From bench to bedside: how do we advance clinical research for nurses?

By definition, nurses primarily work in clinically facing roles involving direct patient care. This is being reinforced due to the demands of acuity of care and patients with chronic conditions requiring complex healthcare needs. The nursing profession has responded to this by the development of advanced practice nurse (APN) and the nurse practitioner role. One of the four pillars of advanced practice is research, and this role is well established in some countries. However, there is still a huge variability in the evolution of the APN role across the world and the scope of the role with some having a fully autonomous role and others being restricted in terms of prescribing and providing treatment for example. Although these roles require demonstration of expertise in multiple facets of the profession, including research, they are strongly grounded in clinical work and direct patient care.1 Despite the application and integration of evidence into practice, the majority of nurses do not participate in clinical research. In terms of leading and initiating research, the numbers of nurses are even lower. A recent paper outlined some of the issues that included a lack of protected research time, funding, and support for nurses undertaking research whilst also commenting on the lack of solid data about nurse researchers noting that the number of nurses with PhDs ranged from 0.05% in Egypt to 4.7% in Brazil, the numbers in the UK were less than 1% and 1.9% in the USA.2 Despite these issues, nursing research publications are increasing with one review reporting over 88 000 publications between 2000 and 2019.3 Often knowledge literacy is an issue: nurses want to work in or perform (clinical) research but do not know where to start. For nurses working in clinical practice wishing to gain experience in a clinical research nurse role, it is worth seeking employment part-time or full-time, as a research assistant/nurse. This provides a good introduction to the role and all aspects of research. There are specific phases in research and being employed in a research role offers a great experience from undertaking a literature review to designing a study, submitting an ethics application, recruiting participants, and collecting and analysing data, to writing up the results and presenting the findings. Having relevant post-graduate clinical experience is useful, as the knowledge and skills gained from being ‘on the floor’ (i.e. having a good set of clinical skills) will be very useful in undertaking research. With a lag time of approximately 17 years from a research discovery to implementation into clinical practice, nurses are in a unique position to be the champions of research implementation in clinical practice. With the patient-facing role and the presence in the clinic (providing access to determine the gaps and unmet needs for research topics), nurses are in a privileged position where translational research could become a reality. Of course, there are often organizational and structural barriers in place that make this translation of research difficult and so not only is there a need for professional-related barriers but also organizational and administrative barriers to be addressed. The pandemic demonstrated how the obstacles and barriers could be overcome with normal legislative and regulatory barriers lifted that allowed near real-time implementation of vaccines.4 Critically, when it came to the roll-out of vaccine programmes, nurses were central to the success of the whole process. In the future, this approach would expedite the implementation of research into practice and the impact on patient care would be significant and impactful. Moreover, models of care have been adopted by international clinical practice guidelines following the concept of integrated care. Such models require a whole of systems approach fusing crucial fundamentals, one of them being interdisciplinary collaboration with significant roles for nurses. Besides the focus on integrated care delivery, these roles have the potential for nurses to engage in research and pursue clinical–academic research pathways and associated careers.5 Critically, a recent paper offering a worldwide perspective (11 countries representing six World Health Organisation [WHO] regions) concluded that there is poor investment in nursing research and a lack of reliable data on the number and amount of funding obtained by nurse researchers.2 Notably, the authors reported the lack of available evidence on the impact of PhD research. The lack of funding is confirmed by researchers from Australia, reporting that nursing and midwifery as the largest global health workforce are under-represented as recipients of research funding. In Australia, there are 479 000 nurses and midwives, who constitute 57% of registered health professionals. However, and to provide some examples, investigator grants provided by the National Health and Medical Research Council (NHMRC), one of the main funding bodies for research in Australia, were awarded to only 7 of the 238 grants awarded to nursing and one to midwifery in 2020. Moreover, of all 2020 NHMRC grant stream applications, only 5 of a total of 673 successful applications were focussed on nursing and midwifery.6 Despite the growth of nursing research, a consolidated approach to optimizing nurses’ engagement in research is required. This needs to be a ‘bottom-up’ approach with student nurses exposed to active academic researchers in nursing and related disciplines from the beginning of their programmes. Opportunities to participate in research electives are also useful and recent experience of this during COVID-19 demonstrated the benefits as reported by one student.7 The majority of nursing research is undertaken in high-income countries, and if we are to optimize nurses’ involvement in nursing research, there is a need to develop partnerships and collaboration between high- and low-to-middle-income countries. Recent work between the UK and Mexico around advanced practice has resulted in one live stream presentation with over 1000 participants, two conference talks, and two publications with further work planned.8,9 Nurses are in a unique position to not only be active researchers in clinical practice but also to drive the research and policy-making and improve the current time lag in implementation into practice. However, there are clear issues that need to be overcome. Ensuring that nurse researchers are visible to our students and developing research electives as part of their programmes10 is a good start. In clinical settings, fundamentals such as protected research time, funding, and resources to perform research should be in place. Finally, working collaboratively nationally and internationally will advance the profile of nursing research.