A guest blog by Eleanor Hoverd , Clinical Research Nurse CRN West Midlands primary care, HEE/NIHR ICA Doctoral Fellow
“ We have to get the work done”
“I paid to do a Masters myself”
“Management want you on the floor”
“I am concerned about the limitation of clinical career progression, if I go down a clinical academic path”
“There is lack of recognition of my achievements”
“Research is seen as doing something extra, doing something nice”
These are the real fears, the issues, the obstacles and attitudes that prevail in primary and community nursing and are potentially preventing nurses pursuing their own nurse-led research or getting involved with health research in everyday practice.
The potential of nurse-led research in these settings is at risk if the importance of health research is not recognised, nor valued. Embedding evidence-based practice into routine care requires giving nurses the time to learn about health research, engage with it and seek answers to their own clinical questions. It is a significant challenge to change this story, but there is a huge opportunity to do so. The CNO’s Strategic Plan for Research has ignited the flame for change, for belief in ourselves as a profession, our capabilities, for an ambition that nurses can and will create impact through their own research and encourage other nurses to get involved, realising the contribution we can make to improving patient care through evidence -based practice on a national and global scale. We though, as a profession, need to change the narrative, to talk more about health research, about the benefits – to patients, to organisations, to the NHS, to economic growth…talk more about how we can get involved and what career opportunities are available …showcase our ideas, innovations and incredible research. We can actually do this. We need to do it together, through collective action. We need to nurture an environment where research is viewed as a vital part of our daily care for patients, exposing nurses to learning opportunities and role models that will inspire them, ensuring opportunities are inclusive.
A Community of Practice
In September 2021, I brought together a Community of Practice which represents nurses who are passionate about improving care for our patients through conducting our own research, developing a research active culture and creating and supporting other nurses.[i] This Community of Practice includes general practice nurses, community nurses and matrons, public health nurses, nurse researchers, clinical academics, senior academics, senior managers and national leaders in the NHS. The passion and dedication within our profession is not surprising, but what may not be so well known, is the incredible nursing research that is happening, the ideas that are being nurtured through initiatives such as the CARE programme, run in partnership with the National Association of Primary Care (NAPC), and Community Healthcare Alliance of Research Trusts (CHART) . The motivation from nurses all around the country to want to work together , to make health research a part of everyday practice and to make visible more opportunities for developing as clinical academics is completely energising. It could be argued that it is within the nature of these nurses to want to engage and pursue careers in health research, it is their desire… but I would argue that if you are not exposed to, or given opportunities to get involved and learn about health research, to develop clinical questions, to innovate, then that motivation may be undiscovered, or lie dormant. My career did not begin in research, I was exposed to research, working in an acute care setting which fuelled my interest and led me to develop my career in Clinical Research Nursing, moving to a whole new world in primary care, and now I am leading my own research as a clinical academic. So far, it has been a journey of determination, perseverance and having the right support along the way.
Nurturing primary care and community nursing
As a Community of Practice, we aim to nurture an environment in primary care and community nursing that encourages nurses to engage with health research and put best evidence into practice. Through thinking together, we can share stories, experiences and reach a deeper level of knowledge that will help to solve problems and understand issues that are affecting the development of clinical academic careers, engagement and participation with health research for nurses working in primary care and community nursing. I never realised how much our profession want this, we are ready for change , we want to empower other nurses and demonstrate the impact on patient care through evidence-based practice and developing nurse-led research and innovation. Although, for nurses wanting to develop a clinical academic career, where one engages with clinical practice and research at the same time, potentially poses more challenges in primary care and community nursing. Between April 2020 and March 2021 50% of GP practices were recruiting participants into health research studies (NIHR 2022). Not only does this mean that opportunities for patients to take part in health research are not equal, it also means that this reduces the exposure nurses in primary care and community nursing have to health research. This often also relies on a GP Research Lead to instigate and oversee the research with support from their Local Clinical Research Network, it does not necessarily mean that a research culture emanates within the entire practice. Nurses in these settings feel the barriers – “In primary care we don’t see the same opportunities for nurses, don’t see value in bringing opportunities back to us”, “Research tends to be led by GP’s”, “It’s not part of my role”. How can we change this narrative?
This does create an opportunity for nurses to increase their capability, with the right support, resources and funding, to champion research within primary care and community health organisations, to create more exposure of research for the wider profession and organisations, and to implement effective engagement strategies that will stimulate interest in health research, building upon that interest from there-on out.
Nature, nurture and the future of nurse-led research
Over the last five months, our Community of Practice has come together every month, opening our eyes to the barriers and inequalities in opportunities that do exist at the coalface within these settings, but more importantly exposing us to the possibilities and the innovative methods and models of engagement that already exist, that we didn’t all know about, and discussing and planning for the possibilities that can and will exist, those which we can nurture. It has also created an avenue for inspiring each other, hearing stories from nurses who have made it work, who are leading the way in their organisations, putting research and innovation at the forefront, pulling people together, conducting important research for the benefit of our patients.
Further narrative suggests as nurses we need to have “belief in oneself”, “improve our awareness and understanding of health research and the opportunities for career development within this field”, “belief from others that we are capable”….is this more about our identity as a profession? Perhaps it’s not just about changing the narrative but visualising ourselves delivering patient care that is always based on the best available evidence (what would you want for your relative, or friend?!), sharing that knowledge with others, ensuring equality of opportunity, and for those within whose nature it may be (or perhaps have not yet discovered) to develop their own nurse-led research, to see themselves as leading important programmes of research, nationally and globally, without forgetting to nurture along the way.
Lave J, Wenger E (1991) Situated Learning: Legitimate Peripheral Participation Cambridge: Cambridge University Press
NIHR (2022) Annual Statistics https://www.nihr.ac.uk/about-us/what-we-do/our-research-performance/annual-statistics.htm