colleagues in caring project in Connecticut, The

Connecticut Nursing News, Jun-Aug 1998 by Witt, Barbara

Funded by the Robert Wood Johnson Foundation, the Connecticut Colleagues in Caring (CIC) project has as its purpose, the development of a method for predicting the ability of the nursing work force to meet the future healthcare needs of the citizens of the state. We have always been subject to periods of shortage and surplus in nursing without having any control over.what type or number of nurses we need to educate. The CIC grant brings together all the interested parties to figure out what data we have and what data we need to obtain to get better control of the swings in the nursing workforce by making recommendations concerning the number and level of preparation of nurses we need to meet the future health care needs of Connecticut's citizens.

A steering committee has been meeting since September of 1996 to brainstorm how to accomplish this task. Various task forces have been formed to collect information from schools of nursing, faculty, employers of nurses, and experts in health care and to predict, based on information available, what the future healthcare delivery system might look like. In addition to the above information, the steering committee also wanted to know what is the value added that nursing brings to the health care system? What is it that nursing contributes to health care that is unique to nursing? How we went about collecting this piece of the information is the subject of this article. Both the process and the outcome of the process are of interest as there are several attractive features to what we did.

The approach we took to answering the question "What is unique about nursing?" was the focus group. A focus group is a small group of people familiar with the topic under investigation. The group is asked a few selected, open ended questions about the issue of interest and their answers are recorded. The recording is transcribed and then analyzed. Comparisons are then made across all of the groups to identify the commonalties and differences. In order to be sure we were getting responses from a representative and cross sectional group of nurses, we designed the study with 20 different focus groups from varying settings. Each group was homogeneously composed of nurses with similar job descriptions. For example, one group was staff nurses from long term care while another was made up of staff nurses from acute care.

How we went about organizing and running this project was the special and unique process I would like to share with you. Because one of the aims of the Colleagues in Caring project is to involve as many people as possible in the work, we decided to ask the graduate schools of nursing to cooperate with us by recruiting students and faculty to participate in collecting and analyzing the data. In order to make this a learning experience for the students, we designed a series of three meetings to provide them with a well rounded experience in qualitative research. At the first meeting, there were 20 graduate students from five graduate programs-Fairfield University, St. Joseph College, Southern Connecticut State University, University of Hartford, and Yale University.

During the first meeting of the students, we oriented them to the project, and gave them an experiential introduction to participating in a focus group. Following the processing of the group experience, written instructions were distributed, and questions were answered. Students were paired to support each other and provided with all the materials they needed-audio tapes, copies of the questions, consent forms, etc. All focus groups were set up by the CIC project staff so the students only had to show up at the appropriate time and place to actually run the group. When they completed their group, they mailed the tapes directly to the transcriptionist who then mailed the completed transcript the the project directors.

At the second meeting of the graduate students, we reviewed the experience of conducting the focus groups and what they had learned from the experience. They wrote that they were impressed by how useful a tool listening is and how powerful the group process is. One consistent comment from the nurses in the focus groups was how empowering it was to talk about the good things in nursing instead of only talking about the problems. Many nurses stated that no one had ever asked them to explain the positives in nursing. The project directors then gave some instructions and demonstrated how to make a "first cut" at locating the descriptors in the transcripts, and had the students practice the skill. They were asked to identify the descriptors, to make process comments about the group, to identify differences of opinion, and to highlight notable quotes. At this meeting, there were faculty, from the students' schools, who worked with the students on the analysis. When the students left with their transcripts, both they and their faculty advisor understood how to carry out the first level of analysis. Within a few weeks, the analyzed transcripts were mailed back to the project directors.