The incentive for hospitals to participate in a pay-to-participate multi- site study is 3-fold. First, lack of research expertise in individual hospitals is common. Most small- to medium-size hospitals do not have the resources to hire experienced researchers or the support services, such as a statistician, required to guide meaningful clinical research projects. Without such expertise, there is usually no one to mentor
or guide the nurses on staff, who typically are not trained to design and conduct even small-scale studies.