Translating healthcare research into clinical practice is a slow process, with statistics showing that uptake can be delayed by up to 17 years. The 60-30-10 rule, highlighted in 2020 research from the Australian Institute of Health Innovation, tells us that only 60 per cent of care provided in health services is evidence-based, 30 per cent is low-value care and 10 per cent is harmful care. So, the need for more efficient pathways for researchers and funders to connect their work with practitioners, institutions and patients is pressing.
One successful strategy to address this is by embedding research into the day-to-day work of clinicians in order to develop and support clinician researchers. Achieving this is not straightforward, despite the potential.
Nurses in particular lag in clinician researcher roles compared with other professional groups. More effective pathways are needed to build capacity in research skill development for nurses to become influential researchers, address the glacial pace of healthcare research impact, and provide career advancement opportunities.
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To that end, a nursing research action plan has been developed for the Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance to support clinician researcher pathways. Its key elements are: engagement and recognition of nursing involvement in research activity, nursing research internships, grantsmanship and writing support, and onsite advisers for higher degree research. All the elements in the research action plan have proved to be effective as pieces of work by different clinical teams within the local health service.
STARS is only four years old, ramping up activity to respond to unmet needs at the height of the Covid-19 pandemic and of a brand-new facility in the largest public health service in Australia. The alliance, which is a partnership between the University of Queensland (UQ) and Metro North Health in Brisbane, aims to support interprofessional education and research. It brings together clinicians, researchers, students and the community to “put research into action”. The alliance team consists of medical, nursing and allied health conjoint roles supporting research, interprofessional practice and consumer engagement. These roles are co-funded by Metro North Health and UQ.
Here are key takeaways from putting the nursing action plan in place.
Recognition for nursing engagement in research
More often than not, the work of nurses as a support role in research is invisible and unrecognised, despite the pressure placed on health systems through in-kind time contributions. Nurses facilitate clinical research in multiple ways including support for patient decision-making, screening patients for eligibility, escalating adverse events and supporting study assessments.
As a part of the action plan, if a nurse has a role in supporting research, we encourage researchers to invite them to become study investigators. Nurses’ access to these roles can then lead to experiential learning through protocol contributions, attendance at steering committee meetings and inclusion in dissemination activities. The intention is to build nursing research capacity, make research accessible, produce relevant study designs and outcomes, and embed research in business-as-usual activities.
We recognise that nurses may not have the confidence to take part, so our conjoint researchers make themselves available to support. We also recognise that nurses may not want to be involved in these roles, but we aim to offer them exposure to research participation on any level that suits their professional development needs.
The nursing conjoint role is an essential element. This funded role leads research programmes in line with their clinical expertise. Considerable executive effort has been invested in developing research supportive infrastructure around this role to ensure business, finance and regulatory requirements are streamlined. These efforts have provided a strong foundation to support other nursing clinical research.
Nursing research internships
As part of the research internships, nurses are released one day a week over 12 months to complete a research project under the support of a PhD-trained nurse researcher. We have published an evaluation of the Nursing Research Internship Program.
Interest in nursing research internships is fostered across the health service through a competitive expression of interest process. The successful outcomes of previous interns have been key to ensuring consistent funding sources. Support from executive leaders and managers, too, despite constant demands on nursing resources across the health service, has been crucial to allowing time and access to the internship. The first nursing research intern to complete the 12-month programme has continued in research after success in a competitive grant programme, supported by the nursing conjoint.
Grantsmanship and writing support
Clinicians’ lack of confidence in their scientific-writing skills can present a significant barrier to pursuing research activity. As much as providing opportunities to improve report, article and grant-application writing, support should also offer ways for nurses to come together and feel less alone in tackling the challenge. Drop-in clinics, for example, can provide ad-hoc support, while weekly writing circles create community. Each writing circle is quarantined time to write as a group, usually 60 minutes away from clinical demands. Success of one can inspire other nurses, so we celebrate successes whenever possible.
Higher degree research pathways
The development of pathways also aims to improve accessibility to higher degrees for clinician researchers. As always, support essentially means time and money – in the form of grants. Key strategies to support these pathways are pre-research higher degree grants to cover time gaining research experience, on-the-ground academic advisers within the facility, ongoing university presence through the alliance and flexible learning. However, it is the culmination of the elements of the nursing research action plan that provide increased accessibility to higher degree research training.
We look forward to accelerating the role of nurse clinician researchers, so that interprofessional research, better knowledge development and knowledge translation can ensure health outcomes are optimised. The action plan goes from 2025 to 2027, but we will be assessing performance annually. Our aim is to increase nursing research capacity. Each key area will be assessed on nursing engagement, and we will evaluate success through nursing access, engagement and activity. We hope to improve research culture and accelerate impact.
Natasha Roberts is a specialist nurse, conjoint clinical research fellow at the Surgical Treatment and Rehabilitation Service and a senior research fellow in the UQ Centre for Clinical Research in the Faculty of Health, Medicine and Behavioural Sciences at the University of Queensland.
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