Clinical nurses cross into nursing research
Organizations are encouraging more nurses to turn questions into studies
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By Heather Stringer
EDITOR'S NOTE: Heather Stringer is a freelance writer.
Wound and ostomy nurse Mary Brennan, RN, CWON, didn’t have an answer when a nursing colleague at North Shore University Hospital in New York asked her whether it was common for a terminally ill patient to start bruising hours before her death. The patient hadn’t been injured, and Brennan saw the question as an opportunity to investigate further and delve into the realm of research
She met with Lily Thomas, PhD, RN, FAAN, Northwell’s vice president of system nursing research, and shared the question. Thomas encouraged Brennan to form a research team, and Brennan approached six palliative care nurses who were all eager to participate. Thomas taught the team how to review the existing literature, design a data collection tool and develop a proposal for the institutional review board at the hospital. Their findings suggested bruising could be an indicator of imminent death, and recently the team submitted an application for a federal grant to launch a national study.  Brennan is among a growing number of nurses who are leveraging their clinical knowledge to turn their questions, observations and concerns into research studies. Hospitals are increasingly open to supporting these investigators because the American Nurses Credentialing Center requires facilities seeking Magnet recognition to submit at least one IRB-approved nursing research study. The results of data analysis or findings must have occurred within 48 months prior to submitting written documentation for Magnet. In February 2019, the minimum will increase to two completed studies and one ongoing study, according to the ANCC.  For Brennan, discovering a new phenomenon was not only exciting, but also important for the nurses who had worried the bruising could be a pressure ulcer. “The skin change was a signal that the end of life was near, rather than negligence on the part of the nurse,” she said. “It could also alert family members that someone’s passing was imminent.”
Gullatte had been working as an administrator at Emory for more than 25 years, and her education and research experience made her an ideal candidate for mentoring potential clinical nurse investigators in this new role. She started by conducting a needs assessment among the organization’s 4,000 nurses, which showed they had a strong interest in research, but were uncomfortable with data analysis and statistics, and didn’t fully understand the research process. In response, Gullatte developed the Nursing Research Academy, which includes two eight-hour sessions covering topics like research methodology, the basics of statistical analysis, research ethics, how to rate the validity of different types of studies and how to write for publication. Nurses at Emory also have access to a biostatistician who provides data analysis support. Gullatte accepts 40 applicants for the annual class, and they spend the last part of the course developing their own research questions and hypotheses. “One of the things I’ve noticed is that nurses want to solve big problems, and I work with them to narrow their questions and focus on something they can manage in a study,” Gullatte said. “They are also accustomed to the fast-paced acute care setting, and research is not fast and furious. I help them understand that a study could take 12 to 24 months from inception to completion of data analysis.” After the course, Gullatte works with nurses who have viable research questions to help them submit a proposal to the IRB, perform the study and eventually disseminate their findings within the health system and at national and international nursing association conferences.  
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The nurses are hungry to know more about research and get involved. They want to make a connection between clinical care and the skills they learn in school.”
— Margaret Barton-Burke, RN
Creating space to learn
Time to explore
During the second four hours, participants work on their own projects and meet one on one with a nurse scientist. They also are allotted eight days during the year to conduct their research project, which typically includes completing the IRB application, gathering and analyzing the data and disseminating the findings of the study, Barton-Burke said. One of the fellows is a nurse anesthetist who is studying whether higher levels of anxiety in women undergoing breast cancer surgery increases the amount of anesthesia required to sedate the patient. “If the data shows that this is true, then the next step would be to develop an intervention for these women,” said Barton-Burke. Nurses at MSKCC have been so eager to launch studies the facility hired three additional nurse scientists within the last three months. “The nurses are hungry to know more about research and get involved,” Barton-Burke said. She attributes the high level of interest in part to the research courses nursing students are taking in baccalaureate or master’s degree nursing programs. “They want to make a connection between clinical care and the skills they learn in school.”
She also recognizes nurses with busy schedules would benefit from virtual forms of support, and as a result she created an online Research Interest Group. Davidson sends information to the e-mail list — which includes 100 nurses — about scholarships, grants, opportunities for networking and calls for abstracts at upcoming conferences. The list also is used to cultivate positivity about research by congratulating each nurse who presents and publishes his or her work. The organization also stimulated interest in research last year by creating a new program in which nurses could advance from a Clinical Nurse III to a Clinical Nurse IV — and one of the requirements for this promotion was conducting a research project. Prior to this change, nurses could only become a Clinical Nurse IV if they became educators, Davidson said. These forms of support for nursing research have been so successful that nurses turned in reports for 51 research studies for the last Magnet redesignation application in 2017. As a result of one nurse's study, nurses in some units started meditating during their breaks, and another nurse's study results led to the routine provision of music in the ICU as a way to decrease pain and promote relaxation for patients. Physicians also have started approaching Davidson to ask for nurses to work as partners on studies. “We’ve gone way past having clinical nurses simply serve as survey participants in studies,” Davidson said. “They are ideal investigators because they are closest to the issues that patients are facing, which enables them to generate knowledge that is more immediately applicable. They take pride in making a meaningful contribution that drives practice forward.”
Margaret Barton-Burke, RN
Judy Davidson, RN
In anticipation of the Magnet research requirements, some hospitals are hiring additional nurse scientists who are equipped to guide clinical nurses as they consider the possibility of conducting studies themselves. The chief nurse executive at Emory Healthcare in Atlanta asked Mary Gullatte, PhD, RN, APN-BC, AOCN, FAAN, if she was interested in becoming the system’s first full-time nurse scientist in 2015.
Mary Gullatte, RN
For many clinical nurses, another significant barrier to conducting research is carving out time to work on a study. At Memorial Sloan Kettering Cancer Center in New York, nurses who participate in the organization’s nursing research fellowship program are excused from their clinical responsibilities during the course sessions, said Margaret Barton-Burke, PhD, RN, FAAN, director of nursing research at Memorial Sloan Kettering. The class meets once a month for eight hours, and the first half of the day includes didactic sessions about everything from quantitative methods and analysis to budgeting for a study.
Although nurse scientists can guide clinical nurses who are interested in conducting research, librarians also are educated to help nurses with certain aspects of the process, said Judy Davidson, DNP, RN, a nurse scientist at UC San Diego Health in California. At this health system, librarian Mary Wickline, MLIS, MEd, is dedicated solely to nursing and allied health and she teaches nurses the nuances of conducting a literature search.
“Forming a search formula for different databases is like creating an algebra equation with words,” Davidson said. Nurses at UC San Diego Health have access to the full text of articles, and they can read these articles on their home computers.

Davidson also found nurses prefer one-on-one meetings with her more than didactic classes about how to conduct research. They find consultation more helpful because they can get answers to specific questions related to their projects, she said.

“Instead of learning about research, they learn through creating research,” Davidson said.
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Nurses cross into research
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Master the basics of EBP and learn how to start your own project.
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