Friday August 22nd 2014

Asking questions, finding solutions

Program aims to create new generation of nurse scientists to improve health care

Questions are good, especially if they lead to better health care and clinical practice. That notion is at the heart of a new program being fine-tuned at the University of North Carolina (UNC) at Chapel Hill School of Nursing.

Scholars’ work can make a difference in bedside practices and policies.

The Hillman Scholars Program in Nursing Innovation at UNC will allow selected undergraduate students to earn a doctorate in nursing in five years. Moreover, it will nurture in those students a spirit of inquiry and give them the knowledge and research skills needed to solve complex health problems and improve patient care, according to Merle Mishel, PhD, RN, FAAN, and Carol Durham, EdD, RN, ANEF, who are leading the program at UNC.

“Most students go into nursing because they want to make a difference,” said Durham, a UNC clinical professor and a North Carolina Nurses Association (NCNA) member. “This program is a great way to target enthusiastic students who can make a difference by looking at issues around quality, cost, access to health care, and bedside policies and practices.”

From idea to program

About three years ago, Linda Aiken, PhD, RN, FAAN, FCRN, a renowned nurse researcher and professor at the University of Pennsylvania School of Nursing (Penn Nursing), and Ahrin Mishan, executive director of the Rita and Alex Hillman Foundation, began working on a program that would produce the next generation of nurse scholars who could transform health care. Their work represented the latest partnership between Penn Nursing and the Hillman Foundation, which has supported promising nursing students for more than 20 years.

“We wanted to determine a way to create nurses who are change-makers early on in their careers,” said Mishan, who recently was named to the American Nurses Foundation Board of Trustees. “And we wanted to equip them with the tools they need to generate transformative ideas and to translate those ideas into real-world applications.”

That collaboration resulted in the Hillman Scholars Program in Nursing Innovation. As originally designed, students who are accepted as innovation scholars participate in studies that take them from junior-year undergraduates to PhDs in about five years. Research elements and projects are integrated throughout their study, and mentorships are a key part of program.

“We want research to be interesting, so undergraduate students will learn tools, such as sampling, by participating in real-world projects,” said Aiken, national adviser and Hillman innovation scholars program director and a Pennsylvania State Nurses Association member.

And Aiken hopes programs, like the Hillman innovation scholars, will help to break down a barrier that prevents young, talented nursing students from pursuing careers as nurse scientists.

“Most people go into nursing because they want to do direct care and think that the only way they can make a difference is by taking care of patients one by one,” she said. “We want to show that through nursing research, nurses can reach hundreds of thousands of patients through a productive research path that influences policies and practice.”

Added Mishan, “Nurses operate at the juncture of science, delivery systems, and patients’ lives, so they are in a unique position to solve real-world problems in health care. This program holds the promise of creating very powerful nurses who are fluent in — and can connect — the worlds of research and clinical practice, and who can play a significant role in improving health care and health care systems.”

The first innovation scholars program was subsequently launched in fall 2011 at Penn Nursing. Earlier this year, UNC and the University of Michigan (U-M) were awarded grants to start innovation scholar programs at their schools of nursing beginning in the 2012-2013 academic year.

Getting on the innovation scholar track

UNC’s Mishel and Durham were deep in discussions about ways to improve undergraduate nursing students’ understanding of research and how it influences practice in the clinical setting when they learned of the Hillman grant opportunity.

Because of the university’s strong focus on improving clinical care, the Hillman program seemed like a good way for UNC to provide students with certain skills not addressed in the traditional curriculum that would help move research and practice, said Mishel, an ANA member.

“One of the things that happens to young nurses who go into clinical settings is that they just pick up on how everything has always been done,” Mishel said. “Through this program, we want to develop students [and ultimately nurses] — who raise questions about what they see and experience, such as ‘Why was a patient moved to a certain unit,’ or ‘Do all patients respond to that treatment in the same way?’

“We don’t want them to be sitting on the sidelines of determining care. We want everything that happens to them to stimulate inquiry.”

Dean Kristen Swanson, PhD, RN, FAAN, a NCNA member, added, “The Hillman scholars program is a perfect match for UNC Chapel Hill, because Chancellor Holden Thorp has challenged all of us to educate learners who are compelled and poised to accelerate and apply innovations that help solve the world’s most pressing problems.”

With the assistance of their colleagues in the UNC School of Nursing and other academic disciplines, Mishel and Durham are busy firming up details of the UNC Hillman program that they outlined in their prospectus.

They are in the process of identifying mentors from the nursing school and perhaps other schools, such as public health or business, to be paired with the first six innovation scholars, who will start in spring 2013. These mentors will guide the scholars from their undergraduate honors research project through their dissertation.

“By having them paired with mentors early on, they can begin to tie everything together and see how research is done and why,” Durham said. “So when they enter into the doctoral portion of the program, they will already be a different kind of student.”

The program will incorporate innovative educational approaches and clinical experiences, and scholars will be immersed in seminars that shape their thinking and guide the integration of what they learned. They will also take tailored clinical and research courses during a post-baccalaureate bridge summer.

Durham and Mishel lately have been spending time developing questions that will help them identify innovative thinkers and help them determine whether potential scholars have the perseverance and support network to help them complete the program. The scholars will be selected from students who were admitted into the BSN option in May 2012 and the accelerated BSN option in January 2013.

Influencing others

Penn Nursing began working with its first student cohort of five, and is now selecting six more scholars for the second cohort.

The undergraduates in the first cohort already have embraced research projects. One student, for example, has been working with a team looking at nurse staffing and the quality of the work environment, Aiken said. Another student is working with other researchers on a project examining the impact of nursing on patient readmission rates.

“We want all the scholars to be the leaders and the innovators of the future called for in the IOM [Institute of Medicine Future of Nursing] report,” Aiken said.

Durham also invoked the IOM report in linking the Hillman program’s ability to meet the IOM’s goals of strengthening nurses’ education, promoting interdisciplinary practice, and ensuring nurses can practice to the full extent of their scope of practice.

Noted Dean Kathleen Potempa, PhD, RN, FAAN, University of Michigan School of Nursing, “The Hillman Foundation grant sets a new stage for the PhD in nursing. It fosters our goal of improving the health and well-being of society through the impact of our research and by educating nurses for leadership in academic and practice areas.

“By starting the research path during the undergraduate years, students will attain a PhD early in their careers and have the opportunity to participate in and lead research in a longer career trajectory that can have a greater impact on caring for patients.”

The U-M Hillman program is focused on health promotion and chronic illness care in vulnerable populations, as well as effectiveness and implementation science. The first cohort will begin this fall.

Upon completion of the baccalaureate and a rigorous three-year PhD program, the scholars will be prepared to lead scientific discoveries for promoting health and managing chronic illness in vulnerable populations, conduct high impact intervention research that spans efficacy, effectiveness, and implementation science to improve individual and population health, participate as emerging leaders of an interdisciplinary teams, and enter a competitive post-doctoral fellowship.

For more information on the Rita and Alex Hillman Foundation, a New York-based philanthropy dedicated to improving lives through nurse-led innovation, or the innovation scholars program, go to www.rahf.org. For more information on the American Nurses Foundation, go to www.anfonline.org.

— Susan Trossman is the senior reporter for The American Nurse.

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