CONTINUOUS PARTICIPATION, cooperation, and collaboration in scientific research at all levels of nursing are required to attain optimal, high-quality patient outcomes. The whole nursing community-from nurse scientists to nurse leaders, executives, and the clinical nurse at the bedside-is responsible for fully understanding why, how, when, to what extent, and who is responsible for each intervention. Yet how often do nurses participate in research to advance evidence-based nursing practice? All members of the nursing community can help enhance the profession through participation in scientific inquiry. To explore the concept of collective partnership among members of the nursing community, this article presents a dissertation-based recruitment exemplar describing one nurse scientist's original research. This recruitment exemplar offers a unique perspective on the potential drivers and barriers to nurses' participation in research.
Why research?
Clarifying the connection between nursing research and patient outcomes is necessary to help nurses understand their important contributions to research and encourage them to participate.1 For example, the impact of a clinical nurse's competence on an organization's financial status cannot be gauged without staff participation in research.
Like nursing practice, nursing research is a multifaceted process with many potential points of failure. There are myriad difficulties in engaging every nurse in nursing research, and recruiting participants can be difficult. The American Nurses Association (ANA) Code of Ethics for Nurses includes an expectation that in all roles and settings, the nurse scientist within the nursing community advances the profession through research and scholarly inquiry. The nursing community must embrace and participate in research. The evidence presented in this article, both through the literature review and the original research recruitment exemplar, reveals that the nurse scientist or primary investigator, the healthcare industry, and the nurses failed to meet minimum expectations of compliance with the ANA's recommendations.
Making connections
Although most nurses agree that research is important, nurse participation in research is lacking.2,3 When surveyed on why they do not participate in nursing research, many nurses say a lack of time is a major limiting factor.3,4 Other commonly listed barriers were a lack of resources and/or an organizational culture that does not support clinical nurse research participation.2,5 Other priorities and a lack of interest in the research were also among the barriers listed, as was an inadequate educational basis for understanding literature, research methodology, and the ability to leverage existing supportive networks.2,5
Moulton and colleagues stated that all nursing research should eventually impact patients in the practice setting, but that does not mean that all research must be directed at a patient.6 Perhaps this is one of the difficulties of nursing research. Potential nurse participants do not make the connection between how nursing research focused on nurses will eventually impact patient-care delivery. In a 2018 study, participating respondents indicated that participating in research had minimal benefit for nursing practice.1
In addition, many nurses do not appreciate how accessing the nurse scientist can improve and enhance the clinical nurse's practice. In the clinical setting, the nurse scientist can provide insight into statistical data such as quality improvement activity results, evaluation of National Database of Nursing Quality Indicators(TM) reports, identification of root causes using statistical tests, and report writing to validate staff utilization. As new policies and interventions are implemented, nurse scientists can help evaluate the practices for improvements using scientific methodology. A nurse scientist could assist in the Magnet(R) designation journey for the Magnet Force: New Knowledge, Innovations, and Improvements with gap analysis as well as study design and conduction. Finally, a nurse scientist would be a necessary addition to an institutional review board hosted by an organization that conducts, or aims to conduct, original research. Research could also help organizations navigate challenges such as recruitment issues, for which a multimodal research approach may be effective.7,8
Nurse scientists and nurse educators must make the connections between nursing research and its impact on the practice setting, and practitioners must be willing to investigate and evaluate the connection when asked to participate.6
Recruitment exemplar
The research for the dissertation recruitment exemplar described in this article was multiphase. Its cross-sectional, mixed-methods methodology included a survey, focus groups, and a Delphi validation process. However, only the survey process will be discussed in this article. For the purposes of the article, the term "system failure" will be used when the healthcare system did not support the clinical nurse in research participation and "participant failure" will refer to examples of potential participants not taking advantage of the opportunity. The author of the recruitment exemplar as well as this article will also be referred to as the nurse primary investigator (NPI).
The first phase of the project, an online survey titled "Leader at the Bedside," was conducted between October 2018 and April 2019. The research was designed to engage clinical nurses in nursing science, to identify bedside nurse leadership competencies that could be used to improve clinical nurse education and training, and to potentially improve patient outcomes. The survey consisted of 95 questions and took about 15 minutes to complete.
More than 80 US hospitals were given the opportunity to have their nurses participate in the research. In keeping with scientific requirements, the NPI obtained permission from each organization's leading nurse executive before recruiting nurse participants. The NPI's first contact was often the administrative assistant for the organization. One administrative assistant, after the NPI briefly explained the research, said before concluding the conversation, "We don't do that. We are not interested in research." Assuming the potential clinical nurse participants would have completed the research activities, this was an example of the supporting healthcare organization(s) not providing the potential RN participants a research opportunity.
Out of the 80 originally selected hospitals, only 23 agreed to allow the nursing research to be conducted at their hospital(s). The research methodology required the CNO/Director of Nursing (DON) to forward an invitation email to the RNs employed by their acute care organization(s). The email included the electronic link to the survey, which took 10 to 20 minutes to complete. However, participation in the survey was low. Only eight nurses started the survey between October 2018 and December 2018. Of those eight, only two fully completed it.
Between December 2018 and January 2019, the NPI accessed nurses at a few select hospitals to attempt to improve survey participation at their organization. These nurses were able to get two more RN participants to access the survey, but neither fully completed it.
To better understand the lack of RN participation in the survey, the NPI spoke with one of the CNO/DONs who had initially agreed to forward the invitation email to nurses at their organization. The NPI discovered that the CNO had forwarded the RN invitation email to his directors for distribution to the frontline clinical nurses, but the directors had not forwarded the invitation email. Again, the RN participants were not given the opportunity to participate in the research. This was another example of system failure in that the organization's leadership culture did not support RN participation in nursing research.
One participating DON later contacted by the NPI stated that she had sent the email to nurses and had talked to them about it repeatedly. "I don't know why they won't do the survey," the DON said. In this case, the participants failed to take advantage of the opportunity.
In March 2019, the NPI switched to a hardcopy survey distributed to several local acute care hospitals, where an additional 23 surveys were completed before the survey data were collected at the end of April 2019. It is important to note that a volunteer staff member from each participating hospital distributed the survey to interested clinical nurses.
Discussion
Nurses at every level must be committed to contributing to fully understanding nursing practice, but participation in nursing research requires effort and consumes resources.9 To ensure optimum resource utilization, each member of the nursing community must make efforts to understand how the research will impact the nurse in his or her practice and how it will benefit the patient. For example:
* The nurse scientist must ensure that expected connections between the research results and patient outcomes are included in marketing materials and during the recruitment process.
* Nursing executives and their representatives, such as administrative assistants, must be willing to spend the time to understand the research-outcome connection(s) when offered research opportunities.
* Practicing nurses and other research participants must seek to understand the research-outcome connection when opting in or out of a research opportunity.
* The nurse scientist-participant relationship should be developed early in the nurse's career.
Recommendations and lessons learned
Adding alternate venues of recruitment and survey distribution may improve organization participation. Broyles and colleagues recommended onsite and/or peer-to-peer interaction, scheduling flexibility that could include stakeholder planning and involvement, and sensitivity to the investigational research topic.7 Heath and colleagues reported that flexibility in data collection methods increased participation, such as a mix of face-to-face interviews, text messaging, and email interviews.8
In the recruitment exemplar, the NPI did not emphasize the importance of clinical nurse participation in the research and explain the connection between patient outcomes and clinical nurse research participation during marketing and recruitment efforts. Further, the participating clinical nurses should have investigated and evaluated the research-outcome connection.
In the recruitment exemplar, the research was designed to engage clinical nurses in nursing science and to identify bedside nurse leadership competencies that could be used to improve clinical nurse education and patient outcomes. While keeping the recruitment materials brief and succinct is important, it is equally important to emphasize the connection between research and outcome.
Future directions
More research is needed to overcome the barriers between the nurse scientist and the nurse participant. More research is needed to understand the drivers and barriers to research participation by all nurses. Improved healthcare industry support for nursing research is needed to allocate time and resources. Improved understanding by practicing nurses of the research-outcome connection is needed, which in turn should improve participation rates.
Nurses at every level and in every position voice the importance of nursing research. However, when push comes to shove, very few actually engage in it. Nurses know in their hearts that the only way to continually improve nursing practice and the patient experience is to learn more about how, why, what, by whom, and when nursing interventions are best implemented. Research participation is, therefore, mandated to ensure nursing practice remains relevant to, supportive of, and actively protecting our patients.
REFERENCES