There is abundant research showing that EBP improves patient safety, health outcomes and quality of care (Melnyk, Fineout-Overholt, Giggleman, & Choy, 2017). In recent years EBP and research utilization have become accepted responsibilities of point-of-care nurses (Andrew & Theiss, 2015; Pringle, 2007; Kelly, Turner, Speroni, McLaughlin, & Guzzetta, 2013). However, nurses report barriers to EBP and research (Squires, Estabrooks, Gustavsson, & Wallin, 2011; Chan et al., 2011; Chau, Lopez, & Thompson, 2008). A variety of interventions have been designed to create research opportunities,improve research engagement and enhance EBP (Chau et al., 2008; Wilson, Kelly, & Reifsnider, 2013; de Pedro-Gomez et al., 2012), including implementation of advanced practice nursing and nurse scientist positions (Chau et al., 2008; Leasure, Stirlen, & Thompson, 2008; Gerrish et al., 2011). Finding ways to overcome barriers and support nurses’ engagement in research and EBP is a priority for most health care organizations. Our work has demonstrated that combining key personnel with supportive programs can result in a shift in workplace culture to one where nurses embrace research utilization, nurses’ research knowledge and ability are increased, and increasing numbers of nurses are inspired to lead or participate in their own research projects.
In 2010, a grant-funded Nursing Research Facilitator position was created at the organization; this role was expanded and re-named in 2017 as the Director of Health Services & Clinical Research and Knowledge Translation (KT). The Director role is held by an advanced practice nurse who supports and leads research and knowledge translation activities throughout the organization, including a research training program. Since the mid-1990s, the healthcare organization has utilized clinical nurse specialists (CNSs) in an increasing number of programs within the organization; over 90% of programs now have a CNS. The CNS functions as a clinical leader and role model within their specialty’s interdisciplinary team and promotes excellent patient outcomes by collaborating with other health care disciplines to develop effective clinical programs. Further, most CNSs hold adjunct faculty positions that enable them to incorporate research activities in their clinical role.
A university-appointed Professorship in Cardiovascular Nursing was created in 2017, jointly funded by academic and clinical stakeholders with the support of non-profit agencies. The goal is to foster a highly productive hub of research, education and practice to improve outcomes and health service delivery. The partnership between academic and clinical nursing is further strengthened by another nurse clinician scientist who actively engages with clinical staff regarding her program of research, as well as mentoring staff nurses’ projects.
The research training program is coordinated by the Director, Research and KT, while CNSs in the organization are key to the success of the program by serving on the advisory committee and as mentors for 17 of the funded research projects to date. The Professor in Cardiovascular Nursing mentors numerous teams in the research training program, provides formal and informal research training, and serves as a role model for nurse-led research in the organization.
Methods:
We evaluated the short- and long-term impact of the research training program on all participants (point-of- care nurses and other clinicians, mentors who supported the teams), as well as on the culture within the organization. We conducted a survey to measure the impact of the program on participants’ knowledge and attitudes regarding research, their clinical practice, their understanding of EBP, and their interest in advanced education and future research involvement. We conducted semi-structured interviews of participants, mentors and managers using open-ended questions to explore their overall experience with the program. Survey results were summarized using descriptive statistics; interviews were recorded, transcribed and themes were identified.
Results:
The research training program has enrolled 584 point-of-care staff who embarked on 95 funded research projects in their own clinical settings, leading to important patient care improvements. 364 RNs have participated in the program, leading nearly 50% of all funded projects (N=47), and 17 projects were mentored by CNSs. Survey results reveal a statistically significant increase in participants’ research methods knowledge and practice (Black, Balneaves, Garossino, Puyat, & Qian, 2015), while qualitative findings show an increase in EBP and a shift in workplace culture to one that is more receptive to EBP and nurse-led research (Black et al., 2015). Participants reported examples of sustained practice changes, and heightened interest in both graduate education and future research engagement. Participants expressed appreciation for the opportunity to shape organizational programs and culture that this program offered them. In the first year of the Professorship, 12 national and international invitations to discuss the role and its contributions were received, 5 nurse-led teams were mentored to present research findings at various scientific meetings, and 3 nurse-led manuscripts have been submitted for peer review. In addition, processes were established to support academic teaching and create opportunities for students to benefit from mentorship in the clinical setting.
Conclusion:
Healthcare leaders strive to improve patient outcomes and it is widely accepted that EBP contributes to this. Nurse involvement in research supports EBP, and an organizational culture that supports nurses’ involvement in research and EBP is critical. Successful models for nurse engagement in research are required. Our evaluation shows that combining key personnel with supportive programs can create a critical mass of expertise and result in a shift in workplace culture to one in which nurses at all levels embrace research utilization and a significant number of point-of-care nurses lead and participate in their own research.