Guidance on pursuing a career in nursing research

Authors

Tonks (Josephine) Nicola Fawcett, Professor of student learning (nurse education), Nursing Studies, School of Health in Social Science, University of Edinburgh, Edinburgh.

Corrienne McCulloch, Critical care research nurse, Wellcome Trust Clinical Research Facility NHS Lothian, and doctoral student in nursing studies, University of Edinburgh.

Short description

Nurses can make an important contribution to clinical research in a variety of healthcare settings. This module explains how to pursue a career in nursing research.

Detailed description

Nursing is an evidence-based profession that uses the latest and best research to improve nursing practice and patient outcomes. Nursing research is needed to generate knowledge and develop nursing care. Despite this, the role of the research nurse is poorly understood and appreciated. This learning module discusses the importance of the nurses' role in clinical research and provides information on how to pursue a career in research.

Module overview

Nursing is an evidence-based profession that uses the latest and best research to improve nursing practice and patient outcomes. Nursing research is needed to generate knowledge and develop nursing care. Despite this, the role of the research nurse is poorly understood and appreciated. This module discusses the importance of the nurses’ role in clinical research and provides information on how to pursue a career in research.

Keywords

care standards, career development, clinical guidelines, evidence-based practice, nursing roles, patient outcomes, research, workforce

Aims

This module aims to explore the importance of the nurse’s role in clinical research. It reflects on how nursing evolved from being almost devoid of any form of literature base to an established evidence-based profession, and examines the contribution of this knowledge to best practice.

Intended learning outcomes

After reading this module and completing the time out activities you should be able to:

• Discuss the development of nursing as an evidence-based profession.
• Demonstrate an understanding of the role of the research nurse in improving patient care.
• Describe the main roles and responsibilities of the clinical research nurse.
• Identify possible career pathways for nurses involved in research.
• Outline the contribution of nursing research to best practice.

Introduction

Nursing as a profession has encountered many challenges and its image of providing high quality patient-centred care has been tarnished (Francis 2013). Despite this, those who choose to enter the nursing profession should strive to deliver best care. The first training school for nursing was set up by Florence Nightingale more than 150 years ago. Since then, nursing was recognised as a profession that not only responded to those in need with care and compassion, but also as a profession that used research and scholarship to underpin the essential nursing attributes and elements of care.

The International Council of Nurses (2007) describes research-based practice as the ‘hallmark of professional nursing’ and states that quality research is integral to best practice, evidence-based care and cost-effective health care. Henderson (1991) stated that:

‘The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to a peaceful death) that they would perform unaided if they had the necessary strength, will or knowledge – and to gain independence as rapidly as possible’.

To fully achieve this ideal, the nurse ‘at the bedside’ must incorporate knowledge and understanding generated by research nurses into their practice.

Knowledge base of nursing

Discussion around nursing as a profession tends to focus on care giving, the nature of compassion, and the importance of dignity and respect. However, nursing is less often considered in terms of its knowledge base and the research evidence on which practice is based.

Historically, nursing existed only in religious orders or was associated with less reputable individuals who could find no other employment (Sarkis et al 1986). Nursing practice was not based on any established body of knowledge or scientific foundation (Sarkis et al 1986).

Florence Nightingale had a significant role in changing this perception and developing the concept of modern nursing. She emphasised the necessity for nurse education and research to produce a body of knowledge that would underpin nursing as an autonomous profession.

When nurse education became available in institutes of higher education, nursing as a discipline developed alongside other scientific disciplines such as medicine.

Significance of research in nursing

Briggs (1972) suggested that nursing should be a research-based profession. This is not to suggest that all nurses must carry out research, but all nurses must be ‘research minded’ (Parahoo 2006).

It is important that nurses question the knowledge and rationale on which they base their practice and, by doing so, seek to develop ways to improve care. It may be that searching the literature will provide the means of improving practice for some, but where no solutions to a problem are easily identifiable, the support of a nurse with specific research expertise may be necessary.

Although nursing research became increasingly recognised, and by the 1980s reputable nursing research units had been established in universities, research was still not perceived as every nurse’s business and was considered the remit of a few elite academics set apart from practice and not part of the matrix of nurses delivering patient care.

Ways to promote nursing research

Tierney (1998) identified four main ways to promote the integration of research into the nurses’ role, which included the development of:

• Bottom-up initiatives.
• Top-down initiatives.
• A research infrastructure.
• Strategic, rather than ad hoc, approaches.

As nurse education in research developed and evidence-based practice became part of the nurse’s repertoire, there was still insufficient opportunity for, or recognition of, nurses who might wish to express their care and improve patient outcomes through research. In recent years, initiatives and recommendations have promoted a more flexible career structure that involves combining clinical and academic work (UK Clinical Research Collaboration (UKCRC) 2007).

Quantitative approach (randomised controlled trials)

Healthcare research is rich and diverse but perhaps because of the dominance of the medical model, research is often viewed within the confines of the ‘gold standard’ randomised controlled trial (RCT). This quantitative approach to research seeks out the statistically supported merits of a new intervention against established practice, be it equipment, a surgical procedure, a wound management product or a new medication.

Clinical trials

In clinical trials, nurses who are involved in research play a vital role in ensuring the wellbeing and safety of patients, alongside the day-to-day running of the trial and an understanding of the research study and research processes.

Poston and Buescher (2010) identified research nurses as being at the fulcrum of such trials. Campbell (2011) recognised the increasing complexity of clinical trials, and in the context of cancer care, stated that the role of the research nurse is ‘multifaceted, and comprises several sub-roles that may be present individually or combined to meet the complex needs of the patient and family involved in a clinical trial’.

Qualitative approach

Research, in particular, nursing research embraces more than RCTs. Consistent with its philosophy of care, nursing research explorations and areas of enquiry often focus on the human experience of health and illness and seek to understand cultural phenomena from the perspective of the individual – the ‘emic’ perspective (Headland et al 1990). Such research is often qualitative in nature and seeks to gain insight into how patients perceive the care they receive, understand their illness and reflect on their experiences as patients. This focuses on human-to-human care and how it can be enhanced.

Learning Points

1. Nursing as a profession tends to focus on care giving and the nature of compassion, and it is less often considered in terms of its knowledge base and the research evidence on which practice is based.
2. It is important that nurses question the knowledge and rationale on the basis of their practice and seek to develop ways to improve care. It has been suggested that all nurses must be ‘research minded’.
3. Randomised controlled trials (RCTs) are often considered the gold standard of research.
4. In clinical trials, nurses who are involved in research play a vital role in ensuring the wellbeing and safety of patients, alongside the day-to-day running of the trial and an understanding of the research study and research processes.
5. Nursing research explorations and areas of enquiry often focus on the human experience of health and illness and seek to understand cultural phenomena from the perspective of the individual – the ‘emic’ perspective.

Developing a career in nursing research

Nurses who wish to pursue a career in research will often have demonstrated an interest in the area during their time as nursing students, recognising the importance of research in improving practice and patient outcomes.

Scope of clinical research nursing

Developing a nursing career in research can be initiated through various routes.

• For nurses who may have only learned about research in their undergraduate course, encountering a clinical research nurse (CRN) in their daily work may increase their awareness of research in practice.
• The CRN is part of the research team and may work across different specialties. The research team in general and the principal investigator in particular, are responsible for the delivery of the research study or programme of research. The CRN requires several new and specialised skills, including an understanding of the research process and adherence to research-specific legislation and guidelines.
• The Research Governance Framework for Health and Social Care (Department of Health (DH) 2005) requires that all clinical researchers follow the principles of good clinical practice, which include ethical guidance for undertaking research.
• Being part of the research team provides opportunities to learn about and become involved in designing future research proposals, writing applications to secure funding and disseminating and implementing research findings in practice.
• Adjusting to the new role is one of the challenges of being a CRN.

Research nurses work in accordance with Nursing and Midwifery Council standards and codes of practice (NMC 2015), as well as national and international legislation and guidelines relating to research (Hill and MacArthur 2006).

CRNs are highly skilled nurses who are integral to the research team and the successful application of research to nursing practice. They possess knowledge of research ethics and legislation and of protocol development and most importantly, ensure the welfare of research participants. However, misconceptions surrounding the role of the CRN continue to exist.

Box 1. Examples of research activities carried out by a clinical research nurse

Identifying potential research participants in collaboration with the clinical team.
Assessing study eligibility using study-specific inclusion and exclusion criteria.

• Approaching and informing potential participants about the research study and what it involves while guiding these individuals through the informed consent process.
• Enrolling participants onto the research study, for example via an electronic randomisation system.
• Performing study-specific procedures, for example collecting and recording data, biological sampling and processing, performing clinical measurements, preparing and administering investigational medicinal products, and informing and guiding participants.
• Communicating with clinical staff and members of the multidisciplinary team caring for participants.
• Monitoring and reporting adverse events.
• Acting as advocate for study participants.
• Interviewing, questioning and eliciting information from participants.
• Increasing the profile of research in the clinical area and the clinical research nurse’s role within it.
• Being involved in study protocol, implementation and analysis.
• Educating healthcare professionals in the clinical area linked to a specific research study or supporting learning needs within the wider research team.

Traditionally, it was the more experienced nurses who became CRNs. This is in keeping with the view of some employers that ‘a solid foundation based on years of experience is vital to the role’ (Pick et al 2011).

• For nurses who wish to develop their own research ideas and lead the way in nursing research, the CRN role, although mainly involved in assisting other people’s and professions’ research, provides an excellent foundation in good research practice.
• The role of the CRN has been associated with job satisfaction, particularly regarding the knowledge that what the nurse is working on today will improve future patient care. However, it is important for anyone thinking about a career in research to consider that many research posts are fixed-term contracts because of the funding or grants attached to each project (Rodrigo 2013).
• Whatever route the nurse decides to take, it is likely that they will be involved with a research team.

Career development in nursing research

• Other career paths and areas of interest available for nurses in research include trial management, research ethics, research governance and education.
• UKCRC (2007) proposed a more flexible career structure so that nurses could pursue and combine their clinical and academic research-based work. As a result, several research training schemes have been developed to offer a comprehensive clinical academic training pathway.
• The emergence of clinical academic research careers (Butterworth et al 2005, NHS Education for Scotland 2011, DH 2012) and programmes for graduate nurses, such as the Masters of Nursing in Clinical Research at the University of Edinburgh, which incorporates research practice into the programme of study, aim to encourage nurses to become involved in research earlier in their career and develop their own research ideas from nursing practice and pre-registration learning. In this way, a structured career pathway for nurses interested in research is established.

An interest in research may arise from student experiences or a research problem identified once qualified and working in a ward or community setting, or within a particular clinical specialty. To pursue this aspiration, nurses are likely to turn to academia where they can be supported in furthering their knowledge as researchers. They may undertake a continuing professional development module in research, perhaps leading to an intermediate degree or doctoral studies.

There is more than one route to pursue a research career. Box 2 provides an example of one nurse’s pursuit of a career in research.

Box 2. Example of a nurse pursuing a career in research

Jane graduated with an honours degree in nursing. During her undergraduate programme, she became interested in the area of critical care and, after two years in a general medical ward, she began working as a staff nurse in a general intensive care unit (ICU). It was within this unit that, for the first time, she met a clinical research nurse (CRN) who was exploring sedation practices in critically ill patients.

The idea of being involved in research that could improve the care of patients was exciting. Jane was interested in undertaking further education and having observed the work and role of the CRN, she was eager to return to postgraduate education and pursue a career in research.

After undertaking various research-based continuing professional development courses, the first step for Jane was the successful move into a post as a CRN in critical care, a different role, but one where she could still work in her specialist area of nursing. Following the principles of good clinical practice (Department of Health 2005), Jane’s research role involved visiting patients and families following a stay in the ICU for follow-up visits and consent for inclusion in a research study.

Because of this new nursing experience, Jane realised that, despite having cared for critically ill patients for several years, she knew little about their experiences and the long and often complicated journey of recovery.

From Jane’s experiences as a CRN, the desire to undertake her own research took shape and with the support of the clinical academic career initiative being piloted in the trust (NHS Lothian 2010), Jane was seconded part time to a PhD fellowship. She carried out research as a doctoral student exploring the experiences and perspectives of patients and their families during and after an episode of critical illness. Jane’s ambition is to gain a PhD and develop post-doctoral work in the field of critical care and patient wellbeing.

Research teams exist in various settings and formats and the specific role of the nurse involved in research will depend on the nature of the research being conducted, the other members of the team and where the research takes place. Working in, or leading, a research team enables the nurse to be involved in the research process and have access to the expertise and experience of other team members. For a nurse undertaking MSc or PhD study, the research team might be quite small, consisting of the nurse and his or her academic supervisors.

Conclusions

• Nurses need to view research as being integral to patient care.
• Research adds to the body of nursing knowledge contributing to evidence-based care and improved patient outcomes.
• There are increasing opportunities for nurses to combine their clinical and academic work with the aim of pursuing a career in nursing research.
• Nurses should be encouraged and supported to consider a career in nursing research.

Acronyms

CRN: clinical research nurse

DH: Department of Health

NMC: Nursing and Midwifery Council

RCT: randomised controlled trial

UKCRC: UK clinical research collaboration

Glossary

Clinical research nurse: highly skilled nurses who are integral to research teams and the successful application of research to nursing practice. They possess knowledge of research ethics and legislation and of protocol development and ensure the welfare of research participants.

Emic perspective: research that is often qualitative in nature and seeks to gain insight into how patients think, perceive and categorise the world, as well as their rules for behaviour.

Randomised controlled trial: a type of study for a proposed new treatment in which participants are randomly assigned to participate in either an experimental group which receives the new treatment or a control group that does not.

References

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Department of Health (2012) Developing the Role of the Clinical Academic Researcher in the Nursing, Midwifery and Allied Health Professions. The Stationery Office, London.

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