Journal of Nursing Education

Major Article 

Building High-Impact Science: The Dean as Innovator

Kathleen M. Potempa, DNSc, RN, FAAN; Virginia Tilden, DNSc, RN, FAAN

Abstract

If funding level is accepted as an empirical referent of research productivity, the nursing profession 's relatively low volume of funded research puts its capacity to influence practice and policy based on scientific evidence at a disadvantage. For the profession to effectively compete with other “high-impact,” health-related disciplines, nursing leaders must find ways for a greater proportion of nursing faculty to excel as scientists, producing sufficient volume and quality of work in their careers to have a major influence on health care. In addition, if nursing leaders are to enhance nurses ' interest in scientific development and use, the academic environment needs to foster greater connectivity of students at all levels of education with the scientific enterprise.

Dr. Potempa is Dean and Professor, Oregon Health & Science University, School of Nursing, Portland, Oregon; and Dr. Tilden is Dean and Professor, University of Nebraska, College of Nursing, Omaha, Nebraska.

Address correspondence to Kathleen M. Potempa, DNSc, RN, FAAN, Dean and Professor, Oregon Health & Science University, School of Nursing, 3181 SW Sam Jackson Park Road, Portland, OR 97239-2941; e-mail: potempa@ohsu.edu.

Abstract

If funding level is accepted as an empirical referent of research productivity, the nursing profession 's relatively low volume of funded research puts its capacity to influence practice and policy based on scientific evidence at a disadvantage. For the profession to effectively compete with other “high-impact,” health-related disciplines, nursing leaders must find ways for a greater proportion of nursing faculty to excel as scientists, producing sufficient volume and quality of work in their careers to have a major influence on health care. In addition, if nursing leaders are to enhance nurses ' interest in scientific development and use, the academic environment needs to foster greater connectivity of students at all levels of education with the scientific enterprise.

Dr. Potempa is Dean and Professor, Oregon Health & Science University, School of Nursing, Portland, Oregon; and Dr. Tilden is Dean and Professor, University of Nebraska, College of Nursing, Omaha, Nebraska.

Address correspondence to Kathleen M. Potempa, DNSc, RN, FAAN, Dean and Professor, Oregon Health & Science University, School of Nursing, 3181 SW Sam Jackson Park Road, Portland, OR 97239-2941; e-mail: potempa@ohsu.edu.

Deans serve multiple roles, including university faculty leader, chief executive officer of a school, and ambassador for the values and goals of the discipline they represent. Such multidimensional responsibilities pose challenges and opportunities to promote needed change both within the university setting and the discipline as a whole. Contemporary deans of nursing face challenges of leading both faculty and the discipline in a context of a U.S. health care system in crisis, rapid population changes creating greater need for health care use, and burgeoning public expectations of universities and the professionals prepared therein. Within this challenging context, the leadership of the dean can leverage decades of knowledge development to substantially augment scientific productivity and use for the greatest societal benefit (Steinbrook, 2002).

Our review of the 2003 National Institutes of Health (NIH) awards to schools of allied health, medicine, nursing, public health, and pharmacy indicated that schools of nursing were among the lowest rungs of NIH funding for research, compared to other health disciplines such as medicine and public health (NIH, Office of Extramural Research, 2003). We refer to these latter disciplines as “high-impact” disciplines because they are able to produce the volume of high-quality research necessary to influence health care practice and policy. If funding level is accepted as an empirical referent of research productivity, the nursing profession 's relatively low volume of funded research puts its capacity to influence practice and policy based on scientific evidence at a disadvantage.

The premise of this article is that if nursing is to effectively compete with other high-impact, health-related disciplines, nursing leaders must find ways for a greater proportion of nursing faculty to excel as scientists, producing sufficient volume and quality of work in their careers to have a major influence on health care. We further propose that if nursing leaders are to enhance nurses ' interest in scientific development and use, the academic environment needs to foster greater connectivity of students at all levels of education with the scientific enterprise.

Deans play a critical role in fostering innovation and cultural change that support these goals. This article provides a model for deans to accelerate the development of research programs within schools of nursing, engage students at all levels in research development and use, and refocus the educational mission on cutting-edge knowledge translation into practice.

Creating a Culture that Supports the Development of High-Impact Science

We propose that the traditional model of nursing faculty and student activity can disconnect the process of scientific development from the core teaching-learning activities of both faculty and students. In addition, we propose that past attempts to integrate missions often diluted the capacity of faculty to develop their scientific potential. The dilemma of balancing multiple roles and missions in ways that foster acceleration of productivity, while also enhancing the learning environment, is challenging.

For example, nursing faculty spend a good deal of their efforts on teaching students, developing curricula, and performing university service. Research is often a competing, secondary focus. Even in research-intensive university environments, faculty carry heavy teaching loads and are evaluated on their performance across multiple missions. Faculty who are highly productive researchers, teachers, and clinicians are rare. We contend that this is related to the true differences in talent required of, as well as the time constraints for, individual faculty to develop excellence across missions.

The student experience in research development and use is often quite different across educational levels. Undergraduate students typically take the required research and statistics courses but are seldom exposed to ongoing research throughout their programs. Graduate students in programs leading to advanced practice preparation may have research requirements but do not typically focus on learning the science of their field. It is now at the doctoral level of study that the focus is heavy on nursing as a scientific discipline.

The model we propose for research development in schools of nursing includes the following, for which the role of the dean in making this model a reality is explicated:

  • The “scientist” role.
  • Balance among missions across faculty as a whole, rather than within individual faculty activities.
  • Incentives and rewards for scientific accomplishment and knowledge use.
  • Inclusion of students at all educational levels in faculty research.

The “Scientist” Role

The “scientist” role, as we conceive it, is one that focuses primarily on research. We do not propose a particular proportion of faculty to assume this role. Instead, we recommend that each institution design a framework for using the scientist role that fosters significant scientific advancement with the academic priorities of that institution. At least 75% of the scientist faculty 's activity should be exclusively related to research, research mentorship, and research leadership within the institution.

To be financially viable in most institutions, maintaining this level of research activity requires that the faculty member have consistent external funding. We have found that faculty with excellent predoctoral and postdoctoral research training require approximately 3 years of research “investment time” (i.e., institutionally funded release time) to consistently secure major external funding.

Other infrastructure necessary for the success of scientist faculty, both during the investment period and afterward, includes a well-developed research support office within the school of nursing and at the university level. We expect that after this 3-year period, scientist faculty will maintain external funding sufficient to support approximately 50% of their salary, as well as the research-related administrative costs of their research program. The additional 25% of research time can be conceptualized as dedicated to doctoral student teaching and mentoring and, thus, be supported by graduate program dollars. This is justified because faculty research is an essential cornerstone of doctoral education and provides the laboratory for student training.

Once established, scientist faculty contribute to research development of faculty and students and provide leadership to the institutional research enterprise. The latter role typically includes participation in research councils, centers, or protocol review panels. In addition, scientist faculty can contribute to the teaching mission such that their scientific expertise enlivens the academic lives of students, faculty, and the institution. The proportion and type of effort in a second mission can be gauged to the level of externally funded research the faculty member averages over time. We expect faculty to be engaged in teaching courses and mentoring students with academic support, such as teaching and research assistants that enable the management of daily teaching and research activities.

It is important to note that the contributions of scientist faculty to the academic mission are specific and measured, but are not exclusive to a particular level of student. We encourage the participation of faculty at all educational levels, from undergraduate through postdoctoral training. The key is finding a blend of activities that fully supports the research production of the faculty, while engaging them in student life and overall institutional development.

Finding Balance Among Missions

While the teaching mission will always be a significant focus in academic institutions, we contend that equal emphasis needs to be given to research development in a greater number of nursing schools. This will require creative solutions to traditional patterns of funding for faculty positions and faculty “investment” or research “start-up” financing; performance incentives and rewards; and the alignment of curricular demands with research expectations.

We recognize that the financial support of research investment is difficult even in research-intensive universities. Creating a research investment plan with clear goals and return-on-investment outcomes is a strategy that has been successful at our institutions, even in tight fiscal environments. Such a plan commits the school to achieving a set of research productivity outcomes within a specified time frame in return for institutional financial investment of faculty release time, new faculty positions, or research start-up monies. Productivity outcomes include increases in the school 's externally funded research, which is associated with full indirect cost recovery; percentage of faculty serving as principal investigators on institutionally approved projects; the number of scientific publications in prestigious journals in relation to the amount of research investment; and the students attracted to the school by faculty members ' reputations.

To be successful, the plan requires effective communication and documentation of goals, and expected productivity outcomes for individual faculty, as well as the faculty community as a whole. For example, individual faculty members hired as scientists or who negotiate a scientist role commit via contract to a specified level of research productivity in return for investment. In our experience, faculty meet this 3-year goal. In rare instances, a faculty member has changed course during the investment period and chooses to return to the heavy teaching load customary for faculty in the multi-mission role. Understanding the level of productivity required of scientists (e.g., the obligation to self-fund a large percentage of their own salaries through research dollars) is essential for the faculty body to support the role and foster integration within the school 's broader missions.

While we emphasize individual productivity of scientists, it is also essential to foster collaboration and support among investigators and research programs. Scientists can be recruited into specific research areas or centers and can be expected to not only develop their program in the area but also facilitate links across multiple areas. For example, a scientist may be recruited in a symptom management center and then bring faculty from such disparate areas as pediatrics and gerontology together around common issues of symptomatology and nursing interventions. The success of the research mission requires a collective effort that leverages intellectual capital and indirect cost recovery to the benefit of the overall scientific development within the school.

Leadership by the research faculty is vital for the development of such a collaborative culture. One way of fostering this leadership is to establish a formal mechanism and expectation for scientists to contribute to the overall goals of the research mission. Research faculty must contribute to the development of the total research mission, including mentorship of junior faculty and students and leadership in their expertise across the university. In addition, we recommend a collective faculty mechanism to enhance the research mission, including development of productivity standards and contribution to decisions about research investment. For example, a research council comprised of elected research faculty can be enormously conducive to scientific maturation and collaboration within the school. The council can have a broad scope within the school that can foster general research development, exposure of students to cutting-edge research, and research use by faculty and students.

Incentives and Rewards for Research Productivity and Knowledge Use

A contemporary view of many faculty members in academic settings is that reward for performance in the research mission is greater than that in the teaching mission. Research-intensive universities place a high value on research productivity and scholarship in promotion and tenure decisions. However, multimission, tenure-track nursing faculty have heavy teaching and university service workloads that preclude the achievement of their full scientific potential. In our opinion, this paradox is related to increasing financial constraints within higher education; the relative underfunding of research development in nursing schools, compared to medicine and basic sciences programs; and the historical tradition of nursing schools giving greater attention to curricular development and implementation, rather than scientific advancement.

We do not value one mission over others but do recommend allowing faculty to focus on a single primary mission, such as research, without prejudice in annual merit review or promotion decisions. This will require promotion and tenure committees to carefully evaluate criteria and expectations to make advancement of scientist faculty possible. The latter demands more flexibility in research-intensive institutions to actually allow a singular focus, rather than the additive demands of scholarship to heavy teaching and service requirements.

The conundrum of faculty contract types also requires review. For example, faculty in traditional academic environments who choose research as an exclusive mission are usually given a modified title to their rank status, such as “research professor,” which does not carry the same prestige as the that of tenure-track faculty. Schools of nursing need to align contract type, prestige, and rewards with the level of performance desired in every mission. Some ways of doing this include removing modifiers to rank, defining comparable ranking standards and criteria for each mission area, and setting realistic trajectories for achievement of the desired performance outcomes for multimission faculty. For example, we have found that hiring new research faculty into multiyear research contracts before rolling them to tenure-track contracts lengthens their development years, while providing motivation and support for high scientific achievement.

Developing high-impact scientific environments also requires rewarding research use by all faculty and students. We promote the specific evaluation of faculty for the currency of their scientific knowledge via their evidence-based practice and the curricular content of their courses. Teaching evaluation processes should include evidence that faculty are presenting cutting-edge knowledge. In addition, an environment that encourages attendance by faculty and students at scientific forums, such as research seminars, dissertation defenses, and lectures by distinguished scientists, enhances the opportunity for the development and use of science in nursing.

Inclusion of Students at All Levels in Faculty-Driven Research

A key philosophical underpinning of this practice is that exposure to faculty-driven research projects and the cutting-edge science of their discipline is a significant curricular enhancement for students at all educational levels. We contend that many nursing curricula emphasize the development of skill-based competencies couched in scientific principles, rather than curricula based on an understanding of the science of the field, the scientific process, and knowledge use. Refocusing the teaching-learning process on scientific inquiry provides enrichment for the academic lives of both faculty and students.

We believe this is especially important for undergraduate students. We encourage opportunities for undergraduate students to participate in faculty research, quality assurance projects of clinical faculty, and senior capstone projects that require data analyses and synthesis. Graduate students are also involved in research application projects at the master 's level and, of course, formal dissertations at the doctoral level. Graduate students have opportunities to participate in faculty research projects, seminars, and so forth throughout their educational experience.

Besides these typical hallmarks of graduate education, creating the expectation of and excitement for furthering the science of the field takes deliberate encouragement by the dean and faculty. One example of this can be a student award structure that includes criteria based on research or research application.

Summary

Deans hold unique positions within both universities and their disciplines. Few others have the potential to influence transformational change within their unit and on behalf of their discipline. To leverage this unique role, deans need to have the methods and skills to implement the institutional changes required, based on an accurate view of the needs of the discipline and the society it serves.

We think that the nursing profession is at a crossroads whereby its potential to meet the needs of the United States is significantly hampered by historical traditions that impair its ability to dramatically increase its scientific productivity. The ability of deans to now place greater emphasis on scientific advancement of the discipline is of pivotal importance.

References

  • National Institutes of Health Office of Extramural Research. (2003). NIH extramural awards current rankings by component of higher education, 2002 [Data file]. Available from National Institutes of Health Web site: http://grants1.nih.gov/grants/award/trends/highedc.htm
  • Steinbrook, R. (2002). Nursing in the crossfire. New England Journal of Medicine, 346, 1757–1766. doi:10.1056/NEJM200205303462225 [CrossRef]

10.3928/01484834-20041101-01

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