EVIDENT THROUGHOUT THE

E

the support, conduct, and applica-tion of research to clinical and administrative practice. More over, ANCC recently in creased the weighting of this organizational attribute for organizations applying for Magnet redesignation (ANCC, 2008).

ANCC Magnet Model Components and Sources of Evidence

In 2007, ANCC developed a

Model for Magnet, which was built from a structured review of previ-ous application requirements and submitted materials. The new model consists of four evidence-derived components — transforma-tional leadership, structural empowerment, exemplary profes-sional practice, and new knowl-edge, innovations, and improve-ments — and includes a linking dimension focused on empirical outcomes (ANCC, 2008). The new knowledge, innovations, and improvements component focuses on research and evidence-based

EXECUTIVE

SUMMARY

Hospital-based nursing research centers can create the structures and processes needed to promote and sustain research and evi-dence-based practice (EBP) and assist in the monitoring of care delivery outcomes.

At the University of Rochester Medical Center, New York, a highly successful nursing research cen-ter has succeeded in creating a Magnet environment that incorpo-rates research and EBP into strategic planning, individual employee performance review, and organizational processes. Support of a hospital-based research center can provide the foundation for an infrastructure that supports achievement of Magnet designation research and EBP criteria.

The costs pertain primarily to the staff required to develop and man-age the center and the education-al programs offered through it. Based on the experience at this center, administrators should plan 3-5 years before significant impact is seen in terms of numbers of consultations performed and tangi-ble increases in staff and leader-ship participation in research and EBP initiatives.

Gail L. Ingersoll

Patricia A. Witzel

Cynthia Berry

Brandon Qualls

Meeting Magnet

®

Research and

Evidence-Based Practice Expectations

Through Hospital-Based

Research Centers

SERIES

GAIL L. INGERSOLL, EdD, RN, FAAN, FNAP, is Director, Clinical Nursing Research Center, Strong Memorial Hospital, and Loretta Ford Professor of Nursing, School of Nursing, University of Rochester Medical Center, Rochester, NY.

PATRICIA A. WITZEL, MS, MBA, RN, FNAP, NEA-BC, is Chief Nursing Officer, Strong Memorial Hospital, Rochester, NY.

CYNTHIA BERRY, BSN, RN, is a Nurse Leader, Clinical Nursing Research Center, Strong Memorial Hospital, Rochester, NY.

BRANDON QUALLS, MPA, is a Co -ordinator, Office of Nursing Data and Information Management, Clinical Nursing Research Center, Strong Memorial Hospital, Rochester, NY.

ACKNOWLEDGMENTS: Several activities described in this article were supported in part by grant funding from the Department of Health and Human Services, Health Resources and Services Administration, through its Nurse Education, Practice and Retention: Enhancing Patient Care Delivery Systems Program (Grant # D66HP03172).

NOTE: The authors and all Nursing Economic$ Editorial Board members reported no actual or potential conflict of interest in relation to this continuing nurs-ing education article.

practice (EBP) and covers expecta-tions for established and ongoing research and EPB programs and the presence of an infrastructure and resources that support the advance-ment of both in all clinical settings. Included within this revised shift from a focus on structure and process to critical analysis of out-comes is an expectation that hospi-tals applying for redesignation demonstrate clear indication of continued growth and expansion of research and EBP activities and achievement of excellent care delivery outcomes. For hospitals applying for Magnet designation or redesignation, this increased focus on research, EBP, and empirical outcomes may present some chal-lenges if hospitals have not devel-oped a plan for meeting these desig-nation expectations.

Hospital-Based Nursing Research Centers

Despite the growing expecta-tion for EBP in nursing practice, few descriptions of hospital-based nursing research centers are avail-able. These centers can create the structures and processes needed to promote and sustain research and EBP and assist in the monitoring of care delivery outcomes. In the reports of hospital-based initiatives undertaken to promote research and EBP, limited information is provided about the ways in which the activities associated with research centers have evolved over time or the sequential steps taken to build organizational capacity. Cullen, Greiner, Greiner, Bombei, and Comreid (2005) summarized the strategies undertaken at the University of Iowa Hospitals and Clinics and highlighted the steps taken to build EBP activities into an existing organizational infrastruc-ture. Aside from an exemplar of an evidence-based initiative with good outcome, however, no information is provided about the impact of these changes on nurses, patients, or organizations. In another article, Gawlinski (2008) reviewed the activities implemented at the

University of California, Los Angeles Medical Center to advance research and EBP, although these were not described as incorporated within a research center. Gawlinski mentioned several projects com-pleted by EBP fellows and the patient-related outcomes achieved as a result of their implementation. Vratny and Shriver (2007) also described a model designed to over-come barriers to EBP in a small medical center, which was facilitat-ed by an EBP council and its chair. A majority of the EBP models covered in the literature focus pri-marily on the evidence determina-tion and applicadetermina-tion process (Gawlinski & Rutledge, 2008), which is helpful but less useful for administrators interested in creat-ing the infrastructure needed to support research and EBP. This is a concern since Kitson, Harvey, and McCormack (1998), and more recently Rycroft-Malone et al. (2002), stressed the importance of attending to organizational context and leadership facilitation in addi-tion to level of research evidence itself. According to Foxcroft and Cole (2004), none of the EBP facili-tation models reported in the litera-ture have been evaluated sufficient-ly to warrant recommended action by administrators and others inter-ested in creating an environment supportive of research and EBP.

At the University of Rochester Medical Center, New York, a highly successful nursing research center has succeeded in creating a Magnet environment that incorporates research and EBP into strategic planning, individual employee per-formance review, and organization-al processes. The actions taken to create a center responsive to staff and leadership needs and the favor-able outcomes achieved over its 9 years of existence are described.

Creation of the Center

Initial planning for the center began with the chief nursing offi-cer’s (CNO) vision, which was focused on moving nursing prac-tice to the next level of care

deliv-ery excellence. This meant mak-ing research and EBP integral components of all strategic plan-ning initiatives and day-to-day practice. To achieve this goal, she recruited an experienced nurse researcher with administrative and program development experi-ence to oversee the process. From then on, she supported the cen-ter’s development through the allocation of funds and resources, the inclusion of the center’s direc-tor in the senior nursing executive team, and the continuous rein-forcement of the need for evidence to support clinical and adminis-trative decision making. She also set an aggressive plan for complet-ing the application process for Magnet designation.

Prior to the director’s arrival, nursing research and EBP initia-tives were poorly defined and no recognized resource was available to assist nurses interested in con-ducting studies or evaluating research findings for application to clinical or administrative prac-tice. As a result, the director’s ini-tial actions were directed at creat-ing the infrastructure needed to meet research and EBP expecta-tions for Magnet designation. During the first year of the center’s development, work groups met to develop goals for the center, iden-tify staff nurse and leadership needs, and clarify the resources required to meet these needs. As a result of this process, several grant proposals were developed and submitted for external funding to support innovative, evidence-based projects that could serve as models for linking researchers and practitioners for purposes of implementing and testing evi-dence-based change. This process resulted in the receipt of over $2.5 million of combined funding from the Department of Health and Human Services, the New York State Department of Health, and several private foundations.

The center’s goals during this infrastructure development phase were focused on hiring personnel

SERIES

to support the needs of staff and leadership, establishing processes for ensuring decision making was based on evidence, and revising existing documents to reflect nurs-ing’s philosophy and expectations for including research and EBP in performance expectations at all levels. The center’s director and staff marketed their willingness to travel to units and departments to meet with staff nurses, advanced practice nurses (APNs), and lead-ers to discuss ideas for research and to assist with the develop-ment of proposals, the measure-ment of program impact, and the creation of measures to evaluate intervention effect. The center assumed responsibility for sup-porting data management and analysis processes and for prepar-ing reports summarizprepar-ing the find-ings of individual studies and projects. The center also assisted with creating documents and processes supportive of organiza-tion-wide mechanisms for moni-toring unit and department per-formance.

Once the infrastructure was created, the principal activities of the center moved to developing educational offerings, providing individual and group mentorship and support, and confirming evi-dence-based project and process quality. The center also added responsibility for reviewing all nursing research proposals prior to submission to the medical cen-ter’s institutional review board (IRB) to confirm the study’s scien-tific integrity and protection of subjects’ rights. In addition, the director oversaw the creation and mentoring of a council devoted to research and EBP. This council is a sub-council of the hospital’s pro-fessional nursing council, which serves as the shared governance organization for the hospital.

Initial Magnet Designation Review

The research center had been in existence for 3 years prior to the submission of initial application

for ANCC designation as a Magnet hospital. The research and evi-dence based practice council had been in place for approximately 1 year and the number of consulta-tions by center staff had increased from 45 in 2002 (the first year of data collection) to 75 in 2003. Thirty-five nurses were principal or co-investigators of active research studies, of which 25 (71.4%) were supported by feder-al, private foundation, or drug/device companies. Ten pro-posals were submitted for external funding support, with three accepted for funding. Ten manu-scripts, two book chapters, and one Institute of Medicine commis-sioned paper were submitted and accepted for publication during the 2 years prior to Magnet appli-cation. Information about the number of presentations was not required and data were not cap-tured for that period.

Despite clear indication of infrastructure supports for the research and EBP dimensions of Magnet environments, the ap -praisers who visited the hospital during that initial review identi-fied areas for improvement. During interviews of staff, confu-sion was evident between re -search and performance improve-ment (PI) related activities and a recommendation was made to

develop programs to better pre-pare nurses for involvement in research and the application of research findings. As a result, sev-eral educational programs were developed, a more formalized process was introduced for moni-toring the types and extent of serv-ices offered and outcomes achieved, and activities directed at marketing the services of the center were expanded and refined.

Among the programs and activities added by the center were a 1-year research internship, quarterly research and EBP-focused grand rounds, delivery of educational sessions for leader-ship and staff, experiential learn-ing opportunities for undergradu-ate and graduundergradu-ate nursing students, a brief introduction to the center during nursing orientation, and the creation of a publication work-shop for nurses seeking facilitated experiences in developing and submitting manuscripts for publi-cation. Over time, the number of consultations by center staff increased significantly (see Figure 1) and the consultee makeup shift-ed from primarily APNs to an increasing number of staff nurses (see Figure 2).

Research internship. The re -search internship was designed to expose experienced nurses to

Figure 1.

Research Center Consultation Growth Over Time

2003 2004 2005 2006 2007 2008 2009 1,200 1,000 800 600 400 200 0 Director Other staff Total

SERIES

research and EBP principles and to provide them with a mentored opportunity to complete a clinically relevant EBP project. The purposes of the internship are to: (a) offer sen-ior nursing staff, APNs, nurse lead-ers, and nurse managers interested in EBP and nursing research the opportunity to develop the skills needed to successfully participate in and facilitate research-related activities; (b) recognize nursing’s key role in the generation and dis-semination of knowledge; and (c) improve the quality of care deliv-ered to patients and families. Continuing education contact hours are provided for each session.

Interns are given 1 paid edu-cation day per month for a full

year to participate in the intern-ship. The morning sessions are devoted to content relevant to the research and EBP process. The afternoon sessions are spent on independent work related to the intern’s clinically or administra-tively focused project. Interns are expected to search the literature and to critically evaluate the evi-dence for application to practice and their project. They develop purpose statements, timelines, and brief proposals, which are modeled after the medical center’s IRB format. The culmination of the internship is a formal presen-tation of their projects to their cohort of interns and a poster ses-sion open to the public.

During the internship experi-ence, the director of the center works individually with interns to design and carry out their projects. She meets with each intern a min-imum of every other month (and as often as requested) to review status, discuss barriers, and assure progress is being made. These scheduled meetings were added 3 years into the internship as a result of an average of 2-3 interns’ failures to progress in each year of the internship. The interns also receive assistance with instrument selection, data entry, management and analysis, abstract and poster development, and preparation of reports and manuscripts describ-ing project finddescrib-ings.

40 35 30 25 20 15 10 5 0 2003 2004 2005 2006 2007 2008 2009 Administrators APNs Faculty Nurse Managers/ Leaders Staff Nurses Students Others

Linear (Staff Nurses) Figure 2.

Consultee Roles

Consultation Services According to Role of Requestor (Percent of Total)

The size of the internship cohorts range from 10-24, with a cap set during the past year at 15 participants per year. This deci-sion was made in response to the realization larger class sizes inter-fered with peer review and the collaborative relationships that developed in the smaller groups. The director’s time availability also was a consideration. From our experience, the most effective size for internship group is 10-15. The majority of internship projects focused on evidence-based PI initiatives, although each year 1-2 interns complete formal studies. The focus on PI projects evolved as a result of the some-times lengthy time period required to review and approve studies through the IRB. The IRB review process generally takes a mini-mum of 6 weeks for expedited review. Prior to that time, the study must be approved adminis-tratively and reviewed for scientif-ic integrity by the research/EBP council, which also can take 4-6 weeks. Because the intent of the internship is to orient nurses to the research and EBP process and pro-vide them with the skills needed to serve as resources to others, the focus on PI rather than research was not seen as a problem. During the internship, we discuss how to move a PI project to a research project and what distinguishes one from the other. All interns are required to complete the medical center’s course on the ethical treat-ment of human subjects, which is required for all persons conduct-ing research in the university.

An evaluation of the intern-ship program was conducted in 2009, with interns surveyed con-cerning their perceptions of the internship program as a whole and the outcomes they achieved post internship experience. Twenty-eight (62.2% response rate) interns from the first 3 years of the program completed online questionnaires. Because the focus of the survey was on outcomes of the program, interns currently

enrolled in the program (N=24) were excluded. Thirteen (46.4%) of the former interns had contin-ued or extended the work of their internship, 11 (39.3%) had imple-mented EBP initiatives based on skills achieved in the internship, 9 (32.1%) had an abstract pertaining to their internship accepted for presentation at a national confer-ence, and 8 (28.6%) had an abstract accepted for other initia-tives undertaken since the intern-ship. Nine (32.1%) had advanced in their career since the intern-ship. None had an article or chap-ter published.

Satisfaction with the program was high, with a mean score of 3.68 (SD=0.72; maximum score=4) for satisfaction with the program as a whole. Mean satisfaction score for faculty knowledge was 3.91 (SD=0.29), 3.86 (SD=0.36) for responsiveness and timeliness of faculty, 3.59 (SD=0.57) for useful-ness of materials provided, and 3.50 (0.86) for likeliness of recom-mending the internship to others. We also collected information about intern reasons for with-drawal from the internship. Over time, we had an approximate 30% withdrawal rate, with the greatest number of departures occurring in the first 3 years. Reasons for with-drawal included difficulty sched-uling time for day-long sessions (n=2), change in job or position (n=2), conflict with school of other non-direct care demands (n=1), amount of work required for internship (n=1), and family ill-ness or death in family (n=2).

Quarterly grand rounds were introduced and are offered at two different times and days (Tuesday or Thursday, 2 p.m. or 7:30 a.m.) to maximize participation rate. Continuing education contact hours are provided and topics range from discussions of research and EBP issues in general to high-lights of projects completed or underway. One of the most highly rated and heavily enrolled ses-sions pertains to what to place in the individual nurse’s annual

per-formance review portfolio demon-strating achievement of research and EBP criteria. This presenta-tion includes informapresenta-tion about how to locate evidence through the medical center’s online search engines, where to find study review and critique forms to assist with the analysis of evidence for application to clinical and admin-istrative practice, and examples of activities that meet expectations for performance according to level of clinical ladder appointment. The evaluations of these sessions are highly favorable, with the number of participants at each presentation ranging from 10 to over 50.

Research and evidence based practice council (REBPC). The activities of the REBPC were for-mally defined and efforts were made to increase the number of staff nurses following initial Magnet review. A change was made to the oversight of the coun-cil, with a staff nurse and an APN assuming responsibility for co-chairing the meetings. The direc-tor of the center provided mendirec-tor- mentor-ship to the co-chairs and center staff provided administrative sup-port to the council.

The REBPC serves as both a process and policy review com-mittee and an educational and resource group for the promotion and support of nursing research and EBP. Council members work with nursing leadership to define the mechanisms for using EBP within nursing and for integrating it routinely into care delivery serv-ices and decision making. They also assist with the update and refinement of evidence-based policies and procedures, review research proposals involving nurs-ing staff, approve surveys for dis-tribution to nurses, work with leadership to identify perform-ance measures reflective of staff nurse and leadership expecta-tions, and review nursing studies for scientific integrity prior to sub-mission to the IRB.

Educational sessions for nurse

managers and leaders. Education -al programs (with contact hours) have been designed and offered on several occasions to nurse man-agers, nurse leaders, and nurse educators. The focus of these ses-sions is on the benefits of develop-ing and implementdevelop-ing a unit-based research and evidence-based outcomes monitoring and management plan and the strate-gies needed to increase activity at the unit level. Attendance at the sessions has been good, with pre-sentations evaluated favorably. An additional program was devel-oped for new managers and lead-ers and incorporated into the hos-pital’s new nurse manager orienta-tion program. This session focuses on strategies for creating a unit culture supportive of research and EBP and for assisting staff with achieving performance expecta-tions for participation in research and EBP. The educational session includes an application-focused component in which managers identify, develop, and complete an EBP change on their unit.

Data management and report generation. One of the first initia-tives undertaken by the research center occurred in response to requests from nurse managers and associate directors who were seek-ing user-friendly and more readily interpretable reports of National Database of Nursing Quality Indicators outcome measure sum-maries. The center’s reports con-tain similar information for all services, but also incorporate data displays specific to individual needs and interests. The center administrator prepares statistical control charts that provide visual displays of individual unit per-formance in comparison to organi-zational and national benchmarks. This information has assisted nursing staff and leadership with identifying unit performance out-liers and trends over time. Moreover, the charts have allowed for comparisons between care delivery outcomes pre and post evidence-based initiatives. The

center also responds to individual requests for summaries to support applications for best practice awards and other new program development processes.

Other EBP-related services.

The center provides individual report preparation assistance to nurses undertaking evaluations of existing or newly developed pro-grams. Center staff work with requestors to identify a reasonable timeframe for completion of tasks, with smaller projects finished within 1-2 business days. Center staff help investigators with data compilation, cleaning, and analy-sis, and with report preparation, including the development of abstracts, posters, presentations, and manuscripts.

The center also oversees the annual staff nurse evaluations of nurse managers. This process serves to achieve Magnet hospital expectations for 360 degree evalu-ations of all nursing employees. The process was implemented in response to staff nurse requests for involvement in annual evalua-tions of nurse managers. The research center assumed responsi-bility for overseeing this process because neither the director nor any members of the center staff have line responsibility for nurse managers or their nursing staff. The center director developed and tested the evaluation tool for relia-bility and validity and designed the reporting process to ensure individual staff could not be iden-tified.

Research center staff prepare evaluation forms, which for the past 3 years have been online, transport the data from the online survey software into SPSSTM _and

WordTM_{(comments) data files, run}

the analyses, and prepare individ-ual reports that are distributed to nurse managers, their associate directors, and the CNO. Over 1,200 staff nurses and others par-ticipate each year in this process, with the results used to assure the leadership team is highly compe-tent and achieving desired

out-comes at the unit and service lev-els. Consistent patterns of low rat-ings by staff nurses, in combina-tion with other leadership per-formance issues, have resulted in the implementation of develop-mental plans for nurse managers and the subsequent removal of managers who were unable to achieve and sustain expected per-formance levels.

Grants management. The cen-ter director and data management coordinator provide assistance to new and experienced nurses seek-ing and receivseek-ing fundseek-ing to sup-port research and demonstration projects. Investigators receive help with the development of propos-als and budgets, the internal administrative review process, and the online or hard copy sub-mission of proposals depending on funding source. Investigators also are guided through the process of setting up a grant account and assuring required documents and materials are maintained to support the work of the project and any auditing spec-ifications of the university and funder. The director works with the investigator to monitor the grant budget and to confirm reporting procedures are consis-tent with university and funding requirements. The data manage-ment coordinator is certified by the university as a grants adminis-trator and has completed a series of educational offerings focusing on the entire grants management process. He serves as a resource for grant proposal processing, monitoring, and reporting expec-tations.

As might be expected, most of the requests for center services focus on research design and methods (14%), followed by pro-posal review/development (11%), instrument development/selection (9%), other/miscellaneous (9%), data analysis (8%), and research study facilitation/oversight (8%). Figure 3 provides a summary of percentages of consultations for services provided by the center.

Marketing the Research Center Resources and Activities

One of the principal methods used to inform nurses and others about the research center’s exis-tence is its intranet site, which is overseen by the center director and its data management coordi-nator. Contained on the center intranet site is information about the services provided, educational offerings planned, applications for the research internship, a new investigator toolkit, guidelines for reviewing evidence, lists of publi-cations and presentations, copies of slides and handouts from quar-terly grand rounds and research

internship sessions, grant propos-al “boilerplates” pertaining to the university and the medical center, REBPC meeting minutes, and highlights of research interns’ projects. The site also contains links to the medical center’s library web page and internal and external resources related to research and EBP.

Information about the center is provided to new staff during nursing practice’s orientation and through nursing’s quarterly news -letter distributed to all staff. Each issue of the publication includes a

Research Corner section that high-lights an issue relevant to research

and EBP or a summary of a study completed or underway. One issue each year is devoted to the research interns, with a picture of each intern along with a brief abstract of his or her internship project. The final issue contains a listing of all publications, presen-tations, and studies underway during the year.

Cost Considerations

The costs associated with establishing and maintaining a hospital-based research center are primarily related to personnel. During the first year of the center, the full-time director was support-ed by an administrative assistant within the CNO’s office. As the magnitude of activity increased, a half-time secretary was added and this position was subsequently increased to full-time and elevated to an administrative assistant and ultimately center administrator status. Grant funding provided support for the hiring of 1.5 full-time equivalent (FTE) nurse posi-tions to support program evalua-tion needs and an addievalua-tion 0.5 FTE position was added by nurs-ing practice to cover expanded activities. As the grant funding ended, the 0.5 nurse position was eliminated. During this same peri-od, personnel associated with data management and reporting for nursing practice were assigned to the center, increasing the total FTEs to 5.5. This figure, at pres-ent, is sufficient to meet the increased consultation and sup-port demands of the center.

Other costs include materials to support the work of the REBPC and the offering of the research internship, quarterly grand rounds, and other educational programs. Computer, printer, and software costs also are associated with the center, including statistical analy-sis software to allow for more extensive data management and analysis procedures. A small amount of funds were expended to develop a logo for the center and to set up the offices for the

4% Abstracts

1% Copyright

8% Data Analysis

4% Document Preview

3% EBP Process 2% Funding 9% Instrument Development 7% IRB 2% Lit Search 5% Manuscript 3% Measurement 1% Policy 6% Poster Prep 2% Presentation 11% Proposals

1% Report Prep 14% Research Methods

8% Research Facilititation/ Study Overnight 9% Other

Figure 3.

Focus of Consultation Services (Percent of Total)

director, research nurses, and administrative assistant.

Table 1 summarizes the most recent year’s costs for the center, which were identified in the hos-pital’s 2008 application for Magnet redesignation. These fig-ures represent about 0.3% of nurs-ing practice’s overall annual budg-et. Hospitals considering imple-menting a research center should anticipate the need for additional resources as the activities of the center evolve over time. With the growth in consultations and serv-ices provided in the center, addi-tional personnel and funds were needed to support the develop-ment of posters in response to the significant increase in number of abstracts accepted for presentation at national conferences. The time spent on consultations and assis-tance with research studies and other evidence-based initiatives also has necessitated the hiring of additional personnel.

Magnet Redesignation Outcome

The activities introduced to meet Magnet designation research and EBP criteria were successful in moving nursing practice from a level of beginning achievement to a setting recognized as exemplary for its research and EBP processes and outcomes. Each of the research and EBP criteria for Magnet review during redesigna-tion were rated as exemplars by the appraisers following their review of documents and site visit. Exemplars are defined as examples of activities that surpass Magnet expectations and reflect the highest standards of practice.

By the year of the Magnet redesignation visit, the number of nursing employee publications had risen to 50 and the number of external presentations (up from 12 in the 2 years prior to the initial review) had climbed to 160. Twenty-five studies were under-way, many of which (N=12) included staff nurses as co-investi-gators. In the year since the Magnet review, the number of

publications, presentations, and studies has continued to rise and the impact of the research intern projects has expanded beyond the hospital. One intern’s comprehen-sive review of evidence concern-ing the restriction of deodorants and other topical agents in cancer patients undergoing radiation therapy resulted in the National Cancer Institute’s revision of its evidence-based standards of prac-tice for the nursing care of these individuals. In another instance, a physician who read an abstract of one intern’s project concerning the measurement of blood loss in the operating room contacted him about the processes recommended as a result of his work.

Lessons Learned

The creation of a hospital-based research center can facili-tate achievement of Magnet hospi-tal designation. Hospihospi-tals consid-ering designing a center should consider the benefit of hiring an experienced researcher with administrative experience if possi-ble. The skills needed to design and implement the programs and services offered by a center require both a high level of com-fort with research design and methods and an ability to work effectively in dynamic systems. For center directors with limited research experience, some mecha-nism should be established to ensure the director receives the mentoring he or she needs for his/her own program of research. As director of a hospital center, the majority of time will be spent mentoring and facilitating the work of others. This doesn’t mean the director should abandon his or her own research, but mecha-nisms will need to be in place to support personal scholarship goals. These individuals may need to be drawn from outside the hos-pital if no other experienced researchers and mentors are avail-able to discuss research ideas and review manuscripts and propos-als.

A second lesson learned is the importance of selecting a director or facilitators who can work with nursing staff with limited experi-ence with research design, meth-ods, and data analysis procedures. Working with individuals who are novices in the research and EBP process requires considerably more time and active involvement by the research director or facilita-tor, which is well beyond what many research faculty have expe-rienced in educational settings where research courses and expectations for students may have been much more prevalent.

A third lesson is the time required to establish the infra-structure required to achieve tan-gible outcomes. Three years is probably a reasonable period of time for establishing this frame-work, with notable increases in outcomes likely in the 4th and 5th year. Administrators should plan for the long haul and avoid with-drawing support or reducing resources before that time.

Visibility and a willingness to travel to clinical settings is key to a center’s success. Avoiding disap-pointment over the number of consultations provided in com-parison to the number of actual outcomes achieved (e.g., publica-tions, studies, grants submitted) is essential. Keeping in mind the staff nurses, managers, and APNs who will be carrying out the proj-ects also are fully engaged in pro-viding care to patients and over-seeing units will help in providing a reasonable perspective and level of expectation for what can be accomplished by any one person or group.

Summary

Support of a hospital-based research center can provide the foundation for an infrastructure that supports achievement of Magnet designation research and EBP criteria. The costs pertain pri-marily to the staff required to develop and manage the center and the educational programs

SERIES

Nursing Practice Budget Expenditures r/t Research and EBP Projected

Personnel % Effort Y2008 FY2009 FY2010

Director 1.00 Assistant director 1.00 Coordinator (6 months)* 1.00 Secretary 0.05 Research nurse 1.00 Research nurse 0.50 Research nurse 0.50

Senior information analyst 1.00

Information analyst I 1.00

Information analyst II 1.00

Student assistants (x2) 0.40

Total FTEs 8.5

Subtotal $500,878 $579,111 $596,484 Equipment Cost # of Units FY2009 FY2010

Computer $1,133 1 $1,133 $1,167

Printer $464 1 $464 $477

Subtotal $1,597 $1,644 Travel Cost # of Units FY2009 FY2010

Director to Magnet conferences to present $2,122 1 $2,122 $2,185

Research nurse to Institute for Healthcare Improvement meetings

$1,030 3 $3,090 $3,183

Friends of Strong travel (staff, leadership) $27,978 1 $27,978 $28,817

Subtotal $33,190 $34,186 Supplies FY2008 FY2009 FY2010

Office/Computer $3,090 $3,183 $3,278

Research internship $535 $551 $567

Subtotal $3,625 $3,734 $3,846 Other FY2008 FY2009 FY2010

Phone $1,761 $1,814 $1,869

Fax $1,415 $1,457 $1,501

Duplication of documents $1,000 $1,030 $1,061

Postage $108 $111 $115

Pager monthly charges (x3) $150 $155 $159

Palm replacement for director $200

Monthly usage charges for mobile device $720 $742 $764

Honorarium for research internship and grand rounds presenters

0 $80 $82

Refreshments for grand rounds $82 $85 $87

Refreshments for research internship $247 $255 $262

SPSS licenses $773 $796

Research internship posters $1,250 $1,875 $1,931

Internship completion acknowledgments $150 $225 $232

Subtotal $6,884 $8,601 $9,059 Total $511,387 $591,445 $609,389

Table 1.

Budgetary Considerations for Research Center

offered through it. Based on the experience of our center, adminis-trators should expect to see a sig-nificant impact in 3-5 years in terms of numbers of consultations performed and tangible increases in staff and leadership participa-tion in research and EBP initia-tives. $

REFERENCES

American Nurses Credentialing Center (ANCC). (2008). The Magnet model components and sources of evidence.

Magnet Recognition Program®_{. Silver}

Spring, MD: Author.

Cullen, L., Greiner, J., Greiner, J., Bombei, C., & Comreid, L. (2005). Excellence in evidence-based practice: Organi -zational and unit exemplars. Critical Care Nursing Clinics of North America, 17(2), 127-142.

Foxcroft, D.R., & Cole, N. (2003). Organi -zational infrastructure to promote evidence based nursing practice.

Cochrane Database Systematic Review, 2.

Gawlinski, A. (2008). The power of cal nursing research: Engage clini-cians, improve patients’ lives, and forge a professional legacy. American Journal of Critical Care, 17(4), 315-326.

Gawlinski, A., & Rutledge D. (2008). Selecting a model for evidence-based practice changes. A practical approach. AACN Advanced Critical Care, 19(3), 291-300.

Kitson, A., Harvey, G., & McCormack, B. (1998). Enabling the implementation of evidence based practice: A con-ceptual framework. Quality & Safety in Health Care, 7(3), 149-158. Rycroft-Malone, J., Kitson, A., Harvey, G.,

McCormack, B., Seers, K., Titchen, A., & Estrabrooks, C. (2002). Ingredients for change: Revisiting a conceptual framework. Quality & Safety in Health Care, 11(2), 174-180. Vratny, A., & Shriver, D. (2007). A concep-tual model for growing evidence-based practice.Nursing Administra -tion Quarterly, 31(2), 162-170.