Nurses working at the point of care should ideally be well-suited to pose relevant questions for clinical inquiry; lead or collaborate in quality improvement, research or evidence-based practice (EBP) projects; and translate data-based findings into practice. The literature is replete with citations corroborating the positive outcomes for both patients and nurses when clinicians incorporate EBP into patient care (Bridges, 2015; Nixon, Young, Sellick, & Wright, 2013; Severinsson, 2014). However, there are a number of challenges that may impede complete and unfettered integration of nurse clinicians into these processes (Yoder, Kirkley, McFall, Kirksey, Stalbaum, & Sellers, 2014). One mechanism that can facilitate engagement of bedside nurses in clinical inquiry is capacity building and development. Ensuring that sufficient resources exist (e.g., dedicated, protected time to participate; infrastructure; clinical inquiry knowledge and skills; leadership guidance and support; financial resources) are key features for success in research and EBP capacity building (Severinsson, 2014; Yoder et al., 2014).
Many hospitals across the globe struggle with how to fully integrate programs of nurse-driven clinical inquiry at the bedside. The director of Nursing Research at our academic, safety-net hospital system, in collaboration with nurses in direct care and leadership positions, embarked upon rebranding nurse-led scholarship activities in order to delineate the preferred future and provide a framework to guide these endeavors.
Purpose
The INSPIRE Team was formed in partnership with the Center for Nursing Scholarship to facilitate personal and professional growth of nurses and other healthcare providers by imbuing them with spirits of inquiry and providing the knowledge, skills, confidence and opportunities to successfully engage in clinical scholarship. INSPIRE is an acronym for Innovations in Nursing Scholarship, Performance Improvement, Research & Evidence-based practice.
Implementation
The team, comprised of participants across nursing, originated in 2006 as the Research Council and transitioned to an EBP Council in 2013 before its transformation to the INSPIRE Team in 2015. The final evolution was initiated in order to better reflect the comprehensive scope of clinical inquiry in which the team engages. Specific goals include: 1) Identify clinical inquiry priorities requiring scholarship-driven solutions; 2) Provide infrastructure for nurses to engage in clinical inquiry; 3) Create and integrate science to improve patient outcomes; 4) Generate and sustain influence, excitement, and support for nurse-led scholarship; and 5) Foster intra-disciplinary, interprofessional and multi-institutional scholarly collaboration.
As previously noted, competing demands on nurses’ time can be a major impediment to developing a research and EBP-active culture. The executive leadership team explored options for providing direct-care providers with paid time to engage in scholarship. A key strategy of INSPIRE has been to increase the number of clinicians and leaders who can demonstrate acquired EBP competencies specific to their roles. The influence of nurse leaders (both clinician and administrative) can make or break scholarship capacity. Shared vision and energy, commitment to patient care quality improvement, and time allocation for successful engagement in scholarship were deemed essential components in ensuring the program’s success. Achieving buy-in from nurse leaders (both administrative and clinician) was a pivotal first step in expanding nurse-driven scholarship. In order to enhance knowledge and appreciation of clinical inquiry, a series of classes were offered in 2015 and 2016. Content included: 1) formulation of clinically-relevant PICO questions; 2) acquisition and critical appraisal of the extant literature; 3) creation, validation and translation of evidence; and 4) dissemination of applicable findings, both internally and externally.
Results
Over 90% of administrative nurse leaders and approximately 30% of direct care providers have been educated. Nurses have access (on-site and remotely) to Nursing Reference Center Plus (with full-text articles) and The Cochrane Library. The Johns Hopkins Nursing Evidence-Based Practice Model has guided the steps delineated above, and the research and non-research appraisal criteria are used to critically evaluate evidence. The process also ensures that nurses have enough understanding of the salient literature to make informed decisions about whether or not to translate the information into practice, launch a quality improvement project, or conduct formal research when gaps in science are detected.
The transition to an INSPIRE team resulted in the implementation or completion of 16 Institutional Review Board (IRB) sanctioned nurse-led research studies (with six others in preparation for IRB submission), 18 peer-reviewed publications in top tier journals, and over a dozen abstracts accepted for podium or poster presentations at national or international conferences. The National Institute of Nursing Research foci (e.g., symptom management, health promotion and disease prevention, quality of life, health disparities, and end-of-life) have provided a roadmap for research and EBP projects. Both novice and experienced nurse researchers have received funding from area Sigma Theta Tau chapters and several private funding agencies (including two American Nurses Foundation grants). The INSPIRE team showcased nurse-led clinical inquiry in public forums (e.g., hospital lobbies and cafeterias). Several hundred nurses, interprofessional colleagues, and the general public have learned more about nurse-driven scholarship during these events. Our hospital system is associated with two medical schools and there have been several nurse-led studies that included physicians and partners from other disciplines. Being aligned with several schools of nursing (four of which have doctoral programs) has also assisted nurses in defining developmental pathways and delineating opportunities for multi-institutional partnerships. Additionally, the hospital system has planned its inaugural nursing symposium (focused on practice, education, leadership, and nursing science) in spring 2017 as a forum to continue building a solid framework to support personal and professional growth of nurses, and exponentially drive nurse-led scholarship.
Implications for Practice
INSPIRE created a framework to enhance our programs of nurse-driven scholarship. The transition has also provided the impetus and commitment to fortify a culture of excellence that pledges to imbue nurses with the knowledge and skills to provide high quality, patient-centered, fiscally responsible, and evidence-driven nursing care.