returning to graduate school. Additional roles for the in-house nurse scientist include helping build the institutions' infrastructure and leadership of applicable organizational clinical and research programs.
Evaluation metrics for nurse scientists working in this model focus on the quality of the research as measured by: 1) refereed articles published in respected journals; 2) professional presentations at local, national, and international meetings; 3) the type and amount of grant funding or other support; and 4) the researcher's influence in the broader scientific community. Although this last metric is less tangible, it's essential not only for the development of knowledge, but also the visibility of nursing within the organization.
In this common model, a formalized partnership between the healthcare institution and a university is created to promote collaboration on clinical inquiry and innovation activities. Although these arrangements are in place in many academic medical centers where there's a unified structure across nursing education and practice, they can also be established through memoranda of understanding or formal contractual arrangements. One or more faculty members commit a designated percentage of their work time to the agency. Faculty members are selected by having the necessary skill set and a willingness to assume this role.
Role functions for nurse scientists in this model often include conducting independent research, seeking external funding, facilitating nursing research committee goals, helping oversee compliance with regulatory research standards, and mentoring staff in developing the necessary skill sets needed to successfully engage in scholarly activities.12 Such activities may include conducting literature reviews, submitting conference abstracts, designing and implementing conference presentations, or conducting grant writing and publication workshops.
Other important role functions are those that help maintain the scientific integrity of an institution's clinical inquiry activities. These may include serving on the healthcare organization's nursing research committee or helping prepare institutional review board documents. In this role, nurse scientists are in an ideal position to champion EBP and research activities jointly conducted by agency staff and university students or faculty. They can also serve as a liaison for students and faculty who have their own research agendas, helping ensure that the focus of their activities is aligned with the organization's strategic agenda and advancing the mission of high-quality patient care.
For these positions to be successful over time, attention to the needs of both the academic and practice arenas must be considered. Evaluation metrics for nurse scientists working in this model are highly varied and determined by the objectives and scope of activities included in the partnership agreement. However, one metric must demonstrate that both the practice and academic institutions benefit from the arrangement to ensure long-term organizational commitment and role stability. This is essential because the impact of scholarly endeavors often takes years to be realized.
A consultant is a professional who provides expert advice on a specific topic. Nurse scientists in this model may be either internal to the organization or hired on a per project basis. This model differs from others in that the consultant's commitment is project and time specific. Internal consultants are personnel who have a percent of their effort tasked to specific clinical inquiry activities for a designated length of time. External consultants have a contractual agreement outside of the institution and are commonly individuals retired from academia or service with nursing research experience or faculty members working beyond their academic role.
The overarching benefit of this model is that consultants can be selected with the specific expertise required for a project. External consultants, however, may lack the organizational familiarity needed to help ensure the project's success. Evaluation metrics are directly derived from the scope and objectives of the prescribed tasks.
Advances in Internet and web-based conferencing allow knowledge uptake across distant sites. Remote knowledge uptake is particularly useful for consultants and nursing services of smaller community and rural hospitals not in close proximity to academic institutions. Less research-savvy nursing staff members can now have access to resources that would otherwise be unavailable.13 Despite the potential of distance learning approaches, nurse scientists' expertise may be difficult for organizations to harness in a meaningful way. Because they're out of sight for many staff members, they're also out of mind. A credibility gap may exist between the advice offered and current practice realities.
Designing a clinical inquiry program
When designing a robust clinical inquiry and innovation program and selecting nurse scientists, an organization's strategic initiatives must be considered. Depending on organizational structure, programs may be housed either within the nursing department or at the hospital level. Because clinical inquiry initiatives frequently cross service lines, settings, and disciplines, interdisciplinary support is required.
Organizational characteristics associated with a successful clinical inquiry and innovation program are resonant leadership within nursing and hospital administration, nurse scientist representation on the senior nursing leadership team, quality librarian and literature retrieval resources, and an adequate budget to support the program's objectives. Including the nurse scientist program as a fixed line in either nursing's or the larger institution's administrative cost centers symbolizes organizational commitment to the endeavor. Relational capital, which refers to the collaborative work and investment among individuals to advance common goals or knowledge discovery and uptake, is requisite for the development of a sustainable knowledge culture.14
When selecting nurse scientists, administrators must consider their fit with the objectives of the organization's mission, size, patient population, geographic location, and strategic plan. A nurse scientist's academic preparation; history of scholarly productivity, including successful refereed publications and grants; and previous experience with clinical research and EBP all need to be considered. No one person with a single skill set can address all of the organization's clinical inquiry needs.
By combining the different nurse scientist models and selecting individuals with varying backgrounds and skill sets, CNOs can build successful clinical inquiry programs regardless of their institution's size. Because success begets success, visibility of clinical inquiry and innovation outcomes is essential for nursing recognition and program advancement.
Expectations must be realistic if insufficient and insecure funding is an issue. It's important that responsibilities in the position description clearly support the nursing department's and larger organization's strategic plans. Ideally, nurse scientists will help produce measurable outcomes that improve the efficacy and efficiency of patient care in high-priority areas. Such evidence supports the need for the clinical inquiry and innovation program.
Nurse scientists often report tension between meeting organizational and individual goals. When other organizational goals viewed as being of higher priority are realigned, current clinical inquiry and innovation activities may be considered unresponsive to organization needs. This is of particular concern if hospital and nursing leadership generally perceive that research and innovation activities are vaguely important, but don't see significant benefit for their institution.
It's unrealistic to expect nurse scientists to advance their own programs of research while simultaneously leading the development of a vigorous organizational clinical inquiry program and mentoring a cadre of nurses engaging in clinical inquiry initiatives on a wide array of topics using diverse methodologies. As in academia, nurse scientists conducting independent research need protected time, research seed monies, and adequate personnel resources to successfully compete for major research and program grants. This is especially important if there's an organizational expectation that they're responsible for funding a portion of their positions in this manner.
There's increasing evidence that recent graduates of doctoral programs are assuming nurse scientist positions in clinical organizations.15,16 Such individuals, especially those who are skilled clinicians, hold tremendous promise to advance clinical inquiry and innovation programs. But in the same way that newly minted RNs need time to develop their clinical skills, recently graduated PhD- or DNP-prepared nurses are novices to clinical inquiry and need time and tutelage by seasoned research mentors to develop their skill sets.15 Their time should be spent in establishing their own research credentials and expertise so that, at later points in their careers, they have the scientific credibility and political savvy to advance the clinical inquiry programs of complex organizations.
When evaluating an organization's clinical inquiry and innovation program, it's imperative to determine the desired outcomes beforehand, followed by specific identified intervals for systematic review.17 Clinical inquiry programs require personnel support appropriate for their scope. Access to librarians, statisticians and data analysts, research assistants, administrative assistants, and sponsored program personnel is invaluable.
Although only the largest medical centers may employ the full cadre of necessary personnel, smaller institutions can contract with individuals or barter with external institutions for necessary support. Care must also be taken to not overly burden the program director with administrative tasks so that he or she is unable to conduct original research, should this be an organizational goal.
Conducting a periodic gap analysis can help provide direction, indicating strengths and areas for improvement.18 Specific research and EBP activities within clinical inquiry programs can contribute to each facet of the outcomes depicted in the Magnet Model, including clinical, workforce, patient and consumer, and organizational outcomes.
Robust or bust
With a growing presence in today's healthcare environment, the nurse scientist role is a viable career option for doctorally prepared nurses. Nurses with PhD degrees are educationally prepared to lead all aspects of clinical inquiry and innovation programs. Nurses with DNP degrees are educationally prepared to improve nursing practice by investigating and implementing EBP and QI. Robust clinical inquiry and innovation programs are created through meaningful collaboration among nurse scientists, administrators, educators, clinical nurses, and interdisciplinary partners. Fostering equal value across stakeholders helps build trust and empower nurses to question their practices by developing, testing, and implementing evidence-based solutions. Ultimately, these activities mutually benefit both stakeholders and patients.
INSTRUCTIONS Nurse scientists: One size doesn't fit all
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