The aim of this study was to identify and describe neonatal nursing research activity within the UK. The study is limited by its response rate as there may be neonatal nurses practising at Doctoral or Masters level who did not complete the survey. The survey was advertised widely on social media and through all schools of nursing in an attempt to reach as many neonatal nurses as possible, however it is acknowledged that this may have impacted on the findings.
Our findings indicate that, from this albeit limited sample, there are 10 neonatal nurses currently working at or above Doctoral level. Of the estimated 5,000 neonatal nurses in today’s NHS this equates to 0.2% of the current workforce. When considering that only 1 participant reported active roles in both academic and clinical practice, the clinical academic rate for neonatal nurses in the UK is 0.02%. This is unsurprising when considering that there are currently no professors of neonatal nursing in the UK (following survey completion, one participant was recently made an associate professor), despite a small number of children’s and specialist nursing professors.
Like previous studies, our findings indicate that there are multiple barriers in clinical practice to undertaking nursing led research. HEE conducted a review of clinical academic careers in 2017 and found the availability of funding, time, positions and inadequate support from employing intuitions were all barriers to progressing research related careers in non-medical health professionals. The report also highlighted the difficulties faced when transitioning to a post-Doctoral phase of research, citing that the majority of participants went into either an academic or clinical post with no formal research sessions. This is again reflective of our findings, which indicate that participants working at Doctoral level do not have a structured post-doctoral career pathway which incorporates their research skills within a clinical academic role, instead assuming a variety of traditional roles within and across both academia and practice. A study exploring the experiences of NMAHPs pursuing clinical academic careers in the East Midlands recently found that participants likened the career pathway to a pyramid, with research progression challenging and poor financial infrastructure to support career choices post-Doctoral qualification. These findings indicate an urgent need for defined career trajectories outside of the traditional management or ANNP pathway, career support and associated pay scales for clinical academic neonatal nursing researchers. This would contribute to developing an innovative workforce who feel their contribution is valued and who are able to continue to pursue their passion of improving infant and family care and outcomes through research.[11, 22–24]
In an attempt to address the limited opportunities in practice, a number of UK Institutions are collaborating with NHS organisations to identify research priority areas and develop defined NMAHP clinical academic pathways. [23, 25] The Council of Deans Clinical Academic Roles Implementation Network (CARIN) provides support to promote and evaluate these joint clinical academic roles, along with advice on how to develop and sustain research activity.[26, 27] At the heart of these collaborations are the identification and recruitment of high potential individuals who can establish successful funding revenue which can transform practice. In our study we have highlighted a number of participants across the UK who are currently working towards Masters and Doctoral level qualification in neonatal nursing, who could benefit from such an approach and mentorship from experienced clinicians. The importance of such organisational support cannot be underestimated; research mentors and institutional leadership, identified as barriers in our own study, have been found to be the highest facilitator for nursing research and the primary barrier when absent.[21, 28, 29] In our study only 30% (n = 17) of participants had a mentor, and only 3 mentors were from a neonatal nursing background. Addressing this issue through the development of research active neonatal nurses will allow us to build a network of mentors who can provide appropriate support for early, mid and senior career level researchers and support the advancement of nurse led research and career progression.
To centralise nursing research and support in the wider organisational agenda, a small number of NHS organisations are pursuing American Nurses Credentialing Centre (ANCC) Magnet® accreditation, an ANCC initiative where recognised hospitals have successfully aligned education, infrastructure and resources to support nursing excellence (incorporating research) in clinical settings.[30, 31]. Nottingham University Hospitals NHS Trust were designated ANCC Magnet® (Nottingham City Campus) and Pathway to Excellence® (Nottingham Children’s Hospital) accredited in 2020, representing the only dual accredited organisation in Europe. Evaluation of outcomes in Magnet® designated hospitals have shown higher levels of job satisfaction and less reported burnout in nurses along with improved patient outcomes.[32, 33] A core domain of nursing excellence within Magnet® accreditation relates to New Knowledge, Innovation and Improvement, thereby focusing attention on nursing research cultures, infrastructure and evidence based practice. Evidence outside of the United States (US) remains limited however, and high quality research is required to measure the impact of hospital accreditation. Accordingly, a grant from the European Union was recently awarded to an international team of researchers to explore the feasibility and sustainability study of the Magnet® model in over 60 hospitals from Europe. Results from this study may prove pivotal for nursing clinical academic careers in the future.
The ability of neonatal nurses to contribute, develop and lead research which shapes clinical practice remains of pivotal importance. There is a national deficit of an estimated 40,000 nurses in the UK, with particular challenges in neonatal nursing, allowing nurses the flexibility to work where they wish and therefore recruitment strategies should draw on the opportunities afforded by clinical academic role development. Developing innovative, defined, financially supported clinical academic pathways may be one way of promoting staff loyalty and excellence through empowerment and autonomy, attracting and retaining high quality staff.[11, 22, 23, 37] One of the biggest barriers identified in this study was lack of time to undertake research; participants’ comments and reports of limited or absent time allocated to research activities in their role highlighted this issue. In the US, several authors have addressed this issue by demonstrating the Return On Investment (ROI) of PhD qualified nurses in clinical practice, highlighting total overall organisational savings of up to $9 million following evidence based nurse led interventions improving patient outcomes in areas such as pressure ulcers and chest tube site dressings.[38, 39] In the UK, studies have again highlighted the impact of nurse led interventions in areas such as less inappropriate use of antibiotics, reduced length of stay in patients in mental health crisis and post anaesthesia dementia care.[23, 40] Highlighting the impact that research active nurses can have in practice could be a huge step in achieving wider organisational support for specialised clinical academic career pathways. In neonatal nursing, various studies have identified nursing research priorities both globally and within Europe; these studies could be used to develop networks of neonatal nursing led research teams who can highlight the impact of evidence-based interventions within the UK.[41, 42] At a time when organisational resources in academic and clinical practice resources are low, strategies such as professional networking, collaboration with outside institutions and, for those teaching in Institutions, working with students (and their mentors in practice) to align similar research interests to facilitate research, must be encouraged to allow nurses to engage with research.[43, 44] There is huge scope for neonatal nurse led research which could transform experiences and outcomes of families, and we must encourage and support nurses to embrace these opportunities.
The results of this study have implications for the future of the neonatal nursing workforce. Much more work is required to develop and initiate opportunities for neonatal nurses who are passionate about research to encourage clinical academic careers in this speciality. At Institutional and organisation level, collaboration is required to develop and evaluate these roles for neonatal nurses at all levels, to ensure that we can attract high-talent nurses early in their career and maximise their research career potential. Development of transition funding to support immediate post-doctoral research nurses in clinical practice would allow for neonatal nurses to continue to build a programme of research post-Doctoral level qualification. At researcher level, there are recommended measures we can and will take to facilitate and initiate networks and collaboration:
Development of a new network of research active neonatal nurses to forge collaboration and develop research proposals
Harnessing social media to engage neonatal nurses in current nursing led neonatal research and develop networks both within the UK and abroad
Development of informal network neonatal nurse mentors to facilitate and guide junior and mid-career researchers
Centralisation of neonatal nursing research information online, including projects currently being undertaken, sample research project forms, funding opportunities, recently published papers