Jisha

Age at interview: 39

Brief Outline:

Jisha is a research nurse and team leader in a neurology department. She “really struggled” for the first six months or so. Now that Jisha has been working in research for four years, she feels “really proud and confident”.

Background:

Jisha is a research nurse. She is widowed and has children. Her ethnic background is Indian.

More about me...

Jisha is a research nurse and team leader in a neurology department. She joined four years ago in her first research nurse post. One and a half years ago, she secured a promotion with a managerial element. Jisha trained to become a nurse in India 18 years ago, and worked in acute settings once she had moved to the UK. For personal reasons, she was keen to find a job to fit around childcare. She was drawn to the pattern and flexibility of the hours in research nursing. 

When Jisha first started as a research nurse, she felt like “a novice”. She completed Good Clinical Practice training online. However, Jisha feels strongly that shadowing and hands-on practice are key to learning: “you need to experience that, rather than just getting the theory”. It took about six months to feel more comfortable and Jisha thinks it is important that new research nurses know this is a common experience. She finds there is poor retention of nurses new to research delivery roles and that many leave within a year – but, in her experience, it takes about a year to feel settled. She thinks that a Trust-wide move to employ all research nurses as permanent staff has helped attract more applicants to research nurse posts and maybe with staff retention too.

Jisha describes the studies she has worked on as having grown in complexity since she first started the job. Some studies have required Jisha and the other research nurses to develop or acquire new skills, including being trained to use centrifuge equipment for studies with hourly bloods. The complexity of the studies can make it tricky to put all the arrangements in place, but Jisha feels it is important to make study participation as convenient as possible for the patients. This includes booking research appointments to dovetail with clinical appointments, and combining routine bloods with those required for the studies. Although Jisha knows research nurses from other departments, she thinks the types of studies they work on and challenges involved are quite different. For example, she and her team were part of a temporary weekend initiative to boost recruitment to a flu study; compared to the neurology studies she has worked on, she felt this was a very simple study. The studies in her area of neurology include phase I and II trials.

Jisha’s research team have daily meetings to plan their activities. They screen for patients in a number of ways – including responding to beeper alerts and attending doctor handovers. For some studies, Jisha and the other research nurses can take consent from patients and/or their families. The timeframes can mean relatives give consent over the phone initially. Jisha encourages all of her research nurses to attend Site Initiation Visits, so they have some knowledge about the studies taking place and can help if other staff are on leave. Finding rooms to see participants can be difficult on the wards, but Jisha’s team have access to a research facility which they can also use.

Being a research nurse makes Jisha “really proud and confident”. She thinks clinical staff in her department now have quite a lot of respect for competent research nurses. Previously, there was an attitude amongst ward staff that “research is extra work”. Jisha has helped develop good relationships with ward staff, and highlights how important this is to the success of studies. For example, if clinical staff do not understand, they might make mistakes which affect the data or pose a risk to patients. Jisha doesn’t “blame” clinical staff who don’t know much about research nurses because she sees it as quite a recent development. Jisha thinks it helps when research is more visible – for example, research nurses wear a uniform and patients enrolled in studies now have wristbands. She thinks having research nurses be an everyday presence on the wards also gives them a chance to check the studies are running smoothly.

Jisha thinks it is good to have experienced nurses come to research posts. She sees it as an advantage if they are also familiar with the clinical content of the studies – in her case, neurology conditions and complications. Jisha has heard other research nurses worry about losing their clinical skills but she feels strongly that there are opportunities to maintain these: “once that [clinical] skill is obtained, that is there. You just need to maybe do it in between”. She thinks “it is your decision” about seeking out and taking up opportunities; one suggestion Jisha has is shadowing a phlebotomist for a day to keep up blood taking skills. In addition, many of the studies Jisha has worked on have involved using skills like collecting blood, doing ECGs and recording vital signs.

Jisha encourages new research nurses to persevere: “In the beginning, everyone struggles but that is nothing to worry about. You may think you are slow, you are not getting the feel of this research, but gradually you will learn the process”. She recommends shadowing experienced research nurses to see how they phrase information to “appeal to the participant”. In the future, Jisha would like to develop more research skills and has enquired about becoming a Principle Investigator for a new study. She knows of opportunities for research nurses in the US to become nurse researchers, but isn’t sure how this works in the UK context.

As a team leader, Jisha reassured new research nurses that it would take a while for them to adjust to the role and activities involved.

So I always reassure them, that's the main thing I have, seeing people- when the nurses after joining after many years of experience, they think 'oh my god, I don't think this is for me'. Because I really struggled. And I, and think ‘maybe I'm thick, they’ll tell me I'm very slow'. But I will tell them, “No, don't worry, this is just how I was feeling when I joined, but it takes time, so you will enjoy after that”. But they have come back to me and said, “You were right”, so it's just like, you know, learning that from their practical experience, then gradually doing one study. Maybe one-, you know, the first patient when they are recruiting, they will have a little bit of an idea how it's run. But when they do the second and third patient, they will be expert. And, you know, with that process. And with the legal issue, like ethics and approvals and things like that. You know. We do still struggle, and because the policies are changed and new other authorities will be joining, HR will be joining, all those things. You know, you just learn as it goes. So that will be different.

But you know, the nurses, after one year, they just run the study by themself. I don't have to help them much. But I just, you know, put a little bit of effort, you know, help with the team, but. Otherwise once they are happy with the trial, they are comfortable.

Jisha described the activities in one study which were carried out or arranged by research nurses at follow-up visits.

So, with the [study name] trial I was talking about in the beginning, that is- , we do follow-ups when they go home, on discharge day. Plus day 28, we bring them back to the hospital because that's the time they finish their IMP [Investigational Medicinal Product]. So we need all the remaining IMP back, so they will have to come and do the blood again. And we will have to centrifuge that blood, and we need to collect the urine. So either we go to the patient if it is really-, the patients are complex, like very disabled, we have been done- doing that before. But nowadays most of the patient come to the hospital and we do that process in the hospital. The next time when we see, it will be three month follow-up. That is the time normally the speciality nurses will be seeing the patient, after a subarachnoid haemorrhage discharge. Or the consultant will be meeting them. So we fit around with that follow-up. Then the next follow-up will be at six months time. They will have to do an MRI. So we arrange that MRI, and the consultant see them. So we fit around with that consultant, follow-up, and arrange the MRI all together. And we just go to the clinic and see them.

Jisha encouraged all research nurses in her team to attend Site Initiation Visits so that they had an understanding of the study and could help if their colleagues were on leave.

With my team, I will always tell them-, when there is an SIV [Site Initiation Visit] coming up- even if they are not the main lead nurse, I invite everyone to attend that. Because it will be better for them to know what's going on in their team. Rather than 'oh, I don't know that study at all'. If someone comes and ask, or maybe a patient relative sees a leaflet and asks, “What is that trial?” it would be really foolish to say, “Sorry, I don't know”. But I will tell them- even if you don't know the in-depth of the study and each steps, just to have a brief idea of what the study's all about. And also, they will be on the delegation log, attending all the trainings. For example, if someone is on leave or someone has gone on sick leave, there is always a buddy nurse to look after that study. So the study won't be struggling and the participants also won't be struggling. So, that's how I manage my team [laughs]. And it, it is working well. Because if someone is struggling and really busy one day, there is another person who is not the lead nurse, can, you know, come in and help them to recruit that patient. And do the steps, yeah.

The studies Jisha worked on involved blood samples. She coordinated with ward staff so that research and routine bloods were taken at the same time.

We do our research blood. But if they are doing a routine blood, we just combine with that because we don't want to prick the patient twice. So we, we plan our study follow-ups when we recruit them. So if we are recruiting for one patient today, we plan their alternative day sample on maybe Monday, Wednesday, Friday. We prepare all the cards and keep them ready. And we communicate it with the NICU nurse or the ward nurses. And they do daily bloods. So we match-, or with those samples. And we tell them, “Okay, do you mind taking this extra sample?” Or, “If you are not doing that blood or if you want just one blood, leave that with us, we will- when we are pricking the patient, we will collect it for you”. So, that's a- we just communicate to each other and just sort it out.