Is 0.1% acceptable?

31 January 2019

Guest blog by Professor Julie Sanders and Professor Sonja Mcilfatrick

Doctorally educated nurses, midwives and allied health professionals (NMAHPs) undertake, translate, implement and integrate research with teaching and clinical practice to increase diagnostic and treatment options and improve quality of care and clinical outcomes, in an ever-changing and increasingly complex healthcare environment. With such a crucial role in enhancing patient care and experience, as well as advancing the NMAHP professions, you would be forgiven for thinking that opportunities to promote such activity should be abundant. In reality, there is great challenge. According to the Medical Research Council, the proportion of clinical academic NMAHPs is less than 0.1% of the workforce – yes 0.1%!!

This leads to many questions exploring why this is the case and how can we seek to address this situation?

In 2018 we were both awarded a Florence Nightingale Foundation Leadership scholarship sponsored by the Council of Deans of Health (Julie Sanders) and the Chief Nurse of Northern Ireland (Sonja Mcilfatrick). In addition to all the other wonderful opportunities this scholarship provided, this also afforded us the time and opportunity to further explore the funding sources, and associated supervisory mechanisms, underpinning current post-doctoral NMAHP research in the UK. We had intended to collate data (including award, clinical speciality, institution) from the Association of Medical Research Charities (AMRC), Research Councils, NIHR and the Royal College of Nursing on all NMAHP research and personal awards where the primary and/or senior investigator was a NMAHP. However, while all institutions overwhelmingly agreed with the importance and value of the work, particularly in using this as a baseline on which to strategically plan future research priorities, only the NIHR were in a position to provide profession-specific data.

This data reveals some interesting findings. The NIHR data indicated 86 post-doctoral clinical academic grants have been awarded since 2006, totalling just over £25million. As previously reported, AHPs fare much better than nurses and midwives in securing NIHR funding, receiving almost £19million in 59 grants, with physiotherapists accountable for 50% of all AHP post-doctoral awards. Unsurprisingly, therefore, almost 20% of all awards were made for musculoskeletal research. Furthermore, there was a distinct lack of parity of awards across England, Wales and Northern Ireland (NMAHPs in Scotland are not eligible for these particular NIHR awards) with a small number of institutions being particularly successful. However, it is important to remember that while the NIHR is a key funding body, there are other funders and we are missing relevant and essential data, especially from charities. So, what does this (dearth of) data tell us?

Firstly, the data raises issues of ‘academic progression’ in the NMAH Professions. While for some, obtaining a PhD is the end goal, academic progression is often deemed unachievable due to the workload required to obtain funding and a perceived lack of NMAHP research teams to provide support (Logan et al 2015). Lack of opportunity, both financial and mentorship/supervision (particularly in clinical academic roles for NMAHPs) is a common theme due to the complexities of clinical and academic life where operational requirements (clinical work, teaching) often take precedent over research. Individuals report feeling ‘abandoned and isolated’ after completing their PhD.

Secondly, there is a lack of defined career paths for clinical academics. The Council of Deans of Health’s 2018 publication ‘Nursing, midwifery and allied health clinical academic research careers in the UK’ highlighted this and also a number of other challenges including, insufficient post-doctoral posts and administrative barriers to creating joint posts. Conversely, opportunities for promoting clinical academic posts included allocating funding and mentorship to dedicated post-doctoral training programmes, balancing research and clinical practice on a case-by-case basis, introducing mentoring scheme with senior clinical academics, developing strong programmes for continuing professional development and pooling financial resources from a variety of funding bodies to support clinical academic career development and progression, to name but a few. So, while there is much opportunity, there is considerable work to get these operationalised.

Thirdly, there is a need for an increased number of funded clinical speciality-specific and interprofessional collaborations. Focusing on current funding awards should emphasise areas of clinical and professional research deficit on which strategic plans could be targeted to increase funding and build NMAHP and interdisciplinary research capacity and capability. For example, Professors Sanders (Barts Health NHS Trust and Queen Mary University of London), Neubeck (Edinburgh Napier University), Fitzsimons (Queen’s University Belfast) and Deaton (University of Cambridge), four of only ten professors of nursing in the UK with a cardiovascular health background, successfully worked with the British Heart Foundation (BHF) to offer NMAHP-specific doctoral and post-doctoral fellowships, as existing schemes excluded NMAHP applicants. These are currently open for the very first round and offer a wonderful and exciting opportunity to increase research into improving patient outcomes as well as increasing NMAHP research capacity and capability in the field.

Fourthly, there are questions around the centralisation and spread of research funding. It is recognised that large, well-established research-intensive institutions have significant long-standing infrastructure support and track record in terms of research funding and therefore have success in securing research funding. However, this leads to questions around whether this contributes to an intensification in one area/institution, rather than contributing towards a corporate and professional responsibility to seek to build research capacity and enhance diversity.

So what next? Highlighting that there is a shortage of post-doctoral NMAHP clinical academic opportunities in the UK is not new, but in this blog we have highlighted the dearth of existing data to understand how our current post-doctoral posts are funded and supervised, and in what clinical areas research is being undertaken (or not). As indicated in Jo Rycroft-Malone’s recent CoDH blog, the newly established NIHR Academy aims to support building research capacity in nursing and other low-research generating clinical professions. However, perhaps more importantly, and as highlighted in the BHF example, we have a professional responsibility to collaborate between individuals and institutions across the UK to support the national agenda of facilitating NMAHP research capacity and capability growth. Without it, the long-term vision for NMAHPs being research-led evidence-based professions to increase treatment options and continually improve quality of care and clinical outcomes will be hindered.

We would like to thank the Florence Nightingale Foundation, Council of Deans of Health and the Chief Nurse of Northern Ireland for the scholarship opportunity.

Professor Julie Sanders, Director of Clinical Research, St Bartholomew’s Hospital, Barts Health NHS Trust and Clinical Professor of Cardiovascular Nursing, Queen Mary University of London

Professor Sonja Mcilfatrick, Professor of Nursing and Palliative Care, Institute of Nursing and Health Research, School of Nursing, Ulster University

Links and References:

  • Medical Research Council (2017) 2017 UK-Wide Survey of Clinical and Health Research Fellowships
  • Logan et al 2015: Transition from clinician to academic: an interview study of the experiences of UK and Australian Registered Nurses. JAN. Mar;72(3):593-604. doi: 10.1111/jan.12848. Epub 2015 Nov 9.

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