As nurses become more curious about best practices and the data that supports the care they provide, hospitals increasingly are bringing on experienced nurse researchers to lead evidence-based practice programs and guide staff nurses through the research process.
“It’s a big job,” said Wendy C. Budin, RN-BC, PhD, FAAN, director of nursing research at NYU Langone Medical Center in Manhattan and adjunct professor at New York University College of Nursing. “I’m involved in a lot of initiatives that help to develop, use, disseminate and illustrate the use of research in evidence-based practice to improve quality patient care.”
Nurses come up with the ideas to research, which Budin said makes her job easier.
“It’s nurse-driven,” agreed Pam Ginex, RN, EdD, OCN, who works part time as a nurse researcher at Memorial Sloan-Kettering Cancer Center in New York City and full time as a professor at Lehman College in the Bronx. “[The nurses] come up with ideas or problems they want to look at and work collaboratively with members of the team to address a specific problem.”
For instance, Memorial Sloan-Kettering nurses often treat patients’ constipation, but they had no standard best practices on how to deal with it. They conducted a literature search, found effective practices and established guidelines adopted by Memorial Sloan-Kettering, which also employs a full-time director of nursing research.
Nurse research drivers
Clinicians’ interest in improving care, not simply tending to patients, remains a prime driver of research taking place in the acute care setting.
“Research is the foundation of practice, seeking knowledge to give the best care,” said Lily Thomas, RN, PhD, vice president of system nursing research at North Shore-LIJ Health System’s Institute for Nursing in New Hyde Park, N.Y. She develops and coordinates innovation and implementation of evidence-based practice and maximizes the health system’s capacity for conducting research. She applies for and oversees grants, consults with the Nursing Research Council and supports intraprofessional collaboration, including patient, medication-safety, pressure-ulcer and fall-prevention studies. Nurses raise many of the questions and propose solutions, then Thomas collaborates. She calls the teamwork “the best part of my day.”
As nurses conduct research and their findings change care delivery, Thomas said it energizes them. “They see the results and get excited that they contributed,” Thomas said.
The American Nurses Credentialing Center’s Magnet Recognition Program’s emphasis on research has many hospitals investing more in such programs, said Ellen Rich, RN, PhD, FAANP, a nurse researcher at the Hospital for Joint Diseases at NYU Langone Medical Center, who said projects sometimes grow out of quality-improvement initiatives.
Jane O’Rourke, RN, DNP, NEA-BC, CENP, director of nursing for evidence-based practice at Montefiore Medical Center in the Bronx, calls quality management, which falls under her responsibilities, a good tie-in.
“Staff know they need to look at their outcomes,” O’Rourke said. “Where there seems to be opportunity, we can have staff look at what best practice is.”
O’Rourke reviewed pain outcomes with the dialysis unit team. The nurses sought to address pain at the needle-insertion site, scoured literature and learned changing the position of the patient’s arm and applying warm soaks could reduce the patient’s pain. They have changed their practice and now will collect data to determine whether the modifications to care make a difference. They then plan to publish their results.
“We’re hoping to add to nursing knowledge as well as [use the results],” she said. “We look for opportunities to do something different. It’s a matter of having it be everyone’s mindset who is practicing.”
Team playersEllen Rich, RN
Answering nurses’ clinical questions typically begins with a literature search, and then either an evidence-based project to test the findings or a full research proposal, including submission to the institutional review board. After that process, nurses publish their findings, Rich said.
“I’m the process expert; the nurses are the clinical experts,” Rich said. “The best part of it is seeing the growth in the nurses.”
When Michael Tagadaya, RN, ambulatory surgery center nurse manager at HJD, wanted to reduce loved ones’ anxiety, he followed this process, tested the use of paddle pagers to locate family members and, when that proved beneficial, the hospital began using them regularly. Other nurses at HJD are investigating boosting gastrointestinal motility after spine surgery.
Ginex finds staff nurses are becoming more interested in research and in tackling it as a group, often with support from nurse managers.
“Nurses don’t do it in isolation; they are part of a team,” Budin said. “The projects are exciting, and it’s great to see the results.”
Labor and delivery nurses at NYU Langone have investigated factors associated with exclusive breast-feeding and discovered having skin-to-skin contact within the first hour strongly contributed to exclusive breast-feeding. That led to changes in policy, and now 100% of moms delivering vaginally and their babies have immediate skin-to-skin contact. Budin said the number of projects and publication of findings have increased in the five years she has held the position.
Involving nurses in research requires education about the process and why it is important, O’Rourke said. A research committee at Montefiore conducts a Nursing Research Symposium, where staff nurses and local university faculty can present their studies.
NYU Langone introduces new nurses to research early. During their nurse residency program, novice nurses conduct a project under the guidance of a mentor. For veteran nurses, Budin conducts lunch-and-learn sessions to demystify research.
The nurse researchers said they enjoy their positions and the opportunities they bring.
“I can influence practice,” O’Rourke said. “It’s a role where you can be creative and focus on important care-quality issues. It’s very dynamic.”