Libby

Age at interview: 45

Brief Outline:

Libby is a research physiotherapist. She enjoys the patient contact aspect of her role and how her research activities will hopefully “help in the long run”. She encourages more allied health professionals to consider pursuing research roles.

Background:

Libby is a research physiotherapist. She is single. Her ethnic background is White Welsh.

More about me...

Libby has a background in physiotherapy and has been in a research role for around two years. Alongside her research role, she is currently studying for an MRes in clinical research funded by the NIHR, and she hopes to go on to doctoral study. Since leaving community physiotherapy, Libby has worked in a team of predominantly research nurses in a large hospital. As a physiotherapist, Libby had not considered pursuing research previously. However, whilst studying for an acupuncture course, she realised “there was an awful lot more that I could get involved in that wasn’t just the white coats in the labs”. She expected that a research role would allow her to take on new challenges whilst building on her skills as a physiotherapist. Libby applied for a research sister role, as there were few posts available in research physiotherapy, but identifies herself as a research physiotherapist. She feels fortunate that her employer recognised the potential “to broaden the variety of professionals that they had within the team”.

Libby feels that it can take some time to adapt to a research role and “shift from the clinical head to the research head, because it’s a different mindset”. She had induction training at both a Trust and departmental level. She thinks it would have been good if more had been covered about the wider context of research activity at this stage, including research governance: “those things that once you’ve been working in research for a while become second nature, but you don’t know what to ask if you don’t know”. Libby has enjoyed the challenge of learning different aspects of the research process and the variety of activities involved: “I like the fact that, within this environment, you can all do a bit of everything”. Since working in research, she has also gained additional clinical skills, such as taking blood samples. Libby is on a permanent contract, which she knows is quite unusual in research. Whilst this “gives you a lot more stability”, she has some concerns that staying in a post for a long time can be stifling; she thinks that exposure to other areas of health research can bring “different viewpoints” and ultimately improve research practices.

Libby works on four observational studies around multiple sclerosis (MS) and she is hoping her Trust will also adopt a new interventional study soon. Libby’s role involves recruiting participants and collecting data through various tests, samples and questionnaires. She enjoys having the opportunity to “build relationships” with participants and their families, and thinks they often benefit from study participation in ways beyond clinical outcomes: “it just gives them a sense of value and worth and input. And I think with a disease like MS which you can end up feeling like you’re on the scrapheap, something like that is invaluable really”. Maintaining a patient-focus is important for Libby, and she has felt uncomfortable in the past by the emphasis on recruitment targets: “I did feel like a salesperson […] I felt like we lost sight of why we’re doing the research and who it’s for”. Libby has not yet had the experience of a study finishing and closing, but would be “very surprised” if she were invited to be involved in writing up findings. Whilst she understands that her role is gathering “good data”, she feels it is a “shame” that the work research staff put into a study is rarely acknowledged in publications and other outputs.

Libby values working in a multidisciplinary environment, where everyone has “complimentary skills” and similar goals: “I like the fact that I work within a team of people that are in a way just like me – questioning, striving to get the best information, treatment, whatever we’re doing [in the research aims]”. However, she has encountered some tensions as a physiotherapist by background working within an environment dominated by research nursing. She finds that often “patients think everyone is a nurse”, and there can be a narrow understanding of physiotherapy held by staff too: “musculoskeletal is one section of being a physio. I also do respiratory, I also do neurology, there’s a whole variety of things I do. […] People see physios as ‘bones and muscles’, but bones and muscles occur in neurology, all over the place”. Through her research role, Libby enjoys having a different relationship to physiotherapy which still allows her to help patients: “I couldn’t get any satisfaction out of treating something that I couldn’t really fix […] Whereas now it’s not my responsibility to do that, it’s my responsibility to carry out the research that will help in the long run”. 

Libby feels research is a “rewarding” career. She values how research offers opportunities to mix clinical and academic pursuits, and to “develop your own career the way you want it to go”. Libby hopes to see more inclusion of allied health professionals in research delivery roles in the future and for distinctions between disciplines to be reduced: “we are research practitioners, all of us, no matter what we do [by background]”.

Libby had always been “a questioner” but hadn’t known that research was an activity that was open to physiotherapists.

But I’ve always liked the sort of academic side of things and you know learning more and sort of stretching my limited brain to do sort of a little bit, and I’ve always been a questioner, always. Since I was a child I, you know I always, like why? Why are we doing it this way? Why don’t we do it that way? And I think research, I, to be honest with you I didn’t realise for a long time that you could actually work in research. It didn’t feel like it was something that was available to me. You know you think research is all about people in white coats in labs, and that just, you know I was never particularly into science at school, never thought of myself as a scientist. Before I trained as a physio, I was a musician, I did a music degree. So, you know the, the concept of research as I know it now, no idea that that was out there and available to me as a physio.
 
And when I found out that it was I couldn’t think of why, you know, anywhere else that I’d rather be really. It really, I mean aside from practically it ticks a lot of boxes, I just, I love the fact that I, every day is different, I like the variety, I like the fact that I work within a, a team of people that are in a way just like me questioning, you know striving to get the best, information, treatment, whatever we’re doing. We all seem to have the same goals. It’s great, I love it.

Libby appreciated that a colleague encouraged her to reflect on “the division between clinical work and research work” and alter her engagement with participants accordingly.

It was my colleague. And I think she was absolutely right to say you know, “You need to take some time to realise that you’re not a clinical physio anymore. That’s not what you’re, you know, employed to do.” “You are, you’re a research physio and your, your job is to carry out the research to the best of your ability. And sometimes that involves, for example, having a straight face, not engaging in conversation while somebody is carrying out a test. Not giving feedback on the results because it might skew the data in some way.” And I would say it took me a while, but I, you know it is a realisation and I think for anyone whose thinking about moving from a clinical role into a research role, that is one of the areas that I would say think about that. And whether you want to work it in that way, before you take the jump. But once you’ve taken the jump realise that it might take a while to mentally shift from the clinical head to the research head, because it’s a different mind set.
 
I like the research mind set and I’m very happy that I’m there and in it now, but I think it is, it is something that kind of takes you by surprise a little bit and you know needs some thought really in the early days. But I mean there was no issue, it was just that, it was, when I say it was made clear to me, I, she, she brought it, my colleague brought it up and I then became aware of every time I did something I thought, “Ah, no, research head. Not clinical head.” You know. Especially I think as a physio, part of being a physio is about encouragement and support and helping the patient to achieve a goal and when somebody doesn’t do so well then, my role as a physio is to build them up and to, to give them that encouragement and to talk them through it. So, that sort of talking through, coaching, empathising, you know it’s engrained really but you have to switch it off. Not always, not always but I think I was probably too switched on at the beginning.

Libby liked that working in research delivery offered her opportunities to help patients without the expectation to “fix things”.

So, moving into research was really quite nice because it allowed me to be that person there with the patient, be in a sort of a medical environment where I could use the knowledge and the skills that I’d had, but I didn’t have the responsibility of clinically treating a patient and trying to make them well. And there’s something very freeing about that, you know, it’s not my responsibility to make you better, and I think that’s, you ask about was I passionate about MS when I was in clinical work, no, because I couldn’t, I couldn’t get any satisfaction out of treating something that I couldn’t really fix and couldn’t really make that much better.
 
Whereas now it’s not my responsibility to do that, it’s my responsibility to carry out the research, that will help in the long run, but you know at any moment in time I’m not responsible for that person’s wellbeing in the same way. So, I guess it, it did, was an identity change but a, for me a good one. But I think that’s a very personal thing to me, it wouldn’t necessarily be something that you could generalise across the board. Although having said that, I don’t think I’m alone probably in being you know a clinician of whatever discipline and thinking actually I’m not sure I really want to do this. But finding the, the academic side of it very interesting, but the reality of day to day treatment quite draining. I’m sure there are a lot of people like that. And I think for those types of people, like me, research is an absolute perfect fit.
 
Perfect fit.
 
Because you still get to make a difference, you just do it in a different way.

In addition to inductions to the Trust and department, Libby also had a research induction. With hindsight, there were topics that she wished had been covered in more depth at that stage.

One thing that I would say at the time that was missing from my induction was research-based knowledge. It came later, but it wasn’t there right at the very beginning, you know, how research works and you know things like GCP [Good Clinical Practice] and governance things, and those things that once you’ve been working in research for a while become second nature, but you don’t know, you don’t know what to ask if you don’t know you know.
 
It’s all very well to say any questions ask me, but you kind of don’t know what you don’t know, do you? So, you, and there was a little bit of maybe learning by making mistakes, and that is, I hate that. I really hate that. I’d much rather be told what’s, what’s possible, what’s not possible and then you know work within it, rather than have to do something that is, turns out to be wrong. And then you know, hmm, I don’t like that at all. So, but, but you know so I would say that research, research specific induction although it did happen, could have happened sooner.
 
I could have actually been a lot clearer, I think we spent a lot of time talking about SAE’s [Serious Adverse Events] and AE’s [Adverse Events] and things like that, and you know I, to me there’s more important, well not more important, more everyday relevance things that we could have spent a lot more time talking about.
 
And which would have been helpful.

As a research physiotherapist, Libby had sometimes struggled working in an environment which presumed everyone was a research nurse. Uniform was an example which highlighted this for her.

When I started I had a conversation with somebody quite high up, who asked for my opinion about what allied health professionals should wear, because they had a set colour with a set trim for different levels within research nursing, and it worked for the nurses, but if you go in as something other than a nurse what do they put you in? I gave an opinion, I was told that they were thinking about it, it’s now nearly two and a half years down the line, and nothing has happened. And I am currently wearing the uniform of a) a nurse and b) a band lower than I am, because they don’t know what to put me in. So, and that is true for all my colleagues as well, so I spend a lot of time not only explaining that I’m not a nurse. But then people will say, “Oh you’re a Band 6, are you? I didn’t know you were a Band 6. I thought you were a Band 5.” So, I’m in an environment where there’s not a lot of people like me, and I’m dressed in something that is me masquerading as something else.

Libby described her research delivery role as being “all about gathering good data”.

I think it, to me it means things like just on a very simple level, checking that I’ve got all the numbers right. So, if I’m going through a questionnaire that has a score attached to it, it’s checking the numbers at the end so that you’ve, you know on a very basic level just got your maths right. But also making sure that the way that you conduct that questionnaire is consistent as far as it can be across the board, so it’s, it’s as replicable as it can be each time. So that the responses that you get aren’t skewed by the environment that they’re given in.
 
So, I mean, so basically it, one are maths, double check, have a second checker to check, but also there’s the more sort of soft, the soft side of it, so was it noisy outside the room when the patient was doing this test? Has it had an effect on, on how they performed? You know, did the patient break down in tears and you had to comfort them and stop, and then you know, making sure that if you’re doing something simple like a walk test, that has you know that you start at the same place with everyone and you finish at the same place with everyone. And standardised ways of timing when you start, when you finish. You know those sorts of things about the data that you gather, if you don’t get it you know as clean as you can then the intricacies and the details about what you’re measuring is lost and I think the devil’s in the detail always, so you know you might as well not do it if you’re not going to make sure that you’ve got it clean and tidy.

Libby would be “very surprised” if she were included in writing up study findings. Even so, the contributions of research NMAHPs like herself are “there in the fine detail because we will have gathered good data”.

Yeah I haven’t, I haven’t got to that bit yet with any of the studies that I’ve been on, so, but I doubt it. I think there’s, there’s only one where I might potentially be required to say something, and I’d be very surprised, very happy, but very surprised if I was asked to contribute to the writing up of that. Also I think, you never really get mentioned do you, when the paper gets written up, you never get mentioned in the, in the writing up or you know there’s a whole tranche of people that work on that study that never get their name in lights, but I mean I kind of understand that from the other side now that I’m doing my own study, cos I think it’s my flipping name up there, not yours, get off.
 
Huh but it does seem like a shame really that you don’t, cos there’s a lot of work that goes into, to carrying out a study. But I guess it’s not part of our role to be, our role is to gather the most clean data that we can, and to keep it in as clean a way as we can so that when it comes to being analysed it can be analysed properly. That’s our role, I would say in it, you know my work life role is all about gathering good data and knowing, knowing what good data looks like and what bad data looks like. And, and being true, true to that really. That, that’s my role. So, I, a part of write up probably not, I’d be surprised. But I think we’re there in the fine detail because we will have gathered good data and if we haven’t gathered good data then the write-ups not going to be good, and it’s got to be true. So it’s important really.

Libby described what was entailed in her Master’s degree.

So, it’s an NIHR [National Institute for Health Research] funded Master’s. It’s a Master’s in clinical research. And the way that it works is you, you win an award. It’s quite competitive. So you have to put forward an idea for research, it has to be practical, has to be patient based, it has to be you know of its time, it has to be relevant. You put that forward and that forms the basis of the Master’s really. So, it is, it’s a modular Master’s and we do different modules that are specific to qualitative research, quantitative research, designing research, but what runs through the whole Master’s is your dissertation module. And it’s a practical empirical research project, and the aim at the outcome is not to produce the, you know 20,000 word dissertation, it’s to produce a paper that can be published. And I really like that because I think it’s so much more practical, you know very rarely people have to write 20-30,000 words. And you know very few people read that amount. Whereas you know so many people read articles in a, in a, in a journal, or on a website, you know open access, that kind of thing. It’s gonna have much more impact by doing that. So, I, I really like that. And so that, that goes throughout the whole of the Master’s

Libby found it was quite an adjustment to be out of her research physiotherapist role for half of the time whilst undertaking a Master’s.

It’s, I’ve found it quite difficult at the start to switch from one to another. And I spent a while thinking oh this would have been better full time, so I could have done all the study, or all work. And I think that’s kind of to do with the way that the course is designed. It’s very heavy upfront, and then it sort of quietens off a bit. But I found it very difficult to, not very difficult but it was a challenge to change my brain from study back into work mode again and getting into the whole swing of being at work, and, and that kind of thing. It’s absolutely fine now, not a problem at all but it, at the beginning I did find that quite tricky. But then I think at the beginning of anything new, I, so I was the only full-time member of the team, so I was the one that kind of had oversight of everything, purely by the fact that I was there all the time. And when I’m then out of it for 50% of the time, that person with oversight is, has gone. And that’s difficult on both sides I think. It’s difficult for me because I’m used to being that person, it’s difficult for the team who are used to having me as being that person. So, I think, you know for everybody at the beginning it was a bit of a you know transitional period really, of getting used to it being different.
 
It didn’t take that long really for it to you know become a lot, lot easier and to be able to just sort of switch from one to another.

Libby was due to be line-managed by a physiotherapist for the first time in her research career.

I have to say I don’t have a bad relationship with my current line manager. I haven’t had bad relationships with any of my line managers. I think it will be really nice to have a physio, as a line manager and I think it’s nice to have a physio at that level. Not that we’re not capable of being at that level, but there’s just historically doesn’t seem to have been that way. It’s been a very nursing dominated environment.
 
So it will be really nice to see what happens with that person and I hope, I’m sure she will be, that she’ll be understanding of the issues. I say issues in the sense that it’s not a huge thing that plays on my mind daily, but it’s one of those things that just makes you feel a little bit different, you don’t feel like you’re part of the whole, because you’re being singled out as different, and I have to keep saying, “I’m not a nurse, I’m a physio, I’m not a nurse, I’m a physio,” and I feel I’m getting bored hearing myself say it, but I feel like I have to keep saying it, because I’m not a nurse, and yet I’m not saying it in any-, it’s not derogatory, it’s not meant to be rude, it’s just is I were to say to my colleague, “Oh this is my colleague the speech and language therapist,” she would turn round to me and say, “I’m not a speech and language therapist, Libby, I’m a nurse.” That’s all that I’m doing, I’m saying “I’m not a nurse, I’m a physio”.

Libby encouraged allied health professionals to “blaze a trail” in research – a phrase also used about the NIHR CRN Allied Health Professionals Strategy for 2018-2020.

I’ve always seen it a little bit like that because it is so nursing biased, that you do feel like you’re blazing a trail for another profession because you are, you have to fight a little bit for recognition and, and it’s very subtle, it’s not always in your face. It could be a subtle sort of discrimination almost, I would say. It can be subtle, and you have to be very, are you sure of yourself and what you’re doing and why you’re doing it to be able to make a stand. But I like the term blaze a trail, and if they’ve used it, brilliant. Because I think that’s how it feels and I think you’re either the sort of person that wants to do that, and will, will get fired up at the idea of doing that, or you won’t. And I would say give it a go, definitely give it a go, but I wouldn’t say, I don’t think it’s for the faint hearted. Research is not for the faint hearted. But it’s incredibly rewarding and I absolutely love it. I can’t imagine doing anything else now. I just, I can’t. I think it’s brilliant.