Any Successful Strategy For Retaining Quality CRCs Must Address Pay, Flexibility, And This Key Relationship
By Teri Crumb, MSN, RN, CCRC, TLC Research, LLC
No, this is not an article about a spouse, significant other, or other family relationship. And no, this is not going to discuss site and sponsor relationships. There are many articles, webinars, and presentations on that subject. Here, we’re discussing the relationships with the clinical research team, specifically the clinical research coordinator (CRC) and principal investigator (PI). You may be asking yourself, “Why is there a need for this?”
I’ll tell you.
In a recent guest article, Kathi Enderes stated that “…for every clinical research coordinator (CRC) looking for a job, there are seven jobs posted.” It is certainly difficult to recruit and retain coordinators. Sites across the U.S. are struggling with maintaining their current clinical trials, and many have had to pause initiating new trials until sufficient staff can be hired and trained. 1,2 While poor salary, work flexibility, and professional advancement opportunities bubble to the top of potential reasons why turnover is high among CRCs, a study by Buchanan DA et al (2021)3 has confirmed something that I’ve known from my career in clinical research: The relationship between the PI and a CRC is crucial to success. In this study, significant predictors of retention of the CRC included the PI being actively engaged and the CRC having a collaborative role with the PI, feeling respected by the PI, and having a close relationship with the PI.
And I can attest to that.
I didn’t seek out clinical research. In fact, it found me. As a clinic nurse, I knew nothing about research. Then, a clinical research position beckoned to me, and I found myself in a whole new world. This new role kept my clinical brain active, it deepened my detailed-oriented skillset, and it enhanced my love of project management. Looking back over the past 20-plus years, I note a few things that guided my success: a curiosity for learning new things, an ability to “just keep swimming” (per Dory of “Finding Nemo”), and supportive relationships with principal investigators (PIs). Working as a clinical research nurse (CRN) at a community-based teaching hospital, I worked in quite a few different therapeutic areas. I have been fortunate to work with PIs who went beyond saying “thank you” or offering a reflexive “Great job on that.”
About 5 years into my CRN role, I was working on a prospective observational multi-center trial. We had been involved in the study for a couple of years and were actively enrolling at our site. The PI invited me to attend an investigator-only meeting with him. I was excited to participate, as our site was very active in the trial. However, being a CRC in a room full of PIs was a bit intimidating. The pivotal moment happened as I sat in a room filled with investigators, and my PI leaned over to say, “If you have an idea, I want you to raise your hand and say it. I support any ideas that you offer.” I knew at that moment I had heard profound words. He didn’t even know what ideas were developing in my head! Yet, he expressed full support. I cautiously lifted my hand, and I spoke.
This moment launched my career from a job to a profession. These words represented respect, collaboration, and empowerment. It catapulted me. In the meeting, I shared concerns and ideas regarding recruitment and retention with the lead investigators. This eventually led to new tools and study activities being added to the study. Have I worked with people like this all along? No, not even close. But it took one PI to make a positive impact and it left lasting effects. This moment provided me with the confidence to express concerns or share ideas. Up until that point, I didn’t feel that I was knowledgeable or experienced enough to contribute. Much like the father in “Encanto,” “you could say that being surrounded by the exceptional, it was easy to feel unexceptional.” I experienced the incredible value of mentorship.
Moving forward, I made a notable effort to connect with mentors, talking through ideas, obstacles, and plans for the future. I also learned how strategic that networking was. This PI, who uttered strong words of support, taught me how to network. I had always been a people person, but I was a novice networker. Once I honed my skill, my reach became wider and wider, which essentially launched my career change to an independent consultant.
If you are experiencing CRC turnover, you can certainly try to offer salary increases or hybrid work options that are likely to capture the attention of a new recruit, but retention may require more than these trending talking points. Find out what motivates your CRCs beyond pay and time off. Consider ways to improve their at-work experience. Do your training, mentoring, and professional development opportunities help build their curiosity and confidence in their position? (I’m guessing not.) A frequently cited article describes the invisible hand in clinical research — the CRC.4 Why does it seem that this role is still invisible? Retention strategies that are effective are ones that go much further than accolades. Clinical research sites as well as sponsors and CROs should engage with PIs to discuss the secret to success with their research studies — the CRC. Cultivating this interprofessional relationship is a key element in clinical research success.
A PI and a CRC can excel as a dynamic duo. The other option is to just focus on pay and hours — because, after all, “we don’t talk about Bruno.”
References:
- Knapke JM, Snyder DC, Carter K, Fitz-Gerald MB, Fritter J, Kolb HR, Marchant M, Mendell A, Petty M, Pullum C, Jones CT. 2022. Issues for recruitment and retention of clinical research professionals at academic medical centers: Part 1- collaborative conversations Un-Meeting findings. J Clin and Transl Science. 6(1): w80. doi:10.1017/cts.2022.411
- Staffing Shortages are hindering clinical trial completion. December 1, 2022. Medical Ethics Advisor. Relias Media. https://www.reliasmedia.com/articles/staffing-shortages-are-hindering-clinical trial-completion
- Buchanan DA, Goldstein J, Pfalzer AC, Lin YC, Kang H, Claassen DO. 2020. Empowering the CRC in Academic Medical Centers. Mayo Clin Proc: Inn Qual Out. 5(2), 265-273. https://doi.org/ 10.1016/j.mayocpiqo.2020.09.014
- Davis AM, Hull SC, Grady C, Wilfond BS, Henderson GE. 2002. The Invisible Hand in Clinical Research: The study Coordinator’s Critical Role in Human Subjects Protection. J Law Med Ethics. 30(3): 411-419. Doi: 10.1111/j.1748-720x.2002.tb00410.x
About The Author:
Teri Crumb is a clinical research nurse. She has coordinated clinical research trials for over 20 years and has experience in multiple pediatric clinical areas. She has been a speaker at local, regional, and national research conferences. She obtained her BSN from Grand Valley State University, her MSN from Drexel University in Clinical Trials Research, and certification through the Association of Clinical Research Professionals (ACRP). Her areas of interest are the training and education of clinical research staff. In 2022, she started her own LLC as a clinical research consultant. As a pediatric nurse, she loves all things Disney/Pixar including a couple of her favorite movies: “Finding Nemo” and “Encanto.”