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From my perspective as a hospital epidemiologist, the important division of perspective here certainly isn't simply quantitative vs. qualitative and nursing vs. medicine. Infection control, for example, cuts across all these disciplines and much of the evidence behind infection control is based on knowledge gleaned from observational study designs in areas where RCT's aren't ethical, feasible or both. Much in healthcare administration and management has been rooted in tradition and assumption, dealing with fundamental questions where a mix of quantitative and qualitative research would better guide decisions. Many decisions in medicine need to be informed about effectiveness as well as efficacy... We certainly need to advance our knowledge by critical appraisal and grading of research evidence. When information needs relate to questions of efficacy, then RCT's are the best form of evidence. When questions relate to effectiveness, then observational studies like cohort & case-referent studies probably are best. When questions relate to efficiency or cost-effectiveness or perceived utility, yet other research paradigms are better tools. That being said, I believe educational deficits are part of the root cause for the chasm between these various camps. Poor numeracy skills hamper many of the students, entering nursing and other disciplines, that I've seen over the years. Inadequate emphasis on interdisciplinary education reinforces many of the silo mentalities I've encountered throughout health care organizations. Simplistic audit approaches reinforced by well-intentioned but short-sighted accreditation mandates have kept the position qualifications and program expectations too low in hospitals' safety, infection control, quality improvement and other such programs. There have been a number of interesting articles published in CLINICAL GOVERNANCE related to these points, including one with a nice flowchart to help distinguish audit from quality improvement from research per se - a spectrum of activity we should be seeing within every healthcare organization (not a spectrum dividing hospital-based health professional activity from university-based researcher activity). This has been an interesting thread. Let's bring our focus back to a convergence of useful tools! -- David Birnbaum, PhD, MPH Adjunct Professor School of Nursing University of British Columbia Principal, Applied Epidemiology British Columbia, Canada