The United Kingdom and Republic of Ireland Clinical Research Nurse and Midwife Census 2021

The UK and Ireland Clinical Research Nurse and Midwife Census working group

Claire Whitehouse , Senior Nurse for Nursing, Midwifery and Allied Health Professions Research and NIHR 70@70 alumni. The James Paget University Hospitals NHS Foundation Trust. Visiting Fellow Staffordshire University, Honorary Fellow University of East Anglia. Co-Chair International Association of Clinical Research Nurses, UK and Ireland Branch. Doctoral student Staffordshire University @ClaireW_UK @JPUHNMAHP_RES

Naomi Hare, Research Matron & NIHR 70@70 Senior Research Nurse Leader Alumni, Guy's and St Thomas' NHS Foundation Trust @NaomiCHare

Linda Tinkler , Trust Lead Nursing, Midwifery and AHP Research and NIHR 70@70 alumni. The Newcastle upon Tyne Hospitals NHS Foundation Trust and RCN Research Alliance Doctoral Fellow, University of Sheffield @TinkleLin

Maudrian Burton , Lead Research Nurse St Bartholomew's Bioresource and NIHR Bioresource Generic and Rare disease, QMUL Honorary Lecturer, NIHR 70@70 Senior Research Nurse Leader Alumni @MaudrianB

Jean Bruce , Clinical Research Nurse Manager, Western General Hospital, Edinburgh. Chair Scottish Research Nurse and Coordinators Network @SRNCN1 @jmbruce63

Lucy Ainsworth , Programme Officer of Nursing and Midwifery Office, National Institute for Health and Care Research @LucyAinsworth9

Dr Catherine Henshall , National Institute for Health and Care Research Associate Director, Nursing and Midwifery; Reader in Nursing and NMAHP Research Lead, Oxford Brookes University and Oxford Health NHS Foundation Trust @cathy_henshall

Carole Schilling, Study Coordinator, Beaumont Hospital, Dublin. Chair Irish Research Nurses and Midwives Network @Irish_RNM

Jayne Goodwin , National Head of Research Delivery, Health and Care Research Wales @ResearchWales

Sonia McKenna , Senior Staff Manager, Northern Ireland Clinical Research Network @NICRNCoordCentr

Nicola Cunningham , Associate Research Delivery Manager and Lead Nurse NIHR Clinical Research Network NENC and Senior Nurse Research Lead South Tees Hospitals NHS Foundation Trust. Visiting Research Fellow University of Sunderland @NickyCunningh20

Helen Jones , Lead Nurse for Clinical Research Workforce, Imperial College Healthcare NHS Trust. Chair Association of UK Lead Research Nurses (AUKLRN) @HelenCJo67

Dr Cate Bell , Chief Nurse Fellows Academic Lead, University Hospitals Sussex NHS Foundation Trust and Research Fellow, NHS England NIHR 70@70 Senior Research Nurse Leader Alumni @CateBell2

Dr Gordon Hill , Assistant Head for International School of Health and Life Sciences, Glasgow Caledonian. Co-Chair International Association of Clinical Research Nurses, UK and Ireland Branch @GordonHill1

Dr Louise Bramley , Head of Nursing and Midwifery Research, Nottingham University Hospitals NHS Trust NIHR 70@70 alumni @LouBramley

Heather Rostron , Senior Research Nurse and NIHR 70@70 Senior Research Nurse Leader Alumni, Leeds Teaching Hospitals NHS Trust @RostronHeather

Jennifer Allison , NIHR Associate Director of Nursing and Midwifery, Lead Matron NIHR Southampton Clinical Research Facility @JenAllisonCRF

Testimonies

Executive Summary

• 7,469 respondents completed the survey between August and October 2021.
  • 413 were Clinical Research Midwives
  • 7,022 were Clinical Research Nurses
  • 34 had a dual role as a clinical research nurse and midwife
• The census was self-reported by those who identified as clinical research nurses and midwives as part or the whole of their roles. It is important to remember, when reading this report, that correlation does not imply causation.
• 72% of respondents aligned themselves to one specialism (eg. Specialist disease area or area of practice)
• 28% worked across multiple specialisms
• 34% are working in joint roles as a clinical research nurse/midwife and another role
• Bands and grades in the UK and Ireland
  • From Band 5 or staff nurse through to Assistant Director or Director of Nursing / Midwifery
• The true size of the clinical research nurse and midwife (CRNM) workforce across the UK and Ireland is unknown. The actual number is anticipated to be higher than the number in this survey.
• The data presented can be used as a catalyst to build on elements of the work, drawing out key themes and further areas for investigation by posing questions in relation to the findings. The work holds much potential in relation to CRNM roles, their visibility, implementation, positioning and strategic planning for this key workforce.

Background

The centrality of research during the international response to the Coronavirus pandemic in 2020/2021, highlighted its unquestionable value in enabling early diagnoses, improving outcomes and reducing mortality. Clinical Research Nurses and Midwives (CRNMs) were crucial to the United Kingdom's (UK) response (Maxton et al, 2021), with research activity remaining pivotal to the path out of the pandemic, pursuing both treatment options and developing and rapidly implementing vaccine programmes (Lopez et al., 2021; RECOVERY Collaborative Group et al., 2020).

The value of research is illustrated by established associations between the extent to which healthcare organisations engage in research, and their subsequent performance (Boaz et al., 2015). Evidence indicates that research active organisations have lower mortality rates and improved Care Quality Commission ratings (Ozdemir et al., 2015; Jonker and Fisher, 2018). Ensuring the success of research in the UK National Health Service (NHS) however, is complex, and the role of the CRNM whilst essential to this agenda can be poorly understood by those outside these roles (Hernon et al., 2020; Tinkler et al., 2022).

The role of the CRNM is dynamic and multifaceted (Gordon, 2008; Johnson and Stevenson, 2010; Hansen et al., 2022). The CRNM works across a range of settings and specialisms, operating at the interface of research and clinical practice. The role is central in leading and contributing to the care, safety, protection, support and monitoring of study participants as part of an interprofessional team. Nurses and midwives are central to the delivery of safe research and clinical care. As registered professionals, CRNM's have a duty to provide fundamentals of care and advocate for patients, participants and their families as they deliver clinical research within academic, industry, health or social care settings. The CRNM will then continue to provide care, interventions, follow up and support to patients along the entirety of their clinical research journey (Hardicre, 2013; Jones, 2015; Hernon et al., 2020). The role is often politically impacted and subject to a range of opinions on how it is best implemented within regions, organisations and teams (Whitehouse & Smith 2018; Tinkler & Robinson 2020; Hernon et al 2020; McNiven et al 2021).

A growing body of literature presents encouraging discussion regarding the increasing scope of research roles in terms of clinical settings, complexity of studies and development of complex skills. Whilst this is improving visibility of the research agenda more broadly, it adds further complexity in understanding and support of the CRNM role (Hill, Ellis and Irvine, 2022).

An accurate representation of the number of CRNMs across the UK and Republic of Ireland has historically been impossible to attain, and it is not possible to describe the current size of the workforce, regardless of how roles are funded or implemented within an organisational structure. Previous attempts in recent years have been made to collect this data with little success. Although never empirically proven and official figures are unavailable, numbers of clinical research nurses alone anecdotally range from 4,000 and 12,000. This has been discussed at various conferences and meetings between 2008 and the present. As a result, whilst the evidence base related to the CRNM role is vibrant and growing, we propose the collective strength of the workforce has yet to be fully realised because accurate data has not previously been collected on the number, reach and range of places where they work.

It is imperative that a more accurate picture of the workforce is gathered in order to address perceived complexities associated with the CRNM role and enable greater collective influence in workforce planning, training and education. This can ultimately lead to improved experiences, confidence and competence of CRNMs to ensure high quality research and patient care is delivered consistently regardless of setting. To this end, a group of senior nurse and midwife leaders from the inaugural National Institute for Health and care Research (NIHR) 70@70 Senior Nurse and Midwife Research Leader cohort, worked with CRNM leaders from the devolved nations of Wales, Scotland, and Northern Ireland, and also The Republic of Ireland to develop a census with a view to collecting this essential data. The project aimed to compliment and build on the established evidence base, focusing upon the role of CRNMs and providing a baseline figure of CRNM staff upon which future research activity may be developed. Descriptions of the workforce incorporate the numbers reported in the census, and reported hours worked as a CRNM. Data is then reported as percentages in relation to alignment to a specialty or group, geographical location and banding / grading (reflecting level and pay).

Aims and objectives

Aim

To capture the size of the CRNM workforce across the UK and Republic of Ireland between August and October 2021.

Objectives

1. To provide comprehensive understanding of the scale (by number) of the CRNM workforce at a single point in time.

2. To identify the breadth of bandings / grading available to work as a CRNM.

3. To describe the range in the number of hours staff are working as a CRNM.

4. To establish the geographical spread and range of sectors covered by CRNMs.

Design and method

Multiple stakeholders co-authored a set of categorical / binary response survey questions related to the size and composition of the CRNM workforce. These were developed and tested to achieve the aims of the project. The project did not intend to draw inferences from the data, rather to present a description of the UK and Republic of Ireland workforce via a snap-shot in time.

Stakeholder engagement

From the outset of the project stakeholders were included from a number of organisations and groups;

• NIHR Nursing and Midwifery Office, Association of UK Lead Research Nurses (AUKLRN), International Association of Clinical Research Nurses (IACRN) UK and Ireland branch, and the Irish Research Nurse and Midwife Network, as the largest leadership groups focused on Clinical Research Nursing and Midwifery across the United Kingdom and Republic of Ireland.
• Patient groups and individuals across each country, multidisciplinary colleagues including allied health professionals and medics were invited to share and contribute their thoughts as to the benefits of conducting the census and the value and impact it might contribute to the workforce, research arena and profession more widely.
• Social media, particularly utilising the hashtag #WhyWeDoResearch via the micro-blogging service Twitter, was included in scoping and stakeholder engagement to include international perspectives.

Stakeholder engagement activities included formal and informal presentations and feedback / discussions with groups, and tweet chats using #WhyWeDoResearch and #YourPathInResearch. Stakeholder involvement continued throughout the project, including promotion of the survey once launched. We were responsive to opportunities which arose to share further information or promotional activities through these groups such as the UK Industry Roadmap group and regional events.

Designing survey content and questions

Survey questions were initially developed within the census working group, offered for discussion with our stakeholders and refined accordingly. Questions aimed to elicit information which reflected the objectives of the project: the overarching number of CRNMs in the UK and Republic of Ireland, the geographical spread of these posts, the breadth of grades/banding and sectors of work, and their areas of specialty practice.

They were tested at two UK NHS health organisations to understand whether the wording was appropriate, understood and whether the staff felt the survey was easy to access and complete, despite pandemic pressures. Minor alterations were based upon the feedback of these groups.

The table below describes each objective, the question asked and the rationale.

Promotion and dissemination routes

The survey was shared via a range of dissemination routes to maximise engagement, response rates and sharing. This included via social media, email circulation and promotion through the networks and contacts of the NIHR 70at70 Senior Nurse and Midwife Research Leaders Cohort and those represented by each of the countries involved. The survey was promoted across the UK and Republic of Ireland and by the organisations and routes listed below, as well as through an advertisement in the Nursing Times journal. Nurse and midwife clinical researchers urged to complete first national census | Nursing Times .

Organisations and routes:

• Royal College of Midwives
• NIHR Senior Research Nurse and Midwife Leader Programme
• Northern Ireland Clinical Research Network
• Health and Care Research Wales
• Irish Research Nurses and Midwives Network
• Join Dementia Research
• Cancer Research UK
• Council of Deans of Health
• Royal College of Nursing
• Northern Ireland Cancer Research Network
• ECMC
• Florence Nightingale Foundation
• International Association of Clinical Research Nurses
• NHS Research and Development Forum
• Pharmaceutical UK Roadmap Industry Forum
• Public Health England,
• UK Clinical Research Facility Network
• Chief Scientist Office, Scotland
• Health Service Executive, Ireland
• Blood Cancer Network, Ireland

Results

All data are presented as numbers and percentages. Where total responses are equal to or less than nine participants, and where the tables are extensive (by size) the results are reported as <10, for ease of viewing for the reader. In total, across the United Kingdom and Republic of Ireland, 34 respondents identified as both research nurse and research midwife. These data will not be stratified by devolved nation or country. Both actions have been taken to protect the anonymity of those participating in the census and to avoid any respondents being correctly or incorrectly identified through their answers.

Total numbers of Clinical Research Nurses and Midwives per country

The first section of results illustrate the responses to question 1, and was linked to countries.

" Are you working as a clinical research nurse, clinical research nurse, both/dual, or none?"

There were a total of 7,469 responses to the census, including those who identified within dual roles. Nearly 95% (n=7,022) of respondents were clinical research nurses, with 5.6% (n=413) working as clinical research midwives. The total number of clinical research nurse and clinical research midwife respondents represents almost 2% of the total nursing and midwifery workforce across the four countries within the United Kingdom (total of 382,566 as per NHS workforce statistics April 2022). The total number of clinical research nurses and clinical research midwives in the Republic of Ireland represent almost 0.2% of the total nursing and midwifery workforce (total of approximately 80,000 as per Nursing and Midwifery Board of Ireland November 2022). An additional 50 responses were removed where the respondents had indicated they worked in 'neither clinical research nurse, midwife, nor dual role', making them ineligible for inclusion in the census.

A total of 34 respondents identified as working in a dual role (as both a clinical research nurse and clinical research midwife). Due to the comparatively low number of these respondents, their potentially identifiable data has not been included in most of the totals below (Table 1, 2, 4 and 5). Dual roles were identified in all four countries and across primary, secondary, tertiary and Higher Education Institution (HEI) settings. The respondents were spread across each country and were not aggregated in specific areas. Respondents holding dual roles ranged from Band 6 - Band 8a and worked within eight specialties; Cancer, Critical Care, Hematology, Trauma, Multi-specialty, Public health & prevention and Management. Multi-specialty roles are where a CRNM works across a range of clinical and disease specialties. 16 out of the 34 (47%) worked in joint clinical roles alongside their research roles.

Table 1: Total numbers of CRNM'S per country

NB Does not include 34 respondents who identified as both research nurse and midwife

Total numbers of Clinical Research Nurses and Midwives per sector

The next section of results illustrate the responses to the Question 2 ,

"In which sector do you work?"

The UK National Health Service (NHS) is divided into primary care, secondary care, and tertiary care. Primary care is often the first point of contact for people in need of healthcare, usually provided by professionals such as General Practitioners, dentists and pharmacists. Secondary care, which is sometimes referred to as 'hospital and community care', can either be planned (elective) care such as a cataract operation, or urgent and emergency care such as treatment for a fracture. Tertiary care refers to highly specialised treatment such as neurosurgery, transplants and secure forensic mental health services. A useful tool for further information is available.

Higher education is third level education after leaving school. It takes place at Universities and further education colleges and normally indicates undergraduate and postgraduate studies. In the context of this Census, higher education institutions include universities conducting health research in clinical trials units and / or health and care settings. Private or industry sector includes private practice, and commercial companies conducting research activities.

The data demonstrated that clinical research nurses and clinical research midwives work across a range of sectors with 62.9%, the majority, working within secondary and 17.8% working within primary or social care. Just 0.2% (n=17) of respondents reported roles spanning secondary and primary care sectors.

Table 2: Total numbers of CRNM'S per sector

NB Does not include 34 respondents who identified as both research nurse and midwife

Banding (UK) and Grade (RoI) of Clinical Research Nurses and Midwives per country

The following data presents the total number of clinical research nurses and clinical research midwives per country participating in the census and includes the thirty four respondents identifying as in dual roles. Bands 8a-9 (UK) are collapsed into a single category order to protect potential for identification of those individuals. In the context of our objectives for this report, we are understanding whether there are options to include CRNM roles at all levels within the professions.

Table 3: Banding and grading of CRNM's per country

NB. The total for Wales has an extra 0.1. This is the case for any small discrepancies throughout the raw data as we chose to display only 1 decimal place and round up and down accordingly.

Clinical Research Specialty

The data presented in this section relates to the question

'What research specialty do you work in? If you work in more than one specialty, click multi-specialty."

A total of 34 distinct clinical specialties were represented within the respondents' data. CRNMs in England worked across all 34 different clinical specialties, 19 in Ireland, 33 in Scotland, 28 in Wales and 19 in Northern Ireland respectively.

Clinical research midwives predominantly worked in reproductive health, however, representation was noted across 25/34 clinical specialties (not including those with dual roles). The three single specialties with the highest number of clinical research nurses and clinical research midwives were Cancer (n=485), Reproductive health (n=394) and Children and Young people (n=385). The lowest representation was noted within oral and dental (n=<10), social care (n=23) and research governance (n=32). 320 CRNMs identified as working in a management or leadership specialty across all countries. There were 2,086 (27.9%) CRNMs within multi-specialty roles.

Specialties with between 1-9 (ie <10) respondents have been removed from the table for ease of reading but include cardiovascular disease, critical care, dementias and neurodegeneration, diabetes, ear nose and throat, hematology, health services research, infection, kidney disorders, management / leadership, mental health, metabolic and endocrine disorders, musculoskeletal disorders, neurological disorders, oral and dental health, primary care, public health and prevention, research governance, respiratory disorders, social care, stroke and surgery. This data does not include the 34 respondents who work in dual CRN and CRM roles

Table 4: Clinical research specialty

NB Does not include 34 respondents who identified as both research nurse and midwife

*NB Does not include 34 respondents who identified as both research nurse and midwife

Total number of clinical research nurses and midwives working within a clinical and a research role

The data presented in this section relates to the question

'Is this a joint role (eg working as a clinical nurse or midwife specialist)?'

Dual roles have been included in this dataset due to the relevance to the question being asked.

Table 5: Responses to the question 'Is this a joint role?'

Hours worked in clinical research nurse or clinical research midwife roles

The data presented in this section relates to the question

"How many hours per week are you contracted to work as a clinical research or midwife?"

A total of one hundred and seventeen variations in working hours were reported by respondents demonstrating a range of contracted hours worked by CRNMs.

The full data set for this question appears in Appendix Two, however, for the purpose of the table below, hours are collapsed into categories split by half days (3.75hrs and 0.1 whole time equivalent (WTE)) and reported WTE only.

Table 6 Whole time equivalent (WTE)

NB Does not include 34 respondents who identified as both research nurse and midwife

Protected characteristics of respondents

Of the 7,469 respondents, 3,608 opted to complete the optional demographics section. The percentages below include the 3,861 respondents who opted out. The data gleaned from the respondents who opted to complete this section is the first to provide any understanding of the diversity of CRNMs working in research delivery roles. We collected three sets of protected characteristics in this survey; ethnicity, age and gender. Each of these require further exploration in their own right to establish the true diversity of the workforce and the associated impact of this on research delivery.

Gender

Of the 3,608 respondents who completed this section, the following categories were reported: female, gender neutral, male, non-binary and transgender.

Table 7a: Gender

Ethnicity

• Of the 7,469 respondents, 3,608 opted to complete the demographics section
• The overarching ethnic groups reported by respondents included; mixed or multiple ethnic groups, White, Black, African, Black British or Caribbean, Asian or Asian British and another ethnic group

Table 7b: Ethnicity

Age

• Of the 7,469 respondents, 3,608 opted to complete the demographics section
• Ages 18 years through to 65+ years were represented in the survey responses
• The top three age groups represented were 25-34 years, 18-24 years, and 35-44 years

Table 7c: Age

Strengths and limitations

Challenges were faced in developing and circulating a scoping survey of this nature during a pandemic, with no knowledge as to whether CRNMs would see its value. Survey fatigue was an experience already felt by members of the working group. The working group therefore sought to combat this through intentionally keeping the survey as short as possible, whilst collecting minimal required descriptive data over and above the 'number' of CRNMs in the workforce. The complexities of reaching a workforce of undefined size were acknowledged, with no knowledge of the exact location of potential participants. Reaching across the variety of organisations and geographical boundaries was a challenge; accepting some CRNMs would be working in silos. The working group attempted to reach as many CRNMs as possible through utilising multiple communication routes. The group made a conscious decision to be 'comfortable with being uncomfortable' at the outset of this project, acknowledging a number of unknowns until the project was launched. For example, the working group could not predict a response rate, if any at all, and were aware it was unlikely all CRNMs would be captured across the UK. This was likely due to survey fatigue, disinterest in completing the survey or simply not being aware of the survey's existence despite efforts to spread the opportunity to participate. The working group were also aware that this was perhaps why previous attempts to undertake such a project had not come to fruition.

The original project concept came from the inaugural NIHR 70@70 Senior Nurse and Midwife Research Leaders cohort. As such, the intention was to focus on these two professional groups. Whilst recognising the existence of a multi-professional workforce in research delivery who may benefit from such a piece of work, a historical lack of understanding of the volume of each group is further challenged by the variety of job titles used to describe roles. During the early planning of the census, a range of discussions - balancing advocacy with inquiry - took place to articulate the value of this work. This was in part to ensure collective support for the work and to address a range of perceptions noted in relation to the value and need for this piece of work at the time.

From a practical perspective, it was identified early on that using an online survey would be the most appropriate route. The logistical aspects of operationalising this represented a challenge in working across country-based boundaries. There was no single-platform which was accessible across each country due to organisational information technology policies and cyber certificates. It was decided that google forms would be used, because of all the options considered, this was the one which appeared to have the most access by each country. It is recognised that with this decision, the numbers in Scotland may not have been as high as they might otherwise have been. There may also be a minority group that may not have access to IT equipment however it was challenging to quantify what this might look like. With this in mind CRNMs were encouraged to complete the survey through their work IT access wherever possible.

Conclusion

This census provides the first UK and Republic of Ireland wide indicator of the size and composition of the CRNM workforce. Historical literature has repeatedly highlighted the need for a definitive figure, which might better enable strategic planning, support, and workforce development. Until now this has not been achieved. A minimum of 7,469 nurses and midwives are now confirmed to work in research delivery roles across the UK and Republic of Ireland. Whilst it is considered likely that there are many more due to the timing and reported limitations of the census, the data demonstrates the existence of a substantial community of highly trained CRNM professionals with specialist knowledge, that was previously unconfirmed and therefore perceived to be little known.

The early outcomes of this work highlight the strong potential of a collective professional voice across geographical boundaries. It is hoped the data collected and presented here will act as a catalyst to build on elements of the work, drawing out key themes and further areas for investigation by posing questions in relation to the findings. This first census holds much potential in generating further meaningful contributions to the evidence base related to CRNM roles, their visibility, implementation, positioning, and strategic planning for this key workforce. The working group acknowledges the baseline nature of this data and the associated limitations in drawing conclusions or making inferences from the results, however there is much potential to explore specific elements of the dataset and explore the implications in depth, with a view to releasing and furthermore realising the potential of this key workforce in driving improvements in the health and wellbeing of the population.

References

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Gordon, C. (2008) Exploring the new specialty of clinical research nursing. Nursing Times. 104(29), 34-35.

Hansen, B. Whitehouse, CL. Nkimbeng, M. Beer, K. Mackintosh, K. Allgood, S. Petchler, C. and Wright, R. (2022). Capturing the value and core concepts of the Clinical Research Nurse. Journal of Research in Nursing. 27(1-2), 32-74. DOI: 10.1177/17449871211073760

Hardicre, J. (2013) An exploration of the role of the research nurse and its impact. British Journal of Nursing. 22(3), 168-169. DOI: 10.12968/bjon.2013.22.5.168

Hernon, O., Dalton, R. and Dowling, M. (2020) 'Clinical research nurses' expectations and realities of their role: A qualitative evidence synthesis', Journal of Clinical Nursing, 29(5-6), pp. 667-683. DOI: 10.1111/jocn.15128

Hill, G., Ellis, M. and Irvine, L. (2022) 'Duality of practice in clinical research nursing', Journal of Research in Nursing, 27(1-2), pp. 116-127. DOI: 10.1177/17449871211070976

Johnson, S. and Stevenson, K. (2010) 'Nursing research or research nursing? Two separate terms, two separate careers', Nurse Researcher (through 2013), 17(3), pp. 32-40. DOI: 10.7748/nr2010.04.17.3.32.c7744

Jones, H. C. (2015) 'Clinical research nurse or nurse researcher?', Nursing Times, 111(19), pp. 12-14.

Jonker, L. and Fisher, S. J. (2018) 'The correlation between National Health Service trusts' clinical trial activity and both mortality rates and care quality commission ratings: a retrospective cross-sectional study', (1476-5616 (Electronic)). https://doi.org/10.1016/j.puhe.2017.12.022

Lopez, B., Andrews, N., Gower, C., Robertson, C., Stowe, J., Tessier, E., Simmons, R., Cottrell, S., Roberts, R., O'Doherty, M., Brown, K., Cameron, C., Stockton, D., McMenamin, J. and Ramsay, M. (2021) 'Effectiveness of the Pfizer-BioNTech and Oxford-AstraZeneca vaccines on covid-19 related symptoms, hospital admissions, and mortality in older adults in England: test negative case-control study', BMJ, 373, pp. n1088. DOI: 10.1136/bmj.n1088

Maxton, F. Darbyshire, P. and Thompson, DR. (2021) Research nurses rising to challenges of COVID-19. Journal of Clinical Nursing. E13-e15. doi: 10.1111/jocn.15504

McNiven, A., Boulton, M., Locock, L. and Hinton, L. (2021) 'Boundary spanning and identity work in the clinical research delivery workforce: a qualitative study of research nurses, midwives and allied health professionals in the National Health Service, United Kingdom', Health research policy and systems, 19(1478-4505 (Electronic)). https://doi.org/10.1186/s12961-021-00722-0

Ozdemvir, BA. Kathikesalingam, A. Sinha, S. Poloniecki, JD. Hinchcliffe, RJ. Thompson, MM. Gower, JD. Boaz, A. Holt, PJE. (2015) Research activity and the association with mortality. PLoS One. 26;10(2). https://doi.org/10.1371/journal.pone.0118253

RECOVERY Collaborative Group, Horby, P., Lim, W. S. and et al (2020) 'Dexamethasone in Hospitalized Patients with Covid-19', New England Journal of Medicine, 384(8), pp. 693-704. DOI: 10.1056/NEJMoa2021436

Tinkler, L. and Robinson, L. (2020) 'Clinical research nursing and factors influencing success: a qualitative study describing the interplay between individual and organisational leadership influences and their impact on the delivery of clinical research in healthcare', Journal of Research in Nursing, 25(4), pp. 361-377. https://doi.org/10.1177/1744987120904778

Tinkler, L. Robertson, S. and Tod, A. (2022) Multi-professional perceptions of clinical research delivery and the clinical research nurse role: a realist review. Journal of Research in Nursing. 27(1-2) pp 9-29. doi: 10.1177/17449871211068017

Whitehouse, CL. and Smith, HA. (2018) The Whitehouse Report: Review of research nursing and midwifery structures, strategies and sharing of learning across the UK and Ireland in 2017. The Florence Nightingale Foundation. The-Whitehouse-Report-2018.pdf (irnm.ie) (.PDF)

Acknowledgements

We would like to acknowledge all clinical research nurses and midwives who took the time to participate in this survey. Thank you to the entire research workforce for your hard work, dedication and tenacity to continue forging progress in science for the benefit of health and care of the population.

Thank you to the employing organisations of those in the working group and the country-wide organisations who supported this project and the promotional activities associated with it.

Thank you to everyone who contributed to, and disseminated the survey links to reach as many CRNMs as possible.

We would like to thank Professor Ruth Endacott for her support, encouragement and belief in the project and its potential impact for the workforce, and Hazel A. Smith, Mehar Shiju and Rachel Dance for acting as critical friends in the development of this report, and particular thanks to Katherine Mackintosh who has supported our considerations of inclusivity and neurodiversity throughout the final document.

Appendix One - Survey questions and answer options

UK and Ireland Census for Registered Clinical Research Nurses and Midwives

Calling all clinical research nurses and midwives!

Please complete this brief survey which will take a few minutes and help us to identify how many registered research nurses and midwives there are across England, Wales, Scotland, Northern Ireland and the Republic of Ireland and their specialties.

This survey has been developed by the NIHR 70@70 Senior Nurse and Midwife Research Leader Programme and research leads in each country of the UK and The Republic of Ireland. It is relevant for all registered research nurses or midwives regardless of employer and including health and social care settings. It does not matter whether you are funded by the NIHR or not, and we would like to hear from you whether you work as a research nurse or midwife from 1 - 37.5 hours.

This survey is not aimed at nurse / midwife researchers. For the purpose of this scoping exercise; A nurse/midwife researcher develops their own research ideas and goes on to lead/undertake that research. A clinical research nurse/midwife supports patients taking part in research developed by others. If you are in a dual role between the two, please record your clinical research nurse/midwife hours for this project. Thank you.

The Department of Health and Social Care are the data controller for the information obtained and by clicking on the submit button at the end of the questionnaire you are giving us consent to use the anonymous information that you are providing.

Please complete the survey once only.

1. Are you working as a…
   1. Clinical Research Nurse
   2. Clinical Research Midwife
   3. Both / Dual
   4. None

2. Which Country are you based in
   1. England
   2. Ireland
   3. Scotland
   4. Wales
   5. Northern Ireland

When people selected one of these, it took them to the appropriate county/province/health board option. These choices were decided by the leads in each country as to what would be the most appropriate / useful for them. Then with England, we also looked at CRN region as Ruth was interested in that.

3. Sector

   In which sector do you work?

   1. Primary / social care
   2. Secondary care
   3. Tertiary care
   4. Private/industry sector
   5. University / Higher Educational Institution
   6. Other (free text)

4. Banding/Grade
   1. Agenda for chance Band 5
   2. Agenda for chance Band 6
   3. Agenda for chance Band 7
   4. Agenda for chance Band 8a
   5. Agenda for chance Band 8b
   6. Agenda for chance Band 8c
   7. Agenda for chance Band 8d
   8. Agenda for chance Band 9
   9. University post
   10. Junior staff nurse
   11. Senior Staff Nurse
   12. CNMI
   13. CNM2
   14. CNM3
   15. Ireland: Assistant Director of Nursing
   16. Ireland: Director of Nursing
   17. Private / Industry sector post
   18. Other

5. What research specialty do you work in? If you work in more than one specialty, click multi-specialty.
   1. Multi-specialty
   2. Management / leadership
   3. Ageing
   4. Anaesthesia, perioperative medicine and pain management
   5. Cancer
   6. Cardiovascular disease
   7. Children and young people
   8. Critical care
   9. Dementias and neurodegeneration
   10. Dermatology
   11. Diabetes
   12. Ear, nose and throat
   13. Gastroenterology
   14. Genomics and rare diseases
   15. Haematology
   16. Health services research
   17. Infection
   18. Kidney disorders
   19. Liver
   20. Mental health
   21. Metabolic and endocrine disorders
   22. Musculoskeletal disorders
   23. Neurological disorders
   24. Ophthalmology
   25. Oral and dental health
   26. Primary care
   27. Public health and prevention
   28. Reproductive health
   29. Research governance
   30. Respiratory disorders
   31. Social care
   32. Stroke
   33. Surgery
   34. Trauma and emergency care

6. How many hours per week are you contracted to work as a clinical research nurse or midwife?
   1. Variable (bank staff)
   2. The options from this point on were from 1 hour to 40 hours, with every half an hour as a drop down option.
   3. A free text option 'other' was also available at the close of the drop down. If participants selected 'other' they were taken to a pop up page which included 'Please advise of the hours per week you work as a registered research nurse or midwife'.

7. Is this a joint role? Eg. As a clinical nurse / midwife specialist?
   1. Yes
   2. No

8. Aboutyou…this section was optional and within each question there was a choice 'prefer not to say'.

   Age

   1. 18-24
   2. 25-34
   3. 35-44
   4. 45-54
   5. 55-65
   6. 65 and over
   7. Prefer not to say

   Gender

   Do you identify as

   1. Male
   2. Female
   3. Transgender
   4. Nonbinary
   5. Gender neutral
   6. Prefer not to say

   Ethnicity

   For ethnicity we used the Gov.UK drop down list which started from the list below, then filtered out in to multiple additional options.

   1. Asian or Asian British
   2. Black, African, Black British or Caribbean
   3. Mixed or multiple ethnic groups
   4. White
   5. Another ethnic group
   6. Prefer not to say

   So people would click one of the above, then the options filtered to…

Thank you for your time, please share this survey link with your registered clinical research nurse and midwife colleagues

Appendix Two - Full dataset of contracted hours within a clinical research nurse or clinical research midwife role

There was a grand total of 7435 responses.

Total number of contracted hours within Clinical Research Nurse role

Total number of contracted hours within Clinical Research Midwife role

NB. All responses below 10 (but at least 1) have been collapsed in to 'all other hours combined' with percentages descriptors.