It wasn't long ago that hospital ICUs were typically drab, windowless rooms where inhabitants couldn't tell if it was two in the morning or two in the afternoon.

    Little did anyone know--until nurses found out through some nifty research on the subject--that such dull environments slowed patients' recovery and caused all kinds of ills among their care-givers as well.

    And what of the idea of putting blankets made of lambs' wool in the cribs of critical-care infants, a move that led to quicker weight gain and better sleep? That discovery, too, is credited to research by nurses.

    "I don't think there's a person in this world who's not going to be touched by a nurse at some point of their lives," says Dr. Evelyn Singer (Ph.D. Marquette), dean of Florida State's School of Nursing. "People generally don't think about the quality of health-care until they're sick."

    Bedside attention from nurses has progressed far beyond being roused from sleep in the middle of the night to have your temperature checked and swallow pills from a miniature white cup. While taking your vital signs, your nurse may very likely be gathering data for a research project.

    Research is becoming more and more a part of nurses' everyday working life. Most nursing students pursuing their bachelor of science degrees these days must pass an "Introduction to Research" course or something similar. If they pursue a masters degree, they'll refine their research skills during a thesis program, and if they plan to teach, their research time may very easily triple on their way to a Ph.D.

    "The purpose of all this research is really to make sure that practice is based on scientific information," says Ruth Stiehl, executive director of the Florida Board of Nursing. "So the focus is really to improve patient care. This is not some esoteric, pie-in-the-sky stuff. Nurses that do research tie it back to how we can give better care to patients."

    Dr. Laurie M. Grubbs (Ph.D. Florida) says research by the nursing profession goes hand-in-hand with research conducted by physicians. Grubbs teaches health promotion and assessment at FSU.

    "Medical and nursing research complement each other," she says. "You can't have one without the other."

    Medical research per se is more about drugs and procedures, but Grubbs believes that nurses spend more time with what's going on with patients in response to medicines and procedures.

    Dr. Deborah Frank (Ph.D. Marriage and Family, FSU) has been a professor in psych/mental health nursing at FSU since 1979. "Clinical research is essential in nursing," she said, echoing her colleague. "Our interventions are based on knowledge gained from research. It has to be more than just intuition. That's a part of practice--you always ask questions."

    From an academic standpoint, Frank says the profession must conduct research to be on an even footing with their colleagues from other departments in the university. "We must be able to document, show and communicate knowledge and in a scientific way," she says.

    Since 1986, to become tenured in nursing at FSU, faculty have been required to have a doctorate degree, says Singer. "To teach effectively, you have to be at the cutting edge," and that means research. Singer has found that even undergraduates are getting this message. During her course, "Issues in Healthcare," she always asks students how many plan to go on to graduate school in the next five years. She says that typically just over half say they plan to keep going because of the career advantages advanced degrees now offer.

    Doctorate programs in nursing didn't even exist 15 years ago, and the rise in such programs has created a tight market in academic settings, Singer says. "It's making recruitment of new faculty a little more difficult, as there aren't as many Ph.D. nurses as one would like. That's true all over the United States."

Glowing horizon for nurses

    On top of the shortage of Ph.D.s in nursing classrooms, the transformation in health care--to managed care--has created a shortage of research-trained nurses in many specialty areas of nursing education, says Singer.

    Some observers think that a continuing trend among hospitals to send patients home as quickly as possible translates into less patient-nurse interaction. Not true, says Singer. In the past decade, major changes in health-care have actually led to more opportunities for nurses and expanded their responsibilities, too, she said. The growing health-care industry has opened doors to nurses at home health-care agencies and outpatient centers, for example.

    "There are pockets of shortages," Stiehl says. Specialty areas have a chronic shortage, as do community health and long-term care, she said.

    The nursing profession has always experienced fluctuations in demand. One year new graduates will be offered signing bonuses and dream assignments. A few years later, the only jobs available will be on the night shift at county hospitals.

    Florida is currently in the upswing for nursing demand. A recent study by the Florida Hospital Association showed that statewide, one out of every 10 positions for registered nurses is unfilled. In South Florida and the Panhandle, the nursing turnover rate is as high as 46 percent in some hospitals. Nurses with training experience in such specialties as adult and pediatric critical care, operating room- and emergency room-treatment are especially in short supply, the study says.

    That trend is expected to continue. Faculty say the future of nursing increasingly will belong not to the registered nurses (RNs) but to "advanced practice" nurses such as nurse practitioners-- at title that comes with increased physician-like responsibilities, such as diagnosing, ordering medications and deciding when a patient is ready to go home.

    Demand for nurses with advanced and graduate degrees has created a backlog of masters-degree applicants at FSU, says Singer. Meanwhile, Florida's only doctoral programs in nursing--at the University of Florida, University of South Florida and the University of Miami--are drawing the highest levels of interest from graduate-level nursing students in their histories. Singer says it's time for Florida State to add its own doctoral program in nursing.

    "I get two or three phone calls a week asking when we're going to start (a Ph.D. program)," Singer says. "You just can't turn Ph.D., research-trained nurses out fast enough."

Classroom or Examining room?

    Adding to the challenge of recruiting Ph.D.s for teaching is the fact that clinical nurses and nurse practitioners can make more money in practice than they can in a university setting, making it more expensive to attract them. "So everybody we have is really a dedicated person," Singer says.

    The tenure requirement keeps many of the faculty on the road, furthering their own education. Laurie Grubbs was hired in 1987 at FSU without a Ph.D. and commuted to Gainesville, the closest school offering the degree. She completed her Ph.D. in 1992 and was tenured a year later. She's now associate professor of health assessment.

    Faculty member Dr. Sandra Faria (DSN, Alabama), an assistant professor in medical/surgical training, also commuted, and Linda C. Amankwaa, assistant professor of community health, still is on the road. Amankwaa is in the research phase of her Ph.D. now at Georgia State University in Atlanta. Her research interests focus on post-partem depression in African American women. In spite of a hectic schedule, she doesn't resent the Ph.D. requirement.

    "I think our entire profession is going in this direction--requiring Ph.D.s and research--to help us further our body of knowledge and in order to get larger sums of money from (National Institute of Health) grants," she says. "To get those kinds of funding, you need to have Ph.D.s as principle investigators."

    Amankwaa says her research spills over into the classroom and creates a more effective means for teaching. "I think it helps as you talk to students about how to change practice patterns. They may want to think about this as an option--or maybe not change it yet. It helps them to see how important research is to nursing."

    Most faculty are continuing their dissertation research while teaching at Florida State--and for good reason. About two years ago, Dean Singer organized several professional development workshops for the faculty on how to publish research papers. A three-page report listing articles of faculty published in the last academic year is proof of the workshops' effectiveness.

    "That has really put a fire under everybody," says Faria. "It made everybody want to work together and get some things done. The nursing faculty are interested in doing research and sharing it and making the school of nursing more visible."

    She says the faculty now realizes they face the same "publish or perish" edict that has governed other faculties for decades, and she's solidly behind the effort.

    "I think it's important that faculty strives to show they're keeping up with what's going on clinically," says Faria. "I've seen people who are teaching get tenured and settle in. That's never good. It's important to stay in the mainstream and share your findings."

The Rigor of Research

    The idea of conducting research comes as a surprise to many undergrads, Stiehl says. It strikes fear in some students who enter the profession under the traditional notion that nursing is mostly a people-profession, not a numbers game. But learning research methods is critical to progress in patient care, she says.

    "You have to instill in (nursing students) a scientific mindset," she says. "They need to categorize the information they're receiving."

    Stiehl, who has taught research courses at three different universities says she's a "people person," too, but says a good foundation in the rules of research make career nurses like her into more effective and efficient care-givers.

    But research can come at a price for anyone in education. In nursing, it can be particularly onerous, says Singer. Nurses must balance the typically high demands of their professions with the demands of a research-intensive doctorate program--a formula that can make for some grueling schedules.

    Amankwaa, for example, says she's usually up by 5 a.m., and does her research in the early morning and late nights, at lunchtime, on weekends and during the Christmas break. That's because there's very little time during the regular course of the day, with the large quantity of contact hours--working with students in a clinical setting--and teaching schedule. Many instructors spend 20 hours a week in hospitals, health departments and clinics overseeing the work of individual students, in addition to teaching. They also must prepare for classes, grade papers and write grant proposals among other things.

    Besides teaching, overseeing students' clinicals, research and publishing, often faculty have to work part-time jobs to keep up with their own certification. As a clinical nurse practitioner, Grubbs is currently juggling research on women issues and heart disease while working part-time at a walk-in medical clinic. It's a regimen she's obliged to keep up to protect her nursing certification. But it pays off when she walks into the classroom, she says. "You've got to (be out in the real world) regularly or you lose touch with technology, the medicines and treatment."

    A tight schedule this fall didn't stop Grubbs from applying for a grant through the American Heart Association to study the heart disease risk in sedentary and physically active women. She and Faria would be primary investigators on the study. Traditionally it was believed that men were always at a higher risk of heart disease, but recent studies have shown that at menopause and post menopause, women catch up. And worse, their first heart attack is usually more fatal to women than men, says Grubbs.

    Efforts such as those by Grubbs and Faria are exactly what Singer is hoping to cultivate. She says a program started this fall on health promotion will likely open up a whole new area to research interests for her faculty. The course emphasizes new, self-help approaches to promoting better health and combating substance abuse.