Creating a Nursing Scholarship Strategic Vision to Transform Nursing Practice

Background

Nurse leaders at our academic safety net healthcare system have long been resolute in promoting an environment where high quality, patient-centered, fiscally responsible, and evidence-driven nursing care are standard. Nurturing an environment where the delivery of innovative, multi-faceted, and interprofessional care is embraced and supported has been an essential component in facilitating the personal and professional growth of both nurses and healthcare partners. The development of a comprehensive nursing scholarship strategic plan has been a significant part of the continuing commitment to building and fostering this culture of excellence.

A strategic plan serves as an organization’s road map in defining goals and outcomes to achieve desired growth, and facilitates decision-making for resources that includes people and capital. A gap analysis was conducted in order to delineate areas of strength and opportunities for improvement. Exploring strategies for further integration of scholarship activities, specifically clinical inquiry related to evidence-based practice (EBP) and research, was deemed a key imperative. The strategy team charged with developing the nursing scholarship strategic vision was intentional in aligning the plan with the organization’s overall system strategic plan and national benchmarks for excellence (e.g., American Nurses Credentialing Center Magnet Criteria and Baldrige Performance Excellence Standards).

Purpose

A group of system-level nurse leaders (subsequently referred to as “nurse strategists”) created a plan to specifically address the vision to advance nursing scholarship. Gaps between the current and desired states were identified and grouped into categories to present a holistic view of the organizational strategic context.

Method

The gap analysis assisted the team in determining avenues for further integration of scholarship activities. The nurse strategists worked over several months to analyze the opportunities and to develop high-level action plans. Priority themes, the organization’s current state, two- and five-year goal statements, outcome indicators, and persons responsible for leading the work were delineated. While the hospitals and ambulatory care services have employed a doctorally-prepared nurse to teach EBP and research methodology, and support nurses engaged in scholarship for many years, there have been resource limitations in ensuring enculturation for over 2,000 registered nurses across the system. Over the past five years, Nursing Services has supported hiring more doctorally-prepared registered nurses. These nurses are educated either as researchers (Doctor of Philosophy; PhD) or expert clinical leaders (Doctor of Nursing Practice; DNP). Engaging these leaders has diminished the burden for one person to bear sole responsibility for all aspects of scholarship and provided a roadmap for delineating an ideal future.

The previously ascribed priority themes include Foundation, Education, Appraisal, Creation, Innovation, Translation, and Dissemination. “Foundation” is defined as cultivating a spirit of clinical inquiry and building the infrastructure to support the enculturation of scholarly activities. Goals included forming key groups to support nurses engaged in scholarship. The first group termed “Coaches Operationalizing Research Excellence (CORE)” is comprised of the nearly 20 doctorally-prepared nurses employed by the organization. As the group’s title implies, the expert nurses are assigned to coach nurses who are novice in scholarship activities. The combination of both PhDs and DNPs is viewed as strength in supporting clinical, administrative, educational, and scientific projects. There has been a concerted effort to pair both types of doctorally-prepared coaches for projects, when warranted. A “Nursing Scholarship Advisory Board,” comprised of members of the academic community engaged in nursing research (associate deans of nursing research and other key stakeholders) and select members of the CORE team was also formed in order to define developmental pathways and delineate opportunities for multi-institutional and interprofessional scientific partnerships.

“Education” provides nurses with the foundation for informed participation in research and EBP projects. The gap analysis revealed that approximately 25% of nurse clinicians and 25% of nurse leaders have being formally prepared in these two areas of focus. The education goal for EBP was increased to 90% for leaders and 50% for clinicians during the first two years of implementation. The organization will soon implement an EBP educational series for all nurse leaders. The 15-hour course, consisting of a combination of didactic instruction, online modules, and independent study will enhance nurse leaders’ knowledge and application of EBP in daily operational responsibilities.

“Acquisition” refers to obtaining and critically appraising evidence gleaned through data-based publications and expert opinions. Nurses have access to an online reference center, both at work and remotely. All nurses are provided with library cards to allow institutional access to a world-class medical library. The nurse strategists completed a comprehensive review of available journals and identified additional resources that would assist with literature searches.

“Creation” is defined as instituting nurse-led or nurse-participative research projects in order to add to the body of scientific nursing knowledge or to validate existing knowledge through replication. The organization has set two year goals of a minimum of one research study per 100 inpatient beds and a minimum of three studies in the ambulatory care settings.

The definition of “Innovation in service delivery and organization [is] a novel set of behaviors, routines, and ways of working that are directed at improving health outcomes, administrative efficiency, cost effectiveness, or users’ experience and that are implemented by planned and coordinated actions” (Greenhalgh, 2004). One initiative is the formation of a mechanism for spreading information across three hospitals and ambulatory care services. A monthly nursing research grand rounds series has been implemented to showcase completed studies by nursing colleagues working in other facilities around the geographic area.

There is a major push in the area of “Translation.” It is defined as translating evidence-based knowledge (acquired, created, or replicated) into inquiry-based practice. A two-year goal includes preparing at least 90% of nurse leaders and 50% of clinicians so they are able to articulate the process for integration of published evidence into clinical practice. The EBP course series, designed for leaders, is one way of implementing this goal.

Lastly, “Dissemination” is defined as sharing the results of nurse-led scholarship through refereed presentations and peer-reviewed publications. The efforts in this area have resulted in significant increases in both areas of dissemination.

Results

Measurable goals and objectives for two- and five-year timeframes have been developed to advance the organization from its current to the desired state for each of the seven foci. Capital and resources are able to be more effectively directed towards efforts that are best aligned with the defined objectives.

Implications for Practice

Having a strategic plan drives the infrastructure and commitment to support scholarship outcomes. Periodic review of the strategic plan and progress made towards targeted outcomes provides an opportunity to realign resources as needed to stay on course to achieve the desired state of advanced scholarship. Partnership with both internal and external partners strengthens the program structure and enhances interprofessional and multi-institutional collaboration.

Conclusion

Nurse leaders within the organization have been mindful of creating opportunities for scholarship across nursing and with external partners. Formulating a nursing scholarship strategic vision has provided a framework for the acquisition and appraisal of evidence, creation of new knowledge, and translation of relevant findings that make positive differences for patients and staff. Nurses will be better prepared to use and generate scientific evidence to provide quality care and healing services for our patients and individuals across the globe.