Fostering Inquiry as Part of Nursing Bedside Practice

Published in Sibley Memorial Hospital Nursing Annual Report - Fiscal Year 2020

The question of what it takes for clinical nurses to engage in and incorporate evidence-based inquiry at the bedside is one that every academic health system must tackle. For a community hospital like Sibley Memorial Hospital within a larger academic system like Johns Hopkins Medicine, the answer may look different than for nurses at a larger hospital.

For example, the very first research project Rowena Milburn, a nurse in Sibley’s Special Care Nursery, worked on at the hospital was a system-wide investigation of clinical nurse engagement in the process of scholarly inquiry, including evidence-based practice, quality improvement and research. That 2016 qualitative study was led by the Johns Hopkins Center for Nursing Inquiry and included nurse investigators from across the system.

The results, published in May 2020 and presented at several prestigious national nursing conferences, introduced an avatar, or profile, of the clinical nurse who incorporates scientific inquiry into care. The study also provided early insight into some of the common barriers and misconceptions that prevent nurses from bringing research into their daily professional practice.

“This ‘avatar’ is a nurse who is very innovative, takes initiative, is eager to learn, is systematic and analytic, with a passion for improving health care,” says Milburn, who served as Sibley’s coordinator for the study.

As a bedside nurse in the hospital’s Special Care Nursery, Milburn is a good example of that avatar. Her experience integrating a research perspective into her work as a clinical nurse in Sibley’s nursery for newborns who need advanced care has allowed her to empower other nurses to bring inquiry to their practice.

To give more nurses the opportunity to learn about, and ultimately harness, evidence-based practice, Milburn and Suzanne Dutton, Sibley’s NICHE (Nurses Improving Care for Healthsystem Elders) coordinator and a geriatric advanced practice nurse, led the launch of Sibley’s first evidence-based practice and research council, modeled after the longstanding and extremely successful council at Suburban Hospital in Bethesda, Maryland. So far, Sibley’s council has brought several guest speakers from the health system and elsewhere into the hospital to bring attention to the resources that exist to help nurses incorporate nursing inquiry into bedside practice.

In the near future, the council is planning evidence-based practice and research-related activities to engage front-line nurses and promote nursing inquiry. Those activities will include classes and training in key areas such as human subjects’ protection. Four members of this new council, including Milburn, are also part of the first system-wide evidence-based practice training cohort, a program of the Johns Hopkins Center for Nursing Inquiry that offers training and education in these topics. They bring back the key learnings to the Sibley council to share with colleagues.

“Our goal is to send the message that nursing inquiry should be a part of nursing practice, and that our organization, both here at Sibley and across Johns Hopkins Medicine, makes this a priority,” Milburn says. “We are the profession with the closest proximity to patients. We are there providing care, and we should be the ones pioneering changes, investigating what works best. Nursing leadership support is key to implementing these practice changes. I truly feel fortunate that I have the unwavering support of our chief nursing officer, as well as my own department’s leadership team, both the director of Women’s and Infants’ Services and our special care nursery nurse managers, as I serve as a principal investigator at Sibley and continue conducting inquiries as part of my day-to-day duties.”