Knowing who is leading: Defining nurse-led projects

The nursing workforce has worked hard to professionalise and demonstrate the importance contribution of the nursing profession for quality global health care. The International Council of nurses defines a nurse as one who has completed a basic nursing education and is authorised to practice in their country (ICN, 1987). The ICN definition of nurses also specifically requires that nurses be prepared and authorised to “be involved in research” (ICN, 1987). As leaders in health care provision, nurses advocate tirelessly for their patients and play an important role in promoting and sustaining evidence-based healthcare (Bianchi et al., 2018). It is important that this nursing leadership is acknowledged in consumer care, and in research, innovation and improvement in healthcare delivery. During the conduct of a systematic review examining nurse roles in physical healthcare of people with mental health, we along with colleagues encountered a clear example of the ad hoc approach to leadership attribution in nursing research (CRD42022321337). While there is clarity around the definition of who is a nurse, there is considerable ambiguity regarding studies that are “nurse-led.” Moreover, clear criteria that define nurse leadership in research pertaining to physical healthcare of people experiencing mental health concerns seem absent from the literature. This ambiguity appears as a continuum and includes studies where “nurse-led” described the role of a nurse as one who collected data, studies where nurses conducted the project yet remain absent from the authorship team, studies where the data was collected by an exercise physiologist or other non-nurse practitioner yet discussion of the nursing role appeared throughout the paper, and studies where nurses were clearly included on the authorship team but reference to nurses or the nursing profession were absent when discussing the study implications. While we acknowledge the diverse roles nurses play in research studies, absence of defined contribution makes the task of identifying the nursing contribution incredibly complex and fails to acknowledge nurses as research leaders. To gain a greater understanding of the scope and value of nurse-led research we suggest a standardised definition of nurse-led research is adopted, allowing authors to assess and classify research activities appropriately. We recommend such definition is included in all publications of nurse-led work. Defining the term “nurse-led” in the research context may serve multiple benefits. Firstly, a definition of what research is nurse-led would reduce ambiguity around the role and importance of nurses in research. There is a continued lack of awareness within the general community of the involvement that nurses have in research and the impact of projects that nurses lead on quality of patient care (Nieswiadomy & Bailey, 2018). A clear definition of nurse-led research would allow for more streamlined and targeted professional promotion. Secondly, as the role of nurses in leading research becomes more clearly identified, it will allow better promotion of nursing research and simplified implementation of relevant research to practice. If academics, and practicing or student health professionals can utilise a single search term such as “nurse-led” to identify practical, relevant research that can be applied to nursing practice, this may encourage research engagement. Nurses working clinically would benefit from clearly defined terminology that allowed them to easily search and identify information that is directly related to their role and scope. Encouraging the use of “nurse-led” as an unambiguous key word would also improve the pragmatics of literature searching and assist in highlighting the importance of nursing in research and research as a career pathway for nurses. There are a variety of organisations that aim to encourage nurses to engage in research, such as the National Institute of Nursing Research in the United States and the International Association of Clinical Research Nurses globally. Nursing courses often incorporate training relating to research conduct. In Australia, the Australian Nursing and Midwifery Federation has mandated that “research must be a recognised and visible career pathway within all Nursing and Midwifery classification structures” (ANMF, 2019). The visibility of Nursing Research could be improved, and the direct relevance of research to practice could be more easily articulated with the use of a nurse-led as a well-defined concept. In the systematic review noted previously a definition of nurse-led consistent with the above-described criteria was applied. Subsequently 256 studies or 46.6% of the 549 studies included at full text review were excluded. This is not to imply nurses were not included in some aspect of the excluded projects, but does highlight the difficulty that an absence of a pre-defined definition of nurse -led creates, since some potentially included papers may have been inadvertently excluded. Nursing research and nurse involvement in healthcare research are increasing (Bianchi et al., 2018). Now is the time to define and agree upon a definition that can be used to identify nurse-led projects in a way that is clearly distinguishable. Having a clear definition of nurse-led projects has the potential to provide significant benefit to the nursing profession. All authors contributed to the design and/or conduct of the manuscript. All authors approved the current version of the manuscript. No funding was received for this project. The authors have no conflicts to declare.