Roles and responsibilities of clinical nurse researchers

Roles and Responsibilities of Clinical Nurse Researchers KaRIN T. KIRCHHOFF,PHD, RN, FAAN,* AND MAGDELENAA. MATEO,PHD, RN, FAAN'

A follow-up survey of 142 nurse researchers employed in clinical settings (NRECS) was conducted 10 years after the first one conducted by Knafl, Bevis, and Kirchhoff in which only 34 individuals qualified for inclusion. An 80-item questionnaire included items about the structure of the position, processes used, variables that may influence outcomes, and outside activities. When ineligible persons were excluded, the response rate was 75 per cent. Most commonly NRECS had positions in clinical settings only (55.7 per cent), offices (75.5 per cent), some staff (72.6 per cent), and secretarial support (52.8 per cent), and they usually reported to the chief nurse executives (71.7 per cent). Although the majority of NRECS reported responsibility for research activities, the average time spent on research is only 50 per cent. Most (82 per cent) have a nursing research committee, but NRECS also sit on other research-related committees in the department or hospital. Details about salary, responsibilities, and processes will be helpful to those preparing themselves or others for this role, for those who wish to start such a position for themselves or another, or for those in the role wanting to know how other NRECS perform. (index words: Clinical nurse researchers; Nursing research; Nurse researchers employed in clinical settings) J Prof Nurs 12:86-90, 1996. Copy-

right© 1996 by W.B. Saunders Company

HE LITERATURE about nurse researchers employed in clinical settings (NRECS) was summarized recently in the Annual Review ofNursing Research (Kirchhoff, 1993). One major study was completed in the early 1980s by Knafl, Bevis, and Kirchhoff (1987) in which NRECS and their corresponding chief nurse executives (CNES) were interviewed by phone about the development and enactment of the roles of NRECS. At that time only 34 individuals at 31

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*Professor,Collegeof Nursing, Universityof Utah, and Chair, Research and Education Division, Universityof Utah Hospital, Salt LakeCity, UT. yResearch Associate, The Ohio State University Hospitals, Columbus,OH. Address correspondenceand reprint request to Dr Kirchhoff: Universityof Utah, Collegeof Nursing, 25 S MedicalDrive, Salt Lake City, UT 84112. Copyright© 1996 by W.B. SaundersCompany 8755-2773/96/1202-0008503.00/0 86

institutions met the criteria of at least 50 per cent employment as NRECS, with 6 months in the position. The typical role enactment was that half of the time was spent in research and the other half in administration and staff development (research inservice and consultation). Their performance was highly and universally valued despite individual differences in activities and organizational contexts. Most of the NRECS (76.5 per cent) reported to their CNES but did not have a budget (62 per cent). Most NRECS had secretaries (76.5 per cent) but did not have professional personnel reporting to them (59 per cent). They were involved in quality assurance, program evaluation, and research utilization as well as in the conduct of research. Interview topics also included role development, role performance, strategies for success in the role, and research activities. Since this study was conducted, the numbers of NRECS have increased to more than 100. Faculty interested in preparing doctoral students for this role and the doctoral students themselves wanted more updated information. Many changes have occurred in health care during these 10 years, and some NRECS have not been able to retain their positions during budget cuts. Additional questions have been raised that were not addressed in the first study, such as process issues about publication with nursing staff or detail about outcomes. An update and expansion of the initial survey seemed warranted. The only other studies of NRECS that have been conducted were regional in nature. Dennis and Strickland (1987) studied 10 researchers at six agencies in eastern states to reveal the implementation of the role. Four models were discovered: the nursing research unit (several researchers), dual roles (research and quality or education), collaborative roles (school and agency), and functional role division (researcher does only research). In a telephone survey of Los Angeles directors of nursing, 6 of the 18 facilities had nurse researchers (Betz, Poster, Randell, & Ornery, 1990). Moderate to extensive research was being conducted in facilities

Journal ofProfessionalNursing, Vol 12, No 2 (March-April), 1996: pp 86-90

CLINICAL NURSE RESEARCHERS

that had nurse researchers in contrast to little or no research in facilities without nurse researchers. There are numerous other articles on the roles of NRECS. Most of them are case reports of a single institution or recommendations about the roles from those in these positions or those who have hired NRECS. Method SAMPLE

A national survey of researchers employed in clinical settings was conducted. The mailing list was comprised of people who are members of the special interest group, Nurse Researchers Employed in the Clinical Setting, which is a special interest group in the American Nurses Association (ANA) Council of Nurse Researchers. To be included in the special interest group, researchers must be responsible for nursing research in a clinical setting and receive at least part of their salary from that setting. Although there is some selection bias in using a membership list, the trade-off would have been a reduction in sample size and much greater difficulty in accessing subjects. All those eligible were considered for the sample. Excluded were those who were not employed in departments of nursing but in sections of the hospital, such as the psychiatry service; these individuals were not able to answer many of the questions.

There are numerous other articles on the roles of NRECS.

Sixteen were found later to have changed positions or were in a position where the items in the survey did not apply. Therefore, 142 were considered to be eligible. One hundred six usable responses were returned. The response rate was computed by dividing the number of completed and usable questionnaires by the total eligible sample (Kviz, 1977). Ineligible persons were those who were no longer in the position, those whose questionnaires were returned by the institution, and those who believed that the questions did not fit their jobs. The response rate was 75 per cent.

87 INSTRUMENT

The 80-item questionnaire, Survey of Clinical Nurse Researchers, had closed-ended and open-ended items. The instrument was designed to elicit information about the roles of NRECS. Items were organized into four parts: structure, process, outcomes, and other. Part one contained questions relating to the structure of the position. Items pertained to job title, type of appointment, reporting mechanism, support personnel, and institution. Part two pertained to the process through which NRECS accomplish responsibilities. Included items were questions on percent of employment, sources of salary, scope of responsibility (eg, research, education, administration, quality assurance), budget, previous positions held as a nurse researcher, orientation, resolution of issues on role enactment, and the research committee and its activities. Part three was designed to elicit information on variables that may influence outcomes. Information was asked about activities and strategies for facilitating research activities: conduct of research, utilization, presentation and publication, acquisition of funds for research, and performance evaluation. Part four included questions on activities of NRECS outside of the employing institutions, such as networking, consulting, reviewing grant applications and manuscripts, and serving on research committees. The last five open-ended questions regarded aspects of the doctoral program that helped or could have helped persons prepare to assume the position, activities pursued to help in the position, and advice one would give to someone who is considering such a position. A letter explaining the purpose of the survey and the general categories of items being considered for inclusion in the questionnaire was sent to NRECS before the tool was developed. Members were asked to respond by sending ideas on additional items. Their suggestions were included when the questionnaire was developed. The questionnaire was pretested by three NRECS, and unclear items were revised. PROCEDURE

In fall 1993, the questionnaire and a return envelope were sent to each person on the mailing list. To keep responses anonymous, code numbers were not assigned before sending the survey. A precoded double postcard was mailed to every person as a follow-up within 3 weeks after sending the survey. Participants

KIRCHHOFF AND MATEO

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were asked to indicate on the return postcard if they had completed and returned the survey. Results

In this article, the results of structure and process will be reported (Mateo & Kirchhoff, 1995). The titles of the positions are most frequently those of a director or associate director of nursing research (27.4 per cent) or nurse researcher (18.9 per cent). Although the "other" category was large (53.8 per cent), those titles usually had the word "research" in it, sometimes combined with "educatioff' or "quality." The usual appointments are to clinical settings only (55.7 per cent); 28.3 per cent have joint appointments. The remainder included other (12.3 per cent) or missing (3.8 per cent). The mean percent time for the clinical appointments is 60.9 per cent and for the academic appointments is 39.9 per cent. Support for the position is evidenced by the fact that 75.5 per cent reported having offices in departments of nursing, and 72.6 per cent have some staff. Although some staff might be considered assistive, such as associate directors (7.5 per cent reported), research associates (11 per cent), nurse researchers (20 per cent reported), or research assistants (20 per cent reported), other staff might be considered an additional responsibility, such as clinical nurse specialists (18 per cent), quality assurance coordinators (18.9 per cent), and nurse educators (20 per cent). Secretarial support is the most frequent type of support received (52.8 per cent). The percentage ranged from .25 full-time equivalent (FTE) to 4.5 FTEs in offices having staff with responsibilities in addition to research. Statisticians were only reported as available as staff in 13.2 per cent of responses. Reporting to CNEs is the most common practice (71.7 per cent). Other reporting mechanisms are to the directors in charge of nursing research if there is more than one researcher. Additionally, 18 per cent report to administrators in colleges of nursing. These NRECS work primarily in regional medical centers (63.2 per cent). Only 7.5 per cent reported community hospitals as their clinical settings. Other settings include specialty hospitals, such as cancer, academic medical, and Veteran's Administration. More than 80 per cent consult with other registered nurses in their regions. These hospitals are located most commonly in urban areas (82.1 per cent). The average number of beds per hospital 632 (median, 547). NRECS are usually employed full time (87.7 per cent) at an average salary of $63,268. Although 13

reported working less than full time and did not answer the full-time salary question, another 10 did not answer it as well. Of the 13 who reported working less than full time, 9 gave annualized salary figures. The mean was $57,978 (median, $53,300). Ninetyone per cent of the individuals reported the employing institution as the source of the salary. The percentage of salary from the institution ranges from 5 per cent to 100 per cent; 20 per cent receive all of their salary from the hospital. Twenty-three per cent receive some salary support from grants. Although the NRECS consistently reported being responsible for research (Table 1), the average percentage of time spent in that area is only 50 per cent. Eighty per cent also have some responsibility for administration (23 per cent of their time). It is possible that some of the administrative responsibility might be research related. Although more than half of the NRECS reported responsibility for education, only 24 per cent of their time is spent in this activity. Other activities include consultation for special projects, managed care activities, and community outreach. The research activities in which the NRECS engage include directing organizational research (84.9 per cent), conducting their own research (93.4 per cent), serving as a coinvestigators on staff projects (75.5 per cent), or spearheading research utilization efforts (80 per cent). Less than half (44.3 per cent) had separate budgets. For those that had budgets, items included were personnel (80.8 per cent), supplies and services (91.4 per cent), and travel (80.8 per cent). Eighty-two per cent have a nursing research committee. The NRECS serve as chairs (53.8 per cent) or members (21.7 per cent) or as cochairs or consultants. There is a mean of 13.6 members on the committees (median, 12). Members include staff nurses (68.9 per cent), assistant head nurses (23.6 per cent), head nurses (56.6 per cent), clinical nurse specialists (73.6 per cent), staff" development coordinators (44.3 per cent), directors of nursing (25.5 per cent), and faculty (43.4 per cent). These research committees review TABLE 1, Areas of Responsibility for 106 NRECS Areas of Responsibility

% reporting

Mean % time

Research Education Administration (meetings, personnel, department budget) Quality assurance Other

98.1 55.7

50.0 24.1

80.2 37.7 22.6

23.4 18.1 27.6

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proposals (71.7 per cent) or govern the research activities of the departments (56.6 per cent). Other specified activities include research dissemination and utilization, staff development and facilitation in research, research days or workshops, and assisting with publication. Other research-related activities are journal clubs (34 per cent) and research utilization groups (33 per cent). Committees that the NRECS serve on are institutional review boards (55.7 per cent) and hospital research committees (39.6 per cent). Other committees listed include those for quality, management, computers, policy and procedures, and health policy. In 55.7 per cent of the positions, the incumbent NRECS are the first in the position. Eighty-two per cent of the NRECS responding are in their first position. Orientation is done by CNEs (26.4 per cent), outgoing NRECS (4.7 per cent), directors of nursing research (12.3 per cent), or no one (29.2 per cent). Orientation is comprised of meetings with nursing executive councils (67 per cent), clinical nurse specialists (67 per cent), nurse managers (65.1 per cent), and the chairs of the medical departments (34.9 per cent). A number of others were added, such as faculty in the college of nursing, other investigators, and department heads. Other orienting activities were to attend unit staff meetings (49.1 per cent), institutional review board meetings (45.3 per cent), and other meetings (38.3 per cent). They were asked to whom they turn for advice about issues in their roles. CNEs were cited most frequently (60.4 per cent). They might also call other NRECS (35.8 per cent) or faculty members (20.8 per cent). Five responded that they would call no one. Discussion

The titles of NRECS indicate a level of status in the institutions at which they are employed. Most of them are not jointly appointed but work full time. A joint appointment could be a difficult combination with heavy administrative responsibility. Reporting directly to CNEs continues to be the most common situation as it was in the earlier survey. This further demonstrates the administrative commitment to the position. The NRECS are employed primarily by large complex urban hospitals where research is an emphasis; only a small percentage of the smaller community hospitals employ NRECS. There was a 11 per cent nonresponse to the item about salary, a sensitive topic. It is not dear how the mean may be affected by the item nonresponse

because information on either a high or a low salary might have been withheld. Although the NRECS position is primarily a research position, the average of 50 per cent of time spent in that activity is less than might be expected although similar to the results of the earlier study. Some of their other responsibilities might be research related although not actually research. Perhaps the advanced education and commitment of these individuals place them in a likely position to receive additional unrelated administrative responsibilities. Many of the activities in clinical settings are enhanced when the evaluation component of a project is readily facilitated by the appointment of NRECS as the responsible administrators for projects. On the other hand, when downsizing is common, maintaining NRECS may be facilitated when additional mandated activities are assigned, especially those that are accreditation related. Obviously these activities distract from the original intent of the role.

The titles of NRECS indicate a level of status in the institutions at which they are employed.

The high response for conducting their own research (93.4 per cent) is surprising in light of the other responsibilities they hold. The definition of "own research" is difficult in a position where so much time is spent helping others with their research or helping the organizations with evaluation efforts. The large numbers who reported facilitating research utilization is impressive. These individuals are uniquely positioned to reduce the gap between research and its ~mplementation into practice. Although less than half had a budget, the remainder did not list that as a difficulty. In those instances, the NRECS use resources from a centralized administrative budget. Research committees seem to be mechanisms used by most of the NRECS to enact their goals in the institution. Proposal review for clinical access is handled in their institutions in a formal manner through the committees. Other committees on which the NRECS serve are of a research nature, such as the institutional review boards, hospital research committees, or committees that are facilitated by those with research expertise, such as computers, policy and procedures, and quality management.

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Most of these NRECS were in their first positions and/or in the institutions' first positions. This situation could be positive or negative. No previous expectations from past incumbents can be freeing or can provide little guidance. Orientation for the new positions seems to be minimally planned. The support of the CNEs for advice is likely due to the newness of these position at the institutions.

In conclusion, the number of NRECS has increased in the past decade, but the proportion of time spent in research by them is still approximately the same (50 per cent). These versatile workers are absorbed into the administrative duties of the nursing departments while conducting their own research, facilitating that of others, and fostering research utilization.

References Betz, C. L., Poster, E., Randell, B., & Ornery, A. (1990). Nursing research productivity in clinical settings. Nursing Outlook, 3& 180-183. Dennis, K. E., & Stricldand, O. L. (1987). The clinical nurse researcher: Institutionalizing the role. International Journal of Nursing Studies, 24, 25-33. Kirchhoff, K. T. (1993). The role of nurse researchers employed in clinical settings. In J. J. Fitzpatrick & J. S.

Stevenson (Eds.), Annual review of nursing research(Vol. 11, pp. 169-181). New York: Springer. Knafl, K. A., Bevis, M. E., & Kirchhoff, K. T. (1987). Research activities of clinical nurse researchers. Nursing Research, 36, 249-252. Kviz, E J. (1977). Toward a standard definition of response rate. Public Opinion Quarterly, 41, 265-267. Mateo, M. A., & Kirchhoff, K. T. (1995). Productivity of nurse researchers employed in clinical settings. Journal of Nursing Administration, 25(10), 37-42.