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Exclusive: Nursing must overcome barriers to vital research

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Workforce pressures, education structures and negative perceptions are all holding back nurse involvement in vital research and innovation that could benefit patient care, a Nursing Times survey has revealed.

Nearly two-thirds of nurses who responded to our survey believe there is insufficient opportunity to build research into their job or career, with lack of time and information cited as the major barriers.

“We need to ask ourselves about what else we can do as part of our work to promote clinical academic careers”

Lisa Bayliss-Pratt

However, in contrast to the perceived challenges, nurses in our survey indicated a desire among the profession to get more involved in research and further develop their ideas for best practice.

Of the 650 or so respondents to our survey, 98% said nurse-led research or research by nurses was “vital” or “important” to furthering best practice among the profession.

In addition, 68% said they were either “very” or “fairly interested” in a career that involved research as part of the job, and nearly half said they had considered conducting their own clinical research.

Three-quarters (74.4%) said they would be interested in finding out more about opportunities to get involved in clinical research.

“I am interested in research, but the pressure of work and lack of staff means working late every shift”

Survey respondent

But 63% of respondents told Nursing Times they did not think there were enough opportunities for nurses to develop a career in clinical research.

Asked what the biggest challenges to nurses getting involved in clinical research, 39% of nurses cited a lack of time, 17% said a lack of information on opportunities, and 11% a lack of staff cover.

“Time constraints prevent much of what may be possible,” said one survey respondent, seemingly reflecting wider concerns about current pressure on the nursing workforce.

Echoing this view, another said: “I am interested in research, but the pressure of work and lack of staff means working late every shift. We have to do our learning in our own time.”

Also citing time as the main barrier to involvement, one respondent said they were “just too physically and mentally exhausted to undertake research, as my work-life balance is a struggle now”.

Meanwhile, other nurses highlighted lack of encouragement from managers, or in some cases even active discouragement. “There is limited opportunities or encouragement within organisations due to the current austerity and political changes within the NHS,” said one nurse.

“It is encouraging that so many people think [research] is important and hopefully it might mean that more nurses get involved”

Kirsty Winkley

Another said: “Managers are often unsupportive and I have heard one manager state that they think nurses who request research opportunities are just trying to get out of clinical work. I believe that these sorts of negative attitudes really need to be challenged.”

The survey also indicated that historical perceptions about the medical profession being being prioritised over nursing were also true when it came to research opportunities.

Nearly three-quarters (72%) felt that nursing research was perceived as less important than studies by doctors, though 23% thought the two were viewed with the same level of importance.

Reflecting a common view among respondents, one nurse said “medical research steals the limelight, leaving nursing in the wings”, adding that it was a “real shame, as much talent is wasted”.

One respondent said nursing research was “less valued by clinical staff than medically-led controlled trials, both because of the topics that nurses consider are important and the methodologies (often qualitative) which are used”. “Therefore, nursing research is both professionally and academically disadvantaged,” they said.

Another agreed, suggesting research by nurses was viewed as “superficial and basic compared to medical research”, but this was because wards were “so short-staffed there is no time for research, professional development or education of any kind”.

A further respondent said nursing needed to have a “similar set-up” to medicine in terms of being able to select research “as an active part of their career”.

“Nurses just qualify and then are left to go through the ranks as they see fit,” they said. “However, medics have ongoing training at each level and a research component us available to them. This is lacking in nursing.”

Nursing Times conducted the survey between the end of September and early December 2016, in partnership with the National Institute for Health Research and Health Education England.

“We are hugely committed to developing research opportunities for the nursing workforce”

Dave Jones

The survey represents the first time in around a decade that Nursing Times has directly asked readers about their involvement and views on research by nurses.

The questionnaire also asked respondents about their own experience of being involved in studies and trials, and how aware they were of research taking place at their place of work.

The majority, 61%, had not been involved personally in clinical research. Of those that had, most had helped recruit or inform patients about taking part in studies.

More than half (56%) said they were aware of clinical research – either nursing or medical – going on at their organisation, while around a third (33%) knew of someone within their department or trust who had received funding to undertake clinical research.

Asked what would make them more interested in a career involving clinical research, the top three factors chosen by respondents were more information, more long-term research career opportunities, and more encouragement and support from managers.

Reflecting opinions cited by several respondents, one nurse said: “There should be protected time for all nurses to be involved in some aspect of clinical research.”

“Nurses need to have more education as students on clinical academic careers,” said another, also reflecting a view stated by several respondents.

Lisa Bayliss-Pratt

Lisa Bayliss-Pratt

Lisa Bayliss-Pratt

The Shape of Caring review, commissioned by Health Education England, made specific recommendations highlighting the importance of research within nursing and developing evidence-based practice.

It called for greater emphasis in nurse education on developing greater decision-making skills and share-decision making and the routine application of research and innovation.

The report, published in March 2015, noted that increasing numbers of registered nurses were engaging with research and seeking to implement research findings to underpin daily work.

But it cautioned that it was “not seen as the norm”, stating that the ability to “research, engage in critical inquiry and implement research findings that imbue everyday practice is imperative”.

It called for nurses and healthcare assistants to have a “strong grounding” that encouraged them to both question inappropriate practice and to adopt flexible and innovative approaches to care.

The NIHR and HEE will now use the insights revealed by the survey to inform their programmes to develop nursing research.

Professor Lisa Bayliss-Pratt, HEE’s director of nursing and deputy director of education and quality, said: “The research undertaken by the Nursing Times stresses the importance of nursing professionals having the opportunity and support to pursue a clinical academic career.

“We are pushing on an open door as three quarters of people surveyed said they wanted to find out more about opportunities to get involved with research but raised concerns about the opportunities for nurses to develop a career in clinical research,” she said.

“We need to ask ourselves about what else we can do as part of our work to promote clinical academic careers and open up opportunities for nurses to be involved in research,” added Professor Bayliss-Pratt.

She told Nursing Times that, over the next few months, HEE would be working with nurses to help understand the factors that “enable and inhibit career progression for those who wish research to be an integral aspect of their chosen career path”.

In addition, HEE and the NIHR have set up the Integrated Clinical Academic programme in order to offer more research education opportunities outside of medicine and provide a pathway for nurses to develop a clinical academic career.

The ICA programme for non-medical healthcare professionals, which started in 2015 and is due to open for its next round of applications in March, provides a range of opportunities to undertake fully funded clinical research, research training and professional development whilst maintaining clinical practice and salary.

National Institute for Health Research/NIHR

Exclusive: Nursing must overcome barriers to vital research

Kirsty Winkley

Kirsty Winkley, a senior diabetes specialist nurse in Lambeth, South London, who has a PhD, said it was positive that so many nurses responding to the survey wanted to be more involved in research.

“It is encouraging that so many people think it’s important and hopefully it might mean that more nurses get involved in research, which would be fantastic,” said Dr Winkley, who is also an ICA senior clinical lecturer in diabetes and psychology at King’s College London and Institute of Psychiatry.

She welcomed fellowships like those provided by the NIHR but called for publicity around such initiatives and called for more similar opportunities, suggesting that research should feature more heavily in nurse education.

“I’ve had to really make my own way to get to this position, whereas I think if nurses were aware that these opportunities existed right at the point where they’re training then they could plan for it, which would be much better,” she said.

She added that nurses who wanted to get more involved in research also needed practical support, for example, via some form of mentorship that would help with things like applying for grants.

“I think most nurses probably have quite a few research ideas and I think most nurses will have particular questions that they would like the answer to but don’t really know how to get from that point to writing a research proposal,” she said. “And that’s where they need the support.”

National Institute for Health Research/NIHR

Exclusive: Nursing must overcome barriers to vital research

Dave Jones

Professor Dave Jones, dean of NIHR faculty trainees at the institute, welcomed that the survey had revealed a “real interest” in nursing research and a feeling that it was “important” for the profession’s development.

“I think it’s a hugely positive survey,” he said. “There is real interest, a real sense that this is important and we can do exciting things, and a real desire to do that.”

However, he noted that it had identified several “learning points” for the NIHR, namely on increasing “awareness of the opportunities to get involved” at an individual level and boosting “organisational buy-in” among trusts facing workforce and financial pressures.

He added: “We are hugely committed to developing research opportunities for the nursing workforce.”

Research survey graphs

Research survey graphs

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