Alice

Age at interview: 29

Brief Outline:

Alice has been working in research for around four years, and is currently employed as a senior research midwife. She emphasises that a person’s abilities to reflect on their experiences and be enthusiastic are important to the role.

Background:

Alice is a research midwife. She is single. Her ethnic background is White European (Italian).

More about me...

Alice is a research midwife. She has been working in research for around four years. She is currently employed as a senior research midwife, after being promoted whilst studying for her Master’s degree two years ago. Before working in research, Alice worked as a midwife in different parts of maternity, including on a labour ward. She enjoyed the research aspect of her BSc in midwifery and this motivated her to pursue a job in research. Alice didn’t have many expectations about what research would involve before she began her post. Starting a new job in a new working environment wasn’t easy for Alice. Her main challenge at this time was being the only research midwife in the department, which was “stressful”, but also pushed her to develop skills and experience. She feels she was well supported by her team. She found the initial Good Clinical Practice training helpful, although it was a lot to remember. 

In her current role, Alice mainly works on studies within a maternity department but she has also worked on studies in fertility and gynaecology. She tends to work on several studies at a time. The activities involved usually include recruiting patients, and ensuring that they understand the aims of the studies and what participation would involve. She collects data, which can consist of anything from questionnaires to collecting biological samples. She also coordinates junior research midwives, data managers and trial practitioners. Conflict resolution is another aspect of Alice’s role, a task she finds “frustrating” but “unavoidable”. She has embraced the challenges that have come with her position: “I really believe in the role of research and I think it helps massively our patients and also the reputation of a unit”. Alice also feels that having a strong research department provides a rich learning environment for students and demonstrates the value of evidenced-based care. 

However, Alice feels that research is not always respected within healthcare professions: “there can be a preconceived idea that research is just some paperwork that you have to go through or just something that’s not really necessary, and it really frustrates me […] Without research there wouldn’t even be a fertility department in the first place”. However, Alice believes that the role of a research midwife is becoming more recognised and valued, though “there’s still room for improvement”. She has a strong working relationship with the other research midwives both within and beyond her own Trust. Having these contacts offers the opportunity to discuss challenges they have faced which can be beneficial for finding out if other study sites are “facing the same problem” and “how they are dealing with it”.

One barrier to research Alice identifies is around language and studies being unable to recruit patients who don’t speak English. Similarly, an uncomfortable aspect of her role is checking patient abilities to understand before recruiting them to studies, although she recognises that restrictions exist for a reason. Nonetheless, Alice is concerned about the impact on study results from excluding some potential participants: “some exclusion criteria will help with the quality of the data but may reduce your ability to generalise the findings of the overall population”. Finding space to see participants can also be a problem: “we should be part of the service so […] we shouldn’t be hoping to find a room [with the possibility that there is not one available]”.

Alice is currently on a fixed-term contract, which is renewed annually. Since her contract renewal is partly based on the number of accruals to studies, she worries that this puts emphasis on efficiency over quality. Although a temporary contract has “worked well” for Alice, she thinks the lack of permanent posts in her Trust needs reviewing. She feels that the lack of financial stability can be a barrier to some in taking research jobs and that it does not generate a “positive working environment”. 

Alice doesn’t believe that a lot of clinical experience is necessary for a research midwife; instead, she emphasises abilities to reflect on experience and enthusiasm over the quantity of time in clinical roles. For this reason, she encourages newly qualified midwives to consider this option if they are “someone who’s passionate about making changes and implementing innovation, and someone who’s able to transmit that to the staff”. She hopes that, in the future, she will publish her Master’s research and pursue doctoral study. She has several aspirations around where her career may take her, from teaching, to working as a consultant midwife, to promoting research at the consultant level.

Feeling more comfortable in her role was a gradual process for Alice.

I think, I don’t I don’t really remember a day where I felt confident all of a sudden I think it came with time and it was just one step every day maybe six months to feel to get into a routine or normal ‘okay so these are the people that would help me develop, people who would help me a bit less’ you know, and I think it just it just kind of developed every day. Probably yeah I would say six months but you never feel fully confident [laughs] I think there’s always room for improvement in your practice there’s always something that you need to learn every day so it’s hard to say that even now I don’t feel like I’m a 100% confident in anything I am very, I’m probably reflective as a person so time to reflect on my practice quite a lot.

Alice worked on several studies and had to approach patients in different circumstances. Since being in the role, she had started explaining to people why she has approached them about the research.

So it depends on the setting, so obviously in fertility it’s a different setting compared to gynae, maternity. So obviously maternity tend to be a bit more jolly as someone is having a baby so that’s good but if I’m, if I’m attending someone who maybe had a miscarriage or is a, has had a bleed and might be about, and might, you know, might be worried about their baby’s health and the pregnancy at early stages then I try to look a bit more maybe professional maybe just, you know try to listen a bit more serious. And in fertility I think it’s again different because patients tend to want to be listened more and have higher expectations because obviously fertility takes long not, I mean it’s just a long process that you have to go through in order to have a baby and some patients have been trying for a baby for a few years unsuccessfully and they’re very frustrated so they’re very, very delicate so any words if it’s not said in the right way can really affect them and affect their perception of the care they’re having which may or may not be reflective of, you know, reality.

But I think it’s yeah communication in fertility is a lot harder than maternity where, you know, you, someone’s having a baby so they’re happy, excited they might be worried about things obviously it comes with the package of anxiety but it’s a different it’s obviously a different layout. So now I’m mainly working in maternity so if I approach someone who is having scans or while they’re having scan I will try and keep it brief because I don’t want to interrupt the you know, the relationship with the sonographer and the patient but obviously because I walk in the room I would say ‘Hi I’m the research mid- I’m Alice I’m the research midwife and I’m just going to have a look at the notes to see if you’re eligible for one of our studies if you’re happy with that?’ and most patients are because it’s just about checking if they’re eligible they don’t have to, you know, make any, any agreement or they don’t have to then take part in the study.

So I will check the notes and then see how they interact with the sonographer and then I will say to the sonographer if they’re eligible and then I, they will wait for me outside the room once the scan is finished and then I will then see them and introduce myself again and explain in a bit more detail what the study’s about and why they’re eligible, that’s another big problem, sometimes we even say to the patient why them.

I think it’s, it’s something maybe I wasn’t doing when I started and, and some patients are very defensive about why me why would I want to be a guinea pig or why I would want to be, you know something that just an experiment and it’s very important to say, you know, you’re eligible because this is your first baby or you’re eligible because you have twins, you’re eligible and it makes a big difference because they immediately know why they can trust the study because that’s why we target them so that’s the first, the second thing after introducing that I try to say. And then what we’re trying to achieve with the study because they might be thinking why am I wasting my time here, what am I doing so what the study is trying to achieve why it’s important. So if we’re trying to prevent disease, why is the disease important and what it entails and why they may or may not be at higher risk of having that disease.

Alice gave an example about something she picked up in the course of carrying out research. She also felt she had gained more insight into the patient experience.

I think another good example is probably when we do data collection that we can pick up things that aren’t sometimes done. Quite recently we noticed that aspirin isn’t always prescribed when there are risk factors at booking and I’m not sure if it’s, I’m pretty sure it’s not just our Trust I think it’s something that can happen very often because early pregnancy seems to be nobody’s business sometimes because the GP tends to send the patients back to the obstetric team and the obstetrics team will send the patients back to the GP and then this goes on and on until the patient is so frustrated sometimes they just wait to see the midwife at 20 something weeks and it’s something that I think we should work on and sometimes we’re able to pick that up especially some studies were where we recruit patients quite early and we can you know, do something about that and we’ve had to really see sometimes step by step what the patients, the patients are going through.

We do something that maybe as a clinical midwife I wasn’t aware so after discharge I will think okay I’m working a 12 hour shift so the patient doesn’t need to be in so we’re going to discharge her and maybe refer her to a midwife and I wasn’t quite aware of how it may be difficult, the process is for the patient who actually access the services or sometimes getting the answers that she wants, it’s sometimes also a bit frustrating.

Alice talked about providing extra support and reassurance in her role as a research midwife.

I think it’s its different because in research because it’s something that it’s not mandatory by definition so it’s an option for, for a patient but it’s not something that they have to take part in, I think the relationship is it can sometimes provide that extra care that the patient may not get when it’s, you know, busy and in the busy clinical environment where if you’re, if you’re seriously ill the healthcare professionals and doctors might be focussing on some aspects of your care because obviously they care about you and your baby and they want to provide you with the best care possible. And sometimes some other aspects of the care are a bit neglected I think and that’s not, and it’s something that, you know, that, it it’s something that we all want to avoid but it can happen when you have to prioritise and you have a busy environment. So I think research can provide that extra support and we can also, you know, we have some time to listen to the patients as well and very often we identify things that weren’t quite picked up in clinical practice. We have a close relationship with our patients as well so they sometimes text us or, you know, they call us if they have a problem so they do end up sometimes getting extra, extra care extra support and I think it’s really nice that we can, you know, we can provide that and most patients in research are usually quite obviously I’m biased [laughs] but I think they’re quite happy and I think that they feel that, you know, they’re being listened to and that they’re given something extra that they wouldn’t have normally so I think that’s something that it’s, it’s quite important and it does reflect on the, the way we communicate with them and we, I think we provide some extra reassurance which is sometimes something that patients feel like it’s lacking. 

Alice felt the Clinical Research Network (CRN) funding system around recruitment was flawed in a number of ways.

So I am with, so I’m paid by the NHS but our posts are funded by the CRN [Clinical Research Network].

Okay.

So that means that it depends on the amount of accruals that we have if we get, if our contracts get renewed or not which puts a lot of pressure on, on, on efficiency of maybe quality of the work that you provide because sometimes there’s a bit of it’s, it’s difficult to define what efficient means. Having lots of patients recruited is probably efficient but also not being able to then follow them up and looking after them properly, is that efficient, I think it is efficient to be able to, you know, to have to, you know, to recruit patients in a smart way so that you’d be able to actually look after them properly and ensure they’re safe and, and that you are actually provided, you’re providing the trial with meaningful findings because if you’re unable to collect the data because you have too much, too many patients or if you’re unable to, you know, follow them up properly, you can see recruited too many patients you then, you will have lots of accruals the next year, you will have lots of midwives, lots of, you know, funding for midwives, the actual quality of the job you’ve done isn’t probably great. So that’s something that I think we probably should all reflect on and I can get there’s room for improvement.

Because I think it’s, some studies are also more time consuming so for, for a patient you have to spend, if you want to do your job properly, if you care you want to spend some time with them and that time is just recognised as one accrual, one patient. Whereas for other studies where the ethical implications are there but they’re still, they’re, you know, minor you can spend less time with patients and that time isn’t recognised in any way and it, it’s, we’re, you know, it’s not encouraged there’s no encouragement for us to spend more time in actual quality of the job that we provide, of the care that we provide so I think yeah that’s probably something that we could look into.

Also all the questionnaire’s I think questionnaires and qualitative research doesn’t count as accruals which is such a shame because it’s so important and there is no, sometimes there’s very little point in having these big numbers if you can’t actually give meaning to the numbers that you have.

Alice pointed out that the notice period on contracts for research midwives risked them becoming unemployed as there may be delays in getting another job.

So also sometimes you may not have enough notice to be able to find a job because we actually have as Band 7’s we have eight weeks’ notice so in theory they could, you know, it doesn’t happen in practice in any decent workplace but in theory they could, you know, decide not to renew at a very short, with a very short notice. 

And then, you know, it’s unlikely that you will find a job in eight weeks because obviously if you start applying for a job there’s a process that you have to go through and the job application would be open for a month and then you have to wait for the shortlisting period and then you have to wait for the interviews and then if you’re lucky enough to get the job you have to go through HR [Human Resources] which is tedious, quite a tedious process and it takes a while for HR then to go through vaccinations with you and, you know, all the checks that they need to do and then you eventually get a job. But it might mean that for a couple of months you might be unemployed and that’s something that for some midwives, some people in general it’s just not something that you may want to contemplate, you know, if you have a mortgage like I said and children you just need a regular income.

Alice’s “ideal job” would involve “promoting research” but she felt there were lots of career options available.

I’m interested in lots of different things I’d like to have I would like to do a PhD in the future I’m trying to publish my research from the Master’s which I think is the first, kind of the first step towards PhD which takes longer than I would have hoped but I think yes that’s probably what my career progression would be. I would like, there are many things I’m interested in so it’s not it also depends on what’s available and what’s, you know, needed at certain time and, and place. I’d like to think that I’d like to move to higher education as well maybe one day be able to teach I’d like to work as a consultant midwife as well one day, I think it’s a very important role so I’d love to do that. But I would love to find a job I’m, you know, comfortable with and maybe promoting research at the consultant level, I think that would be probably my ideal, ideal job. But yeah it would depend, it depends on what’s available and most times I it can happen that you know, you might change your minds in your career and what, what you like and what you hope but at the moment I feel like that’s something I would like to do, yeah.

Alice encouraged newly qualified midwives to consider research roles. She felt that having non-research clinical experience was not the only important characteristic, and instead emphasised enthusiasm and a research-positive mind-set.

The main thing is to be enthusiastic and it is an amazing role and we need more enthusiastic people taking part in research and to promote research and to show everyone why it’s important and why we need, we need new midwives, someone who’s newly qualified, someone who’s maybe fresh from their studies to actually say I may not have enough, you know, I may not have a lot of practical experience but I am going to value my, the experience I’ve had at university, the fact that I know I have more recent studying experience and I know how to access evidence so I’m going to use that towards improving the care that the patients have and to improve the knowledge that we have about diseases that affect our job on a daily basis. So I would say, I think sometimes research is seen as something like a career progression or something you will do when you’ve have enough experience practically, there’s a, this belief in healthcare that you have to have 25 years’ experience before you actually can start pursuing a career which I think experience help but not everyone elaborates experience in the same way. So maybe someone with good reflective ability may be able to learn more from one day, one shift in the labour ward than 25 years, you know.

So I think especially newly qualified midwives should, midwives should, we should encourage because in other fields they do that they, they do a BSc and then Masters and then PhD and then they start working and I think for us it’s something that’s so unthinkable and I understand why but my personal opinion is that I, I don’t think I think that we need someone who’s new, who’s newly qualified maybe or maybe they’ve had some experience, someone who’s passionate about making changes and, and implementing, you know innovation and someone who’s able to transmit that to the staff because I think sometimes especially someone has worked in a certain way for a number of years it’s harder to then re-think your behaviour because it’s so embedded in your identity, you think oh that’s what midwives do so now you’re telling me to do something else.

Whereas I think if you’ve just been trained you probably are more flexible and you, you want to learn and you, and if you, if you learn how to, how to learn from the beginning then this mind, this research mind-set will stay with you throughout your career and you can start your midwifery career with research, I think there, that’s, there’s probably this misconception that you have to be old to start research or you have to be, you have to have a few years of experience before you can start and that’s fine some people do that and that’s fine.

Alice encouraged employers to provide research midwives with more stability with open-ended (rather than fixed-term) contracts.

Obviously there’s there are some Trusts that have permanent contracts for their research midwives and I think it makes a massive difference, I think some midwives may decide to leave because it doesn’t provide financial stability to them. I think it’s, it’s worrying especially if you have children you know, if you have mortgage it’s something that you can’t afford so I think long term that’s something that we will need to look at because we do have research so we should trust the fact that you need a permanent post and it’s not something that may or may not happen next year, you know, you still have your patients you have to follow them up you have to make sure they’re healthy, you can’t just say from one day actually there is no funding for research midwives so you’re on your own. So I think it should be, it’s something that it should be embraced within the NHS and we should provide some more security for our midwives and I think sadly that’s why many midwives don’t get into research because they think how am I going to, you know, afford a mortgage or the rent and what if my contract doesn’t get renewed because there aren’t any funding’s for me how will that affect, you know, my ability to find a new job?