Kelley Kilpatrick, RN, PhD, likes to say that her research makes the invisible visible. Recognized internationally as an expert in studying the roles and impact of advanced practice nurses on interprofessional team functioning and quality of care, Kilpatrick is Associate Professor at the Ingram School of Nursing (ISoN) and holder of the Susan E. French Chair in Nursing Research and Innovative Practice. As she explains, the roles of clinical nurse specialist and nurse practitioner are often misunderstood, not just on the part of the general public, but often by policy makers and healthcare teams. Published in peer-reviewed journals, her findings are changing these perceptions here at home and abroad. We sat down with Prof. Kilpatrick to learn more about the impact of her work and the challenges and rewards of a career in nursing research.
Tell us a bit about your nursing background.
I was attracted to nursing because of its hands-on approach to providing care. After earning my bachelor’s degree, I worked for several years in the intensive care unit, which really suited me. The environment of the ICU is one in which you are working as part of a team caring for an unstable patient while supporting families in challenging situations. When I went to graduate school, I wanted to study these dynamics further. After earning my PhD in Nursing at McGill in 2010, I did a post-doctoral fellowship at McMaster University (2011) at the Canadian Health Services Research Foundation/Canadian Institutes of Health Research Chair Program in Advanced Practice Nursing. I continued my research as a faculty member at the Université du Québec in Outaouais before being recruited to the Université de Montréal. I joined the ISoN in 2019.
What attracted you to the ISoN?
With the support of Mr. Richard Ingram and the Board of the Newton Foundation, the School had established the Susan E. French Chair in Nursing Research and Innovative Practice. The vision of the donor was to showcase the vital contributions of nurses to healthcare – a vision that I share wholeheartedly. This endowed Chair has afforded me and my team the exciting opportunity to develop and validate tools that measure the impact of well-designed and well-implemented advanced practice nursing roles and to publish these findings in high quality peer-reviewed journals. Now that the Chair has been renewed for another five years, in our second mandate, we want to continue building on our results. For example, there is a big gap in the current understanding of how decisions are made around the workload of nurse practitioners (NPs). We have identified factors that influence how much time it takes to evaluate a patient such as whether this is a first visit, the reason for the consult, whether there are mental health issues etc. We are seeking to understand the effects of this workload on patient care and to help determine the optimal number of patients NPs should see per day.
What are the most rewarding aspects of a career in nursing research?
It is so rewarding to interview patients and their families and to hear personal stories of how much they appreciate being cared for by advanced practice nurses (APNs) who took the time to answer their questions. We’ve seen how, in many cases, patients who feel understood and supported have improved care outcomes. APNs are uniquely positioned to provide this combination of specialized knowledge and support. Hearing directly from other members of the healthcare team about how APNs support the overall functioning of the team is equally rewarding. I also enjoy supervising graduate students’ research projects and teaching a graduate course in Leadership and Health Policy, where I encourage students to select the policy issues they want to explore.
What is the one finding in your research that surprised you the most?
I was surprised to discover just how much of an impact well-developed APN roles can have on the team and on healthcare outcomes. In our study on NPs in long-term care, published in the journals Journal of Advanced Nursing, BMC Nursing and Nursing Outlook, we found a 12% reduction in medications given to fragile patients, which resulted in a decrease in complications such as falls, use of restraints and transfers to the Emergency Department as well as significant cost savings to the healthcare system because of the consistent follow-up by NPs. Some patients were able to recognize their family members for the first time in a long time! We have conducted a similar study in the homecare setting and have found similar results where planned follow-ups by the NPs reduced transfers to the Emergency Department.
What are the most challenging aspects of a career in nursing research?
The uncertainty and competitiveness of securing funding is a major challenge. That is why I am deeply grateful to Mr. Ingram and the Newton Foundation for endowing the Susan E. French Chair.
What are you most proud of and why?
The role of nurse practitioner is still being defined here in Quebec and is only just beginning to emerge in other parts of the world. I’m proud that the work of my team is helping to inform policy on how best to integrate advanced practice nurses in the healthcare system. We recently completed two large research reviews synthesizing existing research on APN roles and found that almost all indicators point in favour of including advanced practice nurses such as NPs and clinical nurse specialists in healthcare teams.
Further reading:
“A mixed methods quality improvement study to implement nurse practitioner roles and improve care for residents in long-term care facilities.”
www.bmcnurs.biomedcentral.com/articles/10.1186/s12912-019-0395-2
“Patient and family views of team functioning in primary healthcare teams with nurse practitioners: a survey of patient-reported experiences and outcomes.”
www.bmcprimcare.biomedcentral.com/articles/10.1186/s12875-021-01406-y
“Identifying indicators sensitive to primary healthcare nurse practitioner practice: A review of systematic reviews.”
www.journals.plos.org/plosone/article?id=10.1371/journal.pone.0290977