Target Audience: The target audience for this toolkit is all nurse scientists in the VA with special emphasis on nurse scientists newly hired into the U.S. Department of Veterans Affairs and nurses new to the nurse scientist role in the VA. Nurse scientists are defined as doctorally prepared nurses who, through a program of research, conduct basic, clinical, rehabilitation, and health services research leading to improvements in the healthcare of veterans.
Purpose of this Toolkit: The purpose of this toolkit is to assist in the orientation to the VA focusing on resources for research and for building a program of research.
Note to VA researchers: this Internet version has slight variations due to content that is only available via the VA intranet.
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Building success at the local level depends on your ability to articulate what you are bringing to the role and how this integrates with the VA and VAMC mission. Many positive outcomes can result from the development of the nursing research role, and you should be prepared to share these with your facility leadership. Funding as well as dissemination activities (publications, poster presentations and national and/or international exposure) bring positive recognition for your facility. The outcomes of your research should have the potential for improving patient outcomes and for strengthening evidenced-based practice at your facility. As a nurse scientist you can communicate your skills and knowledge to your leadership including:
Supporting facility priorities and strategic goals,
Supporting nursing leadership priorities for nursing research, policies and procedures
Supporting nursing leadership in endorsing and approving research concerning nursing, such as implementing a nursing service internal review process, (see example). Research Approval Process
Conducting or facilitating journal clubs and evidence-based practice activities,
Building interdisciplinary research teams,
Conducting research that matches the organizational strategic plans, and
Showcasing nursing in the organization.
Strategies for increasing the visibility of you and your research are many. Some may be more useful initially, whereas others may be added as you develop your role. The following activities most likely will be useful initially:
Serving on R&D and IRB Committees within your VA structure and your university affiliate.
Using a strategic plan to guide the work of the nursing research committee. See example of one facility's nursing research strategic plan. Nursing Research Strategic Plan
Establishing joint appointment with local academic affiliation. Joint appointments may be full time VA employee with adjunct appointment at the university, two independent appointments (one at the VA and one at the university), or 5/8th VA appointment and 1/8th university appointment (a 5/8 VA appointment is necessary for serving as a principal investigator for a VA-funded study). The process of negotiating a joint appointment will be site specific. The local VAMC Education Service should be able to assist. Often a memorandum of understanding is negotiated between the VAMC and the affiliated university that specifies time commitments. Local VAMCs and universities may use specific templates. Here is one example of an MOU template.
Writing annual reports and submitting them to Chief Nurse Executive and other Service Chiefs.
Other activities may be added as you develop your role and may include;
Strategies to augment VA/university partnerships may include:
Partnering with university faculty for research and publications;
Partnering with universities through the VA Nursing Academy (VANA), a partnership with accredited nursing schools to increase the capacity of VA nursing to meet the health care needs of the nation's veterans (http://www.va.gov/oaa/vana/)
Establishing research teams between the VAMC and university;
Building and maintaining access to statisticians and health economists; and
Building expertise in VHA administrative databases.
Building a Program of Research
Selecting a focus is an important first step in building a research program. The focus of your program of research will depend on the organization's goals and mission and whether or not your VAMC has a research Center of Excellence. On a practical level a focus will drive many of decisions such as collaborators, funding sources, and professional contacts and base of support. For example, if your program of research is in technology for safe mobility in older adults, you might seek collaborators from academic affiliations in aging studies programs and engineering. Professionally, you would want to align with gerontology and ergonomic organizations. Choosing a focus allows you to leverage resources and efficiently build the science in a given area. For example, laboratories you might build to support safe mobility research could be used by students, fellows, and others who are building science in the same area.
One mistake novice researchers may make is taking on too many projects because they are interesting for a variety of reasons. In building a research career it is probably not wise to spread oneself too thinly or you risk not becoming proficient and credible in any one area. Any researcher should be able to state a program of research in a few sentences in a way that is clearly understood by experts as well as those who are less familiar with the topic.
Researchers select a research focus for a variety of reasons, such an intrinsic curiosity about a certain topic or aptitude for a particular method, available funding opportunities, organizational support, or a personal experience with a health condition. Because we are located in a service organization, the impact of our research is valued very highly. Results of our research need to have a clear impact on improving VA healthcare delivery. Additionally, it makes sense to think about the local resources when settling on a research focus. Think about the expertise at your local VA facility and your local academic affiliation. Draw on existing resources and leverage those resources to secure others. For example, if your local facility has a strong mental health service with providers who are interested in research, and your local university has a nationally recognized department in clinical psychology, think about how you can collaborate with both of them to achieve mutually satisfying goals. Funding priorities for the VA are reflected in specific HSR&D or RR&D solicitations (http://www.research.va.gov/). Developing a Program of Research Building a Program of Research
Building a Team
Strategically assembling an interdisciplinary team is a critical part of insuring a successful program of research. Team members will vary with respect to your research questions and program of research, but at the minimum you can think of content experts (e.g. health promotion, behavioral change, medical specialties, translation science), methodologists (e.g. experts in survey methods, specific laboratory methods, measurement and psychometric evaluation, epidemiology, qualitative methods including interviewing, focus groups, and observational research, research translation methodologies) and data analysts (e.g. statistician, qualitative analysts). Faculty at academic affiliations are often willing to serve on VA research teams in exchange for your serving on their grants, salary support, co-authorship, and opportunities for research assistantships (with tuition reimbursement) for their graduate students.
Like any other team, your research team's work will be facilitated by frequent and meaningful communication whether in person, via e-mail or telephone. Specific to a research team, it is useful to have early and open discussions about authorship-members' expectations and agreed-upon guiding principles. There is no one way to negotiate authorship, but the sooner and more open these discussions occur the more likely you will achieve success. You may find it helpful to maintain a list of potential publications with first author and co-authors specified, target dates and target journals. This list can be revisited at each team meeting.
In writing grants, you will need to obtain letters of commitment from nonVA investigators. Letters of commitment should address specific duties of the collaborator as well as the collaborator's expertise as it relates to the proposed study (See attached template). Your collaborators will appreciate receiving a template of a letter that is individualized to your study and the collaborator's role on the project. Template for Letter of Commitment
Again, clear communication about roles and duties will facilitate overall success of your studies. The following is an example of a description that you can use as a template for your grant proposals:
Jane Doe, PhD [Co-Investigator]. Dr. Doe is a full professor at the University of South Florida Department of Aging Studies. She has 28 years of 20 years of health services research experience and has expertise in survey and qualitative research methods. Her research expertise is in geriatric syndromes including falls, fall-related injuries, and wandering and translation research. She is currently a co-investigator on an NIH-funded study, "Management Strategies for Prevention of Elopement in Assisted Living Facilities." She has a track record of funding in HSR&D and RR&D as a co-principal investigator with VA collaborators. Specifically, her responsibilities for the proposed studies include: (1) Oversight for qualitative data collection (interviews) and content analysis of transcripts; (2) Training and monitoring of interviewers; and (3) Participation in dissemination activities as discussed in proposal narrative. Dr. Doe will serve on the study through an IPA at 20% time at a cost of $16,200 in year one and at 20% at a cost of $16,200 for year 2.
Helpful reference: Albert, N.M., & Siedlecki, S. (2008). Developing and implementing a nursing research team in a clinical setting. The Journal of Nursing Administration, 38(2), 90-96.
Mentoring is an important role for nurse scientists. Nurse scientists in the VA are expected to mentor pre and postdoctoral fellows, career development awardees and other less experienced researchers, both informally and in formal arrangements. Affiliated universities are rich sources of research mentees-another reason why having an academic appointment is important. You may be asked by the Office of Nursing Services, Program Director for Research to serve as a mentor for new VA nurse researchers.
The VA has formalized mentoring arrangements through the Office of Academic Affiliations and the Office of Research and Development. Nursing pre- and post- doctoral fellowships as well as other mechanisms (e.g. Interdisciplinary Patient Safety Fellowship) are available from the Office of Academic Affiliations (http://www.va.gov/oaa). This website contains all of the application requirements. Additionally, a PowerPoint presentation assembled by members of NRAG further explains the nursing pre and postdoctoral programs. Research Mentoring
The VA Office of Research and Development (ORD) training program is different than the OAA programs. ORD pre- and post- doctoral fellowships are available only at Centers of Excellence, but Career Development Program is open to any medical center. The CDA program is composed of five levels: Career Development Award-1 (CDA-1), Career Development Award-2 (CDA-2), Career Development Transition Award (CDTA), Career Development Enhancement Award (CDEA), and Research Career Scientist. Descriptions and requirements for each can be found at (http://www.research.va.gov/funding/CDP.cfm). In addition to providing mentorship opportunities, the CDA program is also viewed as a mechanism to build funding infrastructure in a research center.
If you have never submitted an application for a training grant, it may be helpful for you to talk to a program manager at OAA or ORD, a currently funded trainee, and a mentor who has a funded trainee. These people are often willing to share proposals and tips for successful applications.
We have found a few references that may be helpful in mentoring others including:
Adviser, Teacher, Role Model, Friend: On Being a Mentor to Students in Science and Engineering (1997). National Academy of Sciences, National Academy of Engineering, Institute of Medicine National Academy of Sciences, National Academy of Engineering, Institute of Medicine. Available at http://www.nap.edu/catalog.php?record_id=5789
NIH guide to Training and Mentoring in the Intramural Research Program. NIH Mentor Guide
Success in a research role depends on the ability to develop successful collaborations and partnerships through skillful networking. VA Health Services Research & Development convenes an annual conference, usually in February, that is well attended by researchers from medical centers across the country. Workshops, meetings of special interest groups, and poster sessions provide opportunities for networking. At the annual HSR&D meeting the Nursing Research Advisory Group (NRAG) convenes a face-to-face meeting. This meeting is open to all interested parties. Additionally, the VA nurse researchers hold regular conference calls for updates from central office and education on research methods and other topics. You can contact the NRAG chair or the Office of Nursing Service, Program Director for Research to be added to the e-mail distribution list in Outlook entitled, "VA Nurse Researchers."
Serving on VISN and National groups-committees, task forces, workgroups-offers another way for networking, and can open doors for you in building your program of research. Let others know you are interested in these opportunities. Volunteer, but be careful not to over commit. Volunteer on groups that are related to your program of research.
Developing Infrastructure to Support Research
At the same time you are building your program of research you should be planning ways to build infrastructure to support your developing program. Research infrastructure refers to all of the resources that will support ongoing research endeavors such as information technology including hardware and software, human resources such as access to statisticians and other key researchers, administrative support, space and furniture.
Infrastructure can be built in several ways including donations and in-kind support from your VAMC or VISN, in-kind agreements with schools and colleges in your academic affiliation, and through center-level funding. There is no right way or wrong way to build infrastructure, however it is advantageous to build resources from multiple sources, negotiate resources you expect to receive and you will give in return, and keep communication open and clear.
VA HSR&D and RR&D offer two mechanisms for center funding; both are funded through a competitive process in response to request for proposals. Requests for proposals are issued at the discretion of the Office of Research & Development. Centers of Excellence (COEs) are funded at the higher levels; "Research Enhancement Award Programs" are funded at lower levels and are considered stepping stones to a COE. For links to and descriptions of HSR&D and RR&D COEs, refer to http://www.research.va.gov/programs/default.cfm#rrd-ctr
Office of Academic Affiliations (OAA) http://www.va.gov/oaa For information about pre and post-doctoral nursing fellowships and other fellowships, e.g. Interprofessional Fellowship in Patient Safety
VA Office of Research & Development (ORD). http://www.research.va.gov/ This is the main resource for all VA-funded researchers, including funding opportunities, research guidelines, and deadlines. Its four main divisions are: