Cultivating a Culture of Nurse Research at Cleveland Clinic

In recent years, nursing research has gained momentum at Cleveland Clinic hospitals. “Research promotes professionalism and enhances the science of nursing,” says Karen Distelhorst, MSN, RN, GCNS-BC, clinical nurse specialist at South Pointe Hospital. “Nursing research is foundational; it provides a way of asking questions about nursing practice, and research results provide rationale for making changes in practice.”

The spirit of inquiry is encouraged by the Zielony Nursing Institute at Cleveland Clinic. Researchers in the Office of Nursing Research and Innovation mentor nurses as principal and co-investigators in conducting, analyzing, disseminating and translating research. The research process increases nurses’ knowledge about:

• Clinical and administrative practices
• Environmental situations and disparities
• Healthcare provider
• Patient and caregiver behaviors
• Processes and structures surrounding care delivery

The primary goal is to facilitate evidence-based nursing practices and create novel interventions that improve healthcare outcomes.

Office researchers, led by Associate Chief Nursing Officer Nancy Albert, PhD, CCNS, CHFN, CCRN, NE-BC, FAHA, FCCM, FAAN, work with nurses at hospitals across Cleveland Clinic to cultivate and sustain a culture of research. Some hospitals, like South Pointe, have recently taken up the research mantle. Others, such as Cleveland Clinic Hillcrest Hospital, are further along the path.

Gaining a Foothold in Research – South Pointe Hospital

A year ago, Dr. Albert held an evidence-based research boot camp for nurses at South Pointe. During the four-hour workshop, she discussed how to develop and refine PICOTS questions (Population or problem, Intervention, Comparator, Outcome, Time and Setting), how to review literature on the PICOTS question of interest, and what steps are taken once more is known about current evidence. Following her presentation, the fun began as nurses created questions and searched the literature. “At the end of the day, nurses left with thoughts about next steps in conducting research,” says Distelhorst.

Since the boot camp, two research projects were initiated and approved by Cleveland Clinic’s Institutional Review Board (IRB), including one led by Distelhorst, who is studying early post-discharge follow-up appointments for patients with heart failure. The boot camp was so well-received that Dr. Albert held another one in January 2016, and two new research projects are underway as a result, with more in the start-up phase.

Now, during monthly Shared Governance meetings, representatives on the research council are given time to work on projects. “Nurses can’t step back and reflect on their practice when they are taking care of patients during a 12-hour shift,” says Distelhorst. “So we built time into our day to let nurses think, share and work on projects.” In addition, Mark McClelland, DNP, RN, CPHQ, a nurse scientist with the Office of Nursing Research and Innovation, attends these monthly research council meetings and serves as a mentor.

South Pointe Hospital’s Chief Nursing Officer Sheila Miller, MSN, MBA, RN, and her team provide leadership support. She stresses the many benefits of research, including elevation of the nursing profession and promotion of disciplined thinking. “It’s an ongoing conversation with frontline nurses,” says Miller. “Having that steady discussion – and creating venues for those conversations – helps bring importance to research.”

Collectively, it’s making a difference at South Pointe one nurse at a time. Last year, when nurses on a global hospital Shared Governance Committee signed up for councils, the research council had an abundance of volunteers. “Suddenly we were the popular kids!” says Distelhorst. “People are really starting to get excited about research.”

Sustaining Commitment to Research – Hillcrest Hospital

Three years ago, Dr. Albert held the first research boot camp at Hillcrest Hospital. Since then, nurses have initiated more than a dozen research projects, nine of which are IRB-approved. One of those is a project on medication adherence led by Jayne Rosenberger, BSN, RN, a critical care and emergency room float nurse.

“I have been a nurse for over 34 years,” says Rosenberger. “It is so fulfilling to be contributing to the body of knowledge that drives our practice. Doing something that directly benefits patient care is awe-inspiring.” That level of excitement for research is nourished at Hillcrest Hospital in several ways.

Cleveland Clinic’s Office of Nursing Research and Innovation hosts biannual 4.5-hour research workshops at Hillcrest. Nurses from the research council select topics, which have included developing a research proposal, making good use of literature reviews, finding publishing opportunities for completed research and understanding the concept and practice of peer reviews. “Our nurses have all kinds of ideas for research,” says Erin Sibben, BSN, RN, CCRN, a nurse in the progressive care unit. “These educational workshops help get them the support and knowledge to continue through to the end.”

The monthly research council also offers support. One of the council exercises is to review a “sacred cow” at every meeting. Council members review long-held nursing practices brought to them by frontline nurses and consider why they are still done. The research council has looked into everything from using a Trendelenburg position when patients have low blood pressure to prescribing a neutropenic diet for oncology patients. After examining research evidence behind these sacred cows, the council emails nurses a synopsis of the practice that should be “put to pasture” and the correct practice with research references.

In January, Rosenberger and Sibben began a monthly hospital-wide journal club. “We wanted a place where all nurses could learn how to critically appraise the literature,” says Rosenberger, and Dr. McClelland is serving as the club’s mentor. About 20 nurses attended the first meeting. “Nurses are really stepping up and owning their practice,” says Sibben.

Hillcrest Hospital’s dedication to nursing research can be summed up in one story. In 2011, a nurse spearheaded a project looking at how the hospital’s culture had changed since launching a Shared Governance Committee. She surveyed over 70 nurses before losing her battle with cancer, leaving her research questions unanswered. One of her peers brought the project to the research council, which sought volunteers to continue the project. Six nurses are now completing the study.

Nurses throughout Cleveland Clinic are invigorated by what Distelhorst calls “the spirit of inquiry.” More and more clinical, administrative, advance practice and specialty care nurses are joining the research ranks. “Once they realize all the opportunities, they’re going to be standing in line to do research,” says Rosenberger.

Miller sums it up succinctly: “Research changes the world.”

A Rich Resource Pool

It takes more than personal drive to complete a nursing research project. Among the resources available to Cleveland Clinic nurses are:

• Nursing Research Center intranet website – It provides templates, checklists, forms and information about disseminating and translating completed research. Internally-created and external references, the website links to other research and adjunct departments (art, library, quantitative health sciences).
• Research database – Available on the intranet, the database provides a comprehensive list of active research projects in all phases within the system.
• Online educational modules on evidence-based practice – Four self-administered modules provide continuing education hours for module completion.
• Research educational workshops – Researchers and scientists in the Office of Nursing Research and Innovation offer multiple workshops at each hospital in the system. Nurses can select up to four sessions at a time to create a workshop of content individualized to hospital needs.
• Three-hour writing for publication didactic session – This workshop offers an over overview of the elements of a well-constructed paper (1.75 hours) and common writing errors (1 hour). It also provides knowledge and writing experiences with mentor support.
• Nursing Research Conference – It features nationally recognized speakers, paper and poster presentations, and concurrent sessions to enhance a nurses’ ability to transform practice through research and dissemination. It happens annually in May.
• Nursing Research Grants and Nursing Research-Literature Review Grants – Twice a year, the Office of Nursing Research and Innovation awards a number of small grants to offset costs of nursing research. Grants are competitive and peer-reviewed by nurses.
• The recently published book Building and Sustaining a Hospital-Based Nursing Research Program(Springer; 2016) provides a road map to develop and nurture a nursing research program. Nancy Albert, PhD, CCNS, CHFN, CCRN, NE-BC, FAHA, FCCM, FAAN, Associate Chief Nursing Officer of Nursing Research and Innovation at Cleveland Clinic, is the editor; nurse researchers and other colleagues within and external to Cleveland Clinic contributed content.