Advanced practice has been developing globally to respond to challenges in healthcare provision (Evans et al, 2020). Within the UK, the role of the advanced clinical practitioner (ACP) has developed to fill workforce shortages but also to address concerns about the quality, safety, and delivery of healthcare (Health Education England (HEE), 2017). This has created a cadre of professionals working independently to diagnose, manage and prescribe as part of patient care.
Within nursing, the four pillars of advanced practice—expert clinical practice, education, leadership, and research—were identified by Manley (1997). These are now incorporated in the Multi-Professional Framework for Advanced Clinical Practice in England (HEE, 2017). Many ACPs working in the UK fulfil education and leadership requirements alongside clinical roles (Drennan et al, 2019). Research, however, is less well-established, with many ACPs lacking confidence in this pillar.
This article considers why all ACPs need to be able to work with, and interpret, research evidence and describes the authors' recent experience with an ACP clinical academic role as one way to establish research within advanced clinical practice.
Research in ACP roles
Healthcare is constantly changing, with the evidence base expanding exponentially (Tsay and Yang, 2005). As independent practitioners, ACPs need research capability to keep abreast of the developing literature and critically apply research findings to practice (Manley, 1997). This requires skills and knowledge to identify relevant literature, evaluate its quality, and interpret results to work out what applies to their clinical practice. Understanding different research methodologies, their strengths, and their weaknesses, is essential to be able to identify biases in their conduct and reporting. Due to the breadth of their practice, ACPs need to become confident in interpreting qualitative and observational studies, as well as randomised controlled trials, as each of these are likely to generate insights to guide clinical work. Working as part of the wider multidisciplinary team, ACPs are well-placed to synthesise evidence from multiple different paradigms—for example by helping nursing and medical colleagues to recognise the important contributions of research from each other's disciplines.
However, ACPs can and should go further than this, not just ensuring practice is evidence based, but also driving change in clinical practice through research findings (Manley, 1997). ACPs, because of their experience and expertise, and their role as a permanent core member of the clinical team, are well-placed to assist or even lead the pragmatic implementation of research.
Developing skills in implementation science and service improvement will enable ACPs to translate research findings into clinical practice (Bauer et al, 2015; Munro and Savel, 2016). Awareness of research processes enables ACPs to identify suitable research participants for studies, support research in clinical practice and even lead on clinical research. Thus, ACPs' involvement in research is not just about being able to critically appraise published research studies, but to develop practitioners who bridge the gap between research and clinical practice.
Using clinical academic careers to drive research in ACPs
Consequently, it is important that ACPs develop the competencies to conduct and lead research. The best way to understand research, to shape the research agenda and, in turn, improve clinical care, is by becoming more involved. Clinical academic posts have been the focus of recent initiatives to recruit and train more nurses and allied health professionals (AHPs) as research leaders (Carrick-Sen et al, 2016; Westwood et al, 2018; Cooper et al, 2019; Gibson, 2019).
Clinical academics work in a clinical role while leading research in a related field (Baltruks and Callaghan, 2018). They develop new knowledge and help translate this into clinical practice because they can span the research-practice divide (Carrick-Sen et al, 2016).
In 2019, the first author was supported to develop into an ACP clinical academic using the Clinical Doctoral Research Fellowship from HEE (2018). Funding covers salary, research and training costs for 3 years, supporting both research (80%) and clinical development (20%). Clinical time is used to train as an ACP, completing a clinical rotation and clinical skills module with support and mentorship from two clinical supervisors (Table 1). Research training is undertaken through a PhD programme, focusing on patients' experiences of cannulation for haemodialysis. Two years into this, and the first author has, to date, been able to meet all academic and clinical training milestones. Her passion for research, and the fact she has shown it is feasible, has meant that other ACPs within the organisation have become interested in clinical research. We are now exploring ways to make more such posts available. These steps are early and tentative, but they illustrate how an ACP clinical academic role is feasible and can add value.
Table 1. Clinical rotation
| Date | Department/Module |
|---|---|
| April–August 2019 | Hepatology ward |
| September 2019–February 2020 | Clinical decision-making module (academic study) |
| March–July 2020 | COVID-19 support—renal dialysis unit |
| October–December 2020 | Stroke unit |
| January–April 2021 | Cardiology unit (including one month of COVID-19 support in the renal dialysis unit) |
| May–July 2021 | Respiratory ward |
| August–November 2021 | Gastroenterology luminal ward |
| December 2021 | Endocrinology unit |
| January 2022 | Medicine for the elderly ward |
| February–August 2022 | Medical assessment unit |
| September–October 2022 | Accident and emergency department |
Although developing research leadership within a profession is by no means straightforward (Carrick-Sen et al, 2016; Cooper et al, 2019; Gibson, 2019; Westwood et al, 2018), more clinical academic roles could help ACPs gain insight into research, in turn improving the sustainability of the discipline and the quality of the care that we are able to deliver.
KEY POINTS
- Part of the role of the advanced clinical practitioner (ACP) is to improve patient care through research, but many ACPs lack confidence in this area
- The clinical academic route may be a way of increasing ACPs' knowledge of research and making research an established part of the role once trained
- Clinical academics work in a clinical role while leading research in a related field
- A Clinical Doctoral Research Fellowship has allowed a nurse in one trust to study to become a clinical academic ACP, involving a clinical rotation and research training