Cedars-Sinai Medical Center and The Foundation for the Elimination of Diseases Attacking the Immune System (DAISY) recently honored Cedars-Sinai’s neuroscience nursing staff with the inauguration of the hospital’s DAISY Award for Extraordinary Nurses program. The awards recognize the outstanding and often overlooked efforts of nurses who work with critically ill patients.
The DAISY Award is the country’s first national program conducted by patients and their families to honor excellence in nursing through monthly awards at participating hospitals. The program highlights the irreplaceable role nurses play in treating patients and providing emotional support to their families. The first Cedars-Sinai awards were presented to two nurses: Larie Padre, RN, is Cedars-Sinai’s first DAISY Award Neuroscience Nurse of the Month. Evelyn Ledin, RN, also received an award in appreciation of the care she gave to George Doll, a former neuroscience patient.
Cedars-Sinai is the third hospital in the nation to join the DAISY Award program. Every month, a nurse in the hospital’s Neuroscience Unit will be selected from a pool of nurses who have been nominated by patients and staff.
“We at Cedars-Sinai are proud to be among the first hospitals in the nation participating in the DAISY Award program,” says Linda Burnes Bolton, PhD, the African-American vice president and chief nursing officer at Cedars-Sinai Medical Center. “Nurses are heroes everyday. Given the current national nursing shortage, the DAISY Award could not be launched at a better time. The DAISY Award and other nursing recognition program awards are an appropriate way to recognize nurses for providing the very best care to their patients.”
The DAISY Foundation also recently announced that it is launching a new initiative to encourage patients and their families who have had extraordinary experience with a nurse to apply to The DAISY Foundation to co-sponsor The DAISY Award for their hospital. Applications can be made via the foundation’s Web site at http://www.daisyfoundation.org/.
“There is definitely a need for more minority researchers,” asserts Ida Spruill, RN, MSN, MSW, of the University of South Carolina Medical College in Charleston. “When I try to identify mentors and colleagues, they are few and far between. I have to think in terms of someone outside my city or state because we just don’t have a large enough cadre of minority nurse researchers in this country.”
Spruill is the coordinator for Project SuGAR (the Sea Islands Genetic African American Registry Project), a community-based research study focusing on African-American families affected by type 2 diabetes. She got involved with the project six years ago when she met W. Timothy Garvey, MD, the study’s principal investigator. “He came to me at my previous job and asked me to help him find a black nurse to get involved in the project,” she says. “I looked around and thought of people who might be interested—but I was interested myself! I found out later that he had actually been told to talk to me about getting involved.”
Since then, Spruill has not looked back. “I enjoy research. The challenge intrigues me,” she explains. “Back when I was in nursing school, research was an area I knew little about. I never considered going back for my PhD. Now I’m staying with Project SuGAR until it ends, and then I’m starting a doctoral program.
“It’s important for minority nurses to get involved in researching minority health issues,” Spruill continues. “We need research that represents the community. That’s one reason Project SuGAR has been successful. The research questions, outcomes and interventions are different when they are determined by someone who is a member of that same population, someone who brings a unique insight. Sometimes in the past, pieces of the puzzle have been left out because of a lack of cultural understanding. I’m not saying that Caucasian researchers don’t do a good job, but African Americans start with an advantage when researching an African-American population.”
Asking the “Why” Questions
Spruill’s route into a research career was unusual in two ways. She doesn’t have a doctorate—yet—and she was not originally based at a college or university—the usual prerequisites for researchers. But when Garvey approached her for the SuGAR Project, she already had a research role model: Dr. Linda Burnes Bolton, RN, FAAN, vice president and chief nursing officer at Cedars-Sinai Health Systems in Los Angeles.
“She sparked my interest in research,” Spruill explains. “I met her through the National Black Nurses Association. She was one of the first people who helped me see that African Americans can go into research.” Talking with Bolton also changed Spruill’s whole perception of what research is all about. “Prior to meeting her, my idea of research was dusty books and working alone in a room. She gave me an understanding of what is really involved.”
Spruill’s attraction to scientific investigation was also sparked by the fact that she had unanswered questions about minority health issues. For her, research was the way to find answers.
Wanting to know why things happen is an essential trait of any good researcher, agrees Karen D’Apolito, PhD, RN, assistant professor of Nursing at Vanderbilt University in Nashville, Tenn. D’Apolito, who is African American, got her start in the field by “wanting to validate our practice through practice-based research in neonatal nursing.”
“I first realized that I wanted to do research around 1985,” she says. “I had received my master’s degree four years earlier and was working as a clinical specialist and nursing educator. But I wanted to do more. That was when I got involved in research and decided to earn my PhD in nursing.”
How can you know if research is the right career choice for you? The key is knowing your ultimate goals, D’Apolito advises. She recommends that potential nurse scientists consider the kind of contribution they want to make to the profession and whether they are geared more toward being a practitioner or looking inquisitively at health care issues. As she explains, “People who question care-giving procedures are the ones who are best suited to improve them.”
D’Apolito is alert to students who show an interest in research. “They ask the ‘why’ questions,” she says. “And they don’t accept answers like ‘that’s just the way we do it.’ They want to know why one way is better than another. Potential researchers like to read the literature and are open-minded to discovering more than one way to do something. These are the people who are likely to become good scientists.”
At Delaware State University in Dover, Del., Nursing Department Professor and Chair Mary Watkins, PhD, RN, also watches for potential researchers among her students. “They need to be critical thinkers,” she says. “They must be able to analyze and apply information, and they need to be willing to earn a doctorate. Educators can tell early which students show a talent for research. When our students take the Introduction to Research course, we can tell from their interest level. Research is very time-consuming. You have to have commitment to become a researcher.”
Her own motivation is central to the research process. “I became a researcher because I realized that it is part of what I need to do to gain and create knowledge.” Watkins’ dissertation focused on decision-making among nursing students at the diploma level. Today she continues to conduct research into decision-making processes in health care.
“Being a nurse researcher is such a time-consuming venture that you need to establish a research agenda for your career,” Watkins emphasizes. “You will usually continue to study in the same general area over time, so the earlier you identify your area of interest [such as cancer, mental health, etc.], the more opportunity you’ll have to get substantial research done during your career.”
Ivy-Covered Halls vs. Clinic Walls
For Watkins, academic life—rather than clinical practice—is the environment of choice. “From the outset of my career, I wanted to teach,” she recalls. “My mother was a teacher and my aunt was a nurse. Mother and I had a debate. She said, ‘You don’t want to be a nurse; you want to be a teacher.’ Then as I developed in nursing, I saw I could teach and do research, too. I’ve been tempted to leave academe and go into the clinical setting as an administrator, but I enjoy sharing what I know.”
Making the choice between clinical research and academic research can be difficult. Both have their pros and cons. From the salary standpoint, “clinician researchers make much more money than academicians,” Watkins notes. “Universities have always paid less. That’s why there is such a shortage of nursing faculty. If I try to recruit a potential faculty member from a hospital, they are probably making 30% more than I can offer them. But the love of teaching does draw some nurses into academia.”
Clinical work does not have all the advantages, though. Getting summer off with time to refuel is a persuasive factor in favor of teaching. On the other side of the equation, however, young faculty members sometimes struggle to balance the demands of teaching, research and providing service to the university or community by serving on committees or doing volunteer work.
But regardless of which setting researchers choose to work in, “there are many opportunities for minority nurses,” Watkins says. “For the underserved minorities in the U.S. population, there has only been limited research on their health problems and needs. Yet they suffer from heart disease, cancer and many other diseases at rates higher than the Caucasian population. More funding would help, but it doesn’t seem to be getting easier for minority nurses to get funding.”
And I Can Prove It!
“I got started in research because I’m nosy,” says Carla S. King, PhD, RN, who is CEO of Carla King and Associates in Boulder, Colo. “I’ve always been interested in getting better care for poor people. In nursing school I learned a lot, but I felt that there had to be a better way to address these concerns. I wanted to make a difference.
“I found out that my opinions and ideas counted—but they had much more credibility when I could back them up with documentation. That made them more than just Carla’s ideas or opinions. I could say: ‘This is what I thought and here is the objective information I collected, and this is what I want to change.’”
As the head of her own business, King, who is African American, does health care consultation, programming and outcomes research. She sees a growing interest in research by nurses in clinical practice. “Nursing, as a profession, needs to do more research in order to demonstrate our position as experts and to document our effectiveness,” she says.
“There are many types of research that need to be done,” King adds. “Clinical nurses need to be a part of it as well. They may see things in their work environment that could be changed to improve patient care. Sometimes research comes from seeing things you want to improve, but you need hard data to document the need for that change. Or clinical nurses may have administrative concerns. They need to present data to show how doing something differently would be better for the hospital. Research isn’t just for the academicians.”
What’s the best way to get started in a research career? Daniel O’Neal III, RN, MA, CS, chief of the Office of Science Policy and Public Liaison at the National Institute of Nursing Research, offers this advice: “Collaborating with someone and doing a piece of their research work [on a project] is the best way for a beginning nurse researcher to get involved. Colleagueship and cross-age cohorts are part of the game—the established researchers are always helping the new group of researchers. In addition, going to conferences and association meetings can help you get started.”
Publish or Perish
Although the exact number of minority nurse researchers is not known, published research studies focusing on minority health issues are on the increase. “One interesting thing about being an editor is that you rarely know the ethnicity of authors, but about 10% of the research I see is minority-focused,” says Molly C. Dougherty, PhD, RN, FAAN, editor of the journal Nursing Research.
Dougherty, who is also the Francis Hill Fox Professor of Nursing at the University of North Carolina at Chapel Hill, believes that minority health is definitely a growing area of research. “It is being driven by the National Institutes of Health’s emphasis on research in this area and the increasing amount of work being done to address racial and ethnic health disparities.”
Dougherty says the majority of research articles submitted to her journal come from nurse researchers at universities. Nurses in clinical practice tend to be co-authors. “Academic life is the primary way nurses get into research,” she says. “But today there’s a growing emphasis on programs that prepare nurses to manage clinical trials—at medical schools, health science centers and drug companies.”
Judith Graves, PhD, RN, FAAN, sees nursing research on the upswing from her vantage point as managing editor of the 1999 Directory of Nurse Researchers. “There are now more nursing researchers than ever,” she says. “When we compiled our first edition 15 years ago, there were only 500 or 600 researchers. Now we have 12,000 nurse researchers registered, and I estimate that this is only about half the actual number in the U.S. Most of them are housed in academe—it’s very difficult to get funding if you are not. Even private funding sources do not seem to fund people without an academic base. Universities provide the environment that supports research.”
Though the Directory of Nurse Researchers does not record researchers’ race or ethnicity, Graves agrees that minority-focused research is on the rise. “The trend toward more minority health research started about 10 or 12 years ago,” she notes. “Nurses are more aware of the need for cross-cultural knowledge, and more minorities are going into doctoral programs and becoming researchers.”
Five Ways to Develop More Minority Nurse Researchers
Last June, 27 minority nurse researchers and leaders of minority nursing associations met in Bethesda, Md. to participate in the invitational conference “Minority Health Research Development for Nurse Investigators.” This history-making event was sponsored by the National Institute of Nursing Research (NINR), the National Coalition of Ethnic Minority Nurse Associations and the National Institutes of Health (NIH) Office of Research on Minority Health (ORMH). One key issue the group addressed was how to promote career development of minority nurse scientists. Here are their recommendations:
• Grantsmanship training. Training on how to prepare grant proposals should be made more readily available to minority nurses. Special programs, such as the NINR Summer Institute “Research Training: Developing Nurse Scientists,” can play a valuable role in career development.
• Research training. NINR should evaluate its pre- and post-doctoral research training programs to determine factors associated with successful research careers. NINR should continue to provide special career development opportunities for minority nurse investigators and should consider developing short-term fellowship programs to provide additional training. A centralized database listing federal and non-federal research training opportunities is needed.
• Funding. NIH should increase the availability of grants of all kinds, including start-up funding, for minority researchers. NIH should consider developing a special funding mechanism for enlisting community leaders as research collaborators and should develop a minority R01 [a grant proposal submitted by an individual researcher] as a mechanism for minority scientists. NIH should develop a mechanism to track submissions of grant proposals and funding of minority investigators.
• Mentoring. Mentoring is key to the development of minority nurse researchers. A mentors network for minority nurse researchers should be established. NINR, the National Coalition of Ethnic Minority Nurse Associations and the ORMH should work together to establish a database of researchers interested in working as mentors. Schools of nursing should commit to building research capacity among minority nurse faculty and should provide mentorship opportunities for these faculty members. Schools should also provide support resources and an environment that maximizes the potential for nurse scientists to succeed.
• Peer review. NINR and the National Coalition should identify talented minority researchers to act as reviewers for NIH study sections. These reviewers could also serve as role models for other nursing professionals and would champion nursing research and minority health issues. Peer reviewers should incorporate criteria to address the participation of minority investigators. In addition, minority nurse investigators should be involved at all levels of decision-making for funding decisions.
It all started with a conversation that took place in 1999 between the deans of two highly respected schools of nursing–one of them an Ivy League school, the other a historically black university. These two academic leaders shared a common, passionate goal: to introduce undergraduate nursing students from underrepresented minority populations to careers in advanced practice nursing and research. Today, their germ of an idea has blossomed into a highly successful collaboration that has been praised by the National Institute of Nursing Research (NINR) for its leadership role in addressing racial and ethnic health disparities and has been recognized by the National Institutes of Health (NIH) as a national model for nursing school health disparities partnership programs around the country.
Catherine Gilliss, RN, DNSc, FAAN, dean of Yale University School of Nursing in New Haven, Conn., and Dorothy Powell, RN, EdD, FAAN, associate dean of Howard University’s Division of Nursing in Washington, D.C., wanted to change the face of nursing research by encouraging talented minority students at the baccalaureate level to develop an interest in research, go on to graduate school and pursue doctoral degrees. The most effective way to accomplish this, the deans agreed, would be to immerse the students in research to help them understand the process. Empowered by that understanding, they reasoned, the students would gain confidence in themselves and in their ability to make a difference by becoming nurse scientists.
So it was that the Yale-Howard Scholars Program was born. Each year, the program brings a small, select group of Howard BSN students to the Yale campus to receive mentorship, training and research opportunities. The project’s original design involved an intensive six-week summer internship in which each Howard scholar was matched with a mentor from Yale–a nursing faculty member conducting funded research–with whom they would work closely.
In the summer of 2000, the first group of nurse scholars traveled to Yale for their internship. Five students from Howard University were chosen to participate. During that inaugural year, Yale covered all of the students’ expenses.
“That first summer,” Powell recalls, “we had to convince the students that this was a good thing to do. We chose good students who were considering graduate school and had an interest in learning about research.”
The students stayed at Yale in campus housing facilities, attended seminars, performed some community service and worked on projects with their mentors. Within the context of the larger research project, the Howard scholars had to identify a research question that they could look at more closely, then use the data from the parent project and transform it into a research problem involving minority health disparities. The students were responsible for studying the data, analyzing it and presenting their results.
“An Incredible Experience”
Nicole Laing, RN, BSN, was one of the first Howard University scholars to attend the internship program at Yale. Her research project focused on type 2 diabetes in minority women.
“I originally wanted a clinical experience but was offered the opportunity to learn about research at Yale, so I went. I thought it would be a good experience and would prepare me for graduate school,” she says. “It was an incredible experience. I enjoyed my mentor’s approach. I was introduced to the research project and encouraged to just dive in. I appreciated being able to run with it.”
Laing graduated from the BSN program at Howard in spring 2001 and is now a graduate student at Yale, studying to become a Child and Adolescent Psychiatric Nurse Practitioner. “I love it!” she reports. “I’m having a good time and learning a lot. For minority nurses especially, the impact we can make on health care is so great. It’s worth the time and effort required to complete a graduate school education.
“Attending the Yale-Howard internship program definitely fueled my desire to go to graduate school and to attend Yale,” Laing adds. “The internship experience developed me both as a nurse and as a professional. It helped me prove to myself that I could do it, that I could attend an Ivy League school. Sure, it was challenging. But like anything else, I just had to make the commitment and do it.”
Making an Impression
At the end of their six-week internship, the inaugural group of Yale-Howard scholars presented their research at a symposium held at Yale. They had created PowerPoint presentations in which they demonstrated the application of statistics and their understanding of the research vocabulary to explain their findings. They fielded questions from doctorally prepared nurses in the audience. Everyone was very impressed at how well the scholars were able to articulate their research, says Powell. “Clearly, there was a transformation in these students,” she declares.
“Presenting my project was a challenge,” Laing remembers, “and it was wonderful! I actually understood the process and felt confident about what the numbers meant.”
But the research experience for the minority students didn’t stop when the six weeks were over and they returned to their own campus. To continue the process, the scholars were assigned Howard University mentors to work with them throughout their senior year. These faculty members attended Yale for three days to study the research being done by the Yale mentors so they could help the students continue their research during an independent study.
At the end of their senior year, the scholars presented their research findings to their own student body at the Howard University Carnegie Endowed Visiting Professorship and Research Day, an annual event where 350 people converge on campus to hear minority nurse scientists share their research. Here, too, the Yale-Howard scholars were very well received. “There was such pride and appreciation from their fellow students,” reports Powell. “The scholars did so well and it made a positive impact on their peers.”
One such peer was Angela McKnight, RN, BSN. “When I heard the scholars give their presentation, I felt encouraged. The following summer, I applied for the internship at Yale,” says McKnight, who participated in the Yale-Howard Scholars Program in summer 2001.
A Shining Example
From this early success, a ripple effect began. Students from Howard signed up for the next internship in droves. The program began to attract national attention. The Yale-Howard scholars became highly desired by some of the best graduate schools in the country; 75% of the students have gone on to pursue advanced degrees. The scholars were invited to present their research at the Howard University College of Medicine’s annual Biomedical Research Symposium. “The appreciation of the medical community on campus reflects the respect for the research culture developed in the nursing school,” Powell notes.
Deans Gilliss and Powell decided to bring their partnership program to the attention of the National Institutes of Health, in hopes of obtaining grant funding that would help them continue and expand the project. The agency was so impressed with the program that it agreed to provide funding for five years. In 2001, the NIH identified the Yale-Howard Scholars Program as a model partnership program for developing a pool of minority nurse scientists who can contribute to the elimination of health disparities. Since then, the program has provided a prototype for seven similar nursing school Partnership Center initiatives throughout the United States. (See page TK.)
The two deans agree that the benefits to both universities are great. “We have truly benefited from the relationship with faculty at Howard University, such as [learning from them] how to access [minority] participants for research studies and breach barriers in hard to reach populations,” Gilliss says. Adds Powell, “Yale’s influence helped us cultivate a research culture and a capacity for scientific education. We are experiencing an increase in applications to our undergraduate and graduate schools, attracting more students and faculty interested in research. And we are experiencing an increase in funding for research projects as well.”
Yale, which does not have an undergraduate nursing program, has also gained much from the fresh perspectives and cultural diversity that the BSN students from Howard bring to the campus. “Our faculty are more aware of how their scientific work can and should impact health disparities,” Gilliss explains. “It is exciting to have these extraordinary students on campus. There has been an increase in our graduate school admissions as well as an increase in faculty applications. Nationally, we are being recognized as an institution that values diversity in our faculty and student populations and that welcomes diversity of thought, culture and country of origin.”
Gilliss’ excitement is shared by the Howard scholars who have participated in the initiative, including the most recent group of four students who attended the summer 2002 program. The scholars are immersed in graduate- and doctoral-level culture. The seminars and networking events they attend pull them into the world of research and enable them to experience what happens at the higher levels of learning.
“I learned so much at Yale. It was an awesome experience,” recalls McKnight, who graduated from Howard University in 2002 and will be attending graduate school in the fall at George Mason University in Virginia. She wants to teach and, ultimately, become a nurse scientist conducting research in minority communities. “I am more critical of research studies now,” she says. “You can’t take the numbers at face value. You have to look at the sample used in the study.
“The partnership with Yale is opening doors for us,” McKnight continues. “We need more partnerships like this! This was a new experience for me as a person of color and as a student. I am excited to get involved so I can make sure that research is representative of and real for the minority population.”
McKnight says the hands-on research experience she acquired at Yale helped her truly understand what being a nurse scientist is all about. “The internship at Yale has opened my eyes to the possibilities,” she comments. “It has given me a greater understanding of how research works and how projects are determined worthy for funding. Research makes sense; without research, how will we know how new medicines, for example, impact our [minority] community if the members of our community are not involved in the research studies? Research is so important to our future and it is a critical part of nursing. We’re the ones who are on the front lines with the patient. Patients trust us. Our population needs us.”
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