Laying the Foundation: Partnering to Build Research Infrastructure in the Clinical Setting

Sunday, 28 July 2019: 8:00 AM

Danielle Altares Sarik, PhD, APRN, CPNP-PC
Nursing Research, Nicklaus Children's Hospital, Miami, FL, USA
Renee Kathleen Schweitzer, DNP, RN, FNP
University Relations, West Coast University, Irvine, CA, USA
Jennifer Marie Hayakawa, DNP, CNS, CCRN, CNRN
Nursing Administration, Children's Hospital of Orange County (CHOC), Orange County, CA, USA

Purpose: This presentation will describe the origins and early outcomes of a service-academic partnership that advances the science of nursing to optimize the health of patients and families. This unique partnership provides an innovative solution to the most commonly cited barriers to conducting nursing research in clinical settings –time, resources, and expert guidance. Models of service-academic partnership are not new, but are often focused on creating opportunities for academic faculty and may not necessarily align with the needs of nurses in the clinical setting (Clevenger & Cellar, 2018). However, a true partnership between nurses at the bedside and an academic institution represents one of the keys to a thriving culture of inquiry and improvement in clinical outcomes (Gullatte & Corwin, 2018, Hatfield et al. 2016). New models that emphasize the importance of clinical outcomes (Clevenger & Cellar, 2018) as well as partnerships between academic research centers and direct care nurses (Hatfield et al., 2016) are emerging. Even with successful collaboration, availability of financial resources and protected time for clinical nurses to engage in research is often cited as a barrier (Hatfield et al., 2016; Johantgen et al., 2017, Scala et al., 2016). Conducting clinical research requires executive level support and a financial commitment from the organization (Gullatte & Corwin, 2018; Scala et al., 2016). Additionally, an established infrastructure is crucial to sustaining a robust program of nursing research in clinical settings (Johantgen et al., 2017, Latimer & Kimbell, 2010, Scala et al., 2016). Benefits of collaboration include strengthening of academic rigor and scholarship, enhancing clinical research resources, and spurring innovation in patient care (Hatfield et al., 2016). Of particular interest to hospitals seeking to achieve or maintain Magnet designation, support of research and application of evidence-based practice is fundamental (Johantgen et al., 2017), and such collaboration is one avenue to achieve these priorities. Recognizing an opportunity to facilitate research growth and advance clinical practice, a private university donor established unique research partnerships with geographically diverse pediatric acute-care institutions from 2012-2018. These partnerships are intentionally unique to supplement existing resources and meet each service institution’s educational and research goals. The common thread connecting these partners is that they receive financial support from the same university to advance the science of nursing and optimize patient outcomes.

Methods: University leaders began this initiative by establishing relationships through collaborative discussions with the executive nursing leadership in each hospital. Open and direct communication enabled the university to build a solid foundation of trust and mutual respect with the organizations. Hospital and university philanthropic leaders also met during this initial phase to create a financial framework for collaboration, including establishing mutually agreed-upon goals and expectations of the partnership. Early efforts to enhance the growth of nursing research infrastructure included a comprehensive approach to develop nurse competence in evidence-based practice and research. These efforts included the development of Nursing Research and Evidence-Based Practice Fellowship programs, monthly Nursing Grand Rounds, and educational series to address the learning needs of nurses at all levels. Site One: In early 2017, with an endowed grant to support nursing research from the university partner, the Nursing Research Department began to strategically build opportunities for clinical nurses to engage in the process of research and evidence-based practice. To address concerns about financial and time resources needed to successfully move a project from conception to completion, the Nursing Research and Evidence-Based Practice Fellowship was created. This Fellowship was structured to support up to two clinical nurses each cycle, and to run for 12 months. Envisioned as a mentored research immersion experience, the Fellowship facilitates professional growth and development of the clinical nurse, while also addressing an identified clinical need. Of particular importance, the Fellowship provides time-support, covering one 12-hour shift bi-weekly for the selected Fellow. In addition to targeted efforts to create research and EBP champions through the Fellowship, broad-based education and engagement efforts to improve practice and broaden research horizons were spearheaded. The Nursing Grand Rounds Series represents one such effort. This monthly, lecture-based series highlights either a research or cutting-edge clinical practice issue. All nurses within the institution, including those located in ambulatory care settings or satellite offices, are invited to attend, and a variety of topics are addressed. Additionally, monthly interactive scholarly discussions modeled after an academic dissertation seminar format were created. Attendees are primarily those nurses with doctoral degrees, those in school pursuing doctoral or masters degrees, or those with a strong interest in research. Topics have included research ethics, authorship and publishing, and mentorship. Site Two: The organization’s journey to creating a culture of inquiry began in 2005 with the implementation of a two-year Nursing Research Fellowship (NRF) designed to mentor staff nurses through the role of principal investigator. In 2007, a 6-month EBP Scholars program was established to prepare and empower nurses to translate research (and other sources of evidence) into practice. Together, these programs resulted in multiple national presentations as well as peer-reviewed publications and were instrumental in developing internal expertise. Over the past decade, 25 Nursing Research Fellows and 84 Evidence-Based Practice Scholars have graduated from the program yet, opportunities for improvement were identified. In 2017, the service-academic partnership provided the financial means to hire a nurse scientist to provide expert guidance and program oversight to ensure relevance, quality, and sustainability. The nurse scientist led a multidisciplinary team to establish a nursing research strategic plan with realistic and measurable goals. Strategic focus areas included: preparing nurses to lead a culture of inquiry; empowering nurse participation in inquiry; building a robust and supportive infrastructure; and cultivating relationships that foster scientific collaboration. Existing programs were evaluated and refined and, additional education programs were developed based on needs assessments from nurses at all levels. An organizational model for EBP was adopted, approved through the shared governance structure, and integrated into the quality improvement process. Additionally, a formal process was established to ensure that all nurse-led research or quality improvement proposals are reviewed through shared governance prior to submission to the institutional review board (IRB). This resulted in the creation of a tool to navigate nurses through the steps of local IRB submission.

Results: The described programs are in the early stages of implementation. Measurable outcomes include the number of program participants and the amount of clinical practice changes implemented, as well as the volume of submitted poster, podium presentations and peer-reviewed publications. Data from both clinical settings demonstrate significant improvement with the support of the service-academic partnership as evidenced by an increase in the number of nurse-led grant submissions, IRB-approved studies, and nursing dissemination activities. As the programs continue to evolve and mature, additional metrics will be tracked and reported to assess for further impact. Site One: The first year of the service-academic partnership has shown a significant growth in infrastructure and nurse engagement. The first Fellow is currently undergoing peer review of her Fellowship project, and plans to begin data collection in Quarter 1 of 2019. Attendance at Nursing Grand Rounds is reliably high, with the last interprofessional event attracting over 150 participants. Post-lecture evaluations consistently rate content and learning as excellent. Comparison between our 2017 and 2018 research metrics also demonstrate a significant impact: the number of IRB-approved research studies (including two multisite studies) has doubled, the number of nursing-led grant submissions has increased three-fold and abstract submission and acceptance remains high. Moving forward, as the program grows and matures, metrics will be tracked and reported to assess for impact. Site Two: In just one fiscal year, the service-academic collaboration has provided time, resources, and expert guidance to build upon existing infrastructure and enhance nurse engagement. Outcomes include implementation of a comprehensive program of inquiry that includes: a new translation into practice training program specifically designed for advanced practice nurses and other nurse leaders; interdisciplinary workshops to build capacity for clinical innovation; a redesign of the nursing research fellowship program to create a more meaningful and relatable way to engage nurses in research activities; and quarterly “chat n ’chew” meetings to continue to motivate past scholars’ participation in EBP. Results have included: doubling the number of external poster and podium presentations, tripling the number of nurse-led projects submitted to IRB and, quadrupling the number of peer-reviewed nursing publications. In addition, 6 nurse-led projects were awarded a total of $393,166 from internal grant funding and have led to improvement in clinical outcomes translating to significant organizational cost savings.

Conclusion: Cultivating innovative service-academic partnerships can help lay the foundation upon which to build robust and comprehensive infrastructure to support nursing research in clinical settings. Such relationships advance mutual interests and shared goals which can ultimately lead to improvement in nurse engagement and clinical outcomes.