CR education should extend to clinical care nursing staff

Efforts can help with patient recruitment

Clinical care nurses often have a vague idea about research projects at their medical institutions, and their knowledge about how clinical trials work can be limited.

"Our concern is that staff nurses need to know more about what kind of research is going on here," says Elizabeth Hill, PhD, an associate chief of staff for research at the VA Sierra Nevada Health Care System in Reno, NV.

"They need to know what the issues are around research and what the requirements and regulations are," Hill says. "It'd be a benefit to patients and the people doing research."

For instance, staff nurses who fully understand the research enterprise can be a great resource for recruitment because they're the ones who continually see patients who might be candidates for clinical trials, she adds.

"I also think it'd be good for them to know what kind of study the subjects are enrolled in because a patient could come out of the hospital and be given a drug that counteracts with a study medication," Hill says. "Staff nurses might identify that issue, and they can look for potential complications."

Also, clinical care nurses can play an important role in the checks and balance of the research enterprise. "I have had — more than once — nurses and others involved in the care of patients identify what was wrong with a study," Hill notes. "Nurses are just a good source of information if you educate them about what's required."

Educating clinical nurses about research serves a dual purpose: first it ensures that nurses are more aware of what clinical trials entail, and, secondly, it gives nurses information they need to inform patients, Hill says.

"Families and patients will ask staff nurses about a study," she adds. "The idea is to educate those staff nurses and personnel so they understand the whole research process better and then can educate patients."

For example, a research participant who goes through the informed consent process but has lingering questions down the road might ask a staff nurse for information, Hill says.

"If you had nurses who were educated in the study they could explain it to patients," she says.

A first step might be to offer continuing education units to nurses who voluntarily take courses about clinical research.

Research institutions can encourage this by providing time for staff to complete such credits, Hill says.

Academic medical centers also could place educational posters in hospital lobbies, Hill suggests.

"One year we had a research week where we put up posters of research going on in the lobby of the hospital, and that was one place where people came up to me and said they didn't know there was research being done there," Hill says.

Another strategy is to provide brief educational sessions at changes of shift, Hill says.

"You could give nurses some general information about the research, what it is, and the kinds of patients they're looking for," Hill explains. "So if the nurse sees someone who might be interested in the study, she can give the patient a flier." Research institutions need to do a better job of marketing clinical trials research to the public, and educating staff nurses is a good way to start, she says.

"We'd like people to understand that research is done to improve things for people, and that's really a key issue for the VA," Hill says. "The VA does a lot of good research, but I think we sometimes need to sell it better to the general public and also in our own facility so people have a more positive outlook about research."

Ideally, staff nurses would be trained to understand what a particular study is about, what it involves, what are its risks and benefits, and what are its inclusion and exclusion criteria, Hill says.

"You could give nurses fliers to distribute to patients, and you could discuss with them what goes into enrolling patients in studies, including the informed consent form, explaining adverse events, and what to look for in potential study participants, Hill explains.

"Talk to them about what the benefits could be, if not for their patients, then for future patients," Hill says. "Explain how this study is important because it helps if you make people feel like they're a part of something big."

The key is to make the effort to talk with staff nurses and to build trust and rapport.

"If nurses understood that research relates to the people they're taking care of and could improve outcomes of the people they're caring for, then they might be willing to do anything they can to help with research," Hill says.