The role of clinical trial nurses: an Australian perspective

An underutilised resource: The evolving role of clinical nurses contributing to rural health research

AIM

We aim to discuss the advantages of supporting clinical nurses' involvement in place-based research in rural health services.

CONTEXT

Australian health services are currently struggling with increased demand in services from an aging population, chronic diseases and nursing workforce shortages. This impact is amplified in rural and remote regions of Australia.

APPROACH

Investment in place-based clinical nursing research provides opportunity for nursing recruitment, career and leadership development, and retention, while addressing local health issues and creating pathways for implementation of evidence-based practice.

CONCLUSION

Collaboration between rural health services, universities, policy makers and the Rural Health Multidisciplinary Training program will enable the opportunity for establishment and ongoing development of strong research programs in rural health services to address local health issues and workforce needs.

Characteristics and duties of clinical research nurses: a scoping review

Introduction

The characteristics and duties of clinical research nurses (CRNs) are constantly developing and changing with the progress of medical technology and increasing needs in patient care. With the continuous deepening and standardization of clinical trials, the importance and status of CRNs during the whole process of clinical trials are also increasingly valued.

Methods

A scoping review of studies related to the characteristics and duties of CRNs was conducted to clarify relevant roles and concepts. An electronic search was conducted on three English databases (PubMed, Web of Science, Embase) and two Chinese databases (CNKI and Wanfang database) in December 2023. Two authors independently screened the literature, extracted information from the included literature, and summarized and reported the findings.

Results

A total of 26 articles published between 1991 and 2023 were analyzed, and four characteristics of CRNs were identified as participants and managers of clinical trials, caregivers and protectors of subjects, coordinators of research teams, and educators. Basic knowledge, skills and literacy, communication and coordination ability, and advanced research ability are the competencies required for CRNs.

Conclusion

Further studies should focus on the importance of various characteristics of CRNs, so as to improve the quality of clinical trials and promote clinical evidence-based practice.

Transitioning to the clinical research nurse role - A qualitative descriptive study

BACKGROUND

Studies have reported on the important role of the clinical research nurse in clinical studies. Yet, there is no international consensus about the role's competencies and tasks. Furthermore, the literature offers a little description of the career pathway from a ward-based registered nurse to a clinical research nurse. More knowledge about this specific role could benefit the nursing profession as well as increase the quality of clinical research.

AIM

The aim of the study was to explore Swedish registered nurses' experiences transitioning into the clinical research nurse role.

DESIGN

The study had a qualitative design. Data were collected via semi-structured interviews. Inductive qualitative content analysis was employed.

METHODS

Ten participants (i.e., clinical research nurses) were interviewed in the spring of 2017. A semi-structured interview guide was used to address the transition into the clinical research nurse role, experience working in a new role, experience of ethical dilemmas and experience of organizational and professional issues related to the role. The interviews were analysed inductively using qualitative content analysis.

RESULTS

The registered nurses described experiencing reality shock when they became clinical research nurses; that is, it was a challenging and transforming experience. The main theme, a challenging transition, was developed from the four subthemes highlighting that it defied their previous nursing role. They experienced an unclear professional identity, extended professional mandate, increased professional status and growing ethical consciousness in their new role.

CONCLUSION

The results highlight that registered nurses who became clinical research nurses had needs that were both distinct from and overlapped with those of their former professional role as registered nurses. To avoid reality shocks, the development of clear competence pathways for nurses to become clinical research nurses, including introduction, mentorship and continued support, is necessary. Making their professional title more homogeneous, nationally and internationally, would facilitate role identification and comparisons in research.

Clarifying the role of clinical research nurses working in Sweden, using the Clinical Trial Nursing Questionnaire - Swedish version

Aim

To explore the role of CRNs in Sweden and differences in competences and tasks, using the Clinical Trial Nursing Questionnaire – Swedish version (CTNQ‐SWE).

Design

A cross‐sectional survey.

Methods

Participants were identified through strategic sampling. Data were analysed by descriptive and comparative statistics.

Results

The respondents were experienced nurses who felt proficient in their role, they felt more acceptance by the principal investigators than by nursing colleagues. A majority of CRNs are involved in all procedures specified in the CTNQ‐SWE. The most often performed tasks, also rated as the most important by the CRNs, concerned informed consent and management of investigational products. The education was often informal: with a lack of job descriptions and professional development plans. Need of formal specialist education was expressed.

Conclusions

Knowledge about the role description can be used by clinical research enterprise internationally and healthcare organizations aiming to support CRNs in their role.

Extending the description of the clinical research nursing workforce

Background

The role of Clinical Research Nurses across the globe has not been evaluated to identify similarities or differences among specific activities.

Aims

This study's aims were to determine differences in Clinical Research Nurses most frequently performed activities, if these activities are reflective of those previously described in the literature, and job titles Clinical Research Nurses use to self-identify.

Methods

An online cross-sectional survey distributed via snowball sampling through email, social media, and research nurses' networks included questions on frequency of activities performed and information related to job titles. Pearson's chi-square test is analyzed for associations between the groups.

Results

Respondents returned 252 questionnaires, 233 were eligible for analysis. Research nurse activities performed internationally showed both similarities and differences. Any between country comparisons will be limited to the United States and the United Kingdom. The three most common tasks reported were recruitment 120 (51.5%), monitoring the research participant for potential adverse events 187 (80.2%) and providing nursing leadership within the interdisciplinary team 169 (72.5%).

Conclusion

Considering the context and range of activities of the original Clinical Research Nursing Domain of Practice, broadening the framework to include the leadership domain will better serve as a foundation for the specialty practice.

The role of clinical trial nurses: Transitioning from clinicians to clinical research coordinators

AIMS

This study aimed to explore the role of clinical research coordinators (CRCs) and identify the importance and performance of the role as well as the factors that affect the professional recognition of their role.

METHODS

A total of 102 CRCs from 10 hospitals were recruited for a survey. The Clinical Trial Nursing Questionnaire scale developed by Ehrenberger and Lillington was used to collect data for the importance-performance analysis. The importance and performance data were plotted on a two-dimensional grid, and multiple stepwise linear regression analysis was used to determine the influencing factors on the CRC role.

RESULTS

The influencing factors on the importance of the CRC role were frequency of protocol assessment, implementation and evaluation and professional nursing role performance. The influencing factors on performance were formal education and training in clinical research, institutional career ladder system for professional development and identification as a principal investigator in research studies. The influencing factor on the professional nursing role perception was the lower component of the 'performance of professional nursing role'.

CONCLUSION

Formal educational preparation, identification as a principal investigator in research studies and clear career progression are supportive factors to the professional recognition of CRC as a specialized nursing role.

SUMMARY STATEMENT

What is already known about this topic? Clinical trials ultimately contribute to improving public health. A clinical trial process should cover a number of tasks, such as provision of study information to patients, recruitment of patients, screening and obtainment of their consent. Clinical trial nurses affect the quality of clinical trials, but little is described about the scope and contribution of their roles in clinical trials. What is already known about this topic? This study explored the role of clinical research coordinators (CRCs) and their professional role recognition in the wake of policy changes in South Korea since 2015. Formal education, role delineation and career ladder schemes are critical factors to the career advancement of CRCs, as shown in the study results. Identifying the changes and effects of the relevant policy has implications to the South Korean context and beyond, serving as a reference for countries considering setting up CRC roles or establishing an educational system for CRCs. The implications of this paper: Formal education, role delineation and career ladder schemes are critical factors to the career advancement of CRCs. To improve the performance and professional awareness of CRCs, a government-led system and policies on formal education and career ladder are needed so that CRCs can fulfil their role in improving public health.

The Oncology Clinical Research Nurse Study Co-Ordinator: Past, Present, and Future

Clinical research nursing is a specialty practice that has evolved over the past century. Clinical research nurses (CRNs) work directly (e.g., direct care provider and advance clinician) or indirectly (e.g., manager, educator, and study co-ordinator) to support clinic research. For more than 50 years, oncology nurses have contributed to the body of evidence describing and validating the responsibilities and importance of the nurse in clinical research, especially the study co-ordinator role. This article will focus on the CRN study co-ordinator role in oncology clinical trials highlighting the historical evolution of the role, the contributions of dedicated members of the Oncology Nursing Society, and the future landscape of clinical research nursing through the International Association of CRNs.

[Nurses' participation in clinical research projects: a cross-sectional study in five hospitals]

The number of hospital-based clinical trials is resulting in the growing involvement of nurses. A cross-sectional study in five hospitals involving 60 nurses assessed the clinical research activities, the time allocated and the training level. The results suggest that identifying specific nursing time devoted to clinical research may influence the activities carried out. Improving the definition of these activities could facilitate their integration into nursing practice.

The role of the nurse in supporting cancer clinical trials

Clinical trials are a fundamental component of high-quality care, and have been widely reported to improve care and patient outcomes. For research trials to be successful, patients need to have awareness of trials, be invited to participate, and be supported to make informed decisions about consenting to enrol in clinical trials. Some cancer nurses have been reported to be reluctant to discuss clinical trials with patients, based on their own beliefs about the perceived burden of clinical trials, while others have been reported to facilitate patient access to clinical trials by working closely with their clinical research nurse colleagues. Nursing patients enrolled in cancer clinical trials is a specialised (and often complex) area of practice. There is significant opportunity for nurses to develop their knowledge about clinical trials, for example, through reciprocal learning between clinical and research teams, which might enhance patients' experiences of, and outcomes from, clinical trials.

Translation and validation of the Clinical Trial Nursing Questionnaire in Swedish-A first step to clarify the clinical research nurse role in Sweden

AIM AND OBJECTIVES

To translate the Clinical Trial Nursing Questionnaire (CTNQ) into Swedish and test it for face and content validity as well as internal consistency and reproducibility using test-retest procedures.

INTRODUCTION/BACKGROUND

In many countries, as in Sweden, a registered nurse can be involved in research by becoming a clinical research nurse. The clinical research nurse plays a pivotal role in clinical studies as a part of the research team. Scales have been developed and used with the objective to clarify the role of clinical research nurses: one of them is the CTNQ.

METHODS

A quantitative cross-sectional design with a test-retest procedure was applied to validate the translated questionnaire. By using a snowball sampling method, relevant participants were identified and 49 registered nurses working in the field of research as clinical research nurses answered the questionnaire on two occasions. An expert panel of three clinical research nurses evaluated the questionnaire for face and content validity. The STROBE checklist for observational research has been followed for presenting the research (see File S1).

RESULTS

Face and content validity was agreed upon in the expert panel group. Tests for internal consistency of the CTNQ was calculated and showed a high Cronbach's alpha for both the frequency and importance subscales. The test-retest correlation analysis (reproducibility) also revealed a high correlation coefficient for both subscales.

CONCLUSION

The CTNQ-SWE is a valid and robust instrument in a Swedish version. The instrument can be of importance in assessing the role of clinical research nurses in Sweden in future studies.

RELEVANCE TO CLINICAL PRACTICE

Use of the CTNQ-SWE in future research can be of value for clarification and professional development of the clinical research nurse role in Sweden. The further use of the CTNQ in Sweden can be of value in understanding the process where licensed nurses make a transition into becoming a clinical research nurse, and to identify needs for customised education.

Factors affecting recruitment and retention of nurses who deliver clinical research: A qualitative study

AIM

To provide a better understanding of the factors affecting recruitment and retention of clinical research nurses.

DESIGN

Qualitative exploratory design.

METHODS

An on-line questionnaire comprising open-ended and fixed-choice questions was completed by 121 clinical research nurses. Seven focus groups were held with a subgroup of 26 participants. Data were analysed using inductive thematic analysis.

RESULTS

Participants were attracted to a research nurse post by an interest in research itself, a desire for a change or to achieve personal objectives. The majority expected to continue in a research post for the next 5 years, while others expected to move on to research management, a clinical post or retirement; few had ambitions to become an independent researcher. Factors identified in focus groups as leading to intentions to leave research included desire for further change, concern about loss of clinical skills, rebalancing family/work responsibilities, short-term contracts, unsupportive employers and limited career progression.

The administration of patient-reported outcome questionnaires in cancer trials: Interviews with trial coordinators regarding their roles, experiences, challenges and training

AIMS

To explore cancer trial coordinators' roles and challenges in administering patient-reported outcome (PRO) questionnaires, and establish what PRO-specific training and guidance they received and needed.

METHODS

Eligible cancer trial coordinators experienced with PRO assessment from approved Australian sites participated in an audio-recorded, semi-structured interview (transcribed verbatim). Recruitment continued until data saturation. Transcripts underwent content analysis.

RESULTS

Twenty coordinators participated (professional training: nursing (n = 12), science/research (n = 4), both (n = 4)). PRO administration formed a minor component of most (85%) coordinators' roles. PRO administration challenges included managing 'English second language' participants, participants' companions who attempted to complete questionnaires, burdensome questionnaires, and balancing their duty of care against trial requirements. Coordinators reported inconsistencies in PRO administration, which appeared to arise as a result of confusion and inconsistent or contradictory PRO training. Inconsistencies concerned whether/when they explained the purpose of PRO assessment, which participants they approached to complete PROs, and whether they used PRO trial data to inform care.Coordinators received PRO training from various sources; most commonly study-specific start-up meetings (45%) or from colleagues (30%). Two received no PRO-specific training. Despite the challenges reported, many (55%) felt they did not need further PRO training.

CONCLUSION

Trial coordinators receive inconsistent PRO-specific training and are often unclear how to prioritise different aspects of data quality when faced with everyday challenges, leading to inconsistent methods, missing data, poor quality data, and even bias. Agreement on how coordinators should prioritise the requirements of PRO studies is a necessary pre-requisite for the development of much-needed, consensus-based PRO administration guidelines.

Nurse leaders' perceptions of the ethical recruitment of study subjects in clinical research

AIM

The aim of this study was to describe nurse leaders' perceptions of ethical recruitment in clinical research.

BACKGROUND

Nurse leaders are expected to get involved in clinical research, but there are few studies that focus on their role, particularly the ethical issues.

METHOD

Qualitative data were collected from ten nurse leaders using thematic one-to-one interviews and analysed with content analysis.

RESULTS

Nurse leaders considered clinical research at their workplace in relation to the key issues that enabled ethical recruitment of study subjects in clinical research. These were: early information and collaboration for incorporating clinical research in everyday work, an opportune and peaceful recruitment moment and positive research culture.

CONCLUSION

Getting involved in clinical research is part of the nurse leader's professional responsibility in current health care. They have an essential role to play in ensuring that recruitment is ethical and that the dignity of study subjects is maintained.

IMPLICATIONS FOR NURSING MANAGEMENT

The duty of nurse leaders is to maintain good contact with other collaborators and to ensure good conditions for implementing clinical research at their site. This requires a comprehensive understanding of the overall situation on their wards. Implementing clinical research requires careful planning, together with educating, supporting and motivating nursing staff.