Canadian Conference on Nursing Research: June 13, 2002 Creating Canada-wide Research & Funding Partnerships: Issues and Lessons Learned From a Study of Rural and Remote Nursing Practice Martha MacLeod, UNBC Judith Kulig, University of Lethbridge Norma Stewart, University of Saskatchewan Roger Pitblado, Laurentian University Louise Lapierre, CHSRF Marian Knock, BC Ministry of Health Planning Canadian Conference on Nursing Research: June 13, 2002

The Study Aim: to examine and articulate the nature of registered nursing practice in primary care, acute care, community health, continuing care (home care) and long term care settings within rural and remote Canada 1

The Study Components Survey Registered Nurses Data Base (RNDB) Narrative Study Documentary Analysis

Project Germination Applications August 1999 “a casual comment” October 1999 Saskatoon, Prince George Applications November 1999 CHSRF Open Grants Competition: Submission of LOI March 2000 Submission of full application June 2000 CHSRF-Conditional approval Summer 2000 CHSRF-Request for additional information/clarification December 2000 Resubmission of full application April 2001 Official grant approval May 2001 Project underway August 2001 All sub-contracts signed

Principal Investigators and Decision-maker Martha MacLeod University of Northern British Columbia Judith Kulig University of Lethbridge Norma Stewart University of Saskatchewan Roger Pitblado Laurentian University Marian Knock B.C. Ministry of Health Planning 2

Co-Investigators Ruth Martin-Misener Dalhousie University Ginette Lazure Université Laval Jenny Medves Queen's University Michel Morton Lakehead University Carolyn Vogt U. Manitoba Gail Remus U. Saskatchewan Debra Morgan Dorothy Forbes U. Saskatchewan Barbara Smith Carl D'Arcy Elizabeth Thomlinson U. Calgary Kathy Banks UNBC Lela Zimmer 3

Advisory Team Members Marian Knock, B.C. MOHP, Principal Decision-Maker Denise Alcock, U. Ottawa Madge Applin, Centre for Nursing Studies, Nfld. Donna Brunskill, SRNA Elizabeth Cook, Aurora College, Yellowknife, NWT Marta Crawford, CRNM Fran Curran, Yukon Health & Social Services Joyce England, ANPEI Fjola Hart Wasekeesikaw, Aboriginal Nurses Ass’n Adele Vukic, Dalhousie U. Joyce English, ANPEI Barb Oke, N.S. MOH Cecile Hunt, North Central Health District, SK Kathleen MacMillan, FINHB – Health Canada Maria MacNaughton, MSB - Health Canada Suzanne Michaud, QHA Rachel Munday, Health and Social Services, Nunavut Debbie Phillipchuk, AARN Francine Anne Roy, CIHI Marlene Smadu, Saskatchewan Health Roxanne A. Tarjan, NANB Cathy Ulrich, Northern Health Authority, BC Anne Ardiel, B.C.MOHP

Funding Partners Canadian Health Services Research Foundation Canadian Institutes of Health Research Nursing Research Fund Ontario Ministry of Health and Long-Term Care Alberta Heritage Foundation for Health Research Michael Smith Foundation for Health Research Nova Scotia Health Research Foundation British Columbia Rural and Remote Health Research Institute Saskatchewan Economic and Cooperative Development Provincial and Territorial Nurses Associations Government of Nunavut Canadian Institute for Health Information 1

Researchers’ Perspective Martha MacLeod Lead Investigator Co-Principal Investigator

Time, Timing and Flexibility What is needed to develop and support a Canada-wide study? Lessons Learned: Take hold of the opportunity Don’t underestimate infrastructure or time needed Communicate, communicate, communicate Funding for project development Flexibility of funders is sometimes critical to development Time, Timing and Flexibility Time: It is impossible to overestimate the amount of time required to build teams and networks. The time required of the lead investigators in the development stage was tremendous; the time required in implementation stage is beyond the 5-15% indicated in the Letter of Intent – a rational figure put forward as we were planning Timing: - Taking hold of the opportunity - an important and timely research question, keen investigators, and the deadline of a LOI. - interest in the nursing human resources within many jurisdictions - increasing interest in rural research Take the opportunity but recognize that it takes time to develop a team. Flexibility: (see additional notes) Learn and mobilize the systems in your various institutions; recognize that they may not all work in the same way and build that into the plan (e.g. differences in institutional commitments re publication) - mobilize resources to assist, where they are available What was enormously helpful was the flexibility of the funding agency in the recognition of the developing team.

Building Teams, Building Trust How do we develop and recognize the team? How do we keep the momentum going over time and across country? Lessons Learned: Need a well-working, trusting core group Need mechanisms for recognizing project involvement Make the most of various talents Calling on differing expertise at differing stages of the project Structuring the team(s) into effective working groups with overall coordination The amount of work to develop the proposal and get the project underway has been tremendous. It has taken commitment on the part of all the investigators, the institutions within which they work (e.g. finance), the advisors and the funders. Challenges in keeping people involved, when fax, phone and meeting costs have to be absorbed, sometimes personally, and not are on the e-mail/internet. Need a well-working, trusting core group. When one person’s energy and time is less available, another pulls more. Time and effort to develop this trust, understanding of working styles and strengths, in person, is well worth it. Recognition in academic currency (money brought in, name of Co-PI’s on funding statements), is necessary, but not always built in. Funding agencies need to acknowledge that new forms of research teams are developing (e.g. change of policies about allowable PI’s). Keep the overall goal and plan in mind, while creating the specifics as one goes along Making the most of various talents – creating effective small working groups within the whole while maintaining overall coordination. This is a challenge as, with the exception of the survey team, the working groups are spread across the country. structure the research team in such a way that recognizes and uses varying aptitude, interests and areas of expertise. All areas of expertise are going to be needed some time in the life of the study. Recognize many reasons people are on a research team – and make them work. 2

Developing and Engaging the Advisory Team What do researchers need from an Advisory Team? How can Advisors remain engaged? Lessons Learned: Recognize team will change and evolve All areas of expertise will be needed sometime in the life of the study Be specific in requests of Advisors Don’t underestimate the talents of Advisors Communicate, communicate, communicate (but in ways that Advisors need) Why did we choose the various members on each team? - Best advice re advisory team – look to what we need to shape the project given what nurses need, what managers need, the federal/provincial system and who listens to whom? Who will we get good advice from? Who, other than the research team will listen to them? What do we need from the Advisory Team? - Information on current issues, networks, make sure they’re relevant,.. What the decision-makers need to have from the study and when? How to make sure this study is received by decision-makers and nurses? How are we developing capacity? - In each of the Co-PI’s teams there are research trainees. The team is committed to working together in ways that enable experienced researchers to work with those less experienced in a particular approach, while drawing on their particular skills – These come out at various times in the overall project. How do we address the realities of the Canadian situation? Francophone capacity – still a challenge, for this project that originated and is being led in western Canada. 2

Louise Lapierre Canadian Health Services Research Foundation Funder’s Perspective Louise Lapierre Canadian Health Services Research Foundation

CHSRF Overview An independent, national, public, not-for-profit corporation established in 1997 with a federal fund. Mission: To promote and fund applied health services research ( special focus on nursing research) and to increase the research’s quality, relevance and usefulness for policy makers. Key Difference: Review proposals for potential impact and scientific merit by panels of decision makers and researchers.

Lessons Learned from Experience with this Project Confirms need for matching funding at full-scale application stage. Plans are in place to retain competition themes over a number competitions. An exception was made to the policy of allowing only two co-principal investigators Multi-jurisdictional nature of project can affect ethical approval.

Decision Maker Involvement in CHSRF Funded Research Relationship between decision-maker and research team affects the impact of the research. The decision-maker should be able to discern first messages for dissemination and important short-term deliverables for the project. Appropriate and meaningful involvement of decision-maker partners will vary. Articulation of the planned decision-maker involvement is required in the full-scale application and is assessed by the merit review panel.

Principal Decision Maker’s Perspective Marian Knock B.C. Ministry of Health Planning Executive Director, Primary Care Program

Role of Principal Decision Maker Theoretical Role Actual Role Issues Time/Timing Principal investigators involved early on Not a major focus of the team at early stages Principal decision-maker loses the plot 1.1 Theoretical role input into policy related decisions advise how research may influence policy assist with dissemination of research findings advise decision makers in Government and administer regarding results of research advise regarding translating research results into policy/practice 1.2 Actual role provide advice on where research findings could be shared provide advice on naming key decision makers in Government and health care to receive reports/research advise re ADM, HHR, HA contacts advise re F/P/T possible funding sources media opportunities 1.3 Issue Time/Timing principle investigators involved early on not major focus of team principal decision maker loses plot

Expectations Principal Investigators Principal Decision-Maker Issues Getting to know each other Role confusion – when to become involved Role/connections with Advisory Team Unclear expectations What feedback is appreciated Whose research is this? 2. Expectations 2.1 Principal Investigators decision maker will stay in touch decision maker aware of issues decision maker knows role 2.2 Principal Decision maker Principal Investigator will advise re what they want/need Principal Investigator will advise when to become involved Principal Investigator will give decision maker concrete tasks to do. 2.3 Issues Getting to know each other - when you don’t know each other before Role confusion - when to become involved What is the role/connections expected with the Advisory Team? Unclear expectations what feedback is appreciated? whose research is this? 3. Actuality met with Martha early to discuss role missed/didn’t meet with team until May 2002 length of research time influences involvement unsure of role of Principal Investigator, Co-Principal Investigator and Principal Decision Maker. missed two earlier opportunities for meeting due to travel restrictions CHRF conference in February assisted understanding met another Principal Investigator/ clarified expectations

Recommendations Written description-roles & responsibilities Establish relationship early Clarify expectations (PI/DM) Regular meetings over life of research Teleconferences after meetings 4. Recommendation written description of roles and responsibilities meeting with Principal Investigator early to establish relationship clarify expectations on both sides (PI / DM) meet at least 3 times over life of research schedule teleconference after meeting

Choosing a Principal Decision Maker Determine where you would like the research to make an impact. Choose a person “high enough” to be able to make the appropriate contacts. Meet in person to determine the fit. Explain time commitment with expectations How in the future would you choose a principal decision maker? Determine where you would like the research to make impact Choose person high enough up to be able to be in contact with ADM/DM level or CEO/VP level. Meet in person with choice to determine fit Explain time commitment with expectations

Summary Developing partnerships in a Canada-wide study is exciting, demanding, and will ultimately result in a better study with a greater chance of its findings being used. There are not many recipes out there. Flexibility, trust, and commitment on the part of researchers, decision-makers, and funders make it possible.

Contact Information Overall Project and Narratives: Tel: 1-866-960-6409 e-mail: rrn@unbc.ca macleod@unbc.ca http://ruralnursing.unbc.ca Documentary Analysis: (403) 382-7119 e-mail: kulig@uleth.ca Survey: (306) 966-6260 e-mail: stewart@sask.usask.ca RNDB (705) 675-1151 ext: 3355 e-mail: rpitblado@nickel.laurentian.ca