Exploring the experience of Clinical Research Nurses working within acute NHS trusts and determining the most effective way to structure the workforce: A mixed methods study

摘要

Background The Clinical Research Nurse (CRN) workforce has developed alongside a growing National Health Service (NHS) research infrastructure. However, evidence suggests this workforce is isolated with minimal awareness in acute trusts of the work of CRNs. There is a lack of evidence concerning how best to structure CRN teams within acute trusts. Aim The overall aim of the study was to explore how the CRN workforce is currently organised within NHS Acute trusts, to explore the experience of CRNs working within acute NHS Trusts and determine the most effective way to structure this workforce. Methods A sequential mixed methods design was used. Phase 1 comprised a national online survey sent to Lead CRNs in acute NHS trusts and a statistical analysis of National Institute of Health Research study recruitment data over the period 2010-2016. The survey response rate was 77% (111/144). Survey analysis used descriptive statistics and thematic analysis. Phase 2 comprised four purposively sampled organisational case studies which included 14 semistructured interviews and 4 focus groups. Qualitative data were thematically analysed using NVIVO 10. Findings Over the last fifteen years the CRN workforce has evolved in a reactive and inconsistent manner, shaped by local and external influences. The effect of reviewing CRN workforce structures was found to have a statistically significant effect on recruitment into interventional studies. Lead CRNs have an important role in providing leadership and direction for the workforce and a link to clinical nursing colleagues. The current NHS climate means research delivery can be difficult and often overlooked as it is not perceived as a priority. The level of support and understanding from clinical nursing colleagues impacts CRN experience. Recommendations - Organisations should ensure the CRN workforce is well led with the establishment of a Lead CRN post. - A CRN workforce model is proposed to provide a suggested framework. - Work should be undertaken to address the lack of understanding of research and the CRN role. - R&D Departments should consider the timing of a full review of their CRN workforce. - Work is needed to understand the role of the emerging non nursing workforce within research. Conclusion Development of well-structured CRN teams supported by a local leader with formal links into internal stakeholders is key. Improving integration of the CRN workforce into existing organisational structures and processes will raise the profile of research and may facilitate a longer term shift in attitudes.