Kaveri Mayra - Global Research Nurses

Clinical Nurse Researcher: the least realized and opted role of nurses in India
Kaveri Mayra, Research Associate, Public Health Foundation of India
The perfect placement: Enablers of nursing research
Nurses are indispensable when it comes to health service provision in hospitals and community.
Their placement in health facilities is such that it links them very well with patients/clients (care
seekers) and health care team members (care providers). At community level also, nurse is usually
the sole learned care giver in rural and remote areas. This perfect positioning gives them an
opportunity to communicate with both ends with ease (as shown in Figure 1) but is hampered by
huge workload. Nursing workforce shortage is a serious issue that concerns health service
provision in India. The nurse patient ratio (which should ideally be 1:6i) is so high that it barely
leaves any scope for the nurses to even consider participating in research. The imbalance resulting
from underproduction, unplanned deployment; and ever increasing nurse migration, makes it
difficult to focus on an ideal scenario of nurses doing research. The lack of clarity in responsibilities
increases their workload even more, leaving fewer windows to explore research.
Figure 1: Nurses communication linkages
Mismatch of education and service: barriers to clinical nursing research
Nurses in India usually opt either clinical nursing or teaching in nursing institutions, none of which
come with any mandate of conducting research as a part of their duty. Hence, participation in
research beside clinical work is uncommon. Though not enough, but the only cadre of nurses who
engage in research are nursing teachers. Post graduate nursing students conduct research as it's a
requirement for course completion. There also are a few graduates who work with research and
development organization and focus mainly in research in nursing and other related fields but
there is not any scope for such an arrangement in public sector, which is an emerging trend.
Clinical nurse’s lack of opportunity to participate in research is evident from the member’s profile
of most nursing associations and nurses attending national nursing conferences, most of who are
affiliated to the nursing institutions. For instance, most members of the Nursing Research Society of
India, out of around 1500 members, are affiliated to nursing institutions1. There aren’t enough
platforms to facilitate knowledge sharing between clinical and teaching nurses.
The curriculum of General Nurse Midwives (GNM) and Auxiliary Nurses Midwives (ANM) also acts
as a barrier for research. There is a mismatch in nurse’s education and their placement as shown in
Figure 2. Nurses who complete degree in nursing course i.e. BSc in Nursing have nursing research
in their curriculumii but the nurses holding diploma (GNM)iii or certificate (ANM)iv do not have a
research component in their syllabus. After completion of training, most diploma and certificate
holders choose to work in hospitals and community as they are not eligible to teach. Most degree
holders prioritise teaching rather than working in a clinical area. The teaching wing of nurses does
involve in research at times, but does not play a direct care provider’s role.
Figure 2: Mismatch of nurse’s research education and deployment
Note: The dotted pointer shows low priority in choice of placement
Application of nurse’s role in research: an example
I was involved in a study in 2012v trying to understand the perception of antenatal women,
husbands and service providers, on husband’s presence in delivery room as a birth companion
during childbirth. Interviews were conducted in a public and a private hospital for better
understanding. The involvement of a clinical nurse in this study would have benefited the following
ways:
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1
Gaining the trust of participants might have been easier given the nature of the profession
(nursing),
Nursing Research Society of India. Available at: http://nrsindia.org/. Accessed on 17.10.2013.

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

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Data collected, could have remained in the hospital (to be used as evidence) which could
have been used to make changes in treatment regime to make the antenatal women more
comfortable,
Findings could have been shared with the whole team of care providers for thoughts on
implementation,
The study could have been followed up expanding on the topic. Some examples can be
researching on avenues to involve husbands in public hospitals or an experimental study
on benefits of husband’s presence in labour room.
In the private hospital, where husbands were allowed in the labour room, nurses could
suggest changes required in the on-going practice based on research.
Knowledge sharing between the two hospitals could inform practices. Wider dissemination
could support other hospitals learning from success stories.
Avenues to involve clinical nurses in research
Collaborative efforts can go a long way. A committee of nursing teachers and clinical nurses
working in similar specialty areas can resolve the mismatch (explained in the previous section) by
encouraging cross learning. Clinical nurses will gain research knowledge; and nursing tutors will
get more clinical space. Nurses can thus mutually benefit and flourish.
An optional course in nursing research can be introduced as an in-service course for nurses
interested in research. It is convenient to delegate data collection responsibilities, but not giving the
fair share of acknowledgement and authorship is exploitation and should be avoided at every cost.
Inclusion of nursing research in syllabus of diploma in nursing can be considered as a long term
measure. Clinical nurses should be gradually involved in nursing research. The encouragement and
awareness that research is an option should start early in training, so nurses develop an interest in
clinical research.
Acknowledgement: Dr. Surekha Garimella, who reviewed this article and gave valuable comments.
i
Indian Public Health Standards. Guidelines for District Hospitals. Revised 2012. Ministry of Health and Family
Welfare. Government of India.
ii
Indian Nursing Council. BSc Nursing Syllabus and regulation. New Delhi.
iii
Indian Nursing Council. GNM Syllabus. New Delhi.
iv
Indian Nursing Council. ANM Syllabus. New Delhi.
v
Mayra Kaveri, IK Anil Kumar. Husband as a birth companion during childbirth: Exploring perceptions. Public
Health Research Series. 2012; 1(1): 1-7.

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