nursing research papers examples

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Best Nursing Research Topics for Students

What is a nursing research paper.

• What They Include
• Choosing a Topic
• Best Nursing Research Topics
• Research Paper Writing Tips

Writing a research paper is a massive task that involves careful organization, critical analysis, and a lot of time. Some nursing students are natural writers, while others struggle to select a nursing research topic, let alone write about it.

If you're a nursing student who dreads writing research papers, this article may help ease your anxiety. We'll cover everything you need to know about writing nursing school research papers and the top topics for nursing research.  

Continue reading to make your paper-writing jitters a thing of the past.

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A nursing research paper is a work of academic writing composed by a nurse or nursing student. The paper may present information on a specific topic or answer a question.

During LPN/LVN and RN programs, most papers you write focus on learning to use research databases, evaluate appropriate resources, and format your writing with APA style. You'll then synthesize your research information to answer a question or analyze a topic.

BSN , MSN , Ph.D., and DNP programs also write nursing research papers. Students in these programs may also participate in conducting original research studies.

Writing papers during your academic program improves and develops many skills, including the ability to:

• Select nursing topics for research
• Conduct effective research
• Analyze published academic literature
• Format and cite sources
• Synthesize data
• Organize and articulate findings

About Nursing Research Papers

When do nursing students write research papers.

You may need to write a research paper for any of the nursing courses you take. Research papers help develop critical thinking and communication skills. They allow you to learn how to conduct research and critically review publications.

That said, not every class will require in-depth, 10-20-page papers. The more advanced your degree path, the more you can expect to write and conduct research. If you're in an associate or bachelor's program, you'll probably write a few papers each semester or term.

Do Nursing Students Conduct Original Research?

Most of the time, you won't be designing, conducting, and evaluating new research. Instead, your projects will focus on learning the research process and the scientific method. You'll achieve these objectives by evaluating existing nursing literature and sources and defending a thesis.

However, many nursing faculty members do conduct original research. So, you may get opportunities to participate in, and publish, research articles.

Example Research Project Scenario:

In your maternal child nursing class, the professor assigns the class a research paper regarding developmentally appropriate nursing interventions for the pediatric population. While that may sound specific, you have almost endless opportunities to narrow down the focus of your writing. 

You could choose pain intervention measures in toddlers. Conversely, you can research the effects of prolonged hospitalization on adolescents' social-emotional development.

What Does a Nursing Research Paper Include?

Your professor should provide a thorough guideline of the scope of the paper. In general, an undergraduate nursing research paper will consist of:

Introduction : A brief overview of the research question/thesis statement your paper will discuss. You can include why the topic is relevant.

Body : This section presents your research findings and allows you to synthesize the information and data you collected. You'll have a chance to articulate your evaluation and answer your research question. The length of this section depends on your assignment.

Conclusion : A brief review of the information and analysis you presented throughout the body of the paper. This section is a recap of your paper and another chance to reassert your thesis.

The best advice is to follow your instructor's rubric and guidelines. Remember to ask for help whenever needed, and avoid overcomplicating the assignment!

How to Choose a Nursing Research Topic

The sheer volume of prospective nursing research topics can become overwhelming for students. Additionally, you may get the misconception that all the 'good' research ideas are exhausted. However, a personal approach may help you narrow down a research topic and find a unique angle.

Writing your research paper about a topic you value or connect with makes the task easier. Additionally, you should consider the material's breadth. Topics with plenty of existing literature will make developing a research question and thesis smoother.

Finally, feel free to shift gears if necessary, especially if you're still early in the research process. If you start down one path and have trouble finding published information, ask your professor if you can choose another topic.

The Best Research Topics for Nursing Students

You have endless subject choices for nursing research papers. This non-exhaustive list just scratches the surface of some of the best nursing research topics.

1. Clinical Nursing Research Topics

• Analyze the use of telehealth/virtual nursing to reduce inpatient nurse duties.
• Discuss the impact of evidence-based respiratory interventions on patient outcomes in critical care settings.
• Explore the effectiveness of pain management protocols in pediatric patients.

2. Community Health Nursing Research Topics

• Assess the impact of nurse-led diabetes education in Type II Diabetics.
• Analyze the relationship between socioeconomic status and access to healthcare services.

3. Nurse Education Research Topics

• Review the effectiveness of simulation-based learning to improve nursing students' clinical skills.
• Identify methods that best prepare pre-licensure students for clinical practice.
• Investigate factors that influence nurses to pursue advanced degrees.
• Evaluate education methods that enhance cultural competence among nurses.
• Describe the role of mindfulness interventions in reducing stress and burnout among nurses.

4. Mental Health Nursing Research Topics

• Explore patient outcomes related to nurse staffing levels in acute behavioral health settings.
• Assess the effectiveness of mental health education among emergency room nurses .
• Explore de-escalation techniques that result in improved patient outcomes.
• Review the effectiveness of therapeutic communication in improving patient outcomes.

5. Pediatric Nursing Research Topics

• Assess the impact of parental involvement in pediatric asthma treatment adherence.
• Explore challenges related to chronic illness management in pediatric patients.
• Review the role of play therapy and other therapeutic interventions that alleviate anxiety among hospitalized children.

6. The Nursing Profession Research Topics

• Analyze the effects of short staffing on nurse burnout .
• Evaluate factors that facilitate resiliency among nursing professionals.
• Examine predictors of nurse dissatisfaction and burnout.
• Posit how nursing theories influence modern nursing practice.

Tips for Writing a Nursing Research Paper

The best nursing research advice we can provide is to follow your professor's rubric and instructions. However, here are a few study tips for nursing students to make paper writing less painful:

Avoid procrastination: Everyone says it, but few follow this advice. You can significantly lower your stress levels if you avoid procrastinating and start working on your project immediately.

Plan Ahead: Break down the writing process into smaller sections, especially if it seems overwhelming. Give yourself time for each step in the process.

Research: Use your resources and ask for help from the librarian or instructor. The rest should come together quickly once you find high-quality studies to analyze.

Outline: Create an outline to help you organize your thoughts. Then, you can plug in information throughout the research process. 

Clear Language: Use plain language as much as possible to get your point across. Jargon is inevitable when writing academic nursing papers, but keep it to a minimum.

Cite Properly: Accurately cite all sources using the appropriate citation style. Nursing research papers will almost always implement APA style. Check out the resources below for some excellent reference management options.

Revise and Edit: Once you finish your first draft, put it away for one to two hours or, preferably, a whole day. Once you've placed some space between you and your paper, read through and edit for clarity, coherence, and grammatical errors. Reading your essay out loud is an excellent way to check for the 'flow' of the paper.

Helpful Nursing Research Writing Resources:

Purdue OWL (Online writing lab) has a robust APA guide covering everything you need about APA style and rules.

Grammarly helps you edit grammar, spelling, and punctuation. Upgrading to a paid plan will get you plagiarism detection, formatting, and engagement suggestions. This tool is excellent to help you simplify complicated sentences.

Mendeley is a free reference management software. It stores, organizes, and cites references. It has a Microsoft plug-in that inserts and correctly formats APA citations.

Don't let nursing research papers scare you away from starting nursing school or furthering your education. Their purpose is to develop skills you'll need to be an effective nurse: critical thinking, communication, and the ability to review published information critically.

Choose a great topic and follow your teacher's instructions; you'll finish that paper in no time.

Joleen Sams is a certified Family Nurse Practitioner based in the Kansas City metro area. During her 10-year RN career, Joleen worked in NICU, inpatient pediatrics, and regulatory compliance. Since graduating with her MSN-FNP in 2019, she has worked in urgent care and nursing administration. Connect with Joleen on LinkedIn or see more of her writing on her website.

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Writing a Nursing Research Paper that Meets Professor's Requirements

As a nursing student, you will spend much time researching, reading, and writing papers. Many students find the entire process of writing research papers challenging.

Imagine on top of spending many hours in clinical practice shifts only to find yourself sparing more time researching and writing, not to mention the overwhelming information condensed in a few hours of in-class lecture sessions. Working shifts and studying while having family duties and obligations worsens it, and when done in a rush, you end up with subpar papers and average grades.

Even though many student nurses find writing research papers tricky and daunting, you can write a perfect paper that ticks all the checkboxes your professor uses to mark them and be sure to get an A+ grade on your nursing paper.

Our expert nursing research writers, who have written thousands of BSN, MSN, DNP, and Ph.D. papers, have compiled this comprehensive guide to help you write a strong nursing research paper that leaves a lasting impression on your professor.

Having marked many papers and supervised many theses, capstone projects, and dissertations, you can trust that the information herein is valuable and timely in your pursuit of nursing career success.

What is a Nursing Research Paper?

A nursing research paper is a scholarly and thesis-driven paper that a nursing student (at ADN, BSN, MSN, DNP, or Ph.D. level) writes to comprehensively explore a specific nursing research topic either of their choice or one that the professor assigns.

To write a perfect research paper, the student has to provide concrete, reliable, and trustworthy evidence. In most cases, even professionals such as RNs undertaking clinical practice, nursing education training, clinical studies and evaluations, and nursing research can also write research papers published in journals or conferences to advance and disseminate nursing knowledge. The typical length of most nursing papers ranges from 5 pages to 20 pages, depending mainly on the complexity of the subject, the word count limits, and the requirements. Nurses and nursing students write research papers to share their insights as they learn more about nursing processes and practices. Nursing research papers are used to: document research, organize information, advance nursing scholarship, and improve the writing skills of nurses. Students in the USA, Australia, Japan, and Canada write their research papers in the American Psychological Association (APA) format, while those in Australia and the UK write them in Harvard formats. The research papers fall under three main categories:

• Analytical research papers. These papers present an analysis of the topic using evidence, facts, and examples.
• Argumentative research papers. These research papers are analytical but with a twist where the writer uses evidence to reinforce their opinion and persuade the reader.
• Expository research papers. This category of nursing research papers explains the subject matter using credible evidence such as examples, facts, statistics, and other pieces of evidence.

Structure and Format of a Nursing Research Paper

A simple nursing research paper, especially an expository or informative type, can have 5 paragraphs, like a typical essay. However, longer research papers have additional sections.

Scientific Nursing Research Paper Structure

Here is a breakdown of how a well-formatted and scientific nursing research paper should look like.

• Title Page. The title page comprises the research paper title, details of the student or professional writer, course details, details of the school or institution, and the date. The cover page is the first contact point with the reader. It is brief.
• Abstract. The abstract summarizes the nursing research paper. It is 200-250 words long and should be focused on what the reader expects. It is a condensed version of the paper, which is critical to help professors know what your paper is about. It should not have acronyms. Note that the word count of the abstract is not considered part of the research paper.
• The Introduction. The introduction should have an attention-getter or a hook that can be a statement, statistic, or fact. It should be 10% of the entire word count. It also has background information that details the nursing issue or topic you are exploring. It also comprises a well-thought-out thesis statement related to the topic. If you have a long paper, ensure that your problem and purpose statements are part of the introduction. It should also list your PICOT question .
• Literature Review. This is a critical section of the research paper. Here, you should explore other nursing scholars' thoughts and scholarly findings. Focus on peer-reviewed scholarly articles that address the same issue as your thesis statement or topic. Explore your topic's theories, theoretical frameworks, and other facts. Do it so well that your professor marvels at your research, organization, and writing prowess. Consider the levels of evidence as you choose selection criteria for the papers to include in your nursing literature review.
• Research Methodology. This section of the research paper details the data collection methods, such as ethnographic studies, secondary data collection, literature review, quasi-experimental research, correlational studies, descriptive research, ethnography, phenomenology, grounded theory, meta-analyses, systematic reviews, or experiments. Ensure that you state and give a rationale for your research design (qualitative, quantitative, or mixed-methods). If you are writing a quantitative paper, explain how you tested the hypotheses. Also, report the sampling frame and the sampling strategy.
• Results and Discussion. This section of the paper presents the findings. You can use visual aids such as charts and graphs for a quantitative research paper. If you are writing a qualitative research paper, present the evidence chronologically. When presenting the findings, avoid making definitive facts. Instead, ensure that the results suggest something is true or false, even when testing a hypothesis.
• Conclusion and Recommendations. The conclusion should be 10% of the entire word count. You should restate the thesis and give a summary of your entire paper. Explore the recommendations for future research on the topic.
• Ensure that your reference list is arranged alphabetically. The list should adhere to the formatting requirements (Harvard, ASA, or APA formats). Only use scholarly peer-reviewed references.

Format for a General Nursing Research Paper

If you are writing a non-scientific nursing research paper, you will only have three sections as follows:

• Introduction. The introduction paragraph should introduce the topic by providing an attention-getter, background information, and a thesis statement.
• Body of the paper . The body paragraphs should have strong topic sentences, supporting details (examples, evidence, and explanation), and concluding sentences. It should also portray a good use of transition words. You should analyze the topic and use evidence to support the arguments, and give enough explanation. Use in-text citations within the body paragraphs.
• Conclusion. End the paper by recapping the main points, reasserting the thesis statement, and signaling the end of the paper to give your readers good closure.

An excellent nursing research paper follows this structure as long as it is not research-based. The three-part approach is super recommended if you did not conduct any study. In most cases, when assigned to write those 5-12 pages of nursing school research papers, you will be using this format.

So, what are the steps for writing a good nursing research paper? Let’s find out in the next section.

The 6 Main Steps for Writing a Nursing Research Paper

Writing assignments are an essential training aspect for nursing students. No wonder professors will stress that you write essays, discussion posts, responses, or proposals well. They are doing so to prepare you for research roles somewhere in your nursing career.

According to our most successful research paper writers, writing a top-grade research paper involves decoding the instructions, selecting a good topic, planning, researching, writing, and polishing the paper.

Here is a breakdown of each step for clarity and deeper understanding.

Step #1: Understand the Prompt or Instructions

You can only perfect what you know! Therefore, you can begin the research writing process by reading, analyzing, and understanding the instructions. It is an essential pre-writing stage process where you carefully read the instructions.

Although it sounds obvious, most nursing students who write off-topic and subpar research papers jump into writing without reading to understand the instructions.

You need to skim through the instructions on the first attempt, then read keenly and critically as you take note of the scope of the assignment, the topic, and other things you must fulfill in the paper. Take note of the:

• The number of words.
• Type of research paper (argumentative, analytical, exploratory, or persuasive).
• The structure of the paper (thesis-driven or research/study-based (scientific) research paper.
• The deadline.
• Whether you need to draft an outline.
• Reading materials.
• Whether you need external sources.
• Which sources to use and how many?
• The theoretical constructions or conceptual frameworks.
• The age limit of the scholarly sources.

If you need further clarification, ensure that you ask your peers, professor, or a professional writer in time.

Step #2: Select a Good Nursing Research Topic

Compared to average students, top nursing students always remember to select a research topic they are comfortable handling. When you are confident with a topic, you can develop it without procrastinating.

Sometimes you are given a list of nursing research paper topics, issues, and ideas to consider. Other times, you come up with the topic and consult your professor/educator for approval.  

Choose topics related to patient safety, nursing processes, nurse staffing, nursing policies, nurse privileges, nursing legislations, nursing ethics, mental health, health promotion, chronic disease management, healthcare systems, health informatics, changes in healthcare, and working conditions.

Choose any nursing topic that resonates with your specialization interests. It should be manageable, relevant, and explorable.

Related Readings:

• Nursing informatics research topics
• Capstone project ideas and topics for BSN, MSN, and DNP students
• Mental health nursing topics
• Epidemiology nursing topics
• List of the best nursing research paper topics
• Evidence-based nursing topics and ideas
• Nursing ethical dilemmas

Step #3: Plan your Paper

Create a thesis statement for your research paper if it is thesis-driven rather than study-based or scientific (experimental). After writing the thesis, like any of our nursing assignment slayers, write a good outline using Roman numbers and numbers.

List the ideas you wish to have in your paper in chronological order, starting with the introduction, body, and concluding paragraphs. As you outline, do some preliminary research so that you develop arguments the right way.

Include the in-text citations in your nursing research paper outline to simplify the writing process.

Step #4: Research and Organize Resources

Doing in-depth research as you refine the draft would be appropriate because you know what you want the paper to look like. Use scholarly nursing databases for research and limit yourself to topic-related scholarly articles published within the last 5 years.

You can read the abstracts of the articles to determine if they are fit to use in your paper. If you find the best articles, list them using online citation management tools such as RefWorks, Zotero, EndNote, Citefast, or any of your choice.

Ensure to list them in the most appropriate formatting styles. Take notes and list the points and ideas in your outline. Do your research meticulously and ensure that you organize the process to avoid any confusion.

Step #5: Write the First Draft

With the research, synthesis, and outline, you are now left with the chance to put rubber on the road. Use the Pomodoro technique, where you spend stretches of 25 minutes of focused work and have minor 5-minute breaks.

Ensure you cover as much ground in your research paper as possible before three-quarters of the deadline. When writing the paper, and considering that you have the outline, you can start chronologically from the introduction to the appendices.

Most research paper writing pros prefer working on the body section and conclusion before writing the introduction and finalizing the abstract. Whatever works best for you, adopt it. When writing the first draft, focus on piecing together the information rather than perfection.

Ensure you research lightly as you write and assert your voice while giving the right in-text citations for every idea you paraphrase from a source to avoid plagiarism. Each body paragraph should only have one idea.

Step #6: Edit, Proofread, and Polish the Paper

The final step towards completing your nursing research paper is ensuring everything is in its rightful place. A polished research paper scores 90% and above, which is an A. Begin by reading the paper aloud to identify areas that do not make sense.

If there is a need, do not hesitate to rewrite an entire section so that you have the right flow of information.

Check the grammatical, spelling, and syntax errors and make necessary corrections. You should also check the tenses used in the paper. If you feel like polishing the essay is too much work, you are better off hiring a nursing paper proofreader/editor.

When you receive feedback from your educator or professor, address the changes and resend the paper for grading.

Related Reading: How to write an evidence-based nursing paper.

Valuable Tips to Consider as You Write Your Nursing Research Paper

Nursing schools and educators have their standards and guidelines for writing a research paper. Therefore, ensure that before everything else, you familiarize yourself and adhere to these instructions, which include word count and citation styles.

Do not assume anything when writing a paper. You should also access and understand suggestions from your school’s writing lab. Apart from these essential tips, also ensure that you follow the insights we give below:

• Write your paper using a formal tone. Do not use passive voice when writing the paper. Instead, use active voice.
• Your paper should have a good organization from the introduction to the conclusion.
• Whenever you borrow ideas from a scholarly source, ensure you cite them correctly.
• Have a well-thought-out thesis statement that clarifies your arguments.
• Create a complete outline during the early stages of writing. It gives you a roadmap to follow as you write the paper. Organize the ideas chronologically based on their strength and weaknesses.
• Have a plan and schedule to trace your progress with the paper.
• If you have a more extended deadline, contribute to your research paper daily.
• When writing the paper, start with the body, the conclusion, and the introduction last.
• If you are writing a study-based research paper, include the literature review, methodology, discussion, and conclusion sections per the IMRAD format. A general nursing research paper follows the essay structure: introduction, body section, and conclusion.
• Use peer-reviewed scholarly sources from CINAHL, PubMed, Nursing Reference Center, Cochrane Library, MEDLINE, and other nursing research databases with peer-reviewed articles. Credible sources mean your research paper has rigor since you have strong points.
• Proofread and edit the paper thoroughly to remove any mistakes to signal your seriousness to your professor. If possible, use professional editing services.
• Have a compelling conclusion that is elaborate, clear, and concise.
• Read your paper aloud to identify mistakes.
• Revise the paper, and do not fear rewriting an entire section.

When writing a research paper, adhere to the writing conventions. You should also read well and understand how to communicate through academic writing effectively. Your paper should document evidence that supports your arguments and topic.

Write concisely, coherently, and accurately. It is not all in vain; you are training for your future role as a nurse when you will write conference papers, white papers, essays, policy documents, letters, blog posts, and professional nursing articles.

Checklist for a Great Research Paper in Nursing

Now that you have written your paper, you must align a few things to make it the best your professor will read. Most nursing classes, especially at the graduate levels (MSN, DNP, and Ph.D. levels), have small class sizes, and the professors spend time reading the papers from start to end. This means that you should leave nothing to chance.

Nursing research asserts professional identity, ensures accountability in nursing decision-making, and expands nursing practice. You have to be meticulous when writing a research paper in nursing.

A good research paper demonstrates a complete understanding of nursing knowledge, topic exploration, advanced organization, proper formatting, and mature academic writing skills. The following checklist enlists some main aspects to countercheck before hitting the submit button.

• Have I followed all the instructions outlined in the assignment prompt or rubric?
• Does my paper have the right title page?
• Does the paper have a written title that resonates with the thesis and the research question?
• Is the introduction presenting an attention grabber, background information, and a signpost of the ideas in the paper?
• Is the thesis statement well-thought-out, clear, concise, and elaborate?
• Is the problem statement clearly stated?
• If it is a PICOT-based research paper, is the PICO question well-outlined?
• Does the paper touch well on the nursing issue that the topic needs it to address?
• Is there a logical flow of the paragraphs?
• Are the words in each paragraph balanced?
• Does the paper have correctly formatted headings and subheadings?
• Are the in-text citations done correctly and consistently?
• Does every paragraph in the body of the paper build on the thesis?
• Does the paper demonstrate a mature choice of words and uses nursing lingo?
• Is the literature review section comprehensive? Does it have a theoretical and conceptual framework or constructs?
• Are the data and information presented in the literature review current?
• Has the methodology section listed the sample, sampling strategy, data collection and analyses, and rationale for each?
• Does the discussion section interlink the concepts from the literature review with the findings?
• Does the conclusion offer good closure to the readers? Does it restate the thesis? Does it summarize the recommendations?
• Is the entire paper formatted correctly? Does it follow the formatting guidelines?
• Is the paper devoid of spelling, syntax, and mechanical mistakes?

If your answer to all these questions is a resounding YES, you are sure it will fetch your professor a good grade. Our nursing writers, most of whom are alumni from top nursing universities and colleges such as Chamberlain, Capella, Herzing, Vanderbilt, SFU, Rutgers, Yale, Duke, NYU, UCLA, University of Pennsylvania, University of Toronto, McGill, Ottawa, Queens, and other best colleges in the USA, UK, Canada, and many other places. Besides, they are nursing educators in different capacities, and a couple are nursing professors with big titles; you can trust the checklist to guarantee you an excellent grade.

Where to Get Help When Writing Research Paper

As a nursing student, writing a research paper is something you will most likely enjoy doing. However, unforeseen things happen, prompting you to search the internet for sites to help you do your nursing research paper. NurseMyGrade.com is one such place to pay a nursing writer to do your paper.

Expect a paper that meets all the requirements, is written by a human rather than AI software, and is uniquely tailored to your requirements.  Our rates are affordable, and our writers cover diverse fields. Apart from offering advice about research, writing, and formatting papers, we have resourceful writers whom we allow you to communicate directly with via our platform.

We also maintain high levels of secrecy because we care more about your privacy and confidentiality of your details. Not even your professor can tell you got help from our website because we advise on specific strategies to use the paper. We have assisted students in various levels of nursing education with their writing, and we can do yours too.

Get affordable, well-researched, formatted, and organized nursing research papers done for you today by filling out the order form. Nursing research papers are a chance to stand out. Let our professionals help you achieve your nursing school goals.

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A Phenomenological Study of Nurses’ Experience in Caring for COVID-19 Patients

Hye-young jang.

1 School of Nursing, Research Institute of Nursing Science, Hanyang University, Seoul 04763, Korea; rk.ca.gnaynah@8010etihw

Jeong-Eun Yang

2 Department of Nursing, Jesus University, Jeonju-si 54989, Korea; rk.ca.susej@gnayfle

Yong-Soon Shin

Associated data.

The data presented in this study are available on request from the corresponding author.

This study aimed to understand and describe the experiences of nurses who cared for patients with COVID-19. A descriptive phenomenological approach was used to collect data from individual in-depth interviews with 14 nurses, from 20 October 2020 to 15 January 2021. Data were analyzed using the phenomenological method of Colaizzi. Five theme clusters emerged from the analysis: (1) nurses struggling under the weight of dealing with infectious disease, (2) challenges added to difficult caring, (3) double suffering from patient care, (4) support for caring, and (5) expectations for post-COVID-19 life. The findings of this study are useful primary data for developing appropriate measures for health professionals’ wellbeing during outbreaks of infectious diseases. Specifically, as nurses in this study struggled with mental as well as physical difficulties, it is suggested that future studies develop and apply mental health recovery programs for them. To be prepared for future infectious diseases and contribute to patient care, policymakers should improve the work environment, through various means, such as nurses’ practice environment management and incentives.

1. Introduction

As the novel coronavirus disease (COVID-19) spreads worldwide and becomes more serious, the World Health Organization (WHO) has declared it a global epidemic. In Korea, the first case of COVID-19 was confirmed on 20 January 2020; as of 29 June 2021, the total number of patients was 156,167, of which 6882 were quarantined and treated, with a fatality rate of 1.29% [ 1 ].

COVID-19 is caused by a novel coronavirus—severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)—and manifests in clinical symptoms, such as cough (74.9%), fever (68.0%) and dyspnea (60.9%) among hospitalized patients [ 2 ]. In the case of SARS-CoV-2, it has been reported that if patients are isolated within 5 days of the onset of clinical symptoms, secondary infections occur less frequently; transmission can be effectively blocked by isolating immediately after the onset of symptoms [ 3 ]. However, hospitalizations in negative pressure isolation rooms, to block airborne infections, create a more isolated environment than the general intensive care unit environment; mandate medical personnel to wear unfamiliar and uncomfortable protective equipment; prohibit family visits and outside contact. Isolation affects patients as well, as it has been reported that many patients were insufficiently informed about the isolation environment and period, and this uncertainty caused them to experience depression [ 4 ]. These circumstances increase the importance of caring for patients in isolation.

Caring is an important concept within the field of nursing, as it affects the health of the patient as a whole [ 5 ]. In particular, in the early stages of outbreaks of new infectious diseases, all aspects, such as the pathology, transmission route, and effective treatment of the disease are uncertain [ 6 ]. Even the effectiveness of protective equipment is uncertain. It has been found that healthcare providers’ anxiety and fear in such conditions affects their ability to care for patients [ 7 , 8 ]. In the context of the COVID-19 pandemic, many scholars predict that the time before and after the pandemic will be very different and are asking if we are ready for post- or the ‘with COVID-19 era’ [ 9 , 10 , 11 ]. Even in nursing, this change is difficult to ignore, and nursing professionals and researchers should answer whether we are preparing the ‘with COVID-19 era’. In order to identify the reality of nursing in the ‘with COVID-19 era’, it is necessary to understand what nursing and caring experiences were like for nurses who have been care professionals during the unprecedented COVID-19 pandemic. During the pandemic, nurses played a positive role in the rapid reorganization of the nursing system, improvement of team communication, coordination materials for emergency and continuous care, improvement of efficiency of nursing performance as a front-line caregiver, and caring for other nurses [ 12 ]. However, nurses are starting to experience burnout, having been unaware that the pandemic would soon change health professions universally [ 13 ]. For this, it is necessary to examine the experiences of nurses who have been, and are, caring for quarantined patients.

Studies on the nursing experience of patients with COVID-19 are underway in countries in various trajectories of the COVID-19 pandemic, such as Spain [ 14 ], Italy [ 15 ], Canada [ 16 ], the United States [ 17 ], and China [ 18 ], and these previous studies are focused on the lived nursing experience itself or the ethical aspect. Experiences of nursing care reported so far are summarized as providing nursing care [ 14 , 15 , 16 ], psychosocial and emotional aspects [ 14 , 15 , 18 , 19 ], resource management [ 14 , 16 ], struggling on the frontline [ 19 , 20 ], personal growth [ 18 , 19 ] and adapting to changes [ 18 , 20 ].

In the context of the COVID-19 pandemic, the Korean government responded using the K-Quarantine, also known as 3T–Test (diagnosis/confirmation), Trace (epidemiological survey/trace) and Treat (isolation/treatment) [ 21 ]. In particular, since February 2020, COVID-19 hospitals have been designated and operated for safe isolation beds for hospitalization of COVID-19 patients [ 22 ]. As patients diagnosed with COVID-19 are transferred to a designated hospital, operating a medical system that receives intensive treatment and care, the nurses at the hospitals are facing a high level of depression, anxiety, and stress [ 23 , 24 ].

However, the nursing experience of Korean nurses is only a small part of the research done in the early stage of the pandemic, and that knowledge is not enough to understand the essence of nursing in the special nursing environment of COVID-19. Therefore, this study was conducted to understand the lived nursing experience of the nurses at COVID-19-designated hospitals during the third wave [ 25 ] of the COVID-19 pandemic in Korea. The nursing experience of Korean COVID-19-dedicated hospital nurses could provide a unique opportunity to develop long-term sustainable response strategies under a long-lasting pandemic.

Phenomenological research focuses on vivid experiences, perceived or interpreted by participants, and aims to view and describe the world of their consciousness as a real world. In addition, exploring the experiences of others can discover insights that were previously unavailable, so it is considered a useful method for the purpose of this study. Particularly, Colaizzi’s [ 26 ] method focuses on deriving a collection of common attributes and themes from multiple responses, rather than individual attributes. This method will facilitate an in-depth understanding of how nurses experienced caregiving for patients with COVID-19, and further contribute to the literature, regarding high-quality nursing care for quarantined patients. Therefore, the purpose of this study is to investigate the meaning and essence of nurses’ experiences of caring for COVID-19 patients, using a phenomenological research method.

2. Materials and Methods

2.1. study design.

The philosophical framework and study design of this study were guided by phenomenology. The philosophical aim of phenomenology is to provide an understanding of the participant’s lived experiences [ 27 ]. In order to reveal the true essence of the ‘living experience’, it is first necessary to minimize the preconceived ideas that researchers may have about the research phenomenon (bracketing). Through such a phenomenological attitude, the participant’s experience can be explored as it is [ 28 ]. From a phenomenological point of view, objectivity is obtained by being faithful to the phenomenon, and it can be secured by paying attention to the phenomenon itself rather than explaining what it is. As such, phenomenology seeks to reveal meaning and essences in the participant’s experiences of the participant to facilitate understanding [ 28 ].

This study is an inductive study, applying the phenomenological research method of Colaizzi [ 26 ], in order to gain an in-depth understanding of the essence of nurses’ experience in caring for COVID-19 patients, and it followed the guideline for qualitative research, established by the Consolidated Criteria for Reporting Qualitative Research [ 29 ]. The question of this study is, “What is the meaning and essence of the care experience of nurses who directly cared for COVID-19 patients?”

2.2. Participants and Settings

Participants were nurses working at a COVID-19 Infectious Disease Hospital in Seoul and Gyeonggi Province. The COVID-19 Infectious Disease Hospital was established and is operated by the Ministry of Health and Welfare, one of the central government ministries of South Korea, to respond to infectious diseases during the COVID-19 pandemic. It is dedicated to managing infected patients.

The inclusion criteria were as follows: nurses who had directly cared for confirmed or suspected COVID-19 patients in an isolation ward for at least 1 month; could communicate well and comprehend the purpose of this study; had voluntarily consented to participate. Nurses who had cared for COVID-19 patients for less than 1 month, had not participated in direct care, or had not been released from isolation, were excluded. Fourteen nurses participated in in-depth interviews individually ( Table 1 ).

General Characteristics of Participants ( N = 14).

Note. COVID-19 = coronavirus disease-2019.

2.3. Data Collection

Data were collected through in-depth interviews from 20 October 2020 to 15 January 2021 using purposive sampling (n = 12) and snowball sampling (n = 2). The sample size was determined by data saturation [ 30 ]. Data saturation was considered achieved when no new themes were revealed in the interviews of participants. Data saturation was determined by two researchers after the fourteenth case interview. Interviews were conducted either online or face-to-face by one well-trained researcher, depending on participants’ convenience. During face-to-face interviews, we created a comfortable atmosphere by beginning with everyday conversations. Interviews began with an open-ended question: “Tell me about your experience of caring for patients with COVID-19”, so that participants could elaborately and spontaneously describe their experiences. The interviews lasted about 60–120 min, and data collection and analysis were conducted simultaneously.

2.4. Data Analysis

The interview content was transcribed verbatim within 24 h of each interview by the researcher. Transcripts of each participant’s interview and the memos were used to analyze data. Two researchers with doctoral degrees independently analyzed and discussed findings.

Data analysis was guided by Colaizzi’s seven-step descriptive phenomenological method [ 26 ]: (1) researchers read all accounts multiple times to understand the overall flow of participants’ experiences in caring for COVID-19 patients; (2) we extracted significant statements from each description, focusing on meaningful statements related to participants’ caring experiences; (3) we formulated meanings from those significant statements, trying to discover the latent meaning in the context; (4) we organized those formulated meanings into themes and theme clusters; (5) the phenomenon under study was exhaustively described by integrating all the research results; (6) we identified the fundamental structure of the phenomenon; (7) finally, we validated this study by receiving feedback from two participants.

In the entire process of data analysis, we tried to keep a distance from the researcher’s thoughts and feelings, and point of view about the phenomenon, as well as the content of the data, while being conscious of Husserl’s ‘bracketing’ [ 28 ]. In this way, we tried to avoid data distortion, reduction, and exaggeration by the researcher, and we tried to confirm and understand the perspective, attitude, and feeling of the participant as much as possible in the participant’s statement.

To ensure trustworthiness of this study, the four criteria established by Lincoln and Guba [ 31 ] were used. For enhancing truth-value, we tried to obtain a rich set of data by selecting participants who would like to express the research phenomenon well and making it as comfortable as possible for the participants to state their experiences. We showed the study results to two participants to verify whether the derived results reflected the participants’ experiences.

To ensure applicability, we provided the general characteristics of participants and tried to provide a thick description of the research phenomenon.

To establish consistency, Colaizzi’s analysis method was adhered to, and the detailed research process and original data for each theme were presented to enhance the reader’s understanding of the research results. The researcher conducted the research while taking a neutral attitude throughout the research process, excluding bias, prejudices, assumptions (bracketing), so that the participant’s experience distortion by the researcher was minimized. In other words, in order to establish neutrality, which means freedom from prejudice about research results, at the beginning of the study, the researcher explicated any assumptions that could influence data collection and analysis [ 32 ] (ex. participants will mostly have negative emotions while caring for patients without any preparation. Participants will be withdrawn from the social perspective because they are taking care of infected patients.) The other researcher reviewed data analysis to ensure that the researcher’s assumptions did not influence data interpretation.

2.6. Ethical Considerations

This study was approved by the Institutional Review Board of the researcher’s affiliated institution (HYUIRB-202009-009). Participants were informed about the purpose of the study, reporting of study results, and interview recordings. We obtained written informed consents from all participants before data collection. In addition, it was explained that even after consenting, participants could withdraw from the study at any time without any harm if they wished. All participants were provided with a small reward as appreciation for their participation in the study.

The essential structure of the phenomenon was identified as ‘Going beyond the double suffering tunnel of taking charge of infected patients into the future’. The essence of the phenomenon is presented as five theme clusters, and twelve themes emerged from analyzing nurses’ experiences with caring for COVID-19 patients: (1) nurses struggling under the weight of dealing with infectious disease, (2) challenges added to difficult caring, (3) double suffering from patient care, (4) support for caring, and (5) expectations for post-COVID-19 life ( Table 2 ).

Theme Clusters and Themes.

3.1. Nurses Struggling under the Weight of Dealing with Infectious Disease

Participants felt fear and anxiety while caring for COVID-19 patients, as they have remained unaware of any definitive treatments. Consumed by thoughts of contracting the disease, they reported feeling unable to remain calm and dutifully serve their patients. In particular, it was shocking, as well as saddening, for them to be unable to provide respectful end of life care toward patients who could not recover.

3.1.1. Anxiety and Fear Accompanying Patient Care

The anxiety and fear at the heart of the thought that they could also be infected became an invisible chain, binding the participants. According to them, nursing without being guaranteed safety was challenging. When facing the reality of nursing while fearing patients’ diseases, it felt unfamiliar for participants to worry about their own and their patients’ safety simultaneously, rather than completely immersing themselves in patients’ recovery. They were uncertain of whether their feelings were normal; although they tried their best to provide quality care, they found it challenging to do so while dealing with their persistent anxiety.

To be honest, that was the hardest for me. Since we were constantly exposed to the risk of infection, it was hard to care for patients due to anxiety rather than due to physical challenges while caring for the patient. (Participant J)

3.1.2. Dignity Ignored Due to the Fear of Infectious Diseases

Having to watch patients struggling alone and in isolation, without the support and comfort of their family members during their final moments, made participants feel extremely sorry and heartbroken. The most distressing aspect of caring for patients on their deathbed was that patients and nurses were faced with the reality that patients’ families would not be allowed to be with them during their moment of dying; the fact that they would pass away without receiving appropriate treatment was secondary. “Patients who died during the COVID-19 period were the most pitiful” does not just indicate the limitations of medical treatment. It highlights dignity, which is be protected even in the worst circumstances, but was disregarded due to the fear of contracting infectious diseases. Participants experienced unimaginable shock and ethical anguish as they witnessed patients being taken to crematoriums without being seen by their family members, with their bodies in bags without having their clothing changed. As these uncontrollable experiences kept repeating, participants made a paradoxical resolve to prevent patients from dying.

Patients who die while I work in the ward usually have their families come to see them and hold their hands. However, for those who die of COVID-19, families come and check their patients on the monitor. I think that’s the most heartbreaking and sad thing. (Participant L)

The post-death process was really shocking. I feel like it didn’t treat people like human beings. Thus, that hurt me the most. I think that’s hard while working in the ward. When patients die, I know how they will be treated. I am so sorry, and my heart hurts. That’s why I really want to discharge them. Seriously, I think I’m getting desperate for this kind of feeling. (Participant B)

3.2. Challenges Added to Difficult Caring

Participants struggled every day, and factors that made their lives more challenging are as follows: the personal protective equipment (PPE) that had to be worn for patient care, working in chaotic conditions without clear instructions, and being overburdened with tasks.

3.2.1. The Burden of Triple Distress for Everyone’s Safety; Wearing PPE

Participants had to endure a significant amount of pain and discomfort for safety purposes, especially while nursing patients in PPE. Less than 10 min after wearing them, the inside of the protective clothing would become warm and fill with sweat, and the eye goggles would become foggy. In these situations, participants experienced difficulties in certain activities, such as communicating with patients, securing intravenous (IV) lines, or drawing blood. Occasionally, they had to wear gloves that did not fit well due to a lack of proper supplies, making their practice more difficult.

I think the hardest thing was to wear Level D and go inside. At first, I did the intubation wearing protective clothing. At that time, my body became sluggish, and my vision became narrower because I was wearing goggles. So, even if I moved a little, it got too hot and I would sweat too much, and it was really hard to deal with something in there. Because it was too hot. (Participant D)

3.2.2. Work Loaded Solely on Nurses

To prevent the spread of COVID-19, hospitals implemented policies to minimize the number of family members and caregivers in contact with patients, which increased the burden of caregiving on participants. Blood collections and portable X-ray imaging that radiological technologists performed also became nurses’ duties. In addition, nurses had to prepare documents for the hospital transfers of patients, and were also responsible for checking, storing, and delivering parcels to patients. Nurses were gradually exhausted as most duties, especially those outside their purview, were delegated to them.

To be honest, there are not just nurses in the hospital. However, it’s a situation where we have to take on everything that other employees have done. I feel like they’re giving all their work to the nurses. We have to prepare everything that the radiology department had to do on their own before. For the meal distribution for COVID-19 patients, nurses have to do everything that the nutrition team previously did. For blood collection, we have to do all the things that the laboratory medicine department used to do. It’s overwhelming that nurses have to do most of the work. (Participant F)

3.2.3. Confusing and Uncertain Working Conditions

Participants’ routine caring for COVID-19 patients has been as uncertain as COVID-19 patients’ conditions. Due to the number of confirmed cases increasing daily and sudden confirmations of the infection in colleagues, situations such as the operation of additional negative pressure wards or temporary closures of wards occurred unexpectedly. Consequently, participants were frequently relocated, and their work schedules and wards were changed, creating confusion. In particular, unclear guidelines and insufficient training made their jobs more difficult.

It’s tough to get the work schedule on a weekly basis. Actually, I don’t know my work schedule for Tuesday even on Monday, so I don’t know which shift I will work on the next day. Hence, it’s really very stressful. (Participant E)

3.3. Double Suffering from Patient Care

Participants experienced not only physical difficulties but also mental and social challenges while caring for COVID-19 patients. They endured self-isolation along with their families, and were uncomfortable with causing their family members to experience isolation. In addition, unlike the usual positive public perception of nurses, participants felt a social disconnection from the negativity and stigma surrounding them, which was also hurtful and uncomfortable.

3.3.1. Self-Isolation: Anxiety Becomes a Reality

Participants contracted the virus while caring for patients or had to enter complete self-isolation due to coming in contact with infected colleagues. They endured the anxiety and fear of being infected and suddenly became subjects of self-isolation, leading to concerns about having their personal information exposed, and the social stigma of being confirmed COVID-19 patients. Those who tested negative felt “uncomfortable relief”, even as their colleagues were testing positive during self-isolation.

When being in self-isolation, as you know, I must contact my child’s school. I had to contact a homeroom teacher of my child. Actually I didn’t really do anything wrong, but I really, really felt bad. Wouldn’t the image appear strange to my child? Because of that thought, every time I thought about that, I thought if I should resign. (Participant N)

3.3.2. A Contrasting Perception of Nurses: Heroes of Society versus Subjects of Avoidance

Even with the “Thank you Challenge” campaign spreading among the public, to express gratitude and respect towards health care professionals who responded to COVID-19, nurses did not feel particularly gratified. In a pandemic, the true heroes fighting COVID-19 could only work efficiently in isolation from other people. Close neighbors viewed participants as dangerous sources of pollution or pathogens that threatened their safety. Unlike the warm gaze of the public to see the nurses, participants felt judged by those around them, which made their jobs more uncomfortable.

Above all, the most challenging thing is the social perspective of “these people are working in an isolation hospital now”. People close to me have this kind of perspective… When one of the nurses is reported on the news or the media as a confirmed patient, we also feel like cringing. Such social perspectives were very hard for us because we’ve become people that the public wants to avoid rather them feeling appreciation for us and thinking of us like we are working hard and trying our best. (Participant M)

3.4. Support for Caring

Sympathetic colleagues, and supportive and appreciative patients, encouraged participants to care for patients despite their difficulties. In addition, participants felt rewarded and proud of their care when they witnessed patients recovering, which further drove them to fulfill their duties.

3.4.1. Companionship and Sharing Difficulties

Participants endured difficult working routines with the support of colleagues, who best understood their struggles. In experiencing and sharing the same difficulties, participants found comfort with their colleagues. As nurses cannot quit, as that would mean additional pressures for their colleagues, they rely on each other for support.

To be honest, I think I’m being able to endure hard times thanks to my companionship. It’s hard for us all. And fortunately, all colleagues are friendly, and many colleagues are so considerate of each other. We’re not pushing each other to go in, but we are voluntarily working. Even though COVID-19 is hard for me, this companionship has helped me learn and endure with them until now. (Participant I)

3.4.2. Support and Appreciation from Patients and People

While struggling, words of support and appreciation from patients, family, and friends helped participants withstand their difficult situations.

A patient wrote a very long letter. “Thank you. Thank you so much for taking care of me, and I was moved by the hard work you did. And even in the heat, you never got annoyed”. Well, because the patient wrote a lot of appreciative words like this, I was really grateful. Somehow, apart from the money, I thought it was terrific to work. (Participant A)

3.4.3. A Sense of Satisfaction and Self-Esteem

The sense of satisfaction and self-esteem felt while caring for COVID-19 patients became an essential incentive for participants to remain in nursing. When patients hospitalized in severe conditions were able to recover, participants felt rewarded by their occupation, and their self-esteem was increased.

At first, the patient‘s condition was so bad. So, we thought the patient would actually die, but it turned out that the patient improved so much and was discharged later. We felt like we were being compensated for the hard work. I had pride that we did an excellent job in nursing. (Participant D)

3.5. Expectations for Post-COVID-19 Life

As COVID-19 keeps persisting in everyday life, expectations for life after COVID-19 are gradually blurring. Participants are unsure if there will ever be a time when they can care for their patients without protective clothing. Much of what participants wanted to accomplish after COVID-19 has been delayed for at least a year, but they have some expectations and are preparing for another future.

3.5.1. Restoring Everyday Life

Even in the current uncertain situation, participants have sincerely performed their nursing duties, while dreaming of restoring daily life. They recognized the importance of everyday social activities, such as eating together, watching movies, capturing bright smiles on camera, and realized that these activities were all they wished to do. Conversely, along with these wishes, there are also concerns about being able to return to the past sense of normalcy.

Returning to normality is what I want the most, and I think the next step is to think about it together with the management team and the government. I believe our request should be reviewed to combat physical exhaustion, and psychotherapists need to be involved and actively work on recovering. It’s not just that we get rest. Professional intervention is necessary. (Participant M)

3.5.2. Preparing for the Future

Participants encountered COVID-19, which occurred several years after the Middle East respiratory syndrome (MERS) epidemic, as another infectious disease that was able to threaten society at any time. In addition, chaotic situations in the hospital were not promptly managed, as the effects of the virus were so severe and fast that the experience of nursing MERS patients became insignificant. The MERS experience was inadequate in training healthcare providers to respond to similar future emergencies. Accordingly, efforts have been made to incorporate the vivid nursing experiences of COVID-19 into protocols against bracing for other diseases in the future.

That’s why even though I don’t know when the COVID-19 pandemic will end, once it’s over, I think the protocol needs to be more complete. Furthermore, I think we should regularly stockpile a certain amount of items for the future. And, we need to plan a little more neatly how to manage nursing staff systematically. (Participant K)

Since we don’t know when another infectious disease will afflict us, we have to prepare a lot for response training to infectious diseases, facilities and personnel of institutions, and locations for care facilities. To reduce certain mistakes, I think we should prepare well now. (Participant M)

4. Discussion

This study was conducted to understand the meanings and essence of the experiences of nurses who cared for COVID-19 patients, using a descriptive phenomenological method. As a result of this study, 5 theme clusters and 12 themes were extracted.

The first theme cluster indicated that the nurses struggled under the weight of dealing with infectious diseases. Participants expressed anxiety and fear in the absence of a definitive treatment for COVID-19. This is similar to the results of previous studies that reported that the lack of information and knowledge about unfamiliar diseases leads to ambiguity in nursing services, resulting in nurses feeling fearful and anxious [ 33 ]. The anxiety and fear accompanying patient care may be the result of rushing to the battlefield without any preparation [ 19 ]. In addition, participants appeared to have persistent fears of unintentional exposure and of transmitting the virus to co-workers [ 34 ]. Nurses who performed shift work during COVID-19 had a significantly increased association between COVID-19-related work stressors and anxiety disorder [ 24 ]. These physiological and psychological conditions are reported to create high stress and further lead to post-traumatic stress [ 35 ]. Hence, nurses caring for COVID-19 patients require continuous evaluation and management to sustain their mental wellbeing.

In the COVID-19 pandemic, nurses are experiencing ethical anguish in the face of unique situations that they have never experienced before. In particular, watching patients pass away alone, in isolation, without the support and comfort of family members, causes unimaginable shock and anguish. Moral distress between patient dignity and infection control is a similar experience to nurses in other countries, reported in previous studies. Nurses are known to experience contradictory feelings [ 18 ] as they experience the pressure of having to coordinate their responsibilities for the prevention of COVID-19 infection, along with other moral responsibilities [ 16 ].

Therefore, we need to create an ethically supportive environment [ 36 ], not just alleviate the ethical distress experienced by nurses [ 37 ]. In addition, it is necessary to find ways to guarantee both infection control and dignified death; for instance, family members can wear protective clothing and safely participate in their relatives’ end-of-life processes. Other measures to ensure a dignified death include minimal post-mortem medical interference, and respect for and adherence to cultural customs [ 38 ].

The second theme cluster was participants’ aggravated caring difficulties. Participants in this study were uncomfortable with the heat and sweat caused by wearing sealed PPE. This seems to be a slightly different experience than the Italian nurses who raised some concerns about the lack of PPE, the inadequacy of PPE, and the lack of guidelines for proper use [ 15 ]. In Korea, where resources, such as PPE, were relatively abundant since the COVID-19 pandemic declaration, wearing PPE acted as a triple pain burden on the safety of all people rather than the problem of lack of equipment.

It is similar to a previous study, demonstrating that these devices make it difficult to communicate with patients and perform basic tasks [ 34 ]. The appropriate wearing of PPE has been reported to protect medical staff from burnout [ 39 ]. However, continuous wearing of PPE can cause tissue damage or skin reactions, and prolonged wearing of goggles has been found to increase discomfort and fatigue due to abrasive straps and visual distortion [ 38 ]. Therefore, compliance with the PPE-wearing guidelines should be monitored and shift work should be assigned, taking into account the maximum period during which nurses are allowed to wear protective equipment.

It has also been found that medical workload has been excessively delegated to nurses taking care of COVID-19 patients. Policies to minimize social contact with patients have burdened nurses with extra tasks, causing exhaustion [ 40 ]. The excessive increase in work burden is in line with the results of qualitative research on the experience of nurses in other countries. A study by Liu et al. [ 34 ], in the early days of the COVID-19 pandemic, reported that nurses had done a lot of work. Recent studies also reported that COVID-19 caused a lot of work for nurses [ 20 ], and the treatment characterized by many isolated patients increased the work of nurses exponentially [ 14 ]. Nurses are constantly aware of new knowledge and skills associated with evolving pandemics and viruses, and receive new training, in preparation for adapting to the situation and providing care for suspected or identified patients [ 20 ]. In addition, frequent changes of working locations and wards, changes in work schedules, and confusion over working guidelines, have made nurses’ lives uncertain.

The final theme of the challenge with difficult care was the confusing and uncertain working conditions, partly related to nursing staffing [ 14 ]. However, it was more difficult for the participants in this study to be able to predict their work schedule, rather than the shortage of nursing personnel. This may be due to the difficulty in predicting the hospitalization rates of infected patients and the problems caused by frequent and rapid relocation of nurses, depending on the number of hospitalized patients. In this study, the uncertainty in working conditions is consistent with the report by Liang et al. [ 20 ], that there was uncertainty among nurses about being transferred to the areas where the epidemic was most serious. Moreover, the ambiguity surrounding COVID-19 and whether patients have contracted it have been shown to increase nurses’ stress [ 33 ]. Even in such situations, thoroughly preparing for and predicting potential emergency situations, based on comprehensive data analysis, knowledge accumulation, and education, can reduce the uncertainty and anxiety surrounding infectious diseases.

The third theme cluster was double suffering from patient care. Despite continuing to monitor self-health to avoid infecting others, nurses contracted the virus or had to self-isolate due co-workers’ positive diagnoses. Sabetian et al. [ 41 ] found that 273 out of a total of 4854 cases contracted the virus while caring for COVID-19 patients, of which 51.3% were nurses. The fear of self-reliance approaching reality is a reflection of the situation at the time, when nurses were not allowed to return home after cohort isolation for two weeks as their colleagues were diagnosed with COVID-19 [ 19 ].

Notably, participants felt that they were subjected to dual perceptions, both as national heroes and as contagions. In Korea, the “Thank You Challenge” campaign encouraged expressing gratitude and respect to medical staff. The Korean people were deeply impressed by the situation of nurses and care protection, as they knew that they could not care for patients infected with COVID-19 without the sacrifice and compassionate mission of the nurses [ 42 ]. However, nurses have reported preferring forms of recognition and support other than hero worship [ 37 ], indicating that the campaign alone was insufficient in improving their morale. Participants also felt that their community members wanted to avoid them and considered them as dangerous contagions, threatening public safety. Previous studies reported that nurses were treated as viruses [ 19 ] or suffered from stigma [ 20 ], and conversely, were motivated to work harder through public support [ 19 ]. However, there are few research reports that nurses experience double suffering from patient care due to the coexistence of such contrasting perceptions. These experiences corroborate previous findings that disease uncertainty and social anxiety have caused nurses to be perceived as carriers and spreaders of the virus [ 33 ].

The fourth theme cluster was supporting caring. Participants endured their situations because quitting would have overburdened their colleagues. While participants found it awkward to work with nurses from different wards at the beginning of the COVID-19 pandemic, their relationships improved and became encouraging and supportive [ 19 ]. It is worth noting that, even in situations of extreme stress and emotional exhaustion, support from colleagues and teams can positively impact recovery [ 43 ]. In addition, this study found that support and appreciation from patients and families encouraged participants to endure their difficult situations [ 19 , 35 ]. In previous studies, negative emotions, such as fatigue, helplessness, and fear of infections, prevailed in the early stages of COVID-19, but coping strategies were created with adaptation, support from others, and expressions of positive emotions [ 44 ]. International researchers reported that nurses dealt with and attempted to overcome their challenges and feelings and emotional responses by coping during the pandemic. Nurses in the United States [ 17 ] and India [ 45 ] used teamwork and peer support, and used personal coping strategies, such as relationship development, play, exercise, meditation, and distractions.

In the face of unknown diseases and unpredictable dangers, participants took responsibility and devoted themselves to their mission. Despite nurses and healthcare staff demonstrating professional devotion [ 33 , 34 ], a social atmosphere that demands sacrifice should be avoided to decrease their experiences of stress and fatigue.

The last theme cluster encompassed expectations for post-COVID-19 life. The participants had been doing their best to care for patients, while dreaming of returning to their regular lives, despite working in uncertain conditions. To instill a sense of normalcy in their lives, it is imperative to provide physical and mental health support to exhausted nurses. Even after the impact of COVID-19 has diminished, it is necessary to fully recognize the inherent stress and emotional burden experienced by nurses and support recovery with routine procedures and systems [ 44 ]. This aspect of the pandemic has been reported by Italian nurses to have obvious psychological trauma, which is quite similar to that reported in China [ 46 , 47 ]. As COVID-19 cases begin to decline, research into resilience, particularly post-traumatic stress syndrome in nursing staff, will be needed [ 48 ]. Although new epidemic outbreaks cannot be prevented, risk awareness can direct attention to emerging epidemics and promote capacity development toward disease management and control [ 19 , 49 ]. As seen from this study, experience alone did not prepare nursing staff to deal with novel disease outbreaks. Hence, specific protocols and standard operating procedures, targeting different disease risk scenarios, should be established to support nursing work, with ample resources.

Limitations of This Research

In this study, we applied a phenomenological approach to understanding nurses’ experiences of COVID-19 patient caring, and the participants were the nurses who involuntarily cared for COVID-19 patients. Accordingly, there is a limitation in that the nursing experience of the nurses who voluntarily participated in COVID-19 patient nursing could not be presented. We conducted online or face-to-face interviews, depending on the participants’ preferences, but the online interview had limitations, in that it did not fully grasp the vivid experiences contained in the non-verbal expressions of the participants and did not describe their experiences in more depth. Participants were in a vulnerable situation; not only were they at risk of infection, but were also responsible for covering the duty of their colleagues with confirmed COVID-19, and the work of other health care assistants because they were wearing PPE. Despite these limitations, it is significant that this study gained a deeper understanding of nurses’ experiences of caring for COVID-19 patients and came a little closer to the essence of nursing.

5. Conclusions

This study is significant as it explored and organized nurses’ experiences of caring for COVID-19 patients, using a descriptive phenomenological research method. The findings of this study are useful primary data for developing appropriate measures for health professionals’ wellbeing during outbreaks of infectious diseases.

A limitation of this study is that, because data were collected before the participants were vaccinated against COVID-19, negative emotional aspects, such as anxiety and fear about caring for patients, were drawn as the main results. In the future, it is necessary to balance this perspective by incorporating experiences of healthcare providers who have been vaccinated against COVID-19. In addition, as nurses in this study struggled with mental as well as physical difficulties, it is suggested that future studies develop and apply mental health recovery programs for them.

Author Contributions

H.-Y.J., J.-E.Y. and Y.-S.S. conceived and designed the study; H.-Y.J. acquired data; H.-Y.J. and Y.-S.S. analyzed the data; H.-Y.J. and J.-E.Y. wrote the first draft. All authors contributed to revisions of the manuscript and critical discussion. All authors have read and agreed to the published version of the manuscript.

This research received no external funding.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki, and approved by the Institutional Review Board of Hanyang University (HYUIRB-202009-009-1, 30 September 2021).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

Conflicts of interest.

The authors declare no conflict of interest.

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• Research article
• Open access
• Published: 14 June 2021

Nurses in the lead: a qualitative study on the development of distinct nursing roles in daily nursing practice

• Jannine van Schothorst–van Roekel 1 ,
• Anne Marie J.W.M. Weggelaar-Jansen 1 ,
• Carina C.G.J.M. Hilders 1 ,
• Antoinette A. De Bont 1 &
• Iris Wallenburg 1  

BMC Nursing volume  20 , Article number:  97 ( 2021 ) Cite this article

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Transitions in healthcare delivery, such as the rapidly growing numbers of older people and increasing social and healthcare needs, combined with nursing shortages has sparked renewed interest in differentiations in nursing staff and skill mix. Policy attempts to implement new competency frameworks and job profiles often fails for not serving existing nursing practices. This study is aimed to understand how licensed vocational nurses (VNs) and nurses with a Bachelor of Science degree (BNs) shape distinct nursing roles in daily practice.

A qualitative study was conducted in four wards (neurology, oncology, pneumatology and surgery) of a Dutch teaching hospital. Various ethnographic methods were used: shadowing nurses in daily practice (65h), observations and participation in relevant meetings (n=56), informal conversations (up to 15 h), 22 semi-structured interviews and member-checking with four focus groups (19 nurses in total). Data was analyzed using thematic analysis.

Hospital nurses developed new role distinctions in a series of small-change experiments, based on action and appraisal. Our findings show that: (1) this developmental approach incorporated the nurses’ invisible work; (2) nurses’ roles evolved through the accumulation of small changes that included embedding the new routines in organizational structures; (3) the experimental approach supported the professionalization of nurses, enabling them to translate national legislation into hospital policies and supporting the nurses’ (bottom-up) evolution of practices. The new roles required the special knowledge and skills of Bachelor-trained nurses to support healthcare quality improvement and connect the patients’ needs to organizational capacity.

Conclusions

Conducting small-change experiments, anchored by action and appraisal rather than by design , clarified the distinctions between vocational and Bachelor-trained nurses. The process stimulated personal leadership and boosted the responsibility nurses feel for their own development and the nursing profession in general. This study indicates that experimental nursing role development provides opportunities for nursing professionalization and gives nurses, managers and policymakers the opportunity of a ‘two-way-window’ in nursing role development, aligning policy initiatives with daily nursing practices.

Peer Review reports

The aging population and mounting social and healthcare needs are challenging both healthcare delivery and the financial sustainability of healthcare systems [ 1 , 2 ]. Nurses play an important role in facing these contemporary challenges [ 3 , 4 ]. However, nursing shortages increase the workload which, in turn, boosts resignation numbers of nurses [ 5 , 6 ]. Research shows that nurses resign because they feel undervalued and have insufficient control over their professional practice and organization [ 7 , 8 ]. This issue has sparked renewed interest in nursing role development [ 9 , 10 , 11 ]. A role can be defined by the activities assumed by one person, based on knowledge, modulated by professional norms, a legislative framework, the scope of practice and a social system [ 12 , 9 ].

New nursing roles usually arise through task specialization [ 13 , 14 ] and the development of advanced nursing roles [ 15 , 16 ]. Increasing attention is drawn to role distinction within nursing teams by differentiating the staff and skill mix to meet the challenges of nursing shortages, quality of care and low job satisfaction [ 17 , 18 ]. The staff and skill mix include the roles of enrolled nurses, registered nurses, and nurse assistants [ 19 , 20 ]. Studies on differentiation in staff and skill mix reveal that several countries struggle with the composition of nursing teams [ 21 , 22 , 23 ].

Role distinctions between licensed vocational-trained nurses (VNs) and Bachelor of Science-trained nurses (BNs) has been heavily debated since the introduction of the higher nurse education in the early 1970s, not only in the Netherlands [ 24 , 25 ] but also in Australia [ 26 , 27 ], Singapore [ 20 ] and the United States of America [ 28 , 29 ]. Current debates have focused on the difficulty of designing distinct nursing roles. For example, Gardner et al., revealed that registered nursing roles are not well defined and that job profiles focus on direct patient care [ 30 ]. Even when distinct nursing roles are described, there are no proper guidelines on how these roles should be differentiated and integrated into daily practice. Although the value of differentiating nursing roles has been recognized, it is still not clear how this should be done or how new nursing roles should be embedded in daily nursing practice. Furthermore, the consequences of these roles on nursing work has been insufficiently investigated [ 31 ].

This study reports on a study of nursing teams developing new roles in daily nursing hospital practice. In 2010, the Dutch Ministry of Health announced a law amendment (the Individual Health Care Professions Act) to formalize the distinction between VNs and BNs. The law amendment made a distinction in responsibilities regarding complexity of care, coordination of care, and quality improvement. Professional roles are usually developed top-down at policy level, through competency frameworks and job profiles that are subsequently implemented in nursing practice. In the Dutch case, a national expert committee made two distinct job profiles [ 32 ]. Instead of prescribing role implementation, however, healthcare organizations were granted the opportunity to develop these new nursing roles in practice, aiming for a more practice-based approach to reforming the nursing workforce. This study investigates a Dutch teaching hospital that used an experimental development process in which the nurses developed role distinctions by ‘doing and appraising’. This iterative process evolved in small changes [ 33 , 34 , 35 , 36 ], based on nurses’ thorough knowledge of professional practices [ 37 ] and leadership role [ 38 , 39 , 40 ].

According to Abbott, the constitution of a new role is a competitive action, as it always leads to negotiation of new openings for one profession and/or degradation of adjacent professions [ 41 ]. Additionally, role differentiation requires negotiation between different professionals, which always takes place in the background of historical professionalization processes and vested interests resulting in power-related issues [ 42 , 43 , 44 ]. Recent studies have described the differentiation of nursing roles to other professionals, such as nurse practitioners and nurse assistants, but have focused on evaluating shifts in nursing tasks and roles [ 31 ]. Limited research has been conducted on differentiating between the different roles of registered nurses and the involvement of nurses themselves in developing new nursing roles. An ethnographic study was conducted to shed light on the nurses’ work of seeking openings and negotiating roles and responsibilities and the consequences of role distinctions, against a background of historically shaped relationships and patterns.

The study aimed to understand the formulation of nursing role distinctions between different educational levels in a development process involving experimental action (doing) and appraisal.

We conducted an ethnographic case study. This design was commonly used in nursing studies in researching changing professional practices [ 45 , 46 ]. The researchers gained detailed insights into the nurses’ actions and into the finetuning of their new roles in daily practice, including the meanings, beliefs and values nurses give to their roles [ 47 , 48 ]. This study complied with the consolidated criteria for reporting qualitative research (COREQ) checklist.

Setting and participants

Our study took place in a purposefully selected Dutch teaching hospital (481 beds, 2,600 employees including 800 nurses). Historically, nurses in Dutch hospitals have vocational training. The introduction of higher nursing education in 1972 prompted debates about distinguishing between vocational-trained nurses (VNs) and bachelor-trained nurses (BNs). For a long time, VNs resisted a role distinction, arguing that their work experience rendered them equally capable to take care of patients and deal with complex needs. As a result, VNs and BNs carry out the same duties and bear equal responsibility. To experiment with role distinctions in daily practice, the hospital management and project team selected a convenience but representative sample of wards. Two general (neurology and surgery) and two specific care (oncology and pneumatology) wards were selected as they represent the different compositions of nursing educational levels (VN, BN and additional specialized training). The demographic profile for the nursing teams is shown in Table  1 . The project team, comprising nursing policy staff, coaches and HR staff ( N  = 7), supported the four (nursing) teams of the wards in their experimental development process (131 nurses; 32 % BNs and 68 % VNs, including seven senior nurses with an organizational role). We also studied the interactions between nurses and team managers ( N  = 4), and the CEO ( N  = 1) in the meetings.

Data collection

Data was collected between July 2017 and January 2019. A broad selection of respondents was made based on the different roles they performed. Respondents were personally approached by the first author, after close consultation with the team managers. Four qualitative research methods were used iteratively combining collection and analysis, as is common in ethnographic studies [ 45 ] (see Table  2 ).

Shadowing nurses (i.e. observations and questioning nurses about their work) on shift (65 h in total) was conducted to observe behavior in detail in the nurses’ organizational and social setting [ 49 , 50 ], both in existing practices and in the messy fragmented process of developing distinct nursing roles. The notes taken during shadowing were worked up in thick descriptions [ 46 ].

Observation and participation in four types of meetings. The first and second authors attended: (1) kick-off meetings for the nursing teams ( n  = 2); (2) bi-monthly meetings ( n  = 10) between BNs and the project team to share experiences and reflect on the challenges, successes and failures; and (3) project group meetings at which the nursing role developmental processes was discussed ( n  = 20). Additionally, the first author observed nurses in ward meetings discussing the nursing role distinctions in daily practice ( n  = 15). Minutes and detailed notes also produced thick descriptions [ 51 ]. This fieldwork provided a clear understanding of the experimental development process and how the respondents made sense of the challenges/problems, the chosen solutions and the changes to their work routines and organizational structures. During the fieldwork, informal conversations took place with nurses, nursing managers, project group members and the CEO (app. 15 h), which enabled us to reflect on the daily experiences and thus gain in-depth insights into practices and their meanings. The notes taken during the conversations were also written up in the thick description reports, shortly after, to ensure data validity [ 52 ]. These were completed with organizational documents, such as policy documents, activity plans, communication bulletins, formal minutes and in-house presentations.

Semi-structured interviews lasting 60–90 min were held by the first author with 22 respondents: the CEO ( n  = 1), middle managers ( n  = 4), VNs ( n  = 6), BNs ( n  = 9, including four senior nurses), paramedics ( n  = 2) using a predefined topic list based on the shadowing, observations and informal conversations findings. In the interviews, questions were asked about task distinctions, different stakeholder roles (i.e., nurses, managers, project group), experimental approach, and added value of the different roles and how they influence other roles. General open questions were asked, including: “How do you distinguish between tasks in daily practice?”. As the conversation proceeded, the researcher asked more specific questions about what role differentiation meant to the respondent and their opinions and feelings. For example: “what does differentiation mean for you as a professional?”, and “what does it mean for you daily work?”, and “what does role distinction mean for collaboration in your team?” The interviews were tape-recorded (with permission), transcribed verbatim and anonymized.

The fieldwork period ended with four focus groups held by the first author on each of the four nursing wards ( N  = 19 nurses in total: nine BNs, eight VNs, and two senior nurses). The groups discussed the findings, such as (nurses’ perceptions on) the emergence of role distinctions, the consequences of these role distinctions for nursing, experimenting as a strategy, the elements of a supportive environment and leadership. Questions were discussed like: “which distinctions are made between VN and BN roles?”, and “what does it mean for VNs, BNs and senior nurses?”. During these meetings, statements were also used to provoke opinions and discussion, e.g., “The role of the manager in developing distinct nursing roles is…”. With permission, all focus groups were audio recorded and the recordings were transcribed verbatim. The focus groups also served for member-checking and enriched data collection, together with the reflection meetings, in which the researchers reflected with the leader and a member of the project group members on program, progress, roles of actors and project outcomes. Finally, the researchers shared a report of the findings with all participants to check the credibility of the analysis.

Data analysis

Data collection and inductive thematic analysis took place iteratively [ 45 , 53 ]. The first author coded the data (i.e. observation reports, interview and focus group transcripts), basing the codes on the research question and theoretical notions on nursing role development and distinctions. In the next step, the research team discussed the codes until consensus was reached. Next, the first author did the thematic coding, based on actions and interactions in the nursing teams, the organizational consequences of their experimental development process, and relevant opinions that steered the development of nurse role distinctions (see Additional file ). Iteratively, the research team developed preliminary findings, which were fed back to the respondents to validate our analysis and deepen our insights [ 54 ]. After the analysis of the additional data gained in these validating discussions, codes were organized and re-organized until we had a coherent view.

Ethnography acknowledges the influence of the researcher, whose own (expert) knowledge, beliefs and values form part of the research process [ 48 ]. The first author was involved in the teams and meetings as an observer-as-participant, to gain in-depth insight, but remained research-oriented [ 55 ]. The focus was on the study of nursing actions, routines and accounts, asking questions to obtain insights into underlying assumptions, which the whole research group discussed to prevent ‘going native’ [ 56 , 57 ]. Rigor was further ensured by triangulating the various data resources (i.e. participants and research methods), purposefully gathered over time to secure consistency of findings and until saturation on a specific topic was reached [ 54 ]. The meetings in which the researchers shared the preliminary findings enabled nurses to make explicit their understanding of what works and why, how they perceived the nursing role distinctions and their views on experimental development processes.

Ethical considerations

All participants received verbal and written information, ensuring that they understood the study goals and role of the researcher [ 48 ]. Participants were informed about their voluntary participation and their right to end their contribution to the study. All gave informed consent. The study was performed in accordance with the Declaration of Helsinki and was approved by the Erasmus Medical Ethical Assessment Committee in Rotterdam (MEC-2019-0215), which also assessed the compliance with GDPR.

Our findings reveal how nurses gradually shaped new nursing role distinctions in an experimental process of action and appraisal and how the new BN nursing roles became embedded in new nursing routines, organizational routines and structures. Three empirical appeared from the systematic coding: (1) distinction based on complexity of care; (2) organizing hospital care; and (3) evidence-based practices (EBP) in quality improvement work.

Distinction based on complexity of care

Initially, nurses distinguished the VN and BN roles based on the complexity of patient care, as stated in national job profiles [ 32 ]. BNs were supposed to take care of clinically complex patients, rather than VNs, although both VNs and BNs had been equally taking care of every patient category. To distinguish between highly and less complex patient care, nurses developed a complexity measurement tool. This tool enabled classification of the predictability of care, patient’s degree of self-reliance, care intensity, technical nursing procedures and involvement of other disciplines. However, in practice, BNs questioned the validity of assessing a patient’s care complexity, because the assessments of different nurses often led to different outcomes. Furthermore, allocating complex patient care to BNs impacted negatively on the nurses’ job satisfaction, organizational routines and ultimately the quality of care. VNs experienced the shift of complex patient care to BNs as a diminution of their professional expertise. They continuously stressed their competencies and questioned the assigned levels of complexity, aiming to prevent losses to their professional tasks:

‘Now we’re only allowed to take care of COPD patients and people with pneumonia, so no more young boys with a pneumothorax drain. Suddenly we are not allowed to do that. (…) So, your [professional] world is getting smaller. We don’t like that at all. So, we said: We used to be competent, so why aren’t we anymore?’ (Interview VN1, in-service trained nurse).

In discussing complexity of care, both VNs and BNs (re)discovered the competencies VNs possess in providing complex daily care. BNs acknowledged the contestability of the distinction between VN and BN roles related to patient care complexity, as the next quote shows:

‘Complexity, they always make such a fuss about it. (…) At a given moment you’re an expert in just one certain area; try then to stand out on your ward. (…) When I go to GE [gastroenterology] I think how complex care is in here! (…) But it’s also the other way around, when I’m the expert and know what to expect after an angioplasty, or a bypass, or a laparoscopic cholecystectomy (…) When I’ve mastered it, then I no longer think it’s complex, because I know what to expect!’ (Interview BN1, 19-07-2017).

This quote illustrates how complexity was shaped through clinical experience. What complex care is , is influenced by the years of doing nursing work and hence is individual and remains invisible. It is not formally valued [ 58 ] because it is not included in the BN-VN competency model. This caused dissatisfaction and feelings of demotion among VNs. The distinction in complexities of care was also problematic for BNs. Following the complexity tool, recently graduated BNs were supposed to look after highly complex patients. However, they often felt insecure and needed the support of more experienced (VN) colleagues – which the VNs perceived as a recognition of their added value and evidence of the failure of the complexity tool to guide division of tasks. Also, mundane issues like holidays, sickness or pregnancy leave further complicated the use of the complexity tool as a way of allocating patients, as it decreased flexibility in taking over and swapping shifts, causing dissatisfaction with the work schedule and leading to problems in the continuity of care during evening, night and weekend shifts. Hence, the complexity tool disturbed the flexibility in organizing the ward and held possible consequences for the quality and safety of care (e.g. inexperienced BNs providing complex care), Ultimately, the complexity tool upset traditional teamwork, in which nurses more implicitly complemented each other’s competencies and ability to ‘get the work done’ [ 59 ]. As a result, role distinction based on ‘quantifiable’ complexity of care was abolished. Attention shifted to the development of an organizational and quality-enhancing role, seeking to highlight the added value of BNs – which we will elaborate on in the next section.

Organizing hospital care

Nurses increasingly fulfill a coordinating role in healthcare, making connections across occupational, departmental and organizational boundaries, and ‘mediating’ individual patient needs, which Allen describes as organizing work [ 49 ]. Attempting to make a valuable distinction between nursing roles, BNs adopted coordinating management tasks at the ward level, taking over this task from senior nurses and team managers. BNs sought to connect the coordinating management tasks with their clinical role and expertise. An example is bed management, which involves comparing a ward’s bed capacity with nursing staff capacity [ 1 , 60 ]. At first, BNs accompanied middle managers to the hospital bed review meeting to discuss and assess patient transfers. On the wards where this coordination task used to be assigned to senior nurses, the process of transferring this task to BNs was complicated. Senior nurses were reluctant to hand over coordinating tasks as this might undermine their position in the near future. Initially, BNs were hesitant to take over this task, but found a strategy to overcome their uncertainty. This is reflected in the next excerpt from fieldnotes:

Senior nurse: ‘First we have to figure out if it will work, don’t we? I mean, all three of us [middle manager, senior nurse, BN] can’t just turn up at the bed review meeting, can we? The BN has to know what to do first, otherwise she won’t be able to coordinate properly. We can’t just do it.’ BN: ‘I think we should keep things small, just start doing it, step by step. (…) If we don’t try it out, we don’t know if it works.’ (Field notes, 24-05-2018).

This excerpt shows that nurses gradually developed new roles as a series of matching tasks. Trying out and evaluating each step of development in the process overcame the uncertainty and discomfort all parties held [ 61 ]. Moreover, carrying out the new tasks made the role distinctions become apparent. The coordinating role in bed management, for instance, became increasingly embedded in the new BN nursing role. Experimenting with coordination allowed BNs prove their added value [ 62 ] and contributed to overall hospital performance as it combined daily working routines with their ability to manage bed occupancy, patient flow, staffing issues and workload. This was not an easy task. The next quote shows the complexity of creating room for this organizing role:

The BNs decide to let the VNs help coordinate the daily care, as some VNs want to do this task. One BN explains: ‘It’s very hard to say, you’re not allowed.’ The middle manager looks surprised and says that daily coordination is a chance to draw a clear distinction and further shape the role of BNs. The project group leader replies: ‘Being a BN means that you dare to make a difference [in distinctive roles]. We’re all newbies in this field, but we can use our shared knowledge. You can derive support from this task for your new role.’ (Field notes, 09-01-2018).

This excerpt reveals the BNs’ thinking on crafting their organizational role, turning down the VNs wishes to bear equal responsibility for coordinating tasks. Taking up this role touched on nurse identity as BNs had to overcome the delicate issue of equity [ 63 ], which has long been a core element of the Dutch nursing profession. Taking over an organization role caused discomfort among BNs, but at the same time provided legitimation for a role distinction.

Legitimation for this task was also gained from external sources, as the law amendment and the expert committee’s job descriptions both mentioned coordinating tasks. However, taking over coordinating tasks and having an organizing role in hospital care was not done as an ‘implementation’; rather it required a process of actively crafting and carving out this new role. We observed BNs choosing not to disclose that they were experimenting with taking over the coordinating tasks as they anticipated a lack of support from VNs:

BN: ‘We shouldn’t tell the VNs everything. We just need this time to give shape to our new role. And we all know who [of the colleagues] won’t agree with it. In my opinion, we’d be better off hinting at it at lunchtime, for example, to figure out what colleagues think about it. And then go on as usual.’ (Field notes, 12-06-2018).

BNs stayed ‘under the radar’, not talking explicitly about their fragile new role to protect the small coordination tasks they had already gained. By deliberately keeping the evaluation of their new task to themselves, they protected the transition they had set into motion. Thus, nurses collected small changes in their daily routines, developing a new role distinction step by step. Changes to single tasks accumulated in a new role distinction between BNs, VNs and senior nurses, and gave BNs a more hybrid nursing management role.

Evidence-based practices in quality improvement work

Quality improvement appeared to be another key concern in the development of the new BN role. Quality improvement work used to be carried out by groups of senior nurses, middle managers and quality advisory staff. Not involved in daily routines, the working group focused on nursing procedures (e.g. changing infusion system and wound treatment protocols). In taking on this new role BNs tried different ways of incorporating EBP in their routines, an aspect that had long been neglected in the Netherlands. As a first step, BNs rearranged the routines of the working group. For example, a team of BNs conducted a quality improvement investigation of a patient’s formal’s complaint:

Twenty-two patients registered a pain score of seven or higher and were still discharged. The question for BNs was: how and why did this bad care happen? The BNs used electronic patient record to study data on the relations between pain, medication and treatment. Their investigation concluded: nurses do not always follow the protocols for high pain scores. Their improvement plan covered standard medication policy, clinical lessons on pain management and revisions to the patient information folder. One BN said: ‘I really loved investigating this improvement.’ (Field notes, 28-05-2018).

This fieldnote shows the joy quality improvement work can bring. During interviews, nurses said that it had given them a better grip on the outcome of nursing work. BNs felt the need to enhance their quality improvement tasks with their EBP skills, e.g. using clinical reasoning in bedside teaching, formulating and answering research questions in clinical lessons and in multi-disciplinary patient rounds to render nursing work more evidence based. The BNs blended EBP-related education into shift handovers and ward meetings, to show VNs the value of doing EBP [ 64 ]. In doing so, they integrated and fostered an EBP infrastructure of care provision, reflecting a new sense of professionalism and responsibility for quality of care.

However, learning how to blend EPB quality work in daily routines – ‘learning in practice’ –requires attention and steering. Although the BNs had a Bachelor’s degree, they had no experience of a quality-enhancing role in hospital practice [ 65 ]. In our case, the interplay between team members’ previous education and experienced shortcomings in knowledge and skills uncovered the need for further EBP training. This training established the BNs’ role as quality improvers in daily work and at the same time supported the further professionalization of both BNs and VNs. Although introducing the EBP approach was initially restricted to the BNs, it was soon realized that VNs should be involved as well, as nursing is a collaborative endeavor [ 1 ], as one team member (the trainer) put it:

‘I think that collaboration between BNs and VNs would add lots of value, because both add something different to quality work. I’d suggest that BNs could introduce the process-oriented, theoretical scope, while VNs could maybe focus on the patients’ interest.’ (Fieldnote, informal conversation, 11-06-2018).

During reflection sessions on the ward level and in the project team meetings BNs, informed by their previous experience with the complexity tool, revealed that they found it a struggle to do justice to everyone’s competencies. They wanted to use everyone’s expertise to improve the quality of patient care. They were for VNs being involved in the quality work, e.g. in preparing a clinical lesson, conducting small surveys, asking VNs to pose EBP questions and encourage VNs to write down their thoughts on flip over charts as means of engaging all team members.

These findings show that applying EPB in quality improvement is a relational practice driven by mutual recognition of one another’s competencies. This relational practice blended the BNs’ theoretical competence in EBP [ 66 ] with the VNs’ practical approach to the improvement work they did together. As a result, the blend enhanced the quality of daily nursing work and thus improved the quality of patient care and the further professionalization of the whole nursing team.

This study aimed to understand how an experimental approach enables differently educated nurses to develop new, distinct professional roles. Our findings show that roles cannot be distinguished by complexity of care; VNs and BNs are both able to provide care to patients with complex healthcare needs based on their knowledge and experience. However, role distinctions can be made on organizing care and quality improvement. BNs have an important role organizing care, for example arranging the patient flow on and across wards at bed management meetings, while VNs contribute more to organizing at the individual patient level. BNs play a key role in starting and steering quality improvement work, especially blending EBP in with daily nursing tasks, while VNs are involved but not in the lead. Working together on quality improvement boosts nursing professionalization and team development.

Our findings also show that the role development process is greatly supported by a series of small-change experiments, based on action and appraisal. This experimental approach supported role development in three ways. First, it incorporates both formal tasks and the invisible, unconscious elements of nursing work [ 49 ]. Usually, invisible work gets no formal recognition, for example in policy documents [ 55 ], whereas it is crucial in daily routines and organizational structures [ 49 , 60 ]. Second, experimenting triggers an accumulation of small changes [ 33 , 35 ] leading to the embeddedness of role distinctions in new nursing routines, allowing nurses to influence the organization of care. This finding confirms the observations of Reay et al. that nurses can create small changes in daily activities to craft a new nursing role, based on their thorough knowledge of their own practice and that of the other involved professional groups [ 37 ]. Although these changes are accompanied by tension and uncertainty, the process of developing roles generates a certain joy. Third, experimenting stimulated nursing professionalization, enabling the nurses to translate national legislation into hospital policy and supporting the nurses’ own (bottom-up) evolution of practices. Historically, nursing professionalization is strongly influenced by gender and education level [ 43 ] resulting in a subordinate position, power inequity and lack of autonomy [ 44 ]. Giving nurses the lead in developing distinct roles enables them to ‘engage in acts of power’ and obtain more control over their work. Fourth, experimenting contributes to role definition and clarification. In line with Poitras et al. [ 12 ] we showed that identifying and differentiating daily nursing tasks led to the development of two distinct and complementary roles. We have also shown that the knowledge base of roles and tasks includes both previous and additional education, as well as nursing experience.

Our study contributes to the literature on the development of distinct nursing roles [ 9 , 10 , 11 ] by showing that delineating new roles in formal job descriptions is not enough. Evidence shows that this formal distinction led particularly to the non-recognition, non-use and degradation [ 41 ] of VN competencies and discomforted recently graduated BNs. The workplace-based experimental approach in the hospital includes negotiation between professionals, the adoption process of distinct roles and the way nurses handle formal policy boundaries stipulated by legislation, national job profiles, and hospital documents, leading to clear role distinctions. In addition to Hughes [ 42 ] and Abbott [ 67 ] who showed that the delineation of formal work boundaries does not fit the blurred professional practices or individual differences in the profession, we show how the experimental approach leads to the clarification and shape of distinct professional practices.

Thus, an important implication of our study is that the professionals concerned should be given a key role in creating change [ 37 , 39 , 40 ]. Adding to Mannix et al. [ 38 ], our study showed that BNs fulfill a leadership role, which allows them to build on their professional role and identity. Through the experiments, BNs and VNs filled the gap between what they had learned in formal education, and what they do in daily practice [ 64 , 65 ]. Experimenting integrates learning, appraising and doing much like going on ‘a journey with no fixed routes’ [ 34 , 68 ] and no fixed job description, resulting in the enlargement of their roles.

Our study suggests that role development should involve professionalization at different educational levels, highlighting and valuing specific roles rather than distinguishing higher and lower level skills and competencies. Further research is needed to investigate what experimenting can yield for nurses trained at different educational levels in the context of changing healthcare practices, and which interventions (e.g., in process planning, leadership, or ownership) are needed to keep the development of nursing roles moving ahead. Furthermore, more attention should be paid to how role distinction and role differentiation influence nurse capacity, quality of care (e.g., patient-centered care and patient satisfaction), and nurses’ job satisfaction.

Limitations

Our study was conducted on four wards of one teaching hospital in the Netherlands. This might limit the potential of generalizing our findings to other contexts. However, the ethnographic nature of our study gave us unique understanding and in-depth knowledge of nurses’ role development and distinctions, both of which have broader relevance. As always in ethnographic studies, the chances of ‘going native’ were apparent, and we tried to prevent this with ongoing reflection in the research team. Also, the interpretation of research findings within the Dutch context of nurse professionalization contributed to a more in-depth understanding of how nursing roles develop, as well as the importance of involving nurses themselves in the development of these roles to foster and support professional development.

We focused on role distinctions between VNs and BNs and paid less attention to (the collaboration with) other professionals or management. Further research is needed to investigate how nursing role development takes place in a broader professional and managerial constellation and what the consequences are on role development and healthcare delivery.

This paper described how nurses crafted and shaped new roles with an experimental process. It revealed the implications of developing a distinct VN role and the possibility to enhance the BN role in coordination tasks and in steering and supporting EBP quality improvement work. Embedding the new roles in daily practice occurred through an accumulation of small changes. Anchored by action and appraisal rather than by design , the changes fostered by experiments have led to a distinction between BNs and VNs in the Netherlands. Furthermore, experimenting with nursing role development has also fostered the professionalization of nurses, encouraging nurses to translate knowledge into practice, educating the team and stimulating collaborative quality improvement activities.

This paper addressed the enduring challenge of developing distinct nursing roles at both the vocational and Bachelor’s educational level. It shows the importance of experimental nursing role development as it provides opportunities for the professionalization of nurses at different educational levels, valuing specific roles and tasks rather than distinguishing between higher and lower levels of skills and competencies. Besides, nurses, managers and policymakers can embrace the opportunity of a ‘two-way window’ in (nursing) role development, whereby distinct roles are outlined in general at policy levels, and finetuned in daily practice in a process of small experiments to determine the best way to collaborate in diverse contexts.

Availability of data and materials

The data generated and analyzed during the current study is not publicly available to ensure data confidentiality but is available from the corresponding author on reasonable request and with the consent of the research participants.

Abbreviations

Bachelor-trained nurse

Vocational-trained nurse

Evidence-based Practices

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Jannine van Schothorst–van Roekel, Anne Marie J.W.M. Weggelaar-Jansen, Carina C.G.J.M. Hilders, Antoinette A. De Bont & Iris Wallenburg

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van Schothorst–van Roekel, J., Weggelaar-Jansen, A.M.J., Hilders, C.C. et al. Nurses in the lead: a qualitative study on the development of distinct nursing roles in daily nursing practice. BMC Nurs 20 , 97 (2021). https://doi.org/10.1186/s12912-021-00613-3

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100+ Hot Nursing Research Topics For a Successful Paper

By the end of this article, you’ll have some innovative evidence-based practice nursing research topics for students to use.

Introduction: Why Innovative Nursing Research is Important

Nursing research plays a crucial role in advancing healthcare by generating new knowledge and evidence-based practices that improve patient outcomes. Innovative nursing research is particularly important in addressing current healthcare challenges, such as the aging population, chronic disease management, healthcare disparities, and the COVID-19 pandemic. By conducting innovative nursing research, nurses can contribute to the development of new interventions, technologies, policies, and advocacy efforts that promote health and well-being for individuals, families, and communities.

The Benefits of Conducting Nursing Research

Conducting nursing research has numerous benefits for nurses, patients, and the healthcare system as a whole. Nursing research can improve patient outcomes by identifying effective interventions and best practices by advancing nursing knowledge and practice. Additionally, nursing research contributes to evidence-based healthcare by providing a scientific basis for clinical decision-making and policy development. Furthermore, nursing research can enhance the professional development of nurses by promoting critical thinking, problem-solving skills, and lifelong learning.

How to Choose the Right Research Topic for Nursing Students

Choosing the right nursing research topic is essential for conducting meaningful and impactful research. Nurses can identify gaps in current nursing knowledge by reviewing the literature and identifying areas where further research is needed. Additionally, nurses can consider current healthcare challenges and trends, such as the COVID-19 pandemic or healthcare disparities, when selecting a research topic. Finally, nurses should align their research topics with their personal expertise and experience to ensure that they are conducting feasible and relevant research.

What is a Nursing Research Paper?

A nursing research paper is a written document that presents the findings of a study or investigation conducted by nurses or other healthcare professionals. The purpose of writing a nursing research paper is to contribute to the body of knowledge in the field of nursing and to inform clinical practice. Nursing research papers can cover a wide range of topics, including patient care, healthcare systems, nursing education, and healthcare policy. They may use quantitative or qualitative research methods or a combination of both. The  structure of a nursing research paper  typically includes an introduction that outlines the research question or problem, a literature review that summarizes previous research on the topic, a methodology section that describes the study design and data collection methods, a results section that presents the findings of the study, and a discussion section that interprets the results and discusses their implications for nursing practice. Nursing research papers are important because they provide evidence-based information that can be used to improve patient care and healthcare outcomes. They also help to advance the field of nursing by identifying areas for further research and exploration. In a nutshell, nursing research papers are an essential component of evidence-based practice in nursing. They provide valuable insights into healthcare practices and contribute to the field’s ongoing development.

Here is a list of nursing research topics for healthcare students: 

20 Innovative Nursing Research Topics for Clinical Practice

• The Impact of nurse-led interventions on patient outcomes
• The Effectiveness of Telehealth in managing chronic conditions
• The Use of Simulation in nursing education
• The Role of Nursing in end-of-life care
• The Impact of nurse staffing on patient safety
• The Effectiveness of mindfulness-based Interventions in reducing stress and Burnout among Nurses
• The Use of technology in promoting mental health and wellness among nurses
• The Impact of electronic health records on nursing practice and patient outcomes
• The Use of artificial intelligence in nursing practice
• The Effectiveness of mobile health interventions in managing chronic conditions
• The Role of Nursing in Developing and implementing healthcare technology
• The Impact of Technology on nursing workforce development
• The Impact of nurse-led quality improvement initiatives on patient outcomes
• The Effectiveness of medication reconciliation in reducing adverse events
• The Role of Nursing in Preventing healthcare-associated Infections
• The Impact of Patient-centered Care on patient satisfaction and Outcomes
• The Use of Technology in improving patient safety
• The Impact of cultural competency training on nursing practice
• The Use of Interprofessional Education in nursing programs
• The Role of nursing education in addressing healthcare disparities

20 Innovative Nursing Research Topic Ideas for Patient Safety and Quality Improvement

• The Effectiveness of hand hygiene interventions in reducing hospital-acquired Infections
• The Role of interprofessional collaboration in promoting patient safety
• The Impact of nurse staffing ratios on patient safety
• The Effectiveness of fall prevention interventions among older adults
• The Use of Checklists to improve surgical safety
• The Role of communication strategies in preventing medical errors
• The Impact of rapid response teams on patient outcomes
• The Effectiveness of discharge planning interventions on readmission rates
• The Role of family engagement in promoting patient safety
• The Use of root cause analysis to identify system failures that contribute to adverse events
• The Impact of clinical decision support systems on medication safety
• The Effectiveness of sepsis management protocols on patient outcomes
• The Role of standardized protocols in reducing catheter-associated urinary tract infections
• The Use of electronic prescribing systems to reduce medication errors
• The Impact of teamwork training on communication and collaboration among healthcare providers

20 Innovative Nursing Research Topic Ideas for Education and Training

• The Effectiveness of online nursing education programs
• The Impact of Mentorship on nursing career development
• The Effectiveness of simulation-based training for clinical skills development
• The Use of Gamification in nursing education
• The Impact of Peer-to-peer Learning on student engagement and learning outcomes
• The Role of reflective practice in promoting professional development among Nurses
• The Effectiveness of team-based learning in nursing education
• The Use of virtual reality in nursing education
• The Impact of flipped classroom models on student learning outcomes
• The Role of experiential learning in promoting clinical reasoning skills among Nurses
• The Effectiveness of standardized patient simulations in nursing education
• The Use of case-based learning in nursing education
• The Impact of intercultural communication training on nurse-patient interactions
• The Role of leadership development programs in promoting nurse leadership skills
• The Effectiveness of peer coaching programs for new graduate nurses
• The Use of e-portfolios for professional development among nurses
• The Impact of Continuing Education on nurse competency and job satisfaction

20 Innovative Nursing Research Topics for Patient Safety and Quality Improvement

20 innovative nursing research paper topics for healthcare policy and advocacy.

• The Impact of healthcare policy on nursing practice and patient outcomes
• The Role of Nursing in healthcare reform
• The Impact of nurse-led advocacy on Healthcare Policy
• The Use of nursing research shaping healthcare policy
• The Impact of healthcare policy on nursing workforce development
• The Effectiveness of community health worker programs in reducing health disparities
• The role social determinants of health play in health outcomes
• The Impact of Medicaid expansion access care vulnerable populations
• The Effectiveness of school-based health clinics improving access care children adolescents
• The Role of public health campaigns promoting healthy behaviors among Populations at Risk of chronic disease
• The Impact of state-level policies regulating nurse staffing Ratios patient outcomes
• The Use of telehealth expands access to care in rural communities
• The Role primary care providers play in addressing the mental health needs of underserved populations
• The Impact Affordable Care Act Access preventive Services to underserved populations
• The Effectiveness of community-based participatory research addressing health disparities among marginalized populations
• The role public-private partnerships play in improving population health outcomes
• The Impact of state-level policies regulating scope practice advanced practice registered nurses access Care rural communities.
• The Use of mobile clinics expands access to care for homeless populations
• The role community paramedicine programs play in improving access to care in rural communities
• The Impact of global health policies promoting equitable access to care for vulnerable populations

20 Innovative Mental Health Nursing Research Paper Topics

• The Impact of nurse-led interventions mental health outcomes
• Effectiveness of mindfulness-based interventions reducing stress burnout among Nurses
• Role nursing addressing mental health disparities
• Impact workplace culture nurse mental health wellness
• Use technology to promote mental health wellness among nurses
• Effectiveness of cognitive-behavioral Therapy reducing anxiety depression among patients
• Role family support promoting mental health recovery among patients
• Impact peer support groups’ mental health recovery
• Use art therapy to promote mental health wellness among patients
• Effectiveness of exercise interventions reducing symptoms of depression and anxiety among patients
• Role spirituality promoting mental health wellness among patients
• Impact social support networks mental health recovery
• Use animal-assisted therapy to promote mental health wellness among patients
• Effectiveness of group therapy reducing symptoms of PTSD among veterans
• Role trauma-informed care promoting mental health recovery
• Impact of workplace stressors on nurse mental health wellness
• Use self-care strategies promoting nurse mental health wellness
• Effectiveness psychoeducation reducing stigma surrounding mental illness
• Role community-based mental health services addressing unmet needs of vulnerable populations
• Impact policy changes improving access to mental health services

20 Innovative Nursing Research Topics for Technology and Innovation

• Impact Electronic health records nursing practice patient outcomes
• Use artificial intelligence nursing practice
• Effectiveness of mobile health interventions managing chronic conditions
• Role nursing developing implementing healthcare technology
• Impact technology nursing workforce development
• Effectiveness of telemedicine improving access to care rural communities
• Use wearable technology monitoring vital signs in patients’ home settings
• Impact social media promoting healthy behaviors among populations at risk of chronic disease
• Role virtual reality pain management interventions
• Impact big data analytics improving population health outcomes
• Use robotics to assist with activities daily living older adults
• Effectiveness gamification promoting healthy behaviors
• Role telemonitoring improving medication adherence
• Impact blockchain technology improving supply chain management medical products
• Use machine learning to predict adverse events
• Effectiveness of chatbots providing emotional support patients
• Role telepsychiatry expanding access psychiatric services
• Impact 3D printing producing customized medical devices
• Use augmented reality enhancing surgical training
• Effectiveness of personalized medicine improving treatment outcomes

Conclusion: Inspiring the Next Generation Of Nursing Researchers

Innovative Nursing research is essential for advancing healthcare by generating new knowledge, evidence-based practices, technologies, policies, and advocacy efforts that promote health and well-being for individuals, families, and communities worldwide. As such, it is crucial to encourage and support the next generation Of Nursing Researchers to drive innovation In Nursing Practice And Healthcare. 

By providing opportunities for mentorship, funding, networking, And Professional Development Programs That Foster Critical Thinking And Problem-Solving Skills Among Nurses. We can inspire future generations Of Nurses To Conduct Meaningful And Impactful Research That Addresses Current Healthcare Challenges And Improves Patient Outcomes For Years To Come!

• Qualitative vs Quantitative Research Methods

Commonly Asked Questions About Nursing Research Topics

What is a nursing research topic.

A nursing paper research topic refers to a specific area of study within the nursing field that requires investigation and analysis. It focuses on exploring and addressing various aspects of nursing, such as patient care, healthcare practices, or nursing education.

How can I choose the best nursing research topic?

When selecting a nursing research topic, you can start by identifying your areas of interest within the nursing field. Consider current healthcare issues, gaps in knowledge or practice, and the topic’s relevance to your nursing career goals. Consulting with your professors or experienced nurses can also provide valuable insights.

What are some exciting nursing research topics?

Some interesting nursing research topics include examining the Impact of technology on patient care, exploring cultural competency in nursing practice, investigating the Effectiveness of alternative therapies in pain management, or studying the long-term effects of shift work on nurses’ well-being.

How can I develop a strong nursing research question for my nursing research paper?

A robust research question in nursing should be clear, specific, and relevant to your research topic. It should also be answerable through empirical research. Consider using the PICO(T) framework, which stands for Population, Intervention, Comparison, Outcome, and Time, to help structure your research question.

Where can I find research topics in nursing?

You can find research topics in nursing by exploring academic journals, attending nursing conferences, or accessing online databases specializing in nursing research. Additionally, discussing potential research ideas with your professors, colleagues, or nursing mentors can help you discover new and relevant topics.

What are some popular nursing research topics in the healthcare field?

Popular nursing research topics in the healthcare field include studying evidence-based practices in patient care, examining the Role of nurses in primary healthcare settings, investigating the Impact of nurse-patient ratios on quality of care, or exploring the Effectiveness of nursing interventions in preventing healthcare-associated infections.

What is the difference between qualitative and quantitative nursing research?

Qualitative nursing research involves exploring phenomena, perceptions, or experiences through methods such as interviews, observations, or focus groups. On the other hand, quantitative nursing research focuses on numerical data and uses statistical analysis to draw research conclusions . Both approaches offer unique insights and can complement each other in research studies.

Can you give examples of quantitative nursing research topics?

Examples of quantitative research topics in nursing can include “The Impact of Nurse-to-Patient Ratio on Fall Rates in Hospital Settings,” “The Effectiveness of a Diabetes Self-Management Program in Controlling Blood Sugar Levels,” or “Evaluating the Relationship Between Nurse Communication Skills and Patient Satisfaction.”

What is the importance of nursing research topics?

Nursing research topics are important as they contribute to the body of knowledge in the nursing profession. They help identify effective healthcare practices, improve patient outcomes, influence nursing education, provide evidence for policy-making, and enhance the overall quality of nursing care.

How to Write a Nursing Research Paper: A Comprehensive Guide

Nursing research is essential for the development of evidence-based practices that improve patient care and health outcomes. It enables nurses to provide high-quality care grounded in scientific evidence, contributing to the advancement of the nursing profession. Research findings can lead to better patient care protocols, enhanced healthcare policies, and innovative treatments. The purpose of this article is to provide a detailed guide for nursing students and professionals on how to write a nursing research paper . By following this guide, you will understand each step of the research process, from selecting a topic to presenting your findings.

Understanding Nursing Research

Definition and types of nursing research.

Nursing research involves systematic investigation to develop knowledge about health, healthcare, and nursing practice. It includes various types such as qualitative, quantitative, and mixed-methods research. Qualitative research explores phenomena through detailed observation and interviews, while quantitative research involves numerical data and statistical analysis. Mixed-methods research combines both approaches.

Significance in the Nursing Field

Nursing research is significant because it provides the foundation for evidence-based practice. It helps nurses understand patient needs , improve care delivery, and address healthcare challenges. Research also informs policy decisions and contributes to the professional development of nurses by enhancing critical thinking and analytical skills.

Common Research Methods in Nursing

Common research methods in nursing include surveys, experiments, observational studies, and case studies. Surveys gather data from large groups of people, experiments test hypotheses in controlled environments, observational studies explore behaviors and outcomes in natural settings, and case studies provide in-depth analysis of individual or group experiences.

Choosing a Research Topic

Identifying areas of interest.

Begin by identifying areas within nursing that spark your curiosity or passion. Consider your clinical experiences, coursework, and current healthcare issues. Reflect on what aspects of nursing you find most intriguing or where you believe there is a need for more research.

Reviewing Current Literature

Conduct a preliminary review of existing literature to understand what research has already been done in your area of interest. This will help you identify gaps in knowledge and avoid duplicating previous studies. Use databases like PubMed, CINAHL, and Google Scholar to find relevant articles and journals.

Narrowing Down the Topic

After reviewing the literature, narrow down your topic to a specific research question or hypothesis. Ensure your topic is manageable within the scope of your research capabilities, resources, and time constraints. A focused topic will make your research more effective and easier to conduct.

Formulating Research Questions or Hypotheses

Formulate clear and concise research questions or hypotheses. These should guide your study and provide a framework for your research design. For example, a research question might be, “What is the impact of nurse-led patient education on medication adherence in diabetic patients?”

Conducting a Literature Review

Purpose of the literature review.

The literature review serves several purposes: it provides context for your research, identifies gaps in existing knowledge, and demonstrates your understanding of the topic. It helps to justify your research by showing the need for further investigation.

Searching for Relevant Literature

Search for literature using academic databases, journals, and other credible sources. Use keywords related to your research topic to find relevant studies. Review abstracts and titles to quickly determine the relevance of each source before delving into full-text articles.

Evaluating Sources

Evaluate the quality and credibility of your sources. Consider the publication date, the reputation of the journal, the qualifications of the authors, and the methodology used in the studies. Prioritize recent and peer-reviewed articles to ensure your literature review is current and reliable.

Organizing the Review

Organize your literature review by grouping studies with similar themes, methodologies , or findings. Use headings and subheadings to structure your review logically. Summarize each study and highlight its relevance to your research question.

Identifying Gaps in the Literature

Identify gaps in the literature where further research is needed. These gaps can provide a rationale for your study and help you refine your research questions. Highlighting these gaps will also demonstrate the originality and necessity of your research.

Designing the Research Study

Selecting an appropriate research design.

Choose a research design that best suits your research question and objectives. Common designs in nursing research include descriptive, correlational, experimental, and quasi-experimental designs. Your choice will depend on the nature of your research question and the type of data you plan to collect.

Sampling Methods and Considerations

Decide on a sampling method to select participants for your study. Common sampling methods include random sampling, convenience sampling, and purposive sampling. Consider factors such as sample size, representativeness, and ethical considerations when selecting your sample.

Data Collection Methods

Quantitative methods.

Quantitative methods involve the collection of numerical data. This can include surveys, questionnaires, and structured observations. Ensure your data collection tools are valid and reliable to produce accurate results.

Qualitative Methods

Qualitative methods involve collecting non-numerical data, such as interviews, focus groups, and open-ended surveys. These methods allow for a deeper understanding of participants’ experiences and perspectives.

Ethical Considerations in Nursing Research

Ethical considerations are crucial in nursing research. Obtain informed consent from participants, ensure confidentiality, and minimize any potential harm. Follow guidelines set by institutional review boards (IRBs) and professional organizations to maintain ethical standards.

Writing the Research Proposal

Structuring the proposal.

Your research proposal should be well-structured and include the following sections:

Introduction

The introduction should provide background information on your research topic, state the research problem, and explain the significance of the study. Clearly outline your research questions or hypotheses.

Literature Review

Summarize the key findings from your literature review , highlighting the gaps your research aims to fill. Discuss the theoretical framework or models that underpin your study.

Methodology

Detail your research design, sampling methods, data collection procedures, and data analysis plan. Justify your choices and explain how they align with your research questions.

Detailing the Methodology

Study design.

Describe the overall design of your study, including whether it is qualitative, quantitative, or mixed-methods. Explain why this design is appropriate for your research question.

Provide details about your sampling strategy, including the criteria for selecting participants, the sample size, and any potential biases. Describe how you will recruit and obtain consent from participants.

Data Collection Procedures

Outline the procedures for collecting data, including the tools and techniques you will use. Specify the timeline for data collection and any logistical considerations.

Budget and Timeline

Prepare a budget that outlines the costs associated with your research, such as materials, travel, and participant incentives. Create a timeline that includes key milestones and deadlines for each stage of the research process.

Addressing Potential Challenges

Identify potential challenges and limitations of your study. Discuss how you will address these challenges and mitigate any risks to the success of your research.

Conducting the Research

Data collection process.

Implement your data collection plan according to the methods and procedures outlined in your proposal. Ensure that all data is collected systematically and ethically.

Ensuring Data Quality and Integrity

Maintain the quality and integrity of your data by following standardized procedures, double-checking data entries, and keeping detailed records. Address any discrepancies or issues promptly.

Managing Research Logistics

Manage the logistics of your research, including scheduling, communication with participants, and data storage. Stay organized and adhere to your timeline to keep the research process on track.

Analyzing the Data

Data preparation and cleaning.

Prepare your data for analysis by organizing and cleaning it. This may involve coding qualitative data, checking for missing values, and ensuring consistency in your data set.

Choosing Appropriate Analysis Methods

Select analysis methods that align with your research design and questions. For quantitative data, this may include statistical tests such as t-tests, ANOVAs, or regression analysis . For qualitative data, consider thematic analysis or content analysis.

Interpreting the Results

Interpret your results in the context of your research questions and hypotheses. Discuss whether your findings support or refute your hypotheses and how they contribute to the existing body of knowledge.

Utilizing Statistical Software

Use statistical software, such as SPSS , SAS, or NVivo, to assist with data analysis. These tools can help you manage and analyze large data sets efficiently and accurately.

Writing the Research Paper

Structuring the paper, title and abstract.

Create a clear and concise title that reflects the main focus of your research. Write an abstract that summarizes the purpose, methods, results, and conclusions of your study.

The introduction should provide background information, state the research problem, and outline the significance of the study. Clearly articulate your research questions or hypotheses.

Describe the research design , sampling methods, data collection procedures, and analysis techniques used in your study.

Present your findings in a clear and logical manner. Use tables, graphs, and charts to illustrate key results. Avoid interpreting the results in this section.

Interpret your findings in the context of your research questions and the existing literature. Discuss the implications of your results, any limitations of your study, and suggestions for future research .

Summarize the main findings of your study and their significance. Highlight the contributions of your research to the nursing field and suggest areas for further investigation.

Ensuring Clarity and Cohesion

Ensure that your paper is clear, cohesive, and logically organized. Use headings and subheadings to guide the reader through each section. Write in a concise and professional manner, avoiding jargon and complex language.

Referencing and Citation Styles

Use appropriate referencing and citation styles, such as APA , MLA, or Chicago, as required by your institution or publisher. Cite all sources accurately to give credit to original authors and avoid plagiarism.

Proofreading and Editing

Thoroughly proofread and edit your paper to eliminate errors and improve clarity. Consider seeking feedback from peers or mentors to ensure your paper is polished and professional.

Example of a Research Proposal

The impact of nurse-led patient education on medication adherence in diabetic patients.

Diabetes is a chronic condition that requires continuous management to prevent complications. Medication adherence is critical for effective diabetes management, yet many patients struggle to consistently take their prescribed medications. Poor adherence can lead to adverse health outcomes, increased hospitalizations, and higher healthcare costs.

Problem Statement

Despite the known importance of medication adherence, a significant number of diabetic patients fail to adhere to their medication regimen. This research aims to investigate the impact of nurse-led patient education on improving medication adherence in diabetic patients.

Significance of the Study

This study will provide insights into the effectiveness of nurse-led education programs in promoting better health outcomes for diabetic patients. The findings could inform healthcare practices and policies, leading to improved patient care and reduced healthcare costs.

Research Questions

• What is the current level of medication adherence among diabetic patients?
• Does nurse-led patient education significantly improve medication adherence in diabetic patients compared to standard care?
• What factors influence the effectiveness of nurse-led education on medication adherence ?

The literature review will summarize existing research on medication adherence in diabetic patients and the role of nurse-led education programs.

Current State of Medication Adherence

Studies have shown that medication adherence rates among diabetic patients are suboptimal, with many patients missing doses or not following prescribed regimens.

Nurse-Led Education Programs

Nurse-led education programs have been implemented in various healthcare settings to improve patient knowledge, self-management skills, and adherence to treatment plans. These programs often include personalized education sessions, follow-up support, and motivational interviewing.

Gaps in the Literature

While previous studies have explored the general impact of education on medication adherence, there is limited research specifically focused on nurse-led education programs for diabetic patients. Additionally, factors influencing the success of these programs need further investigation.

This study will employ a quasi-experimental design with a control group and an intervention group. The intervention group will receive nurse-led education, while the control group will receive standard care .

Participants

Participants will be recruited from a primary care clinic. The sample will include 100 diabetic patients aged 18 and older who are currently prescribed medication for diabetes management.

Sampling Method

Convenience sampling will be used to select participants who meet the inclusion criteria.

Intervention

The nurse-led education program will consist of five weekly sessions covering topics such as medication management, lifestyle modifications , and the importance of adherence. Each session will be tailored to individual patient needs.

The control group will receive standard care, which includes routine consultations and printed educational materials.

Data Collection Tools

Medication adherence measurement.

Medication adherence will be measured using the Morisky Medication Adherence Scale (MMAS-8), a validated self-report questionnaire.

Demographic and Clinical Data

Demographic information (age, gender, education level) and clinical data (HbA1c levels, duration of diabetes) will be collected from medical records .

Data Analysis

Statistical methods.

Descriptive statistics will summarize participant characteristics. Independent t-tests and chi-square tests will compare medication adherence between the intervention and control groups. Multiple regression analysis will identify factors influencing adherence.

Statistical analysis will be performed using SPSS software.

Ethical Considerations

Informed consent.

Informed consent will be obtained from all participants. They will be informed about the study’s purpose, procedures, risks, and benefits.

Confidentiality

Participant confidentiality will be maintained by assigning unique identifiers and storing data securely.

• Personnel: $5,000 (Nurse educator salary)
• Educational Materials: $500
• Data Collection Tools: $300
• Statistical Software: $200
• Miscellaneous: $500
• Total: $6,500
• Literature Review: 1 month
• Participant Recruitment: 2 months
• Intervention: 2 months
• Data Collection: 3 months
• Data Analysis: 1 month
• Report Writing: 2 months

Potential challenges include participant dropout, variability in patient engagement, and time constraints for both patients and researchers.

Mitigation Strategies

To address these challenges, we will:

• Implement reminder calls and follow-ups to reduce dropout rates.
• Tailor education sessions to be flexible and accommodating to patient schedules.
• Allocate sufficient time for each stage of the research process to manage time constraints effectively.

This research proposal outlines a study designed to evaluate the impact of nurse-led patient education on medication adherence in diabetic patients. By addressing a critical gap in the literature, this study aims to contribute valuable insights into nursing practice and patient care. The findings have the potential to improve health outcomes for diabetic patients and inform future educational interventions in the nursing field.

Writing a nursing research paper involves several critical steps, including choosing a topic, conducting a literature review, designing the study, writing the proposal, conducting the research, analyzing data, and writing the final paper. Each step requires careful planning and attention to detail. Engage in nursing research to contribute to the advancement of healthcare and improve patient outcomes . Your efforts can lead to meaningful discoveries and innovations in nursing practice.

Embark on your research journey with confidence, knowing that your work has the potential to make a significant impact. For professional assistance with academic writing, consider our expert writing services to help you achieve your research goals.

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