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Appendix A - RIC Study Review Application

Application

Appendix A

Research & Innovation Council
Research Study Application for Nursing Review
All research studies involving use of nursing time, effort, and/or resources at UCLA Health System sites (including, but not limited to, as subjects, investigators, clinical care providers or data or specimen collectors) require Research & Innovation Council (RIC) approval to assure that the rights and welfare of all patients and nurses are protected.

Please complete the brief application below. For additional information on the RIC study review exemptions and process, please visit https://www.uclahealth.org/nursing/researchstudyreview. 


 
This question requires a valid email address.
This question requires a valid email address.
6. Has this research study been submitted to the UCLA Institutional Review Board (IRB)? *This question is required.
7. STUDY LOCATION (check all that apply): *This question is required.
9. NURSING RESOURCES: Describe the activities for which nursing staff will be responsible (check all that apply): *This question is required.**Procedures related to STANDARD PRACTICE requires no additional collections or handling beyond routine care for patients. RESEARCH-RELATED procedures are those that are not part of routine care, but are instead performed specifically for a study (e.g. requires additional data or specimen collection and/or special handling).
12. COMPENSATION: How will nurses/nursing cost center be compensated for their participation?
13. STUDY DOCUMENTS: Please submit the following documents: abstract/synopsis, proposal/protocol, informed consent, recruitment material, and data collection instruments. *This question is required.
13. ADDITIONAL DOCUMENTS: Please submit any additional documents that you feel will be pertinent to the review of your study that has not already been submitted to the UCLA Institutional Review Board.
By submitting this form, you provide assurance that you have fully discussed with, and have received the support of, the Clinic Head/Manager/Unit Director/Clinical Nurse Specialist as it relates to nursing time, effort, and resources in the clinical care area where the research will be conducted. 

Please send by clicking "Submit" below. If you are having difficulty, then please e-mail:

Pamela Miller, PhD, RN, ACNP, CNS
Senior Nurse Scientist 
psmiller@mednet.ucla.edu

UCLA Health
Center for Nursing Excellence
924 Westwood Blvd., Suite 720
Los Angeles, CA 90095

Dedicated to Bridging Research and Practice