Over the past decade, the nursing profession has experienced significant change. Ten years ago hospitals were restructuring and reengineering nursing positions out of staffing grids; today, extraordinary efforts are in place to both recruit and retain experienced nurses at the bedside. Given this schizoid history, it's not surprising that it has been challenging to both entice new talent into the field and re-enchant experienced nurses with their careers.

Linking Patient Outcomes to Nursing Autonomy
One strategy that may help strengthen the profession during this unsettled period is taking action to foster the science of clinical nursing to better support an autonomous and accountable practice that is clearly linked to improved patient outcomes. Autonomous decision making is a hallmark of any profession. Nursing autonomy has long been recognized as a major source of nursing satisfaction. In fact, autonomy is an essential attribute of the culture of excellence characteristic of what are known as magnet hospitals, those recognized for their ability to both recruit and retain nurses.

Within the past five years, several large research studies have provided evidence linking autonomous nursing practice to improved patient outcomes. This evidence supports nurses' assuming accountability for managing aspects of nursing care that require ongoing vigilance and titration, such as enteral nutrition, sedation assessment and titration, wound care, ventilation weaning, extubation readiness testing, and family support. Every day, for instance, cardiovascular nurses monitor and treat potential primary and secondary injuries related to a congenital defect or disease process. Nursing's impact on patient outcomes is seldom obvious. But this was not always the case.

Clinical Inquiry in Nursing
The birth of professional nursing is often attributed to Florence Nightingale, a nurse serving in the Crimean War who systematized data-keeping practices. Nightingale's calculations of mortality showed that an improvement of sanitary methods could reduce patient deaths and her hypothesis proved correct. Her work stimulated significant breakthrough thinking on disease prevention: hospitalized patients no longer experienced 43% mortality due to preventable infections.

Over a century and a half later, clinical inquiry is still considered an essential nursing competency. By definition, clinical inquiry is the ongoing process of questioning and evaluating and then providing informed practice; it's about clinical innovation through the application of evidence and experiential learning. In practice, nurses at varying levels of expertise identify aspects of care that are important for quality monitoring. They contribute to the development of evidenced-based algorithms, decision trees and protocols, and they use an evidenced-based process to evaluate current practices and to make recommendations for best practices. In addition, nurses develop and/or participate in studies to evaluate patient-care issues, products and technology. Over the past year, for example, the Nursing Critical Care/Cardiovascular Clinical Practice Group at Children's reviewed and implemented modifications based upon the program-based core metric reports that describe quality care. They reviewed best practices and made recommendations on many clinical issues, including the insertion and maintenance of nasojejual feeding tubes, the obtaining of arterial and central venous blood specimens, and eye-care routines. The group also systematically evaluated a superfluous system that was found to be inadequate to meet the unique needs of the pediatric patient.

The Science of Nursing
The science of nursing is unique. Because of the nature of nursing, both qualitative and quantitative scientific methods are equally important. The method used depends upon the research inquiry-questions derived from direct patient care, from observing recurrent clinical problems, from noting variations in practice and knowledge to practice gaps.

The American Nurses Association acknowledges four essential features of contemporary nursing:

1. Attention to the full range of human experiences and responses to health and illness
2. Integration of objective data with knowledge gained from understanding of the patient's subjective experience
3. Application of scientific knowledge to the process of care
4. Provision of caring relationships that facilitate heath and healing.