Christine

Age at interview: 54

Brief Outline:

Christine has been a research nurse for two and a half years. She is based in a generic research team but has a special interest in paediatric care and research. She enjoys the work and wishes she had known about the research nurse role earlier.

Background:

Christine is a research nurse. She is married and has children. Her ethnic background is White British.

More about me...

Before becoming a research nurse, Christine had been a clinical nurse for nearly 35 years, with 12 years in the private sector. She was thinking about leaving nursing as she felt frustrated by the role and found the shift patterns were negatively affecting her quality of life. By chance, a friend suggested she might enjoy working in research and, in a way, she feels the role “found me”. Christine was initially put off because she thought she would need to have a nursing degree and possibly a Master’s. However, she looked into the role more, and liked the idea that she would have more time for patients and would be helping improve care in the future. Christine was a bit unsure about going into a fixed-term contract but also saw it as “a bit of a ‘get out of jail free’ card” in case she didn’t like the job. She has been in post now for two and half years, and expects that her contract will be made permanent in another six months.

The first 12 months in post were a “massive learning curve” for Christine. Someone gave her an academic paper about going from an ‘expert’ to a ‘novice’ when changing professional roles, and this really resonated with Christine. She worried about whether she was doing things correctly and it meant getting to grips with unfamiliar abbreviations. She was also new to the Trust and had to learn about how it worked. Christine found her research team were very supportive and she had lots of training; she didn’t feel pressured to instantly understand the “very different world” of research. Christine gradually built up confidence and, after a year, could reflect back on how far she had progressed. She has dealt with some difficult situations but feels it is important to “never be afraid to ask” if you’re not sure what to do and, each time, she has learnt something new.

Christine has worked on many different studies, including on diabetes, eczema and asthma. Some studies are focused on adults but paediatric research is the area that Christine is most passionate about. Her role has involved identifying potential participants, recruiting, collecting data, and doing follow-ups. There is also a lot of paperwork and inputting data. Christine finds that “each day is different” and she has to carefully plan her time. As her skills and confidence have grown, she has felt more able to take on more studies and other tasks – such as setting up studies. A major challenge for Christine in her role has been a lack of available space in the hospital for research activities, meaning she often has to “beg, steal and borrow” it, although good working relationships with clinical colleagues can help. 

Christine thinks research nurses should be “optimistic, organised, methodical, a good listener” and able to get on with different people. She feels it is important to develop a rapport in even relatively brief research encounters, so that participants know their contribution is valued. Likewise, for participants who are on the placebo arm of a study, Christine says the data is important because “we need both sides of the coin to tell us what is best”. For Christine, it is important that research nurses working with children have their assent and tread carefully, taking everything step-by-step. She has found that sometimes parents are very keen that their child take part in the research, but Christine feels it is her job to give the child the choice – especially if the child is a ‘well’ volunteer and the study involves something that might hurt or frighten them (such as having blood samples taken).

Christine likes that she has other research staff in her team that she can talk to and seek advice from. She feels that having a line manager who is “very active and enthusiastic about research” is important, and that this “passes down to the team”. Christine has also made connections with other research nurses regionally – including those who specialise in paediatrics. Christine plans to continue building on her skills and experiences in research nursing, and to be involved in “raising the profile of paediatrics [research]”. She wishes she had known about research nursing sooner, particularly as she thinks it would have been ideal when her children were younger, and she could have already established herself as a research nurse by now. Christine’s key message to research nurses who are relatively new is to “stick with it and speak to your colleagues, because they know how it feels” when adjusting to the role.

Christine explained that there is not always a direct benefit to the participants in studies, but hopefully there will be one for future patients.

Not all studies give the patients a-, there's not always a benefit for the patient, but it's about the bigger picture. And so I think as long as you sell it or tell them that that's what it's about, it's about adding to that picture, and the more information we get to this picture, then hopefully somewhere down the line- especially with diabetes and sort of for example the [study name 2] study, it's about screening relatives. So, you know, these people have got relatives who've got type one. They don't. They're well participants who are contributing, who are agreeing to have a blood sample taken and information taken, and look to see whether they've got the antibodies, to give us information. And hopefully they'll come in to monitoring because that's the important bit, really.
To get that long term picture of patients who've got antibodies, and what that journey for them is going to be before they will develop type one, or do- may develop type one.

And when you explain that to them, that it's about that travelling, that journey with them, to gain as much information. Possibly not for their benefit. But hopefully it's going to add to that aim of 'can we find a cure for type one', or ‘can we prevent it'. 

So it's about- for me, it's about knowing the study. It's about looking at what your patient is going to gain from it. And if they're not going to gain something, what are they going to give to the society, to the group in the whole. And I think everybody wants to feel that they've done something to help. And I think that can be a very positive thing, and a very positive way of putting the study across.

Christine hoped that a move into a research job might revive her enthusiasm for nursing.

I had been a ward-based nurse and was getting to a point where I was feeling a bit frustrated within that role. And within nursing, really. And I didn't know whether it was the role, or whether it was me and nursing and I’d come to the end of the line with it. And was considering leaving altogether. But my love, my passion, has always been [laugh] for nursing and healthcare and making things better for patients really. So I'd met a friend who worked in research. She was a clinical trials assistant. And who knew me personally, not sort of professionally, but knew me personally. And said, “I think research would be really-, you'd really enjoy it”. And I sort of thought, I hadn't really thought about it. And so then I did a bit of research about what research nursing was about. I'd always felt that it was too academic for me, that I wasn't sort of in that sphere of academia, cos I never did a degree, and I'd been very much a hands-on nurse. So I didn't know whether or not it'd be, I'd be able to understand it, or facilitate it and be good at it really. And then I met up with the lead research nurse at where I'm working now and I thought 'yeah, I think I could give it a go'. And I didn't think I would have anything to lose, because if I was going to leave, at least I'd tried to regenerate my enthusiasm for the healthcare system.

So, that was really- it was more a case of it sort of found me really through a friend. And then I had to sort of find out what it was about, because I had no real idea. Cos it wasn't anything I had really looked into it before.

Christine couldn’t tell whether she was enjoying working in research or not for the first few months. She was given a helpful article about going from “expert to novice”.

And I think the biggest thing for me was, you know, people when you transfer, when you move across from- which I was, was a clinical nurse, into that, I had no reference point. So for me, if I'd moved from one ward to another, I still had, there was still basic things there, I knew what I needed to do. But within research, it was- people said, “Are you enjoying it?”, and I thought 'actually, do you know what, I don't know'. Because I don't know whether I'm doing it right, I don't know whether I actually know what I'm doing. I didn't. So it took-, I think it took 12 months before I could look and think ‘have I learnt anything? Have I, can I do this? And am I enjoying doing it?’ So there was two very different things that I just had to be-, I just had to ride it out. Whereas I'm very much one with you think, you know, you get a, I get a very strong gut feeling of 'yeah, I've happy at this, this is great'. I didn't miss my clinical work.

So, that was the my thing of 'well, I'm not missing that, so I must be quite liking this' [laughs].

[laughs]

And it took a long time, really. I think family were a bit worried, because I couldn't- I didn't talk about it, because I didn't know how to talk about it, because I didn't really know. You know, I was just every day, was a massive learning curve. And it was interesting, there was an article* that I’d, that somebody gave me when I started the job. About that, from expert to novice. And it's a brilliant, it is actually a really good article, I'd recommend it for anybody that's transferring across specialities or into a diverse bit of your career path with whatever it is. It's a very good reflection that they've done on, you know, from something that I could have run a hospital basically with my eyes shut, to being in a situation where I thought 'I don't even know what you're talking about'.

You know, 'What is GCP [Good Clinical Practice]?' You know [laughs] all these lingos and sort of term-, abbreviations that are used that I had no idea about.

*Gleason, K. (2011) ‘Role Transition’ when becoming a Research Nurse, available at https://clinfield.com/role-transition-when-becoming-a-research-nurse/

Christine had supportive colleagues, which helped when she started her research job.

And I think the team were amazing. Because everybody just said they had no-, you know, they just said, “Don't expect anything, just be a sponge, just see as much as you can, ask what you can, if you don't understand just ask”. And they had no expectation to put pressure on me for any length of time, until you felt ready to do it really.

So I think it was- and that was difficult, because in a ward, you know, we're not quite so patient when a new nurse comes on the ward [laughs]. Because you're like 'come on, really need you to go and do that admission, and we need that admission done really efficiently and really quickly because there's another one needs doing'. And that, that- there wasn't that. That certainly was not the atmosphere. It was a very supportive, and just you know, “Just take as long as you need”, there's no, you know, “You've just got to,” you learn this as you do it really.

Christine had lots of training and opportunities to shadow other research nurses when she started.

The, there was a sort of a- I had a month where I just had lots of gaps to fill. So there was lots of training needs needed doing. So GCP [Good Clinical Practice] training, informed consent. And in the sort of department we're in, they say, “Yeah, you need to have your GCP done straight away”, but what they insist is when you're six months in the job, you go back and redo it. Just cos actually after six months it actually makes more sense, although you need it to start the job. To actually make it a usable day, you need to go back and relook at it once you've had a little bit more sort of submersion in research really.

So all of that we were given time to do. There's lots of obviously mandatory training that has to be fulfilled. I hadn't worked in the Trust before, so that was a whole new level of, just basic level of how the Trust works. And then sort of orientating with departments. So going-, working with kind of, with R&D [Research & Development] themselves. Going to work with different research nurses to see how different people do it, because there's no hard and fast rule in this. And, and, and seeing as much as you can. So watching patients-, watching somebody else do informed consent. No matter what the patient was being consented for, whether it was my speciality or, it was immaterial. It was about that process of how you prepared a patient and how you spoke to them, and information they needed to be given. Watching visits. You know, some of the visits in diabetes research at that time were very clinical visits, so it could take a couple of hours just to watch and see that process. And also the preparation before the visits. So you were given a lot of time. But it was- although you were sort of, as I say, a month, it was just long as I needed really. So if there was something I needed to see, I just went and did it. If there was a course that was going to be beneficial like, you know, informed consent, I went and did it.

Christine said research nurses need “to get on with people across a broad spectrum of networks”. This included trying to motivate consultants engaged in research who are often under a lot of clinical pressures.

Optimistic, organised, methodical, a good listener, able to get on with people, across a broad spectrum of networks really. Because you're dealing with, you know, academics and, like yourself, from universities. Or you're dealing with businesses. And you're dealing with consultants. You're trying to motivate consultants. That's quite challenging, sometimes. It's just like, I'm, I'm sort of go on the principle of a bull in a china shop, must be it's my Taurus. But I'm very much of 'I just need you to do this, is there any chance you could get this done?' and I'm very much a face to face. If I email, if I don't get a response, I'm like 'do you know what, I'll just go and see them'. So I know I've always got to put myself out there a little bit more, you know. And you know, within the first few weeks, I very quickly realised they do need- You know, they're very busy. They've massive clinical load. So as regards research, it's, it's there, but it, it will always take a second to the clinical needs. Which is obvious. But, so things like reminding them when they need to do the GCP [Good Clinical Practice] training, when they need to do it, sending that reminder. And actually giving them the link to-, you actually, there's a lot of, you know, really pushing that side of that relationship to support them, to do, to help you do what you need to do.

So, yeah. I think it's about not always taking no for an answer. Being able to push past that. And, and finding ways to see solutions to problems. So, yeah. A bit more lateral thinking helps.

Christine said it was a major challenge to find rooms to see patients, and there were no obvious solutions. She had visited another hospital with a purpose-built clinical research unit.

[Exhales] Beg, steal and borrow really.

[laughs]

It's a bit, yeah, that is- it's a really tough one. Really tough. I mean, there's some room- there's a room that's available, that's been sort of designated a research room but diabetes research have dominated its use. And that's not a problem, because they are constantly using it. But it then means that we've got no other fall back for anywhere else. So, you know, like I today go down to paeds outpatients and a day off tomorrow but one of my colleagues is seeing a patient. And I said, “I just need a small space”. And it ends up being any space. You know, as long as you've got two chairs and a table, that's all we need. And, “I need it for half an hour, and I promise I won't be any longer than that”. So there's a lot of negotiating. I mean, we can go through outpatient systems, but they're- you just know that they're really busy and every space is being used. So yeah, that's- that is always a bit of a headache when it comes to-. You know, some of the studies see their patients in outpatient clinic, as part of the clinic. So that's usually, that's fine, because the consultant's part of that visit. So, they'll, they'll have a-, they know that they can take them in, when they're being seen, and that's fine. But, yeah. Space is a major issue. And it, it's one that we would all just love- you know, I went to [City] and they've got a purpose-built clinical research bit, and you just go 'I'm just so envious'.

[laughs]

And everybody's together. So not only have they got clinical space of like a bay area, but individual rooms. All of the team are in one massive open plan office. So R&D [Research & Development] are there. Everybody from all of the different research nurses, from all the different- are all in one space. And you just think 'that's just so supportive'. It all works. It, you know. 

And yeah, they just have the spaces and it’s a bit like ‘yeah, it's nice’. And I think from patients-, you know, when you go to [City], it's the clinical research department. It's got its own door, it's got a waiting area. That means such a lot. You know, and I, and I think- but space is always an issue with a small hospital, it's always going to be, you know, building upwards [laughs].