Progress of the regional alliances in moving the New York State Research Agenda forward.
Abstract: The New York State Research Agenda promotes nursing research and evidence-based practice as a means of improving the quality, efficiency, and effectiveness of care in the state. One way to put the research agenda into action is through the development of regional nursing research alliances across New York State. These alliances are focused on ways to make research and evidence-based practice more tangible to all nurses. In this article the authors provide an overview of each alliance and detail the activities being undertaken to move the research agenda forward.
Subject: Medical care (Quality management)
Nurses
Evidence-based medicine
Authors: Myers, Gina
Malmgreen, Christine
Havener, Jeanne-Marie
Pub Date: 09/22/2009
Publication: Name: Journal of the New York State Nurses Association Publisher: New York State Nurses Association Audience: Academic Format: Magazine/Journal Subject: Health; Health care industry Copyright: COPYRIGHT 2009 New York State Nurses Association ISSN: 0028-7644
Issue: Date: Fall-Winter, 2009 Source Volume: 40 Source Issue: 2
Product: Product Code: 8043100 Nurses NAICS Code: 621399 Offices of All Other Miscellaneous Health Practitioners
Accession Number: 242592188
Full Text: It has been said that when faced with a difficult or daunting task one must remember that the only way to eat an elephant is one bite at a time. For the past 20 years this has been the lived experience of a group of committed pioneers in the discipline of nursing--nurses who long ago recognized that nursing care must be evidence-based if it is to meet the public mandate for quality, efficiency, and effectiveness.

Today one can hardly open the pages of a nursing journal, conference brochure, job advertisement, or curriculum plan without seeing the words 'evidence-based' or 'research' popping off of the page. Despite this new buzz about nursing research and evidence-based practice (EBP), the real evidence suggests that while much has changed, there is still much to do if nursing practice is to truly be evidence-based. That is, more nurses need to be educated in how to critically analyze the evidence that exists, more institutional support is required to invest in examining and refining practice, and more research is needed on the pressing practice problems that continue to affect the quality, efficiency, and effectiveness of nursing care. All of this change needs to occur in the midst of a nursing shortage and burgeoning fiscal restraints. To this end, the work of a small but committed group of transformational leaders continues.

History of the Research Agenda

The historical roots of the New York State Nursing Research Agenda (NYSRA) have been chronicled by several teams (Cote-Arsenault, Worral, Havener, & Gurney, 2005; Levin, Perry, & Gurney, 2002; Welch, Shortridge, & Tucker, 1991). A brief review is provided here.

The seeds of the Agenda first appeared in 1988 at a conference convened between the Foundation of New York State Nurses, the New York State Nurses Association (NYSNA) Council on Nursing Research, and the Delta Pi Chapter of Sigma Theta Tau International.

Conference attendees articulated five common beliefs regarding nursing research: (1) a link exists between research and quality of care; (2) there is a connection between rigorous research and the strength of the discipline; (3) a clear research agenda would facilitate research and encourage innovative inquiry; (4) there is a need to bolster research efforts through collaboration between individuals and organizations; and, (5) nursing research in New York State could impact nursing and health care in other places (Welch, Shortridge, & Tucker, 1991). It was further decided that a coordinated nursing research agenda was needed to facilitate this effort. Progenitors of the nursing research agenda movement, Levin, Perry, and Gurney (2002), reaffirmed these beliefs, calling for research as "a driving force in the evolution of nursing and health care" (Welch, Shortridge, & Tucker, 1991, p. 4).

The Council conducted a Delphi survey to identify nursing research priorities and, in 1989, convened a conference to review and refine those research priorities. As a result of these recommendations, the Center for Nursing Research was conceived under the auspices of the Foundation of New York State Nurses (Levin, Perry, & Gurney, 2002; Welch, Shortridge, & Tucker, 1991).

In 1994, another conference convened to assess the gap between nursing research, education, and practice. Participants working in small groups identified the nursing research needs and developed strategies to promote nursing research efforts. In 1998, the New York State Nursing Research Leadership Summit was convened for nurse researchers and others interested in nursing research. The assembly was charged with "establishing benchmark criteria for a realistic nursing research agenda" (Levin et al., 2002, p. 5). Interestingly, the same issues identified as impeding the advancement of nursing research 10 years earlier persisted. Failure to develop a plan to overcome barriers was cited as a major impediment to the advancement of nursing research; this was compounded by the overwhelming changes in healthcare reimbursement during the 1990s.

In 2000, the Foundation and the Council turned to the nursing community to gather input on the nursing research agenda through a mailed survey and focus groups (Levin et al., 2002). The intent was to create a more realistic agenda and included nursing professionals from education, practice/service, and research. Data provided answers to the question: How can nurses collaborate to promote and implement research and research utilization statewide (Levin et al., 2002, p. 8)? Findings were broadly sorted into five themes:

* Involvement/collaboration/mentoring

* Infrastructure

* Education

* Dissemination

* Research utilization (at micro and macro levels)

From the data emerged the five goals of the new Nursing Research Agenda for New York State. The goals provide a framework for planning (Cote-Arsenault et al., 2005).

Working from this structure, the members of the NYSNA Research Council created a working document with sub-goals, timelines, assigned accountability, progress reports, and outcomes. This document provided members with greater direction to drive the process. This "living document" continues to move the process forward and is reviewed and updated four to five times a year by members of the Center for Nursing Research Planning Committee (CNR-PC). The current goals of the NYSRA are to: (1) expand the human, technological, and financial infrastructure that is currently available to support the nursing research endeavor; (2) facilitate collaboration among all stakeholders in the nursing research endeavor to promote sharing of expertise, mentoring of novices, and coordination of resources in order to improve patient care; (3) create learning opportunities for nursing students and professional nurses to enhance their understanding of nursing research and their ability to apply research findings to practice; (4) disseminate nursing research findings to members of the nursing profession and the community at large; and, (5) promote the use of nursing research findings to solve clinical problems and influence healthcare policy. The full NYSRA can be viewed at http://foundationnysnurses.org/CNR/ statewideresearchagenda/index.php.

From agenda to action

Moving the agenda into action was facilitated by the creation of the national Magnet Hospital Recognition Program, which called for the support and integration of research into patient care as a standard to be met for Magnet designation or re-designation. The goals of the NYSRA and the research standards required for Magnet designation were and remain remarkably aligned (Cote-Arsenault et al., 2005). Both call for a commitment of human and material resources to nursing research as a means of improving the quality, efficiency, and effectiveness of care. The confluence of these factors gave rise regionally to the emergence of joint clinical appointments of doctorally prepared faculty in clinical settings and spawned the development of regional nursing research alliances to bring nurses from academia, service, and research together to advance nursing science.

The work of the regional research alliances is jointly supported by the Foundation for New York State Nurses and NYSNA through the work of the CNR-PC. In turn, the alliances have expanded the human infrastructure for nursing research and EBP through collaboration, networking, the sharing of expertise, and the mentoring of nurses interested in research and EBP. Many members of the CNR-PC serve in formal and informal leadership roles in their regional research alliances. Through their involvement, the goals of the NYSRA are woven into alliance activities.

In 2007, the Foundation hosted its first annual meeting of the research alliances. This meeting coincided with a meeting of the CNR-PC and allowed time for networking and mentoring opportunities. The 2008 annual meeting focused on ways that the CNR-PC and the alliances could partner to work on projects and research. The 2009 meeting focused on a collaborative effort of the alliances to offer an evidence-based practice conference in the spring of 2011 and further opportunities for fundraising and joint research studies. The fourth joint annual meeting of the alliances is scheduled for June of 2010 at the Foundation of New York State Nurses headquarters in Guilderland, N.Y

A history of the alliances

In 2004, two nursing research alliances in upstate New York simultaneously developed: the Capital District Alliance, organized in the metropolitan Albany area, and the Leatherstocking Alliance for Research in Nursing (LeARN) in rural, south-central New York. Both of these alliances were loosely based on the well-established Hartford Alliance in Connecticut. The map in Figure 1 details all of the current nursing research alliances in New York State.

The Capital District Alliance

The formation of the Capital District Alliance was spearheaded by Patricia Edwards, EdD, of Excelsior College in Albany, and Glenda Kelman, PhD, of the Sage Colleges in Troy. Initially, this alliance was composed of representatives from academic institutions and healthcare organizations but expanded to include two chapters of Sigma Theta Tau and the Foundation of New York State Nurses.

The stated mission of the Capital District Alliance is to facilitate collaboration. Specifically identified in that collaborative effort are nursing students, nurses, and nursing scholars in healthcare organizations and academic institutions. Their mandate is to conduct, use, and disseminate research findings readily translatable into EBP and health policy. Their goals include: (1) creating, nourishing, and sustaining a collaborative culture for nursing research and EBP; (2) facilitating the conduct and use of nursing research to support practice; and (3) promoting awareness of nurses as scholars and researchers and making visible their contributions to nursing, health care, and society.

[FIGURE 1 OMITTED]

Since its inception, the Capital District Alliance has provided a number of research and EBP programs, including educational programs where nurse researchers share and discuss their work. All nurses are invited to attend these conferences and display posters highlighting EBP projects they have facilitated. Members of the alliance have also successfully mentored two researchers who received American Organization of Nurse Executives seed grants, implemented two collaborative research projects, and created EBP educational modules that can be accessed on their website. The Capital District Alliance continues to invite and encourage area nurses from practice, academia, and administration to participate in their activities and committees. The website, which includes further information about the alliance and educational programs, is located at www. capitaldistrictnursingresearchalliance. com. You may also contact them via e-mail at nursing_research_alliance@excelsior.edu.

The Leatherstocking Alliance

The mission of the LeARN is to improve health outcomes by promoting nursing research and evidence-based nursing practice. The goals and subgoals of the organization were constructed to mirror those of the New York State Research Agenda at the local level. The LeARN meets five times per year at various host sites throughout the region, offering opportunities for nurses to network and learn about findings from original nursing research studies. Members of the rural LeARN network with surrounding urban alliances; present findings of original research or EBP projects at regional, national, and international conferences; and have participated in collaborative research projects and fundraising events with other alliances. Current membership includes nurses from practice, academia, research, and administration. Founder and co-chair, Jeanne Marie Havener, PhD, APRN, chair of nursing at Hartwick College and nurse research facilitator at Bassett Healthcare, extends an invitation to all nurses in the Leatherstocking region to join their efforts; she may be contacted at havenerj@hartwick.edu.

These two embryonic examples of alliances, one in an urban setting and one rural, both dedicated to nurturing nursing research, have been instrumental in the formation of three more regional alliances in New York State.

And then there were five

The Central New York Nurses Collaborative to Advance Research and Evidence-Based Practice (CNY-NCARE) started as an informational electronic mail listserv in 2005 under the management of Priscilla Worral, PhD, RN, coordinator of nursing research at Upstate Medical Center in Syracuse. Inspired by the work of the other two alliances, Worral and Gina Myers, PhD, RN, then a professor of nursing at the State University of New York's Institute of Technology in Utica, decided to form an alliance in Central New York. The first meeting took place in early 2007 and was successful, with more than 35 nurses attending. The group decided to meet quarterly and, by February 2008, the group had approved their mission, goal, and objectives. The mission of CNY-NCARE is to "facilitate collaboration of research activities through the conduct and promotion of research and the use of evidence-based practice to improve patient care in Central New York." Their vision is, "bringing evidence to the point of care," and their goal is to "elevate nursing research activities and the application of evidence-based practice to improve the health outcomes of the Central New York community." Various objectives have been developed to support this goal.

Most recently the group has launched a website, www.cnyncare.org, with the assistance of a graduate student from Capella University. Other activities have included development of bylaws, pursuit of 503(c)(3) status, and fundraising to support the growth of the Foundation's research endowment. Currently, there are 95 members of CNYNCARE from approximately 12 different organizations. For more information about this group, visit the website or contact Worral at worralp@upstate.edu.

Also forming in 2007 was the Montauk to Manhattan Evidence-Based Practice Alliance (M2M), "... an innovative and dynamic regional alliance committed to advancing evidence-based nursing practice in Long Island and New York City." Pat Lavin, MS, RN, then Magnet coordinator of Good Samaritan Hospital and founder of the alliance, was interested in partnering with area schools of nursing and service organizations to advance the state of nursing research and the translation of research into practice. Lavin, along with Patricia Hogan, MA, chief nursing officer, arranged for a conference call between key stakeholders and the chairs of the existing alliances in New York State to learn more about how to proceed. With expert mentoring from Rona Levin, PhD, RN, chair of the CNR-PC and professor of graduate nursing education at Lienhard School of Nursing, Pace University in New York City, and Lillie Shortridge-Baggett, EdD, FNP, RN, also at Pace, the M2M has taken off.

Like the other nursing alliances, membership in M2M is comprised of nurses in acute and long-term care institutions and academic nursing centers. M2M's mission is more directly focused on the translation of research into practice and providing skills and competencies to students of nursing and nurses at the point of care in EBP than on pure research.

The goals of M2M include: (1) promoting excellence in patient outcomes by translating research into practice and the dissemination of interventions that promote and hasten adoption of evidence in practice, (2) creating and coordinating innovative partnerships between students of nursing and nurses at the point of care, and, (3) becoming regional leaders in the discovery and application of nursing knowledge.

M2M has been very active in its short existence. The group's accomplishments include two multi-site collaborative research studies, participation in annual meetings of the Statewide Regional Alliances, poster presentations at Queens Hospital's EBP Conference in July 2008, and development and implementation of an EBP Characteristics Survey. In fall 2008, Good Samaritan and Molloy College collaborated to present, "Knowledge Transfer-Knowledge Uptake: An Evidence-Based Nursing Practice Conference."

Most recently, M2M has been active in a pressure ulcer initiative, has moved to holding virtual meetings, is partnering with Pace University, and is in the initial stages of developing a regional website. For more information about the group at this time, contact Lavin at Patricia.Lavin@nyumc.org.

In March 2008, under the mentorship of Worral, the newest regional research alliance, the Hudson/Harlem Valley Nursing Collaborative to Advance Research and Evidence-Based Practice (HVN-CARE) was founded by Christine Malmgreen, MS, MA, RN-BC, CHES, research coordinator at Hudson Valley Hospital Center in Cortlandt Manor. The genesis of this organization grew out of recognition of the lack of such an organization in the region as well as Malmgreen's participation as a nursing research fellow for the NYSNA Council on Nursing Research. The alliance attracted attendees from Bronxville to Poughkeepsie representing 15 area organizations. Meetings are held at different member sites. The objectives of this group are similar to those of the alliances that preceded it. The kick-off meeting was held in the area's only Magnet hospital, Hudson Valley Hospital Center, in March 2008. The second, third, and fourth meetings have been hosted by Pace University, Vassar Brothers Medical Center, and Westchester Medical Center, respectively. The one-year anniversary meeting was convened at Hudson Valley Hospital Center in March 2009. In June 2009, the group met at Phelps Memorial Hospital Center and, thanks to a grant obtained by Shortridge-Baggett, was able to connect with three other sites using GoToMeeting[TM] technology.

The HVN-CARE group is still in the formative stages. Two presentations at quarterly meetings focused on EBP areas of critical concern to nurses in clinical practice. The first was on catheter-associated urinary tract infections and the second on falls. A panel presented on rounding in March 2009. Members are discussing sponsoring a regional research/EBP seminar in 2010. It is fortunate that Laura Caramanica, PhD, RN, senior vice president/chief nursing officer at Westchester Medical Center in Valhalla, has taken an active role in HVN-CARE activities, including networking with her administrative peers to encourage attendees from clinical facilities. Caramanica was a co-founder of the Connecticut Nursing Research Alliance and served that group for more than 12 years. Nurses in the Hudson/Harlem Valley interested in participating in the 2010 gathering should e-mail Malmgreen at cmalmgreen@hvhc.org for information.

Building new bridges

Creating research networks across the state is of benefit to all nurses and nursing organizations in New York State. To facilitate growth in this endeavor, a member of CNY-NCARE contacted Dianne Cooney Miner, PhD, RN, dean of Wegman's School of Nursing at St. John Fischer College in Rochester, to discuss the formation of an alliance in the area. Based on that conversation, members of the alliances were invited to give a presentation at a meeting of the Finger Lakes Organization of Nurse Executives (FLONE). In November of 2008, four alliance members attended the meeting, three from CNY-NCARE and one from LeARN. The group presented a historical overview of the alliances, where they are located, their missions, goals, objectives, and activities to date. Further, they encouraged attendees to consider the formation of an alliance in the Rochester region with support and encouragement from the Foundation. The presentation was well received and attendees agreed that a research alliance was needed in the area.

Recently, members of the FLONE decided to initially form the Finger Lakes Alliance for Nursing Research as part of their existing group. They believed this would be advantageous since members were both interested in and believed that their established networks would provide the alliance with numerous opportunities for growth. Their first meeting took place in July 2009. Currently, no regional alliances exist in the Buffalo or Watertown areas. Members of the CNR-PC intend to make contact with interested individuals in the near future.

Diffusing innovations

Nursing meets the highest ideals of the profession when it puts aside narrow self-interests for the interests of those they serve: the patient, the public, the practice, and the profession. In the current professional environment, one characterized by increasing demands for quality, efficiency, and effectiveness in the midst of great fiscal and human constraints, it is easy to lose sight of those high ideals. Hence, there is the need for visionary leadership that encourages us to work collaboratively and collectively across contexts.

Working from a vision established in 1988, a group of thoughtful, committed nursing leaders developed a living, breathing document that served as a foundation for establishing the structures and processes currently driving nursing scholarship and science forward in New York State. Through their efforts, and the efforts of those who followed in their footsteps, New York State currently boasts six regional research consortia. These consortia and their members work individually and collaboratively to move the NYSRA forward in an effort to improve both the practice and the profession so that our patients and the public are better served.

As evidence-based leaders, these paradigm pioneers worked to tap into the energies and talents of other nurse 'innovators' (Rogers, 1995) across the state. Likewise, these innovators tapped into the energies and talents of regional innovators as well as the collective wisdom of their colleagues across the country. In particular, the work done by Caramanica and her colleagues (2002) in the Hartford Capital Area Alliance for Nursing Research and Research Utilization provided much needed practical insight for those regional leaders. The excitement of these innovator's efforts were, in turn, brought to fruition by early adopters from practice, administration, and academia (Rogers, 1995) who were sold on the practical utility of such collaborative efforts. These efforts married the needs of those in service to conduct and use research to guide the practice, with those in academia to conduct and disseminate the research. Likewise, these early adopters or opinion leaders went back to their home organizations and sold the idea for a collaborative regional research consortium to their constituencies and gathered other followers.

As noted anthropologist Margaret Mead said, "Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has."

Through the catalytic efforts and vision of a small group of pioneering nurses, the NYSRA has begun to be regionalized and realized. From genesis to reality, diffusing this innovation has taken nearly 20 years. Hopefully, the lessons learned in this process can assist other likeminded committed nursing constituencies across the nation and across the world to realize similar results.

REFERENCES

Caramanica, L., Maljanian, R., McDonald, D., Taylor, S. K., Mac Rae, J. B., & Beland, D. K. (2002). Evidence-based nursing practice, Part I: A hospital and community collaborative. The Journal of Nursing Administration, 32(1), 27-30.

Cote-Arsenault, D., Worral, P. S., Havener, J., & Gurney, C. (2005). Moving the New York State research agenda forward: The stakeholder is you! Journal of the New York State Nurses Association, 36(1), 4-7.

Levin, R. F., Perry, P., & Gurney, C. (2002). Designing a statewide agenda for nursing research. Journal of the New York State Nurses Association, 33(2), 4-10.

Welch, C. A., Shortridge, L. M., & Tucker, L. M. (Eds.). (1991). Nursing research: Forging an agenda for New York State. (Available from the Veronica M. Driscoll Center for Nursing, 2113 Western Avenue, Guilderland, NY 12084.)

Rogers, E. M. (2003). Diffusion of innovations (5th Ed.). New York: Free Trade Press.

Gina Myers, PhD, RN

Christine Malmgreen, MS, MA, RN-BC, CHES

Jeanne-Marie Havener, PhD, APRN

Gina Myers is an assistant professor of nursing at LeMoyne College in Syracuse, NY; Christine Malmgreen is associate director for professional practice development at Hudson Valley Hospital Center in Cortlandt Manor, NY, and Jeanne-Marie Havener is chair of the department of nursing at Hartwick College in Oneonta, NY.
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