Involving staff nurses in research can be challenging, but is possible. At The Queens Medical Center, the largest private, not for profit, acute care hospital in Hawaii, we forged a partnership with the University of Hawaii (Manoa) School of Nursing and Dental Hygiene (SONDH) to promote participation of staff nurses in research. One of our first projects was a smoking cessation study. In this article, I describe how the partnership works and the outcomes of the study.
Building the partnership
Barriers that can hinder staff nurse participation in research include lack of knowledge about research, insufficient management support, limited time, inadequate funding, and the production of research findings not applicable to the clinical nurses’ practice.
Our partnership was designed to break down these barriers.
A clinical nurse interested in a particular research question or area was paired with a faculty member who had research expertise in the area of interest. The faculty member provided expertise in research design and proposal writing, and the staff nurse provided clinical expertise that helped in designing interventions.
Working together, the two submitted a seed research grant proposal to the Cooperative Research Partnership Review Committee, composed of representatives from SONDH and the Queen’s Medical Center, for funding. The partnership grant helped to break down barriers by providing funds for time spent on the project and administrative support. Approval of research protocols was received from both agencies’ institutional review board.
The medical center’s nursing institute funded informational sessions and research workshops for interested staff nurses and provided support for dissemination of research findings through reimbursement of conference fees. The article Nursing Research Fellowship: building nursing research infrastructure in a hospital further discusses steps taken to build the medical center’s nursing research infrastructure.
The chief nursing officer (CNO) budgeted 8 hours of paid time a month for the lead staff nurse researcher; it was up to the researcher to use the paid time to accomplish what needed to be done. The unit’s nurse manager allocated additional paid time for the rest of the selected staff nurse researchers and provided paid time off for them to attend informational sessions. There was also in-kind support provided by the CNO and unit-based manager in the form of use of existing resources such as the computer room, printers, telephones, and a secured cabinet to store research data.
The SONDH research office provided statistical assistance and handled the grant funding process. Faculty members received workload credit to participate in research and scholarship. The research partnership team jointly worked on resolving emerging problems, analysis, and dissemination of findings.
Identifying a research idea
Often performance improvement projects can lead to the development of research questions, and this was the case with the study related to smoking cessation, part of the initial cohort of research projects in the partnership. The study grew out of a staff nurse’s project on a medical unit where patients are generally admitted for pneumonia, heart failure, diabetes, cellulitis, and GI bleeding.
The research was a feasibility intervention using staff RNs as smoking cessation coaches to teach smokers under their care. The staff nurses were already assessing patients’ smoking status and providing smoking cessation education; funding for the project enabled staff to be trained for the intervention. The nurses in the intervention arm were certified in basic tobacco intervention skills by the state department of health. The team also attended a daylong motivational interviewing course taught by an external expert consultant.
Participants in the study were patients 18 years of age or older who smoked and were admitted or transferred to the study medical unit. The staff nurse researcher identified potential subjects before requesting the Clinical Trials Office staff to obtain consent and complete smoking history and demographic questionnaires with patients. Once this was done, the RN coaches were notified and the intervention implemented. Follow-up calls were done 2 weeks post discharge to determine the effect of the smoking cessation intervention.
In all, 12 patients consented to be in the feasibility study, but only 6 subjects completed through the 2-week post-discharge follow-up phone call. Of the six, most (83%) reported 12th grade as their highest grade completed and all earned less than $40,000. The sample included of mix of ethnic groups that make up the state’s population.
At the 2-week follow-up phone call, 50% reported still smoking and 50% reported they had maintained their smoking abstinence. Of those who continued to abstain from smoking, 66% (2 out of 3) had tried quitting before enrolling in the study.
A larger study with longer follow up is needed to fully determine the effectiveness of this intervention. The research team had an opportunity to present their results at a Pacific Institute of Nursing conference.
We learned several lessons from conducting the study.
Changes may need to be made due to conditions beyond the researcher’s control. The study was initially designed as an intervention study comparing the use of one designated staff nurse to do all smoking cessation intervention versus the use of all trained staff RNs to deliver the smoking cessation intervention to smokers under their care. A variety of factors kept patient enrollment low, so the research was changed to a feasibility study with the intervention being done by all the trained staff RNs. Changes in research personnel also required resubmission to both organizations’ IRBs.
It’s important not to overestimate the number of subjects. Changes in reimbursement resulted in short lengths of stay (average of 3-4 days on the unit) This short time frame limited the ability to provide smoking cessation education. Patients were too sick or in too much pain to be interested or receptive to the study, and once they were well enough to be receptive, they were discharged. In addition, fewer patients were interested in forced abstinence during hospitalization than we had expected. This meant recruiting a sufficient number of subjects took longer than we had planned.
Education for staff interested in research should be provided early. Having introductory research workshops and preparatory classes in place before the research partnerships began would have instilled greater confidence and knowledge of the research process for a novice researcher. These classes could have armed the novice researcher with information such as IRB requirements, tips on writing a research protocol, or being prepared to deal with issues that arise.
Empowering staff nurses
Development of evidence-based practice through research partnerships not only serves to improve patient outcomes, but also diminishes the barrier between clinical practice and nursing research. As partnerships are fostered, the academic nurse researchers are able to pique the interest in research in clinical nurses. Through the support of administrators and managers, barriers can be broken down and staff nurses can feel empowered to undertake research projects.
At the time this article was written, Katrina Lu was a staff nurse at The Queen’s Medical Center in Honolulu, Hawaii, and Dianne Ishida was a professor at the University of Hawaii (Manoa) School of Nursing and Dental Hygiene.
Centers for Disease Control and Prevention. Annual Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses – United States, 2000-2004. Morbidity and Mortality Weekly Report. 2008;57:1226-28.
Hawaii State Department of Health. Behavioral Risk Factor Surveillance System (BRFSS) Prevalence and Trends Data. 2010. http://hawaii.gov/health/statistics/brfss/brfss2010/2010/demo10/rsmoker.html. Accessed August 15, 2013.
Improving America’s Hospitals: The Joint Commission’s Annual Report on Quality and Safety. 2010.
Jeffs L, Smith O, Wilson G, et al. Building knowledge for safe care: nursing research advancing practice. J Nurs Care Qual. 2009;24(3): 257-62.
Latimer R, Kimbell J. Nursing research fellowship: building nursing research infrastructure in a hospital. J Nurs Adm. 2010;40(2):92-98.