The Problem: For many years, physicians have formed practice-based research networks, groups of practices that primarily provide patient care but also conduct research on clinical practice. In 1999, the federal Agency for Health Care Research and Quality (AHRQ) solicited applications for start-up funds for new networks, including for advanced practice registered nurses, who perform 60 percent to 80 percent of physicians' duties.
The Proposal: At the request of AHRQ, Margaret Grey, DrPH, RN, then an associate dean at the Yale University School of Nursing, had applied for and received a grant to set up a practice-based research network for advanced practice registered nurses, APRNet. The grant covered establishing a network only for students and nurse practitioners associated with Yale. Grey had recently become a 1999 Robert Wood Johnson Executive Nurse Fellow. She decided to use the project portion of her fellowship from the program to expand ARPNet to include other nursing schools.
Grantee Perspective/Results. Grey hired an assistant and extended APRNet to four other nursing schools in New England: Boston College, University of Connecticut, University of Massachusetts and University of Rhode Island. She also organized the first conference of network members, which Grey leveraged to get three more grants for research projects. “The network was the first of its kind and has served as a model for other similar networks,” Grey says.
“The idea was to involve advanced practice nurses who are primarily practicing to use research to solve the problems they face every day,” says Grey. As of June 2007, APRNet included some 65 advanced practice registered nurses in New England. Research studies involved diabetes prevention in primary care and a system to remind older patients to take prescribed medicines.
Grey said that the growth of the network paralleled her own growth as a person. She used the leadership fund for personal coaching to help her better manage her time. Program staff and consultants helped Grey learn to delegate more. Her career had emphasized research, but even with research assistants she “never wanted to let it go.” Now she sees how the ability to relax, take time off and delegate was her key to career advancement.
She was particularly eager to praise the program's eight-member Core Resource Team, whose duties include reviewing fellows' projects, and coaching them on leadership and career issues. Grey's initial project on entering the fellowship program had been to develop an Internet-based disease management system. But it proved too complicated and time consuming. Core Resource Team members encouraged her to use the APRNet project and expand it.
“From a personal perspective, this program was life-transforming,” she says. “I learned it was not good to work seven days a week. It didn't make me a healthy role model. If I took a day or two off, I came back better.”
In 2005, Margaret Grey was named dean of the Yale University School of Nursing. “If it had not been for the program showing me I could not do it all myself and teaching me how to delegate,” she says, “I would never have accepted this position.”
RWJF Perspective: The Robert Wood Johnson Executive Nurse Fellows Program was created in 1997 to capitalize on the profession's strengths and build the leadership capacity of nursing. “Nurses are in a unique position to serve in leadership roles and contribute to transforming our health care system,” says Susan Hassmiller, PhD, RN, RWJF senior program officer. “The executive nurses program is part of the Foundation's building human capital strategy to attract, develop, and retain diverse and high quality leaders and a workforce to improve health and health care,” says Hassmiller.