A scoping review of outcomes of operational success for nurse scientists in clinical practice settings

Highlights

• The role of the nurse scientist in clinical settings has evolved over recent decades.

• The definition, operationalization, and measures of success in these roles vary widely.

• Understanding gaps in role expectations and measures of success can refine the role.

• Improved infrastructural support for nurse scientist roles can advance nursing science.

• The future of nursing and health policy may benefit from nurse scientists in practice settings.

Abstract

Background

The nurse scientist in the clinical setting is a role that has evolved over recent decades to encompass the concomitant development of personal research programs and the facilitation of staff and advanced practice nurse research in health care settings. However, the definition, operationalization, and measures of success are extremely variable.

Purpose

To identify the defining features and characteristics of the nurse scientist role in clinical practice settings as represented in the existing literature.

Methods

We conducted a scoping review using PubMed and CINAHL databases. We initially identified a total of 3345 references from 1976 to June 2020, 217 of which were published from 2005-2020. We used the Joanna Briggs Institute (JBI) framework to explore the state of the science of the role of nurse scientists in practice settings.

Discussion

Approximately 100 articles met the criteria for full-text analysis, and the final review consisted of 20 descriptive analytic studies addressing the nurse scientist role definition, operationalization, and outcome measures.

Conclusion

Findings suggest that nurse scientist roles serve to promote health system success through a host of research-focused activities that conceivably contribute to improved patient care outcomes. Work is needed to support the cost of requisite resources and infrastructure and to increase acceptance of the role as part of a tenure-earning track in academic settings that also stand to benefit.

Introduction

Roles for PhD-prepared nurses in the clinical setting began to appear in the 1980s and 1990s (Grant, 1999; Mayhew, 1994). With the establishment of the National Institute of Nursing Research (NINR), widespread recognition of nursing research was beginning to take hold, and visionary nursing leaders in hospitals and health systems recognized the need to link nursing research more directly with patient care (Bostrom, 1994; Zelauskas, 1988).

Following the initial arrival of clinically based PhD-prepared nurses, a convergence of support for the nurse scientist role took place. Promotion of nursing research in the clinical setting became more prevalent with the American Nurses Credentialing Center's (ANCC) introduction of Magnet accreditation (McClure, 1983). The intent of Magnet criteria was to encourage the provision of infrastructure and support for nursing staff to be mentored in generating new knowledge and adopting existing evidence in the clinical setting with the goal to improve patient care (ANCC, n.d.). With these new expectations, nurse leaders needed research experts to advance these efforts. As hospitals meeting Magnet criteria have increased in number by nearly three-fold over the last two decades, the need for experts has become even more apparent. Currently, 547 (8.9%) of United States (U.S.) hospitals are recognized as having achieved Magnet status (ANCC, n.d.).

The premise for the nurse scientist in the clinical service setting was solidified with the Future of Nursing Report (Institute of Medicine, IOM, 2011). The report promoted bridging academia and clinical practice to inform the practice setting of emerging science by creating a role model for nurses desiring to return to school for higher education. The nurse scientist acted as a representative liaison in the policies and politics of the clinical setting as related to academic preparation. To advance the objectives set forth in the proceedings of the Future of Nursing campaign, the American Association of Colleges of Nursing (AACN) also sought to establish partnerships between hospital settings and academic settings (American Nurses Credentialing Center 2021, American Association of Colleges of Nursing (2021)). The objectives for the AACN were to further the mission of Magnet recognition and to assert the value of a role that encouraged academic involvement in health system efforts to achieve Magnet criteria (Petit, 2015).

Persistent national and international interest in the growth of Academic-Practice Partnerships (Enders, 2016) has supported the generation of new evidence, primarily in the form of research, although also including program evaluation, quality improvement, and implementation science. The Academic-Practice Partnership roles described in the AACN's New Era Report (Enders et al., 2016) depict the relationship between doctorally prepared academic nurses and health system nurses and care teams, providing a strong evidence base for practice. Efforts to date support improved patient-level quality outcomes and strengthen nurses’ critical thinking skills, job satisfaction, life-long learning, and professional development through Magnet accreditation (ANCC, n.d.-a). While support for the nurse scientist role has increased through this convergence of thinking, in many cases the scope of practice, operational role expectations, and measures of success for this role remain highly variable and loosely defined.

With the increasing focus on generating and implementing evidence, the drive to meet Magnet criteria, and the corresponding increase in hiring nurses to lead these efforts, a widely accepted definition of the role is needed. However, a definition that encompasses the broad scope of practice and an understanding of the requisite structure and support needed in these roles is unclear, both in the literature and in clinical practice settings. This gap has evolved in part from the fact that the term 'nurse scientist' has been used both in clinical and academic settings with very different meanings and role expectations. For example, the titles and qualifications of nurses in these roles are immensely varied (e.g., Masters-prepared, DNP-prepared, PhD-prepared) as are the titles of the roles themselves (e.g., nurse scientist, Director of Nursing Research, Director of Nursing Practice and Education). A lack of consistent nomenclature has led to a limited understanding of what nurses appropriately hired into these positions can achieve.

Definitions of the nurse scientist role as outlined in the Future of Nursing initiative (IOM, 2011) and operationalized at the National Institutes of Health (NIH) Clinical Center (NIH Clinical Center, 2020) specify that the nurse scientist functioning in a clinical setting is a nurse with advanced preparation in research principles and methodology (i.e., PhD in nursing or related field) who also has expert content knowledge in a specific clinical area. Expectations of the role are as follows: (1) providing leadership in the development, coordination, and management of clinical research studies; (2) mentoring staff nurses in research; (3) leading evaluation activities that improve outcomes for patients; and (4) contributing to the larger body of health sciences literature (NIH Clinical Center, 2020). The nurse scientist as defined by the NIH Clinical Center is expected to develop a portfolio of independent research that provides the vehicle for achieving these primary objectives. The extent to which this definition, the expectations for performance, and the standards for measurable outcomes are generalizable across clinical care settings in the U.S and abroad remains unclear.

While the original definition of the nurse scientist has been well-specified, adoption into practice remains highly variable. The culmination of varying perspectives on the role and goals of the nurse scientist has created confusion; therefore, health systems are subject to a wide variation in implementation, scope of practice, and quality of measurable outcomes. In addition, this variability has created a breeding ground for the generation of poorly designed, less than rigorous studies, which fail to meet the original intent of contributing generalizable evidence to the broader body of nursing science. More fundamentally, because of the variability in role definitions, infrastructure, and support included in hiring packages, evidence for the effectiveness of “current state” nurse scientists in clinical practice settings is challenging to interpret.

The purpose of this article is to report a scoping review of the literature regarding the nurse scientist role in the clinical health care setting. The specific objectives of this review are to examine the current state of nurse scientist role definitions and scope, explore how the role is operationalized in the clinical setting, identify common measures of success, and describe requisite support and infrastructure deemed necessary for the growth and success of the role. Based on these objectives, the research questions were as follows: (1) What is the role definition of the nurse scientist in the clinical setting? (2) How is the role operationalized? (3) What are the measures of success in the role?