My Scope of Practice: Taking the Fear out of Research

    The American Nurses Credentialing Center (ANCC) awards magnet status to fewer than 5% of all US hospitals. Institutions seeking such recognition must excel in 14 Points of Magnetism, which are measures and benchmarks for professional practice.

When Alice Gordon, BSN, MA, Vice President of Clinical Operations and CNO at Billings Clinic, Billings, Mont, investigated pursuit of ANCC magnet status for her hospital, Celeste Dimon, MSN, Director of Women’s and Children’s Services, became a key player on the magnet project team. Celeste saw magnet status as a way to validate nursing excellence. After an initial unsuccessful attempt to achieve magnet status (due, in large part, to deficiency in nursing research efforts at their organization), Celeste and Alice “took the bull by the horns.” They developed a process to get nurses involved in clinical studies by creating a Research Council that acts as the clearinghouse for all nurse-led research. Magnet documentation has been submitted and now Billings Clinic awaits word on the next step in the process, which if successful, would entail a site visit by ANCC appraisers.

    In nursing since 1976, Celeste came to what was then called Deaconess Billings Clinic in 1999 from Port Huron Hospital, Port Huron, Michigan, where she had served as a CNA, RN, and Birthing Services LDRP Clinical Coordinator for 24 years. She earned her Master of Science degree in Parent-Child Nursing and Midwifery from the University of Michigan. Billings Clinic, a 272-bed “foundation” model system, similar in structure to the Cleveland and Mayo Clinics, attracted her — its “physician led, professionally managed” style of healthcare promotes Billings Clinic clinicians to be committed and intimately involved in making the system the best it can be. Using her experience in leadership and skills in parent/child nursing, Celeste assisted Billings Clinic in “going back into the baby business” after a 20-plus year hiatus. Celeste is an advocate of single room maternity care. “The LDRP model supports the concept of all providers of mother and newborn care working together to provide a systems approach for the family during the birth of a baby,” she says. “The ability to provide prenatal care, birth care, newborn care, and pediatric care — all within our system — creates a seamless approach that we believe promotes excellence in care.”

    Drawn to the need to strengthen nurse-led research opportunities available, Celeste helped establish the Billings Clinic Research Council. “The Council was our first step in laying the foundation for how nurses might approach research at Billings Clinic,” she explains. “We invited two professors from Montana State University-Billings School of Nursing to join our Research Council and serve as our research experts.” Alice Gordon became Chair of the Council, which now meets monthly.

    Celeste acknowledges that research has a negative connotation for too many nurses. “They initially have difficulty putting their research ideas into a viable research format and often struggle with trying to figure out the correct approach to take,” she says. “Valid research must be rigorous and cover all the bases. People are afraid they will fail.”

    In the Billings model, once nurses pose their basic research question, the Research Council assigns a research expert member to assist. These Council members, either Masters- or PhD-prepared nurses, provide support and direction to help the RN Research Lead. “Between 70% and 75% of our nurses at Billings Clinic are BSN-prepared but they still appreciate the help provided by advanced level RNs who are passionate about research and continually promote the dividends that nurse-led research can provide to our profession,” says Celeste.

    To reduce the research intimidation factor, Celeste developed a step-by-step approach the staff RN would use for research project start-up (see Figure 1). The steps, available in booklet form, include:
  • RN proposes a research question or idea for a nursing research project
  • RN submits a one-page Nursing Research Idea Form to the Research Council (see Figure 2)
  • Lead RN (and team members, if appropriate) attends Research Council meeting to present and discuss research idea
   • Research Council reviews proposal, utilizing critique criteria
  • If the proposal is accepted, Lead RN and research team are assigned an expert from the Research Council to facilitate process
   • Research expert meets with RN Lead and research team (if appropriate) to further discuss concept/question
   • Research idea continues to be refined using critique criteria as a tool
  • Literature review is done for current evidence
  • Further refinement of question, conceptual framework, and development
  • Development of timeline for research project
  • Determination for additional resources
  • Submission to IRB (if applicable)
   • After approval from IRB, add project to Research Council Tracking Form
   • Request funding from Friends of Nursing (if necessary).

    The Council found another way to lessen the fear factor: the Great Cookie Experiment. “While not a new idea, this basic and fun approach to research helped get us started,” Celeste says. “We rated cookies baked with traditional ingredients against cookies baked with healthy ingredients, collected the data, and tallied the results to demonstrate the basic research process. We really want to convey the message that nurses can, and should, be a part of the research that impacts their practice.”

    In her current Director capacity, Celeste can indulge her primary passion — caring for women. “I have been involved in women’s care my whole professional life,” she says. “I’ve had the opportunity to set up new care systems and create enviable birth experiences using the single-room model, providing a positive, safe birth experience for the moms and their families. Women’s care and creating such birth systems have truly been the high points of my career thus far.”

    The magnet experience, Celeste says, is exciting in a different way. According to the ANCC website, https://nursecredentialing.org/magnet/contact.html, the Magnet Recognition Program® was developed to acknowledge healthcare organizations that provide the very best in nursing care and uphold the tradition within nursing of professional nursing practice. The program also provides a vehicle for disseminating successful practices and strategies among nursing systems. “In short, bedside nurses don’t have time to toot their own horns,” says Celeste. “Becoming a magnet facility offers a way to recognize nursing’s role, validate exceptional care, and share important care methods.”

    The ANCC magnet recognition is based on quality indicators and standards of nursing practice defined in the American Nurses Association’s Scope and Standards for Nurse Administrators. The designation process includes appraisal of both qualitative and quantitative factors in nursing. “We’ve spent months pulling our documentation together,” says Celeste. “Our Magnet Team continually reviewed and rewrote our documentation submission information to ensure we were presenting our best efforts in order to meet the 14 Points of Magnetism. We currently await word on whether we will be granted a site visit, which is the next step in a successful Magnet recognition process. Once achieved, the recognition is good for 4 years, with interim monitoring required annually. The re-designation process, which takes place during the fourth year, doesn’t appear to be quite as intensive as the initial submission.”

    Along with the rewards of being a magnet hospital come the challenges of today’s healthcare climate. Celeste says they are lucky her facility’s nurse vacancy rate, a problem plaguing many facilities, is only 4%. “Orienting new staff is time-intensive and expensive. We have been fortunate in maintaining consistency in our nursing staff, which in turn, allows us to focus energy on quality initiatives.” However, like other institutions, Billings Clinic faces reimbursement and budget issues. “The public wants the latest and greatest equipment and technology,” Celeste says. “It’s a continual, but very rewarding, balancing act.” Uninsured patients also are a concern that requires vigilance regarding legislation that can impact care and reimbursement. These challenges, Celeste is quick to note, are overcome by a safe and welcoming nursing environment, something she believes speaks to the importance of achieving magnet status, as these are clearly measured expectations. “Our nursing environment sets a supportive stage for good nursing practice and a competent leadership team fosters opportunities for people to do a good job when they come to work each day. If we’re doing things right, people will like where they work and they will stay.”

    Celeste sees her role as a leader evolving. In that role, she will continue to ensure that bedside nurses have the tools they need and remove barriers to providing patient care, negotiating good wages and benefits and pushing for needed resources. Plus, she will continue to encourage nurses in the research arena. “I try to promote the idea that nursing research can be a positive, exciting experience. Ideally, the words love and research could appear in the same sentence in my vision for nursing in my scope of practice.”