Barriers and enablers to support clinical academic careers

Barriers and enablers to support clinical academic careers in the NHS: learning from experience. March 29 th 2018 Suratthani Rajabhat University, Thailand Dr Ros Kane, Reader in Healthcare, University of Lincoln, UK. Dr Christine Jackson, Honorary Fellow, University of Lincoln, UK and Visiting Professor, University of Maribor, Slovenia.

Aims • To present findings from a qualitative study exploring the experiences of clinical academic nurses and allied health professionals after a tailored training programme • To give examples of barriers encountered and strategies to overcome them • Present an innovate intervention to support research among newly qualified nurses www. lincoln. ac. uk

What is CARPAL? Clinical Academic ca. Reers Pathway Ana. Lysis. An impact analysis of the experiences of the Clinical Academic Careers (CAC) pathway for health care staff previously and currently in receipt of a HEE-EM Bronze and Silver award.

Methods • 1: 1 semi-structured interviews (n=20) • Topic guide developed from the national CAC work profiles and desired outputs from the developing CAC roles strategy (DH, 2012) and UKCRC (2007) • Each interview 60 -90 minutes in a convenient location • Have undertaken Bronze, Silver or both

The Clinical Academic Pathway ‘Gold’ award Masters in Research Methods www. lincoln. ac. uk ‘Platinum’ award

The Bronze Award • For those without formal Masters qualification • Structured 5 day educational programme • Support from experienced Clinical Academic Mentor • 5 facilitated Action Learning Sets-delivered by an academic • Enhance ability to compete successfully for the next stage of the Clinical Academic Pathway e. g. MRes www. lincoln. ac. uk

The Bronze Award Outputs • 6, 000 word dissertation (80%) • 1, 000 reflective piece (20%) • Presentation www. lincoln. ac. uk

Benefits: Feedback from Bronze Scholars The Bronze Award ignited my passion for research and gave me the confidence to apply for a masters. It has changed my career and has opened doors for me and has given me a chance to focus on something different. www. lincoln. ac. uk The award has definitely given me more confidence and I have more motivation to achieve. I think I have become more evidence based and less afraid to look into the evidence for whatever I am doing.

The Silver award • For those with Postgraduate Masters qualification. • Bespoke educational programme and development plan based on training needs assessment. • Support from experienced Clinical Academic Mentor. • Enhance ability to compete successfully for the next stage of the Clinical Academic Pathway e. g. NIHR Ph. D. www. lincoln. ac. uk

Silver programme outputs • 5, 000 word literature review. • A fully worked up Ph. D proposal in line with the NIHR requirements. • Ethics approval. • Presentation (formative) • Mock Interview (formative) www. lincoln. ac. uk

Benefits: Feedback from Silver Scholars It has allowed me to shape my career and has given me the opportunity to develop clinical practice and make it better. I found the Silver programme really rewarding and I felt very privileged to be on it. It has enhanced my confidence. www. lincoln. ac. uk I’ve used the skills and knowledge that I’ve gained to try and do something and to help move practice forwards. I always try to evaluate what I do and then roll that out to the team; to check that we are doing as well as I hope and see where we may need to change things.

Recognised challenges Lack of research culture in nursing and the AHP’s Academic pressures Time CHALLENGES Funding www. lincoln. ac. uk Clinical pressures

Interim findings Leadership Confidence Personal development Spread Patient Care Management and Structures

Personal development • Passion and drive for improving patient care. • “I question why it’s done the way it’s done. I begin to realise that unless you naturally find evidence to show what’s beneficial or how to do things to make outcomes better, then it’s really hard to get anywhere or develop service without that sort of evidence. ” • “It’s given me a new passion for what I am doing”.

Personal development Given time to reflect, develop, and translate “All of these programmes give time out of the clinical workplace. Thinking time. Time to consider where you want to go. Time to consider what your skills are. How you develop those. “It’s given me the time really to be able to integrate findings into clinical practice”. “It’s given me the time to look into my clinical field. Find out what best practice is…what the current evidence base is. That’s made me more confident in doing.

Confidence • Approach practice and own abilities with more confidence “If there is a new project that’s happening, I feel like I’ve got the skills now to help evaluate that project”. “It’s made me feel up-to-date in my current area of practice by just having a chance to read and reflect. I’m more confident in my every day interactions”.

Confidence A more inquiring practitioner “I was never confident enough to say…. . ‘well actually why are we doing it like this? That’s what my seniors told me to do, so it must be right’. It got to the point as I became more confident, I would go off and do things on my own. That’s when I started to question why things are done the way they are. ” Promotes resilience “[you] just need to keep going. You have to get over those hurdles and learn from them to improve”.

Leadership Broadened skillset to become expert “[it’s] opened my eyes to different things. I hear what’s going on in the wider world of things”. Experts within teams/depts. “I’ve got lots of experience and knowledge about things which a lot of the clinicians here haven’t”. A new identity “I never thought research was possible for me because I thought it was for the clever people”. “The new initiatives have opened research to lay people like me”.

Leadership Consulted by colleagues “Things within the Trust do come to me now”. “They are always asking me about research things that I wouldn’t have felt competent to answer before”. Discovered networking opportunities “[it’s] opened up a network of people that I didn’t know was there”.

Spread Importance of early adopters initiating spread “It has only taken one or two interested people to actually steer it in a different direction and making those links to the Research and Development team”. Others interested in their work Encourage others to undertake awards

Spread Improved team confidence and ability “The team is probably more confident with treating that type of patient…the service is better and the team are more confident in their clinical work with those patients”. “That knowledge has been shared and asked about in my team”. • Established learning groups within their trust/field

Management and Structures Understanding benefits: Cost-saving “Sometimes people can see the rational[e] for cost saving agendas more clearly than they can for a research agenda”. “Even thought it’s beginning to get more evidence based, and we’re getting some really good feedback from the wards. That needs to translate somewhere into financial contribution to increase the staff”. “Colleagues thought “they were just taking time out on a jolly”.

Management and Structures Research as an ‘add-on’ “It was there: research. It was talked about but it was mainly thought about being done in your own time rather than in organisational time”. ‘We haven’t got time for research’ “The biggest barrier I have in terms of improving the services…is time”. “We’ve got very good links with therapy team now…which has developed which doing the…award. I’ve had the time to go and visit them”.

Management and Structures Management, structures and roles: lack of opportunities and pathways in NHS “Even though it would be ideal to have someone in a dual post, there is no money for it”. “My influence only goes so far. I can put forward suggestions and case studies about what I think would be useful but ultimately other people make that decision”.

Management and Structures Importance of supportive individuals/leaders “If I was in any difficulty explaining it to my boss, [the head of research] would have been happy to support and help out”. “The medical director…is very forward thinking…comes from a Trust where research was very high profile”. “When I presented to the Trust, my boss came along… now [they] can see the value in it. [They’re] supporting me to do other things”. Normalisation “It’s about having people with those skills based within a clinical environment. To change it from within…you are just making that how things are. That takes ages”

A new initiative: Clinical Academic Fellowship Clinical practice • Newly qualified nurses • Substantive posts in local trusts (LPFT, ULHT) • 30 hours per week contracted to clinical practice Academic practice • • • www. lincoln. ac. uk 7. 5 hours per week Secondment to the University of Lincoln Engagement in research activity and teaching opportunities Opportunity to contribute towards papers for publication and presentations for national conferences Establishing links between research projects and clinical practice

Clinical Academic Fellow profiles Trish Tsuro • • • Staff Nurse on a vascular inpatient ward - United Lincolnshire Hospital Trust Contributing to work around a values based project on dignity in clinical practice and a project on selfmanagement living with and beyond cancer. Student liaison link nurse. www. lincoln. ac. uk Emily Scott • • • Staff Nurse on a male acute inpatient ward – Lincolnshire Partnership Foundation Trust Contributing to work around Mental Capacity and DOLs standards and monitoring and assessing the physical healthcare needs of patients in inpatient settings. Diabetes link nurse.

Being a Clinical Academic Fellow • Exciting, challenging and rewarding. • Opportunity to be part of a team that nurtures the development of good research skills. • Develops communication and organisational skills. • Networking opportunities. • Enhances the ability to become evidence and value-based practitioners. • Clinical practice enhanced because we think around our activities, the reasoning behind them and how they can be improved. • Opportunities for continued personal development. ` www. lincoln. ac. uk

Challenges of being a Clinical Academic Fellow • Time – being a newly qualified nurse and managing the workload • Gaining managerial support and the support of clinical team • Travelling • Progression after the secondment year has ended www. lincoln. ac. uk

The research team Dr Christine Jackson cjackson@lincoln. ac. uk Dr Ros Kane rkane@lincoln. ac. uk Dr Ian Mc. Gonagle imacgonagle@lincoln. ac. uk Emily Scott escott@lincoln. ac. uk Trish Tsuro ttsuro@lincoln. ac. uk Heidi Green hgreen@lincoln. ac. uk Holly Hamer Shona Maclean Funded by Health Education: East Midlands www. lincoln. ac. uk