Nursing science fellowship at Boston Children's Hospital
Introduction
The development and implementation of hospital-based research infrastructures to foster nurse-led inquiry and evidence-based practice has been well described in the literature (Authors, 2019; Berger & Polivka, 2015; Johantgen, Weiss, Lundmark, et al., 2017; Pintz, Zhou, McLaughlin, Kelly, & Guzzetta, 2018). For many hospitals, the development and implementation of a nursing research infrastructure was included in their journey toward Magnet® designation (Berger & Polivka, 2015; Johantgen et al., 2017; Pintz et al., 2018; Turkel, Ferket, Reidinger, & Beatty, 2008). Hospitals have implemented various programs to promote evidence-based practice and research support, the specifics of which have evolved over time (Albert & Siedlecki, 2008; Authors, 2019; Gattuso, Hinds, Beaumont, et al., 2007; Johantgen et al., 2017; Latimer & Kimbell, 2010; Turkel et al., 2008; Wells, Free, & Adams, 2007). In a recent study, investigators examined characteristics of productive nursing research programs in Magnet® designated hospitals and found that organizations scored higher when there was a director of nursing research, department of nursing research, and had more than 10 studies published during the past five years (Pintz et al., 2018). However the investigators also found a number of barriers to support implementation of nursing research that related to lack of a designated budget and funds to recognize and support nursing research activities and accomplishments. In another study of Magnet® designated hospitals, investigators found the allocation of resources to support nursing research and clinical nurses' time away from the bedside remains a challenge (Johantgen et al., 2017). In these two studies, implications for nurse executives focused on establishing a designated budget for nursing research, individuals that can provide appropriate mentorship, and an infrastructure to sustain a research program (Johantgen et al., 2017; Pintz et al., 2018).
In January 2011, the Nursing Science Fellowship (NSF) was launched to provide a structured program of clinical inquiry and mentorship to generate pediatric nursing science and advance clinical practice. The NSF began as a program-based effort to support nurse-led inquiry across the cardiovascular and critical care units in response to the dearth of evidence supporting many pediatric nursing practices. Through a collaborative process between program-based nurse scientists and nursing clinical leadership, a formal infrastructure named the Cardiovascular and Critical Care Academy for Scholarship and Innovation in Pediatric Nursing was established to support scientific mentorship, advancement, and rapid dissemination of pediatric nursing knowledge (Authors, 2019). The first cohort of nursing science fellows who participated and successfully completed the two-year program consisted of three bedside nurses from across the cardiovascular and critical care units. This early experience of the NSF led to the progression of an enterprise-wide forum to facilitate clinical inquiry across [institution removed to ensure blind review] Department of Nursing and Patient Services. The vision, mission and values put forth by the Cardiovascular and Critical Care Academy for Scholarship and Innovation leadership served to inform development of the enterprise-wide NSF infrastructure and processes and to secure committed resources (Authors, 2019). We describe the initial development and implementation of the NSF, current infrastructure and oversight, and outcomes to date.
Section snippets
Clinical setting
The NSF is based in a large, urban, quaternary free-standing children's hospital located in the northeast of the United States. The enterprise spans two campuses and multiple satellite clinics. The main campus contains 405 inpatient beds and includes 4 specialty intensive care units totaling 101 beds. The hospital achieved Magnet® recognition in 2008, and has received Magnet® re-designation in 2012 and 2017.
Across the enterprise, nursing care is guided by the Professional Practice Model and
Nursing science infrastructure and oversight
Established in 2012, the Nurse Executive Committee for Research and Inquiry (NECRI) aligns clinical inquiry with nursing clinical operations across the enterprise. The committee is chaired by a nurse executive and co-chaired by a PhD nurse. The committee members include the chief nursing officer, nurse executives, PhD-prepared nurses, a DNP-prepared nurse, and Magnet® Program director. The development of NECRI and detailing of activities has been previously published (Authors, 2019). As the
Development of Nursing Science Fellowship
The NSF was developed as a two-year structured program of clinical inquiry and mentorship to advance nursing science. The experience integrates collaboration with nurse scientists, administrative leaders, and other interprofessional staff across the enterprise engaged in clinical research. As envisioned, the NSF allows each nursing science fellow to experience nurse-led clinical inquiry, which includes research, quality improvement science, and implementation science. To guide this experience,
Nursing Science Fellowship infrastructure
The NSF includes six nurse scientists who serve as faculty and assume responsibility for mentorship (Fig. 3). The NSF faculty are full-time nurse scientists who are engaged in their own program of research as well as facilitating the inquiry of nurses from their designated program within the hospital. Each of the NSF faculty hold appointments at schools of nursing and medicine including [institutions removed to ensure blind review]. The NSF employs one full time Master in Public Health
Enrollment, mentorship, and quarterly forums
Enrollment into the NSF is accomplished through completion of an application, confirmed support by the nurse's direct supervisor, and agreement by the NSF faculty. There is no exclusion based on the prospective fellow's academic preparation, clinical role, or clinical experience. However, it is expected that the applicant has participated in some form of prior clinical inquiry, which should be highlighted in the NSF application (Fig. 4). Upon enrollment, each fellow receives a formal letter of
Outcomes and impact
As summarized in Table 1, 84 fellows have enrolled in this two-year long program. Sixty-two nurses have graduated from the NSF Fellowship and 22 fellows are currently active. The NSF has supported the generation of 91 projects, with 36 considered quality improvement projects, 54 research projects, and 1 an evidence based project. Collectively, the fellows have received a total of 46 internal (35) and external (11) grants to support their projects. Twenty-one fellows have received promotions
Discussion
The practice of nursing inquiry in the healthcare setting has significantly increased as a result of the ANCC Magnet® recognition program (Johantgen et al., 2017; Pintz et al., 2018) as described in the fifth component of the ANCC Magnet® Model: New Knowledge, Innovation, and Improvements,
“Magnet organizations have an ethical and professional responsibility to contribute to patient care, the organization, and the profession in terms of new knowledge, innovations, and improvements. Our current
Leadership considerations
Clinical and scientific leadership collaboration is key to implementing and sustaining an enterprise-wide program of nurse-led clinical inquiry (Authors, 2019) that is a reflective of Magnet® recognition (American Nurses Credentialing Center, n.d.). The development and evolution of the NSF occurred alongside our Magnet® history. In both the first and second Magnet® re-designation, the NSF was recognized as an exemplar of the Magnet® component New Knowledge, Innovation, and Improvements.
We
Conclusion
The development and implementation of the NSF has resulted in an enterprise-wide effort to foster nurse-led clinical inquiry. The collaboration of nursing clinical leaders and nurse scientists to commit to a formal infrastructure and process of inquiry has led to a culture of inquiry. Staff guided by mentorship and support are empowered to generate, translate, and impact practice with evidence. Continued evaluation from the perspective of the nursing science fellows will continue to inform the
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
CRediT authorship contribution statement
Jean A. Connor:Conceptualization, Methodology, Writing - original draft, Writing - review & editing, Supervision.Sandra Mott:Conceptualization, Methodology, Writing - review & editing, Supervision.Michele DeGrazia:Conceptualization, Writing - review & editing, Supervision.Debra Lajoie:Conceptualization, Writing - review & editing, Supervision.Patricia Dwyer:Conceptualization, Writing - review & editing, Supervision.Mary Poyner Reed:Conceptualization, Writing - review & editing, Supervision.
Declaration of competing interest
None.
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