Educational Needs and Perceptions of Needs Among United States Rheumatology Nurses: A Mixed Methods Study

In the last decade, beginning with the advent of newer disease modifying anti-rheumatic drugs (DMARDs) and biologics, rheumatology nurses have assumed increasingly complex roles within this emerging field.  International literature provides evidence of this trend through tracking the increase in assumption of roles since the early 1980s. However, there is a dearth of information about these enhanced roles and the level of preparedness required of the nurses from the U.S. perspective. In the U.S., the level of acuity and complexity of delivery of care for rheumatology patients have steadily increased. Simultaneously, the specialty area of rheumatology nursing is expanding in membership, as increasing numbers nurses gravitate to this long term-care patient population.  It is important to monitor and make recommendations for the development of and changes to specialized education as nurses will need to serve as competent and safe providers of care. It is thus imperative for the expanded roles, perceptions, and educational needs of the rheumatology nurse in the U.S. to be documented in order to illuminate these roles, challenge existing practice, enhance professional capabilities, and further inform the practice of rheumatology nursing.   

The proposed mixed methods study was designed to answer the following quantitative, qualitative, and mixed methods research questions:

Quantitative

1. What are the demographic characteristics of currently practicing rheumatology nurses in the U.S.?
2. How are practice, leadership, education, and, research roles enacted by currently practicing rheumatology nurses in the U.S.?
3. What is the perceived educational preparation needed specific to the role of rheumatology nursing as reported by currently practicing rheumatology nurses in the U.S.?

Qualitative

1. What are the perceptions of the roles of the rheumatology nurse in the U.S.?
2. What are the recollections and perceptions regarding educational preparation for current roles and responsibilities by rheumatology nurses in the U.S.?
3. What are the perceived educational needs for future practicing rheumatology nurses as expressed by currently practicing rheumatology nurses in the U.S.?
4. What are the perceptions regarding the development of an advanced practice specialty role for rheumatology nurses as expressed by currently practicing rheumatology nurses in the U.S.?

Mixed Method

1. To what extent do the quantitative and qualitative results converge?

Purpose:  

The purpose of this mixed methods study was to characterize the demographics and level of academic and clinical preparation of currently practicing rheumatology nurses across the U.S.; ascertain how their roles were implemented in various settings; and, determine their perceptions of their educational and clinical preparation for currently held roles.  Data collected served as the basis to support further development of the specialty role of rheumatology nursing and to identify emerging educational components to adequately prepare nurses for this specialty role.

Methods:

The selection of the mixed methods research design allowed the researcher to explore the relationships that support the emerging assumed roles in rheumatology nursing identified through descriptive analysis with the qualitative narrative responses.  From an integral perspective, each role within the identified domains of practice, leadership, education, and research were examined in this study.  The participant’s perceptions regarding preparation for each of the four domains and the emerging educational needs for advanced practice roles was examined in-depth due to the added qualitative questions utilized in this study.  The merging of quantitative and qualitative data provided valuable insight that would not have been achieved by either single methodological approach.

This study included the use of two instruments, one for the web-based survey and the other for the telephone interviews.  Both were designed for single-use to gather data to answer the research questions.  The web-based survey is discussed followed by a description of the telephone interview guide. An investigator-initiated single-use survey instrument was developed for use in this study.  This survey is a ‘first in the U.S.’ data-gathering survey and was not designed to be a repeated-use measurement tool.  Items within the survey were based on a literature search for the most common roles and role preparations identified for the rheumatology nurse.  This extensive evidence based listing of roles was later defined following review by a panel of expert rheumatology nurses.  The survey instrument was administered to a panel of seven rheumatology nurses to obtain validity. A minimally acceptable level, 68% of completion involving questions 1-21 of 31 was the acceptable evaluable survey definition. There were 160 surveys for final analysis.  The researcher developed interview guide questions for utilization during the telephone interview phase of the study.  The interview guide consists of eight general questions with guiding probes designed to elicit the participants’ perceptions of their current roles, educational preparation, educational needs, and future expanded roles for rheumatology nurses practicing in the U.S.

Results:

This study was designed to provide insight about emerging roles, educational needs, and practice preparation for registered nurses caring for individuals with rheumatologic conditions.  The purpose of this mixed methods study was to characterize the demographics and level of academic and clinical preparation of currently practicing rheumatology nurses across the U.S.; ascertain role implementation in various settings; and, to determine perceptions of educational and clinical preparation for currently held roles.  A mixed methods convergent parallel design with added emphasis on qualitative data collection was utilized to allow deeper introspection and insight to the nuances of the roles.  A convenience sample of 160 rheumatology registered nurses completed a single-use investigator initiated survey.  Additionally, there were 12 phone interviews from the volunteer participants of the survey.  Quantitative data were analyzed with descriptive statistics. 

 Qualitative data were explored culminating with the discovery of commonalities and themes.  Findings support the international literature for the four domain roles of practice, leadership, education, and research in benchmarking rheumatology nursing roles.  The additional sub-roles within each domain role identified from this study require further exploration and research.  Results demonstrated within the practice role, personal knowledge and communication skills were key themes to successfully fulfill the sub-roles of educator/counselor and drug treatment monitor.  The theme of content leader was evident as the basic sub-role for sharing knowledge with colleagues in the leadership role.  In the education role, participants indicated general knowledge of rheumatology as well as insurance knowledge were key themes in order to serve as an education resource and that personal continuing education is requisite of the role.  Lastly, in the research role the main sub-role was a combination of expert/liaison/educator for the primary theme identified by the participants as encouraging research.

Conclusion: Future research recommendations include continued exploration of the roles and sub-roles.  Further evaluation with competencies and educational requirements within each role is desirable.  Additionally, documentation of effectiveness and outcomes of these roles concerning patient care, education, delivery of care, as well as access to care and cost effectiveness is encouraged. The education for the rheumatology nurse does not need to be on-the-job training, left in the hands of the rheumatologists for nurses post-graduation from a nursing program.  Rather, innovative, and updated teaching strategies are needed to meet this newly recognized specialty practice of nursing care.