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The Interdisciplinary Nursing Quality Research Initiative
A Research Program That Quantifies the Role of Nurses in Improving Patient Care
Nurses represent the single largest group of health professionals who deliver hospital care, yet, until recently, little was known about what they can do to ensure that care is safe, beneficial, patient-centered, timely, efficient and equitable. There was limited rigorous research demonstrating causal linkages between nursing care and patient outcomes, and without that, many policies and programs were based on the unproven assumption that developing effective performance measurement systems would enable health care stakeholders to better understand and monitor the degree to which nursing care influenced patient safety and health care quality.
In 2005, the Robert Wood Johnson Foundation (RWJF) created the Interdisciplinary Nursing Quality Research Initiative (INQRI) to address this gap in knowledge and identify the ways in which nurses affect the quality of care patients receive and the ways in which they can improve patient care and outcomes. Some INQRI projects have produced evidence that better nursing improves quality of care by reducing medical errors and identifying measures, processes and protocols that help health systems and health professionals ensure the best patient outcomes possible. Findings from INQRI projects also help hospital administrators, policy makers and other key health care decision makers understand what drives better nursing care and the environmental changes necessary to support nursing’s efforts to achieve better patient care and outcomes.
INTERDISCIPLINARY RESEARCH TEAMS
As its name suggests, INQRI strategically focused on supporting interdisciplinary teams that proposed diverse, innovative research initiatives designed to establish the link between nursing and high-quality. INQRI’s leadership is also an interprofessional team: Mary D. Naylor, PhD, RN, FAAN, a nurse and health services researcher, and Mark V. Pauly, PhD, a health care economist, direct the program at the University of Pennsylvania, in partnership with Lori Melichar, PhD and her colleagues at RWJF. Believing that interdisciplinary collaboration enhances the production of rigorous science, the INQRI program supported research teams that applied diverse perspectives and methodological techniques to answer questions without sacrificing the relevance and insights provided by clinicians. This interprofessional approach was extended also to the group of stakeholders selected to advise INQRI grantees and program leaders. By involving key stakeholders in the conduct of research from the outset, INQRI leaders hoped to build strong partnerships with potential end-users of the research findings.
In 2006, the first round of INQRI-funded interdisciplinary teams began their research studies. These nine projects addressed three major areas: (1) investigating the link between the work of nurses and the quality of care provided in hospitals; (2) producing and validating measures that capture nurses' contributions to quality care in hospitals; and (3) evaluating the impact of innovative nurse-led initiatives on patient outcomes. Each subsequent year and with each round of grantees, INQRI sought to build upon the first cohort’s body of research. The program also increased the scope of research from that conducted in acute care settings to considering projects that cut across a diverse range of health care settings.
Program leaders recognized that the work of the first round of grantees could provide the building blocks for several nursing quality improvement strategies. With that in mind, the program leadership invested in research that would examine the processes that could improve nursing-sensitive measures, and provide deeper understanding of the major care processes delivered by nurses and their impact on the quality of patient outcomes. INQRI funded 12 additional teams in 2007 to investigate such topics as nurses’ roles in: avoiding readmissions; addressing patients’ risk for falls; medication reconciliation; and other key processes of care.
In its third year, the program further expanded its scope to coincide with the national health care agenda to deliver high quality patient care while increasing value and reducing waste. Specifically, the call for proposals sought projects that would clarify the role of nurses on interdisciplinary health care teams and the effect of work environments on the efficiency of nursing care. INQRI awarded grants to eight teams in 2008, including studies that: tested the effectiveness of a nurse-physician co-leadership model in treating heart failure; examined the effects of nurse staffing and skill mix on patient outcomes in long term care; and investigated the effect of off-peak (i.e. night and weekend) shifts on nurses’ work, among other important topics.
The fourth call for proposals built on the question of efficiency and delivering care cost-effectively by examining the value of nursing in achieving efficient, high quality patient care. INQRI sought proposals that would investigate the value of nurses in generating and leading innovations, preventing medical errors and other complications, and community-based quality improvement efforts. Among the five grantees selected for funding in 2009 were teams that: examined nursing’s contributions to quality palliative care; initiated an interdisciplinary team approach to reducing pressure ulcers; and conducted an intervention with visiting nurses to reduce the risk of Type 2 diabetes in at-risk adults.
INQRI’s final grant solicitation in 2010 sought to build on the research conducted in the first four years of the program. Instead of identifying new topic areas, the call for proposals addressed another core dimension of INQRI’s mission, the translation of knowledge to improve nursing care and patient outcomes. In this final phase, INQRI sought proposals focused on projects that would promote ways to implement successful evidence-based strategies and practices. The six projects selected in 2010 included: the creation of a nurse manager development program to increase patient safety; the dissemination and implementation of evidence-based methods to measure and improve pain outcomes; and the implementation of a risk-specific fall prevention intervention to reduce falls in hospitals.
USING THE EVIDENCE
INQRI research provides a robust body of results that can be shared with policymakers, hospital administrators and others who determine how nursing resources will be distributed to improve the quality and outcomes of patient care. In addition to providing communications assistance to help researchers disseminate their findings to a broad and diverse audience, the INQRI leadership team produced syntheses that placed the work of INQRI grantees in the context of similar research by others in the nursing and other health care fields. The influence of INQRI grantees extends beyond the life of each individual grant. INQRI researchers have implemented systems changes, made recommendations for improving care, and are making a lasting impact on how care is delivered. INQRI program leaders continue to support those researchers in sharing and promoting their findings with decision makers and stakeholders nationwide.
For 40 years the Robert Wood Johnson Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of all Americans. INQRI continued this tradition of success and advanced the science of nursing through rigorous, interdisciplinary research, focused on new methods to facilitate and advance efforts to improve care for patients. INQRI also fostered early engagement of potential end-users to shape each initiative and ongoing collaboration with multiple stakeholders to promote timely use of important findings. Finally, INQRI was and remains committed to building the next generation of scholars who will pursue this important line of inquiry and build on the great foundation provided by 40 teams.