The nurses, midwives and allied health professionals (NMAHPs) in research* that we talked to had various career plans. Many were not sure about what would be next for them but felt there were lots of avenues possible because of their research experiences. Layla explained that working as a research midwife had “opened up quite a lot of possibilities and I'm just still finding out what are all the different routes that you can go… If something interesting comes along that's relevant to it, to take up the opportunity”. However, some felt that, despite the research career pathways available to them having got better over time, there was still a lot of room for improvement.
Rachel X felt she had developed transferable skills for other work situations, but that she would need to be pro-active about career progression.
Rachel X felt she had developed transferable skills for other work situations, but that she would need to be pro-active about career progression.
Age at interview: 28
Sex: Female
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I think you need to be quite careful that you don’t that you move things on quite quickly yourself. Because I, I’m in this role and I’ve done it for just over a year, and I feel that I need to move on. And I feel that there isn’t a clear route, it’s not that if you do this for so many, you demonstrate that you’ve done this and you do it for a year, then we’ll move you up to a Band 7, you have to, you have to be quite pro-active, pro-active in your own career.
So that would be the one thing I would probably tell people to advise, that you have to, you have to know what you want to do next because you could quite easily sit in a role for quite a number of years, doing the same thing. It gets quite comfortable and ultimately, you’re in academics and like I said before, your name doesn’t tend to appear on any papers, so if it’s some, it that’s something that you want you need to fight for it, and you need to really push for that. Or you need to think about your own research and whether you’re going to do a Master’s or a PhD, or just your own research project in general, but you need to, I think you need to think further ahead than I’m just going to go into research.
Alice’s “ideal job” would involve “promoting research” but she felt there were lots of career options available.
Alice’s “ideal job” would involve “promoting research” but she felt there were lots of career options available.
Age at interview: 29
Sex: Female
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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.
Carlos felt there were many directions physiotherapists interested in research could go.
Carlos felt there were many directions physiotherapists interested in research could go.
Age at interview: 26
Sex: Male
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I guess people that do a PhD will get involved in, in teaching quite a lot. And, but again within, within research that’s-, as a physio like any other professional, health professional, there’s a lot of things you can do. Yeah from being, from becoming a professor and having your own, own trials, as specialising in clinical trial management, and being-, and later on being the manager of a unit and having your- your unit with trial managers and trial coordinators, so working with you. As simple as focussing and recruiting on the Clinical Research Network and recruiting patients for physio trials. So, on this particular trial we don’t have any objective assessments, but some trials do, and sometimes they are required to be physios or in or nurses to do that specific assessment. So yeah, there’s a lot of things, even inside research as a physio or as an occupational therapist, as a nurse, you can go to. I think it’s pretty much an open book [laughs] once you get into it.
Many people spoke about their ideal future careers, but also about the barriers and considerations which shaped their hopes and intentions. Those on fixed-term contracts in research delivery roles and those without a post to return to once they completed their academic qualification often described having a ‘back-up’ plan which was not their first choice. Sugrah’s contract was due to end soon – she hoped it would be renewed but would pick up bank nursing shifts if not. Gavin hoped to secure a clinical-academic post once he finished his doctorate but returning fully to clinical non-research work was the “fallback position”. Melanie, Sugrah and Ginny highlighted that any plans they had for their future careers needed to fit with their families.
Career options were also adjusted as circumstances changed. A contract renewal allowed Paul to go from having a one year to five year plan for the future. Katherine thought that changes in her family over time would allow her to take up opportunities, including within her doctoral fellowship: “[as my children] get older, I’m ready for new challenges”. A couple of people were planning to stay in research for a while but did not see it as a long-term commitment. Sarah felt that the balance of activities in research delivery roles were not quite right for her long-term.
Abi had two more years of a contract left, but wasn’t sure what would be next.
Abi had two more years of a contract left, but wasn’t sure what would be next.
Age at interview: 37
Sex: Female
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So now I’m on a sort of a three-year trajectory I suppose on, on three different research projects, one of which I’m a co- investigator on, so I was on the application for the funding, and we got the funding, so I’m a researcher and a co-investigator on it, which is really good. Obviously that’s a fixed term affair, so I’m going to be a researcher, a post-doc researcher, for well I’m a year in, so the next two years. And beyond that I don’t know. I don’t feel particularly inclined to be a lecturer, that might change, so, but that’s, that sort of the long term employed permanent position way to go, within academia. I don’t feel particularly inclined to be a permanent position, clinical speech therapist in a, an NHS setting for instance. But I don’t know where that leaves me, so I guess I’ve just been enthusiastic about everything I do up until now, and opportunities have presented themselves, and I’ve seized them. And I don’t necessarily always know quite what it’s going to be, but I’m quite open to the next interesting thing, so, watch this space, I suppose.
James planned to stay working as a research nurse for now, but was open to the idea that this might change.
James planned to stay working as a research nurse for now, but was open to the idea that this might change.
Age at interview: 39
Sex: Male
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I'm very open-minded really, about the future. I would, I wouldn't- I'd never say never to anything. And if you ask me again- If we were to meet again in five years, and I was an electrician, I wouldn't be surprised. Or if I was back working on a ward, I wouldn't be surprised at that either. I'm really open about what will happen. Short term, I think I will definitely be staying as a research nurse. But I'm open-minded as to what the future may hold. And you know, the- Will the NHS be privatised? Will fundings be cut? I'm, I'm just totally open to where life might go.
Being a research midwife suited Tabitha currently, but it was not something she wanted to do for a long time.
Being a research midwife suited Tabitha currently, but it was not something she wanted to do for a long time.
Age at interview: 35
Sex: Female
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No. I was no, I don’t. I think at the moment it affords me a really good work-life balance and there are lots of opportunities that come with it, especially in the project that I’ve just finished. And, you know, there was there was a lectureship that came up at [university] and the head of the course at [university] told me I should apply cos I’d been and done the seminars and stuff [baby noise]. And I didn’t because I thought my work-life balance would completely change, but I feel like that’s probably the direction I'm going to go in one way or another. Whether that’s, that means doing a PhD or not, I don’t know. I really-, I really value what I do now for the opportunities it’s given me but it’s essentially, it’s doing someone else’s research for them and I just don’t find that very interesting at the end of the day, compared to doing my own research, I just found it a lot more fulfilling I guess.
Continuing in research jobs
Some people planned to continue in their research delivery roles, or go into similar ones, for the foreseeable future. This was the case for Laura Y who was intending “to stay in research for a long time, I don’t want to leave. I'm really happy here”. Many people emphasised that they enjoyed constantly learning in their research roles, and anticipated this would continue. Jo, a research nurse, described it as “a layering up process”. A few people said they had no plans to change jobs/role, but they would like tweaks to it. For example, Ella said she would like her job to involve less travel.
Some people anticipated that they would gain more skills, develop their expertise and have scope to diversify within their current research role. Rachel X was interested in broadening her experience of clinical research beyond midwifery to include areas like infectious diseases and oncology. Sugrah was hoping to be approved to teach Good Clinical Practice soon. Sometimes it was anticipated that taking on new activities or gaining training within their jobs might lead to promotions, but other times this was not a key motivator. Jisha was a research nurse and said she would like to lead/run studies but felt she needed training, perhaps through a Master’s degree, on how to do this.
A few people were planning to stay within research delivery but move into managerial and leadership roles. Louise was thinking about doing a leadership course, and thought this might lend itself to a role bridging “the gap between the Band 6 [staff] and then the management”. Nikki and Ellen were about to start new jobs which would involve leading teams of research staff.
Rachel X described some career options available to her. These including moving into a senior research midwife role, undertaking a PhD and moving to work in a pharmaceutical company.
Rachel X described some career options available to her. These including moving into a senior research midwife role, undertaking a PhD and moving to work in a pharmaceutical company.
Age at interview: 28
Sex: Female
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Well there’s, there are Band 7 senior research midwives, who, it, again it’s the same as a normal job, you do, you kind of have to wait for the opening and then apply. And they would be, you would definitely need experience for that, and they have more of a, an oversight of a lot more studies, and they’re, they supervise junior research midwives, and then, so there’s the NIHR, have a, a scheme for health professionals, to do their own research project. So they fund it, so you need to, but it’s a bit, bit like kind of applying for a PhD, you have to formulate your own research proposal and apply, and they would give you the funding to, and they would also fund it in such a way that you can maybe continue with a bit of clinical work and then, you know, half your week is actually dedicated to your research. And then you know you write that up. Unfortunately, that used to be a master’s degree, and then when I wanted to do it this year, they stopped the funding.
So, I would, that’s what I was intending to do, but I felt that it was a shame that you would do all of that and not get anything, not get any qualification at the end of it. So there’s that, and then a lot of people go and do PhD’s and you don’t need to do a master’s for a PhD is what I recently found out. I thought that it was a straight line, but that’s what a lot of people do. And then actually a lot of people are going, that I know are going into pharmaceuticals. So, there is a quite a, you can make that step, the skills that you learn within research midwifery can translate quite directly over to a pharmaceutical company.
Ellen’s new job would be a move away from the clinical areas she was familiar with. She hoped to channel her experiences as a research nurse into being a manager.
Ellen’s new job would be a move away from the clinical areas she was familiar with. She hoped to channel her experiences as a research nurse into being a manager.
Age at interview: 50
Sex: Female
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So I've been offered a Band 7 team lead at the other hospital, the one with all the staff in the big offices [laughs], so that's to manage a team of Band 6 research nurses in clinical trial offices.
So I should still be doing some of what I do now. I'm going to keep my stroke patients that are in follow-up and do that as part of that clinical thing. Because you build up a relationship with them. And so, and then- but stroke actually isn't-, is only at the centre I'm at now, it's not at the centre I'm going to.
So I will be involved in other specialities. A lot of overseeing. And a lot of supporting staff with study set-up. And managing staff really, which I haven't done before, and all the annual leave and sickness and all that stuff that my line manager now does. Appraisals. And I have to do the nursey bits because the other Band 7 isn't a nurse by background. So I have to do all the revalidation thing.
It'll be interesting. And I'll be taking part in a lot of the more managing, management meetings. Which we're not privy to at the minute, so. Well I've already been to one. So it's interesting. It's interesting to see where- well, the pressures they're under [laughs]. And that's why the work filters down to my level.
Being a nurse and helping patients was at the core of Michael’s plans for career development.
Being a nurse and helping patients was at the core of Michael’s plans for career development.
Age at interview: 29
Sex: Male
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I would say I’m quite an ambitious person, but equally I’m very much a nurse, and I will always be a nurse at my heart and my core. So it’ll always be a job in nursing. But what I love is service innovation and research. That’s why I’m doing my PhD at the moment. And I would like to see that coupled in a clinical-academic role, so an area where I am bedside, patient-facing but perhaps leading a team, looking at service improvement, and I could do all that as a research nurse. So I could work three or four days a week running my own clinical trials and then be helping, you know, six hours a week set up academic studies, collaborating with studies, and looking at service and improvement, service improvement. I think it ultimately as any health professional, not just a nurse, you always need to be asking the question, “How can we do this better?” And being a research nurse and being somebody who can be involved in that process is a good way of answering that question. Cos you are looking at trying to do things better.
Those who had a clinical* and academic split in their posts, or separate jobs in both areas, were usually keen to continue this arrangement. A few people planned to adjust the balance slightly, and there were different reasons for this. Mary had two separate jobs – one as a researcher at a university and one as a health visitor. She felt the climate for health visiting had become increasingly difficult and she was unsure whether she would continue practising in addition to her research job.
Sandra would like to continue supporting research capacity building and maybe carry this through to other “research naïve areas”.
Sandra would like to continue supporting research capacity building and maybe carry this through to other “research naïve areas”.
Age at interview: 43
Sex: Female
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I think I do feel that I’ve got more to give in my career but I’m not sure what that’s going to be yet. I don’t have any imminent plans to leave research. I love what I do. I think I work for a great organisation, I feel very cared for and looked after I think there’s great opportunity, I think there’s always new things coming up, I think I do, have realised that I like setting up new things, so when I came into working with palliative care and setting all the stuff up with the hospices, which wasn’t necessarily as much my nursing side, more a facilitation role, I’ve really enjoyed that helping other people to be able to do this, and I can’t do all of that on my own, but seeing that actually multiply that up by all these people, it’s really good. And the same with my care home work, I’ve been able to do those same sort of things. So, whether I think there might be some opportunity to work with other research naive areas, so I think that’s something that I’m quite interested in, so possibly doing more work with maybe schools, or with prisons. Areas that perhaps research doesn’t go on quite so much in but is equally valid areas for people to do it. Apart from that I’m not really sure. I feel that I want to do more, but I haven’t quite got a handle on what that is, but I’m not in a rush to find it because I’m enjoying what I’m doing right here, right now.
Jo planned to start working bank shifts to keep up her clinical nursing skills.
Jo planned to start working bank shifts to keep up her clinical nursing skills.
Age at interview: 49
Sex: Female
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One of the things that I’d quite like to do is pick up a few bank shifts and do, go back and do a few clinical shifts just to, just to sort of keep my skills up. So, I mean you do, it’s not the same as working in a clinical environment, you know, I mean I still, there’s, you know, you’ve still got that patient contact, you’re still doing, you know, taking blood samples and all those kind of things, observations and various, but it’s, you know, it is different, most definitely, you know, they’ve, the desk time is different and you know, and all the paperwork is, there’s much more but yeah I would, would, I will go, I have been planning to do it for a while but I’m definitely going to go back and do some clinical shifts and sort of see how I get on.
Sarah had tried to combine more clinical work with her research job, but it had proven difficult to arrange.
Sarah had tried to combine more clinical work with her research job, but it had proven difficult to arrange.
Age at interview: 31
Sex: Female
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To find a clinical and a research role combined is very, very rare. To work- so, you could, so you could say, “Okay, well I could work part-time clinical, and part-time doing research”. Well actually, most clinical jobs are shifts, doing shift work. So then you have to be that awkward person that kind of says, “Well I can only work, you know, I can't work Thursdays and Fridays, you know, I have to commit to a certain kind of-”. And most places, unless you've built up a very, very strong relationship, they don't want you to do that.
What about doing some clinical within your research role? Again, funding across departments is very, very complicated. So then, the clinical- the research might say, “Okay yeah, that's valuable to our research,” but does your- does your research add anything to your clinical? You'd have to again put forward a very, very strong case for that. And again, I don't think- unless you've got really strong relationships or really good senior support, there's no natural thing. That doesn't happen naturally.
I tried for a very long time to get a day a week clinical. Where I was going to be given the time to do that out of my research hours. And the clinical people just couldn't- even though I worked in the same Trust, they couldn't find a place for me, even though there's-. They couldn't commit to one day a week long-term, even though every single day there's bank shifts that go out.
So they couldn't say, “Yes, we'll do one day a week”. And there were things like, “Oh well, yeah, but what about your mandatory training? We don't do anything less than two and a half days a week, you have to do two and a half days a week”. And my research manager was like, “Well, I'm not- that's not going to happen, I don't want you to go down to two and a half days a week”. So it just- it's possible [laugh]. Don't get me wrong. It's possible. And people have done it. But it, it doesn't come naturally.
Growing the next generation of NMAHPs in research
Those currently in leadership and managerial roles often talked about aspirations for their research staff. These included growing the size and skills of the team. Simona hoped to one day support more of her research nurses to pursue PhDs. Other key aims of those in lead/managerial roles were to increase the amount of home-grown and profession-led (e.g. nurse-led) research, and a more seamless integration of research in healthcare environments as part and parcel of patient care. As Imogen said, “The medical innovations are fantastic but we also need some nurse-led research for our professional growth to help the care of our patients and ensure that their experiences are as good as they can be”.
Simona would like to develop more research in her team with patient input.
Simona would like to develop more research in her team with patient input.
Age at interview: 48
Sex: Female
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I will be a nurse researcher [laughs], that is the key and I will probably I want to be very involved with the patients and go and talk directly to the patient and take their ideas of what is important for them in terms of research and put it onto a, into research projects. So to have absolutely, you know, to get it from the horse’s mouth if you want.
Know exactly what is of importance to them. It’s very nice when you go and you have all these panels and you decide you know, you do all this daily surveys and all the nurses decide what is good for the patients but have we really asked what the patients want? Because we, we probably fall into the, the medics trap, they do tend to do things-, I’m not saying they’re not important for the patient but they do it from their perspective. And now we as nurses, we go and do it from our perspective but what do we do from the patient perspective?
And that’s where I’m, that’s where I’m quite keen on patient experience and patient-, their say.
Claire had plans for developing research at her hospital but also wanted to have a role in national strategy too.
Claire had plans for developing research at her hospital but also wanted to have a role in national strategy too.
Age at interview: 35
Sex: Female
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I would like to increase the amount of home-grown NMAHP research at [hospital] and build more relationships, possible dual-posts between the Trust and universities to encourage this, perhaps a PhD programme with competitive entry at some point.
From a hosted study perspective I would like to continue to expand the research workforce and number of study opportunities for patients.
At some point I would like to move in to a national role focusing on increasing the research nursing/midwifery workforce and believe there could be more cross-country working with research from frontline staff with big patient impact.
Some people who managed research staff talked about the career options that had been taken up by their staff. Imogen found there was a high turnover of research nurses, who typically worked in the role for 1-2 years, which she thought was a positive thing (“it’s a great development part”) as many had gone on to more senior clinical, research and/or education roles. Julie also mentioned advanced nurse practitioner and clinical nurse specialist roles for nurses who have completed research secondments. A couple of team leaders expressed concerns that research staff who later wished to return to clinical non-research work might struggle to do so, especially if they were in an area of rapidly changing skills and technologies.
Julie encouraged both research and ward staff in her unit to present at conferences and publish. There are various ways she supported this, including reviewing drafts of conference posters.
Julie encouraged both research and ward staff in her unit to present at conferences and publish. There are various ways she supported this, including reviewing drafts of conference posters.
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So for example my day today has been a lot of work preparing work for conference submission, so very, we’re very careful to scrutinise all the work that goes in. So we’re very careful first of all to encourage our nursing and allied health staff on ITU to submit work for conferences, to share what we’re doing. Paediatric intensive care is quite a small community and especially in terms of units that have over ten patients, ten beds. And so actually we all need to learn from each other. And so we have a very strong approach on our unit to support people to put work in for conferences and to also write it up for publication. That side of it needs a bit more work, but the public-, the conference presentations we do really well at. And we have lots of really high-quality work and we make sure that when it’s written up it’s also conducted to a high standard. So a big part of my job is helping people to do that, so I spent four hours yesterday reviewing posters [laughs] but it’s a worthwhile investment because actually staff very quickly pick up those skills and then the next time they come to do a piece of work, actually it’s a lot easier. It’s a much better standard, so it’s takes less investment in the long run.
In her own career, Karen had always coupled research and clinical work. She felt a “duty to think about the long term career prospects of your staff”.
In her own career, Karen had always coupled research and clinical work. She felt a “duty to think about the long term career prospects of your staff”.
Age at interview: 55
Sex: Female
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Yeah, I think that-, given that I believe that the best questions come from clinical staff, I think if you work in research as somebody who is newly qualified, you haven’t got a lot of clinical yards under your belt. And it’s good that you understand all the research process to work on a few trials, you know, they, even when they’re doing that they work an afternoon a week on, you know, or you know probably the equivalent of a day clinically. But there’s a point if they’re going to develop their careers so that they are not unemployable in the wider NHS, where you can stay too long in a research post, and you become so narrow that it is very hard, so if you moved, you know, to a different town you would really struggle to get a, a post. So, I think it’s you know as an employer you’ve got a duty to guide their career in total, and for the newly qualifieds yes, a year, 18 months in research, but then they do need to get their clinical skills up. Yeah hopefully come back or go into a hybrid role.
In terms of their own career development, some research team leaders felt unsure about next steps. Nicky was keen to keep working with patients but felt this left her in tricky situation for career progression: “what would I do next if I wanted to do something else? It feels like everything would be a sideways move”. Some had completed PhDs and were interested in pursuing the next steps of a clinical-academic career as NMAHP researchers.
Carrying out research projects and/or pursuing qualifications
Several people spoke about wanting to design and carry out their own research. Some planned to pursue research as part of a Master’s or a doctorate. Others, such as Laura X, wanted to carry out research through other arrangements with the support of their hospital/department. Osi had some research ideas and thought it would be “really rewarding for myself if I manage to actually write my own protocol”, although she wasn’t sure whether she wanted to pursue this through a PhD or by getting “the hospital on-board” to carry it out.
Many saw a Master’s degree or doctorate as a step upwards in their career ladder. Others didn’t anticipate that they would change their role much and wanted to pursue a qualification for personal interests rather than for career development.
Once Vicky has completed her PhD, she hoped to use it as a “springboard”. She planned to develop a postdoctoral fellowship application and carry out more research projects.
Once Vicky has completed her PhD, she hoped to use it as a “springboard”. She planned to develop a postdoctoral fellowship application and carry out more research projects.
Age at interview: 47
Sex: Female
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I'm halfway through a fellowship. And so that's funded for me personally to work on a project that I designed, that incorporates a number of different studies. So some of those I've completed already. One I'm partway through. And then the next stage will be to develop a complex intervention that I'll be looking to do some acceptability and feasibility testing, towards the end of my fellowship. It's a doctoral fellowship as well, so it's my PhD project so I'm writing up a thesis as I go along as well. So there'll be that to submit at the end of my fellowship as well.
But it's a matter really of looking for how to progress some of that work, but also my own research career from here, using that opportunity I've been given really as a sort of springboard to new opportunities. So I'll be looking to develop a postdoctoral fellowship application and perhaps to do some individual projects, research projects, to help develop some of the work I've already done. To eventually hopefully have a sort of independent research career, so to lead this sort of programme of research that's sort of built on my own work.
Julie’s job description was rebadged, from research sister to nurse researcher, since completing her PhD.
Julie’s job description was rebadged, from research sister to nurse researcher, since completing her PhD.
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It has actually been an evolution of the role, I think that’s because I’ve had very supportive managers who’ve seen the need to grow and develop the role. The job description itself we’ve changed so during that period of time, I should say, for eight years of it, I’ve been doing a PhD part-time as well, so that impacted on it because during that time you’re obviously becoming a chief investigator of your own study. But it’s also, it’s, we re-did, about 18 months ago we re-did the job description to reflect where I wanted the job to go and where, where the unit needed the job to go. And actually now it’s re-badged from being ‘Research Sister’ to ‘Nurse Researcher’, not with any increase in pay and not re-banded in anyway, but just the focus of the job description changed so it’s much more now about moving from that delivery to being an independent researcher, developing the research culture, supporting other staff, education about what research role could involve, you know, what does good research look like, and actually a lot more of an emphasis on public and patient engagement.
Alison would like to do a PhD one day, but wasn’t sure how to “do that without stepping off the earning treadmill”.
Alison would like to do a PhD one day, but wasn’t sure how to “do that without stepping off the earning treadmill”.
Age at interview: 45
Sex: Female
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I would like to be someone doing my own research. And so that’s-, I'm kind of banging on my drum about that because I-, I've always felt that, but then I've been sort of stumbled by how difficult that could be in practical terms, because as I said, I can't-, I can't just do a PhD because I fancy it and I'm independently wealthy and that’s what I'm going to do for five years. I need it to be through an awarded really well supported process. So, there are those amazing awards, like the NIHR [National Institute for Health Research] doctorate one. But the doctorate application probably takes a year to do the application and to have a really good supportive team around you. But then, just a few months ago there was the announcement of a new award, which is a pre-doctorate award, which is investing in people's time to get to be able to submit a competitive PhD application. So, it essentially buys out your time and sets you-, and you-, you submit an application where you’ve set up some supervisory relationships and a bespoke training package for yourself. And then if the lucky people who are awarded this would have a couple of day-, perhaps a couple of days a week, or 50% of their working time, to devote to the development of their own research pathway as a clinical academic.
And that’s what I want to do.
Clinical-academic pathways
Those who were undertaking, or had recently completed, a PhD often talked about the next steps on a clinical-academic pathway. Graham was interested in “hybrid type roles”, which would include elements of both clinical and research work. However, many felt these posts were hard to come by and needed to be proactively carved out. Jed was seconded from two posts to complete his PhD. He was unsure about the next steps after his doctorate – namely how he could acquire post-doctorate level experience before applying for a clinical lectureship.
Those who were seconded from a clinical non-research post were sometimes involved in helping build the research culture and capacity at work, and some hoped that this might lay the groundwork for adjusting their job into a joint clinical-academic one once they returned. Katherine was also involved in some networking activities which she hoped might build a clinical-academic role for her in the future.
As he nears the end of his doctorate, Jed was thinking about ‘what next?’ He would like to develop posts for himself as an art psychotherapy researcher in the two settings where he works, but there are challenges.
As he nears the end of his doctorate, Jed was thinking about ‘what next?’ He would like to develop posts for himself as an art psychotherapy researcher in the two settings where he works, but there are challenges.
Age at interview: 44
Sex: Male
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But what I’m trying to kind of negotiate is to be able to kind of create a research element to those posts, and certainly in the Mental Health Trusts that’s more possible. It’s harder in a hospice because it’s the way that the funding works is different. Although, although there is a big kind of movement of research active hospices, so if there, if there was ever a time for me to do it, it’s now. And certainly, I’ve had a lot of interest from the hospice movement in my research, and Hospice UK have a head of research now who’s, you know, looking at sort of capacity building and what have you. So yeah, it’s, I think it’s possible, but it’s not, it wasn’t part of my post. I’ve had to kind of create it [laugh].
And if you want to keep a clinical and an academic role going, that’s harder than just going into the university. You know, that’s the, the pull already is to just go into the university full-time but then you lose that contact with clinical which sort of defeats the object of doing it in the first place. Or just going back to work and back into practice, and then you lose the contact with the university. So I’m just trying to sort of work out how I, you know, how I proceed post-doctorally really.
Graham would like to continue on a clinical-academic pathway, but was unsure about how to make this work in practice.
Graham would like to continue on a clinical-academic pathway, but was unsure about how to make this work in practice.
Age at interview: 40
Sex: Male
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I know what I would like to do, how I actually go about making that happen is a different matter. I would like to carry on down the clinical-academic type route I think. The, the experience I’ve had, the contacts I’m making, the-, I think I can-, I’d like to think I can use that to make a difference going forward. I’d like to think having a foot in the ambulance service and a foot in academia allows me to link up people, put people in touch, make things happen, help studies get through, develop more research and also bring more sort of-. Research isn’t for everybody and it’s certainly not, not every paramedic [laugh] is going to be interested and not every paramedic is going to see it as a career like I’m trying to do, but there is people out there who would like to go down that and hopefully I can ease the path for them a little bit and let them learn from the mistakes and the time that I’ve had.
And, you know, help them develop the ideas that they have got. So I’d like to see myself continue going down this route, but that relies on finding a role within the ambulance service and a research or academic role that I can combine to make that happen. And that’s something I’m exploring at the minute.
Nikki thought there was a lot of support for clinical-academic posts at a high level, but that there were major barriers to overcome.
Nikki thought there was a lot of support for clinical-academic posts at a high level, but that there were major barriers to overcome.
Age at interview: 34
Sex: Female
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I think there's a lot of focus isn't there, at the minute, on clinical-academic careers, and. And sort of providing infrastructure for non-medics. In that the medics have had those sort of structures in place for a while. And non-medics really struggle with that. And I think, I think- And I think there's a bit of a disconnect between- And I'm talking sort of Trust level now. Between sort of director level, there's a lot of chat about you know, clinical academic careers, and we need to support this as a Trust, and we need to see, you know, this needs to be supported by the Trust, and this is going to help put us on the map, and this is going to help us build our relationships with university, and this is going to help us promote our sort of university hospital name, and we want to be seen as a centre of excellence for a clinical academic career, and this is hopefully what's going to draw people to us. And help us from an employment point of view, and a recruitment kind of retention point of view. And, and will also ultimately help us you know, develop leading researchers, and which will then generate income for the Trust. So I think they are looking at it over a much sort of a longer term plan. But to try and then get your middle managers to try and tap into that vision, and- And I guess understand how on earth they can deliver that is much more difficult. You know, certainly for- And I guess this is one other reason why I left clinical, is that the direction that I wanted to go in was really pulling against what they wanted from me as a clinical physio.
That they just couldn't support me, in fostering these other interests. That they just needed me to come in and see patients. And I get- And I get why they needed that, and I understand the pressures that they were under to deliver a clinical service. And I think that was probably why I then in the end ended up leaving, because I just felt 'you know what, there's a whole team here that are going to support me in what I want to do, and you aren't able to do that'. But in terms of developing a clinical academic pathway, we need to overcome that somehow, and I don't know how we do that. You know, you look at- Perhaps the medical model is the right way to do it, in that, you know, they have posts don't they, that are certain grades that they go for. And some are pure clinical, and come are combined clinical and research. And you can apply for what pathway you want to, but the pathways exist. And it's kind of built into that role. But it's trying to get someone to fund that, and fund the research time that's attached to clinical time. Because I think that's probably the only way you're going to get clinical teams to be able to, to cope with- You can't suddenly give everybody you know, half time study leave. You can do that, on the funding that's currently available. So it probably does come down to money.
Many people felt that there was a relatively well-established clinical-academic pathway for medics, but that this was not yet the case in their own disciplines and/or locality. Julie drew on guidance and knowledge from consultants when thinking about how she would like to pursue this pathway in nursing. Most people had sought out mentors with experience from their own profession to get more insight, but others were helpful too. Katherine’s mentor was from another AHP background to her own; she thought this gave “a different and enriching perspective, a way to see things differently”.
Abi felt there was no clear clinical-academic pathway for speech and language therapists, and that often the roles had been “cobbled” together.
Abi felt there was no clear clinical-academic pathway for speech and language therapists, and that often the roles had been “cobbled” together.
Age at interview: 37
Sex: Female
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So this goes back I think to what I was saying about having that pathway set up, there isn’t necessarily a clear pathway set up for you to integrate clinical work and research work. So, it’s interesting to think about why, you know how, everybody who I know is a researcher and a clinician has sort of cobbled together something and found their way and uses their skills and enjoys using their clinical skills, whether it be within delivering a clinical intervention, whether it be in supporting students to train, or informing research methods so that they’re appropriate for people with communication needs. Yeah, it’s, there’s no clear cut path and it, it can be a bit of a, a challenge to identify how you fit in it I suppose.
Graham was grateful for the mentorship he had received. He anticipated that, as paramedic research developed, there would be a cohort of mentors from his own profession.
Graham was grateful for the mentorship he had received. He anticipated that, as paramedic research developed, there would be a cohort of mentors from his own profession.
Age at interview: 40
Sex: Male
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But also- the big RCT’s that I’ve been involved in, the big studies that has sort of brought me to the position and that have taught me a lot, have all been led by academic emergency medicine doctors or stroke doctors or critical care doctors, you know, academic physicians that have seen opportunities to develop research, and often take from the hospital setting and take the pre-hospital setting, and they’ve mentored people like myself, they’ve developed people like myself. But within the paramedic profession, we have a few senior clinical-, sort of clinical academics that have the, the contacts, the knowledge, the background to do that, but they are very few and far between. And that makes it difficult, so in terms of support we’re, we tend to look outside of our own profession to get people to develop us, and I certainly wouldn’t be doing what I was- what I’m doing now if people hadn’t taken me [laugh] under their wing and sort of helped me and guided me and looked after me to get me to this point. But as things are changing, as we do develop our own academics and our own clinicians and our own research experience, hopefully then we can sort of help the next generation of researchers to come through and sort of set the path and help them and guide them.
Katherine had discussed clinical-academic careers for speech and language therapists on Twitter. Building on this, she was hoping to gather examples to create a resource for others seeking these careers.
Katherine had discussed clinical-academic careers for speech and language therapists on Twitter. Building on this, she was hoping to gather examples to create a resource for others seeking these careers.
Age at interview: 38
Sex: Female
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So yeah, the but the blog post that I wrote, particularly about clinical academic careers obviously really resonated with a lot of people who had read it within Twitter, and I got lots of comments and retweets, and I think that led onto other people reading it and commenting and retweeting, and the essence of the blog was that there aren’t really clear clinical academic careers for speech and language therapists. There aren’t that many examples where people can do both research and clinical practice within one role. I can understand why they aren’t skills that necessarily sit well together, as I said earlier, you know, clinical practice is maybe much more reactive, academic practice is maybe much more reflective, you need slightly different thinking skills, and you-, a clinical academic career for me would definitely require protected research time and protected clinical time, rather than something that embodied doing both at the same time.
But yeah there are obviously lots of other people felt very similarly – they were interested in doing research, they were interested in being involved in research activity and in developing a research career but were kind of reluctant to step away from clinical practice. And that’s in essence, where this idea of developing a sort of support network came from. The idea of well if we can capture examples of good practice, if we can learn from each other’s experience, if people are developing clinical academic careers in different parts of the country or developing networks then, you know, maybe we can use the momentum behind that blog post and this Twitter conversation to really start to influence strategy, and to build some really practical sort of, some real practical framework and infrastructure stuff that will help people going forward, then that would be great.
Managerial and funder level support for NMAHPs pursuing clinical-academic pathways was seen as crucial. This included support around practical arrangements (e.g. contracts and finances) as well as ‘championing’ both researchers and research studies. Katherine felt it was important for there to be a culture that supported clinical-academic roles and that this required conversations between “health organisations and leaders, higher educational institutes, and leaders with health strategy organisations such as NHS England and the NIHR [National Institute for Health Research]”.
Other plans
Not everyone planned to stay in research. Some people were thinking about teaching and lecturing or returning to a clinical/managerial role without a research element. A few people considered carrying on with a research career but in a different setting. Helen was thinking of a few options, including becoming a nurse consultant or a researcher in the charitable sector. Sanjos, a research radiographer, was undertaking a Master’s in genomic medicine which he hoped would yield a new career with more scope for independent research. A few people spoke about retirement plans coming up. Barbara, for instance, was due to retire in a few months and was in the process of handing over her work responsibilities.
Barbara was due to retire shortly. She pursued a research career as she felt it offered valuable opportunities to “empower” and support patients, whereas managerial career pathways would likely have more constraints.
Barbara was due to retire shortly. She pursued a research career as she felt it offered valuable opportunities to “empower” and support patients, whereas managerial career pathways would likely have more constraints.
Age at interview: 64
Sex: Female
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In talking about why I choose to do chose say, a research way of moving up in my career, rather than a management one is, something that has always been so absolutely important to me in, in nursing midwifery, whatever is actually, empowering people, you know, yes, we can go in and we can be benevolent providers of care and supervision and, and, and take quite a parental role. But that's, you know, that's very old fashioned and that just isn't that way anymore. And you, you need to and it was particularly acute in midwifery. You need to empower people, women particularly, families, young couples, whoever they are and say to them, you're going to be good at what you want to do here. And, you know, you can do this. And it's just, and, and even that's what research is all about too. Yeah, so. And get you to do that in research and you don't maybe get to do that so much if you're going to worry about management and budgets and things like that.
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).
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