Nursing research in Europe exists, but is not visible enough and still remains a relatively new activity in most EU Member States. The design of the European Nursing Research Foundation (ENRF) is therefore key to connect better research findings with political decision-making at EU level. The European Council, the European Parliament and the European Commission need better and more strategic and systematic research input to design “fit for purpose” health and social policies. There is no doubt that, when setting the EU political agenda and developing the nursing profession, nursing research and EU policy-making should go hand in hand, knowing that nurses look at improving the delivery of evidence-based care to strengthen quality and safety from a joined research and clinical practice perspective.
Within the context of the increasing austerity measures and disruptive models to reform healthcare systems throughout the EU, the EFN members felt the importance of securing reliable evidence from which to base future workforce decisions. This implied the development of the European Nursing Research Foundation (ENRF).
Based in Brussels, the European Nursing Research Foundation (ENRF) is a non-profit, non-governmental organisation. Founded by the European Federation of Nurses Associations (EFN) in May 2013, the European Nursing Research Foundation (ENRF), is aiming at making the bridge between evidence and policy-making process and act as a contact point for EU policy-makers and politicians, and analysing and compiling what already exists in terms of nursing research in the EU Member States, in order to convert existing data into evidence-based advocacy for the EU policy-making process. The Foundation has the ambition to become a reference point and identifiable value in nursing research, translating knowledge into health policy with the ultimate objective to improve our knowledge base when reforming national healthcare systems, and to become the scientific foundation to enhance the EU health policy agenda. As such, the ENRF, together with EFN, has been closely monitoring the developments of Horizon 2020 – crucial for creating an evidence base for nursing research.
From May 2013 to December 2015, the Foundation was managed and represented by a Board of Directors composed of four members coming from the EFN Executive Committee, as approved by the EFN General Assembly in April 2013, Brussels:
Icelandic Nurse Association
Irish Nurses and Midwives Organisation
Royal College of Nurses – UK
Paul De Raeve
ENRF Secretary General
AN EFN MEMBERS’ INITIATIVE
For achieving a context based evaluation, it is important to have a view on why the ENRF has been established, and why there was a need to create such a Foundation. To understand that, we need to go back in time!
Nursing research has been for many years recognised as having a vital role to play in maintaining and promoting the health of European citizens while fostering the development of quality, efficient, and safe healthcare services delivery.
The EFN supports the idea that: nursing research has to be acknowledged as an integral part of building a healthier and competitive Europe; Research Capacity for Nursing has to be prioritised at both European and National levels; and, the European Commission and the European Parliament need to support nursing research by developing closer partnerships with European professional nursing organisations.
But for more than two decades after the Council of Europe Recommendations on Nursing Research (1996) Europe has still some way to go if its Health and Lisbon objectives are to become reality. A research base in Nursing is essential not just for nurses but also for funders of health services and health policy makers. Therefore, we can say that Nursing Research has become an imperative component in building a healthier and competitive Europe.
As such, in 2008, during the EFN April General Assembly, held in Copenhagen, the EFN Members recognised that National Nursing Associations (NNA’s) needed to reach a consensus on the collective priorities of European NNA’s in relation to nursing research in Europe and reached agreement on the most efficient and effective means of realising these priorities. It was thus decided to establish a “Delphi Group” constituted by the EFN members from Germany (DBFK), Portugal (Ordem dos Enfermeiros), and UK (Royal College of Nursing) aiming at facilitating this debate.
Four strategic priorities were recognised by the Delphi Group: identify/develop nursing research evidence to underpin European Union lobbying for the benefit of nurses and nursing; lobby for the inclusion of a nursing perspective in all European national research agencies, ensuring that nurses are participating in national research development and budget setting; identify/develop research evidence to underpin nursing care for the benefit of patients and those living in Europe; identify support mechanisms for nurses in those countries with fewer professional development opportunities. The vision was that in the long run there would be a nursing infrastructure / institute based in Brussels that would closely aligned to, but at arm’s length from the EFN. To reach an agreement on the most efficient and effective means of realising these priorities and this vision, the Delphi group proposed that a feasibility study for a nursing research institute should be carried out.
At the October 2009 EFN General Assembly, the EFN Members were informed on the first results of the survey entitled “Nursing Research in Europe: reaching a consensus on strategic priorities”, and concluded that it would be important to focus on areas where the EU has competencies, namely highlighting work that has been/is being done and/or on the outcomes of such research. The first priority should be to collect what already exists in terms of research made by nurses, and come up with a statement on the number of nursing scientists needed in all the EU countries. For the EFN Members, it is crucial to have research evidence, and to think on how to make these results alive, how to move it forward strategically, and how to connect it with existing networks.
The former EFN President, Unni Hembre, from Norway, suggested at that time that in order to reach these goals, the EFN should look for possibilities to work for establishing an “EU Florence Nightingale Research Institute”, with its official location in Brussels, near the European Commission, and specifically near DG Research. Being located, as EFN, next to the EU Institutions and the EU policy & decision makers, is key to empower nursing research in the EU.
In 2010, after two years of data collection (Delphi Study) and sharing of views on new developments for nursing research priorities and needed structures, the EFN Executive Committee asked the EFN Secretary General to put together ‘A Vision for the Future on European Nursing Research’, explaining the need to create a ‘constitutional independent’ and ‘virtual’ nursing research network, taking into account the growing demand for research evidence and good quality data, and the European Commission preparations for the 8th Framework Program of DG Research, called H2020.
This was timely for the EFN members to decide on how to best move the nursing research agenda forward and what resources and structures would be needed linked to EFN and its NNAs to achieve the best outcome for nurses and nursing. Most EFN Members agreed on the necessity of immediate engagement in H2020 research and that it was time to develop a strategic EU approach to research. For them, research must overcome the gap between evidence and clinical practice and bring effective political outcomes to the nursing practice, and the data collection and evidence base need to support the EFN lobby work and emphasise the professional development across the EU and Europe.
The discussion on the document developed by the EFN Secretary General as well as the mission and the future of Nursing Research in the EU went on in 2011 during the two EFN General Assemblies, with the members very enthusiastic, aiming to be involved in this huge project, and fully supporting the initiative seen as crucial to get evidence and promote the role of nurses in research.
In the 2012 Spring General Assembly in Slovenia, the EFN members gave a mandate to the Delphi group to take further the feasibility study on the European Nursing Research. The Delphi group met online and developed Terms of Reference for the feasibility study. The study results were presented at the autumn 2012 EFN General Assembly in Luxembourg. The EFN members’ main conclusion and recommendation were that a European Nursing Research Institute would be a unique opportunity to bridge evidence and policy-making while acting as a contact point for policy makers. The purpose of the institute would not be to do research but to analyse and compile what already exists in terms of nursing research in the EU Member States so that existing data can be converted into evidence-based advocacy for the EU policy-making process. The structure, governance and funding of a European Nursing Research Institute was also discussed and the EFN members agreed to move forward with this unique institute in Brussels which is expected to gain credibility over the years and become an EU added value in the EU policy-making process.
In meantime, the European Commission developed its digital agenda, and within its 2012-2020 roadmap, added an important article, highlighting the importance of nurses and nursing in eHealth. This political opportunity was used to attract EU funds through a call for tender. EFN submitted a project, with 24 partners, of which the ENRF was a work package leader. To be a partner in EU projects, there was an urgent need to register ENRF as NGO under Belgium law. Following the discussion in the General Assembly, in April 2013, the EFN President, Unni Hembre (from the Norwegian Nurses Organisation), signed on 3 May 2013, before the notary, the Constitution of the newly established European Nursing Research Foundation (ENRF), officially published in the ‘Moniteur Belge’ on 8 May 2013. EFN submitted the EU project ENS4Care immediately after.
However, the EFN members realised more work was needed on the ENRF Constitution and started immediately a working group on the ENRF Constitution and Internal Regulation in 2014.
In October 2013, the EFN General Assembly approved the revision of the ENRF Constitution published in May 2013 to take into consideration the ENRF members’ concerns. As such, a Working Group (ENRF CWG) was established at the EFN April 2014 General Assembly and was given the mandate to undertake this work.
Meeting for its first meeting on 15 January 2014, the ENRF Board agreed (also approved by the EFN Executive Committee, on 16 January 2014) that the EFN existing Constitutional Working Group should take this work further. Thus, those individuals of the EFN Constitutional Working Group who were still present in the EFN General Assembly were asked to continue their work in the ENRF Constitutional Working Group, as their expertise was seen as extremely important in this development.
As a first step, the ENRF Constitutional Working Group developed a working document outlining the principles under which the ENRF would operate and serving to orient the drafting of the necessary changes to the current ENRF Constitution. Furthermore, taking into account the ENRF Board questions, as: How are the ENRF Board members elected?, For how long/how many terms?, Financial sustainability of the ENRF?, Is ENRF working under EFN goals?, ENRF network development in the long term? Important to keep the link with EFN and its key goals/priorities,- the ENRF Constitutional Working Group developed an ENRF Governance and Management Model that was presented to and approved by the EFN Executive Committee on 18 September 2014, and the EFN General Assembly, in October 2014.
Máximo Gonzalez as the Chair of the Constitutional Working Group met the EFN Executive Committee on 18 September 2014 to explain the process and the principles of the Constitutional Working Group proposal, as well as the governance and management structure of the ENRF. The Executive Committee was quite happy with the draft proposal but expressed concerns on the composition of the ENRF board, which led to a consensus of 4-4 composition. Furthermore, the EFN Executive Committee expressed the importance of the EFN Secretary General’s role in the Foundation, due to the knowledge base of how to pursue EU projects, and the importance of EFN having a key role in setting the direction and work of the Foundation. Furthermore, it is important to recruit, based on the finances provided by the founding members, an Executive Director to run the Foundation who will take their direction from the ENRF Board and will report for day today management to the Secretary General of EFN.
In order to continue this well engaged revision process, the October 2014 General Assembly gave a mandate to the Working Group to continue its work. After several meetings, the new ENRF Constitution was presented to and approved by the EFN April 2015 General Assembly, who gave a new mandate to the Constitutional Working group to develop the ENRF Internal Regulation, based on the new ENRF Constitution. The Working Group accepted to go on with this work and met on: 11 June; 8 July; and 16 July and 7 September to develop the new ENRF Internal Regulation. Finally, the draft Internal Regulation was presented to, and amended and approved by the EFN October 2015 General Assembly, in London.
With these two documents in place, the ENRF can now focus on its main objectives: To pursue and enhance nursing research as an element of professional excellence to benefit the health of the population in the EU and Europe; To use nursing research to influence EU policies; and To promote evidence-based decision-making.
The members of the ENRF Constitutional Working Group were: Maximo Gonzalez (Spanish General Council of Nursing) – Chair; Herdís Gunnarsdóttir (Icelandic Nurses Association); Elizabeth Adams (Irish Nurses and Midwives Organisation); Dorota Kilanska (Polish Nurses Association); Eva Szutkowska (Vårdförbundet – Swedish Association of Health Professionals); Matthew Hamilton (Royal College of Nursing – UK); and Paul De Raeve (EFN General Secretary). The EFN lawyer, Hans Neirynck, was also involved in this process to make sure the ENRF Constitution and Internal Regulation were complying with the Belgian law.