30th Anniversary Invited Editorial reflecting on Luker K.A. (1990) Research and development in nursing. Journal of Advanced Nursing 17, 1151–1152
The ability to provide high-quality care to service users is to a great extent dependent on the availability of a well-educated and clinically competent nursing workforce which, in turn, is dependent on its members being able to access and utilize up-to date knowledge. Over the past decade, there have been many changes in the organization and delivery of healthcare, and high-quality care is inextricably linked to knowledge production and its dissemination to practitioners, in this case nurses.
When I wrote my Guest Editorial for JAN in 1992, the volume and quality of nursing research had been increasing apace. However, it is possible that further progress will slow – unless some fundamental issues are resolved. Nursing is a divided occupation and, despite registration for practice, there is no national or international consensus about the academic preparation required to equip a nurse to undertake research. In addition, there is no real agreement on what constitutes ‘good quality’ research. For some nurses, good research means anything and everything that produces findings, which have the prospect of direct utility for practice or policy, irrespective of mode of production. For others, good research is work that is well-crafted and rigorously conducted, irrespective of immediacy of utility. The considered view probably lies somewhere between these two positions.
The nursing profession as a whole seems to be ambivalent about the contribution of research, and of its researchers. Within nursing an anti-intellectual culture still seems to persist and, to some extent, this is maintained by the heterogeneity of a workforce that is mainly action focused. In the context of the United Kingdom (UK), at least in the case of England, the weak support for intellectual achievements and endeavour tends to be perpetuated by government funding of pre-registration nursing education which, although based in the university sector, provides better financial support for nursing students taking a diploma than for those who choose to study for a degree. This inequity ensures that more students opt for diploma level studies, thus placing the nursing profession in a disadvantaged position compared with other health professionals and, in turn, makes it more difficult for nurses to go on later to study for a higher degree – and thus to study, at a more advanced level, the requisites of ‘good research’.
There is a plethora of literature which documents the global shortage of well-qualified nurse researchers and the lack of funding for nursing research. It is ironic therefore, at a time when the rank and file nurse is becoming more research-aware through the international evidence-based practice movement, that ‘nursing research’ as a descriptor may become redundant because ‘health services research’ and ‘multidisciplinary collaboration’ have become more fashionable, and hence more fundable.
Nursing has a dilemma. Experienced nurse researchers are often burdened with large research supervision loads and, therefore, with less opportunity to continue to build up their own knowledge and expertise as a nurse researcher. Working in multidisciplinary research teams provides the opportunity to learn from colleagues and, increasingly, to participate as equals, and nursing now has many excellent researchers who badge their work as ‘health services research’. Some of these researchers continue to contribute a nursing voice, but others do not. The jury is out on whether this re-naming will have negative consequences in the long term for the generation of knowledge that is relevant to nursing and to the care that patients receive from nurses. There is also a cadre of nurse researchers who define the quality of research in terms of its application and utilization in patient care: these individuals place most emphasis on the ‘D’ of R&D, and this focus is usually more highly valued by clinical nurses. The focus on ‘D’, arguably at the expense of sufficient concentration on ‘R’, was one of the issues that I raised in my 1992 Editorial and it seems to be a continuing tension.
The difficulty, then, for nursing and nurse researchers is in deciding which audience or culture to select in which to ‘come of age’. In order to have scientific credibility and international recognition of research there are rules to be followed, and it is not for nursing, as a relative newcomer to the world of research, to rewrite the rules. In the context of research, the profession of nursing perhaps has spent too much time being concerned with educating the rank and file and making sure everyone is on board, and too little time on nurturing and encouraging the knowledge producers – tomorrow's professors and research stars. If nursing research (or a nursing contribution to health services research) is really to come of age, we need a clear strategy for both service provision and for research that gives equal weighting in terms of rewards to both intellectual and clinical endeavour. How the future unfolds will be determined by cultural constraints and the tenacity of nurse leaders.