Research Nurse Business Case - Veterans Affairs



The Business Case for a Nurse IV Nurse Scientist

Opportunity Statement: Research is an integral part of the mission of the Veterans Health Administration of the Department of Veterans Affairs (VA). VA nursing research is critical to provide the evidentiary basis for innovative means of providing healthcare that is Veteran-centric and cost–efficient. The VA Nurse Scientist is in a unique position to focus on translational and implementation science in addition to engaging with the interdisciplinary team to create a bridge between research and quality improvement. A Nurse Scientist provides leadership to develop evidence that supports culturally congruent, health equity, cost-effectiveness and outcome-driven care for Veterans, guided by the VHA Strategic Plan and Mission.

Background: The rich history of federal involvement in nursing research can be traced back to 1946, with the establishment of the Division of Nursing within the Office of the Surgeon General, Public Health Service. The National Center for Nursing Research (NCNR) was established in 1986 and later became the National Institute of Nursing Research (NINR) after the National Institutes of Health Revitalization Act of 1993 occurred. Born of this tradition, VA Nurse Scientists have been conducting funded research in all areas of Veterans’ health using bench to translation research designs.

Funded VA Nurse Scientist-led research studies have focused on a variety of healthcare issues including but not limited to: Congestive heart failure,18,19chronic obstructive pulmonary disease,15,75 stroke,1,2 healthcare disparities ,91 telemedicine7,8,37,89, physical activity in the VA Mental Health Intensive Case Management Program,92 Alzheimer’s disease ,93 smoking cessation,8,29 behavioral health research, hazardous alcohol use11, cancer pain management34,74, traumatic brain injury (TBI) recovery70 & 90, stress management, diabetes 28, improving mobility,22vulnerable and older population health,85 spinal cord injury,68 chronic disease management,70,75 bacterial biofilms,23 chronic wound healing,22 heavy metal toxicology90, blast injury models90, improving health care access for rural Veterans85, quality of life,17 and suicide.86,87 Some have developed innovative technology78, caregiver models,45,46 and explored ways to improve employment conditions for nurses2. To meet growing trends in alternative and complementary care, VA Nurse Scientists are exploring complementary and spiritually-based interventions for Veterans18,19. Examples of work by VA investigators may be found on this website:

VA Nursing Research Commitment: The Nursing Research Initiative (NRI), is a mentored research funding award (similar to the NIH “K” awards) that was initiated by the Undersecretary for Health in 1995. It represents a commitment by VHA to encourage development of nurse investigators. The intention of this initiative was to increase opportunities for career Nurse Scientists to conduct VA- priority focused-research, and increase quality outcomes for Veterans. In 2016, a survey was sent to 52 of the total 53 NRI award recipients (since 1995)1. The responding NRI recipients provides the following brief snapshot of the contributions Nurse Scientists make to the VA:

Of survey respondents, 28 NRI recipients have served as a principal investigator on other studies since their award on a total of 273 studies with total funding reported of $167,535,623 (mean $7,777,136). Among this group, 78.6% still work within VA, 82% hold an academic appointment (50% rank of associate professor or professor), and 68% serve on an editorial board for a journal. Survey respondents indicated they devote 54.3% of their time to research. Since their NRI award, these respondents have disseminated their research through a total of 334 peer-reviewed research publications, 589 podium presentations, and 302 poster presentations. Moreover, these 28 NRI recipients surveyed mentored 289 doctoral students, served on 132 grant proposal review panels, and served on 202 national committees.

Nurse Scientist Qualifications: Nurse Scientists are doctorally prepared nurses with advanced analytic skills and research experience gained through educational preparation, dissertation and/or post-doctoral fellowships. Through a program of research, Nurse Scientists conduct basic, clinical, rehabilitation, and/or health services research leading to improvements in the health and well-being of Veterans. Successful VA Nurse Scientists have an active RN license, a Baccalaureate in Nursing and/or Master’s degree with a PhD or equivalent research degree (required to be competitive in the research field), and are VA employees (minimum of 5/8th position).

Nurse Scientist Role: Nurse Scientists possess a unique perspective and expertise for developing and conducting a program of nursing research and translating evidence into practice within their facility. Other responsibilities may include promoting collaborative inter-professional research; overseeing research compliance; and mentoring colleagues and trainees in various research methodologies (clinical trials, evidence based practice and quality improvement)2,3.

Nurse Scientists collaborate with operational partners, and play an essential role on research teams in various settings (such as GRECC, MIRECC, COINS ORH, Office of Community Care). Nurse Scientists are particularly well suited for assuming executive roles that include LEAN program leads, IRB and R & D committee representation and leadership, ACOS for Research, and Research Compliance Officers. Their expertise is frequently called upon to provide consultation and guidance to senior leadership and facilitate research projects with teams from all disciplines in the medical center. Nurse Scientists advocate for evidence-based and ethical standards throughout work processes, and help to elevate recognition of high quality VA nursing care and research in the community.

Nurse Scientists can be a critical resource for nursing staff by promoting the implementation of evidence-based research into practice; collaborating with Magnet coordinators to ensure accuracy of required outcome measures; and improving research and quality improvement team effectiveness4,5. Nurse Scientists engage staff nurses in a variety of research activities and assist them to meet research requirements for nurse proficiency advancement, increase nursing satisfaction and retention, and provide career pathway mentoring and professional guidance. The Nurse Scientist is also in a key position to partner with Clinical Nurse Leaders (CNLs), Advance Practice Nurses (APNs), and Doctors of Nursing Practice (DNPs) as well as with Physicians, Pharmacists and other health care providers to improve overall health services outcomes. Nurse Scientist responsibilities are commensurate with a Nurse IV classification and may vary based on organizational needs and the experience of the individual. Although roles and responsibilities of the Nurse Scientist are variable and tailored to the facility, if combined with other roles, the percentage of assignment (research focus or mixed focus) must be discussed, evaluated, and maintained for long-term success. Therefore, strong caution is warranted when contemplating the combination of roles such as Nursing Education and Nursing Research leadership roles into one Nurse Scientist role without separate support for each Focus (ie: Chief of Nursing Education and Nursing Research supervises an Associate/Assistant Chief of Nursing Education and an Associate/Assistant Chief of Nursing Research). To expect one person to assume full responsibility for both full program leadership roles (Nursing Education and Nursing Research) without separate program supporting roles is to create an anticipated conflict of priorities whereby education (required competencies) will always come first. This combination has a potential to reduce the effectiveness of all three programs (Research, Education, and EBP), decrease research productivity, and may result in early burn-out of the individual. In addition, it may create a conflict of interest for the Nurse Scientist/researcher (e.g. if research evaluation of nursing education programs is desired).

Fiscal Value: Nurse Scientists are eligible to serve as Principal Investigators and submit proposals for research grants and awards for their programs of research, which provides the unique opportunity to acquire funding from professional organizations, research foundations and industry and may be eligible for acquisition of Veteran's Equitable Resource Allocation (VERA) funding – internal VA resource: . It has been estimated that successful Nurse Scientists generate revenue from grant awards to the institution that may exceed their average salary by 300% within the first 10 years (extrapolated from the average funding of the NRI survey respondents).

Summary:

Nurse Scientists with an independent program of study can enhance the prestige and expertise of a medical center attributable to the groundbreaking innovations their research can provide. The Nurse Scientist role is a vital element for continuous improvement of quality care and development of effective healthcare processes for Veterans within the VA system. Active engagement of Nurse Scientists within research and the healthcare team further strengthens VA commitment to improve quality health care, foster a culture of interprofessional collaboration, generate evidence to inform practice, and promote effective healthcare leadership.

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11-20-2017

VA Nurse Scientists have demonstrated an impressive body of research over the past 20 years. Specifically, during that time $167 million in research dollars have been awarded to VA [pic]-!"(1245åÓÁ¯Á?‹ygUC1#hyvÍh$9ö5?CJOJ[?]QJ[?]^J[?]aJ#hyvÍhGð5?CJOJ[?]QJ[?]^J[?]aJ#hyvÍh…Y5?CJOJ[?]QJ[?]^J[?]aJ#hyvÍhbxJ5?CJOJ[?]QJ[?]^J[?]aJ#hyvÍhGE

5?CJOJ[?]QJ[?]^J[?]aJ#hyvÍhQ#õ5?CJOJ[?]QJ[?]^J[?]Nurse Scientists for more than 273 studies. (NRI survey)61

Based on this track record and skillset, a Nurse Scientist adds value to a VA medical center by generating new discoveries and areas of inquiry that:

• Facilitate innovation at the bedside

• Improve Veteran satisfaction and clinical outcomes.

• Support cost savings and cost avoidance for the organization

• Project a positive image of VA research

• Enculturate a spirit of inquiry within nursing

• Increase interdisciplinary collaboration

• Expand opportunities for dissemination of research findings through awards, presentations, and publications

• Inform healthcare policy

• Produce and translate evidence to improve health services

•

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