The Science of Care
Nurse researchers thrive on the positive effects of nursing studies|
on patient care

By Scott Williams
January 31, 2005

Jane Morse, RN, is living proof that you don’t have to have a graduate degree to work in nursing and medical research. Morse, a nurse at the Iowa City Veterans Affairs Medical Center is participating in her third research project.

She joined the research world in 1999 when a nurse who was working on a study on atrial fibrillation had to leave her job. Morse, whose nursing background included stints in cardiology and a cardiac catheterization lab, was asked to step in because she had experience reading telemetry strips.

“It sounded really interesting and at that point I thought it would be nice to do something because it was a national study and we 85 were able to do something for more than one patient at a time,” she says.

Morse now is participating in two research studies. One involves educating patients on blood thinners to monitor their health at home and to do so more frequently than they would if they had to go to a physician’s office for testing. The second study involves assessments of congestive heart failure patients by telephone or videophone. That study is supervised by Bonnie Wakefield, RN, PhD, associate chief of nursing research at the Iowa City VA hospital. Wakefield, who has been a nurse for 28 years, began conducting research in 1997 after earning her doctorate. She credits an enthusiastic college nursing professor with inspiring her to go into research.

“Her knowledge and enthusiasm for the effect that nursing research could have on patient care just motivated me,” she says. “I decided that’s the role I wanted to have.”

Patricia Grady, RN, PhD, FAAN, director of the National Institute of Nursing Research (NINR), says the NINR, a division of the National Institutes of Health, encourages nurses to become researchers to help develop a body of knowledge in the areas in which they are interested.

The NINR supports clinical and basic research to establish a scientific basis for care for everything from management of patients during illness and recovery to the reduction of risks for disease and disability. Nursing research also promotes healthy lifestyles, quality of life in those with chronic illness, and care for people who are dying.

“What we are doing is research to improve patient care,” says Grady, an internationally recognized stroke researcher. “Our research mostly looks at patient symptom management and involves behavior intervention. It also has a very large focus on prevention and health promotion as opposed to the medical model, which is the treatment/testing research model.”

Grady says one example of how nursing research can improve patient care is a study in California to help Hispanic adults with arthritis. Researchers came up with a program delivered in Spanish to arthritis sufferers that resulted in decreased reporting of pain and an increase in activity and exercise. The program has been adopted by the Arthritis Foundation in California, she says, and may be adopted nationwide.

Marti Buffum, APRN, DNSc, CS, associate chief of nursing service for research at the San Francisco Veterans Affairs Medical Center, has worked with both physician and nurse researchers. She says nurses and physicians generally have different approaches when it comes to conducting research. Physicians, she says, tend to focus on things like preventing diseases or which drugs work best. Nurses, on the other hand, generally don’t study drug treatments because they don’t prescribe medicine.

“What a nurse researcher delves into more is symptom management,” says Buffum, whose research has focused on dementia and pain management. Nurse research, for example, might look into how to help patients manage their illness, medication, or the aftereffects of a medical procedure. It also might involve helping a patient cope with mental illness or providing family members with the education they need to help a sick relative.

“Sometimes, pain treatments involve medication and so I usually will include a physician on my team as a coinvestigator,” says Buffum, who became a nurse in 1969 and earned her doctorate in 1992. “I look at MD researchers and nurse researchers as different but complementary, and I like it when they work together because I think they [each] bring a different skill set.”

Nurse researchers and physician researchers generally answer different questions, she says, but there is room for both types of research and they sometimes dovetail into one another or even cover the same territory.

“It depends on the nurse and the physician and their area of inquiry,” Buffum says. “It could be a nurse is asking a medical question or a physician is asking a question that overlaps nursing care.”

Familiar ground

Colleen Goode, RN, PhD, FAAN, vice president of patient services and chief nursing officer at the University of Colorado Hospital, often works in an area in which physicians would have little or no interest or expertise: nursing administration research. Goode has conducted research on nurse manager interventions that provide recognition to staff, how staff nurses participate in decision-making, and case management in acute care hospital settings, among others.

She also is known for her practice-changing research on vein irrigation comparing the use of heparin and saline. Her analysis of existing research showed that saline worked just as well as heparin and was both safer for the patient and less expensive. That research study is a good example of an area in which nurses would be much more interested than physicians, she says.

“Nurses are the ones that irrigate IVs and I was interested in it because it was a nursing intervention, whereas [physicians] would be interested in a medical intervention,” Goode says.

Morse, like Goode, has worked with both nurses with doctorate degrees and physician researchers and she, too, notices differences in the way they do their jobs.

“I would say probably nurses would not be involved so much in things like drugs or devices that are placed inside the body,” she says. “They have more to do with giving advice and anything that has to do with nursing interventions.

“I would say Bonnie [Wakefield] is more hands-on when it comes to the studies that she’s doing, such as keeping track of how many patients are involved,” Morse says. She says physicians involved in research tend to spend less time with patients and find their time divided between research, making rounds with patients not involved in research, and running clinics, among other things. That leaves less time to devote to hands-on involvement in their research, she says.

“After all is said and done, I would say the nurses who are just involved in research 85 watch a little more closely,” she says.

Wakefield says that one of the primary differences she sees between physician researchers and nurse researchers is that physician researchers are more likely to conduct “bench research” in a laboratory setting. This can involve the use of animals or cell lines rather than working with patients.

“It’s not as if nurses couldn’t do that, but it’s less typical for nurses to do bench research,” she says. She says physicians often focus more on interventions that might cure a disease like a surgical procedure or research on a particular medicine.

Wakefield says what she finds enjoyable about research is finding ways to improve patient care by systematically evaluating interventions. One of the main challenges, she says, is recruiting patients to participate in a study, because they tend to be a bit suspicious of researchers.

“They think you’re going to do some kind of questionable experiment on them,” she says. “It’s sometimes challenging to convince patients that this is a good study to enroll in.”

Grady says researchers often have several studies running concurrently and they’re usually in different phases. The first step is to come up with an idea and review the literature to get a feeling for what is known. A researcher looks for gaps in this knowledge, designs a study to capture that knowledge, and writes grants seeking funding.

Researchers must work with others to gather information from patients and often must train people to collect the needed information. They then analyze the data that comes in, find ways to quantify it, and examine it in a systematic way. The next step is to come to some conclusions based on the data and to identify the study’s limitations. Then the researcher must write up the results, getting critiques from colleagues along the way, before publishing it and inviting further critiques from the scientific community at large. Researchers also must present their findings to internal review boards and, at times, external groups.

“In any one day, a person can be doing any of those activities,” Grady says. “It is really a career with a great deal of variety.”

Grady says what she enjoys about research is the freedom it gives her to study whatever interests her, although the lack of guideposts might make some uncomfortable.

“The good news is that as you develop new things, a good study often generates as many questions as it does answers,” she says. “It’s a self-renewing process.”

Long-term commitment

One downside is the amount of time it takes to complete a study, Grady says. Buffum agrees. “You have to be very persistent and tenacious and you have to have passion and belief that will carry you through all those years and be important enough to last,” she says.

Another negative to research, Morse says, is that studies have a finite time line, which means a nurse might run out of work when the research project is finished.

“You always have to kind of consider what’s going to happen when this particular study is finished,” she says.

She also finds it hard to distance herself from her work.

“It’s not easy to take a vacation,” she says. “Many times, I’m checking my voicemail daily when I’m on vacation.”

Goode says any nurse who wants to become involved in nursing research should turn to the nearest school of nursing to offer their services. “I think all nurses need some scholarly focus,” she says. Many institutions have research committees that would likely welcome interest from nurses whether or not they have advanced degrees.

Grady says the NINR encourages nurses to become involved in research. She says it’s one of the most rewarding things a nurse can do.

“What I most wanted to do was to be able to make a difference, to be able to create new information that was helpful to people, and it’s a rare privilege that individuals have to literally create new knowledge,” she says.

“If you have an opportunity to do something like that, it is just simply hard not to do it.”