State of Leadership in Nursing Science in Iceland
10.4 Expansion of Nursing Science
In the middle of the last century, there were strong international forces that worked on promoting science and education, mainly under the auspices of enhancing eco- nomic growth. These influences received high attraction in Iceland and were reflected in a “new science policy” which the Icelandic government instigated in the 1960s, and which reached to all educational levels. Education, science, and eco- nomic growth were intertwined terms, which were meant to lead the nation into a very different society in the future. As regards the UI, it was not only to receive the vast growing number of students but also new faculties. With new faculties being established, more faculty members were needed. Simultaneously faculty research gained an increased credence [3].
Graduate education in nursing started to become a possibility at the UI with a growing number of doctorate faculty in nursing in the 1990s. The first master’s student was enrolled to the FoN in the fall of 1998. The growing number of master’s and doctoral prepared nurses and the rise in graduate education at the UI became pivotal in facilitating the growth in nursing research, which took place in the 1990s.
The launching of doctoral education in the year 2004 was further to booster that trend. As of the beginning of 2018, eleven nurses have defended their doctoral thesis at the FoN, in addition to three midwifes. Along with this there has become an out- burst in faculty research and publications. This is reflected in national publications in the Icelandic Nurses’ Association Journal, The Nurses’ Journal, as well as inter- nationally in peer-reviewed journals. For trends in international peer-reviewed pub- lications by the faculty at the FoN, who in the year 2018, were 24 persons in 20.2 full-time positions (of those there are four midwives in 2.5 full-time positions), see Fig. 10.1. Comparison of international peer-reviewed publications with other
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Fig. 10.1 Development in publications of the Faculty of Nursing University of Iceland from 1985 to 2017 in peer-reviewed journals—Science Citation Index Expanded, Social Sciences Citation Index, and Arts and Humanities Citation Index
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faculties within the UI shows that research activity at the Faculty of Nursing is on a par with them [4].
10.4.1 Collaboration Between the University of Iceland and Landspitali the National University Hospital
Collaboration in nursing between the academia and health care institutions has vari- ous forms internationally [23, 24]. Communications about materializing formal col- laboration between FoN and nursing at Landspitali, the main teaching hospital in Iceland, to enhance nursing education, research, and research utilization for the betterment of quality nursing care, date back at least to the year 1991 [25]. Ten years later, in 2000, following the merging of hospitals in Reykjavik into one national university hospital, a formal contract between University of Iceland (UI) and the newly formed Landspitali the National University Hospital (LSH) was instigated.
The contract was renewed in the years 2006 and 2012 [6].
Following that first contract, joint positions, academic chairs, in nursing, were established. They were modelled by a long tradition of such positions within medi- cine. Nurses designated to joint positions were given the title, academic chair, of the relevant field of specialty: cancer, chronically ill, family nursing, geriatric, pediat- ric, psychiatric, surgical, sexual and reproductive health, nursing informatics, and nursing administration. Two new positions have been added more recently: emer- gency nursing and neurological and rehabilitation nursing. In addition to research, the role of the academic chair was to support advancement in education and prac- tice. Academic chairs were to lead policy making in research in the field, to facili- tate establishment of research groups, and to support other nurses in conducting research and spearheading research projects themselves.
As regards education, the academic chairs were responsible for supporting the structure of the education of undergraduate and graduate students, to promote new courses to support the specialization within the fields of focus and to guide the stu- dents in selecting research projects and finding thesis’ supervisors. Concerning nursing practice development, the academic chairs should contribute to advance- ment of the practice, to participate in policy making within the practice specialty section and to initiate and participate in implementation of evidence-based practice.
The academic chairs were also to contribute to regular meetings of the Nursing Strategy and Policy Group, headed by the Chief Nursing Officer (CNO) of the LSH with head nurses and clinical nurse specialists also participating. This group is a platform for presenting and discussing implementation of innovations in nursing care on a hospital-wide basis. The significance of this platform for collaboration grew in the year 2009 due to changes in the organizational structure of the hospital, including termination of positions of Division chairs for nursing who led the spe- cialty sections (one manager instead of two previously). Earlier these nurse manag- ers were pivotal in lines of communications with academic chairs. Concurrent with these changes, the accountability of nursing unit managers over practice develop- ment has enlarged [26].
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The joint positions have become catalysts for strengthening clinical nursing research. They have given the faculty opportunities to collaborate closely with clini- cal nurse specialists, staff nurses, and head nurses on research and practice develop- ment. Another side is the growing number of clinical nurse specialists that the FoN has hired to adjunct positions and as sessional teachers. As of the beginning of the year 2018, there were 13 nurses hired in adjunct positions. Participation in research and even more importantly, teaching of undergraduate students, is the primary role of the adjuncts by the way of lectures, simulation, and clinical teaching. Their part in the curriculum development is expanding as well, as is their role in high-quality clinical teaching. The joint positions at the LSH have provided the faculty with an uncomplicated access to research activities and some research funding, i.e., to the Science Fund of LSH and the Science Fund of the Icelandic Nurses’ Association.
By the means of the collaboration, clinical nurses have become more familiar with the academia, and interest in graduate education has risen. With more graduate stu- dents, research activities have multiplied. Frequently, nurses with a master’s degree continue working on study projects after graduation, particularly in their specialty areas. To further enhance nursing research and practice, professional councils in specialty areas, led by the academic chairs and with nurses with master’s education in the area of specialty and the head nurses, started to emerge in the 1990s and were formalized in the year 2009 [26]. The role of the professional councils, a total of 13 at the outset, was to further strengthen and execute some of the academic-practice responsibilities of the academic chairs.
10.4.2 Resources to Promote Nursing Research
As a research university, research activities at the UI are regarded 40% of the work- load of faculty members with teaching 48% and administration 12%. Every faculty member is also entitled to a one-semester sabbatical leave every sixth semester, depending upon the fulfillment of certain requirements [5]. This system has been in place at the UI for decades and sets the stage for the emphasis that is placed on research within the school. In the beginning days of the FoN when teaching respon- sibilities were overriding, the faculty did not always have an opportunity to take a sabbatical. Those times are over with, and the faculty eagerly uses their sabbatical to the maximum of their research endeavors. The fundamental facilitator of research in nursing as in other disciplines is the budget model that was instigated for univer- sities in Iceland in the 1990s. With this new budget model, Icelandic government dedicated a more stable financial system to run universities in Iceland [4]. By the way of the budget system, there came incentives for research performance of fac- ulty, especially international publications of high academic standard and the attain- ment of competitive research grants. This means that individual faculty members get an extra payment for research performance [4].
With a more stable financial system, there became possibilities to put forward regular strategic planning—policy—for education and research. The first strategic planning was ratified in the year 2001. It was followed by another plan in the year
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2006, which was based on a stronger financial governmental support, in which the UI managed to actualize its aim of becoming an international standard research university. The 2006–2011 UI strategy became of particular significance for increasing research endeavors [5]. The strategy set forth by the FoN at the time mirrored that plan. In it a special emphasis was placed on increasing research activ- ities with high-quality research, particularly intervention research, more attain- ments in grant applications on national and international levels, and more interdisciplinary and international collaboration, concurrent with strengthening graduate education, especially the doctoral education. This was to be followed by improvement of the infrastructure in research [27]. Despite serious budget cuts due to the financial crash in 2008, the increased emphasis on high-quality performance, not the least on research endeavors, resulted in the university becoming among the world’s 300 best universities in the Times Higher Education World University Rankings in 2011 and moving up to become the top 201–250th universities in 2018. In Nordic comparison, UI was number 13th of the best universities in Scandinavia in the year 2016 [5, 28, 29].
Appropriate funding for research activities has to go hand in hand with increased capacity to conduct research. The University of Iceland runs a Science Fund to support faculty research, especially allowing for hiring research assistants. Some faculty members receive yearly financial support from this fund. There are some other funds, among them the Science Fund of the Icelandic Nurses’ Association, which yearly award research grants to promote research endeavors among nurses, especially clinical research. The fund is a part of a union contract of INA with employers. It supports research projects on three levels: Those which are a part of a master’s degree in nursing (and health sciences in which the focus is nursing top- ics), research conducted by nurses in doctoral studies, and more generally research by nurses working in institutions that pay into the research fund. Between the years 2007 and 2017, there have been 27 applications annually. The great majority of graduate nursing students receive funding for their study projects, and all of the doctoral nursing students so far have received a one million IKR (approximately € 8.000) grant from the fund [30]. An upsurge of the European Nursing Research Foundation, founded in 2016, and housed within the European Federation of Nurses Association (EFNA) in which the Icelandic Nurses’ Association actively participates, is on the horizon.
A newly developed fund, the RIM Research Fund (Rannsóknasjóður Ingibjargar R. Magnúsdóttur), is dedicated to nurses in doctoral education in Iceland. The founder is Ingibjórg R. Magnúsdóttir, the first head of the Department of Nursing.
This fund yearly supports one or two doctoral nursing students. Bigger, more com- petitive funding on national (e.g., RANNIS the Icelandic Centre for Research) and international level (e.g., NordForsk, a research organization run by the Nordic Council of Ministers and some European Union funds) is of increasing interest to Icelandic nurses. In the past, application calls from funding organizations have, however, seldom been considered relevant to nursing research (see, e.g., [31]). The UI runs two highly competitive funds to support doctoral students with salaries for 3 years (ice. Eimskipasjóður Íslands and Háskólasjóður) [32]. Indirectly, these
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grants contribute to faculty research. As yet, a few doctoral students in FoN have received grants from these funds.
Sufficient resources for nursing research have, through the years, been of con- cern of the nursing faculty. In collaboration with the LSH, a research institute, Institute of Nursing Research at the University of Iceland and Landspitali National University Hospital, was established in the year 1997. The main goal of the institute was to support clinical research, to strengthen research infrastructure, and not the least to facilitate doctoral education [33]. The LSH provided funding for one full- time research position, of which some doctoral students held, later to be reduced to a 50% position and then to be discontinued in the year 2011 due to budget con- straints [34]. After that the FoN, with support from the President of UI’s Fund, funded a 50% position. That support was discontinued in 2017, also due to financial shortage, which subsequently led to a temporary discontinuation of the function of the institute. The institute was successful in supporting research and serving as a venue for research activities of various kind. For instance, faculty and guests regu- larly presented their research to the nursing community, and seminars were orga- nized aiming to introduce and promote various methodological issues. Of particular importance was support in scientific writing and statistical analysis. The function of the institute became, in part, transferred to individual academic chairs at the LSH as well as to the School of Health Sciences, which at similar times set out to strengthen research infrastructure. The SoHS now provides assistance such as with grant appli- cations, maintenance of research grants, and statistical counselling and support.
Priority setting for knowledge development has been highly recommended to promote nursing research. It maximizes scarce resources, increases collaboration among nurses and other scientists, and increases depth and continuity in knowledge generation leading to the building of strong knowledge bases [35]. In the USA, priority setting in nursing research is seen successful to “ensure excellence in nurs- ing science” ([35], p. 16) and is the source for funding allocation at the National Institute of Nursing Research [36]. In the Nordic countries, such an idea was intro- duced in a seminar held by the Northern Nurses’ Federation on nursing research in Denmark back in the year 1966 and was reactivated in 1995 by different agencies [37]. Setting priorities for nursing research has not gained momentum in Iceland. At current times large national research funds dedicated to nursing research do not exist. On a national level, the bigger competitive funds run by the government are interdisciplinary for which a strategic vision for allocation has been delineated.
The notion of academic freedom continues to be a strong ethos at the UI. Priority setting in research is not antithetical to academic freedom, although in a sense it may turn out as restrains in relation to funding possibilities of which priority set- tings are in place. The Promotion System for Academic Positions [38] and the Annual Performance Report [39] indirectly give directions as to how to climb the academic ladder as well as the kind and how much value different research out- puts make in terms of monetary values. Individual researchers are themselves responsible for their work, which needs to fall within the general policy frame- work defined by the University Council. Still academic freedom remains a prem- ise for creative and critical research activities indicating that each faculty member
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is entitled to study that which is of interest to him/her. Consequently, UI’s code of ethics says: Faculty members and students “work in the spirit of the general truth that knowledge is valuable in itself in addition to its value for individuals and society” [40].