Nursing seems to be dichotomizing the research process and other approaches to obtaining evidence.1 Although there appears to be agreement that patient care practices and outcomes must be evaluated on a continuing basis, nurses with differing graduate degrees are being categorized as those who can do research and those who cannot or should not. A recommendation at the national level to develop a "nonresearch clinical doctorate in nursing" proposed to educate nurses to be leaders in healthcare, enhance decision making, and focus on quality.2 Does this recommendation suggest that nurses who graduate with a clinical doctorate (DNP) must not conduct research? If so, this position presents a conundrum when nurses with associate and baccalaureate degrees, at a 391-bed Magnet(R)-designated community hospital, are primary investigators of studies and 1st authors on publications in peer-reviewed journals.3,4
Definitions of research range from "systematic inquiry that uses orderly, disciplined methods to answer questions or solve problems",5 or a broad understanding of the process, to definitions that include the words "new," "original," and "generalizable."1,6,7 These words suggest that research always describes a process that leads to original or new findings and results are generalizable. The federal definition of research, "a systematic investigation, including research development, testing and evaluation, designed to develop or contribute to generalizable knowledge,"8 uses the phrase "contributes to" in relation to whether or not results of a study can be generalized. There are 8 steps in the research process: construct a question; review previous research; select a design; identify measures; describe an intervention, if appropriate; collect data; analyze date; and disseminate results.5 To obtain evidence to support clinical practice, 2 or more steps may be used. For example, a question may be constructed, and a review of literature may be conducted. Information discovered from those 2 steps may contribute to a practice change. If all 8 steps are addressed and a randomized controlled trial is conducted, results may be generalized. The words and phrases used are important because they form the basis for distinguishing between research and other approaches to obtaining evidence. The term research does not necessarily imply the generation of new knowledge or that results are generalizable. In relation to new knowledge, many research studies replicate previous work. The results of randomized controlled trials are generalizable, as are some quasi-experiments. Descriptive research is not generalizable.
Although it is acknowledged that "subtle" differences exist between a quality improvement (QI) approach to obtaining evidence compared with research,1 the recommendation is frequently put forth that nurses with clinical doctorates should use QI methods and not the research process. The focus of QI is on specific organization or patient population outcomes and could involve all or a number of the steps associated with the research process.5,9 Would it not be better to encourage nurses obtaining a DNP to learn the research process and apply appropriate steps to resolve clinical questions? According to Reavy,9 it is the depth and rigor of clinical experience versus research experience that differentiate the clinical doctorate from the PhD. If a project is limited to improving care based on available evidence in 1 setting, it could be labeled QI.
If DNP students and graduates are advised not to conduct research, they may face limitations in their careers. Projects conducted by DNP graduates submitted as QI projects are less likely to be published than studies categorized as research, and funding is largely unavailable. Furthermore, DNP students may design projects with the understanding that, because they are labeled QI, institutional review board approval is unnecessary. This also may be a limitation for publication.
Is this dichotomy necessary? Could DNP students use whatever steps in the research process are useful given their topic of interest? Could they not use the term "research" when appropriate and "QI" when appropriate? The rigidity of conveying to a group of healthcare professionals that they cannot use the 8 steps to obtain evidence to improve practice and call those steps research is limiting to that group of nurses. Individuals who obtain clinical doctorates in physical therapy and psychology have the skills to conduct research and are encouraged to publish their work as research. It seems that preventing nurses from doing the same creates divisiveness and is harmful to the profession and, ultimately, our patients.
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