Welcome to the Nursing Outlook Blog – “3 Questions” – Timely Interviews with Thought Leaders in Nursing and Health Care Policy

2017 American Academy of Nursing Living Legend – Elaine Larson

Elaine L. Larson, PhD, RN, CIC, FAAN is Associate Dean for Research and Anna C. Maxwell Professor of Nursing Research, School of Nursing and Professor of Epidemiology at the Mailman School of Public Health, Columbia University

Elaine L. Larson, famous for her hand hygiene research, has focused her career on the ultimate goal of controlling and preventing infections. For this work, she is known globally, and its impact has been foundational to what we understand today about preventing infections.

Dr. Larson began her work with curiosity about how preventable infections were more common than many had noticed, and with the growing problem of microbes that are increasingly resistant to treatment, she gained a prominent place in demonstrating that personal and environmental hygiene was the key. She was one of the co-authors of the WHO and CDC evidence-based guidelines for hand hygiene in the health care setting. Her work on infection control and general patient safety stimulated her interest in bioethics, and she serves as chair of two institutional review boards (IRBs) in addition to the research she is conducting on informed consent. Dr. Larson was Chair of the White House-appointed CDC Healthcare Infection Control and Prevention Advisory Council and served on the President’s Committee for Gulf War Veterans’ Illnesses.

As Associate Dean for Research at Columbia University and Professor of Epidemiology at the Mailman School of Public Health, Dr. Larson is currently involved in efforts to bridge the divide between clinical nursing practice and nursing research. She directs the Center for Interdisciplinary Research to Prevent Infections at Columbia University and has been Editor of the American Journal of infection Control since 1995, along with other leadership activities that connect collaborators from different disciplines outside of nursing. With over 400 journal articles, four books and numerous book chapters, she deserves the distinctive accolades reserved for nurse researchers with stellar programs of study in an area that has become synonymous with her name and reputation related to infection control.

Veronica D. Feeg, PhD, RN, FAAN

We invite commentary that is thoughtful and provocative! Join the online dialogue!

Elaine L. Larson

2017 American Academy of Nursing (AAN) Living Legend

Columbia University School of Nursing and School of Public Health

Editor, American Journal of Infection Control

Question 1. What do you see as the interface between clinical nursing practice and nursing research?

From the very beginning when I was a nursing student, I always thought that nursing research was an integral part of clinical nursing practice. And in fact I feel so strongly about it that, I feel that it’s our ethical mandate to make sure that as good clinicians, we have to understand what works and what doesn’t work and we have to have a sense of commitment to evaluating what we do. So to me it’s all the same spectrum: I think that you have to have research, you have to have clinicians, and implementation science is sort of, to me, another word for evidence-based practice. The clinician maybe on one end of the research spectrum and the researcher may be on the other, but we’re all on the same spectrum.

Question 2. How did you get involved with doing research?

I remember the first year that I graduated from my baccalaureate program and I had a patient, a young woman who had rheumatic heart disease. In those days that was very common – not so common anymore, fortunately. She was fairly young, she was in her 30s, and she called me into her room and she told me that she wasn’t feeling very well. She couldn’t breathe very well. So, I listened to her heart, I took her blood pressure, took her respirations, did the usual things.  She wasn’t in an intensive care unit. She seemed to be relatively okay, so I propped her up with a pillow on her bedside stand and I told her to call me if she didn’t get better. Within a half an hour she died of acute pulmonary edema.  As a young nurse, I promised myself that I would do everything I could to make sure that I knew as much as possible about my patients’ disease, their conditions, their ability to cope etc. What I did was I wrote my first paper my first year out of nursing school. I sent it to the AJN. It was about taking care of patients with acute pulmonary edema and sort of my defense mechanism or my way of making sure that I didn’t make mistakes, and learned from every – every – experience that I had was to read all about it. So I wrote the paper. It was published by the American Journal of Nursing many years ago. It would never get accepted for publication now because basically it was a case study and most of my references were from textbooks! But I got a letter from the American Journal of Nursing editor saying “we need more articles that are relevant to clinical practice like you’re doing” and I was hooked! So from then on, I just thought “wow”! An important part of what we’re doing as practitioners is also understanding what we’re doing and learning from mistakes, learning from our experiences From then on I’ve been hooked!

Question 3. How can clinicians and ‘academics’ collaborate more?  What are some strategies to make it work?

It’s funny, because over the years “academics” and clinicians have sort of been systematically separate from each other so that hospital nurses aren’t necessarily on the faculty and vice versa. That’s really got to change! I think what’s happened over the years is that nursing went through sort of a period of adolescence where they had to sort of make their own way, divorce themselves from their parents – which at the time were sort of the hospitals – and then make a stand and establish themselves as an academic discipline. Now it’s time for us to get back together because this is not working.

Just a couple of things that we’ve been doing lately that are very exciting and I think are wonderful strategies. One is we produced an academic clinical partnership so that we have staff nurses who are applying, writing a three-page little idea, a problem that they are seeing on their clinical units. So they are writing a little proposal about how they might like to do a project or study or a QA project to try to resolve the problem. Those that are selected are actually given some time on the clinical side and they are linked up with an academic mentor. They are mentored to actually do the project. So they are mentored through the IRB process. We have faculty who are being the mentors and some of the nurse researchers in the hospital. So this is very exciting! We’ve got some exciting ideas: for example, a nurse in the medical ICU was very concerned because they have a lot of ICU dementia (patients who become delirious in the hospital). She wants to look at the extent to which the nursing staff are appropriately documenting delirium. She’s going to do that as a project. That’s one thing – academic clinical partnerships, where faculty link with clinicians and mentor them to do projects that are very relevant to their practice.

Another thing that is very successful that we’re working on now and other places have as well, I think, although it’s still not to the place where it should be is actual joint appointments between academic nursing schools of nursing and hospitals. So we now have four full-time nurse researchers with PhDs. We have a memorandum of understanding between hospital and the school, so they spend 50% of their time in the school, 50% of time in the hospital and are paid by both. And they jointly report to the hospital and to the school. That’s a real win-win because then the researchers who are in the hospital have access to statisticians and other kinds of help and advice writing grants etc. and they can serve as a link between the clinical staff and the academic environment.

So those are just two ideas. We have a project called the link project which does that, in fact, and actually provides to staff and the hospitals some statistical help. I think the important thing is that some of us are appliers of practice and some of us are developers of new ideas. So the idea is to build on the strengths of each. A lot of nurses researchers are sort of “silo-ed” and may not really even have a realistic idea of what the problems in the field are on the ground. And the people on the ground are so busy providing care that they may think of an idea, but if they aren’t trained to follow it through and if they don’t have the resources, they just let it go because they have to! They have to make immediate decisions. The joining of the two I think are strategies for how to make it work!