Making Nurse Research Part of What We Do

In 2004, our Professional Nursing Staff Organization (PNSO) sought to develop a formal, robust, and sustainable clinical research program for nurses at the University of Virginia Health System in Charlottesville. We recognized that to make research part of what we do, we needed to provide nurses with the tools to effectively innovate practice by conducting studies on topics important to them. In doing so, we believed we would further strengthen our evidence-based practice culture.

Although some suggest that conducting research studies is beyond the realm of bedside clinicians, we believe the opposite. Because essential questions emerge from practice, bedside nurses are perfectly positioned to both ask and answer the questions. To that end, we sought to develop a program for practicing clinicians that was rigorous yet practical. This thriving program is now in its fifth year and is described below.

Key components of the program
Central to the program's success is that it is led by a research director who understands the clinical environment, has successfully done clinical research, and who is a recognized clinician mentor. The key program components include concrete support of projects (i.e., unit and administrative support), mentorship and guidance of the research clinicians by the director, and a practical method that guides the clinicians through the research process from inception to completion, including presentations and publications, one step at a time.

Application to the program
A call for research clinicians (called research mentors, or RMs) is published annually via hospital intranet.

The call for applicants describes the elements of the program and, most importantly, notes that the role of the RM is to lead a unit-based research team study. No previous research experience or educational level of preparation is required for application to the program.

Applicants submit a short description (no more than one page) about why they wish to be an RM and also describe a unit project that they have completed from beginning to end. This is a key part of the application as we recognize that an individual's perseverance and follow-through are important predictors in ensuring the successful completion of a research project.

In addition to the clinician's application, we ask that the applicant's manager and administrator write a note of support for the applicant. These application elements are all sent to the director via e-mail; no other supporting material is required. Administrative support.

The PNSO office supports the research program by providing partial salary support for the director—and now also the assistant director who recently joined the program. In addition, the PNSO provides funding for statistical support on a project-by-project basis.

The participants who are selected as RMs are supported by their respective units. In reality, this requires little financial support given that the projects are all unit-based, carefully constructed so that they can be accomplished on the unit, and most learning experiences are provided one-on-one by the director as the research team progresses through each step of the research project.

The RM research process
Once accepted into the program, the clinicians attend a one-day in-house conference on clinical research program and process. The focus of the conference is to energize and inspire the clinicians, explain the RM role (to mentor and guide other team members), and formalize the participants' commitment to the program.

In addition, they are taught the process for leading the team, starting with how to develop a research question. A rough timeline is set—the projects generally take a full year to complete and a second year to present formally and begin the process of writing for publication.

Following the kick-off conference, the individuals move at a pace that works in their setting; learning is done one-on-one with each research step. Prior to each team meeting, which is usually accomplished during the course of a workday, the RM meets with the director to review the steps.

Following the meeting, he or she debriefs with the director about the meeting and also discusses the next step and the timing of that step. For each of these meetings, the director generally goes to the unit where the RM works, but sometimes the discussion is conducted by phone or even by e-mail.

Regardless of the method, the RM and director are in close communication throughout the process. Clinicians are busy, and time away from the unit is sometimes very difficult to accomplish. The program acknowledges this fact by making the process reasonable and doable.

The selection of a study is determined by each research team and is always a team decision. Generally, the team identifies multiple research questions, but before any are voted on, the director reviews them with the RM to eliminate those that may be unduly cumbersome, difficult, or not amenable to a design that will work well without sacrificing rigor.

The goal is to design and implement a study that is feasible in terms of the study population (i.e., accrual of an adequate number of study variables in a short period of time [three months], complexity of data collection, timing, and study design).

RMs are reminded that the studies are not dissertations, and to that end, the projects are somewhat narrowly focused and convenience sampling is often employed. In addition, all the projects are sent for review to our Institutional Review Board (IRB).

Although most of the projects are designed to be both expedited and not require a full written consent, they vary in complexity; teams that have previously successfully completed a project often design second studies that are a bit more sophisticated and complex than the first. A number of these "second generation" studies have been accomplished, and others are in process.

The majority of RM projects take a full year to complete, and once completed, the teams present the study findings formally at our annual "Evidence-based Practice Day" conference.

Following these presentations, and often simultaneously, the RM teams submit abstracts to local, regional, and national conferences. The process of writing for publication is quite a bit slower, but each project goes through the process with the director with the intention being to publish the work eventually.

Outcomes of the RM program
To date, the program has 38 active RMs. Although 44 clinicians have gone through the program, some anticipated attrition has occurred as some have left the institution, are involved in other focused professional activities such as school, or have left the program for personal or other professional reasons.

Thirty-four IRB-approved projects have been completed or are close to completion, and seven more are in process. The RM teams have presented more than 200 presentations at local, regional, or national venues, and more than 400 clinicians throughout the hospital are involved in these projects. Fourteen articles have been published; many others are in progress.

Most important to the program's success is that the study results are shared within the hospital and vetted through our professional practice mechanism for implementation. In many cases, the projects have been adopted for application in the units in which they were developed or for widespread use throughout the hospital. The program's sustained success has surpassed all expectations.

Where are we now?
The program will enter its sixth year in September. It continues to be extremely popular, and applications are numerous. In part because of its popularity, program applications were not accepted in 2009 because of the workload. Not only were many projects ongoing, but second generation studies were increasing as were requests for the director's time to guide those doing research outside of the established research program model.

In addition, writing for publication is a necessary and essential step that we wished to focus on, and the time and effort to do so is substantial. An assistant director was hired in September 2009 to help support the program growth and so that future program innovations and strategic planning for the next five years might be accomplished.

Conclusions
The PNSO research program is a user-friendly program that ensures success of the participating clinical researchers. Unlike traditional research programs, this program is designed to teach research to bedside clinicians; no previous research background is required.

Not only has the program resulted in the professional growth of the participating clinicians, but the studies have helped improve the care we provide our patients. In fact, the program has changed the way many clinicians think about evidence-based practice because it is an important, essential, and expected part of practice—and indeed, it is doable.