Careers advisory service for aspiring clinical academic nurses and midwives

Introduction

The need for research to improve the health and care of the nation is one of the guiding principles of the NHS Constitution for England (Department of Health and Social Care, 2023). In the last decade, studies have shown positive links between research activity and patient outcomes in NHS trusts (Jonker and Fisher, 2018; Hanney et al, 2013). For example, higher levels of National Institute for Health and Care Research (NIHR)-adopted research activity are associated with lower mortality rates (Jonker and Fisher, 2018). Engaging clinicians and healthcare organisations in research can improve healthcare performance and increase the likelihood that staff recommend an organisation to colleagues or patients (Jonker et al, 2020).

Research led by nurses and midwives is necessary to advance and improve practice (NHS England, nd). The vision outlined in the chief nursing officer for England’s plan for research is for nurses “to lead, participate in and deliver research, where research is fully embedded in practice and professional decision-making, for public benefit” (NHS England and NHS Improvement, 2021). A research-active nursing workforce underpins quality, safety and innovation in practice, with the ultimate aim of transforming patient care (Royal College of Nursing, nd).

Despite the benefits of a research-active workforce, nurses and midwives make up a small percentage of those with academic, clinical academic and principal investigator roles. In both nursing and midwifery, there is an urgent need to build research capacity. To increase the number of nurses and midwives pursuing a research-related career, the NIHR and Health Education England have developed the Integrated Clinical Academic (ICA) programme. This provides a framework for clinical academic careers, with a series of funding opportunities available to support individuals at different stages of their career. There are four schemes:

• Internships are an introduction to clinical academic research, including designing trials, data management and undertaking research in the clinical environment;
• Pre-doctoral awards provide time to develop a doctoral fellowship application;
• Doctoral awards fund health professionals to undertake a PhD;
• Post-doctoral awards support individuals to develop both their academic and health or care career (NIHR, nd).

Strengthening research activity within these professions will not happen overnight (NHS England and NHS Improvement, 2021). Recent studies have shown that nurses who carve out this kind of role often encounter considerable challenges, including difficulties negotiating time for academic work and convincing managers of the value of academic training (Trusson et al, 2021; Avery et al, 2020).

Mulvey et al (2022) conducted a secondary analysis of data from the NIHR’s (2017) strategic review of training to identify factors associated with successful and unsuccessful applications. The data related to 4,388 applications to the NIHR Academy between 2007 and 2016 for personal funding awards from the Integrated Academic Training programme (open to doctors and dentists), the ICA programme and other fellowships. Taking all factors into consideration, nurses and midwives were as successful as their medical counterparts in being awarded fellowships (Mulvey et al, 2022). There was, however, a stark difference in the number of applications. For example, 37% of applications came from doctors, 24% from people without any form of professional registration, 14% from allied health professionals, 12% from other health professions, and 11.5% from nurses or midwives (Mulvey et al, 2022). The number of applications received from nurses and midwives was not as high as it could be (NIHR, 2017), and this deficiency in funding applications and awards for nurses is mirrored internationally (Tranmer et al, 2020).

Mulvey et al’s (2022) secondary analysis also showed a geographical and institution-based variation in application rates for personal awards. The highest proportion of applications (78%) came from the ‘golden triangle’ (which includes Cambridge, London and Oxford) and Russell Group institutions, a group of UK universities with a shared focus on research and a reputation for academic achievement; 22% were from other institutions. Although the study showed success rates to be similar across all institutions (Mulvey et al, 2022), Burkinshaw et al (2022) highlighted that the perception of inequity remains. Their qualitative study, which interviewed 22 past NIHR award holders and managers to explore the barriers and enablers to progressing an NIHR-supported research career, identified perceptions of a biased ‘playing field’, with inequalities perceived by those outside established research institutions (Burkinshaw et al, 2022).

The NIHR Nursing and Midwifery Incubator was set up to accelerate growth in the clinical academic workforce across the nursing and midwifery professions (NIHR, 2022). One key area of focus was the wide geographical variation in support for career development. The NIHR Nursing and Midwifery Incubator considered the different ways in which this situation could be improved; one strand was the development of a clinical academic careers advisory service.

“Clinical academics have a key contribution to make in supporting excellence in care and improving patient outcomes through research and innovation”

The careers advisory service

The intention was to develop a service to help nurses and midwives start or advance a clinical academic career. The careers advisory service aimed to offer nurses and midwives who are interested in clinical academic careers – and prospective applicants to the ICA programme and other NIHR fellowship schemes – additional support by providing information and advice. We hoped that this would increase the number of applications to NIHR fellowships.

The service centred around clinical academic career pathways, training, development and funding. We aimed to focus the advice on the ‘person’ and ‘place’ aspects of a fellowship application, rather than on the project. The service worked alongside the NIHR Research Design Service (RDS) and complemented the advice it offered. The careers advisory service comprised a virtual network of advisors operating through regional hubs. It was piloted during 2020-21 to test operational processes and supporting resources and to understand demand and acceptability of the approach.

The service was promoted via the NIHR RDS, partner websites and Facebook, and was delivered over two phases. An initial phase took place between November 2020 and March 2021 in three RDS regions (North West England, the East Midlands and South East England), involving nine advisors (eight nurses and one midwife).

A second phase was undertaken between June and October 2021, involving the same nine advisors but expanded to include individuals from any region in England (10 regional hubs in total). This allowed evaluation of demand across a national footprint. The advisors were experienced nurse and midwife researchers with experience of supporting and advising other nurses and midwives about career development in research. They were either professors or associate professors, and some had clinical academic appointments. During the advisor-selection process, we invited expressions of interest and explained the desirable skills and qualities. We also used our networks to contact relevant individuals in the regions taking part.

The nurses and midwives seeking an appointment with an advisor completed an initial enquiry form, which included a tickbox to indicate they agreed to being contacted by email and for their details to be held for the purposes of service administration and management; this involved agreeing to the NIHR privacy policy. Consent to survey completion was assumed through return of the feedback questionnaire by service users, and completion was voluntary.

The 60-minute appointments were conducted online at a mutually convenient time. An evaluation form (via Microsoft Forms) was distributed by email after each appointment (on the same day) to both the service user and the advisor. When the responses were received by the administrators, each form was allocated an identifier and anonymised in order to be analysed. We used a screening process to identify those that only required signposting and/or brief information via email.

The data was stored on a computer in a password-protected file. We did not seek university research ethics approval because the work was classed as a service evaluation. Participants were aware feedback would be sought following the appointment and the data generated would be used to develop a publicly available publication.

At the conclusion of the service, the advisors provided feedback about their motivations to act as an unpaid advisor, as well as suggesting resources and training that would be useful going forward. The core skills required to be an advisor were set out in a person specification document. These included communication skills, an understanding of the clinical academic role, and experience of support and mentorship.

What we learned: views of service users and advisors

Enquiries and appointments

There were 78 enquiries to the careers advisory service across the two phases of the pilot. The second phase closed early to new enquiries due to demand exceeding the number of available appointments (which were reduced due to the pilot running over the summer holiday period).

Most enquiries were from nurses (77%). In phase one, enquiries came from all three of the included RDS regions. When the service was expanded nationally in phase two, enquiries were received from all but two RDS regions, and 44% came from the London RDS region. Overall, across the two phases, 72 appointments were offered and 65 were arranged. There were 43 completed evaluations from the nine advisors, and 44 from people accessing the service.

Accessing the service

Although the service was advertised through RDS contacts and on Facebook, very few of those who accessed the service and completed the evaluation heard about it through these routes. They were most likely to hear about it through word of mouth (30%) or Twitter (now X) (20%). Using a scale where 1 represents hard and 5 represents easy, more than two thirds of service users rated accessing the service and booking appointments as easy (score 5). The majority (80%) also rated administration support as good (score 5) on a scale where 1 represents bad and 5 represents good.

Advice session: service users

Those accessing the service were asked which areas they most wanted to receive information and advice about (Fig 1). Of those who completed the evaluation, the highest proportion wanted to discuss clinical academic career options (73%). Other commonly selected areas were exploring potential funders (34%) and preparing oneself or a CV to make a high-quality application (41%).

When asked whether they had enough time with their advisor, based on a scale where 1 represents not at all and 5 represents plenty, 77% of service users selected plenty (score 5). In addition, most (90%) would recommend the service to friends and colleagues.

Advice session: advisors

The advisors reported feeling equipped to deal with the enquiries, and most had plenty of time to discuss the query during the session. When asked to rate how well the appointment went using a scale of 1-5, nearly three quarters of advisors gave it the highest rating of 5. Meanwhile, 63% thought frequently asked questions were not suited to dealing with the types of enquiries received.

When the service was extended across England, 72% of advisors said they felt equipped to deal with enquiries where the advisee came from outside of their region or required only general advice, for example, when “no local knowledge [was] required to meet [the] needs of [the] individual”.

The feedback survey also included open questions for the advisors and service users about the outcomes of the advisory session, feedback and additional comments (Table 1).

Advisor perspectives at the end of the pilot

At the end of the pilot, the advisors took part in focus groups. The discussions centred around motivations for taking part in the pilot, resources required during the sessions, and time demands involved. The sustainability of the service going forward and aspects that would support this were also discussed.

The nursing and midwifery advisors were motivated by making a difference and supporting the growth of clinical academic careers, increasing opportunities and lessening inequalities in access and resources. When discussing the resources used, advisors reported using their own experience of navigating their career as well as local and national resources, such as the 70@70 network, NIHR masterclasses and local internship schemes. The need for a common resource hub for advisors was highlighted. The service’s time demand was considered reasonable, and advisors felt it was manageable to incorporate two appointments per week into their workload, as long as there was administrative support. It was recognised that a larger team of advisors would be needed if a national service was to be sustainable.

“If we are to accelerate growth in clinical academic numbers, we need to find new and innovative ways of supporting nurses and midwives”

Overall learning

Clinical academics have a key contribution to make in supporting excellence in care and improving patient outcomes through research and innovation (Cooper et al, 2019). The aim of the careers advisory service was to strengthen mechanisms for developing a nursing and midwifery clinical academic workforce and reduce geographical variation in support and opportunities. Overall, the evaluation found there was demand for the service and those who accessed it positively evaluated it. The evaluation of the second phase of the pilot, in which it was expanded across England, confirmed that both regional and national models of delivery could work.

A healthy research culture and institutional support have been highlighted as important factors in successfully securing NIHR personal training awards across all disciplines (Burkinshaw et al, 2022). While many institutions provide these for their medical staff, the health professions other than medicine are more likely to need to rely on chance encounters with individuals and senior managers to provide the encouragement and support they need (Burkinshaw et al, 2022).

Shortcomings in this support are also more likely to affect those in district general hospitals and community services than in other settings, which often lack an established research culture. This type of advisory service has the potential to tackle inequities and variation in access to support and advice, particularly for those not working in a research-intensive organisation.

There are various ways in which this service could be organised and developed going forward. For example, a service could be developed that links to existing programmes of research support and funding. Research advisory services, such as the NIHR Research Support Service or local/regional services and infrastructure, could incorporate it into the services they already offer.

There might also be an opportunity for relevant stakeholders to collaborate to offer a service across a regional footprint (such as integrated care systems), modifying it to meet local needs and develop a service based on learning from the pilot. The NIHR’s (2023) announcement about the establishment of regional research leadership offices also presents the potential to consider incorporating some form of service into office functions. Overall, multiple routes and channels to raise awareness of the service are needed going forward.

Conclusion

If we are to accelerate growth in clinical academic numbers, we need to find new and innovative ways of supporting nurses and midwives. The need to tackle inequities in access to advice and support due to geographical location or place of work is key. The approach tested and reported by the careers advisory service is feasible and has merit.