Introduction

The Chief Nursing Officer (CNO) for England’s Strategic plan for research set out the ambition to:

Matrons and health and care leaders are central to fulfilling this ambition by embedding research and innovation in their nursing teams; creating  environments where research and innovation can thrive across all settings, including through the development of clinical academic careers. This research toolkit offers practical information that can support you in developing research and deliver innovation within your nursing teams.

Watch this short video, to hear first-hand how matrons and other leaders are driving excellence in their settings through research and innovation.

For those less familiar with research in practice, creating the environment in which nurses can lead, participate in and deliver research may appear an additional responsibility. This research toolkit can help nurture research in your teams as part of their day-to-day practice to achieve excellence in person-centred outcomes, and this animation gives an overview of the benefits.

The toolkit responds to feedback from matrons and health and care leaders who specifically asked for guidance on:

• how to recognise key components of research leadership
  • where and how to access research and innovation support
  • how to develop, measure and evidence growth in research engagement across teams
• how to reflect on individual research leadership and create a research development action plan
• how to access communities of practice and share ideas with likeminded leaders

Nichola Verstraelen and Dr Philippa Olive from Lancashire Teaching Hospitals NHS Foundation Trusts have developed this toolkit with input from over 200 leaders across the health and care system who are committed to advancing research in nursing practice and improving the confidence leaders have in enabling a vibrant and inclusive culture of research, for the benefit of the people and communities they serve.

The research toolkit complements other tools, such as the self-assessment of organisational readiness tool (SORT) and the multi-professional practice-based research capabilities framework.

A coaching approach supports wider academic development including research capabilities, and you may find the 5-staged framework to self-coaching and self-coaching in research leadership tool helpful as you work through the research toolkit.

For more ideas about how to get started and advance a positive research culture, to access wider resources and to share your learning, we also encourage you to join the Community of Practice for Matrons and Health and Care Leaders on the FutureNHS platform. Registration to FutureNHS is free and is open to anyone working in health and care organisations. Please contact hcl.researchcop@nihr.ac.uk if you require more information about this community.

1. Understanding research and innovation

Health and care organisations that embed research and innovation in their systems and structures achieve better health outcomes and improved patient and staff experiences (Boaz et al, 2018; Jonker et al, 2019). Building research capacity and capability across the health and care workforce is therefore crucial for the delivery of high quality, evidence-based services; the Care Quality Commission (CQC) asks organisations about research and innovation in its care quality and safety assessments.

What is research?

NHS England uses the UK Policy Framework for Health and Social Care Research definition of research:

The new knowledge generated from research increases understanding of best practice, education and leadership. All relevant legal and research governance standards are followed and the safety and dignity of research participants is primary. Research findings are used to make changes that improve the way services are delivered for:

• disease prevention, diagnosis and treatment
• safety
• population health, wellbeing and quality of life

You may want to share this video Who benefits from clinical research? with your teams. It describes the broad remit of ‘clinical research’ and illustrates why research is everybody’s business. To hear from a research leader about the difference research can make, this podcast describes how the Big CACTUS study is leading to improved therapy for people with communication difficulties following a stroke. Additional podcasts and information about how the distinct types of research contribute to health and care are available from the National Institute of Health and Care Research’s (NIHR) ‘Be Part of Research’ campaign.

How do I know if my evidence generation project is a research project?

The Health Research Authority (HRA) provides a tool to help people determine if their project constitutes research and provide this email to help with queries – contact@hra.nhs.uk. Your local research and innovation department, if your organisation has one, will also provide advice about governance and research ethics requirements.

People may have to complete Good Clinical Practice (GCP) training for research before they can conduct or support research. GCP training is free for people supporting clinical research in the NHS, UK universities and other publicly funded organisations in England.

NHS England also provides a free e-learning course to help you understand the complementary roles of research, audit and quality improvement.

Where does research funding come from? 

The NIHR is the principal organisation funding healthcare research in England and is funded by the Department of Health and Social Care. Its core workstreams are:

• funding research and innovation through its many funding programmes
• investing in research facilities and expertise and supporting research delivery so that patients, the public and health and care organisations across England can participate in high-quality research
• partnering with the public
• funding research professional development and providing free and confidential support for researchers to apply for funding
• working with industry, local authorities, charities and other research partners
• funding research to benefit people living in low- and middle-income countries

What is innovation?

Innovation covers invention (creating innovative ideas, products, technologies, services or models of care) and adoption (implementing what has worked well elsewhere) (Care Quality Commission, 2022). It involves testing and evaluation using robust research methods. The NHS Innovation Service provides a guide to innovation in the NHS.

The regulatory requirements around innovation depend on the type of innovation and its associated level of risk:

• the Medicines and Healthcare products Regulatory Agency regulates medicines, medical devices and blood components for transfusion in the UK
• the AI and Digital Regulations Service supports compliance with regulations around the development and adoption of artificial intelligence (AI) and data-driven technologies in health and care

What infrastructure supports innovation in health and care?

England has a variety of support infrastructure for research, some of which is listed below:

• 15 regional Health Innovation Networks [formerly the Academic Health Science Networks (AHSNs)]
• the NHS Innovation Service
• the NHS Accelerated Access Collaborative
• the NIHR Research Support Service
• the NIHR Innovation Observatory
• the NIHR also has a range of guidance for research teams on making research more inclusive. Login to NIHR Learn and enrol on the Research Inclusion Toolkits Hub
• the Health Foundation also supports adoption and spread of innovation and technology in the NHS

2. Understanding evidence-based practice

What is evidence-based practice?

Evidence-based practice brings together the best available research evidence with clinical expertise as well as patient experience.

Evidenced-based practice:

• makes the ethical care of the patient its top priority
  • demands individualised evidence in a format that clinicians and patients can understand
• is characterised by expert judgement rather than mechanical rule
• shares decisions with patients through meaningful conversations
• builds on a strong clinician–patient relationship and the human aspects of care

How do I assess the quality of research evidence?

It is important to be able to judge whether research evidence is of the highest quality, valid, reliable and generalisable or transferable to other contexts.

Evidence pyramids, also known as hierarchies of evidence, can help when considering the quality or trustworthiness of published research. Generally, the higher up the pyramid, the greater the strength and generalisability or transferability of the evidence.  

Evidence pyramids, however, were developed in the context of epidemiological and experimental research methods, such as randomised controlled trials, and it is important to use the research methods that best fit the research question being asked.

Also, knowledge generated from audit, other routinely collected data and service improvements can be vital in informing the design of future research studies.

The University of Exeter provides an online tutorial for nursing on using an evidence pyramid to identify the most robust evidence.

Models of evidence-based practice

The process common to most models for determining evidence-based practice involves 5 steps:

1. ask the right question
2. search for and access all relevant information (finding the best evidence) to answer the question
3. appraise and evaluate the quality and relevance of the information found
4. apply the information in combination with patient / client values and professional judgement
5. evaluate outcomes

A clinical librarian or clinical academic may be able to help you and your teams work through these steps. Also, Cordrey et al (2022) and Cooke (2005) provide evidence-based frameworks you may want to use to underpin your assessment, and BMJ Best Practice provides freely available evidence-based practice learning materials.

Embedding evidence-based practice: practical examples

The following examples show how nurses have approached embedding evidence-based practice in their area.

3. Enabling a research culture

What does ‘research culture’ mean? 

According to The Royal Society, “Research culture encompasses the behaviours, values, expectations, attitudes and norms of research communities. It influences researchers’ career paths and determines the way that research is conducted and communicated.” For health and care providers this means making research everybody’s business and embedding research and innovation in everyday practice and professional decision-making, as identified in the CNO for England’s strategic plan for research.

Benefits of a positive research culture for your patients, team(s) and organisation are:

• better patient/service user outcomes including decreased morbidity and mortality rates and fewer readmissions
• a more satisfied workforce with improved retention
• improved performance of health and care systems

How can I assess the research culture where I work?

The Self-Assessment of Organisational Readiness Tool (SORT) has a series of aspirational maturity statements about research-related activities to aid assessment of research culture and organisational readiness for research.

Other aspects to consider are:

• does the environment include or inhibit research? Is practice evidence-based?
• are there opportunities for staff, patients, service users and carers to take part in research?
  • are staff encouraged to question practice?
  • is research and innovation discussed at staff appraisals?
• how is engagement with, and impact of, research and innovation activities measured and monitored across your team(s)?

Enabling a research culture: practical examples

The following are examples of what you can do to support the development of a positive research culture in your team(s) or organisation. Please note some of these examples link to the Community of Practice for Matrons and Health and Care Leaders on the FutureNHS platform.

4. Supporting research delivery

‘Research delivery’ is the collective term for all the activities and resources required to deliver research studies to the highest possible standards.

The NIHR’s Research Delivery Network co-ordinates and supports delivery of its portfolio of research in the NHS and wider health and care settings. These studies are delivered in a variety of settings, including hospitals, GP practices and community settings, and in participants’ homes, place of residence or school. Some care homes have adopted ENRICH (Enabling Research in Care Homes) – a toolkit to help care homes make the most of research opportunities.

What do research delivery teams do?

Research delivery teams deliver a research study according to the research protocol that has been designed by a researcher and approved by an ethics committee. These can be national or international commercial studies or ‘trials’ that are funded by pharmaceutical companies and delivered in collaboration with the NHS or wider health and care settings. Watch this video to hear from Dr Rebecca Clark, GP, about primary care’s untapped potential for delivering commercial trials.

Research delivery teams will first decide whether their organisation can deliver a study: for example, by checking that a study design meets research governance and ethics criteria, that the organisation will be able to recruit the target population and has the necessary resources to deliver the study successfully.  

Research delivery staff will then recruit and consent eligible participants, implement any interventions and provide care, and undertake data analysis, such as for blood test results and physiological measurements that are then sent to them. They often work closely with or as part of the usual care team. For example, some areas include research delivery staff in daily huddles, and some have research champions within their usual care teams to open up recruitment to research studies outside usual working hours: for example, if a pregnant woman goes into labour during the night.

Why is it important to support the delivery of research?

Offering patients and carers the opportunity to participate in research studies is a right enshrined in the NHS Constitution. The CQC asks providers if they offer patients and carers this opportunity as part of the well-led domain in its Single Assessment Framework. This video created jointly by the NIHR and CQC provides insights into clinical research and the well-led assessment.

Asking yourself the questions below may help you reflect on how to improve your engagement with research delivery activity and explore how you can increase opportunities for involvement of your staff:

Staff involvement in research delivery and leadership opportunities to act as principal investigator are widening. For example, Anthony Jemmott, a community matron in a mental health care setting, has taken the opportunity to be principal investigator (PI) for 2 research studies taking place in his services:

• culturally-adapted family intervention for African and Caribbean people diagnosed with psychosis and their families
• what people think about taking part in physical activity: a questionnaire study for people with psychosis

As PI Anthony oversees the running of the studies, ensuring the data collected is as good as it can be and that safety for participants is protected.

The RECOVERY Trial showcases how clinical teams can assist research delivery by offering their patients new treatments through trials, as part of routine clinical care. In this animation, a nurse describes how seeing her patient on this trial recover from Covid-19 prompted her to get involved in research.

In 2024, the NIHR launched the Pre-registration Nursing & Midwifery Research Delivery Awareness Programme to equip nurses and midwives with a good understanding of clinical research by the time they graduate. This resource can be used as self-directed learning by nursing/midwifery students or as a facilitated presentation by university lecturers in schools of health. Students and lecturers will need to register for an account on NIHR Learn to access it.

Resources to help you and your teams get involved in research delivery are available in the Community of Practice for Matrons and Health and Care Leaders on the FutureNHS platform.

How can I measure involvement in research delivery activity?

Examples of ‘clinical academic activity’ include staff undertaking research skills training, evidence-based practice and quality improvement activities; publishing their research findings; collaborating on or leading research; and applying for clinical academic research funding.

You can use performance indicators to generate evidence for and monitor research delivery engagement in your area, and your local research delivery team may be able to help you with this. As a starting point, you could audit the following performance indicators:

• number of staff who know about Be Part of Research
• number of staff who know how to contact their local research delivery team
• number of staff who have undertaken research delivery training such as Good Clinical Practice
• number of studies ongoing in the service
• number of referrals by staff to research delivery teams

Frameworks and tools are available for capturing clinical academic activity and development within an organisation: for example, the Self-assessment of organisational readiness tool (SORT) and Multi-professional framework for advanced clinical practice in England).

5. Embedding clinical academic careers

What do clinical academics typically do?

“Clinical academics are clinical professionals working across healthcare providers and academic institutions. They have a dual role combining their clinical career with a research career. They work in health and social care while researching ways to improve patient outcomes.” (NHS England, 2021)

Clinical academics typically work across organisations and have affiliations or hold joint posts across universities and health and care providers. Their titles are varied: clinical research fellow, consultant practitioner, associate professor or reader, professor or chair, for example. See the example definitions of clinical academic research role titles in the the Community of Practice for Matrons and Health and Care Leaders on the FutureNHS platform.

Clinical academics are well placed to lead research to improve, maintain or recover health. They understand the requirements of how to conduct research, drawing on expert practice, safety, quality improvement and efficiency. As someone who continues to work in clinical practice, they see how evidence-based practice can best be embedded in everyday care.  

They also have an important part to play in role modelling a curious mindset – how could care deliver better outcomes? – and bringing their knowledge and experience in applied research methods into the clinical workplace. By inspiring other health and care professionals to consider their own research questions and showcasing the wider career opportunities that are available to them, clinical academics support professional development, recruitment and retention.

Resources you may find useful in supporting members of your teams to explore a clinical academic career are: 

• Starting out in clinical academic research video created by the University of Southampton and NIHR ARC Wessex. This explains what it means to be a clinical academic and how to develop a clinical academic career
• Mental Health Research Incubator
• NIHR nursing and midwifery incubator masterclass series (on the FutureNHS platform)
• NIHR and Royal College of Nursing Introduction to clinical nursing research programme (on the NIHR Learn platform)
• Royal College of Nursing list of research funding opportunities available to nurse or midwife applications

Routes to becoming a clinical academic

There are several routes to becoming a clinical academic and various development opportunities to take to pursue this path. Some clinicians start their clinical academic career journeys by asking a question about practice; they may then seek some research training so they can carry out an audit or service evaluation. Others may become involved in delivering a particular research project with colleagues and this sparks them to explore the research landscape in their area of practice and research training opportunities within that.

You can find examples of how individuals have developed clinical academic research careers on the Queen’s Nursing Institute Research Forum, and in the Nurse researcher podcasts you can hear from nurses and midwives who have carved their clinical academic careers. Other examples are on the Community of Practice for Matrons and Health and Care Leaders is available on the FutureNHS platform, clinical academic careers section, that describes how clinical academic roles can be aligned to the 5 underpinning themes of the CNO for England’s strategic plan.

To provide a real-life example of clinical academic career development, we have created a poster (available separately for download) showing the career path of community matron, Paula Berridge, from community staff nurse to her current PhD study.

Poster: real-life example of clinical academic career development

Paula’s career path is divided into 6 stages:

• Paula started as a community staff nurse.
• She then became a district nurse.
• This led her to mentor other nurses and developed her community knowledge and skills.
• She then undertook postgraduate studies to explore service development. This led to her completing a postgraduate certificate in healthcare education, which enabled her to teach district nursing students.
• Paula then completed her Masters qualification which identified a research question that she wanted to explore further.
• She sought funding from her trust to do her PhD and was awarded 3 years’ funding and has been able to study for her PhD while continuing to work clinically in the community.

Paula is passionate about research and developed a research group in the community for newly qualified nurses and allied health professionals. The group considers quality improvement, service development and holds journal clubs.

Her top tips for nurse leaders are to support research early in people’s careers, embed research into the daily routine and identify funding for all staff who want to develop their own research along their career journey.

What training and development opportunities support clinical academic career development?

Clinical academics often undertake formal research training such as PhD or professional doctorate programmes of study.

As outlined below, several funding streams are available in England to support clinical academic training and career development.

Clinical academic training internships and fellowships

Health and care professionals can apply for research career development funding. These programmes are run by NIHR and provides a range of opportunities to undertake fully-funded clinical research fellowships, research training and professional development, while maintaining clinical practice and salary.

The Research career development programmes support individuals at 4 stages of their career and are for all professionals across health and social care:

• Predoctoral-level opportunities
• Doctoral-level opportunities
• Postdoctoral-level opportunities
• Professorships and Senior Investigators Award

In addition, further investment is given for an extra £30 million a year to expand research opportunities for health and care professionals.

Each region in England has a NIHR Applied Research Collaboration (ARC), a regional partnership between NHS providers, universities, charities, local authorities and third sector organisations. Many of these offer research training, some with salary backfill.

Some charitable trusts and professional organisations also offer funding for clinical academic training. Some fund all costs (salary, training and development, and research costs) and others fund student fees or a stipend to cover living costs. Your local research and development (R&D) or research support service should be able to advise  on how to access research training and identify available funding.

How can I support the development of clinical academic roles in my organisation?

Matrons and health and care leaders are best placed to support staff aspiring to a clinical academic career, by leveraging organisational support for these roles in workforce planning and the backfilling of posts during fellowship opportunities to ensure consistent care provision.

Your organisation may want to consider joining the UK-wide Clinical Academic Roles and Career Pathways Implementation Network (CARIN). Many CARIN member organisations have successfully embedded clinical academic roles.

Do seek advice and opportunities through communities of practice for research, such as the Clinical Academic Careers in Primary Care and Community Nursing Community of Practice and the Queen’s Nursing Institute Research Forum. There will likely have members who are well connected with the research going on in your area, including for areas prioritised for improvement, such as the NHS England Core20PLUS5 areas for adults and children and young people, and the James Lind Alliance research priorities identified through priority setting partnerships.

If you or colleagues have contacts with academic staff in universities or colleges, they too may be able to tell you about local research collaboration opportunities, as well as research skills training, research awards and funding.

Asking yourself the questions below may help you reflect on how well established clinical academic roles are in your area/organisation and identify some actions to support the skills and training your organisation needs.

Contact

We welcome feedback on this toolkit. Please email england.researchcno@nhs.net

Please take every opportunity to engage with the FutureNHS Community of Practice for matrons and health and care leaders.

Publication reference: PRN01040