Nadeem Khan

  • Nadeem Khan

    Nadeem Khan is originally from Pakistan. He joined Oxford Brookes as a research student in the Oxford Institute of Nursing and Allied Health Research (OxINMAHR) in 2016. His thesis title is ‘What factors influence nurses’ intention to leave the adult critical care settings?’

    What attracted you to Oxford Brookes University to conduct your research?

    I have been living in Oxford for a while now and have studied multiple courses at Oxford Brookes University including PGCert, BSc (Hons) and Critical Care Course. Oxford Brookes University is like a second home to me.

    What were you doing before?

    Having qualified and practiced professionally in a large surgical ICU in Pakistan I decided to move to the UK to develop my career in nursing. I progressed to become a lead nurse in oncology before moving to critical care where I have continued to develop my clinical, managerial and teaching roles. I currently work as a Professional Development Nurse in Adult Critical Care. 

    How easy did you find it to settle into the research environment?

    I settled well despite some initial challenges and have been well supported by everyone.

    Tell us about your research project.

    Introduction to the problem: My interest and passion in the subject of turnover and nurse retention started after my involvement in the recruitment, education and development of novice critical care nurses. I started looking at the issue of nurse retention after seeing the effects of high nurse turnover first hand in my own unit. My initial thoughts were that this may be a local issue; however, I was surprised after initial searching to find out that this was a national and even international issue. I wanted to do a research project at a PhD level but something which is current and relevant to a clinical area. Therefore, I decided to explore this issue as a PhD project.

    The aim of this research project was to explore the views and experiences of nurses about their working conditions in adult critical care areas and possible factors that may influence nurses’ decisions to continue or discontinue their employment. This study was needed as high turnover and nurse retention in critical care areas has been an ongoing issue for many decades. Nurse retention is more problematic in critical care areas due to increased number of specialist nurses required to care for the critically ill patients. It can take up to a year to prepare a novice critical care nurse to a level where they can safely and independently care for a critically ill patient and could cost up to $64,000. Given the limited research relating to nurses’ intentions to leave (ITL) adult critical care areas and the vast resources required to hire and train critical care nurses, this study aims to explore factors influencing nurses’ intentions to leave adult critical care settings.

    The first stage of this project was to establish the need for this research by exploring the current evidence. A systematic literature review was undertaken which is published in the Journal of Critical Care (a BACCN journal). The literature review identified a gap in previous and current research; therefore the decision was made to move this forward as a PhD project.

    The primary aim of the research was to explore nurses’ views about their working environment and possible factors influencing nurses’ intention to leave adult critical care areas. Secondary aims include: to develop strategies that may improve the retention of critical care nurses, and to contribute to the body of knowledge in developing insight into the factors influencing the stability of critical care nursing workforce.

    Objectives:

    • To conduct a national online survey with critical care nurses across England via the Critical Care Network about factors influencing nurses' intentions to leave adult critical care areas;
    • To undertake in-depth phone interviews with a sample of critical care nurses to explore their views and experiences of critical care and possible factors influencing nurses' decisions to continue or discontinue their current job and profession;
    • To employ both quantitative and qualitative techniques in analysing the data;
    • To disseminate research findings via peer-reviewed journals, conferences and critical care networks.

    Plan of work:

    • Phase 1: Quantitative data collection and analysis: Quantitative data was collected from all nurses currently working in adult critical care areas via a cross sectional survey. An adapted version of the validated Nursing Work Index-Revised (NWI-R) tool was used. The study was conducted from November 2017 to March 2018 at 263 adult critical care units across England. A link to the online survey questionnaire was emailed to the national lead for critical care networks which has representatives from every region of England. The email was then forwarded to the managers of adult critical care units via the local critical care network leads. They were asked to distribute the link to the survey to all nurses working in their units in order to reach all nurses currently working in adult critical care areas across England. An invitation letter and a participant information sheet were included in the email. The data were analysed using chi-square tests, t-tests, factor analysis and logistic regression analysis to determine factors which are associated with nurses’ intentions to leave adult critical care areas.
    • Phase 2: Qualitative data collection and analysis: Qualitative data was collected via in-depth telephone interviews from a sample of nurses currently working in adult critical care areas. Participants who were happy to be interviewed were asked in phase 1 to provide contact information to be followed up for interviews. Semi-structured in-depth telephone interviews were carried out to collect data from participants who agreed to be interviewed. Interview questions were developed using the information collected from the findings of literature review and survey in phase 1. Data collection for phase 1 and 2 happened sequentially. The literature review findings and information collected from questionnaires including qualitative comments were used to aid the interview questions in phase 2. Interviews have been transcribed verbatim. I am currently in the process of analysing the data. Qualitative data will be analysed using framework method of analysis which involves the following stages; transcription, familiarisation with the interview, coding, developing analytical framework, applying the analytical framework and charting data into the framework matrix. Additionally, field notes, analytic memos and analysis from phase one will also be used to aid the analysis of phase 2.

    Methodology: A mixed method sequential explanatory study design was used. In sequential design, one data collection phase and analysis occurs before the next. In this study, the survey was undertaken first. This helped to identify the appropriate questions required for the qualitative phase of the study. A sequential design is used when the intent is to conduct a qualitative phase of the study to help understand the findings of quantitative phase.

    The theoretical framework that has been adapted for this research is pragmatism due to its strong association with mixed method research. The philosophical theory of pragmatism is seen as a means of bridging the gap between the quantitative and qualitative research hence can be pivotal to the conduct of my research. Pragmatism uses purposeful human inquiry as its focal point. With this in mind, recognising the multiple factors and subjectivity that influence nurses’ intentions to leave adult critical care areas, a pragmatic theoretical framework is an appropriate means of inquiry for this study.  

    Phase 2 will be used to get in-depth information about the findings of phase 1 and how these findings may influence nurses’ intentions to leave current job and profession. For example, what autonomy means to nurses working in adult critical care areas and how having this may influence their decision to leave or stay in adult critical care settings. I aim to complete data analysis for phase 2 by December 2019. Phase 1 and 2 will be analysed separately and findings will be put together to get a full picture of the problem. 

    Moving forward: Following data analysis of both phase 1 and 2 separately, I aim to put the findings of both quantitative and qualitative data analysis together to get a full picture of the problem and come up with evidence based recommendations model for easy implementation. I aim to disseminate the findings of my study through publication and presentation at the appropriate forums. I aim to complete my thesis by December 2020.

    What do you enjoy about being a research student?

    I love being a research student. Despite its challenges and hard work, I really enjoyed my first year and successfully completed a systematic literature review. The biggest challenge for me is to study with full time work and not being able to continue working on a project without having a break for work. Therefore, I have to be super organised.

    What are your future plans?

    My plans include finishing my PhD project on time and to a high standard. I am a critical care nurse and I shall always remain a critical care nurse. The dream job would be to become a ‘clinical academic’. I plan to be in a patient facing role where I can give bedside nursing care, but also a role where I can further educate and practice and expand the evidence base to high quality healthcare.