Since the earliest days of modern nursing, nurses have connected clinical inquiry with clinical practice to advance care and outcomes. One of the 1st known practitioners was Florence Nightingale, who linked poor sanitary conditions to high death rates among soldiers in the Crimean War.1
Today, a robust culture of inquiry is considered essential to the delivery of high-quality patient care. Research generation and integration of evidence into practice influence and shape the nursing profession. Nurses at all levels are encouraged not just to ask questions but also to answer them, driving hospital-wide improvements that make care safer and more effective and improve community health.
Research: A Magnet(R) Hallmark
Research is an essential component of the American Nurses Credentialing Center's Magnet Recognition Program(R). In fact, it was research that led to the program's creation more than 35 years ago. An enterprising team of nurse researchers from the American Academy of Nursing took a hard look at the nursing shortage of the 1980s. Rather than chronicling what was wrong at hospitals with high nurse turnover, they focused on what was right at hospitals where nurse vacancy and turnover were low. These institutions were dubbed "magnet hospitals" because of their ability to attract and retain well-qualified nurses, and the credentialing program was born.
The original Magnet study identified characteristics that shaped an environment of excellence. Prevalent among them were quality improvement, practice autonomy, clinical authority, and the imperative to improve patient care. These have transformed into a broad scope of nursing research over the last 4 decades.
Today's Magnet-recognized organizations conscientiously integrate evidence-based practice (EBP) and research into clinical and operational processes. Nurses are encouraged to explore the safest and best practices for their patients and practice environment. New knowledge is routinely evaluated, used, and disseminated to the greater nursing community.2
Organizations that achieve the Magnet credential have established evolving research programs and practices. Infrastructure and resources are in place to support the advancement of EBP and research in clinical settings. Nurses help to set targets for research productivity and review research proposals, oftentimes in collaboration with nursing academic partners.2
Research Versus EBP: What Is the Difference?
Although both research and EBP fall under the broad umbrella of clinical inquiry, there is an important distinction. Research begins with a question and uses systematic, scientific inquiry to answer it. Its purpose is to generate new knowledge or validate a theory. The process may start with a literature review to identify knowledge gaps, proceed to data collection and analysis, and conclude with results interpreted and shared. When no evidence exists, it is important for nurses to identify issues to be studied or improved.
Evidence-based practice involves finding and translating the best available evidence into clinical practice. It takes research 1 step further by connecting clinical decision-making with clinical expertise and patient preference. Gaining knowledge of EBP and learning strategies for implementation are critical skills for nurses in every healthcare setting.
Fostering a Research-Intensive Organization
How does an organization bring the spirit of inquiry to life, especially among bedside nurses? Every organization does it differently. A key component is the professional practice model, which gives nurses at all levels a place to bring ideas, lend their voices, and participate in collaborative decision-making.3 Another successful strategy is to establish structures and resources (such as PhD-prepared nurse scientists), either directly or through academic partnerships, to support clinical nurses who want to explore research questions.
Hospitals on the journey to Magnet excellence should consider the following: Do we have the resources we need to generate new knowledge, not only for the occasional randomized controlled trial, but also to support a culture of inquiry that advances nursing research? Support from the top is critical. Leadership must adopt a continuous improvement mindset that gives clinical nurses the time, means, and accountability to say, "I wonder what would happen if[horizontal ellipsis]?"
Striving to Do Better
As members of a profession, nurses have an obligation to use prevailing science where it exists, or advance new science where there are gaps. Being part of a research community helps nurses influence and shape the focus of their investigative efforts on behalf of all patients. In today's rapidly changing healthcare environment, a strong nursing research agenda can help organizations redesign care delivery and improve work environments, which lead to better patient care, experience, and outcomes.
Above all, nurses cannot sit still. They must persevere to manage the complexities of modern healthcare and deliver consistently excellent care to their patients. Dr Muriel Poulin, EdD, RN, FAAN, coauthor of the original Magnet study, put it best: "Nurses should always strive to do better," she said (personal communication on September 2003 to Dr Ives Erickson). Magnet organizations are poised to lead the advancement of nursing science.
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