Ginny

Age at interview: 53

Brief Outline:

Ginny has been a research nurse for around eight years, although she is a midwife by training. She thinks there is a tendency for research nurses to be excluded from wider aspects of the research process beyond that of recruitment.

Background:

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

More about me...

Ginny has worked as a research nurse for around eight years, although she is a midwife by training. She is currently employed by a university to carry out research in a fertility clinic. Ginny “never intended to always stay doing clinical practice” and had an interest in research. Another factor in her decision to pursue a research nurse role was to provide a more family-friendly alternative to shift work. Her first research role was working for a professor in biochemistry who was involved in experimental bench research rather than clinical trials. She enjoyed the autonomy she was given in this role and the chance to gain experience in a research environment, including the laboratory work, and multi-disciplinary team. Because Ginny “went into it blind”, one thing she found helpful was the support of a colleague who was already in post as a research nurse. Through this job, Ginny was approached by a consultant at a fertility clinic and started her current post. 

In her current role, Ginny is the only research nurse at the clinic, which means she works across all the projects: “there’s lots of variety”. She helps clinical nurses if they are busy and, in turn, they support her with access to patients to recruit. Although she does not want to be seen as part of the clinical team, she suggests the respect and “credibility” associated with clinical practice are often missing in research. Ginny thinks there is a tendency for research nurses to be excluded from wider aspects of the research process, and this is something she finds frustrating and unsatisfying: “you’re not really doing research, you’re kind of helping other people do it”. The emphasis on targets is another aspect that Ginny dislikes, especially as she believes the numbers of potential research participants is frequently overestimated.

Ginny suggests several barriers to research and the challenges involved. She speaks about the difficulties in recruitment generally. Ginny is concerned that difficulties in sampling and recruiting may be “skewing” research, including in relation to unconscious bias and language barriers: “I’m sure there are whole populations of people that just don’t get a way into research at all”. Ginny feels that research is now sometimes over-regulated. Although patient protection is essential, she thinks “it’s gone probably the opposite way now, it’s so off-putting [to potential participants]”. Another frustration Ginny has found in her work is the time taken to communicate findings from studies; this is particularly difficult when patients want to see change. She has also felt disappointed by how studies do not seem to inform clinical practice: “it’s been very few studies I think that have […] really seemed to impact clinically”. 

Despite her frustrations with her role, there are aspects of her work that Ginny really enjoys. She would encourage others interested in becoming a research nurse to talk to others and ensure that they have realistic expectations. Ginny has recently completed her PhD, which she did part-time alongside her current position. This has changed how she thinks of herself: “I’m slightly thinking of myself as being a nurse researcher rather than a research nurse because I do research myself”. Ginny hopes that in the future she will find a post-doctoral position, though she is aware of potential barriers to this. She has no expectation that her contract will be renewed, and finds this uncertainty “really difficult”.

Ginny enjoyed research from her midwifery training onwards, but the working hours were a major attraction to her first research nurse job.

And when I did my midwifery degree because by that point that’s, midwifery was a degree subject, we did a dissertation for that and I can remember at that point doing a, the reflective essay at the end kind of going I know I’m gonna do, you know, one day I’m gonna do something with my, you know, my own I’m gonna do this research into XYZ. And I’d written a couple, again I sort of started doing wrote a couple of papers and things when I was in midwifery practice and kind of thought oh this is great this is what I want to do which was kind of why I went for that research job, that wasn’t the only reason though to be honest.

So [laugh] one of the, so the research job seemed a really brilliant idea, attractive because of what it was as in doing research in a kind of nebulous way but frankly one of the reasons to do it was to get out of shift work as a midwife which, and I’m in my early fifties now so this was, I was probably early forties I don’t mean it’s just age but it’s certainly-. I did midwifery kind of clinically for about not that long maybe five or six years I guess really by the end and it’s just exhausting and yeah a really, really, really, really hard job and I had children growing up and things like that and I think one of the reasons I wanted to move was to get out of that environment. But it’s not just the kind of physical tiredness about it I think it’s just a really difficult job I completely [laughs] hats off for admiration to anybody who can carry on doing it but it’s so hard. So that was another reason really was to kind of find something to do that wasn’t that shift work, endless repetitive exhausting terrifying work it was doing something else. So I’d love to be able to say it’s all nobly wanting to do research but that wasn’t really the only reason.

Ginny highlighted that all nurses and midwives take consent from patients as part of their role, and that this is not only in research.

Well I suppose that’s the other thing I should have said about being a nurse midwife I guess it’s, you know, that’s part of what you do anyway really so consenting’s not a, not an unusual thing, it’s not alien to us at all really so I think that’s probably helpful knowing, you know, being able to do that anyway. I’m sure the nurses do it all the time and midwives have quite, some quite complicated consents, so they do things like ante-natal screening and things like that which is really complex.

So or rather it’s really complex information, whether they do it very well or not I’ve no idea and [sigh] consent’s funny actually because I think I, so I’ve just said that, just said nurses and midwives do that all the time and lots of people in their roles do consenting, again other health professionals would do but whether we do it very well or not is a different matter. So I did one again and I have been on a consent training course at some point which was just a couple of hours and partly I felt a bit eye rolling about well of course, you know, I’ll make sure everybody puts the same date that they sign it and all the rest of it but actually some things to do with consent are quite interesting because clearly it’s often that things are to do with how you present information aren’t they and whether you believe people and. In some ways this is another big philosophical question isn’t it because, because the thing about consent which is the idea that it’s informed consent but kind of that’s not really a real thing, I don’t think so you can tell people as much as you can in the hope that they understand it because you never really know.

Ginny felt that ‘bad’ practices in health research were not always prevented through insisting staff undertake Good Clinical Practice, and that tight governance sometimes inhibited research unnecessarily.

So we all go along to these things and of course that’s turned into this big thing about everybody has to have GCP [Good Clinical Practice] training and it’s kind of, you know, it seems to be the same thing and it never changes and it’s always, you know, the thing about, you know, protecting patients and making sure that you do XYZ which is all good and great but I don’t think it changes the way that people work particularly and I think maybe we ought to do something a bit more radical to try and get some of these groups that just don’t, just don’t get involved in research I think. And I don’t think it’s, it’s not good enough anymore to talk about the you know, the sort of scandals of the past really that have happened you know, I know Alder Hey is not that long ago and things like that but you know, it’s not, in all, you know, you have this thing about the, you know, do you talk about Nazi experiments and things like that and really awful things that have happened in the name of research but it’s kind of more subtle than that now I think.

And so I think, you know, it’s a sort of double edged sword really in some ways I think it’s sort of, it’s inhibited the way that people could do research because we’re all so careful about not, you know, approaching people when we shouldn’t and saying the wrong thing and, you know, and so on, you know I’ve just said the thing about it’s quite difficult to even be able to ask somebody a question without it somehow having to go through committees and having huge amounts of paper and so on. So that becomes very difficult and yet you still do see or you can do or I do anyway bad practice research, you know, people, people can still get away with that.

Ginny thought revalidation had helped challenge notions that research midwives had to “show that you’re doing ‘proper’ midwifery work”, an attitude she had encountered in a previous system of supervisions.

But when I first changed jobs midwives at that point still had this thing called supervision and which was, so a supervisor of midwives is meant to be somebody who’s not a manager they’re somebody often quite senior but they’re meant to be somebody who can talk about they’re meant to be protecting, protect the public really so they’re making sure that you do your job that protects the public but not in a kind of day to day, you know, you’re not doing that blood test very well or whatever. And they, similar to research actually started becoming more and more sort of well seemed to me anyway a bit more sort of procedure lead, so rather than it being a nice chat which it always used to be beforehand and they’d kind of go ‘Yes Ginny, brilliant, tell me how your years been, ohh any problems? Lovely’ and, you know, ‘Yes you’ve been working as a midwife,’ and then sign this thing and it was the supervisor of midwives who send your form back off to the to the NMC who are the regulatory body for the nurses and midwives and then that’s fine then you’d be on the registrar, my names on there, that’s lovely.

But they started becoming a bit more kind of, you know, form filling again, similar sort of thing to research really and they, my supervisor in particular used to, right towards the end, sorry I’m making this really difficult, supervision stopped with midwifery a few years ago but, when they brought in revalidation. Just before it was ending she started saying ‘Oh Ginny do you do any, you know, when was the last time you worked on the delivery suite, you really need to do some proper midwifery work?’ And I always used to go ‘What do you mean, I’m still employed, I’m employed as a research midwife, I’m, this is my job, that’s what I am, I’m, I’m a midwife, I’ve done the training I’m on the register I don’t need to do any, you know, it doesn’t matter how many babies I’ve delivered’ or whatever like that. But they, she started getting sort of quite a thing about this sort of going you’ve gotta show that you’re doing ‘proper’ midwifery work and I always used to argue very, you know, what I thought was quite strongly that your job is, you know, you’re a midwife if you’re employed as a midwife in whatever capacity then whatever your job is that, that should be enough. Anyway and we used to have to do things like all the research midwives they’d, again because of this mandatory study days we used to have to do things like emergency obstetric workshops which were kind of, you know, as you can imagine what happens in an emergency and you join this role play and things like that.

I haven’t delivered a baby for years and if I ever had to go back and work as a midwife I would obviously have to do some re-training I wouldn’t just walk onto a ward and do it but I can assure you I’d be able to learn how to do that again and I’ve learnt how to do it so it’s, I can’t see it as being a big problem but I don’t think I need to do it as, you know, in a hospital base now because it’s silly. And anyway so revalidation came in and I think it’s really good because it’s kind of made, it made it really clear to everybody that that’s exactly what, exactly what I’ve just had, I don’t really mean that but it is what I just said, so anybody employed in whatever capacity it doesn’t matter, if you’re a nurse or a midwife that’s what you are but you work in education or something, you’re still a nurse or a midwife and that’s your revalidation just is saying are you doing your job, whatever your job is, properly.

Ginny felt there needed to be a balance in a research nurse role between building rapport with potential participants and being a “neutral voice”.

I wouldn’t say that I have a particularly kind of close relationship any different to the nurses really, I think that they in a way, I think in a way you see I’ve just done that thing about going particularly with IVF [In-Vitro Fertilisation] I don’t know if it is particularly with IVF I think with whatever it is that the nurses are working on that’s, is the nursing role or at least it should be, I think, is the whole holistic patient-centred thing you know, they often build up good relationships with people and different relationships and sometimes not so good but they have a relationship that’s not a kind of removed objective clinical one. And I think the research nurse person is slightly different, I think it’s a bit of neutrality going on and I don’t think that’s such a bad thing I think if it was kind of, kind of really friendly, I mean it’s not that it’s friendly I don’t think it’s particularly, I don’t feel like it’s close and I don’t think you can have that, so I think you need to have a little bit of objectivity somehow.

I’m not doing it on purpose particularly but I think that’s how it is I don’t think, I think there’s a bit of a, insider/outsider thing I think you’ve always got that slight barrier I think.

Maybe that’s not such a bad thing because I think theoretically I think we’re supposed to be a neutral voice anyway. So that’s the other thing, funnily enough that’s going back to the recruitment thing as well so if the role of a research nurse is to recruit people to studies that’s kind of really against that idea of them being a kind of autonomous, you know, an independent voice to be able to tell people about the study neutrally and all the rest of it because you can’t, if you’re trying to get people to do something then clearly you’re going to use persuasion and make things attractive otherwise you wouldn’t be doing it so.

Ginny felt that research nurses were often confined to recruitment and excluded from wider study activities, despite rhetoric about “teamwork”.

But there seems to be an awful lot of people counting and over counting and doing more counting all the time about how many people you’ve recruited and how many this month and how many other people you recruited and this that and the other. So I think the focus seems to be less about, about the research really and you just feel, or you could feel it’s, like I say it’s a sales job really. I don’t think that’s very good for either the people doing it or for the patients actually because it’s, it’s not what it’s about or it shouldn’t really be what it’s about. And I also think the, I’m talking about clinicians really because they tend to be the people doing clinical trials obviously but it can also be scientists or whoever it is as well, can sort of stand back because the clinicians in particular tend to again have a lovely time designing these things and then they, you know, the ones that have money for a research nurse to do it, who do all the recruitment for them and then they get to, you know, analyse the data and write the papers and that strikes me as I don’t know I don’t know whether it’s unfair exactly because of course you know, that’s fair enough if you’re a researcher you wouldn’t want, you want to be able to do all of that yourself but I think sometimes they don’t- it’s not always teamwork, I think it’s sold as that.

So some clinical trials there’s a lot of talk about, "Oh this is a team thing, oh it’s really important that, you know, people come to our-", I’m saying ‘our’, people come to a clinic where I work and go, "There’s this project, do you want to get involved?" Lots of people go, "Yes, that would be great". "How are we doing?" there’s lots of that talk about how, how well we’re doing but it’s literally what they’re talking about is how many people they’re getting to sign to do something.

Ginny found it “very patronising and also really irritating” being asked frequently for updates on study recruitment numbers.

I’m sure I’m not the only person to say this but I find the e-mails and things that I get from the people who are co-coordinating, managing whatever there’s loads of them all seem to be doing the same thing who seem to spend a lot of time asking ‘Ginny, you know, how many dah dah dah have you done this month?’ or going ‘Oh well done’ and I find it very patronising and also really irritating having that all the time.

Because I’m quite self-motivated I think so I would do that anyway so I’ll, I’ll recruit people because I want to and because I’m interested in doing that, I don’t find it very helpful having somebody kind of doing targets like that.