By: Anne Summach, NP
Nursing Research is a phrase which elicits excitement in many, trepidation in others, and outright horror in a few. Regardless of your reaction to the idea of participating in it, research is a key way to advance the science of nursing, and, in particular, to highlight the benefits that the role of the Nurse Practitioner can have within the healthcare marketplace and society.
So what is Nurse Practitioner Research anyway?
There are different approaches and foci for research, and some differing opinions regarding the purpose of research with a Nurse Practitioner lens. One summary of the purposes of Nurse Research comes from Duke University, and highlights Health Innovation, Population Health, Precision Health and Data Science as topics which can be approached from a nursing perspective.
The question is: How should the ways in which Nurse Practitioners participate in research differ from those of the nurses who provide direct nursing care, nursing education, healthcare administration or nursing academic leadership? Jim Rankin, NP and Professor at the University of Calgary would argue that the focus of NP research should be on developing Evidence-Based Practice Guidelines with NP practice as the focus. He feels that it is critical that NPs have evidence that supports the manner in which we practice. Additionally however, Jim suggests that research from other disciplines can also inform our practice, since NPs operate at the cross-section of Nursing, Medicine, Psychology, Sociology and others.
Professors (and NPs) Edie Pituskin and Kathleen Hunter at the University of Alberta state that Nurse Practitioners are key “research consumers and evaluators”. NPs need to maintain up to date knowledge of evolving practice, need to have the capacity to critically assess research conclusions to apply them to their own practice, and to be able to contribute to clinical practice guidelines.
Ensuring that current research is asking and answering relevant questions is key. Jim Rankin asserts that asking if patients are “satisfied with the care of NPs” is old news – the question has been answered, and re-answered for thirty years and we should “stop asking it”. Instead, perhaps we should be asking about how NPs’ particular skill set contributes to improvement of clinical outcomes, and how health systems can be improved by the addition of more NP clinicians?
What are the existing barriers to NP research?
Unfortunately, and this is echoed by all of the researchers contacted for this post, most NP research is being conducted at an Academic Faculty level, for multiple reasons. NPs engaged in clinical practice experience a lack of time, lack of funding, lack of opportunity, and a lack of research training. They also may have chosen clinical practice because they aren’t particularly interested in research. These are all valid reasons to not participate in the research process. Especially with novice NPs, who are perhaps closest to their “research roots”, time is at a premium. Transitioning to a career as a clinician takes incredible focus and time to learn, which often precludes involvement in external research work. The traditional “role” of the NP in healthcare continues to be a barrier to the advancement of NP research. Identifying NPs as clinical supports for physicians alone disempowers them as independent scientists, a myth which is being actively deconstructed by NP organizations across Canada.
Structural factors also exist that erect barriers to clinical NPs participating in research, including a lack of access to key research supports such as statisticians, economists, and research assistants. Even if research is conducted, the costs and time associated with dissemination of findings through Open Access Publication and presentations can be substantial.
How do we push NP research forward?
What can be done to facilitate the expansion of Nurse Practitioner research, arguably one critical way to advance our profession in a field dense with other researchers? One method is to increase the involvement of Clinical Associates at academic organizations – allowing direct clinicians to participate as members of the team, rather than leaders, allows for growth and a gradual increase in research competence. Secondly, those NPs who are interested in ongoing research participation can reach out to centers conducting NP research and volunteer to be involved. It will be important to recognize that research teams depend on everyone in the team to be productive in whichever roles they hold. It may be that the practicing NP is a clinical champion, spearheading the coordination of the research at the site of practice. It may be that the NP advises the research team on their data plan, to ensure it aligns with local electronic health record capacity. There are many roles on the research team which could be filled by an NP.
Perhaps it would be beneficial to form a local NP Research Consortium which bridges academic institutions, healthcare organizations, and frontline clinicians. This has been done in Eastern Canada, with the establishment in 2000 of the Canadian Centre for Advanced Practice Nursing Research (CCAPNR) based at McMaster University. This group has been actively studying the work of NPs and how our roles can be evaluated. May key national NP initiatives and research projects have been initiated through this group.
If NPs are interested in guiding research, it will be important to guide them to possible sources of research funding. Larger grants are almost exclusively associated with academic institutions, and if NPs wish to participate they will need reach out to faculties which align well with their research interests. Smaller grants may be also available through funding for Alberta Health Services Clinical Teams, through Strategic Clinical Network seed grants, and from individual hospitals and organizations such as the Glenrose Rehabilitation Hospital, the University Hospital Foundation, or Covenant Health. Connecting with the research departments of faculties, professional practice leaders of health organizations, or local foundations may yield financial results.
So what’s your response?
Do you feel research-ready? Is NP research a priority to you? Do you miss the thrill of discovery? If there are NPs in Alberta who are committed to advancing research, perhaps forming a small, local interest group through the NPAA is the way to go. If there are projects already planned which engage with NP practice, publishing a call for interested participants in the Members Moments section of the NPAA monthly newsletter could yield opportunities for collaboration and synergy. Publication of research can advance our profession and enhance patient care across the healthcare continuum, from homes to hospitals. Let’s work on it together!
Editor’s Note: Thanks to the NP Researchers who participated in this post – Dr. Kathleen Hunter, Dr. Edie Pituskin, and Dr. Jim Rankin. Without people like you at the head of this charge, NP research would stall.
Here are some links to research sites for you to explore: