Sometimes, the most impactful innovation is grounded in a simple insight – like pairing two smart skill sets together to tackle complex challenges.
That’s the approach taken by Ascension, one of the nation’s largest health systems. There, the real-world know-how of bedside nurses and operational leaders is paired with the rigor and curiosity of practice-based nurse scientists. One group understands the daily challenges and complexities of healthcare delivery; the other knows how to gather, test and translate evidence into action. Together, they form a partnership that turns frontline insights into solutions that scale.
“It’s the exquisite pairing of nurse operators and nurse scientists,” says Mary Sitterding, PhD, RN, CNS, FAAN, Vice President of Nursing Quality and Regulatory. “Operators bring situational awareness and decision-making agility, paired with scientists who contribute translational research and data-driven rigor.”
Building a culture of evidence-based practices enables nurses at the point of care to have autonomy, authority and accountability to advocate through the evidence.
The approach is creating real change, including millions in cost savings, measurable improvements in safety, higher nurse retention, and, importantly, a culture where nurses know their ideas matter.
From an ED concern to a national solution
The power of the partnership model is best illustrated in the story of fall risk assessments in the emergency department.
“Reducing falls was our primary clinical goal,” said Cynthia LaFond, PhD, RN, CCRN, FAAN Senior Director, Nursing Research. “We were visiting sites, asking nurses – what’s working? What’s not working?”
LaFond shared that Vallire Hooper, PhD, RN, CPAN, FASPAN, FAAN, a Senior Nurse Scientist in Texas, learned of an issue in the emergency department related to current fall risk screenings.
“We’ve had a fall risk scale, which has been around a very long time,” LaFond said, “But it wasn’t working for this population.”
Most assessment scales target fall risk factors associated with inpatient care. Emergency departments face different risks, posing a unique challenge to health systems.
“Nurses in the emergency room need to be able to conduct a quick risk assessment in triage, because patients can even fall while in the waiting room,” LaFond said. “We also see different reasons for falling in the emergency room. For example, a young person without any other risk factors could fall due to substance use, which isn’t specifically accounted for in other scales. There’s this disconnect.”
One of the nurse operators suggested a newer tool called KINDER 1, a fall risk assessment tool designed for emergency room use. However, the tool wasn’t well-studied, so Hooper worked to design pilots to establish more evidence around outcomes and quality.
After about 5,000 patients, the results were clear – nurses loved it. Then, after about 64,000 patients, research results demonstrated that KINDER 1 sufficiently distinguished the patients who fell from the patients who did not fall.
“It was so successful, it scaled nationally,” LaFond said. “It was one of the implementations we’ve had the joy of being a part of, where people were knocking on the door to get this tool. There was really great energy behind it.”
What started as a concern voiced by ED nurses is now a national standard at Ascension. The team, which includes Hooper as well as Kristi Stephenson, BSN, RN, CEN; Angela Wright, PhD, RN, MBA, NEA-C; Shelly Rupp, MSN, RN; Sarah Riley, MSN, RN; Lori Lewis, MSN, RN, NPD-BC; Diana D. Canales, MSN, RN; and Hayley Craft, DNP, RN, expects to present published findings at the Emergency Nurses Association annual conference in September 2025.
Grounding in real-world feasibility and scientific rigor
At the heart of Ascension’s success is the close partnership between nurse operators and scientists.
Ascension defines nurse operators as nurse leaders overseeing staffing, workflows and the healthcare environment. The category includes nurse managers and goes all the way up to the Chief Nursing Officer. Nurse scientists at Ascension are PhD-prepared, and bring expertise in research design, analytics and evidence translation.
Working side-by-side, they move seamlessly from identifying a need to finding and testing solutions, to scaling what works. The model has been cemented through visionary leadership and investment, Sitterding says. These investments include having a team of nurse scientists and a program manager, as well as access to other experts, like biostatisticians and data scientists from the Ascension Data Science Institute and a medical librarian/clinical informationist.
She attributes that to executive vice president, Sally Dietch, MSN, MHA, RN, FACHE. “Sally’s intent was not only to generate new knowledge, but knowledge informed by operations,” she said. “Building a culture of evidence-based practices enables nurses at the point of care to have autonomy, authority and accountability to advocate through the evidence.”
Nurses at the point of care know their voices matter. There’s a structure to raise concerns, see them validated, and watch solutions take root across the system.
And the payoff has been clear. Ascension reports the nurse operator/scientist model has resulted in $17 million in cost avoidance from targeted innovations, 98 percent nurse retention through a targeted apprenticeship program, 35 publications and 27 practice changes informing systemwide improvements. Additionally, this approach expedites knowledge translation. The time from the first KINDER 1 pilot to national scaling was two years, a far cry from the commonly reported 17-year evidence-to-practice gap.
A culture that turns insights into outcomes
Ascension’s model presents a blueprint for other health systems seeking to accelerate nurse-driven solutions and enhance patient care. Through operational expertise and scientific rigor, the team is capable of scaling proven solutions quickly and empowers nurses as innovators and owners of change.
Ultimately, the nurse scientist role serves to help leaders address issues faster and more effectively. “We live in the space between quality improvement and research,” LaFond says. “We’re working to help address issues right now for care delivery.”
