Building and Sustaining
Research Capacity in
Community Practice,
Midwifery and Nursing:
Report of An Expert
Colloquium
Convened by the Research
Collaborative of
Community Practitioners’ and
Health Visitors’ Association
The Royal College of Midwives
The Royal College of Nursing
October 15th 2006
Collated by Martin Johnson on behalf of
participants
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Introduction
There is no doubt that health visiting and community practice, midwifery
and nursing have developed enormously in research output and quality in
the last fifty years. There are several crude indicators of this. The Royal
College of Nursing’s Steinberg Collection of PhD theses by and about UK
nursing contains more than 600 volumes. International nursing and
midwifery research conferences now attract upwards of 500 delegates.
Many health service posts now explicitly contain a research and
development role. Since all the relevant professional education is based in
higher education and has been for over ten years, the research-based
nature of these professions has never been more evident.
Despite these developments, in 2001 the nursing and midwifery unit of
assessment remained at the bottom of the Research Assessment Exercise
(RAE) league table of research quality. Significant grant capture by these
disciplines remains weak in comparison to medicine.
It was increasingly realised that to develop policy and agree common
strategy the research forums, groups or societies representing the
Community Practitioners and Health Visitors Association (CPHVA), the
Royal College of Midwives (RCM) and the Royal College of Nursing (RCN)
should meet to share plans and achievements. The new ‘collaborative’
began in 2004 with a position paper on research ethics and governance in
the light of the difficulties which had resulted from the new DH
governance arrangements. In recent months and especially in the light of
Best Research for Best Health (DH, 2006) that focused on England, it has
become essential to continue this collaboration with a meeting or
‘colloquium’ addressing research capacity building in the health
professions.
The collaborative group invited a range of stakeholders in the research
policy and practice framework to speak to a colloquium of representatives
of the three organisations. These stakeholders represented the four UK
countries’ relevant government departments, senior professionals in the
health services and higher education, and leaders of research units and
support machinery. Each speaker provided a short written text, the
contributions here reported are taken partly from these and partly from
notes and records made at the time. The event took place on 15th
October 2006 and was chaired by Dr Judith Ellis, Chief Nurse and Director
of Workforce Development at Great Ormond Street Children’s Hospital.
Why build capacity?
Tony Butterworth, Director of the Centre for Clinical and Academic
Workforce Innovation at the University of Lincoln set the scene arguing
that research capacity building is a recurring theme in policy reviews and
research performance analysis. The view is mixed. There have been some
very purposeful strategies to build capacity and yet the research
performance of health visiting, midwifery and nursing has been less than
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spectacular, and our ability to interrogate outcomes is hampered by poor
data gathering.
There are probably two tests for capacity building policy. The first is to
examine policy initiatives for signs of dedicated investment the second is
to assess changes in research performance and grant award success by
the profession(s). On the first count there are two opportunities. The first
is that all health care professions can make applications to funding
agencies offering capacity building opportunities and be equally successful
(or not) in their results. The second is to create a particular professionspecific fund to build up capacity amongst professions less wellestablished in research. Both these opportunities have been available.
Data suggest that between 1998 and 2001 Medicine and Dentistry (M&D)
showed a 27% increase in PhD starters. Subjects Allied to Medicine
(SAM), including the nursing and midwifery professions, showed a 13%
increase. Also in this period PhD qualifiers showed a growth of 95% in
M&D and 70% in SAM. There is an interesting banding in the SAM group
where most registrants are between the ages of 40-50. Permanent
professorial appointments show that there are 208 Professors in Nursing
and 1089 in medicine as at 2005. There are substantially more
professorial posts in medicine funded through Research Funding Councils
than through the NHS, the opposite is true for the other professions.
The (then) National Coordinating Centre for Research Capacity
Development (NCCRCD) Doctoral and Post-doctoral awards (2000 to
2005) show that 408 applications were made by nurses. Within a range of
4 out of 50 total applications in 2001, to 125 out of 308 total applications
in 2002, 27 awards were made to nurses during the 5-year period. In
2005 the awards ratios in the new scheme had a 16.6% success rate for
nurse applicants. To make a judgement on these data is hard. They are
incomplete and if nothing else demand better attention to labour market
intelligence.
The Policy Background in the Four UK Countries
Northern Ireland
Nicola Armstrong, Programme Manager for Nursing at the Northern
Ireland Research and Development Office informed the colloquium that
Northern Ireland is unique in the United Kingdom and Ireland in having
integrated health and social services.
In 1998, the Research &
Development Office for the Health and Personal Social Services (R&D
Office) was established to support and encourage research and
development in both health and social care in Northern Ireland (NI). The
R&D Office supports a wide spectrum of R&D activity involving a range of
HPSS professionals and scientists, working in many different areas of
relevance to health and social care.
The R&D Office published its first strategy Research for Health &
Wellbeing in 1999 and one of the key areas identified for development
was the need to support the health care professions which have
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previously had a low R&D base, including nursing and midwifery. The
Programme Manager for Nursing role is a tangible example of the
commitment of the R&D Office to this aim. The R&D Office recognises the
important contribution nursing has to play, by virtue of its unique position
in the provision of direct care to patients, in delivering high quality,
clinically relevant R&D. In addition to supporting individual professions,
the R&D Office has a strong focus upon multidisciplinary research and so
nursing is encouraged to work in partnership with other health care
professions and scientists alike to improve the quality, cost effectiveness
and efficiency of health and social care services.
The R&D Office’s new strategy Research for Health & Wellbeing 20072012 was recently circulated widely for consultation. The new strategy
builds upon the successes of the preceding years and prepares for the
next five years in the context of new opportunities. Indeed, there are
more opportunities and support for research in nursing and midwifery
than ever before. This will be achieved through 4 main strategic themes:
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developing an effective infrastructure to support and enable
Health and Personal Services Research & Development (HPSS
R&D)
building research capacity for HPSS R&D
funding HPSS R&D
supporting innovation as means of transferring HPSS R&D
findings into practice
ensuring patient public involvement in HPSS R&D
Scotland
Nursing and Midwifery Research Capacity and Capability Building
Scotland
Theresa Fyffe, Deputy Chief Nursing Officer (Interim) noted that in
Scotland the key stakeholders in this area are the Nursing, Midwifery and
Allied Health Professions Division of the Scottish Executive Health
Department (SEHD), Chief Scientist Office (CSO, SEHD, NHS Education
for Scotland (NES), the Scottish Funding Council (SFC) the Higher
Education Institutions and NHS Scotland.
There has been a longstanding commitment by the Chief Scientist Office
to core fund a research unit which focuses on research relevant to
Nursing and Midwifery practice and which build capacity and capability
within relevant spheres. The unit came into being in 1994 and is now co
hosted by two Higher Education Institutions and has also expanded to
cover the Allied Health Professions.
NMAPHRU aims to promote rigorous research to underpin NMAHP practice
that reflects the needs of the people of Scotland and the NHS. The
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foundations for an extensive evidence base have already been
established, mainly built on quantitative studies. The unit has a strong
focus on NMAHP-led research, with NMAHPs not only involved in research,
but also leading projects. It has considerable experience in running
NMAHP trials, which are somewhat different in nature from medical drug
trials, particularly in the level of involvement of NMAHP staff in the trial
sites.
For further information, access: http://www.nris.gcal.ac.uk/index.html
<http://www.nris.gcal.ac.uk/index.html>
In 2000, the Chief Scientist Office launched a postgraduate studentship
(PGS) scheme for health services research and a generic research training
fellowship (RTF) scheme for (mostly) pre-doctoral health services
researchers. It became clear over time that NMAPH professions were
both willing and able to participate successfully in both these schemes.
These nurses have been supported and mentored effectively, allowing
them to develop new roles within clinical practice and research.
More recently, a research training scheme was developed in partnership
with NHS Education for Scotland (NES), the Scottish Executive Health
Department and the Health Foundation. This is funding pre-doctoral and
postdoctoral opportunities for NMAHPs and is delivered through a
consortium including the NMAHP Research Unit and a range of Higher
Education Institutions in Scotland. The Research Training Scheme is
managed by NES.
In 2003, a major initiative building on a platform of a strategic research
development grant through the Scottish Funding Council was launched.
This provided £8 million to support the development of research capability
and capacity in the NMAHP professions, and was contingent on additional
funds being made available from the Higher Education Institutions. The
final scale of the investment remains to be determined but is likely to be
in the range of £12m-£15m. This investment will taper in 2008/09 and an
evaluation will be undertaken at that time.
This initiative has driven the creation of three regional consortia in
Scotland to oversee and develop NMAHPs research within a multidisciplinary context. These consortia are building on the ethos adopted by
the Nursing, Midwifery and Allied Health Professions Research Unit
(NMAHP Research Unit) to encourage a programme-focused approach
built on collaborative relationships to develop the evidence base to
underpin nursing and midwifery practice.
Clinical academic career pathways were identified as a key issue in
Choices and Challenges. At present the Scottish Executive is undertaking
a major scoping exercise for nursing and midwifery to examine current
capacity, to comment on the early impact of these initiatives and to help
direct future investment and models for academic careers in Scotland.
SEHD has contributed to the development of the UKCRC report
'Developing the best research professionals' which, whilst in agreement in
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terms of the general principles, will be seeking to develop models that
build upon current schemes and seek to do so in partnership and
collaboration with key stakeholders.
Wales
Joyce Kenkre. Senior Research Officer at the Welsh Assembly Government
noted that her organisation has a commitment to evidence policy-making
that is now embedded. This commitment to using evidence effectively
impacts on future required outcomes and budget planning.
In 2004, ‘Realising the Potential: briefing paper 6 achieving potential
through research and development’ was published. The goals of this were
the development of:
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A robust infrastructure at national level
A research workforce capable of delivering high quality research
Flexible career pathways
A supportive culture and infrastructure
Full participation of Nursing, Midwifery & Health Visiting
Equity of access to resources to support and sustain research and
development (R&D)
However, following a scoping study across Wales it was highlighted that:
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There are not enough experienced personnel to address current
needs
Nurses and Allied Health Professionals (AHP’s) need to be more
active in R&D for the development of their own practice
We need to help each other in our development
Research findings need to be implemented into practice
In Wales there has been extensive funding in the development of
research infrastructure including the Clinical Research Collaboration
Cymru (CRC Cymru). This initial expenditure of over £20 million has been
used towards the development of nine new thematic networks, five
infrastructure support services, two research units and a co-ordinating
centre. The strategic aim of the Wales Office for Research and
Development is to ensure that policy and practice are underpinned by
evidence for the benefit of both patients and policy. The Wales Office for
Research and Development, in collaboration with The Health Foundation
are funding a three-year fellowship programme for fourteen fellows in
Wales.
England
Ros Moore, Professional Officer for Acute Care Nursing and Research
outlined to delegates the position in England. At present, the DH for
England spends over £150 million annually on research and development;
it funds and supports nursing research in a variety of ways:
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Through commissioned programmes, in particular the Policy
Research Programme (PRP) and the Service Delivery and
Organisation (SDO) but other programmes such as the Health
Technology Assessment (HTA) Programme also frequently
commission projects that have implications for the profession and
nursing practice. Most of the NHS R&D commissioning in all
programmes is done via open competitive tender particularly for
strategic initiatives and high cost projects. Advertisements are
usually placed in professional journals, the national press and on
the DH, SDO and HTA websites.
Fellowships and support with research training,
Supporting university based centers of excellence – e.g. the
Nursing Research Unit at Kings College, London.
Working with the Higher Education Funding Council for England
(which funds universities)
Leading on research and development strategy.
Today nurses are represented in research policy decision-making at all
levels and on commissioning panels and there has been significant
investment in capacity building since the last review of research in
nursing & midwifery in 2000 with figures suggesting:
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A rapid expansion in PhD enrolments (mainly for part time study),
A rapid increase in research income secured by universities for
research related to nursing, and
A rapid increase in research active staff in nursing departments.
Despite progress in all these areas nurse researchers still highlight factors
they believe impact on capacity and the quality of nursing research in the
UK and internationally. These include the lack of dedicated funding;
problems competing for generic research monies; little emphasis on
research in many university departments of nursing; and the lack of a
dedicated research career pathway leading to problem with sustainability
of the nursing research workforce
Strategies for Building Capacity
The HE Perspective
Karen Cox, Head of the School of Nursing, University of Nottingham
began this section with an overview of key strategies universities have
used to build capacity. The national research context in healthcare
presents both challenges and opportunities for the further development of
research for Nursing, Midwifery and Health Visiting. As the largest
occupational group in health care Nursing, Midwifery and Health Visiting
have a major contribution to make to generating, challenging and testing
this evidence base.
Over the last 5 years a series of influential national reports and reviews
have shaped the way research in these disciplines in Universities is
carried out:
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The White Paper on the future of higher education
The Roberts Review of the Research Assessment Exercise (RAE)
The Lambert Review of links between business and universities
The OST/Department of Trade review of the sustainability of
university research
Task Group 3 report, Promoting Research in Nursing and the Allied
Health Professions
The StLaR (Strategic Learning and Research Advisory Group for
Health and Social care) HR Plan Project
Review of NHS R and D ‘Best research for best health’
Reviews underway:
 The Cooksey review of funding for health research
 Modernising Nursing Careers
 United Kingdom Clinical Research Network Clinical-academic
Careers
These reports and reviews demand sustainability, transparency regarding
funding, relevance, usability of research, career pathways and education
and training in research. One key way in which universities do this is
through HEFCE research income generated through the 2001 RAE
exercise. The subsequent 2008 RAE exercise will determine the volume
of income available to each discipline for developing and sustaining its
research base for the foreseeable future.
This is clearly a challenging environment for disciplines like Nursing and
Midwifery that are relatively new in the academy. However, it is also one
where there are several opportunities. Following the 2001 RAE a powerful
case for a capacity and capability development fund for nursing and the
allied health professions, was made by the HEFCE/DoH Task Group 3,
which reported in December 2001. In its final report Task Group 3
concluded that “existing funding mechanisms… make it hard to develop
excellence in areas without a research tradition unless seed corn funding
is provided to enable research groups to develop excellence and, equally
important in terms of long-term viability, a reputation for excellence”.
HEFCE has since recognised that some disciplinary areas have a limited
research base and hence require research capacity building monies. In
addition, there are growing opportunities available to encourage
universities to build their links with business (including the NHS, local
authorities and the voluntary sector) with an increased emphasis upon
knowledge transfer of research findings to business.
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Against this background universities have undertaken a number of key
strategies to build capacity and capability in Nursing, Midwifery and
Health Visiting:
1. Focus on areas where there are research programmes of
national/international standing
2. Develop strategic collaborations within universities, with other
universities, with NHS Trusts and with other ‘health’ and ‘clinical’
partners
3. Continue to develop the overall research and scholarship culture
from pre-registration through to postgraduate education
4. Develop and enhance postgraduate provision and research training
environments
5. Working for sustainability for research posts
6. Support multidisciplinary research across disciplines, schools and
faculties.
7. Improve staff development opportunities through providing
programmes such as MRes and MClin. Res. and in-house support
for staff to undertake PhDs.
8. Adapt promotion criteria to take account of research, teaching and
knowledge transfer activities
9. Re-align the balance between basic, translational and applied
research.
10.Develop and sustain technology transfer links with industry
11.Enhance the quality of research funding bids
12.Recognition and reward of early career researchers
Views from Primary Care
Sally Kendall, Director of the Centre for Primary and Community Care,
University of Hertfordshire offered a Primary and Community Care
perspective. The Task Force 3 Report (chaired by Prof. Janet Finch) to the
Higher Education Funding Council made it clear that research capacity in
nursing and the allied health professions was well behind comparable
practice-based research disciplines such as education. However, whilst
the report made a series of recommendations for funding that did lead to
some important changes for nursing, there were no specific
recommendations for community and primary care nursing, which like
General Practice highlighted by the Mant Report, was and is even further
behind in research capacity than secondary care. There is a certain
paradox in the fact that whilst most health care is delivered in the
community and primary care environment, much of it by nurses,
midwives and health visitors, the evidence base is still relatively weak,
and the research capacity is low compared with other parts of the
profession. It remains extremely difficult to identify the actual numbers of
nurses working in the community who are undertaking any form of
research training, the CPHVA have been trying to accumulate such data
for some years but data systems remain impossibly inadequate.
Whilst the CPHVA is building up a small data-base of community
practitioners who are undertaking Masters and PhDs it is difficult to
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account for practitioners who are undertaking PhDs in other disciplines,
such as medical anthropology, and academics who whilst not practitioners
are undertaking research that is highly relevant to nursing e.g. medical
sociology and epidemiology. There is only a small handful of Professors in
Primary and Community Care Nursing across the UK. At the level of
enabling activities we know from surveys conducted across the UK that
the appreciation of research led practice is modest at best among
community nurses.
Barriers that have been identified through these surveys include time to
undertake the necessary searches and reading, lack of managerial
support and lack of technical access such as computers and Internet
access. Clearly, whilst barriers remain towards such enabling activities it
is more problematic to move into the developmental and application
activities and strategies are needed to both grow good researchers in
primary and community care and to implement research into practice.
Nigel Mathers, Professor of General Practice, University of Sheffield
offered the belief of the Royal College of General Practitioners’ Research
Group that a twin-track strategy of not only building research capacity but
also research capability is essential i.e. both the quantity and the quality
of research in primary care needs to be expanded. The RCGP Research
Group is a multidisciplinary, multi-professional group with wide
representation, not only from organisations such as the Medical Research
Council (MRC) but also from the Royal College of Nursing (RCN) and
Community Practitioners’ and Health Visitors’ Association (CPHVA) who
make important contributions to the development of research strategy.
The objectives in the Research Group are not only to raise the profile of
primary care research, both within and without the College, but also to
campaign for increased resources and support to undertake that research.
Both of these objectives contribute to the aim of building research
capacity. The principles that underly the work of the Research Group are
that good-quality primary care research is best done in multidisciplinary
and multi-professional teams. On that basis, of course, partnership
between the RCGP, the RCN, the CPHVA and other organisations is crucial
if building research capacity is to continue.
A key issue that needs to be considered is the “personal research
pathway” of an individual.
This is a description of their research
trajectory that starts with research awareness and ends with research
leadership. The necessary stages through which an individual needs to
pass on this pathway include those of the utilisation of research results
in clinical practice, participation in research studies, collaboration in
developing a research protocol and partnership in submitting funding
applications. To undertake this journey, however, an individual needs to
develop skills in both qualitative and quantitative methods – the so called
“skills escalator”. In the real world once you step on the escalator it can
be difficult step off as there are always new skills for us to learn – of
course, it can also be difficult to step back down a moving escalator once
you have been bitten by the research bug! Such journeys are supported
by the regional or local research and development support units (RDSU).
The Trent RDSU, for example, provides an excellent scheme called the
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New Researcher’s Training Programme to support new researchers and
hence the building of research capacity.
In addition to these considerations, the RCGP has a Scientific Foundation
Board that awards pump-priming grants for new researchers and their
research proposals.
The Teaching Hospital View
David Foster Chair of the Association of United Kingdom University
Hospitals Directors of Nursing Group offered to illuminate the NHS
Perspective with data from a survey of member Trusts, which are all in
some way related to a particular university:
It is well recognised that nursing and midwifery research has an
important role to play in the development of the NHS and of clinical
practice. Member Trusts of the AUKUH Directors of Nursing are uniquely
placed to work with their academic partners to develop excellence in
nursing and midwifery research and development. Important to this will
be the recognition within Trust research strategies of the opportunities.
The Directors of Nursing Group therefore decided to undertake a baseline
assessment to determine the current levels of nursing and midwifery
research within University attached Trusts across the UK.
The
questionnaire considered Trust nursing and midwifery research across
four key areas: strategy, capacity, funding and research culture. 18
responses have been received so far and the following document provides
a summary of findings and more detail is available from
d.foster@hhnt.nhs.uk.
Research Strategy
Of the 18 responses, 15 had a Trust research strategy, six of which
mention nursing and midwifery research specifically. Additionally, 11
Trusts have a separate strategy for nursing and midwifery research, led in
most cases at Nurse Director or Deputy Director level. Two of the Trusts
who do not have a research strategy, nonetheless have a nursing and
midwifery research strategy.
Research Capacity
There are approximately 90 nurses and midwifes employed solely in
nursing and midwifery research compared to more than 600 research
nurses funded by grants for medical research. Seven Trusts do not
employ any nurses or midwives solely for nursing and midwifery research,
whilst all but one Trust employs medical research nurses.
As is expected by the nature of the Trusts surveyed there is a wide
variety of interactions between Trusts and HEI partners, including one
with Monash University in Australia. 18 Trusts engage with 51 HEIs,
however, unlike in medicine or dentistry, there are relatively few joint
Trust/HEI joint appointments. Across the 18 Trusts, there are 23 joint
appointments, six of which are at Professorial levels. There are no jointly
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employed Readers across the Trusts. There are 93 nurse or midwifery
consultants, 60% (57) of these are also involved in research.
It is clear that member Trusts are supportive of and wish to develop their
capacity in nursing and midwifery research, increasing numbers of PhD
students will be important in this.
There were 18 research
assistants/fellows concentrated in six Trusts returned and approximately
70 PhD students in nursing and midwifery across 15 Trusts.
Research Funding
One of the most striking findings from this survey is that whilst every
Trust is engaged to some extent in nursing and midwifery research there
is relatively little funding available specifically for this type of research.
Only four Trusts received any additional income specifically for nursing
and midwifery research. Ten Trusts did receive some degree of external
funding to support nursing and midwifery research posts, a significant
proportion of this funding was still emanating from NHS sources.
Research Culture
Most Trusts, particularly at nurse consultant level, have posts with a
specific requirement for the holder to have research experience or
qualifications, as opposed to a general knowledge of research. However,
there were only 16 nurses or midwives holding formal research
qualifications at MPhil level or above returned.
A Clinical Research Facility Perspective
Jackie Oldham, Operational Director, Manchester Wellcome Trust Clinical
Research Facility argued strongly that those working in such facilities
were not sufficiently recognised as strategically placed to capitalise on
both the industry and patient benefit aspects of current policy:
To mark the Millennium the Wellcome Trust invested in developing the UK
clinical research agenda through infrastructure funding to establish five
clinical research facilities (CRFs) - Birmingham, Cambridge, Edinburgh,
Manchester and Southampton. These facilities, supported by the
Department of Health, provide dedicated equipment, staff and resources
to support the experimental medicine and clinical research agenda across
a wide range of clinical disciplines. A review undertaken on behalf of the
Wellcome Trust, Department of Health and Scottish Executive confirmed
the success of this initiative (Wellcome Trust 2004). Key indicators of
success included:
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Establishment of CRFs as centres of clinical research excellence.
Recognition of CRFs as beacons of best practice for governance and
ethics.
Establishment of strong collaborative links throughout the NHS.
Development of rigorous procedures for assessing research proposals.
Appointment of educational leads to support clinical researchers.
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This review also highlighted the importance and contribution of the five
Wellcome Trust Clinical Research Facilities (WTCRFs) to the development
of both Wellcome and non-Wellcome Trust funded clinical research
facilities in other cities throughout the UK.
A key contributor to the success of the WTCRFs has been the
development of a cohesive partnership between the CRF nurse managers.
Initially serving as an informal forum for sharing ideas and experience,
this partnership has evolved into a structured group known as the Nurse
Managers’ Association (NMA). Some of the key outputs of the NMA
include:
 A guaranteed platform for dissemination of examples of best practice.
 Adaptation of the National Institutes of Health (NIH) General Clinical
Research Centre (GCRC) Nurse Acuity Model to enable benchmarking of
activity between CRFs.
 Shared education and training opportunities.
 The establishment of an informal peer group mentoring system.
 Informing of national consultation processes i.e. the Bell report and
INVOLVE initiatives.
 Informing the national and international clinical research nurse agenda
through presentations at
the Royal College of Nursing (RCN) and
GCRC annual meetings.
 Coordinated approach to links with national organisations e.g. UKCRC.
 The establishment of shared Standard Operating Policies and
Procedures (SOPs)
 Brainstorming of ideas to support development of new initiatives.
 The establishment of an annual national CRF conference.
 The development of a Research Nurse Competency framework.
 The shared development of job specifications particularly in relation to
Agenda for Change.
 Developments are now underway to capitalise on these successes and
establish a UK wide network of Clinical Research Facilities.
Development of these opportunities are envisaged both between CRFs
and beyond (i.e. throughout the NHS and industry) and will be
harmonised with the aspirations of UKCRC and UKCRN.
Members of the NMA have also been instrumental in informing the
deliberations of the UKCRC Workforce Careers (Nursing) Group. An initial
trawl of the five millennial CRFs identified some 700 nurses, working as
clinical research nurses not as nurse researchers, associated with the
CRFs and their local NHS partners. Whilst these numbers are
approximated, as no detailed UK audit has been undertaken, it provides
some feel for the vast numbers of nurses who are likely to be working in
clinical research nursing roles throughout the UK. Furthermore, of those
identified only between 60-80% had a first degree, 13-20% had a
Masters level qualification and approximately 5-10% aspired to obtain a
PhD. Informal observation has also identified: variations in job
descriptions, titles and roles; lack of recognition of speciality and skills;
some have no clear management, appraisal and PDP opportunities; there
are no specific education and training opportunities to progress careers.
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In order to address these concerns a career structure and training
opportunities that map onto the UKCRC Workforce Careers (Nursing)
recommendations for preparing and supporting researchers and educators
of the future are envisaged whereby clinical research nurses are afforded
the same training, development and career opportunities as those nurses
working in other sectors of the profession.
The Regional Research and Development Support Units
Dr E Anne Lacey , Senior Research Fellow at Sheffield University seconded
to the Trent Research and Development Support Unit (RDSU) gave their
perspective. As in many countries in Europe, nursing research in UK is
seen as lagging behind biomedical and other clinical research. After a slow
start compared with some other professions, investment in nursing
research capacity has been limited, and there is still a culture within
clinical nursing that sees research as intimidating and difficult to access
(McCaughan et al. 2002). Despite numerous policy initiatives (DH 2000,
HEFCE 2001) slow progress has been made, but the establishment of a
nursing strand within the Department of Health’s Service Delivery and
Organisation (SDO) Programme and the introduction of research
fellowships for nurses in each of the four UK countries have been small
advances that need to be built upon.
The new R&D strategy in England (DH 2006) proposes large scale
changes in the funding and organisation of R&D within the NHS. There are
both threats and opportunities here for nurses.
The new responsive funding programme ‘Research for Patient Benefit’ is a
real opportunity for NHS based nurses and allied health professionals to
compete with other health professions for project funding at a regional
level. It remains to be seen whether the National Institute for Health
Research (NIHR) Faculty will comprise more than a token complement of
non-medical researchers.
To take advantage of the new brave world being set up by the UKCRC and
NIHR, nurses will need to promote nursing research with confidence and
strategic awareness, will need to collaborate with other disciplines, and be
sure that the research they are promoting is of high scientific quality and
clinically relevant to the needs of the NHS. In this last goal, nurses should
use their unique closeness to the concerns of patients and users to
maximise their ability to embrace the current policy initiatives to ensure
public and patient involvement in research.
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A recent systematic review of the international evidence base for research
capacity development in health and social care (Cooke et al 2006)
highlighted eight strategies that have been used, alone or in tandem, to
build research capacity. These were identified as:








Priority setting
Mentoring
Research leadership
Research facilitators
Training
Funding
Networks and collaborations
Infrastructure
Many of these strategies are in place in UK, but have perhaps been
underused by nurses lacking confidence to engage with national and
multidisciplinary structures and funding sources.
Research and Development Support Units (RDSUs) were established in
England in 1990s by the old regional health authorities to build research
capacity among NHS staff in their regions. Some regions (notably North
East, West Midlands and London) did not set up such RDSUs and are
today without an equivalent service, though some academic units function
in a similar way. RDSUs survived the demise of the old regions, and are
now directly funded by the Department of Health, though their funding is
currently under review. Most RDSUs are located within multidisciplinary
university departments, but some are located within the NHS and some
are collaborative between the two sectors. A national RDSU steering
group is now meeting regularly and coordinating work across the country.
The national group is also giving a united voice to RDSUs, allowing them
to engage with the new structures in the DH R&D strategy. Negotiations
are ongoing to align the RDSU training programmes with those being set
up by the UKCRN.
RDSUs provide support for health services research through training,
advice and support, small-scale funding, collaborative research and
specialist services. Trent RDSU provides academic expertise in statistics,
health economics, primary care, qualitative research, information
resources and social care. Some of the staff employed come from a
professional background of nursing, medicine or allied health.
To take advantage of RDSUs and other structures that are available for
research capacity building, nursing must move out of its uni-disciplinary
habits and work with other disciplines to develop, fund, carry out and
disseminate high quality research of relevance to the NHS. The divide
between academic and clinical nursing has perhaps held back the
strategic development of quality research programmes of national
importance and relevant to patient care.
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The Nurse, Midwife and Health Visitor Consultant
Tom Quinn, Professor of Cardiac Nursing at Coventry University and a
Nurse Consultant in Cardiac Care suggested that nurse, midwife and
health visitor consultant posts were intended to help improve outcomes
for patients by improving services and quality, to strengthen leadership
and provide a new career opportunity to help retain the experienced
practitioner. Irrespective of the field of practice, setting or service in
which they are based, each consultant post should be constructed around
four core functions:




Expert practice
Professional leadership and consultancy
Education, training and development
Practice and service development, research and evaluation.
Thus research is seen as a core function of the consultant nurse. The
original guidance issued by the Chief Nursing Officer (England) elaborated
briefly on the research function. Key responsibilities in this domain would
include promotion of evidence-based practice, standard setting and
monitoring, and the identification and promotion of measures to secure
and evaluate quality improvement. Consultants would be expected to
have a track record of scholarship and the appraisal and application of
research in practice; and in many cases formal research expertise (my
emphasis). Thus research expertise was not mandatory for potential
consultant appointments.
Around three per cent of consultants had a PhD but the vast majority had
at least Master’s level education. Surprisingly, around eight per cent had
no degree at all. It remains unclear to what extent nurse consultants are
securing either joint or honorary appointments with academic partners
(such arrangements could of course apply in either direction: how many
suitably qualified and experienced nurse researchers have secured
honorary NHS consultant nurses?).
To what degree do we expect consultant nurses to be involved in
research? Arguably strengthening the critical appraisal capability –
assessing the quality of the available evidence- will yield greater benefit
than enthusiasts dabbling in the small-scale, under-funded, very localised
and often non-reproducible projects that typify nursing research. We need
consultants first to be able to critically appraise ‘evidence’ in the literature
(with the degree of scepticism that accompanies an understanding that
many research results are contradicted within three months of
publication) and to distinguish ‘quality’ (appraised, based on metaanalyses etc) and ‘currency’ (the latest report in this week’s journal, with
all its immediacy and potential for excitement).
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The extent to which consultant nurses are leading – e.g. as principal
investigators or funding applicants - research projects or programmes is
unclear. Analysis of NIHR, research council and charitable foundation
applications (for example) and the National Research Register may yield
important information as to the level of engagement of consultant nurses
compared with ‘traditional’ academics from nursing and other disciplines.
Growing numbers of nurse consultants are being appointed, most with
higher degrees and thus some appreciation of critical appraisal, but
potentially only a minority with the interest or aptitude to embark on
careers as independent researchers. The best hope for widespread
introduction of evidence based healthcare (with all that implies for patient
safety and quality of care) rests, possibly, with ensuring that appointees
are (and take steps to remain) competent in critical appraisal, while a
(realistically) smaller cohort undergo formal research training and
continue to develop as independent researchers of the future.
Punching our weight
Liam O-Toole, Chief Executive of the Clinical Research Collaboration
summed up the day with a challenge to non-medical professionals to act
quickly to influence the future. He suggested that our professions need to
take a leadership role and not ‘wait in line for everything to be sorted’. He
argued that partnerships are the future, with the healthcare industry, with
charities and with the health and social care research community.
In particular, O’Toole asked ‘what is the profile of research within your
profession?’ and told delegates to ‘Make your minds up on “Research
Nurses”’.
He asked nurses, midwives and health visitors: ‘are you
addressing the issues only you can sort or are you waiting for someone to
sort them out for you?’ In short, have we got the structures in place to
punch our weight?
Key Messages
The debates and discussions largely reflected the content of the papers,
but the following are key issues.
1

Midwifery, nursing and health visiting have significant potential to
do research of great benefit to patients and service users

Research policy has frequently taken insufficient account of this
potential, but nurses, midwives and health visitors need to act
assertively to influence policy makers and get their seat at the
table. 1
DH, Northern Ireland R&D and Scottish Office staff noted that this is not current Government Policy
16/02/2016
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
The professions should work together to influence policy and
funding decisions.

The restoration of responsive funding in England with Research for
Patient Benefit is to be welcomed and taken advantage of.

Nursing, midwifery and health visiting should have a dedicated
research funding stream focused on important practice issues
unlikely to attract ‘industry’ sponsors.2

There should be greater transparency of accounting procedures and
use of funds in research, but only at the same time as equal
transparency in other areas of work, such as learning and teaching
and enterprise.

The much-discussed flexible career pathways need to be made a
reality. More joint appointments and other models need to be tried.
In many ways, the simple but effective ‘sessions’ and honorary
contracts system that has worked well in the medical field should
be exploited for other professions.

Better attention needs to be paid to spotting, developing and
nurturing early career researchers and high achievers.

Security of tenure needs to be a more prominent feature of
research work than at present.

Those undertaking clinical research as ‘research nurses’ need
support to develop their role and career into stronger contributors
to project teams and outputs.

Databases of research topics, expertise, and research degree
completion are insufficient at present.

There needs to be a stronger relationship between research, and
researchers, and undergraduate education in nursing and
midwifery.
Whilst those working from Government Offices were not able to actively
endorse such a policy at present, there was a strong overall feeling
among the representatives of the other organisations present that a
Nursing, Health Visiting and Midwifery Professions’ Research Council
would be a key aspect of the strategy to build capacity in these
disciplines, of such vital importance to patient care and public health.
2
As above
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References
Butterworth, C., 2004, Developing and sustaining a world class workforce
of educators and researchers in health and social care. Strategic
Learning and Research Committee (StLaR): London.
Cooke J, Booth A, Nancarrow S, Wilkinson A, Askew D 2006, Re:Cap – A
Scoping review to identify the evidence-base for research capacity
development in health and social care. Trent Research &
Development Support Unit, University of Sheffield.
Department of Health 2006, Best Research for Best Health. Department
of Health: London.
Department of Health, 1998 R&D In Primary Care: The Mant Report., DH
London.
Gerrish, K., Cooke J., Kendall S., Bryar R and McNeilly E. 2007 A survey
of the facilitating factors for evidence based practice in primary
care nursing (forthcoming).
HEFCE, Research in Nursing and Allied Health Professions: Report of the
task Group 3 to HEFCE and the Department of Health. 2001.,
DH/HEFCE, London
Howarth, M. and R. Kneafsey, 2005, The Impact of Research Governance
in
Healthcare and Higher Education Organisation. Journal of Advanced
Nursing, 9.
McCaughan, D., et al. 2002 Acute care nurses' perceptions of barriers to
using research information in clinical decision making. Journal of
Advanced Nursing,. 39: 46-60.
McKenna, H. and C. Mason, 1998 Nursing and the wider research and
development agenda: influence and contribution. Nursing Times
Research,. 3(2): 108-115.
McKenna, H., S. Ashton, and S. Keeney 2004, Barriers to evidence-based
practice in primary care. Journal of Advanced Nursing,. 45(2): 178189.
NHS Executive, 1999 Nurse, midwife and health visitor consultants:
Establishing posts and making appointments. HSC 1999/217
September
http://www.dh.gov.uk/assetRoot/04/01/09/67/04010967.pdf. .
Research and Development Office for the Health and Personal Social
Services, 1999, Research for Health & Wellbeing: A strategy for
research and development to lead Northern Ireland into the 21st
century. The Stationery Office, Northern Ireland: Belfast.
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Welsh Assembly Government, 2004, Realising the potential: achieving
potential through research and development, in Realising the
potential. Welsh Assembly Government: Cardiff.
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16/2/1616/2/16
Colloquium participants
Professor Judith Ellis (Chair)
Chief Nurse and Director of Workforce Development
Great Ormond Street Hospital for Children NHS Trust
London
Email: ellisj@gosh.nhs.uk
Dr Cheryll Adams
Professional Officer
Community Practitioners & Health Visitor’s Association
London
Email: cheryll.adams@amicustheunion.org
Dr Nicola Armstrong
Programme Manager – Nursing
R&D Office, for the Health and Personal social Services (HPSS)
Belfast
Email: Nicola.Armstrong@rdo.n-i.nhs.uk
Professor Tony Butterworth
Director
The Centre for Clinical & Academic Workforce Innovation
University of Lincoln
Email: tbutterworth@lincoln.ac.uk
Professor Sarah Cowley
CPHVA member
Professor of Community Practice Development
King’s College
London
Email: sarah.cowley@kcl.ac.uk
Professor Karen Cox
Head of School
School of Nursing
University of Nottingham
Email: karen.cox@nottingham.ac.uk
Dr David Foster
Chair, AUKUH Directors of Nursing Group
Director of Nursing
Hammersmith Hospital NHS Trust
London
Email: D.Foster@hhnt.nhs.uk
Ms Theresa Fyffe
Nursing Officer
Scottish Executive
Edinburgh
Email: theresa.fyffe@scotland.gsi.gov.uk
21
16/2/1616/2/16
Professor Kate Gerrish
Chair, RCN Research Society
Professor of Nursing Practice
Sheffield Hallam University
Email: k.gerrish@shu.ac.uk
Dr Gina Higginbottom
CPHVA Member
Sheffield Hallam University
Email: g.higginbottom@shu.ac.uk
Professor Martin Johnson
RCN Research Society Steering Committee
University of Salford
Email: m.johnson2@salford.ac.uk
Professor Sally Kendall
Professor of Nursing
University of Hertfordshire
Email: s.kendall@herts.ac.uk
Professor Joyce Kenkre
Senior Research Officer
Welsh Assembly Government
Cardiff
Email: joyce.kenkre@wales.gsi.gov.uk
Dr Anne Lacey
Senior Research Fellow – Nursing
University of Sheffield
Email: e.a.lacey@sheffield.ac.uk
Professor Nigel Mathers
Chair, RCGP Research Committee
Chair of General Practice & Director of Institute
University of Sheffield
Email: n.mathers@sheffield.ac.uk
Dr Tanya McCance
Nursing Research & Development Director
Ulster Community & Hospitals Trust
Belfast
Email: Tanya.mccance@ucht.n-i.nhs.uk
Ms Sue Macdonald
Education & Research Manager
Royal College of Midwives
London
Email: sue.macdonald@rcm.org.uk
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16/2/1616/2/16
Ms Ann McMahon
RCN Research & Development Adviser
RCN Research & Development Co-ordinating Centre
University of Manchester
Email: ann.mcmahon@rcn.org.uk
Ms Ros Moore
Professional Officer for Acute Care Nursing and Research
Department of Health
Leeds
Email: ros.moore@dh.gsi.gov.uk
Professor Jackie Oldham
Operational Director
Wellcome Trust Clinical Research Facility
Manchester
Email: jackie.oldham@manchester.ac.uk
Dr Liam O’Toole
Chief Executive
UK Clinical Research Collaboration
London
Email: info@ukcrc.org
Dr Pauline Pearson
CPHVA Member
University of Newcastle
Email: p.h.pearson@newcastle.ac.uk
Professor Tom Quinn
Professor of Cardiac Nursing
Coventry University
Email: hsx419@coventry.ac.uk
Professor Jane Sandall
Professor of Midwifery and Women’s Health
King’s College London
London
Email: jane.sandall@kcl.ac.uk
Dr Lesley Sapsford
CPHVA Member
Amersham
Email: sapsford921@btinternet.com
Dr Mary Steen
Research Fellow
Royal College of Midwives
London
Email: mary.steen@rcm.org.uk
23