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• Research article
• Open access
• Published: 14 June 2021

Nurses in the lead: a qualitative study on the development of distinct nursing roles in daily nursing practice

• Jannine van Schothorst–van Roekel 1 ,
• Anne Marie J.W.M. Weggelaar-Jansen 1 ,
• Carina C.G.J.M. Hilders 1 ,
• Antoinette A. De Bont 1 &
• Iris Wallenburg 1  

BMC Nursing volume  20 , Article number:  97 ( 2021 ) Cite this article

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Transitions in healthcare delivery, such as the rapidly growing numbers of older people and increasing social and healthcare needs, combined with nursing shortages has sparked renewed interest in differentiations in nursing staff and skill mix. Policy attempts to implement new competency frameworks and job profiles often fails for not serving existing nursing practices. This study is aimed to understand how licensed vocational nurses (VNs) and nurses with a Bachelor of Science degree (BNs) shape distinct nursing roles in daily practice.

A qualitative study was conducted in four wards (neurology, oncology, pneumatology and surgery) of a Dutch teaching hospital. Various ethnographic methods were used: shadowing nurses in daily practice (65h), observations and participation in relevant meetings (n=56), informal conversations (up to 15 h), 22 semi-structured interviews and member-checking with four focus groups (19 nurses in total). Data was analyzed using thematic analysis.

Hospital nurses developed new role distinctions in a series of small-change experiments, based on action and appraisal. Our findings show that: (1) this developmental approach incorporated the nurses’ invisible work; (2) nurses’ roles evolved through the accumulation of small changes that included embedding the new routines in organizational structures; (3) the experimental approach supported the professionalization of nurses, enabling them to translate national legislation into hospital policies and supporting the nurses’ (bottom-up) evolution of practices. The new roles required the special knowledge and skills of Bachelor-trained nurses to support healthcare quality improvement and connect the patients’ needs to organizational capacity.

Conclusions

Conducting small-change experiments, anchored by action and appraisal rather than by design , clarified the distinctions between vocational and Bachelor-trained nurses. The process stimulated personal leadership and boosted the responsibility nurses feel for their own development and the nursing profession in general. This study indicates that experimental nursing role development provides opportunities for nursing professionalization and gives nurses, managers and policymakers the opportunity of a ‘two-way-window’ in nursing role development, aligning policy initiatives with daily nursing practices.

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The aging population and mounting social and healthcare needs are challenging both healthcare delivery and the financial sustainability of healthcare systems [ 1 , 2 ]. Nurses play an important role in facing these contemporary challenges [ 3 , 4 ]. However, nursing shortages increase the workload which, in turn, boosts resignation numbers of nurses [ 5 , 6 ]. Research shows that nurses resign because they feel undervalued and have insufficient control over their professional practice and organization [ 7 , 8 ]. This issue has sparked renewed interest in nursing role development [ 9 , 10 , 11 ]. A role can be defined by the activities assumed by one person, based on knowledge, modulated by professional norms, a legislative framework, the scope of practice and a social system [ 12 , 9 ].

New nursing roles usually arise through task specialization [ 13 , 14 ] and the development of advanced nursing roles [ 15 , 16 ]. Increasing attention is drawn to role distinction within nursing teams by differentiating the staff and skill mix to meet the challenges of nursing shortages, quality of care and low job satisfaction [ 17 , 18 ]. The staff and skill mix include the roles of enrolled nurses, registered nurses, and nurse assistants [ 19 , 20 ]. Studies on differentiation in staff and skill mix reveal that several countries struggle with the composition of nursing teams [ 21 , 22 , 23 ].

Role distinctions between licensed vocational-trained nurses (VNs) and Bachelor of Science-trained nurses (BNs) has been heavily debated since the introduction of the higher nurse education in the early 1970s, not only in the Netherlands [ 24 , 25 ] but also in Australia [ 26 , 27 ], Singapore [ 20 ] and the United States of America [ 28 , 29 ]. Current debates have focused on the difficulty of designing distinct nursing roles. For example, Gardner et al., revealed that registered nursing roles are not well defined and that job profiles focus on direct patient care [ 30 ]. Even when distinct nursing roles are described, there are no proper guidelines on how these roles should be differentiated and integrated into daily practice. Although the value of differentiating nursing roles has been recognized, it is still not clear how this should be done or how new nursing roles should be embedded in daily nursing practice. Furthermore, the consequences of these roles on nursing work has been insufficiently investigated [ 31 ].

This study reports on a study of nursing teams developing new roles in daily nursing hospital practice. In 2010, the Dutch Ministry of Health announced a law amendment (the Individual Health Care Professions Act) to formalize the distinction between VNs and BNs. The law amendment made a distinction in responsibilities regarding complexity of care, coordination of care, and quality improvement. Professional roles are usually developed top-down at policy level, through competency frameworks and job profiles that are subsequently implemented in nursing practice. In the Dutch case, a national expert committee made two distinct job profiles [ 32 ]. Instead of prescribing role implementation, however, healthcare organizations were granted the opportunity to develop these new nursing roles in practice, aiming for a more practice-based approach to reforming the nursing workforce. This study investigates a Dutch teaching hospital that used an experimental development process in which the nurses developed role distinctions by ‘doing and appraising’. This iterative process evolved in small changes [ 33 , 34 , 35 , 36 ], based on nurses’ thorough knowledge of professional practices [ 37 ] and leadership role [ 38 , 39 , 40 ].

According to Abbott, the constitution of a new role is a competitive action, as it always leads to negotiation of new openings for one profession and/or degradation of adjacent professions [ 41 ]. Additionally, role differentiation requires negotiation between different professionals, which always takes place in the background of historical professionalization processes and vested interests resulting in power-related issues [ 42 , 43 , 44 ]. Recent studies have described the differentiation of nursing roles to other professionals, such as nurse practitioners and nurse assistants, but have focused on evaluating shifts in nursing tasks and roles [ 31 ]. Limited research has been conducted on differentiating between the different roles of registered nurses and the involvement of nurses themselves in developing new nursing roles. An ethnographic study was conducted to shed light on the nurses’ work of seeking openings and negotiating roles and responsibilities and the consequences of role distinctions, against a background of historically shaped relationships and patterns.

The study aimed to understand the formulation of nursing role distinctions between different educational levels in a development process involving experimental action (doing) and appraisal.

We conducted an ethnographic case study. This design was commonly used in nursing studies in researching changing professional practices [ 45 , 46 ]. The researchers gained detailed insights into the nurses’ actions and into the finetuning of their new roles in daily practice, including the meanings, beliefs and values nurses give to their roles [ 47 , 48 ]. This study complied with the consolidated criteria for reporting qualitative research (COREQ) checklist.

Setting and participants

Our study took place in a purposefully selected Dutch teaching hospital (481 beds, 2,600 employees including 800 nurses). Historically, nurses in Dutch hospitals have vocational training. The introduction of higher nursing education in 1972 prompted debates about distinguishing between vocational-trained nurses (VNs) and bachelor-trained nurses (BNs). For a long time, VNs resisted a role distinction, arguing that their work experience rendered them equally capable to take care of patients and deal with complex needs. As a result, VNs and BNs carry out the same duties and bear equal responsibility. To experiment with role distinctions in daily practice, the hospital management and project team selected a convenience but representative sample of wards. Two general (neurology and surgery) and two specific care (oncology and pneumatology) wards were selected as they represent the different compositions of nursing educational levels (VN, BN and additional specialized training). The demographic profile for the nursing teams is shown in Table  1 . The project team, comprising nursing policy staff, coaches and HR staff ( N  = 7), supported the four (nursing) teams of the wards in their experimental development process (131 nurses; 32 % BNs and 68 % VNs, including seven senior nurses with an organizational role). We also studied the interactions between nurses and team managers ( N  = 4), and the CEO ( N  = 1) in the meetings.

Data collection

Data was collected between July 2017 and January 2019. A broad selection of respondents was made based on the different roles they performed. Respondents were personally approached by the first author, after close consultation with the team managers. Four qualitative research methods were used iteratively combining collection and analysis, as is common in ethnographic studies [ 45 ] (see Table  2 ).

Shadowing nurses (i.e. observations and questioning nurses about their work) on shift (65 h in total) was conducted to observe behavior in detail in the nurses’ organizational and social setting [ 49 , 50 ], both in existing practices and in the messy fragmented process of developing distinct nursing roles. The notes taken during shadowing were worked up in thick descriptions [ 46 ].

Observation and participation in four types of meetings. The first and second authors attended: (1) kick-off meetings for the nursing teams ( n  = 2); (2) bi-monthly meetings ( n  = 10) between BNs and the project team to share experiences and reflect on the challenges, successes and failures; and (3) project group meetings at which the nursing role developmental processes was discussed ( n  = 20). Additionally, the first author observed nurses in ward meetings discussing the nursing role distinctions in daily practice ( n  = 15). Minutes and detailed notes also produced thick descriptions [ 51 ]. This fieldwork provided a clear understanding of the experimental development process and how the respondents made sense of the challenges/problems, the chosen solutions and the changes to their work routines and organizational structures. During the fieldwork, informal conversations took place with nurses, nursing managers, project group members and the CEO (app. 15 h), which enabled us to reflect on the daily experiences and thus gain in-depth insights into practices and their meanings. The notes taken during the conversations were also written up in the thick description reports, shortly after, to ensure data validity [ 52 ]. These were completed with organizational documents, such as policy documents, activity plans, communication bulletins, formal minutes and in-house presentations.

Semi-structured interviews lasting 60–90 min were held by the first author with 22 respondents: the CEO ( n  = 1), middle managers ( n  = 4), VNs ( n  = 6), BNs ( n  = 9, including four senior nurses), paramedics ( n  = 2) using a predefined topic list based on the shadowing, observations and informal conversations findings. In the interviews, questions were asked about task distinctions, different stakeholder roles (i.e., nurses, managers, project group), experimental approach, and added value of the different roles and how they influence other roles. General open questions were asked, including: “How do you distinguish between tasks in daily practice?”. As the conversation proceeded, the researcher asked more specific questions about what role differentiation meant to the respondent and their opinions and feelings. For example: “what does differentiation mean for you as a professional?”, and “what does it mean for you daily work?”, and “what does role distinction mean for collaboration in your team?” The interviews were tape-recorded (with permission), transcribed verbatim and anonymized.

The fieldwork period ended with four focus groups held by the first author on each of the four nursing wards ( N  = 19 nurses in total: nine BNs, eight VNs, and two senior nurses). The groups discussed the findings, such as (nurses’ perceptions on) the emergence of role distinctions, the consequences of these role distinctions for nursing, experimenting as a strategy, the elements of a supportive environment and leadership. Questions were discussed like: “which distinctions are made between VN and BN roles?”, and “what does it mean for VNs, BNs and senior nurses?”. During these meetings, statements were also used to provoke opinions and discussion, e.g., “The role of the manager in developing distinct nursing roles is…”. With permission, all focus groups were audio recorded and the recordings were transcribed verbatim. The focus groups also served for member-checking and enriched data collection, together with the reflection meetings, in which the researchers reflected with the leader and a member of the project group members on program, progress, roles of actors and project outcomes. Finally, the researchers shared a report of the findings with all participants to check the credibility of the analysis.

Data analysis

Data collection and inductive thematic analysis took place iteratively [ 45 , 53 ]. The first author coded the data (i.e. observation reports, interview and focus group transcripts), basing the codes on the research question and theoretical notions on nursing role development and distinctions. In the next step, the research team discussed the codes until consensus was reached. Next, the first author did the thematic coding, based on actions and interactions in the nursing teams, the organizational consequences of their experimental development process, and relevant opinions that steered the development of nurse role distinctions (see Additional file ). Iteratively, the research team developed preliminary findings, which were fed back to the respondents to validate our analysis and deepen our insights [ 54 ]. After the analysis of the additional data gained in these validating discussions, codes were organized and re-organized until we had a coherent view.

Ethnography acknowledges the influence of the researcher, whose own (expert) knowledge, beliefs and values form part of the research process [ 48 ]. The first author was involved in the teams and meetings as an observer-as-participant, to gain in-depth insight, but remained research-oriented [ 55 ]. The focus was on the study of nursing actions, routines and accounts, asking questions to obtain insights into underlying assumptions, which the whole research group discussed to prevent ‘going native’ [ 56 , 57 ]. Rigor was further ensured by triangulating the various data resources (i.e. participants and research methods), purposefully gathered over time to secure consistency of findings and until saturation on a specific topic was reached [ 54 ]. The meetings in which the researchers shared the preliminary findings enabled nurses to make explicit their understanding of what works and why, how they perceived the nursing role distinctions and their views on experimental development processes.

Ethical considerations

All participants received verbal and written information, ensuring that they understood the study goals and role of the researcher [ 48 ]. Participants were informed about their voluntary participation and their right to end their contribution to the study. All gave informed consent. The study was performed in accordance with the Declaration of Helsinki and was approved by the Erasmus Medical Ethical Assessment Committee in Rotterdam (MEC-2019-0215), which also assessed the compliance with GDPR.

Our findings reveal how nurses gradually shaped new nursing role distinctions in an experimental process of action and appraisal and how the new BN nursing roles became embedded in new nursing routines, organizational routines and structures. Three empirical appeared from the systematic coding: (1) distinction based on complexity of care; (2) organizing hospital care; and (3) evidence-based practices (EBP) in quality improvement work.

Distinction based on complexity of care

Initially, nurses distinguished the VN and BN roles based on the complexity of patient care, as stated in national job profiles [ 32 ]. BNs were supposed to take care of clinically complex patients, rather than VNs, although both VNs and BNs had been equally taking care of every patient category. To distinguish between highly and less complex patient care, nurses developed a complexity measurement tool. This tool enabled classification of the predictability of care, patient’s degree of self-reliance, care intensity, technical nursing procedures and involvement of other disciplines. However, in practice, BNs questioned the validity of assessing a patient’s care complexity, because the assessments of different nurses often led to different outcomes. Furthermore, allocating complex patient care to BNs impacted negatively on the nurses’ job satisfaction, organizational routines and ultimately the quality of care. VNs experienced the shift of complex patient care to BNs as a diminution of their professional expertise. They continuously stressed their competencies and questioned the assigned levels of complexity, aiming to prevent losses to their professional tasks:

‘Now we’re only allowed to take care of COPD patients and people with pneumonia, so no more young boys with a pneumothorax drain. Suddenly we are not allowed to do that. (…) So, your [professional] world is getting smaller. We don’t like that at all. So, we said: We used to be competent, so why aren’t we anymore?’ (Interview VN1, in-service trained nurse).

In discussing complexity of care, both VNs and BNs (re)discovered the competencies VNs possess in providing complex daily care. BNs acknowledged the contestability of the distinction between VN and BN roles related to patient care complexity, as the next quote shows:

‘Complexity, they always make such a fuss about it. (…) At a given moment you’re an expert in just one certain area; try then to stand out on your ward. (…) When I go to GE [gastroenterology] I think how complex care is in here! (…) But it’s also the other way around, when I’m the expert and know what to expect after an angioplasty, or a bypass, or a laparoscopic cholecystectomy (…) When I’ve mastered it, then I no longer think it’s complex, because I know what to expect!’ (Interview BN1, 19-07-2017).

This quote illustrates how complexity was shaped through clinical experience. What complex care is , is influenced by the years of doing nursing work and hence is individual and remains invisible. It is not formally valued [ 58 ] because it is not included in the BN-VN competency model. This caused dissatisfaction and feelings of demotion among VNs. The distinction in complexities of care was also problematic for BNs. Following the complexity tool, recently graduated BNs were supposed to look after highly complex patients. However, they often felt insecure and needed the support of more experienced (VN) colleagues – which the VNs perceived as a recognition of their added value and evidence of the failure of the complexity tool to guide division of tasks. Also, mundane issues like holidays, sickness or pregnancy leave further complicated the use of the complexity tool as a way of allocating patients, as it decreased flexibility in taking over and swapping shifts, causing dissatisfaction with the work schedule and leading to problems in the continuity of care during evening, night and weekend shifts. Hence, the complexity tool disturbed the flexibility in organizing the ward and held possible consequences for the quality and safety of care (e.g. inexperienced BNs providing complex care), Ultimately, the complexity tool upset traditional teamwork, in which nurses more implicitly complemented each other’s competencies and ability to ‘get the work done’ [ 59 ]. As a result, role distinction based on ‘quantifiable’ complexity of care was abolished. Attention shifted to the development of an organizational and quality-enhancing role, seeking to highlight the added value of BNs – which we will elaborate on in the next section.

Organizing hospital care

Nurses increasingly fulfill a coordinating role in healthcare, making connections across occupational, departmental and organizational boundaries, and ‘mediating’ individual patient needs, which Allen describes as organizing work [ 49 ]. Attempting to make a valuable distinction between nursing roles, BNs adopted coordinating management tasks at the ward level, taking over this task from senior nurses and team managers. BNs sought to connect the coordinating management tasks with their clinical role and expertise. An example is bed management, which involves comparing a ward’s bed capacity with nursing staff capacity [ 1 , 60 ]. At first, BNs accompanied middle managers to the hospital bed review meeting to discuss and assess patient transfers. On the wards where this coordination task used to be assigned to senior nurses, the process of transferring this task to BNs was complicated. Senior nurses were reluctant to hand over coordinating tasks as this might undermine their position in the near future. Initially, BNs were hesitant to take over this task, but found a strategy to overcome their uncertainty. This is reflected in the next excerpt from fieldnotes:

Senior nurse: ‘First we have to figure out if it will work, don’t we? I mean, all three of us [middle manager, senior nurse, BN] can’t just turn up at the bed review meeting, can we? The BN has to know what to do first, otherwise she won’t be able to coordinate properly. We can’t just do it.’ BN: ‘I think we should keep things small, just start doing it, step by step. (…) If we don’t try it out, we don’t know if it works.’ (Field notes, 24-05-2018).

This excerpt shows that nurses gradually developed new roles as a series of matching tasks. Trying out and evaluating each step of development in the process overcame the uncertainty and discomfort all parties held [ 61 ]. Moreover, carrying out the new tasks made the role distinctions become apparent. The coordinating role in bed management, for instance, became increasingly embedded in the new BN nursing role. Experimenting with coordination allowed BNs prove their added value [ 62 ] and contributed to overall hospital performance as it combined daily working routines with their ability to manage bed occupancy, patient flow, staffing issues and workload. This was not an easy task. The next quote shows the complexity of creating room for this organizing role:

The BNs decide to let the VNs help coordinate the daily care, as some VNs want to do this task. One BN explains: ‘It’s very hard to say, you’re not allowed.’ The middle manager looks surprised and says that daily coordination is a chance to draw a clear distinction and further shape the role of BNs. The project group leader replies: ‘Being a BN means that you dare to make a difference [in distinctive roles]. We’re all newbies in this field, but we can use our shared knowledge. You can derive support from this task for your new role.’ (Field notes, 09-01-2018).

This excerpt reveals the BNs’ thinking on crafting their organizational role, turning down the VNs wishes to bear equal responsibility for coordinating tasks. Taking up this role touched on nurse identity as BNs had to overcome the delicate issue of equity [ 63 ], which has long been a core element of the Dutch nursing profession. Taking over an organization role caused discomfort among BNs, but at the same time provided legitimation for a role distinction.

Legitimation for this task was also gained from external sources, as the law amendment and the expert committee’s job descriptions both mentioned coordinating tasks. However, taking over coordinating tasks and having an organizing role in hospital care was not done as an ‘implementation’; rather it required a process of actively crafting and carving out this new role. We observed BNs choosing not to disclose that they were experimenting with taking over the coordinating tasks as they anticipated a lack of support from VNs:

BN: ‘We shouldn’t tell the VNs everything. We just need this time to give shape to our new role. And we all know who [of the colleagues] won’t agree with it. In my opinion, we’d be better off hinting at it at lunchtime, for example, to figure out what colleagues think about it. And then go on as usual.’ (Field notes, 12-06-2018).

BNs stayed ‘under the radar’, not talking explicitly about their fragile new role to protect the small coordination tasks they had already gained. By deliberately keeping the evaluation of their new task to themselves, they protected the transition they had set into motion. Thus, nurses collected small changes in their daily routines, developing a new role distinction step by step. Changes to single tasks accumulated in a new role distinction between BNs, VNs and senior nurses, and gave BNs a more hybrid nursing management role.

Evidence-based practices in quality improvement work

Quality improvement appeared to be another key concern in the development of the new BN role. Quality improvement work used to be carried out by groups of senior nurses, middle managers and quality advisory staff. Not involved in daily routines, the working group focused on nursing procedures (e.g. changing infusion system and wound treatment protocols). In taking on this new role BNs tried different ways of incorporating EBP in their routines, an aspect that had long been neglected in the Netherlands. As a first step, BNs rearranged the routines of the working group. For example, a team of BNs conducted a quality improvement investigation of a patient’s formal’s complaint:

Twenty-two patients registered a pain score of seven or higher and were still discharged. The question for BNs was: how and why did this bad care happen? The BNs used electronic patient record to study data on the relations between pain, medication and treatment. Their investigation concluded: nurses do not always follow the protocols for high pain scores. Their improvement plan covered standard medication policy, clinical lessons on pain management and revisions to the patient information folder. One BN said: ‘I really loved investigating this improvement.’ (Field notes, 28-05-2018).

This fieldnote shows the joy quality improvement work can bring. During interviews, nurses said that it had given them a better grip on the outcome of nursing work. BNs felt the need to enhance their quality improvement tasks with their EBP skills, e.g. using clinical reasoning in bedside teaching, formulating and answering research questions in clinical lessons and in multi-disciplinary patient rounds to render nursing work more evidence based. The BNs blended EBP-related education into shift handovers and ward meetings, to show VNs the value of doing EBP [ 64 ]. In doing so, they integrated and fostered an EBP infrastructure of care provision, reflecting a new sense of professionalism and responsibility for quality of care.

However, learning how to blend EPB quality work in daily routines – ‘learning in practice’ –requires attention and steering. Although the BNs had a Bachelor’s degree, they had no experience of a quality-enhancing role in hospital practice [ 65 ]. In our case, the interplay between team members’ previous education and experienced shortcomings in knowledge and skills uncovered the need for further EBP training. This training established the BNs’ role as quality improvers in daily work and at the same time supported the further professionalization of both BNs and VNs. Although introducing the EBP approach was initially restricted to the BNs, it was soon realized that VNs should be involved as well, as nursing is a collaborative endeavor [ 1 ], as one team member (the trainer) put it:

‘I think that collaboration between BNs and VNs would add lots of value, because both add something different to quality work. I’d suggest that BNs could introduce the process-oriented, theoretical scope, while VNs could maybe focus on the patients’ interest.’ (Fieldnote, informal conversation, 11-06-2018).

During reflection sessions on the ward level and in the project team meetings BNs, informed by their previous experience with the complexity tool, revealed that they found it a struggle to do justice to everyone’s competencies. They wanted to use everyone’s expertise to improve the quality of patient care. They were for VNs being involved in the quality work, e.g. in preparing a clinical lesson, conducting small surveys, asking VNs to pose EBP questions and encourage VNs to write down their thoughts on flip over charts as means of engaging all team members.

These findings show that applying EPB in quality improvement is a relational practice driven by mutual recognition of one another’s competencies. This relational practice blended the BNs’ theoretical competence in EBP [ 66 ] with the VNs’ practical approach to the improvement work they did together. As a result, the blend enhanced the quality of daily nursing work and thus improved the quality of patient care and the further professionalization of the whole nursing team.

This study aimed to understand how an experimental approach enables differently educated nurses to develop new, distinct professional roles. Our findings show that roles cannot be distinguished by complexity of care; VNs and BNs are both able to provide care to patients with complex healthcare needs based on their knowledge and experience. However, role distinctions can be made on organizing care and quality improvement. BNs have an important role organizing care, for example arranging the patient flow on and across wards at bed management meetings, while VNs contribute more to organizing at the individual patient level. BNs play a key role in starting and steering quality improvement work, especially blending EBP in with daily nursing tasks, while VNs are involved but not in the lead. Working together on quality improvement boosts nursing professionalization and team development.

Our findings also show that the role development process is greatly supported by a series of small-change experiments, based on action and appraisal. This experimental approach supported role development in three ways. First, it incorporates both formal tasks and the invisible, unconscious elements of nursing work [ 49 ]. Usually, invisible work gets no formal recognition, for example in policy documents [ 55 ], whereas it is crucial in daily routines and organizational structures [ 49 , 60 ]. Second, experimenting triggers an accumulation of small changes [ 33 , 35 ] leading to the embeddedness of role distinctions in new nursing routines, allowing nurses to influence the organization of care. This finding confirms the observations of Reay et al. that nurses can create small changes in daily activities to craft a new nursing role, based on their thorough knowledge of their own practice and that of the other involved professional groups [ 37 ]. Although these changes are accompanied by tension and uncertainty, the process of developing roles generates a certain joy. Third, experimenting stimulated nursing professionalization, enabling the nurses to translate national legislation into hospital policy and supporting the nurses’ own (bottom-up) evolution of practices. Historically, nursing professionalization is strongly influenced by gender and education level [ 43 ] resulting in a subordinate position, power inequity and lack of autonomy [ 44 ]. Giving nurses the lead in developing distinct roles enables them to ‘engage in acts of power’ and obtain more control over their work. Fourth, experimenting contributes to role definition and clarification. In line with Poitras et al. [ 12 ] we showed that identifying and differentiating daily nursing tasks led to the development of two distinct and complementary roles. We have also shown that the knowledge base of roles and tasks includes both previous and additional education, as well as nursing experience.

Our study contributes to the literature on the development of distinct nursing roles [ 9 , 10 , 11 ] by showing that delineating new roles in formal job descriptions is not enough. Evidence shows that this formal distinction led particularly to the non-recognition, non-use and degradation [ 41 ] of VN competencies and discomforted recently graduated BNs. The workplace-based experimental approach in the hospital includes negotiation between professionals, the adoption process of distinct roles and the way nurses handle formal policy boundaries stipulated by legislation, national job profiles, and hospital documents, leading to clear role distinctions. In addition to Hughes [ 42 ] and Abbott [ 67 ] who showed that the delineation of formal work boundaries does not fit the blurred professional practices or individual differences in the profession, we show how the experimental approach leads to the clarification and shape of distinct professional practices.

Thus, an important implication of our study is that the professionals concerned should be given a key role in creating change [ 37 , 39 , 40 ]. Adding to Mannix et al. [ 38 ], our study showed that BNs fulfill a leadership role, which allows them to build on their professional role and identity. Through the experiments, BNs and VNs filled the gap between what they had learned in formal education, and what they do in daily practice [ 64 , 65 ]. Experimenting integrates learning, appraising and doing much like going on ‘a journey with no fixed routes’ [ 34 , 68 ] and no fixed job description, resulting in the enlargement of their roles.

Our study suggests that role development should involve professionalization at different educational levels, highlighting and valuing specific roles rather than distinguishing higher and lower level skills and competencies. Further research is needed to investigate what experimenting can yield for nurses trained at different educational levels in the context of changing healthcare practices, and which interventions (e.g., in process planning, leadership, or ownership) are needed to keep the development of nursing roles moving ahead. Furthermore, more attention should be paid to how role distinction and role differentiation influence nurse capacity, quality of care (e.g., patient-centered care and patient satisfaction), and nurses’ job satisfaction.

Limitations

Our study was conducted on four wards of one teaching hospital in the Netherlands. This might limit the potential of generalizing our findings to other contexts. However, the ethnographic nature of our study gave us unique understanding and in-depth knowledge of nurses’ role development and distinctions, both of which have broader relevance. As always in ethnographic studies, the chances of ‘going native’ were apparent, and we tried to prevent this with ongoing reflection in the research team. Also, the interpretation of research findings within the Dutch context of nurse professionalization contributed to a more in-depth understanding of how nursing roles develop, as well as the importance of involving nurses themselves in the development of these roles to foster and support professional development.

We focused on role distinctions between VNs and BNs and paid less attention to (the collaboration with) other professionals or management. Further research is needed to investigate how nursing role development takes place in a broader professional and managerial constellation and what the consequences are on role development and healthcare delivery.

This paper described how nurses crafted and shaped new roles with an experimental process. It revealed the implications of developing a distinct VN role and the possibility to enhance the BN role in coordination tasks and in steering and supporting EBP quality improvement work. Embedding the new roles in daily practice occurred through an accumulation of small changes. Anchored by action and appraisal rather than by design , the changes fostered by experiments have led to a distinction between BNs and VNs in the Netherlands. Furthermore, experimenting with nursing role development has also fostered the professionalization of nurses, encouraging nurses to translate knowledge into practice, educating the team and stimulating collaborative quality improvement activities.

This paper addressed the enduring challenge of developing distinct nursing roles at both the vocational and Bachelor’s educational level. It shows the importance of experimental nursing role development as it provides opportunities for the professionalization of nurses at different educational levels, valuing specific roles and tasks rather than distinguishing between higher and lower levels of skills and competencies. Besides, nurses, managers and policymakers can embrace the opportunity of a ‘two-way window’ in (nursing) role development, whereby distinct roles are outlined in general at policy levels, and finetuned in daily practice in a process of small experiments to determine the best way to collaborate in diverse contexts.

Availability of data and materials

The data generated and analyzed during the current study is not publicly available to ensure data confidentiality but is available from the corresponding author on reasonable request and with the consent of the research participants.

Abbreviations

Bachelor-trained nurse

Vocational-trained nurse

Evidence-based Practices

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Acknowledgements

The authors would like to thank all participants for their contribution to this study.

The Reinier de Graaf hospital in Delft, who was central to this study provided financial support for this research.

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Jannine van Schothorst–van Roekel, Anne Marie J.W.M. Weggelaar-Jansen, Carina C.G.J.M. Hilders, Antoinette A. De Bont & Iris Wallenburg

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A.W. and I.W. developed the study design. J.S. and A.W. were responsible for data collection, enhanced by I.W. for data analysis and drafting the manuscript. C.H. and A.B. critically revised the paper. All authors have read and approved the manuscript.

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van Schothorst–van Roekel, J., Weggelaar-Jansen, A.M.J., Hilders, C.C. et al. Nurses in the lead: a qualitative study on the development of distinct nursing roles in daily nursing practice. BMC Nurs 20 , 97 (2021). https://doi.org/10.1186/s12912-021-00613-3

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Why Nursing Research Matters

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• 1 Author Affiliation: Director, Magnet Recognition Program®, American Nurses Credentialing Center, Silver Spring, Maryland.
• PMID: 33882548
• DOI: 10.1097/NNA.0000000000001005

Increasingly, nursing research is considered essential to the achievement of high-quality patient care and outcomes. In this month's Magnet® Perspectives column, we examine the origins of nursing research, its role in creating the Magnet Recognition Program®, and why a culture of clinical inquiry matters for nurses. This column explores how Magnet hospitals have built upon the foundation of seminal research to advance contemporary standards that address some of the challenges faced by healthcare organizations around the world. We offer strategies for nursing leaders to develop robust research-oriented programs in their organizations.

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How to Become a Research Nurse

What is a research nurse.

• Career Outlook

Research Nurses, also referred to as Clinical Nurse Researchers or Nurse Researchers, develop and implement studies to investigate and provide information on new medications, vaccinations, and medical procedures. They assist in providing evidence-based research that is essential to safe and quality nursing care. This guide will explain what a Research Nurse does, how much they make, how to become one, and more!

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Research nurses play a pivotal role in developing new and potentially life-saving medical treatments. Typically, clinical research nurses have advanced degrees, assist in the development of studies regarding medications, vaccines, and medical procedures, and also the care of research participants. 

Nurses that know they want to be a clinical research nurse will often work as a research assistant, a clinical data collector, and/or clinical research monitor. It is essential to gain some bedside experience, but not as important as other nursing specialties. 

Clinical research nurses have advanced degrees such as an MSN or Ph.D. This is vital to those that want to conduct independent research. For that reason, most clinical research nurses do not work in this field until they are in their 40s-50s.

Find Nursing Programs

What does a research nurse do.

Research Nurses primarily conduct evidence-based research through these two types of research methods:

• Quantitative: Meaning it’s researched that can be measured via statistical, mathematical, or computational techniques.
• Phenomenology
• Grounded Theory
• Ethnography
• Narrative Inquiry

Clinical research nurses perform a variety of tasks, all centered around research. These specific job responsibilities include:

• Collaborating with industry sponsors and other investigators from multi-institutional studies
• Educating and training of new research staff
• Overseeing the running of clinical trials
• Administering questionnaires to clinical trial participants
• Writing articles and research reports in nursing or medical professional journals or other publications
• Monitoring research participants to ensure adherence to study rules
• Adhering to research regulatory standards
• Writing grant applications to secure funding for studies
• Reporting findings of research, which may include presenting findings at industry conferences, meetings and other speaking engagements
• Adhering to ethical standards
• Maintaining detailed records of studies as per FDA guidelines, including things such as drug dispensation
• Participating in subject recruitment efforts
• Ensuring the necessary supplies and equipment for a study are in stock and in working order
• Engaging with subjects and understanding their concerns
• Providing patients with thorough explanation of trial prior to obtaining Informed Consent, in collaboration with treating physician and provides patient education on an ongoing basis throughout the patient’s course of trial.

>> Show Me Online MSN Programs

Research Nurse Salary

Glassdoor.com states an annual median salary of $95,396 for Research Nurses and Payscale reports that Clinical Research Nurses earn an average annual salary of $75,217 or $36.86/hr . 

Research Nurse Salary by Years of Experience

Research Nurses can earn a higher annual salary with increased years of experience.

• Less than 1 year  of experience earn an average salary of $68,000
• 1-4 years of experience earn an average salary of $73,000
• 5-9 years of experience earns an average salary of $73,000
• 10-19 years of experience earns an average salary of $80,000
• 20 years or more of experience earns an average salary of $78,000

Via Payscale

To become a Research Nurse, you’ll need to complete the following steps:

Step 1: Attend Nursing School

You’ll need to earn either an ADN or a BSN from an accredited nursing program in order to take the first steps to become a registered nurse. 

Step 2: Pass the NCLEX-RN

Become a Registered Nurse by passing the NCLEX examination.

Step 3: Gain Experience at the Bedside

Though not as important as in some other nursing careers, gaining experience is still a vital step for those wanting to become Nurse Researchers. 

Step 4: Earn an MSN and/or Ph.D

Research Nurses typically need an advanced degree, so ADN-prepared nurses will need to complete an additional step of either completing their BSN degree or entering into an accelerated RN to MSN program which will let them earn their BSN and MSN at the same time. 

Step 5: Earn Your Certification

There are currently two certifications available for Clinical Research Nurses. They are both offered by the Association of Clinical Research Professionals. 

• Clinical Research Association (CCRA)
• Clinical Research Coordinator (CCRC) 

These certifications are not specific to nurses but rather those that work in the research field. 

CCRA Certification

In order to be deemed eligible for the CCRA Certification exam, applicants must attest to having earned 3,000 hours of professional experience performing the knowledge and tasks located in the six content areas of the CRA Detailed Content Outline. Any experience older than ten years will not be considered.

What’s on the Exam?

• Scientific Concepts and Research Design
• Ethical and Participant Safety Considerations
• Product Development and Regulation
• Clinical Trial Operations (GCPs)
• Study and Site Management
• Data Management and Informatics

Exam Information

• Exam Fee: $435 Member; $485 Nonmember
• Exam Fee: $460 Member; $600 Nonmember
• Multiple choice examination with 125 questions (25 pretest non-graded questions)

CCRC Certification

In order to be deemed eligible for the CCRC Certification exam, applicants must attest to having earned 3,000 hours of professional experience performing the knowledge and tasks located in the six content areas of the CCRC Detailed Content Outline. Any experience older than ten years will not be considered.

Where Do Research Nurses Work?

Clinical Research nurses can work in a variety of locations, including:

• Government Agencies
• Teaching Hospitals
• Medical Clinics
• International Review Board
• Medicine manufacturing 
• Pharmaceutical companies
• Medical research organizations
• Research Organizations
• International Health Organizations
• Private practice
• Private and public foundations

What is the Career Outlook for a Research Nurse?

According to the BLS , from 2022 to 2032, there is an expected growth of 6% for registered nurses. With the aging population and nursing shortage, this number is expected to be even higher.

The BLS does identify medical scientists, which includes clinical research nurses, as having a growth potential of 10% between 2022-2032. 

What are the Continuing Education Requirements for a Research Nurse?

Generally, in order for an individual to renew their RN license, they will need to fill out an application, complete a specific number of CEU hours, and pay a nominal fee. Each state has specific requirements and it is important to check with the board of nursing prior to applying for license renewal.

 If the RN license is part of a compact nursing license, the CEU requirement will be for the state of permanent residence. Furthermore, some states require CEUs related to child abuse, narcotics, and/or pain management. 

A detailed look at Continuing Nurse Education hours can be found here .

Where Can I Learn More About Becoming a Research Nurse?

• American Nurses Association (ANA)
• Nurse Researcher Magazine
• National Institute of Nursing Research
• International Association of Clinical Research Nurses
• Association of Clinical Research Professionals
• Society of Clinical Research Associates
• American Association of Colleges of Nursing

Research Nurse FAQs

What is the role of a research nurse.

• Research nursing is a nursing practice with a specialty focus on the care of research participants. 

What makes a good Research Nurse?

• Research Nurses should be excellent communicators, have strong attention to detail, be self-assured, have strong clinical abilities, be flexible, autonomous, organized, and eager to learn new information.

How much does a Research Nurse make?

• Research nurses earn an average salary of $95,396 according to Glassdoor.com.

What is it like being a Research Nurse?

• Research Nurses provide and coordinate clinical care. Research Nurses have a central role in ensuring participant safety, maintaining informed consent, the integrity of protocol implementation, and the accuracy of data collection and data recording.

Kathleen Gaines (nee Colduvell) is a nationally published writer turned Pediatric ICU nurse from Philadelphia with over 13 years of ICU experience. She has an extensive ICU background having formerly worked in the CICU and NICU at several major hospitals in the Philadelphia region. After earning her MSN in Education from Loyola University of New Orleans, she currently also teaches for several prominent Universities making sure the next generation is ready for the bedside. As a certified breastfeeding counselor and trauma certified nurse, she is always ready for the next nursing challenge.

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Peer Reviewer Contributions, Challenges, and Training

Nursing Research. 73(5):337-338, September/October 2024.

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Enhancing Understanding and Management of Obesity: Reflections on Behavioral Weight Loss and Food Cue Reactivity

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Influence of Preterm Birth and Environmental Context on Academic Performance and Neurodevelopmental Outcomes

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Treatment Complications Associated With Hospital Admission in Oropharyngeal Cancer Patients

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Symptoms and Health-Related Quality of Life Among Older Adults Living With HIV

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COVID-19 Vaccination Uptake, Infection Rates, and Seropositivity Among Youth Experiencing Homelessness in the United States

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Musical Activity Engagement, Depressive Symptoms, Physical Activity, and Cognitive Function in People With Type 2 Diabetes

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Comparison of Weighting Methods to Understand Improved Outcomes Attributable to Public Health Nursing Interventions

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Reliability and Validity of Measures Commonly Utilized to Assess Nurse Well-Being

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The Arcus Experience: Bridging the Data Science Gap for Nurse Researchers

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Acute Care Use Among Patients With Multiple Chronic Conditions Receiving Care From Nurse Practitioner Practices in Health Professional Shortage Areas

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The power of nurses in research: understanding what matters and driving change

The next blog in our series focussing on how research evidence can be implemented into practice, Julie Bayley, Director of the Lincoln Impact Literacy Institute writes about the power of nurses in research and how nurses can support the whole research journey. 

Research is a funny old beast isn’t it? It starts life as a glint in a researcher’s eye, then like a child needs nurturing, shuttling back and forth to events and usually requires constant checking to make sure it’s not doing something stupid.

As someone who spends the majority of their working life on impact – the provable benefits of research outside of the world of academia – it is extraordinarily clear to me how research can make the world better. And as a patient advocate – having chronically and not exactly willingly collected DVTs over the last decade – it’s even more clear how good research and good care together make a difference that matters.

Having had some AMAZING care, nursing strikes me as both an art and a science. A brilliant technical understanding of healthcare processes combined magically with kindness, compassion and care.  Having been hugged by nurses as I cried being separated from my newborn (post DVT), and watching nurses let dad happily talk them through his army photo album as they check on his dementia, I am in no doubt that such compassion is what marks the difference between not just being a patient, but being a person .

One of the oddities about research is how we can so often get the impression that only big and shiny counts. ‘Superpower’ studies such as Randomised Controlled Trials, and multi-national patient cohort studies are amazing, but can mask the breadth of the millions of questions research can explore in endless different ways. Of course we need trials to determine ‘what works’, but we also need research to unveil the stories of those who feel their rarely heard, understand how things work, and connect research to people’s lives.

Research essentially is just the act of questioning in a structured, ethical and transparent way. It might seek to understand things through numbers (quantitative) or words and experiences (qualitative), and may reveal something new or confirm something we already believe. Research is the bedrock of evidence based care, allowing us – either through new (‘primary’) or existing (‘secondary’) data – to explore, understand, confirm or disprove ways patients can be helped. Some of you reading this will be very research active, some of you might think it’s not for you, some may not know where to start, and others may hate the idea altogether. Let’s face it, healthcare is an extremely pressured environment, so why would you add research into an already busy day job? The simple truth is that research gives us a way to add to this care magic, helping to ensure care pathways are the best, safest and most appropriate in every situation.

The pace and scale of research stories can make it easy to presume research is something ‘other people’ do, and whilst there are many brilliant professionals and professions within healthcare, nurses have a unique and phenomenally important place in research in at least three key ways:

• Understanding what matters to patients. A person is far more than their illness, and being so integral to day to day care, nurses have a lens not only on patients’ conditions, but how these interweave with concerns about their life, their livelihood, their loved ones and all else. And it is in this mix that the fuller impact of research can be really understood, way beyond clinical outcome measures, and into what it what matters .
• Understanding how to mobilise and implement new knowledge. Even if new research shows promise, the act of implementing it in a pressured healthcare system can be immensely challenging. Nurses are paramount for understanding – amongst many other things – how patients will engage (or not), what can be integrated into care pathways (or can’t), what unintended consequences could be foreseen and what (if any) added pressures new processes will bring for staff. This depth of insight borne from both experience and expertise is vital to mobilising, translating and otherwise ‘converting’ research promise into reality.
• Driving research . Nurses of course also drive research of all shapes and sizes. Numerous journals, such as BMC Nursing and the Journal of Research in Nursing bear testament to the wealth of research insights driven by nurses, and shared widely to inform practice.

Research isn’t owned by any single profession, or defined by any size. Whatever methods, scale or theories we use, research is the act of understanding, and if nurses aren’t at the heart of understanding the patient experience and the healthcare system, I don’t know who is. So when it comes to research:

• Recognise the value you already bring. You are front and centre in care which gives you a perspective on patient and system need that few others have. Ask yourself, what matters?
• Recognise the sheer breadth of research possibilities, and the million questions it hasn’t yet been used to answer. Ask yourself, what needs to be understood?
• Use – or develop – your skills to do research. Connect with researchers, read up, or just get involved. Ask yourself, how can I make my research mark?

Research is important because people are important. If you’re nearer the research-avoidant than the research-lead end of the spectrum, I’d absolutely urge you to get more involved. Whether you shine a light on problems research could address, critically inform the implementation of research, or do the research yourself….

….from this patient and research impact geek…

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How to Become a Research Nurse

4 min read • April, 28 2023

Are you looking for a new challenge in your nursing career? Whether you're just starting out or you're an experienced nurse, there are many nursing career paths from which to choose. Neonatal or dialysis nursing, for example, let you expand your knowledge within a specific discipline. Clinical research nursing, on the other hand, offers the opportunity to help conduct clinical trials for developing and testing new treatments, medications, and procedures.

Becoming a nurse researcher can be incredibly satisfying if you want to enhance your medical knowledge, expand therapeutic options for patients, and enjoy face-to-face care.

What Does a Research Nurse Do?

Clinical research nurses are on the front lines of medical innovation, helping research teams test the latest treatments and procedures. The role of a research nurse may vary daily depending on specific studies or trials in which you're participating. You can generally expect a mix of patient care, academic reporting, and record maintenance.

Some studies call for higher levels of patient interaction. You may interview patients before a new procedure or monitor, record, and report their progress after they've received an experimental treatment. Research nurses must often supervise patients to ensure they follow the study protocols correctly.

Besides patient interactions, a clinical research nurse may be responsible for writing reports or study results, submitting and publishing studies in medical journals, or presenting research findings at a medical conference.

What Studies Do Clinical Research Nurses Participate In?

Medical research is either quantitative or qualitative. As a clinical research nurse, you may participate in both. Quantitative studies focus on results that can be empirically measured, such as statistics. Qualitative studies, like case studies, are more holistic and help you better understand a question or issue from all angles.

Most clinical research is quantitative. For instance, a quantitative study of a new surgical procedure might measure how many days it takes a patient to recover compared to the previous method. Qualitative research, on the other hand, might focus on better understanding how cultural norms in a particular population affect their decision to get vaccines.

What Experience and Education Are Required?

The role of a research nurse isn't an entry-level position and typically requires extensive studies, which may include job-specific courses and additional nursing certifications. Due to the time involved in becoming a nurse researcher, you usually won't find many nursing professionals in this role early on in their careers. If you're interested in pursuing a position as a clinical nurse researcher, it's wise to start planning in advance.

Besides your licensure as a registered nurse (RN), you may want an advanced nursing degree such as a Master of Science in Nursing (MSN) or Doctor of Nursing Practice (DNP). Not every research nursing job will require an advanced degree. However, some employers prefer them, so having one can make it easier to get work.

Advanced degrees typically require a Bachelor of Science in Nursing (BSN) as a prerequisite. If you plan to get one, you'll need to take a longer path to get an RN degree or go back to school for your BSN before pursuing the necessary degrees for clinical research nursing. Some programs offer an accelerated program that combines BSN and MSN degrees.

Depending on your position or employer, you may also need specialized training in clinical research methodology and a certification from the Association of Clinical Research Professionals . To obtain a certificate, you must demonstrate as many as 3,000 hours (the equivalent of eighteen months of full-time work) of relevant work in human subject research within the last ten years. If you meet that requirement, you'll also need to take an exam before receiving your clinical research nurse certification.

How Long Does It Take to Become a Nurse Researcher?

Becoming a clinical research nurse can take ten years or more, depending on how much education and work experience you decide to pursue before applying for your first research position. If you intend to maximize your education and subsequent hiring possibilities, this comprehensive timeline outlines the steps you might consider:

• Years 1–4: Obtain a BSN degree, typically issued as a standard four-year degree.
• Year 4: Get licensed by taking the NCLEX-RN exam for registered nurses.
• (Optional) Years 5–7: Obtain an MSN degree. This program typically takes up to three years to complete.
• (Optional) Years 5–9: Obtain a Doctor of Philosophy in Nursing (Ph.D.) degree, which can take three to five years to complete.
• 2+ years of work experience: Whether you go directly from your BSN to your MSN or work in the field before pursuing an advanced degree, you'll likely need to spend time working as a nurse before you can apply for a clinical research position. If seeking certification, you'll also need relevant work hours in human subject research, which can take several years to accrue.

Clinical Research Nurse Salary and Career Prospects

The demand and salary for clinical research nurses are strong. Nurses, in general, are in high demand, and an increasingly technological health care industry always needs nurses to develop new treatments and procedures. The salary for a clinical research nurse is higher than the average for RNs, and these specialists make around $90–100,000 per year on average.

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Research Nurse

What is a Research Nurse?

Research nurses conduct scientific research into various aspects of health, including illnesses, treatment plans, pharmaceuticals and healthcare methods, with the ultimate goals of improving healthcare services and patient outcomes. Also known as nurse researchers, research nurses design and implement scientific studies, analyze data and report their findings to other nurses, doctors and medical researchers. A career path that requires an advanced degree and additional training in research methodology and tools, research nurses play a critical role in developing new, potentially life-saving medical treatments and practices.

How to Become a Research Nurse

A highly specialized career path, becoming a nurse researcher requires an advanced degree and training in informatics and research methodology and tools. Often, research nurses enter the field as research assistants or clinical research coordinators. The first step for these individuals, or for any aspiring advanced practice nurse, is to earn a Bachelor of Science in Nursing (BSN) degree from an accredited nursing school and pass the NCLEX-RN exam. Once a nurse has completed their degree and attained an RN license , the next step in becoming a research nurse is to complete a Master's of Science in Nursing (MSN) program focusing on research and writing. MSN-level courses best prepare nurses for a career in research, and usually include coursework in statistics, research for evidence-based practice, design and coordination of clinical trials, and advanced research methodology.

A typical job posting for a research nurse position would likely include the following qualifications, among others specific to the type of employer and location:

• MSN degree and valid RN license
• Experience conducting clinical research, including enrolling patients in research studies, implementing research protocol and presenting findings
• Excellent attention to detail required in collecting and analyzing data
• Strong written and verbal communication skills for interacting with patients and reporting research findings
• Experience in grant writing a plus

What Are the Schooling Requirements for Research Nurses?

The majority of nurse researchers have an advanced nursing degree, usually an MSN and occasionally a Ph.D. in Nursing . In addition to earning an RN license, research nurses need to obtain specialized training in informatics, data collection, scientific research and research equipment as well as experience writing grant proposals, research reports and scholarly articles. Earning a PhD is optional for most positions as a research nurse, but might be required to conduct certain types of research.

Are Any Certifications or Credentials Needed?

Aside from a higher nursing degree, such as an MSN or Ph.D. in Nursing, and an active RN license, additional certifications are often not required for work as a research nurse. However, some nurse researcher positions prefer candidates who have earned the Certified Clinical Research Professional (CCRP) certification offered by the Society for Clinical Research Associates . In order to be eligible for this certification, candidates must have a minimum of two years' experience working in clinical research. The Association of Clinical Research Professionals also offers several certifications in clinical research, including the Clinical Research Associate Certification, the Clinical Research Coordinator Certification, and the Association of Clinical Research Professionals – Certified Professional Credential. These certifications have varying eligibility requirements but generally include a number of hours of professional experience in clinical research and an active RN license. Here’s a breakdown of the various certifications you can get as a research nurse:

What Does a Research Nurse Do?

A research nurse studies various aspects of the healthcare industry with the ultimate goal of improving patient outcomes. Nurse researchers have specialized knowledge of informatics, scientific research, and data collection and analysis, in addition to their standard nursing training and RN license. Nurse researchers often design their own studies, secure funding, implement their research, and collect and analyze their findings. They may also assist in the recruitment of study participants and provide direct patient care for participants while conducting their research. Once a research project has been completed, nurse researchers report their findings to other nurses, doctors, and medical researchers through written articles, research reports, and/or industry speaking opportunities.

Where Do Research Nurses Work?

Nurse researchers work in a variety of settings, including:

• Medical research organizations
• Research laboratories
• Universities
• Pharmaceutical companies

What Are the Roles and Duties of a Research Nurse?

• Design and implement research studies
• Observe patient care of treatment or procedures, and collect and analyze data, including managing databases
• Report findings of their research, which may include presenting findings at industry conferences, meetings, or other speaking engagements
• Write grant applications to secure funding for studies
• Publish articles and research reports in nursing or medical professional journals or other publications
• Assist in the recruitment of participants for studies and provide direct patient care for participants

Research Nurse Salary & Employment

The Society of Clinical Research Associates reported a median salary for research nurses of $72,009 in their SoCRA 2015 Salary Survey , one of the highest-paying nursing specializations in the field. Salary levels for nurse researchers can vary based on the type of employer, geographic location and the nurse's education and experience level. Healthcare research is a growing field, so the career outlook is bright for RNs interested in pursuing an advanced degree and a career in research. Here’s a full range of salaries you can expect as a research nurse, according to ZipRecruiter.

Helpful Organizations, Societies, and Agencies

• National Institute of Nursing Research
• Council for the Advancement of Nursing Science
• International Association of Clinical Research Nurses
• Nurse Researcher Magazine

List of Other Alternative Nursing Careers

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The Role of the Clinical Research Nurse

Published: 17 May 2019

Version: 1.0 - June 2019

Clinical Research Nurses: In their own words

We spoke to nurses about their experience of working in this exciting space and the variety of roles our clinical research nurses undertake. All speak of having started their research careers with an uninformed view of what a research role could bring them.

All speak of their surprise at the autonomy of the role, the skills they have developed and the variety of work they undertake. All speak of working in great teams, the career opportunities that have opened for them and the importance of their relationships with the clinical research nursing community.

All speak of the challenges they have faced and overcome in research. And all speak of their passion for research. Most importantly they all speak of their crucial role in delivering high quality patient care. 

Here are their stories, in their own words.

Building Local Research

Anne Suttling, Senior Research Nurse, Portsmouth Hospitals Trust

After qualifying as a nurse, I commenced a rotation programme for 18 months. I worked in surgery, medicine, Accident and Emergency, critical care and also coronary care – where I gained a permanent post. That’s where my love is in coronary care and cardiology.

After seven years, I needed a change but still wanted to remain in cardiology. That’s when the opportunity to set up a research study came up. On the first day I was faced with an empty six – bedded bay, on an empty ward and told this was the available space to set up the clinic. The study was a success and on the back of this, the PI got funding for a full – time research nurse, to run interventional studies.

I remember the first complex commercial portfolio study I set up. Before I recruited my first patient I did not sleep the night before. I took home the packaging for all the bloods and biomarkers and had it all out in my living room … there was so much to get my head around. It did go ok – we became one of the top UK recruiters for the study. Because research in the department was working well, more PIs wanted to come on board. They could see research wasn’t such a demanding workload for them because research nurses were organising what they had to do and carrying out the study management.

I currently manage 17 staff in eight specialities. This brings its own challenges. A ward manager has one speciality on their ward and can see what is happening. In this role, you can’t be in renal, gastro and surgery if problems arise. So it’s slightly more difficult to manage. But I am learning so much about other specialities. I enjoy the patient contact and the patients really enjoy being in research. Patients have a hotline to consultants and any problems or issues they call the research nurse.

Our role is so diverse – it is not just recruiting patients. 

I go to monthly meetings with the industry manager. If a company want 8 sites in the UK, they will send out expression of interest forms. If they get 20 back, they will do site selection visits. We also get selected for commercial studies off the back of our success in recruiting to other studies … you start to build up a name for yourself. We also get selected for commercial studies off the back of our success in recruiting to other studies. You start to build up a name for yourself.

A clinical research nurse has a certain amount of autonomy. You have to be able to manage your own time, prioritise and pay attention to detail. Data queries can drive you insane, but that is what research is about. It is all recruit, recruit, but, what is the point if the data is not correct? Part of being a research nurse is having the determination to meet targets. Follow ups don’t necessarily count (as part of the target). You are under pressure to recruit but you still have to follow-up patients … that is what I find difficult. You are perceived to be successful if your recruitment figures are high. Follow up and maintaining consent throughout the trial is just as important – this is when the majority of data is collected.

Our role is so diverse – it is not just recruiting patients. There are follow-ups, collecting data for the CRFs, maintaining site files, knowing about the agencies, regulatory bodies, protocols, consent and giving presentations to inform colleagues about what we do in research.

Cardiology were nominated in 3 or 4 categories at the Portsmouth Hospitals Research Conference and won a “Research Merit Award”. This was in recognition of how we built up cardiology research over the last three years. In cardiology we are getting more PIs on board because they can see we are organised. The PIs are understanding that they don’t have to do all the work. They have a team of experienced research nurses to co-ordinate their trials.

Change Research Cultures

Alison Mortimer, Lead Nurse, NIHR Clinical Research Facility, Sheffield

I fell into research. I bumped into an old colleague on the stairs, she was working in research and had a job going. My first reaction was negative, as research was like a swear word and I hated anything to do with research in my training but I went away, did some reading and decided to apply. I was shocked when I actually got it. I had no idea what I was walking into.

I absolutely loved it. It was so fast-paced, the workload was immense but the patient benefit was amazing. I could see positive outcomes, but it wasn’t only that. I was working with the same patients for a year or longer and built up rapport with them, and they spoke to you about everything that was going on with them. I loved it.

For me research has the best mix of autonomy and teamwork. You manage your own caseload but good communication across the team is essential. I also love the element of surprise … on one occasion I came in to find an email saying we needed to pull all of the patients on one of our trials off the drug immediately. I love that fast-paced excitement, it makes you grateful for the rare moments you do get to sit down at your desk and answer a data query.

My main passion is thinking about how we can unite clinical and research nursing.

I moved into the Comprehensive Local Research Network (CLRN) in 2009. To me it felt like a completely new way of thinking. You were working across such a wide area and with acute and primary care organisations that weren’t at all geared up for research. We had to be flexible so we could be responsive to the different needs of the Trusts. We also had to be sensitive to the internal politics, we were perceived as outsiders. It took a lot of thought and time to ensure we didn’t mess that up. But it was definitely rewarding.

In my role I have responsibilities for the Clinical Research Facility, research nurses within the trust and the CLRN. After that first conversation on the stairs I would have laughed if you had said I would be in this position now. I think research is still a dirty word amongst nurses. The most common reaction is ‘why would you want to do that’. It’s mainly a misunderstanding of the role, research used to be an easy role that people took when they are coming up to retirement. Once that perception exists it is hard to change. My main passion is thinking about how we can unite clinical and research nursing.

One of my main struggles is getting buy in from matrons on the ward. A lot hate research because they feel keeping posts open while nurse go on research secondments depletes their staff. For ward matrons they have targets and certain expectations to make their ward high quality and forward thinking. They don’t realise that we are feeding into that. I think some of the tensions arise because clinical nurses don’t realise that patient welfare and good patient outcomes are as central to our work. We need to stop speaking our own research language, go back to our roots and speak the same language.

After the Francis Report, nurses developed the 6 Cs to guide nursing – Care, Communication, Compassion, Courage, Competency and Commitment. If you think about what a research nurse does these are as essential to us as they are to clinical nurses. We should use this as a common language to unite us.

Supporting Surgical Trials

Joyce Katebe Clinical Trials Nurse, Surgery/Gastroenterology

I am a Surgical Clinical Trials Nurse and I trained and qualified in Zambia. My research started during post basic nursing training, during my BSc Nursing. Research was not part of the pre-registration nursing diploma/certificate then, but it was a requirement for the completion of the BSc Nursing.

After this, I became interested in research and was encouraged as I worked with my lecturers. I helped with data collection which I found very interesting and thought it was something I would like to do more of in the future. I was fortunate to be involved in research for the World Health Organization (WHO) on family planning in Zambia, and this inspired me to want to do more and helped me to develop my own questions about improving nursing practices to improve patient care.

While working in a local teaching hospital, I helped come up with a proposal about teenage pregnancy and the provision of ante-natal clinics for them. It was noted that most of them were first seen in labour when they were admitted to give birth. This prompted me to ask about what services were available for these mothers. I thought I would use this project to help set up ante-natal clinics for teenagers.

In research I find that there are many opportunities to learn.

Having moved to the UK and having spent time working in the NHS, I applied for a position at the Oxford University Hospitals. It was my first research nurse role and I worked with an enthusiastic professor who was very keen to involve nurses in his research. Very exciting. There were always new studies and each of the studies had different research questions to answer.

In my role, I was required to attend research meetings as well as having regular meetings with the principal investigators. I really got a buzz from these meetings as I felt really involved in trying to improve health of patients for the future. I lived in Oxford during the week and went home to Bristol at the weekends. Family life was difficult because my family stayed behind in Bristol and could not relocate as the children felt settled in their schools in Bath and were not keen to move to Oxford.

Many people when they hear the word research think having a career in research is beyond them, but in research I find that there are many opportunities to learn different things. I applied for my current position in Bath to help set up a research unit in the department of General Surgery and Gastroenterology. I was the first research nurse recruited to work purely for the two units.

Initially, it was a challenge because I had to find my way around the system. With the help of the surgeons and colleagues from oncology clinical trials unit, I had to look for office space, desk and all the equipment needed. I had to ensure that everyone joining the unit had Good Clinical Practice training and I went around the wards meeting the different specialists and nurses to discuss the research we did in the unit and this was repeated as required.

It is important that I develop good working relations with non-research nurses because most of my patients are in their care. It also allows them opportunity to understand the research we are doing. I meet patients in pre-op assessment unit, wards and in outpatients. The majority of them are keen to participate in research, the phrase I hear a lot from patients is "I am doing this because I want to give something back to the NHS and community at large” and some say "If no one did this years back, we would not have the treatment we have today."

To hear these words from patients is very encouraging. Many people when they hear the word research think having a career in research is beyond them, but in research I find that there are many opportunities to learn different things as well as witnessing how research is improving lives.

Developing Nurses

Lisa Berry, Senior Research Nurse, NIHR Wellcome Trust Clinical Research Facility, Southampton

The desire to be a research nurse came from a passionate belief that healthcare needs to be evidence based. It combines all the things that I enjoy; law, ethics, clinical care and working in complete partnership with research participants. At times, healthcare can be paternalistic. Patients come to us unwell and we do things to make them better.

Whereas in research the balance of power shifts considerably, we cannot achieve medical advances without help from patients (research participants). We work with them to assess the efficacy and safety of novel therapies and there is no guarantee that participating in a research study will be of benefit to the participant. In research, the safety and wellbeing of our participants is at the centre of everything we do and the research nurse is crucial to supporting them through the whole process of taking part in research.

Research nurses bring a study to life.

There are a specific set of skills that a research nurse needs. All the skills you learn on the ward are transferable and it is essential to have a good clinical grounding. You also need to pay attention to detail, understand the principles and importance of informed consent and be extremely organised. You need to understand not only the science behind the protocol but what participation will entail for the patients/healthy volunteers taking part.

Our nurses need to have the confidence to act as an advocate for the participant and must remain clinically relevant. We specialise in experimental medicine and provide care to healthy volunteers and patients with a wide range of disease and conditions. It is possible that a participant could become very unwell during a trial and therefore it is essential that research nurses remain sufficiently engaged with their clinical training to act appropriately and quickly.

Part of my role is to ensure that researchers are allocated appropriate levels of support and that the studies are set-up in a timely, safe and efficient manner and that we deliver an excellent standard of clinical and research care. Research nurses bring a study to life; they make a huge contribution to advancing healthcare and are a valuable asset for any research team. I was a Health Care Assistant before qualifying as a nurse. Although I am passionate about research nursing, this is not enough to build a career. I would not have progressed as quickly to the role of Senior Research Sister without support, mentoring and developmental opportunities.

Since I started in research in 2006 I have seen more career opportunities. More training has become available and there is a greater understanding of what clinical research nursing is. Even I didn’t really know what research nursing was when I started. We try to encourage our nurses to consider all their development options. We facilitate academic development as needed and also strive to provide career opportunities. A few of our band 6 and 7 nurses have been very fortunate in obtaining MRes funding. The NIHR funds the course fees, salary and also backfill for their position. The NIHR fund one person to do a Masters degree in research, but really they are funding the development of two people because someone else can then act-up into a more senior role and is also developed.

Our aim is to ensure that research is fully embedded within healthcare at this hospital. All research nurses now wear a dark grey uniform. This has given us a very visible identity and it is exciting to see how integrated into and dispersed around the hospital we are. Suddenly people become very much aware of the research presence in every division.

Informed Consent

Arshiya Pereira, Research Nurse, Renal Transplant Department, Central Manchester University Hospitals NHS Foundation Trust

I was trained in India to become a nurse. My first placement was in renal dialysis. I was interested in learning more about renal because of its vast subject area; renal medicine, renal transplant, research, transplant clinic and dialysis.

The main aim was to get more knowledge and experience working in a specialised unit. After moving to the UK I worked on the renal ward and dialysis unit at Sunderland Royal Hospital. I moved to Manchester as I wanted to gain more knowledge and experience of transplant. Initially working in the renal transplant clinic conducting follow up I became aware of research and I was curious about the research studies my patients had been recruited to. When a vacancy in Renal Transplant Research was advertised I applied.

I was a bit apprehensive in taking the role initially as I had heard many people say you lose your clinical skills and you do not get to take care of the patients as you would on the ward. I realise that those assumptions are inaccurate. I get to spend more time with the patients and I have discussions about the research. What we do in research today may change the way we practice medicine in the future.

Every day is different in renal research.

We work with two different types of donors, live donor transplant and cadaveric donors. With live donor transplant we know when they are coming to us. With cadaveric donors we don’t know when we are going to get the kidney. So I have to organise myself on the day itself. Recruitment always takes priority. The first thing I do each day is check if there are any transplant operations and if there are, I see if the patients are eligible for my study, and recruit them if they are happy to take part.

At times I have found it difficult to get the Principal Investigator (PI) to consent the patients because they were either in surgery or clinic. I began to wonder whether it would be possible for me to conduct informed consent? At the same time, the Trust was undertaking a scoping exercise to assess the need for clinical staff who were not doctors to take informed consent and developed policies and procedures to support us to take on this role. This is a wonderful opportunity for clinical staff who were not doctors to extend their role. Initially the role was delegated by the Principal Investigator who had to justify the need for a clinical research nurse to take the informed consent for a specific study. 

The main aim was to get more knowledge and experience working in a specialised unit. A half day training programme was developed to gain more in depth knowledge of informed consent and group activities to explore the issues and processes involved. My competency in obtaining informed consent was assessed by the PI. I passed and felt really proud of myself.

To take consent I screen the patients’ eligibility and send information sheets two weeks prior to clinic visit, so they have time to read the information and speak to family. I also consult with the respective surgeon to see whether they are happy for their patient to be approached for the particular study. When the patient comes to clinic I discuss the study and if they are happy to take part, I make sure they are fully aware of what the study involves. In total, I have taken 20 informed consents so far, which has enabled the team to recruit to time and target.

I have now been working in research for over five years. I feel that due to the skills and expertise gained in particular informed consent my leadership qualities have improved significantly. I ensure the patient feels valued, they are followed closely from their pre-transplant appointment to their aftercare and they always remember me for the care I provide for them.

Ruth Hulbert, Lead Nurse, Kent and Medway Comprehensive Local Research Network

I came into the NIHR from the pharmaceutical industry, working with GSK and then Pfizer, I was used to an environment where money was no object and it wasn’t necessary to get people on board with the idea of research. The need to influence the right people in order to get research done was completely new to me.

Clinical research nursing is definitely not for the fainthearted. Most people get into nursing for the patient contact. You still have that but you also get other experiences like handling data, project managing and making direct approaches to very senior managers and consultants. You have to be proactive which can be difficult. The patients don’t come to you, you have to go out and find them.

When I began in the Cancer Research Network my personal worry was about approaching patients to join a study. It is an unusual position for a nurse, you are asking them to help you. The first patient I recruited was a lung cancer patient for an observational trial. He was very receptive which gave me the confidence going forward.

Clinical research nursing is definitely not for the fainthearted.

Clinical Research Nursing comes with a lot of autonomy, you don’t get that freedom in other areas of nursing. Nurses are in a much better position now in clinical research as there is a much clearer career structure. Most nurses come into our CLRN as a Band 5 with some nursing experience. Our goal is to develop them, and within a year to 18 months, most become Band 6s.

Training is passion of mine. I think there is a lot of satisfaction to be gained in passing on your knowledge and skills to people who are new and inexperienced. It is great when you see people growing and becoming a more confident and competent version of themselves. I am one of the Network’s Good Clinical Practice facilitators. At the last facilitators meeting it was announced that we had now trained 30,000 people across the network, to be even a small part of that it great.

Clinical research nursing is definitely not for the fainthearted. I was twice involved in developing new networks in Kent and Medway; the Cancer Research Network and then the CLRN. There was very little research activity at the time but awareness of research is definitely starting to change. A major culture shift but there are still areas within our CLRN where there is no research activity. In the early days there was a mixture of lack of knowledge and lack of interest in research, but most of all the clinical staff didn’t realise we were there as a resource for them to handle the more time consuming aspects of starting up a trial. That has changed.

My hope is that within my lifetime research will be embedded into the NHS in Kent to such an extent that the public can go to their doctor and ask what clinical trials are available for them and their doctor will know. Wherever my career takes me from here, I know that I want to stay within research I have developed a passion for it.

Research Management

Debbie Beirne, Nurse Consultant, Cancer Research UK, Leeds

I loved research from the start. I loved the autonomy, responsibility, the degree of change, the degree of learning. When new nurses start with me I tell them that they will probably feel like a fish out of water for six months. I explain it is a very dynamic and interesting environment, not suitable for anyone who likes things to stay the same.

Adapting to change is probably the most important thing. With research we don’t want things to stay still, we want them to move forward and nurses have to be able to move with that. A big misconception is that research nurses float around with a clipboard, drink tea and work very standard hours. None of that is true. I don’t think that there is the appreciation that we are actually delivering care, not just writing protocols for others.

Research nurses can now have a role that is much broader.

I have several parts to my role – my day-to-day operational role, a translational development role, a role within my trust as a research expert for other departments, and my Cancer Research UK role in engaging with the public at events. I work with some of our clinician scientists to deliver their protocols. I help them look at what they are currently doing in the labs and how that could translate into patient care. As a result, I have some co-investigator roles on a few grants.

I have seen huge changes in almost every aspect of research since 1999, except for the fundamental of how we care for the patient. Research Governance has changed, the way we structure and deliver clinical research has changed, the way we inform people has changed. Clinical trials are much more complex than they were ten years ago, and so the role of a research nurse is much more complex too. It's a very dynamic and interesting environment, not suitable for anyone who likes things to stay the same.

Obviously medical science wants to engage with the public and keep them aware of advances but when a newspaper runs a 'magic bullet' headline it impacts the work I do. I frequently get calls from patients who don’t realise that the headline doesn’t relate to their situation or refers to something in a lab which could take us 18 months to translate. I think we have a duty to give people hope but make sure it is a realistic hope.

Research allows you a degree of personal and professional development in a more flexible framework than traditional nursing. There are lots of different avenues; Network managers and lead nurses, Trust and R&D lead nurses and new roles are always coming up. As recently as five years ago if you wanted to move beyond a Band 7 you had to leave nursing, now I am a Band 8b and still a nurse.

We need to move away from the idea that as a research nurse you are just picking up the trial and delivering it. Research nurses can now have a role that is much broader. You can be involved in writing the protocol, be a patient voice with scientists, change the research culture within the wider trust.

Patient and Public Involvement

Maggie Peat, Lead Research Nurse, Harrogate and District Foundation Trust and Patient and Public Involvement Lead North and East Yorkshire and Lincolnshire Comprehensive Local Research Network

I was working as a nurse giving chemotherapy. It was just at the start of the cancer research networks. I didn’t really have much idea about what research networks might do, it just sounded like a really interesting job. When I started there was a lot of feeling your way, there wasn’t a lot of guidance around. There is a lot more now. We mentor people.

We recognised fairly early on that most student nurses didn’t really know anything about research. I wanted to show them that it wasn’t just about systematic reviews and all the really dull stuff but about actually recruiting patients into studies and the really exciting stuff of being at the sharp end of research. Student nurses absolutely loved it.

Often patients will take part in research because it's for the greater good.

Some of the Patient and Public Involvement work has been about raising awareness because patients and the public have all sorts of good ideas that we don’t think of, like putting information up on screens in patient waiting areas. Everybody is doing that now but none of us had thought of that because we didn’t wait in the waiting areas. Accessibility to information is really important. The people who need properly accessible information the most, are the people who are least likely to ask because they don’t want to look stupid or think that they are going to be judged.

It’s a simple thing that after taking consent to say to the person "right I want to be really sure that you understand what you are taking on. So can you say to me, what you might say to your wife when you get home?" It is simple but nurses are not taught how to do that. It is important that we have tools to measure understanding.

The power imbalance between a nurse and a patient is less than between a consultant and patient. It makes it easier for a patient to say no to taking part in a study. It is important, that people can say no to a trial. Patients understand the incremental process of research. One of the things they say is "all that I have benefited from has come from someone else doing a study." Often patients will take part in research because it is for the greater good or sometimes it is a positive thing to come out of something bad that has happened to them. 

I wanted to show them that it wasn’t just about systematic reviews and all the really dull stuff. I think people are sometimes terrified of signing up for Patient and Public Involvement, thinking that they may have to do more than they want to do. So all our stuff is about saying to people, you can be involved as much as you want to be, you can do the occasional information sheet, you can look at a questionnaire and comment on it or you can come and be part of a steering group. People and patients can be involved in research as much or as little as they like.

NIHR has made it easier for consultants to take a study on, partly because of the nursing infrastructure. Nurses and support staff can work with consultants and we are here to stay. If you are interested in research nursing just do it, it suits most people. We have not had anyone work here that doesn’t love doing research.

Informing the Public

Karen Doyle, Senior Nurse, Cancer Research UK

When I started, research nursing was on the fringe of nursing. At the time we were told "you look after the doctors that is your role". That old fashioned view of nursing was still there.

I started in clinical research nursing because I wanted to be using all of the knowledge that I had gathered in my career. There were nurse specialist posts but I wanted something more intriguing, more complex. I didn’t want to do nurse management because it would take me away from patients. I always wanted to be patient centred. Research nursing offered all of that. I loved the fact that research nurses were involved in the science.

There were a lot of cancer patients with horrible side effects from the treatments available at the time. I wanted to be part of something that was not just accepting what we had because there was room for improvement. I wanted to be with the team that was making things better for these patients. Initially we were given early phase work such as toxicity and safety of the drug or treatment. So lots of additional testing. I loved the intensity and you got to know patients really well. I loved that in-depth interaction.

We are getting out into the communities with the right messages.

Medical teams sometimes want to get their patients into trials for compassionate, for misguided reasons. Sometimes you will get medical teams saying "But we have no other treatment to give them." You have to be strong. A clinical trial is not a treatment option and I think people forget that. We have to make sure that it is the right thing for the patient. That is what we are there for. When deciding if a trial is the right thing for a patient it is not only the science that matters. Sometimes it is the simple questions that matter for patients. Can you take tablets? Will you be able to cope with travelling to the trial? Those questions are missed if you haven’t got a nurse. We are the practical voice that makes the trial work.

I have developed my research nursing role to include informing members of the public about research. I love talking in the community because that is where the information is needed. We are getting out into the communities with the right messages – myth busting about clinical trials. Public understanding is better than it was but it has a long way to go. I have discovered that in addition to being face to face with the patient making the difference, I can also become the person (as a trainer) who will influence the nurses who are face-to-face. I can benefit many more patients through training than I could with nursing alone. I get a lot of reward from influencing other nurses. It is not management to me, management was taking you away from patients.

Research nurse leaders should be proud. We have taken the role of nurses in research from setting out someone’s lunch to a dynamic career. We have got national research nurse networks, we have got training and we have got the support of the NIHR. The change really is dramatic. I don’t know of any other type of nursing where it has improved as much and got more respect over time. You are really working as a specialist team member. That is the way it should be.

Claire Merritt, Lead Research Nurse Manager, Dementias & Neurodegenerative Diseases Research Network, Oxford

I caught the research bug in my first research post about 10 years ago. A consultant colleague had a grant to do a pilot study and asked me if I would be interested in working as a research nurse on their research study. 

I was the only research nurse and was responsible for recruitment and study delivery and very quickly learnt about how challenging it was identifying patients and accessing patients for research. Rightly, there are people who want to protect patients, but it’s about persuading them that research is a good idea. Encouraging them to introduce the idea to a patient can be hard. People think there is a large cohort of people out there for trials. In reality, the numbers are much lower than you expect them to be.

What we have done for the last seven years within DeNDRoN is about trying to facilitate a culture change within the Trusts and make research part of everyday thinking. We’ve introduced what we call link workers into teams. Each of the community mental health teams has an honorary research worker linked to it. This has been successful as they develop an understanding of what that teams needs and wants and how they work.

Working with patients is what nurses do best.

As well as building up a team it’s about building up an infrastructure to support research to happen. During the time I have been working with DeNDRoN the portfolio of research studies within Trusts has grown, as has the complexity of studies we are able to support. The key message is that research becomes embedded in patient pathways so it becomes everyone’s business and not just ours.

Our job is about helping to facilitate research to happen. Partly, that’s just continuously giving that message that research is an important activity. We’ve had a degree of success, but I think we still have a way to go to persuade all clinicians that research is their business. Some clinicians have bought into this concept well, some still argue they do not have the time to do research and some say they find research is something scary. However, research is about empowering patients and their caregivers and the general population to help.

You get a very interesting range of people who are keen to take part in research. Some people want to be able to access something that may make a difference to their relatives or themselves. Others have altruistic motives and want to help, because it will help others rather than help themselves. On the other hand some people don’t really understand what we mean by research, or feel it’s too scary or risky or too much of a burden. So education is important. We must always remember we work with people in crisis and sometimes it is not the right time for them to consider research.

Working with patients is what nurses do best. So for most research nurses the contact with patients bit deals with itself. There is though a lot to learn and it’s all the other stuff around research you have to work hard at. As a lead nurse most of my job is about providing clinical leadership to staff, making sure that things happen and supporting workforce development. Key to what I do is making sure we have the right people with the right training in order for us to do research that can go on to make a difference to people in the future. Everything we do is about forward thinking, you always have to be thinking about the future.

Toward the end of a long career in mental health nursing I am really pleased to have found myself following a career in research. I am quite passionate about working in research. You have to believe in research to make this job a success.

Patient Care

Kathryn Kennedy, Trainee Advanced Clinical Research Nurse Practitioner, Manchester Clinical Research Facility

When I worked as a clinical nurse we did not have that much interaction with the research nurses who came onto the ward, even though most of the children were on trial drugs with a protocol I don’t think I really understood what that meant. Because I was nosy and interested I got to know more about the research side of things.

When I started in clinical research nursing the studies were lower intensity to what we have now, generally well children in an out-patient setting. At first it felt like a little bit of step back on the clinical side but that gave me the opportunity to really develop my research knowledge.

The team is now dealing in phase 1, phase 2 trials now in children who have no other treatment options, sometimes quite unwell, so we are in the heart of clinical nursing on a daily basis. The role of the research nurse is critical to keeping families motivated to stay on the trial … we spend a lot of time ensuring that their journey through the trial is a positive experience.

Our expertise is essential in ensuring that the study runs smoothly.

I think the perception of losing the clinical part of the nursing role perhaps puts some people off. Friends have expressed that they would not consider research because they see it as a very academic, very administrative based role. That could not be further from the truth. We don’t cut corners with informed consent. Parents need to understand at a level where they are able to put their emotions to one side and make a decision based on the knowledge we have given them.

Some of our children come from Europe and can be re located in this country for up to 6 months with their family. The research nurse is very much responsible for that relocation, as the liaison with hospital services or sponsors, ensuring bank accounts are in place, other children are getting educated. A lot of biotech companies are new companies. It might only be their third or fourth clinical trial.

Our expertise is essential in ensuring that the study runs smoothly. It is not reasonable to involve parents in that process if these things have not been thought through. We are invited earlier now to go to (sponsor and management) meetings because they are recognising our expertise. We are the ones who understand how to get things right from the very beginning.

I am a trainee advanced practitioner due to qualify in September. It is really exciting to be the first. This is a brand new role to research; able to recruit children to clinical trials, deal with physical examinations, prescribe and see patients without the support of a medic. As an advanced practitioner we can provide support for PIs hopefully this will ease some of that pressure so that trials that we wouldn’t perhaps have been able to do, because there wasn’t the medical support, get done.

I wasn’t sure that research nursing was somewhere I would stay forever. I wanted the research knowledge and experience but knew that my heart would be in clinical nursing. This new opportunity coming along has allowed me to be even more clinical in research nursing.

My new role has generated interest from other nurses that did not know this kind of role would be possible in research. You get to make a difference in a very different way. I still get to look after sick children which is what I always liked about nursing. But now there is a deeper level to this.

Supporting Primary Care

Julia Rooney, NIHR Primary Care Research Nurse, Kent, Surrey and Sussex Clinical Research Network

I used to manage the cardiac care unit at Brighton for many years. I also had a period in the Middle East working in a heart centre. When I came back I worked for the heart network in Sussex where I also worked within primary care which was great experience as it is very different from secondary care.

I am now a research nurse working in primary care, coordinating and running studies in practices where there isn’t capacity to carry out research. I started in this post six months ago and I have found it to be a very fulfilling job for many reasons. It is so rewarding what you get back from patients who want to be involved in research for the greater good

In nursing you cannot move forward without research and we are an evidenced based profession, for example we wouldn’t have made the advances we have in the treatment of heart attack patients without research. The autonomy you get within this role and the one-to-one patient contact you have means the whole process is extremely worthwhile. I cannot recommend the role highly enough. I was looking for a something that would get me more contact with patients and a new challenge … it allows me to utilise my clinical background and experience within research and means I can make a difference that way.

As a nurse you always are an advocate for patients. You make sure they are the priority in the research.

I was apprehensive recruiting my first patient despite years of experience in nursing. I am a bit of a perfectionist and wanted to get it right, taking the informed consent, making sure the patients understood what they were entering into. Once you start it becomes very natural. In my previous position I was moving further away from patients and then this opportunity came up. Everyone who asks about my job I say 'I love it! There isn’t anything I don’t like about it'. People are probably getting a bit bored of me talking about it now.

I underestimated the job in the beginning. I knew it was something I wanted to do but I underestimated how much I would love it and how much of a difference I could make to patients’ lives. This will change lives for future generations. You actually get time with a patient. In that hour or so you can hear other concerns they have and you can talk to them and advise them. You get the opportunity to discuss issues that may be of concern to the patient.

My working days vary so much, for example for one study I arrive in clinic, order a courier to collect the bloods, get the clinic room ready and all of the paperwork. Then you consent the patient and run the study. I might have to then go to another clinic in another practice to complete paperwork or run a shorter clinic. I genuinely don’t have two days the same. If you have the clinical background just do clinical research. Until you are doing the job you cannot be sure how fantastic it is. The studies I am involved in will change lives. You cannot put a price on that.

Susan Read, NIHR Primary Care Research Nurse, West Midlands Local Clinical Research Network

Five years ago the Midlands Research Practices Consortium (MidRec) secured funding to recruit some half-time research nurse posts based in local GP research active practices. I’ve always been interested in research and was working in a very busy GP surgery at the time, seeing patients every 5-10 minutes, with no quality time available to spend with my patients. I thought this job would give me the opportunity to spend more satisfactory time with patients while becoming involved in gathering accurate information to provide evidence based medicine.

I was the first nurse appointed and now part of a successful team of six nurses, based in our own individual surgeries, overseen by a Lead Research Nurse. Before we started running research studies in our nominated surgeries our Lead Nurse manager ensured that we underwent a programme of mandatory training so we had an understanding of what was required to safely be involved in research.

We have this supportive network of research nurses which makes for a powerful effective team.

Gradually the studies came in and I remember being asked by Professor McManus how many studies we were running and I said we were currently running about 20 studies. He was surprised. I think that opened the GPs’ eyes and they realised the opportunity they had with the support of the nurses.

Many studies are observational where you are looking and extracting data. We also look at feasibility of studies, so we are contacted by a study manager and asked to find out the number of patients we have. So we can go back to the study team and say these are the numbers for this head of population which we think you will be able to access at these surgeries.

The medical knowledge nurses have comes in useful when running feasibility studies. We can search effectively for eligible patients. We significantly help the GPs. I remember my first patient recruited to a study. I was absolutely thrilled because patients were willing to participate in the study where we were doing near patient testing and baseline health measurements with immediate feedback of results which we then had time to discuss. If necessary the patients could be referred back to their GP for any concerns that were highlighted.

The patient contact, the communication pathway that opened up in the last five years with the team has given me job satisfaction. We really feel included more so now than ever before. What pleases me the most is that although we are autonomous within our own environment there are five other host nurses. We have this supportive network of research nurses which makes a powerful effective team. We have opened up effective pathways between the university, study teams and other professionals. If they need help or an answer to a query we can normally provide the information quickly and efficiently because we have close contact with the GPs.

If someone is considering a career in research I would say come and join me for a day and see things first hand. Many of the host nurses have come from a Practice nurse background and have a wide range of knowledge because you can in any given day look after babies, give travel jabs, look after women’s health to caring for a patients with a chronic condition. Over the years our training has covered an enormous remit.

You learn a lot from problems, you have to be pragmatic and always look for solutions. When they set up this scheme, we were a pilot study. The success of the Pilot enabled funding to continue and currently the NIHR fund us through their networks even after MidRec itself came to an end. Patients deserve the opportunity to be involved in research.

Building Social Media Networks

Nathaniel Mills, Research Nurse Manager, Clinical Research Network: Yorkshire and Humber

My research career started in 2007. I was working in a large teaching hospital, part-time research and part-time primary care. When I started there was some negativity around working in research from colleagues who thought it was not real nursing. They thought it wasn’t direct patient care. But for me it was something I felt I could do to make a difference.

The whole notion of improving health and wellbeing through research appeals to me. I joined the NIHR Clinical Research Facility in Sheffield when it was a relatively new facility and I was in one of the first cohorts of research nurses. As a novice to clinical research you think ‘what’s it all about?’ but with experience and as time goes on, you physically see a patient’s symptoms improving. That gave me a great deal of job satisfaction.

In some cases the patient you see at the beginning of a trial is different to the same patient at the end of the trial. This is not just because they have had an trial intervention but because you, the nurse and the research team have given them the support and care that comes with trial participation.

I am passionate about twitter because it pulls together these groups of people who have common themes and needs.

When the NIHR Coordinating Centre began to consider social media as a tool to support research staff and utilise established tools, I became involved in the work of the NIHR Clinical Research Network Nurses Strategy Board. I met up with Fiona O’Neill, a few colleagues and Teresa Chinn from ‘@WeNurses’ to start up a clinical research nursing network on twitter. Teresa was inspiring in the sense that she’s a nurse working on her own and used social media to connect with other nurses. She now has a community of over 10,000 active and innovative followers.

So we developed a social media strategy (#crnnurse) with the aim of connecting the clinical research nursing community - especially reaching out to those nurses working in silos, something which is common in clinical research. We advertised this through the Clinical Research Network newsletter, and widely on Twitter we have regular ‘tweet chat’ debates and anyone who has anything to say about clinical research can participate - this has led to an active and vibrant community on social media.

Sometimes I get the odd negative responses such as 'I don’t want to do this in my own time' or 'what’s the point?' and that’s the beauty of it, you don’t have to, you can participate as much or as little as you like, the conversation is always going on.

Since its launch we have achieved a lot. We have a community of nurses and international nurses from the USA, Australia, South America and North Africa. We promote good practice and social media brings the learning to the community ... it’s free, cheap and easy. People who link in to our network can find out which Trusts are running trials. Problems can be shared rather than dealing with them by yourself, because it is highly likely someone will have already encountered the problem. So I would encourage nurses to get out there and start networking through social media, it can help make the life of clinical research nurses much easier.

I think the future is whatever you want it to be in terms of social media. If we do it right we can respond to what the nursing community wants. I am passionate about twitter because it pulls together these groups of people who have common themes and needs. Of course we have to consider what we say on a public forum, but we are all professional nurses and we are accountable for our actions. Follow me @natwm10 or @resnurse.

University of Missouri

Mizzou researchers explore solutions to help reduce nurse burnout

Study finds giving nurses massages during their shifts may improve physical health and mental well-being.

August 27, 2024 Contact: Brian Consiglio, [email protected]

Even before the coronavirus pandemic, high rates of burnout and staffing shortages plagued the nursing industry, primarily because of the stressful demands of the job. The COVID-19 pandemic only amplified these challenges, and with nearly a third of all Missouri nurses nearing retirement , improving nurse retention is key to avoiding an impending nursing workforce crisis in our state.

Despite dozens of studies proving burnout is an issue, few provide interventions to help nurses — and their patients — overcome its challenges.

A recent study by the University of Missouri has found that a simple and common-sense solution — giving nurses massages during their work shift — not only reduces their physical aches and pains but also leaves them feeling mentally rejuvenated to return to work. The findings can help leaders in health care and other industries with high rates of burnout consider the impact massages or other interventions can have on improving employee well-being and reducing high rates of staff turnover.

From the bedside to the research lab

Jennifer Hulett has been a nurse for 30 years and is now an assistant professor and researcher at Mizzou’s Sinclair School of Nursing. She knows firsthand how 12-hour shifts lead to physical aches and pains, chronic stress and a high rate of burnout.

With so many nurses leaving the profession for less stressful careers, the extremely high rate of burnout has caused a constantly revolving door of staffing shortages throughout the nursing industry, with the average new nurse becoming burned out within 18 months on the job.

“I have seen over the years the physical and mental toll the job puts on nurses, and many nurses are not healthy as a result,” Hulett said. “It is unfortunate because nurses dedicate their careers to taking care of their patients, but no one is taking care of the nurses. I’m determined to change the culture of the nursing industry in a way that improves well-being through mind-body interventions.”

In the recently published study, nurses were surveyed on their physical symptoms related to aches and pains as well as their mental well-being before and after receiving 15-minute massages twice per week during their work shift for a month.

“After just one month of the intervention, the nurses reported fewer aches and pains after receiving the massages,” Hulett said. “Perhaps the most important finding was the nurses often reported feeling rejuvenated to go back to work after the massages, improving their overall mental well-being.”

Hulett’s main objective is to create a healthier work environment where nurses are excited to go to work and want to remain in the profession long-term. Massages could be just one intervention among a toolbox of options nurses could potentially choose from. She added that more research is needed to further explore other types of interventions to see which ones might be most effective in improving employee well-being.

“It is time to start thinking outside the box because if we do nothing, current staffing shortages will continue to get worse,” Hulett said. “We have seen over the years that it becomes a vicious cycle where you are constantly hiring new nurses without enough experienced nurses to mentor and train the new hires. This ultimately impacts the quality of care that gets delivered to patients, and that is another critical topic future research can explore.”

While this particular study focused on burnout in the nursing industry, Hulett added that other healthcare professionals and professions that experience high rates of staffing shortages because of burnout could benefit from this type of intervention.

“Massage therapy for hospital-based nurses: A proof-of-concept study” was published in Complementary Therapies in Clinical Practice. Hulett collaborated on the study with Susan Scott, a nurse scientist in the Office of Professional Nursing at MU Health Care.

MU Sinclair School of Nursing

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• v.14(8); 2024
• PMC11340706

Determinants of clinical nurses’ patient safety competence: a systematic review protocol

Jong-hyuk park.

1 Seoul National University College of Nursing, Seoul, Republic of Korea

2 Research Institute of Nursing Science, Seoul National University, Seoul, Republic of Korea

Hanseulgi Lee

Gihwan park, associated data, introduction.

Patient safety has become a fundamental element of healthcare quality. However, despite the ongoing efforts of various organisations, patient safety issues remain a problem in the healthcare system. Given the crucial role of nurses in the healthcare process, improving patient safety competence among clinical nurses is important. In order to promote patient safety competence, it is essential to identify and strengthen the relevant factors. This protocol is for a systematic review aiming to examine and categorise the factors influencing patient safety competence among clinical nurses.

Methods and analysis

This review protocol is based on the Joanna Briggs Institute (JBI) Methodology for Systematic Reviews of Effectiveness and Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. Four electronic databases, including Ovid-MEDLINE, CINAHL, Cochrane Library and EMBASE, will be used for the systematic review. After consulting with a medical librarian, we designed our search terms to include subject heading terms and related terms in the titles and abstracts. Databases from January 2012 to August 2023 will be searched.

Two reviewers will independently conduct the search and extract data including the author(s), country, study design, sample size, clinical setting, clinical experience, tool used to measure patient safety competence and factors affecting patient safety competence. The quality of the included studies will be assessed using the JBI critical appraisal tool. Because heterogeneity of the results is anticipated, the data will be narratively synthesised and divided into two categories: individual and organisational factors.

Ethics and dissemination

Ethical review is not relevant to this study. The findings will be presented at professional conferences and published in peer-reviewed journals.

PROSPERO registration number

CRD42023422486.

STRENGTHS AND LIMITATIONS OF THIS STUDY

• The review protocol has been rigorously and systematically developed according to the Joanna Briggs Institute Methodology for Systematic Reviews of Effectiveness and Preferred Reporting Items for Systematic Review and Meta-Analysis Protocol.
• This study will rigorously select relevant articles according to the Canadian Patient Safety Institute’s patient safety competence framework.
• The anticipated heterogeneity of contributing factors is expected to make it challenging to conduct a meta-analysis.
• This study will only include articles in English and exclude grey literature, which could result in potential publication bias.

Patient safety has become a global public health issue and a fundamental element of healthcare quality. 1 2 According to the WHO, patient safety is a framework of organised activities that creates cultures, processes, procedures, behaviours, technologies and environments in healthcare that consistently and sustainably lower risks, reduce the occurrence of avoidable harm, make errors less likely and reduce the impact of harm when it does occur. 3

Despite its importance, patient safety issues continue to undermine the healthcare system. 4 5 Annually, an estimated 421 million patients worldwide are admitted to hospitals while approximately 42.7 million patient safety incidents occur within the healthcare system. 6 The impact of patient safety incidents during patient care is noteworthy on a global scale, leading to over 3 million deaths annually. 7 An estimated 237.3 million medication errors occur annually in England, 8 resulting in a financial burden of more than 750 million pounds. 9 Approximately 15% of healthcare expenditures are allocated to address the consequences of patient safety incidents. 6 This results in a considerable decrease in the global economy costing trillions of dollars annually. 6 7 However, it has been found that a significant portion (ranging from 25% to 50% or more) of these events are preventable within the healthcare system. 6 10 11

In all dimensions of the healthcare process, nurses are responsible for patient safety. 12 Nurses, who spend more time with patients than other healthcare professionals, play a vital role in identifying patient safety risks and ensuring high-quality care. 12 , 14 Through careful monitoring of patient conditions, quick identification of risks, and supervision of the healthcare process, they actively contribute to patient safety. 13 15 In addition, nursing activities such as medication administration, infection control and fall prevention have a direct impact on patient safety. 16 Therefore, maintaining high levels of patient safety competence among nurses is crucial for decreasing patient safety issues and enhancing the quality of patient care. 13 17

The Quality and Safety Education for Nurses project identified the fundamental elements of quality and safety competence in nursing, including patient-centred care, teamwork and collaboration, evidence-based practice, quality improvement, safety and informatics. 18 These core principles improve evidence-based standards with a systemic perspective and enhance the quality of patient care. 19 In addition, the Canadian Patient Safety Institute (CPSI) outlines crucial aspects of patient safety competence, including the ability to recognise, respond to and disclose patient safety incidents, foster patient safety culture, promote effective teamwork and communication, ensure safety and manage risks, promote quality improvement and optimise both human and system factors. 20

The definition of patient safety competence encompasses the attitude, skills and knowledge that prevent unnecessary risk and harm to patients. 18 21 This competence helps prevent patient safety incidents and addresses latent problematic issues in the healthcare system. 13 22 A recent study revealed that patient safety competence can reduce preventable adverse events, including medication errors, surgical site infections, urinary tract infections and ventilator-associated pneumonia. 13

In addition to recognising the significance of the patient safety competence of nurses, there are many aspects of patient safety competence that require further investigation and understanding. 23 First, it is important to identify the factors relevant to patient safety competence and enforce the contributing factors. A study by Huh and Shin revealed that demographic factors such as age, education level, patient safety education and experience in patient safety activities are associated with patient safety competence. 16 However, prior studies have focused primarily on the individual attributes of patient safety competence and have not emphasised the organisational factors. 24 Patient safety is a complex process within the context of a system that requires collaborative efforts from both the individual and the organisation. 14 25

Although there are limited reviews of patient safety competence instruments, 26 27 there are currently no systematic reviews of the factors that contribute to the patient safety competence of clinical nurses. A previous review by Okuyama et al 26 conducted in 2011 explored patient safety competence across diverse healthcare professionals. However, the patient safety competence of clinical nurses may differ from other healthcare professionals. In addition, the most recent instruments of patient safety competence may not have been included in that review. Mortensen et al 27 published a scoping review of the instruments of patient safety competence in nursing. However, scoping reviews have methodological limitations that offer a general overview rather than a comprehensive in-depth analysis and they do not include a formal quality appraisal process. 28 Moreover, there is a lack of consensus on the definition of patient safety competence and its conceptual framework in that study.

This protocol aims to provide guidance for a systematic review to identify the factors affecting the patient safety competence of clinical nurses. To foster a comprehensive understanding of patient safety competence, we will categorise those factors into two domains: individual and organisational. Moreover, this study will encompass research that has examined the core concept of patient safety competence based on the CPSI framework. This review would essentially provide a starting point for identifying the determinants of patient safety competence.

Study objectives

The purpose of this research is to examine the factors that influence the patient safety competence of clinical nurses. The specific research questions include (1) what is the definition of patient safety competence, (2) what instruments for assessing patient safety competence are examined in this research and (3) what factors affect the patient safety competence of clinical nurses?

Before conducting this review, we thoroughly searched the International Prospective Register of Systematic Reviews, which revealed no ongoing systematic reviews of the factors influencing the patient safety competence of clinical nurses. To conduct a systematically organised review, this protocol was developed based on the Joanna Briggs Institute (JBI) Methodology for Systematic Reviews of Effectiveness. The JBI checklist, an organised tool to promote and support evidence-based practice, provides a rigorous systematic review process. 29 Some elements were updated and modified from the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocol. 30 We registered this systematic review with the International Prospective Register of Systematic Reviews (CRD42023422486). The systematic review started in August 2023 and included a preliminary search and pilot study selection process to screen the search results based on the eligibility criteria.

Search strategy (PICO) and data sources

This systematic review will explore the determinants of patient safety competence among clinical nurses (P-population). The study will examine the impact of various factors that either enhance or impair patient safety competence (I-indicator), comparing their effects on nurses exposed to these factors to those who are not exposed (C-comparison). The primary outcome to be measured will be the level of patient safety competence (O-outcome). According to the PICO statement guidelines, the search strategy was developed in consultation with a health sciences librarian. Four databases, including EMBASE, CINAHL, Ovid-Medline and Cochrane Library, will be explored from January 2012 to August 2023 ( online supplemental appendix A ). The reason for selecting this period is that the Medical Subject Headings for patient safety was introduced in 2012. The specific search strategy is presented ( table 1 ). In order to conduct a more thorough examination, we will use both backward and forward citation search methods.

This review will include studies involving clinical nurses directly engaged in providing patient care in hospitals. According to a previous study, clinical nurses consist of registered nurses or licensed practical/vocational nurses providing direct care to their patients in hospitals. 31 Therefore, this study aims to encompass a diverse group of clinical nurses, including medical, surgical and intensive care unit nurses. To minimise variations in competence attributed to distinct professional roles, articles exclusively focused on nurses not directly participating in independent front-line patient care, such as nursing students and nurse managers, will be excluded.

This study will explore multiple influencing factors that serve as indicators of patient safety competence. The JBI quality appraisal tools employ a rigorous assessment process to evaluate the validity and reliability of indicators. A diverse and heterogeneous range of tools is expected to be employed in the study.

This systematic review will allow for comparisons based on exposure to the indicators. Comparisons can be made between clinical nurses who have been exposed to specific factors and those who have not. Furthermore, the study enables comparisons across different hospital settings providing valuable insights into the variations in patient safety competence.

The primary outcome will be patient safety competence, which encompasses complex patient safety principles, including the CPSI’s patient safety competence. This competence includes the ability to recognise, respond to and disclose patient safety incidents; manage safety, risks and quality improvement; communicate effectively; foster teamwork; understand patient safety culture and optimise human and system factors. 20 The outcome measure will be rigorously evaluated for its validity and reliability.

Study design

The study will encompass original descriptive cross-sectional analyses, comparative research and mixed-method research. Only peer-reviewed articles on patient safety competence will be included, to ensure high-quality and reliable information. Grey literature will be excluded as it does not meet our criteria for being valid, rigorous and peer-reviewed.

Inclusion and exclusion criteria

All published studies examining factors related to the patient safety competence of clinical nurses directly involved in patient care in the hospital setting will be included. The measurement of patient safety competence among clinical nurses serves as the primary outcome in the included studies. According to the CPSI, 20 the competence should cover various attributes, including (1) patient safety culture; (2) teamwork; (3) communication; (4) safety, risk and quality improvement; (5) optimised human and system factors and (6) recognition, response and disclosure of patient safety incidents. The selected articles will be peer-reviewed, written in English and published from January 2012 to August 2023.

Articles exclusively focusing on nurses who are not directly engaged in front-line patient care, such as nurse managers, will be excluded. The review will not include studies in which the participants are individuals without official nursing licences, including nursing students and patients’ family members. Research exploring patient safety competence in populations other than nurses (eg, hospitalists and medical students) will also be excluded. Studies that focus exclusively on a single attribute, such as communication or medication competence, will be excluded. Additionally, to maintain methodological clarity with measurable indicators, qualitative studies will be excluded. Furthermore, review articles, theses and dissertations, conference abstracts, editorials, opinion articles and case studies will be excluded. Articles not available in full text will also be excluded.

Study selection

Using the Covidence platform, two independent reviewers will conduct the article screening process by evaluating the titles and abstracts and classifying them into the categories of relevant and irrelevant. Disagreements regarding irrelevant articles will be resolved through discussion between the two reviewers. Only articles classified as relevant during the initial screening will be selected for the subsequent step of full-text screening, which will also be conducted by the same two reviewers. During this stage, the reviewers will each compile their own list of relevant articles, which will then be compared. Any discrepancies will be resolved through discussion. For any unresolved discrepancies, a third reviewer will be consulted, and the final decision will be made by the entire team.

Data extraction

Two researchers will collect information independently based on the following criteria: the author(s), country, study design, sample size, clinical setting, clinical experience, instrument to measure patient safety competence and factors affecting patient safety competence. Any discrepancies between the results obtained by the two researchers will be resolved through discussion or with the involvement of a third reviewer.

Quality assessment

The JBI critical appraisal checklist will be used for a strict quality appraisal process. 32 The objective of the appraisal is to assess a study’s methodological quality and identify any potential bias in its design, conduct and analysis. 29 Two reviewers will independently evaluate the quality of every study included in the analysis. Any discrepancies between the reviewers regarding the risk of bias will be resolved through discussion, with the inclusion of a third reviewer when required. The results of the critical evaluation will be reported through narrative descriptions and a table. The outcomes of the quality appraisal will play a pivotal role in assessing the overall quality and reliability of the included studies. Since this review will encompass peer-reviewed articles, no study will be excluded solely based on its quality rating.

Data synthesis

Due to the expected diversity in research methods and outcome measures, the researchers will employ a narrative synthesis to incorporate the study findings, rather than conduct a meta-analysis. Recognising that individual and organisational factors are associated with patient safety competence, content analysis will be used to categorise the factors influencing clinical nurses’ patient safety competence into two groups: individual and organisational factors. Previous studies on nurses’ competence have examined both individual and organisational factors. 33 34

Patient and public involvement

This study will not include any patient involvement.

Ethical approval was not required for this review as it does not involve the collection of primary population data. The results will be presented at professional conferences and peer-reviewed open-access journals.

supplementary material

Online supplemental file 1.

Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Prepublication history and additional supplemental material for this paper are available online. To view these files, please visit the journal online ( https://doi.org/10.1136/bmjopen-2023-080038 ).

Provenance and peer review: Not commissioned; externally peer reviewed.

Patient consent for publication: Not applicable.

• BMJ Open. 2024; 14(8): e080038.

Review Process File

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Nursing (BScN)

Compassionate care grounded in scientific excellence.

Why choose this program?

Whether caring directly for patients, conducting valuable research, or engaging in public policy advocacy, nurses make a difference in the quality of people's lives. Dal's Nursing program will prepare you to apply current evidence and respond with professionalism to the health and illness needs of people in a variety of healthcare settings, like hospitals, homes, schools, businesses, clinics, and communities. 

We offer two admissions options for Nursing:

Semester 1: for students coming directly from high school or who do not have the required prerequisites for the Semester 3 option; made up of 8 semesters over a 3-year period.

Semester 3: for students who have all of the required non-nursing university-level courses (equivalent of semesters 1 and 2) completed with at least 30 credit hours, and will enter the program at Semester 3 in September and complete the program in 2 years.

Admission requirements

Minimum admission requirements.

To be considered for admission to this program, you must meet minimum academic criteria:

• Completion of secondary school (Grade 12)
• Achievement of the minimum average for your program of choice.
• Completion of Grade 12 English (or equivalent course).

Admission to many Dalhousie programs is competitive. This means that meeting minimum requirements does not guarantee admission.

Program-specific admission requirements

Owing to the limited enrollment and the large number of applicants, this program primarily serves permanent residents of Nova Scotia. However, each year a limited number of direct entry (directly from high school) and advanced standing entry (for those with previous university experience) seats are also available for qualified residents of other Canadian provinces and international students.

Bachelor of Science (Nursing) Semester 1 Admissions Requirements

Minimum overall average: 70%

Academic English 12

Academic Math 12

Academic Biology 12  

Academic Chemistry 12

One additional academic subject

Completion of the CASPer test (see information below)

This program may employ a competitive average for admission purposes; meeting minimum posted requirements does not guarantee admission. 

Due to residency restrictions and limited capacity, international students are not eligible for Direct Entry admission to this program. 

Bachelor of Science (Nursing) Semester 3 Admissions Requirements

This two-calendar-year (six-semester) continuous period of study is designed for students who have previously studied at university and have completed the following pre-requisite courses:

1. A minimum grade of C in each of:

• Physiology (6 CR or 3 CR + Biological Science 3 CR)
• Microbiology, and
• English writing or equivalent is required.
• A minimum grade of C in each of the open electives and science elective is required.

2. Subject requirements:

• Anatomy (ANAT) 1010 or equivalent - 3 credit hours.
• Physiology (PHYL) 1001 and 1002 or 1011 and 1012 (or PHYL 1001 + Biological 
• Science) - 6 credit hours.
• Statistics (STAT) 1060 or equivalent - 3 credit hours. 
• Microbiology (MICI) 1100 or equivalent - 3 credit hours 
• English (ENGL) 1100 or equivalent writing course- 3 credit hours. 
• Science elective - 3 credit hours. 
• Open electives* - 9 credit hours.

In order to be eligible for Semester 3 entry admission, the 5 core pre-requisite courses (Anatomy, Physiology, Microbiology, English, and Statistics) cannot be more than 10 years old from the forecasted date of graduation from Dalhousie's Nursing program. Elective pre-requisite courses cannot be more than 15 years old.

3. A student with a .03 credit hour combined Anatomy and Physiology course will also be required to have .06 additional credit hours of Biological Sciences. 4. A minimum cumulative GPA of 2.5 based on overall post-secondary career or most recent year of studies (30 credit hours) 5. Meeting the minimum entrance GPA does not guarantee admission. As a result of the competitive admission process, applicants typically require a higher entrance GPA than the minimums listed in the admission requirements.

Visit the Academic Calendar to learn more about applying as an advanced standing student. Additional information for Semester 3 applicants:

• Students must seriously consider whether financial, work and family responsibilities will allow them to study full time, year-round. Enrolment is limited—not all applicants with the minimum GPA will receive a place in this option.
• Applicants must carefully compare courses completed with the published information to determine, to the best of their ability, whether the subjects align. Academic admissions requirements can be met by attending any recognized university or college. Visit Dalhousie’s  Transfer Credit Equivalency Table  for more information.
• Our Nursing Admissions Committee reserves the right to make the final decision on if a course satisfies admissions requirements.  We encourage you to apply early to ensure you satisfy the course requirements for admissions consideration.

All newly admitted BScN students must be certified in CPR-Health Care Provider (CPR-HCP) level. Certification must be obtained in the year of entrance to the program. It is the student’s responsibility to ensure that certification is renewed prior to expiration.

CASPer test requirement (all applicants)

All applicants to Dalhousie's Bachelor of Science (Nursing) program are required to complete a 90-minute computer-based online assessment ( CASPer Test ), in addition to meeting academic requirements. Successful completion of CASPer is mandatory in order to maintain admission eligibility.

CASPer is an online test which assesses for non-cognitive skills and interpersonal characteristics that are important for successful students and graduates of the Nursing program. In implementing CASPer, we are trying to further enhance fairness and objectivitiy in our admission selection process.

Please note that the CASPer test can only be written once within an admission cycle. Multiple test attempts are not permitted. Additionally, CASPer test results are only valid for one admission cycle. Applicants who have already taken the test in previous years will therefore be expected to re-take it.

Please direct any inquiries on the test to CASPer provider,  Altus .

Registering for the CASPer test

A Dalhousie ID number (B00 number) is required to register for the CASPer test, and to have your results sent to Dalhousie. In order to receive a Dalhousie ID or Application number you must:

• Apply to Nursing - Complete and submit the  online Dalhousie undergraduate application for admission .
• Log into your  Application Portal  to find your Dalhousie ID number. It can be found with your application information in the upper right-hand corner of the page

Once you receive your Dalhousie ID number you can use it along with a piece of government issued photo ID to register for a CASPer test date. Please note that CASPer is a separate organization that sets test dates for multiple Nursing programs across Canada. As such, the test dates may or may not align with the Dalhousie University application deadline for the Nursing program. Please plan accordingly so that you receive your Dalhousie ID number in time for the last CASPer test date registration. 

CASPer test dates and times for September 2024 Nursing admission will be available at  takealtus.com  in early Fall 2023.

You will be provided with a limited number of testing dates and times. Please note that these are the only testing dates available for your CASPer test. There will be no additional tests scheduled. 

Once test dates are posted, you can register for the CASPer test at  takealtus.com  using your Dalhousie ID number ('B00' number) and a piece of government-issued photo ID. Your Dalhousie ID number will be issued to you via email no later than one week after the submission of your Dalhousie Undergraduate Application. Please use an email address that you check regularly to ensure that you receive relevant updates to the test schedule.

There is an additional fee for applicants payable to CASPer for the CASPer test. CASPer fees consist of two components:

• A fee to take CASPer 
• A fee to distribute your results to the institutions you select

For more information on CASPer fees please visit  takealtus.com

Test results

Once received by Dalhousie, your CASPer score will be used in combination with your academic performance for admission assessment.

Test structure

The CASPer test is comprised of 12 sections of video and written scenarios. Following each scenario, you will be required to answer a set of probing questions under a time limit.

No studying is required for CASPer, although you may want to familiarize yourself with the test structure at  takealtus.com/casper . You should also review the technical requirements below and ensure you have a quiet environment to take the test.

Technical requirements

In order to take CASPer you will be responsible for securing access to a computer with audio capabilities, a webcam, and a reliable internet connection on your selected test date. CASPer can be taken practically anywhere that you can satisfy these technical requirements.

Please note that CASPer's policy is that no exceptions will be provided for applicants unable to take CASPer online due to being located at sites where internet is not dependable due to technical or political factors.

Financial information

A university education is a significant financial investment. Every student is unique, and so are their financial circumstances. We offer competitive tuition, a robust scholarship and bursary program, and resources and support to help you explore financial options and develop a plan that works for you. 

Program options

As a Dal Nursing student, you’ll have the option to earn your degree at either our Halifax campus or our Yarmouth Campus. Wherever you study, practical experience is a huge part of your degree – each year, you’ll participate in clinical courses that include placements in a variety of healthcare settings.  

You can also customize your degree and specialize in an area of nursing practice by earning a certificate alongside your degree in:

Perinatal and Pediatric Nursing

Public Health Nursing

Mental Health Nursing

Acute/Critical Care Nursing

The following Nursing program options are offered by Dalhousie University’s Faculty of Health. Connect with an academic advisor after you start your studies to explore options such as:  

Bachelor of Nursing

Certificates in Perinatal and Pediatric Nursing, Public Health Nursing, Mental Health Nursing and Acute/Critical Care Nursing. 

What you will learn

 At Dal, you'll find flexible program options and hands-on learning opportunities alongside world-class faculty.

The program curriculum will be completed over three calendar years (eight semesters) for direct entry students and over two calendar years (six semesters) for advanced standing students (qualifying students who have previous university experience), offering graduates the opportunity to enter practice one year earlier.

Beyond studying human anatomy and physiology, you'll explore the broad spectrum of nursing—from proper hygiene practices and mobility protocols to legal issues and medical ethics.

Sample courses may include:

Human Physiology

Basic Human Anatomy

Human Growth and Development

Health Science Microbiology 

Nursing and Community Health

Foundation of Nursing Practice

Nursing Research and Evidence Informed Practice

Health and Healing: Pathophysiology and Therapeutics 

Nursing and Episodic Illness: Preventative Care and Intervention

Professional Formation of Nursing Practice: Leadership Perspectives

Exploratory Nursing Practice

Outside of the classroom, there may be opportunities to boost your knowledge and skills by working with faculty as research assistants or volunteering in their research labs.

For nurses, no two days are alike — and for many nurses, that's one of the reasons they do what they do. The scope of nursing covers a broad range of healthcare settings. Nurses have a complex role in advocating for patients while striving to assist individuals in reaching an optimal level of wellness and capability. 

A nursing career offers limitless opportunities in practice, education, research, and leadership. Graduates of Dalhousie's Nursing program are pursued by national and international recruiters offering competitive employment packages.

Possible careers include:

community health

home health care

Many nurses who complete graduate degrees move into roles in advanced practice and nursing specialties. Your degree in nursing lays the groundwork for graduate programs in nursing, health administration, and interdisciplinary studies.  

I'm ready to apply!

While every effort is made to ensure accuracy on this page, in the event of a discrepancy,  Dalhousie's Academic Calendars  are the official reference.