Introduction

“I think it’s that whole culture change around understanding what research is, and what it is there to deliver and how it impacts on the quality and safety of what we provide [for] patients.”

(The quotes through this guide are from interviews with chief nurses and taken from a December 2024 report to the NHS England South West Region on chief nurse perspectives on research culture, organisational support and research activity.)

Health and care research provides the evidence we need to develop or transform services, enhance quality and safety and improve outcomes for patients. The NHS should have a significant role in delivering research. As well as contributing to the scientific basis for prevention, earlier diagnosis and more effective treatment and care protocols, other direct benefits of research by those who work in the NHS are: increased workforce satisfaction and retention and better patient and carer experience; and improved system design and understanding of the most effective ways to adopt and scale innovations across different health and care settings.

The Chief Nursing Officer for England’s strategic plan for research, launched in 2021, set out the nursing profession’s ambition for “a people-centred research environment that empowers nurses to lead, participate in and deliver research, where research is fully embedded in practice and professional decision-making, for public benefit”.

Executive chief nurse leadership is essential if we are to realise this ambition and those set out in the complementary Chief Midwifery Officer for England’s strategic plan for research (2023) and the Allied health professions’ research and innovation strategy for England (2022); where research becomes the responsibility of every nurse, midwife and allied health professional across the NHS. As an executive chief nurse, you set the tone and expectation among the nursing, midwifery and wider health and care workforce and your role is pivotal in enabling a culture where the benefits from research can be fully realised through implementing these plans.

This guide suggests actions executive chief nurses can take to help their organisation become a research-positive healthcare organisation with research sustainably embedded in everyday practice and professional decision-making. These actions help build foundations in the 5 areas executive chief nurses from a range of NHS providers told us they needed guidance on:

• understanding the research landscape
• fostering a research inclusive environment
• leading and sustaining a culture that values research
• embedding research practice in careers and workforce planning
• cultivating partnerships and collaborations

NHS providers will be at different stages in their work to embed research across their organisation. They vary in size, complexity, services offered, volume and type of research activity and populations served, and will have varying strengths, resources and available infrastructure. For this reason, the guide does not set out a linear, stepwise approach. You should start in the place(s) that best suits your organisation.

The guidance is summarised in a downloadable schematic and found here: NHS England » Research matters – schematic

Executive chief nurses were invited to post descriptions of initiatives enabling a research-positive culture. These can be accessed by visiting the Chief Nursing Officer for England’s Research Programme workspace on the FutureNHS collaboration platform (registration required).

This guide compliments other resources: the Self-assessment of Organisational Readiness Tool  (SORT), research toolkit for matrons and other health and care leaders, multi-professional practice-based research capabilities framework and guidance for integrated care boards (ICBs) on maximising the benefits of research.

Understanding the research landscape

“There was a clear nursing, midwifery and allied health professional strategy for research, which set some ambition and some milestones and that was very much embedded into the research strategy [of] the organisation.”

Unfamiliarity with local and national research strategies and the language and abbreviations used in research can make it hard to get a sense of the agenda. This can get in the way of you identifying areas where it may be important to use your influence.

By becoming more familiar with what the national and local ambitions are, the metrics used to assess research performance and how research is funded, you will be better able to scrutinise relevant information and data, plan effectively and use available budgets and resources.

Potential actions

• Ask the board member with overarching responsibility for research to take you through the organisational strategy(ies) relevant to research, who was involved in developing and delivering it, and how progress and performance will be monitored.
• Work with those responsible for leadership and professional oversight of the midwives and allied health professionals (AHPs) in your organisation to establish a research strategy for nursing, midwifery and the allied health professions. Align this with the Chief Nursing Officer for England and Chief Midwifery Officer for England’s strategic plans for research and the allied health professions’ research and innovation strategy for England. Depending on the approach your organisation takes, the strategy could be standalone and profession specific or woven into strategies for research and education or quality, research and innovation.
• Identify what available data might help you understand your organisation’s research activity and monitor progress. Talk to your organisation’s research office if there is one.
• Establish ways to hear about the contributions that nurses, midwives and AHPs are making to delivering and supporting research and the impact this is having on safety, quality and productivity.
• Link with other organisations to learn about their approaches for developing and implementing a research strategy for nurses, midwives and AHPs.
• Investigate what National Institute for Health and Care Research (NIHR) research infrastructure (facilities, networks, opportunities including funding, and expertise) is available to support and enable research in your organisation and ask your directors what they will do to help you deliver your research strategy.
• Determine what types of research studies patients across your organisation are being invited to participate in and whether nurses, midwives and AHPs are involved in these studies.
• Use SORT to establish a baseline and identify areas for focus going forward.
• Many aspects of the financial management of research activity require specialist knowledge, but developing some understanding of the funding streams for research in your organisation will help you identify how you might secure investment to support business plans. NHS England has published guidance on Managing research finance in the NHS.

Benefits

• By developing a strategy, action plan and key performance indicators you will set out a clear direction of travel, underline the value you place on research and help staff identify how they can contribute.
• With a better understanding of research performance metrics you will be able to ask more pertinent questions, interpret relevant data and make informed arguments for resources to support organisational development.
• By aligning your vision and research priorities with related national strategy and organisational goals you will leverage cross-organisation support and accelerate progress.

Fostering a research-inclusive environment

“One thing I think we should be focusing on is to how we support direct care nurses and other nurses, midwives and AHPs to remain as close to the bedside as possible, while having the opportunity to think about research.”

Everyone should have the same opportunity to be part of research studies and health and care research needs to involve participants from all communities if it is to address the needs of the whole population. Inclusive approaches to research provide results that reflect the whole population and therefore the evidence for approaches to improving patient safety, care and health outcomes for whole populations. Historically, those participating in research studies may not have been representative of those most in need, meaning health and care inequalities will persist.

Research funding is often awarded to a select group of organisations and professions and this has tended to concentrate research expertise in particular locations and professions, not necessarily where it is most needed. Diversifying the health and care professionals involved in research and developing researchers from multiple disciplines, specialisms, geographies and backgrounds will improve your organisation’s capacity to reach the populations underserved by research.

Establishing a supportive and inclusive research culture where diversity is celebrated, and every healthcare professional gets an opportunity to contribute to research, will ensure your organisation can draw on the many different talents and energies of people across the workplace. Staff can feel research is not for them and is someone else’s responsibility. Those whose primary role is research can feel undervalued and that they do not belong.

Potential actions

• Ensure any research-related opportunities in your organisation are offered in an open and fair way and responsive to the needs of your workforce. Advocate for inclusion of nurses, midwives and AHPs in all research activities across your organisation.
• Promote the message research is for everyone in some shape or form, not confined to the few. Publicise that every type of contribution is important – whether informing research questions, leading research, contributing to recruitment and delivery activities, disseminating findings or translating research into improvements in care and practice.
• Embed mechanisms that give visibility to those involved in delivering, supporting and leading research.
• Set and track targets for the percentage of staff engaging in research and include those for diversity, equity and inclusion.
• Identify barriers and encourage your research leadership team to develop ways to encourage staff to make research part of their everyday work/careers.
• Ask the departments responsible for research activity in your organisation to develop communications that make staff aware of the research going on around them.
• Build links with research leaders at all levels across organisations and professions to get buy in and cultivate supportive environments.
• Introduce roles like research champions or ambassadors. Consider targeted approaches for the underrepresented professions and groups, and use allyship across professional groups.

Benefits

• More patients will have the opportunity to participate in research, including that giving them earlier access to treatment and increased monitoring.
• Diverse and inclusive research environments result in workplaces where everyone feels they belong, connected to others across the organisation and can make the most of their talents.

Leading and sustaining a culture that values research

“How we showcase the good work that is already going on…research development can be a bit of an island… they need to be coming to board. We have a patient story and a staff story, so why don’t we have some of the staff stories to be research stories?”

You play a pivotal role in developing and sustaining a culture that actively shows research is valued. While the executive leadership responsibility for research at board level commonly sits with the chief medical officer, an organisation’s research strategy cannot be designed, created and delivered by one individual or one team. Your role is vital in reinforcing that research is as important as the other pillars of professional practice, namely practice, education and leadership, in achieving care excellence.

Potential actions

• Assign responsibility for the research portfolio to (a) named individual(s) in your corporate team. Work closely with those who have strategic and professional oversight of the AHP and midwifery workforce. Ensure the impact of research activity led by nurses, midwives and AHPs is celebrated at your senior leadership meetings.
• Use the process of developing your research strategy or plans to build a shared purpose and vision, establishing expectations among clinical leaders that support for and engagement with research is a core component of their role and those of their teams.
• Propagate a culture of curiosity and enquiry, cultivating environments where staff have the freedom to ask questions, challenge established ways of doing things and can think outside the box to come up with new solutions.
• Advocate for staff who have research as a major part of their roles and establish structures and processes so they can support and work with you in leading this agenda.
• Build on and link research activities related to organisational streams of activity, like continuous improvement, innovation, organisational development and human resources. Help your workforce see how a focus on research is improving quality, safety and productivity and enabling an organisation that learns continually.
• Show how research and evidence-based practice is enabling care excellence. Ensure those with relevant research expertise have opportunity to contribute to developing and evaluating strategy, policies and continuous improvement programmes.
• Determine how success will be measured at an early stage using tools and frameworks like SORT and VICTOR. Use celebration and learning events to raise the profile of how nurse, midwife and AHP involvement in research is contributing to evidence-based practice and organisational performance.

Benefits

• Research-active organisations have better patient and organisational outcomes.
• People who are cared for by organisations that are research active have more confidence in the staff looking after them.
• A powerful, purpose-driven context and narrative around the value of research will mean people are more likely to engage with studies.

Embedding research practice in careers and workforce planning

“I am thinking about the retention piece, the attraction piece of workforce strategy. Because if we are a research-active organisation then people can see the fantastic work that is going on here.”

Many staff want to get more involved in research and everyone can have a role in generating evidence, delivering research and ensuring their professional practice is informed by evidence from research.

Research is one of the 4 pillars of practice but in challenging health and care service environments organisations may sometimes view it as a ‘nice to have’. Staff already engaged in research can find themselves diverted to deliver direct care at times of significant pressure. Involvement in research can also be hampered by lack of opportunities and staff not knowing where to start and who to reach out to for advice and support.

Potential actions

• Develop effective communication mechanisms to publicise internal and external research opportunities and information on how staff can maximise their engagement in these.
• Introduce the multi-professional practice-based research capabilities framework into your organisation and use it to set realistic expectations for research activity as part of everyday practice, recognising and supporting research potential and talent.
• Review job descriptions to ensure these reflect the capabilities in the framework and reinforce that duties extend to contributing to research in some shape or form. As a starting point, ensure time for research is included and preserved in job plans for those working at an advanced or consultant level of practice.
• Work with your chief people officer (or equivalent) and managers to incorporate research knowledge and skills into staff development plans and continuing professional development provision. Make contributing to and engaging with research an element of appraisal and include it as a criterion for career progression.
• Establish initiatives that support staff to access and use research evidence to improve practice.
• Support staff to undertake NIHR good clinical practice training courses (the agreed international standard for conducting clinical research) and make this a requirement for staff supporting clinical research delivery.
• Develop workforce plans that build time for research at the point of care delivery, including as the principal investigator for suitable studies, and introduce clinical academic posts in partnership with higher education institutions (HEIs). The Clinical Academic Roles Implementation Network (CARIN) is a useful source of information on establishing these posts.
• Create opportunities for recognition and reward to encourage involvement in and leadership of research activities.

Benefits

• Research-active NHS providers are attractive places to work, learn and develop. Organisations that empower staff to be involved in research increase staff job satisfaction and retention, and can find it easier to recruit staff.
• Active engagement with the research pillar by all practitioners helps embed research in everyday NHS care delivery and ensure practice and policies are evidence based.
• Increasing the capacity and capability of staff to engage in and lead research provides the foundation for better decisions that deliver better outcomes and patient experience.

Cultivating partnerships and collaboration

“Across [the South-West] there will be people that are ahead of others and we should be able to share that experience and not reinvent the wheel.”

There will be many individuals, teams, departments, organisations and networks (internal and external to your organisation) willing to help and partner with you to help progress your plans for increasing the involvement of your workforce in research.

There is a raft of individual research career support, development and training opportunities through the NIHR and other funders of research. The NIHR invests in centres of excellence, collaborations, services and facilities to support research in England, collectively known as NIHR research infrastructure. It has a specific remit for research capacity development and training. Medical research charities invest in research that accelerates access to innovation, research facilities and the clinical research workforce and clinical academics.

Success in these competitions often depends on demonstrating a record of accomplishment in partnership working with HEIs.

Potential actions

• Join forces with the senior responsible officer for research at board level and your organisation’s research and development (R&D) director. If there is limited R&D support in your organisation, contact the person with remit for research in your local ICB or NIHR Research Delivery Network (RDN). Ask them to introduce you to people within the local and regional research infrastructure so you can draw on their support.
• Involve the person in your organisation with responsibility for the research delivery workforce (clinical research nurses, midwives and AHPs) in the development and delivery of your research strategy.
• Where they exist in your organisation, work with those in chief AHP and chief midwife leadership positions to develop integrated and mutually supportive research-related strategies and annual plans.
• Establish and monitor metrics for how many nurses, midwives and AHPs in your organisation are acting as chief investigators and/or principal investigators for research studies and how many staff have joint posts with HEIs.
• Establish connections with managers, departments and teams responsible for research, innovation, education and training, human resources, knowledge and library services, and continuous improvement.
• Find out about existing research collaborations and the priorities of your HEI partner(s). Establish how they can help you deliver your research strategy.
• Establish clinical academic posts with (an) HEI(s) for staff with a doctorate and other types of posts that strengthen partnership working between your organisation and academic partners for research and education purposes. Ensure you adhere to the Follett principles for joint working between HEIs and NHS providers for regulated, registered health and care professional clinical academics. Identify any memorandum of understanding between your organisation and HEIs that set out nature of the partnership and framework to support working relationships.
• Work with relevant communities and individuals to foster community-led approaches to research, embedding patient and public involvement, engagement and participation (public partnerships) in your plans.
• Enlist the help of NIHR translational, delivery and research support infrastructure local to your organisation when considering ways to involve staff in research – for example, the regional applied research collaborations between organisations that undertake applied health and care research; the RDN, which co-ordinates and supports the delivery of research in the NHS and wider health and social care environment; and the free Research Support Service that assists researchers in applying for funding. Explore the support available through the Nursing and Midwifery Office at the NIHR and CAHRP (Community for Allied Health Professions Research).

Benefits

• Public partnerships will help ensure the needs of patients and communities are at the centre of your plans.
• Strong productive partnerships with the higher education sector increase staff access to research-related career development, mentoring, training and honorary academic appointment opportunities.
• When HEIs understand local need they are more likely to tailor their strategies and plans for research, and develop and conduct research that is responsive to and meets the evidence needs of patients, communities and healthcare providers.
• Collaboration with those who generate and lead research will increase the rate at which evidence-based practice is implemented into practice to deliver improvements in the delivery, efficiency and sustainability of health and care services.

Acknowledgements

We thank the project management group for their contributions in developing this guide:

• Tracey Brigstock, Chief Nursing Officer, University Hospitals Coventry and Warwickshire NHS Trust
• Maggie Davies, Chief Nurse, University Hospitals Sussex NHS Foundation Trust
• Dani Marlow, Patient and Public Voice contributor
• Paul Morris, formerly Chief Nurse, James Paget University Hospital NHS Foundation Trust
• Sarah O’Brien, Chief Nursing Officer, NHS Lancashire and South Cumbria Integrated Care Board
• Claire Whitehouse, Clinical Director for Research and Development, James Paget University Hospital NHS Foundation Trust

and all those who took the time to attend an engagement meeting or submit a case study.

Publication reference: PRN01995