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Berthelsen, C., Martinsen, B., & Vamosi, M. (2020). The positive impact over time of Master’s level education on nurses’ utilization of nursing research-related tasks in clinical practice – A longitudinal cohort study. Journal of Nursing Education and Practice, 10(4), 1- 10. https://doi.org/10.5430/jnep.v10n4p1  

Publication metadata   Title: The positive impact over time of Master’s level education on nurses’

utilization of nursing research-related tasks in clinical practice – A longitudinal cohort study

Author(s): Berthelsen, C., Martinsen, B. & Vamosi, M. Journal: Journal of Nursing Education and Practice DOI/Link: https://doi.org/10.5430/jnep.v10n4p1 Document version: Document license:

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ORIGINAL RESEARCH

The positive impact over time of Master’s level education on nurses’ utilization of nursing research-related tasks in clinical practice – A longitudinal cohort study

Connie Berthelsen∗, Bente Martinsen, Marianne Vamosi

Research Unit of Nursing and Healthcare, Institute of Health, Nursing, Aarhus University, Denmark

Received: November 7, 2019 Accepted: November 27, 2019 Online Published: December 10, 2019 DOI: 10.5430/jnep.v10n4p1 URL: https://doi.org/10.5430/jnep.v10n4p1

ABSTRACT

Objective: To describe and compare the development of Master of Science in Nursing graduates’ utilization and improvement of nursing research-related tasks and knowledge in daily clinical practice, six months and twelve months after graduation. Methods: A longitudinal cohort study of 65 Master of Science in Nursing (MSN) graduates from a Danish university was conducted from 2016 to 2017. Data were collected six and twelve months after graduation using a purposive-constructed questionnaire based on four validated questionnaires. Data were analyzed using descriptive statistics and STATA software (12.0). Results: The overall results of the longitudinal cohort study showed a positive impact 12 months after graduation on the MSN graduates’ development and improvement of their utilization of nursing research-related tasks and knowledge in clinical practice. The results also showed a development in the MSN graduates’ employment in academic positions, as well as an increase in the number of hours per week spent on nursing research-related tasks. Conclusions: Providing nurses with Master’s level knowledge and skills can make a difference for them in clinical practice. However, knowledge is still needed on how the MSN qualification can have an impact on patient care: Future research must focus on practical observations of how the Msn graduates use their academic knowledge and skills to improve patient care, using specific outcomes and observable criteria.

Key Words: Clinical practice, Longitudinal study, Master of Science in Nursing, Nurses, Research collaboration, Research utilization

1. INTRODUCTION

The healthcare system is continuously increasing its demands for evidence-based practice to improve patient care.[1] Nu- merous studies show that research-based knowledge is infre- quently used in clinical practice,[2–4] which may have unde- sirable consequences for patient care and treatment.[5, 6] The reasons for the lack of research-based knowledge in clinical

practice is due to several barriers to research utilization, such as lack of time,[7, 8] lack of academic role models,[3] lack of support from the organization,[1, 9] and lack of support from colleagues.[10] Studies also show how lack of knowl- edge is a considerable barrier to registered nurses working in basic hospital positions.[10, 11] In order to improve and en- hance knowledge about research, as well as research-based

∗Correspondence: Connie Berthelsen; Email: [email protected]; Address: Research Unit of Nursing and Healthcare, Institute of Health, Nursing, Aarhus University, Campus Emdrup, Tuborgvej 164, 2400 Copenhagen, Denmark.

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knowledge used in clinical practice, nurses are encouraged to undertake postgraduate education to improve their educa- tional, management, and scientific knowledge.[12, 13] MSN graduates view their postgraduate education as an important part of being in clinical practice[12] and the direct benefits of postgraduate nursing education to improve nurses’ compe- tencies are well established.[13]

The value of postgraduate education for nurses is increas- ingly recognized and there is growing evidence that nurses who undertake further academic education are more likely to have greater academic knowledge and competencies,[14]

which may lead to greater opportunities for nurses to en- gage in nursing research in clinical practice. The requisition of advanced professional and research capabilities, such as advanced academic skills and subject knowledge used to per- form nursing research-related tasks[15] are important factors for nurses completing a higher education degree.[12] Nurs- ing research-related tasks are related to the specific tasks of initiation and preparation of the research project, tasks during the research project, finishing the research project, and interacting with students.[16] However, the tasks also concern concrete actions related to research, such as the use of methods and analysis, literature search, ability to read, appraise and disseminate research, and obtaining funding, but they also see the tasks as project related.[17]

The literature also show how completing a MSN educta- tion kan have positive professional and personal gains for nurses.[13] The professional gains for the MSN graduates are related to enhancing academic knowledge and integrating the new knowledge into clinical practice, applying theory to prac- tice, and developing competencies in writing and appraising research.[13, 18] The personal gains for nurses completing an MSN degree include increased confidence and self-esteem, analytical thinking and decision-making, and evidence-based practice skills[13, 14, 18, 19] as well as an improved cognitive function [18] and a higher level of critical thinking which has shown to be a significant predictor of nurses’ sense of competence.[4, 19]

A Most research in nursing has been performed at universi- ties, but owing to an increasing number of academic posi- tions in clinical practice, experienced nursing researchers are now more frequently employed in the healthcare system.[20]

Although the nurses with MSN degrees have attained the sci- entific and academic competencies and knowledge needed to support evidence-based practice, new knowledge is needed on how the MSN graduates actually use, include and develop their academic skills in their clinical practice positions. We therefore conducted a longitudinal cohort study to describe and compare the development of MSN graduates’ utiliza-

tion and improvement of nursing research-related tasks and knowledge in daily clinical practice, six months and twelve months after graduation.

2. METHODS 2.1 Design A longitudinal cohort study of MSN graduates from a Danish university was conducted. The longitudinal design was cho- sen due to its strength of examining whether changes have occurred over time,[21] which was why it was appropriate for our study to compare the MSN graduates’ utilization of nurs- ing research-related tasks at six months and twelve months after graduation.

2.2 Participants Two classes of nurses graduating from an MSN programme at a Danish university in the year 2016-2017 were invited to participate in our longitudinal cohort study. The nurses (N = 112) were contacted one month before graduation via the university’s internal mail system and were informed about the study and their ethical and legal rights as participants. The nurses were requested to send an email to the first au- thor within 14 days if they wished to participate. A gentle reminder was sent after 14 days to those who had not replied.

2.3 The questionnaire The questionnaire used for data collection in this longitudi- nal cohort study was constructed by the authors for a cross- sectional study concerning MSN students’ expectations of participating in nursing research-related tasks in daily clinical practice after completing their education.[22] The question- naire was constructed from six validated and published ques- tionnaires[12, 17, 23–26] and finally validated through construct and content validity by the three authors, and face validity by MSN students enrolled in the current programme.[22] The specific descriptions and psychometric values of the six ques- tionnaires are described in detail in the referred paper.[22]

The alterations creating the final questionnaire The questionnaire went through minor alterations before be- ing included in this current study, since it was constructed for MSN students’ expectations to participate in research-related tasks,[22] and was now to be used for the MSN graduates’ experiences of utilization of nursing research-related tasks in daily clinical practice. After much consideration, the three authors decided that the themes covering the nurses’ expec- tations regarding their opportunities for engaging in nursing research-related tasks,[23, 25] their motivation[17] and research collaboration[24] should be omitted, since these were of minor relevance to the study.

The final questionnaire for this study consisted of five themes:

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1) the demographic data on the participating MSN graduates, consisting of age, number of years qualified as a nurse, num- ber of years of experience in clinical practice, professional development after nursing school, where the participant was currently employed, and which settings and positions they were employed in.[12, 17] 2) Which nursing research-related tasks the MSN graduates were currently utilizing and improv- ing.[17, 24] 3) Improvements in the MSN graduates’ nursing research knowledge.[17] 4) The MSN graduates’ current participation in research projects in clinical practice.[24, 26]

5) The time spent by MSN graduates on nursing research- related tasks per week.[17]

2.4 Data collection We used the online survey software “SurveyMonkey R©” (https://da.surveymonkey.com/) as an electronic data collec- tion device through which the questionnaires were sent to the participating MSN graduates by e-mail. To describe and compare the development of the MSN graduates’ uti- lization of nursing research-related tasks and knowledge in daily clinical practice, the questionnaires were sent to them at six months and twelve months after graduation. The class graduating in the summer of 2016 received and completed the questionnaire in the winter of 2016 (six months after graduation) and in the summer of 2017 (12 months afer grad- uation). The class graduating in the summer of 2017 received

and completed the questionnaire in the winter of 2017 (six months after graduation) and in the summer of 2018 (12 months after graduation). Two gentle reminders to complete the questionnaire were sent to the participants in all four data collection rounds.

2.5 Data analysis Data were analyzed using descriptive statistics and the re- sults are presented as numbers and percentages. All statistics were performed using STATA software (12.0). We compared the MSN graduates’ research utilization at six months and twelve months after graduation by examining the difference in percentages in the two periods.

2.6 Ethical considerations The study was approved by the Danish Data Protection Agency (AU-case no.: 62908; unique AU-id: 310). The grad- uates were informed in writing prior to their participation about their legal and ethical rights. Consent to participate was considered as having been given when the graduates completed the questionnaire at six months after graduation.

3. RESULTS A total of N = 112 MSN graduates (2016: N = 60; 2017: N = 52) were invited to participate. Of these, 65 graduates accepted, giving a response rate of 58.0% (see Table 1).

Table 1. Description of the participants

Invited graduates N

Participants accepted N (%)

Data collection six months after graduation N (%)

Data collection twelve months after graduation N (%)

Class of 2016 60 38 (63.3%) 31 (81.6%) 28 (73.7%)

Class of 2017 52 27 (51.9%) 25 (92.6%) 21 (77.7%)

Total sample 112 65 (58.0%) 56 (86.2%) 49 (75.4%)

A total of N = 65 (58.0%) MSN graduates out of the N = 112, who agreed to participate, N = 56 (86.2%) graduates, com- pleted the questionnaire at six months and N = 49 (75.4%) graduates at twelve months after graduation (see Table 1).

3.1 Characteristics of the participating MSN graduates

Demographic characteristics of the MSN graduates were col- lected during the first round of questionnaires at six months after graduation (N = 56) (see Table 2).

The age distribution among the 56 MSN graduates was great- est at 31-35 years of age (N = 17 (30.4%)) and 36-40 years (N = 16 (28.6%)). The youngest MSN graduates were in the age range 25-30 years (17.9%), whereas the oldest group, greater than 56 years, contained just one (1.8%) graduate (see Table 2).

The majority of the MSN graduates (N = 26 (46.4%)) had qualified as nurses in the previous 5-9 years. Four MSN graduates had qualified 0-4 years previously (7.1%) and 12 (21.3%) MSN graduates had qualified more than 15 years previously (see Table 2).

The distribution of the number of working years in clinical practice among the MSN graduates showed that 20 MSN graduates had worked from zero to 4 years (35.7%) in clin- ical practice and 20 (35.7%) had worked from 5 to 9 years. Only a single participant (1.8%) had been working ≥ 25 years in clinical practice (see Table 2).

The MSN graduates were asked if they had continued their professional development after nursing school. N = 33 (58.9%) said “no” and N = 23 (41.1%) said “yes”. The majority of MSN graduates who confirmed having continued

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their professional development after nursing school had com- pleted parts of a bachelor’s degree (N = 15 [65.2%]). Of the remaining N=8 participants, N = 2 (8.7%) MSN graduates had completed a Master of Arts (MA) degree, N = 2 (8.7%) had completed a Master of Science (MSc) degree (8.7%), and N = 3 (13.0%) had completed a bachelor’s degree (see Table 2).

Table 2. Characteristics of the MSN graduates (N=56) at six months after graduation

Variable N = 56 (%)

Age (years)

25-30 10 (17.9%)

31-35 17 (30.4%)

36-40 16 (28.6%)

41-45 4 (7.1%)

46-50 1 (1.8%)

51-55 7 (12.5%)

> 56 1 (1.8%)

No. of years qualified as a nurse N = 56

0-4 4 (7.1%)

5-9 26 (46.4%)

10-14 14 (25.0%)

15-19 4 (7.1%)

20-24 4 (7.1%)

>25 4 (7.1%)

No. of years in clinical practice N = 56

0-4 20 (35.7%)

5-9 20 (35.7%)

10-14 6 (10.7%)

15-19 3 (5.4%)

20-24 6 (10.7%)

≥ 25 1 (1.8%)

Continuing professional development after nursing school N = 56

No 33 (58.9%)

Yes: 23 (41.1%)

Bachelor’s degree 3 (13.0%)

Parts of a bachelor’s degree 15 (65.2%)

Master of Arts (MA) degree 2 (8.7%)

Parts of a Master of Arts (MA) degree 0 (0.0%)

Master of Science (MSc) degree 2 (8.7%)

Parts of a Master of Science (MSc) Degree 1 (4.3%)

Almost all of the MSN graduates were in employment after graduation (see Table 3).

N = 52 (92.9%) of the 56 graduates who participated during our first data collection were in employment after six months. Of the N = 49 graduates who participated in our second data collection, N = 47 graduates (95.9%) were in employment after 12 months (see Table 3).

The employment settings with the greatest rise from the six to 12 months were the medical hospital departments,

in which the MSN graduates’ employment increased from 33.3% to 45.5% (+12.2%), and the surgical hospital depart- ments, in which their employment increased from 18.8% to 27.3 (+8.5%). The employment settings with the biggest decrease from six to 12 months were employment in private institutions, which decreased from 22.9% to 3.0% (-19.9%), in home care from 12.5% to 3.0% (-9.5%), in nursing homes from 6.3% to 3.0% (-3.3%), and in psychiatric departments which decreased from 6.3% to 3.0% (-3.3%) (see Table 3).

The greatest difference regarding increases among positions in which the MSN graduates were employed at six and 12 months after graduation was clinical development nurse: 15.2% to 22.2% (+7.0%). A small increase was detected in positions as clinical educational nurses from 6.1% to 7.4% (+1.3%), clinical nurse specialist from 21.2% to 22.2% (+1.0%), and charge nurse from 3.0% to 3.7% (+0.7%). The biggest differences regarding decrease in employment po- sitions of the MSN graduates were positions as registered nurses, which decreased from 33.3% to 22.2% (-11.1%) and research nurses from 9.1% to 7.4% (-1.7%) (see Table 3).

The MSN graduates’ workload also changed between six and 12 months, where full-time employment increased from 73.1% to 78.7% (+5.6%) and part-timea employment de- creased in total from 26.9% (6 months) to 21.3% (12 months) a decrease of 5.6% (see Table 3).

3.2 Changes in the MSN graduates’ utilization of nurs- ing research-related tasks and knowledge

An improvement was detected from six to 12 months after graduation in the majority of items concerning the MSN graduates’ utilization of nursing research-related tasks (see Table 4).

An increase was found in 10 items: using qualitative methods and analysis (+19.9%), writing professional papers (+15.8%), developing posters (+15.4%), performing projects from own ideas (+15.3%), getting ideas for new projects (+14.8%), un- derstand and evaluate Danish (+13.8%) and English (+8.7%) research papers, using statistical analysis (+10.9%), search- ing for literature in databases (+7.4%), and developing clini- cal guidelines (+0.5%) (see Table 4).

A decrease in utilization of research-related tasks from six to 12 months was found in conducting presentations using power point (-5.6%), designing projects from own ideas (-3.9%), writing scientific papers (-2.1%), and project man- agement (-1.0%) (see Table 4).

Improvements in the MSN graduates’ nursing research- related tasks were detected from six to 12 months after grad- uation in 14 of the 15 items, with a difference from +1.1% to + 15.8% (mean 9.2%). Only one item, writing scientific pa-

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pers, had decreased, from 33.9% six months after graduation to 30.6% 12 months after graduation (-3.3%) in the MSN graduates’ ongoing improvement of nursing research-related tasks (see Table 4).

Besides improving nursing research-related tasks, the MSN graduates also expressed an increased knowledge of research

(see Table 5).

An increase in development of research knowledge was de- tected from six to 12 months in knowledge on qualitative analysis (+14.0%), theory of science (+9.7%), qualitative methods (+5.1%), and statistical analysis (+3.1%) (see Table 5).

Table 3. Development in MSN graduates’ employment, positions and working hours

6 months after graduation 12 months after graduation Difference (-/+ %)

Currently employed N = 56 (%) N = 49 (%)

Yes 52 (92.9%) 47 (95.9%) +3.0

No 3 (5.4%) 2 (4.1%) -1.3

Currently employed in (setting) N = 48 (%) N = 33 (%)

Home care 6 (12.5%) 1 (3.0%) -9.5%

Nursing home 3 (6.3%) 1 (3.0%) -3.3%

Acute/internal medicine 4 (8.3%) 2 (6.1%) -2.2%

Psychiatric department 3 (6.3%) 1 (3.0%) -3.3%

Medical hospital department 16 (33.3%) 15 (45.5%) +12.2%

Surgical hospital department 9 (18.8%) 9 (27.3%) +8.5%

Nursing education (university college) 5 (10.4%) 3 (9.1%) -1.3%

Licensed advanced nursing Education 1 (2.1%) 0 (0.0%) -2.1%

University 0 (0.0%) 0 (0.0%) 0%

Private institutions 11 (22.9%) 1 (3.0%) -19.9%

Other 0 (0.0%) 0 (0.0%) 0%

Currently employed as (position) N = 33 (%) N = 27 (%)

Clinical nurse manager 0 (0.0%) 0 (0.0%) 0%

Charge nurse 1 (3.0%) 1 (3.7%) +0.7%

Clinical nurse specialist 7 (21.2%) 6 (22.2%) +1.0%

Clinical development nurse 5 (15.2%) 6 (22.2%) +7.0%

Clinical educational nurse 2 (6.1%) 2 (7.4%) +1.3%

Staff nurse 11 (33.3%) 6 (22.2%) -11.1%

Research nurse 3 (9.1%) 2 (7.4%) -1.7%

Teaching 5 (15.2%) 4 (14.8%) -0.4%

Working hours (per week) N = 52 (%) N = 47 (%)

Full-time (37 hours per week) 38 (73.1%) 37 (78.7%) +5.6%

Part-time* (30-35 hours per week) 10 (19.2%) 6 (12.8%) -6.4%

Part-time† (< 29 hours per week) 4 (7.7%) 4 (8.5%) +0.8

Note. *:30-35 hours per week; †: <29 hours per week

However, the MSN graduates were less concerned about knowledge of design, which decreased by -1.5%, and quan- titative methods, which decreased by -0.3%, from six to 12 months after graduation (see Table 5).

The results showed a tendency in the MSN graduates’ partic- ipation in research practice to decrease over time (see Table 6). At six months after graduation, N = 29 (51.8%) MSN graduates replied “No” when asked if they were currently

participating in research projects in clinical practice, whereas, after 12 months, N = 30 (61.2%) of the graduates replied “No”, giving an increase of +9.4% in zero participation (see Table 6).

While 15 (26.8%) MSN graduates confirmed their participa- tion in research projects at six months after graduation, the number decreased to N = 12 (24.4%) at 12 months, giving a decrease of -2.6% over time. The MSN graduates were

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asked whether they were participating in planning, executing and/or presenting an accomplished project. A decrease was detected over time in developing a project from 26.8% to 20.4% (-6.4%) however, an increase was found in the num- bers of MSN graduates participating in the execution of a project from 21.4% to 24.4% (+3.0%) and in presenting an

accomplished project from 19.6% to 20.4% (+0.8%) (see Table 6).

3.3 Time spent on nursing research-related tasks The results showed a time range from zero to greater than 20 hours per week spent on nursing research-related tasks (see Table 7).

Table 4. The MSN graduates utilization and improvement of nursing research-related tasks

Utilization of research-related tasks

Improvement of research-related tasks

6 months after graduation N = 56 (%)

12 months after graduation N = 49 (%)

Difference (-/+ %)

6 months after graduation N = 56 (%)

12 months after graduation N = 49 (%)

Difference (-/+ %)

Getting ideas for new projects

18 (32.1%) 23 (46.9%) +14.8% 23 (41.1%) 22 (44.9%) +3.8%

Designing projects from own ideas

17 (30.4%) 13 (26.5%) -3.9% 12 (21.4%) 11 (22.5%) +1.1%

Performing projects from own ideas

12 (21.4%) 18 (36.7%) +15.3% 11 (19.6%) 13 (26.5%) +6.9%

Using qualitative methods and analysis

14 (25.0%) 22 (44.9%) +19.9% 14 (25.0%) 20 (40.8%) +15.8%

Using statistical analysis 3 (5.4%) 8 (16.3%) +10.9% 0 7 (14.3%) +14.3%

Searching for literature in databases (PubMed, CINAHL mm)

21 (37.5%) 22 (44.9%) +7.4% 15 (26.8%) 18 (36.7%) +9.9%

Can understand and evaluate Danish research papers

14 (25.0%) 19 (38.8%) +13.8% 13 (23.2%) 18 (36.7%) +13.5%

Can understand and evaluate English research papers

18 (32.1%) 20 (40.8%) +8.7% 15 (26.8%) 18 (36.7%) +9.9%

Developing posters 4 (7.1%) 11 (22.5%) +15.4% 5 (8.9%) 9 (18.4%) +9.5%

Conducting presentations using PowerPoint

26 (46.4%) 20 (40.8%) -5.6% 16 (28.6%) 20 (40.8%) +12.2%

Writing professional papers

6 (10.7%) 13 (26.5%) +15.8% 6 (10.7%) 12 (24.5%) +13.8%

Writing scientific papers 16 (28.6%) 13 (26.5%) -2.1% 19 (33.9%) 15 (30.6%) -3.3%

Applying for research funding

8 (14.3%) 7 (14.3%) 0% 5 (8.9%) 9 (18.4%) +9.5%

Project management 12 (21.4%) 10 (20.4%) -1.0% 6 (10.7%) 9 (18.4%) +7.7%

Developing clinical guidelines

10 (17.9%) 9 (18.4%) +0.5% 6 (10.7%) 6 (12.2%) +1.5%

Table 5. The MSN graduates’ improvements in nursing research knowledge

After 6 months N = 56 (%) After 12 months N = 49 (%) Difference (-/+ %)

Designs 18 (32.1%) 15 (30.6%) -1.5%

Theory of science 6 (10.7%) 10 (20.4%) +9.7%

Qualitative methods 20 (35.7%) 20 (40.8%) +5.1%

Qualitative analysis 15 (26.8%) 20 (40.8%) +14.0%

Quantitative methods 7 (12.5%) 6 (12.2%) -0.3%

Statistical analysis 4 (7.1%) 5 (10.2%) +3.1%

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Table 6. The MSN graduates participation in research projects in clinical practice

6 months after graduation N = 56 (%)

12 months after graduation N = 49 (%)

Difference (-/+ %)

No 29 (51.8%) 30 (61.2%) +9.4%

Yes 15 (26.8%) 12 (24.4%) -2.6%

I am participating in developing a project 15 (26.8%) 10 (20.4%) -6.4%

I am participating in executing a project 12 (21.4%) 12 (24.4%) +3.0%

I am participating in presenting an accomplished project 11 (19.6%) 10 (20.4%) +0.8%

Table 7. Time spent on nursing research-related tasks per week

Hours spent on research per week

6 months after graduation N = 50 (%)

12 months after graduation N = 41 (%)

Difference (-/+ %)

0 hours 11 (28.9%) 6 (19.4%) -9.5%

1-5 hours 16 (32.0%) 12 (29.3%) -2.7%

6-10 hours 10 (20.0%) 12 (29.3%) +9.3%

11-15 hours 3 (6.0%) 4 (9.8%) +3.8%

16-20 hours 6 (12.0%) 4 (9.8%) -2.2%

> 20 hours 4 (8.0%) 3 (7.3%) -0.7%

At six months after graduation the majority of MSN gradu- ates (N = 16; 32.0%) spent 1-5 hours per week on nursing research-related tasks, and at 12 months after graduation the majority of graduates spent 1-5 hours (29.3%) or 6-10 hours (29.3%) per week on nursing research-related tasks (see Table 7).

From six to 12 months after graduation, a decrease was found in the number of MSN graduates spending zero hours per week on nursing research-related tasks (-9.5%); similarly, there was a decrease in the number of MSN graduates spend- ing only 1-5 hours per week on these tasks (-2.7%). However, in the same period there were increases in the number of MSN graduates spending 6-10 hours per week (+9.3%) and 11-15 hours per week (+3.8%) on these tasks. A decrease was found in the number of MSN graduates spending 16-20 hours per week on nursing research-related tasks (-2.2%) and in the number of MSN graduates spending more than 20 hours per week (-0.7%) (see Table 7).

4. DISCUSSION

The overall results of the longitudinal cohort study showed a positive impact on the MSN graduates’ development of their utilization and improvement of nursing research-related tasks and knowledge in daily clinical practice 12 months after their academic education. The MSN graduates had developed their utilization of nursing research-related tasks from six to 12 months after graduation with an average of +13.6% and developed their improvement of nursing research-related tasks with an average of +9.2%. The results further showed

an ongoing improvement from six to 12 months in design- ing projects from own ideas (+1.1%), conducting presen- tations using PowerPoint (+12.2%), applying for research funding (+9.5%), and project management (+7.7%). The positive development in the MSN graduates’ use and im- provement of their academic competencies and knowledge in clinical nursing practice could be caused by the natural flow in the research process due to the late level of activi- ties, such as applying for funding, presenting projects and project management. The development shows an increase in the MSN graduates’ research experience over time, which is a well-known phenomenon in hands-on research[20]). Sev- eral studies[27–29] show healthcare researchers’ development of research experience through self-evaluated increases in research experience over time, led by exposure and com- mitment to research programmes and engaging in research activities. The development of the MSN graduates’ research utilization from six to 12 months can also be viewed in com- parison with their statements in our qualitative study of their experiences of engaging in nursing research-related tasks in daily clinical practice six months after graduation.[30] In the semi-structured interviews the MSN graduates described barriers concerning how they felt limited in participating and utilizing nursing research-related tasks due to restrictions with their nursing management, the hierarchy and culture among their nursing colleagues and the limited time due to restrictions in their employment positions.[30] Some of these barriers could very well have been overcome and improved over the following six months, which was what we found in our present cohort study according to the MSN graduates’

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positions of employment.

The results showed a positive change in the MSN graduates’ positions of employment from six to 12 months after their graduation. An increase was found in the MSN graduates’ positions of employment covering research and development, such as clinical nurse specialist +1.0%, clinical educational nurse +1.3% and clinical development nurse +7.0%, and a de- crease of -11.1% was found in registered nurse positions. The development could show that more MSN graduates are hired in clinical practice because of their academic competencies and knowledge, as opposed to being employed in positions where the tasks of a staff nurse are required. Research shows that even though MSN graduates are underutilized in their early career they tend to be promoted relatively quickly.[12]

Furthermore, the results could also indicate that the MSN graduates change their workplace according to where there are opportunities for them to use their academic skills in clin- ical nursing practice, which is related to the increase in their utilization of nursing research-related tasks and improve- ments in their research knowledge and skills. The qualitative study describing the MSN graduates’ experiences after six months showed that nursing management prioritized patient- care tasks for the graduates, instead of providing time for them to perform nursing research-related tasks.[30] However, our results after 12 months could indicate a change in nursing management’s prioritization of the MSN graduates’ utiliza- tion of academic competencies and knowledge in their daily work. In this context, our results showed an increase over time in the number of hours per week the MSN graduates spent on nursing research-related tasks. After 12 months an additional 9.3% of the MSN graduates spent 6-10 hours per week on nursing research-related tasks and an additional 3.8% spent 11-15 hours per week on these tasks, compared with the percentages at six months after graduation. After 12 months one-third (26.9%) of the MSN graduates spent more than 11 hours per week on nursing research-related tasks.

There is clearly a positive development in MSN graduates’ utilization and improvement of nursing research-related tasks and knowledge in daily clinical practice. However, do these research practices have an effect on the patients and do they have an impact on nursing care? Or is it research just for the sake of research? A questionnaire study was conducted by Hardwick and Jordan[31] to survey 60 nurses and mid- wives graduating from a bachelor’s or master’s programme about their perceptions on how their practice had changed as a result of the academic knowledge they had required dur- ing their education. The findings showed that the graduates could provide many examples of which academic and re- search skills they had required: However, even though most felt their clinical practice had changed due to their studies, no

practical examples were given.[31] Change management was also taught successfully to many of the graduates; however, no examples of change or of new knowledge for clinical gain were given and the graduates blamed the existing barriers of time and lack of encouragement.[31] In a systematic re- view exploring whether there is evidence that MSN nursing education affects patient care, Cotterill-Walker[13] found no evidence of this in the 15 included studies. The participants explained their constraints in terms of colleagues and man- agers limiting their abilities to apply knowledge to clinical practice, feeling powerless to implement knowledge into practice and experiencing frustration at being unable to move forward in clinical practice.[13] Cotterill-Walker[13] states that future research must focus on specific clinical outcomes in order to evaluate MSN graduates’ competencies to improve patient care.

Strengths and limitations In our cohort study we only included graduating nurses from the MSN programme at one Danish University. We could have chosen to include graduating MSN nurses from other Danish Universities; however, the academic programmes dif- fer in both teaching and acquired skills, which would have meant our results were not comparable. The study results, however, are still generalizable to other countries and prac- tice settings due to the comparability to the international literature on the subject. In our search for questionnaires for data collection no complete questionnaire was found that met our study aim. However, we developed a purposive- constructed five-theme questionnaire based on four validated questionnaires, which allowed us to address the specific ques- tions we needed to be answered. This study contains a high proportion of missing values, which could affect its internal and external validity. However, decreasing response rates and missing values are often seen when outcomes are mea- sures over two or more points in time, which is not the case in this study.

5. CONCLUSION The overall results of the longitudinal cohort study showed a positive impact on the MSN graduates’ development of their utilization and improvement of nursing research-related tasks and knowledge in daily clinical practice, as an increase in research and developmental positions of employment, and as an increase in time spent on nursing research-related tasks per week 12 months after graduation. Our study and the literature shows that providing nurses with Master’s level knowledge and skills can make a difference for them in clin- ical practice. However, knowledge is still required on how MSN graduates’ academic qualifications can have an im- pact on nursing and patient care. Future research needs to

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focus on practical observations of how the MSN graduates use their academic knowledge and skills to improve patient care and must furthermore focus on specific outcomes and observable criteria, in order to evaluate the MSN graduates’ performance.

ACKNOWLEDGEMENTS We appreciate and would very much like to thank the MSN

graduate nurses for being able to take time out of their busy schedule to participate with valuable knowledge for this study.

CONFLICTS OF INTEREST DISCLOSURE The authors declare that there are no conflicts of interest.

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