Nurses, midwives & allied health professionals in research

Employment and working arrangements for research nurses, midwives and AHPs: an overview

Working arrangements and employment circumstances were often talked about by the research nurses, midwives and allied health professionals (NMAHPs)* we spoke to. Comparisons were frequently drawn between their experiences in clinical non-research jobs* compared to research jobs. Covered in more detail in their own sections, the main topics discussed were:

Vicky outlined some of the changes in her work life when she moved from a clinical to research post. This included shift patterns but also hours and having work-life separation.

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Age at interview: 47

Sex: Female

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So when I was working clinically, it was 12 and a half hour shifts that could be days, nights, weekends, weekdays. And then when I moved into a research post, it's Monday to Friday, effectively nine to five. Although it's flexible, in terms of hours worked. And also changed from 37 and a half hours, if I were to have been full time. I was part time, but to in my post now of full time, is 35 hours a week. But it brings different aspects to it as well. So obviously when you're working clinically, whilst you might access email a little bit as part of the role, it's not a big part of my role. Whereas now, the boundaries I guess between working hours and not working hours is a little bit different, in terms of accessing email and working on paper-writing, and those sorts of things, which inevitably fall outside working hours. So it, it's different.

Their working arrangements depended on many factors such as the employing organisation, funding arrangements for studies and whether they also had clinical non-research jobs/splits. The main employers were: Trusts/hospitals, research networks (including the Clinical Research Network/CRN), universities, hospices, and commercial organisations. The relationship between employing organisation and funding allocation was not always clear-cut to research staff, and was further complicated by the fact that many worked on a mix of studies with different funding origins. Some people had two or more contracts for research jobs with different employers and this was potentially in addition to separate clinical non-research jobs (including bank shifts). For example, Jed was employed by both a Mental Health Trust and a hospice, whilst Barbara was employed by a university in one job and a commercial organisation in another.

There were advantages and disadvantages to different employers and funding arrangements, including impact on pensions, mandatory training, and access to libraries/journals. Sandra felt the Clinical Research Network was “one of the best organisations to work for ‘cos I just get loads of opportunity [for research training]”. In terms of those employed by (or with a dual contract that included) a university, Abi liked being able to go to seminars with invited speakers and Ginny felt it came with “kudos”. In order to carry out their research in healthcare settings, those employed by universities were required to have an honorary contract/a letter of access with the Trusts they would work within. Another issue around the employing organisation was whether or not research staff could be officially asked to cease or reduce research activity to ease clinical staff shortages (especially in wintertime) and whether they were given time off (and their jobs back-filled) in order to undertake internships or academic qualifications involving research.

Helen explained a bit about the funding arrangements for research NMAHPs in her team.

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Age at interview: 53

Sex: Female

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None of us are funded by the Trust at all and we get what’s called Activity Based Funding Units so we have a target that we set ourselves in many ways but it is also given to us by the Network, Clinical Research Network that we’re affiliated to in this area. And then we have to recruit really a number of, a certain number of patients so if it’s an interventional study then you get 11 ABFU [Activity Based Funding Unit] points, if it’s a non-interventional study with less than 10,000 patients you get 3.5 and if there’s more than 10,000 patients you get one ABFU, so that equates to anywhere between £65 and £85. So half of our funding in my department comes from ABFU funding but that doesn’t really cover the costs of the staff, all of the staff. We get some funding then from supporting and facilitating commercial studies so and one of the high level objectives in the Department of Health is to recruit and open more commercial studies.

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

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Age at interview: 29

Sex: Female

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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.

Dawn described tensions when there are major pressures on clinical staff. She is employed by the Clinical Research Network, rather than her hospital Trust, but expected that research staff might be pulled in to help.

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Age at interview: 55

Sex: Female

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I know that there was a comment made on, on a, on an adult ward when I was on there and, and it was during the crisis time at Christmas when the, there was a crisis right across the UK. And one of the sisters suggested that during crisis, should we be doing research and not be relocated back onto the ward? But actually within our Trust, if they wanted the support in any department during crisis, we know that we would, would be asked to go and help. And we do help, I would-, I did help more during the crisis period but I didn’t go onto the ward and do a full shift as a, as a ward-based nurse. But what I did say was-, so I did explain that to her, that we would if we were needed, and if she felt that while I was on the ward she wanted-, the staff needed a bit of help doing anything and I was quite happy to do, to help out, within my capacity for what my knowledge base. But I did say, suggest to her that she, we are contracted as well to our studies and that that’s important too. And that it may be that we have a responsibility to find the patients and consent the patients onto the studies, but balancing that against if somebody, if nurses on the ward are really struggling then of course our Trust is going to pull us off and put us onto the ward, yeah. But I don’t think they realise that that would be the case.

Footnotes

*The people interviewed for this website were mostly research NMAHPs (i.e. those employed in a research delivery role). However, we also interviewed some NMAHP researchers (i.e. those leading research as independent researchers). The latter group included people who were undertaking or had completed academic research qualifications, such as PhDs, and many had previously been in (or continued to also be in) research delivery roles. For more information about the distinctions between these roles and the sample of NMAHPs interviewed for this project, please see the Introduction section.

*Many research NMAHPs and NMAHP researchers felt strongly that they continued to be clinical within their research roles. As such, the wording of ‘research’ NMAHPs/staff and ‘clinical’ NMAHPs/staff can be problematic for implying that research is not also clinical activity. Where the wording ‘clinical staff’ is used on the website, we mean for this refer to non-research clinical staff (i.e. those who are not currently employed to carry out research or enrolled to pursue research through an academic qualification).