Nurse researcher Jeanne-Marie Nollen breaks routine and gives nurses more autonomy

By: Lennart 't Hart

Nollen joined LUMC via the Bachelor of Nursing (HBO-Verpleegkunde) program in Leiden and a Master’s degree in Health Sciences at Vrije Universiteit Amsterdam. While working as a nurse in the neurology/neurosurgery department, she was given the opportunity to develop her thesis into a PhD project. “That’s how I basically rolled into it,” she says.

Normally, PhD candidates at LUMC are mainly physicians in specialist training (residents) or researchers with a background in, for example, medicine or biomedical sciences. Nollen explains: “There are not many nurses who pursue a PhD. Here at LUMC, I think you could count them on two hands.”

The role of nurse researcher did not yet exist

When she started, the position of nurse researcher did not yet exist. Her manager arranged for her to have time and budget to conduct research. According to Nollen, this resulted in a kind of dual role: “Half of the week I was on the ward in uniform, the other half I was working on my PhD research.” She describes this combination as “very valuable, because you know what is happening on the ward and what the problems are.”

It was pioneering work, and that came with challenges. “A physician-researcher who is pursuing a PhD often has an entire group around them to ask for advice and share experiences. I didn’t have that. At the same time, I experienced a great deal of support. There were nurses who actively participated in the studies and physicians who shared their knowledge with me. I could turn to them for advice, and that gave me confidence.”

Making nurses responsible

Nollen’s research focused on postoperative care (care for patients after surgery) for neurosurgical patients—patients with conditions affecting the brain, nerves, or spinal cord. The focus of her research was on urinary catheters. A catheter is a tube that is inserted into the bladder through the urethra to drain urine.

“My research revolved around improving the position of the nurse and the patient in routine care. Catheters turned out to be a good starting point. It was always unclear who was responsible for them: physicians or nurses? But nurses perform the procedure,” she explains. “After my study, we developed a clearer protocol for nurses, with room for independent action and always in consultation with physicians.”

Remove the catheter as soon as possible

The usual practice was that most patients received a catheter after surgery. After an operation, patients often cannot get out of bed easily, experience pain, or feel nauseous. But the convenience of placing a catheter also had a downside. This medical device carries risks, such as infections and slower recovery, and it is often unpleasant for patients.

Nollen investigated the reasons for placing a catheter, how patients experienced this, and whether catheters could be removed sooner. She also examined the optimal timing of removal. “There was a lot of discussion about that: is it better to do it in the morning, in the evening, or at night?” she says.

She reviewed various international studies on the subject. Based on these, Nollen concluded that there is no single “best” moment to remove a catheter, except “as soon as possible.” It was therefore not the time of day that mattered, but the duration of use.

Faster recovery for patients

With this knowledge, she initiated a study in five Dutch hospitals. These hospitals followed a protocol in which catheters were only placed if there was a medical indication—and not routinely for everyone. As soon as there was no longer a medical reason, the catheters had to be removed as quickly as possible. The result: less unnecessary use of catheters. It also helps patients get back on their feet sooner and hopefully contributes to a better overall experience of their care pathway.

Nollen published six scientific articles*, in which she describes and demonstrates that the protocol works. In one of these articles, she also describes the experiences of patients and nurses. She also explains how she had patients measure the specific gravity of their urine (a measure of density used to detect possible complications after surgery) using a simple system. “By measuring it themselves, patients were more involved in their recovery and had a better understanding of the course of their illness. Moreover, in almost 6 out of 10 cases it worked just as well as when the nurse did it. In the other cases, the nurse had to repeat the measurement.”

More flexibility and autonomy for nurses

With her PhD, Nollen has shown how a practical view of care can lead to scientifically substantiated solutions. She has also demonstrated that nurses do not have to be merely executors of care, but can also make independent decisions. “My research gives nurses more flexibility and autonomy. Instead of constantly having to check whether an action is allowed, they can often judge very well themselves what needs to be done.”

Nollen obtained her PhD on 25 November 2025. Wilco Peul was her PhD supervisor, and Anja Brunsveld-Reinders and Wouter van Furth were her co-supervisors.

Scientific publications:

1. Impact of early postoperative indwelling urinary catheter removal: A systematic review.
2. Patient perspectives on indwelling urinary catheters and fluid balances after transsphenoidal pituitary surgery: a qualitative study.
3. De-Implementation of Urinary Catheters in Neurosurgical Patients during the Operation and on the Ward: A Mixed-Methods Multicentre Study Protocol.
4. Decision-making around removal of indwelling urinary catheters after pituitary surgery.
5. Patient Participation in Urine Specific Gravity Screening for Arginine Vasopressin Deficiency in an Inpatient Neurosurgical Clinic.
6. Improving postoperative care for neurosurgical patients by a standardised protocol for urinary catheter placement: a multicentre before-and-after implementation study.