A National Survey of Hospital Nursing Research Requirements and Outcomes*

2012 National State of the Science Congress on Nursing Research

Session Title: EVIDENCE-BASED PRACTICESession Date, Time: September 14,2012  8:30 AM-10:00

AM Maureen McLaughlin PhD RN, Medstar Georgetown University Hospital

Karen Gabel Speroni PhD RN, Inova Loudoun HospitalKathy Patterson Kelly PhD RN, Children’s National Medical Center

Cathie E. Guzzetta PhD RN AHN-BC FAAN, Children’s National Medical Center

Sameer DeSale, MS, Medstar Health Research InstituteAnnette Turner MSN RN, The Catholic University of America

(*Washington Regional Nursing Research Consortium)

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Introduction/Background• Noted variable IRB policies regarding whether

RNs can be PIs on RN-led research in the metropolitan Washington DC area hospitals

• Such IRB requirements present a potential barrier to clinical nurses functioning as PIs of their studies in hospitals

• Study investigators members of the Washington Regional Nursing Research Consortium (WRNRC)

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• To identify hospital and/or IRB requirements for RN PIs to conduct RN-led research

• To describe outcomes of hospital-based nursing research programs

• What are the hospital/IRB requirements for RN PIs: – RN education level &

qualifications?– Nursing research mentoring

processes?– Research education

programs?– Nursing research review

processes?• What are the scholarly outcomes

of hospital-based research programs?

• What are the facilitators and/or hindrances of RN-led research studies?

Purpose of Study/Research Questions

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• Descriptive, comparative national electronic survey of hospitals (purposive, convenience sample) – 798 hospitals from 3 groups:

• 202 Magnet-designated• 195 Children’s Hospital Association (CHA)• 401 The Joint Commission (TJC)

• HNRRO Survey: 60-item questionnaire; CVI = 1.0: 1. Educational & qualification requirements for nurse PIs 2. Nursing research mentoring process3. Nursing research education & training4. Nursing research peer-review process5. Scholarly research outcomes6. Facilitators and hindrances of RN-led research studies &

research productivity (2 open-ended questions)

Methods

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• Quantitative:– Category fields: chi- square test & Fisher’s exact test – Continuous variables: t-test, ANOVA, Wilcoxon rank

sum test, & Kruskal-Wallis test – Level of significance set at < 0.05

• Qualitative:– Conventional content analysis for 2 open-ended

questions – Verbatim comments downloaded from electronic

survey– 2 co-investigators worked with doctoral student to

code data– Responses analyzed together & then divided into

Magnet & non-Magnet hospital groups– Coding validated with 10% of dataset

Analysis

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• 20% response rate• Total 160 returned surveys (Magnet & non-

Magnet hospitals)– 66% (n= 106) Magnet hospitals – 34% (n= 54) Non-Magnet hospitals

• Non-Magnet hospitals = 29 (18%) TJC & 25 (16%) CHA

• Majority were not-for-profit & in urban areas • Magnet hospitals had > number of licensed

beds & full-time equivalent RNs compared to non-Magnet hospitals (p<0.0001)

Results: Demographic Findings

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• Only 8% (n=13) of hospitals had a minimum educational requirement to be a PI– More Magnet than non-Magnet hospitals had

no minimum educational requirement (p=0.02)

• 25% (n=36) of hospitals appointed a PI designee to sign IRB application if a RN did not meet IRB requirements to be a PI

Results: Educational Level & Qualifications Requirements for Nurse

PIs

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• Research mentors/leaders were available to guide nurses throughout the research process at the majority of hospitals (n=131, 83%)

• More Magnet (n=103, 98%) than non-Magnet (n=28, 53%) hospitals had research mentors (p<0.0001)

Results: Nursing Research Mentoring Process

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• 23% (n=37) required RN PIs to complete a research education course before conducting research

• 21% (n=33) had research education classes available to their nurses

• 20% (n=32) provided a nursing research internship/fellowship – Nearly all (97%) were expected to assume

various roles in research at their hospital

Results: Nursing Research Education & Training

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• Majority had a Nursing Research Committee (NRC) (65%) or interdisciplinary research council (31%)– More Magnet (83%) than non-Magnet hospitals

(30%) had a research council (p<0.0001)

• Majority required NRC or other persons to review (84%) or approve (73%) the nursing research proposal before IRB submission

• Majority required PI to report progress on study to research mentor (62%) or NRC (68%)

Results: Nursing Research Peer-Review Process

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• Hospitals reported an annual total of 4 studies initiated, 4 disseminated (podium/poster), 1 published, & 2 funded

• As hospital bed size increased, so did number of studies initiated (p=.03)– <100 beds = 1.95 studies– 101-200 beds = 2.76 studies– 201-300 = 2.94 studies– 301-500 = 3.61 studies– 501-700 = 4.42 studies– 701-1000 = 5.63 studies– >1000 = 6.4 studies

Results:Research Program Scholarly Outcomes

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Conclusion:

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Findings from this study provide a prototype & benchmark information for nursing administrators planning to establish,

evaluate and/or expand nursing research programs

• 95% of surveys included written comments• 960 units of analysis

– Facilitators• 477 Magnet, 107 non-Magnet

– Hindrances• 279 Magnet, 97 non-Magnet

• Total 24 codes (12 facilitator; 12 hindrance codes)

• Commonly facilitator codes had mirror hindrance codes representing lack of the underlying construct (n=10 mirror constructs)

Qualitative Results:Facilitators & Hindrances

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Facilitator & Hindrance Codes with Magnet & non-Magnet Rank

Facilitators Magnet Non-Magnet

Hindrances Magnet Non- Magnet

Nursing research mentor 1 1 Lack of time 1 2

Institutional research infrastructure 2 8 Lack of research knowledge or research training opportunities

2 9

Leadership support 3 2 Lack of financial resources for nursing research

3 3

Making research relevant 4 3 Lack of experienced nursing research mentors/ academic affiliation

4 1

Research training 5 4 Lack of institutional research infrastructure

5 5

Nursing Research Committee/Council 6 5 Intimidated by research 6 10

Nursing culture that supports research 7 7 Lack of leadership support 7 7

Research is part of the job 8 8 Nursing culture does not support nursing research

7 4

Financial & other tangible resources 8 6 Nurse educational level 8 6

Magnet 9 9 Nursing research is not a priority 9 9

Dedicated time for research 9 5 Lack of relevance to nursing practice, lack of interest

10 8

Impact of higher education 10 8 Lack of nursing research committee/ council

No report 9

• Findings based on respondent’s familiarity with institutional work

• Nursing research outcome data collected for years 2004-2008, other data provided in 2009 and/or 2010

• Findings likely overestimate influence of Magnet designation on nursing research in hospitals (66% our study vs 7% nation-wide)

Limitations

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Expanded prototype forhospital-based nursing research program:

Integration of quantitative & qualitative findings

Hospital InfrastructureInstitutional Research InfrastructureConnects nursing research with institutional research enterpriseLibrarian and online research resourcesBiostatistician consultationOnsite IRB with RN membershipImpact of Higher EducationRNs pursuing higher education (BSN, MSN, DNP/PhD)

Hospital CultureAttitudes and values that support nursing researchNursing Culture Supports Nursing ResearchBeliefs and behaviors that reflect the value of nursing researchLeadership SupportCNO and nursing and other leaders support essentialFunding for nursing research Resources to build nursing research departmentMaking Research RelevantLink research relevance to practice and EBPIntegrate EBP into nursing processesJournal clubsAnnual awards and recognition

Building a Nursing Research Program

Research Education & TrainingHospital-based research educationResearch fellowships/internships availableAcademic credit or continuing credit for classesAfter education, RN expected to serve as PI and conduct study including dissemination of findings

Nurse as Principal InvestigatorMeets institutional qualifications to conduct researchSigns IRB applicationAssumes all PI responsibilities

Policies & Procedures-Nursing Research Committee/CouncilNursing/Interdisciplinary Research Committee with membership from all levels of nursingCommittee facilitates ideas for researchCommittee does peer review of research proposalsCommittee reviews study progress reports as required

Tracking Research and Scholarly OutcomesNumber of research studiesNumber fundedNumber of presentations Number of publications related to study findings

Research is Part of the JobRN job descriptions includes research componentsPerformance appraisals specify research activitiesClinical ladder incorporates research criteria

Dedicated Time for Nursing ResearchPaid time to conduct research: includes release time, protected time or time off to conduct research

Financial and Other Resources for Nursing ResearchDedicated budget for nursing researchFoundation, intramural funding support for researchMonetary support for administrative assistants, consultants, computer softward, data entry and analysis, Travel funding for dissemination of findings

OutcomesEffect on care delivery

Effect on patient and family outcomes

Dedicated Nursing Research Mentor/LeaderEncourages & guides novice researcherRequired to take specific role on studyFacilitates research from study inception to dissemination of findings

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• Nursing leaders need to partner with IRBs to create policies (e.g., mentor guidance, education, peer review) to ensure hospital-based RN researchers can be identified as PI & assume all responsibilities

• Nursing leaders need to consider their hospital infrastructure, hospital culture, & components necessary for building a hospital-based nursing research program

• Findings provide prototype for nursing leaders to guide development of a new nursing research program & provide benchmarks to evaluate and/or expand an existing program

Implications

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Maureen McLaughlin, PhD, RNmmm116@gunet.georgetown.edu Karen Gabel Speroni, PhD, RNkgabelsperoni@smartneighborhood.netKatherine Patterson Kelly PhD RNkakelly@childrensnational.org Cathie E. Guzzetta, PhD, RN, AHN-BC, FAAN Cguzzett@childrensnational.orgSameer DeSale, MSSameer.desale@medstar.net Annette Turner, MS, RN03turner@cardinalmail.cua.edu

Contact Information

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