Michael

Age at interview: 29

Brief Outline:

Michael was a research nurse for 4 years, working on first-in-human (phase I) cancer clinical trials. He is now studying for a PhD. At first, he continued working as a research nurse but recently stopped to focus on completing his studies.

Background:

Michael previously worked as a research nurse and is now undertaking a PhD. He is in a relationship. His ethnic background is White British.

More about me...

Michael worked on a cancer ward when he first qualified as a nurse, where he came across some research nurses and helped administer some trial drugs. After four years in cancer nursing, Michael moved to intensive care. However, the shift patterns involved alternating weeks of nights and days, and left him exhausted after a year. He decided to return to cancer care via a permanent research nurse role. The post provided him with more contained working hours (e.g. weekday daytimes only). During this time, he also completed a Master’s degree. A few years ago, Michael moved to a new city to start a PhD and started a research nurse job part-time. He found that the combination did not fit well together and it took a substantial toll on his well-being, but was necessary at the time for financial security. He recently stopped working as a research nurse to focus on completing his PhD. Michael’s involvement in research has been two-fold: as a research nurse delivering clinical trials, and as a nurse researcher working on his own academic projects (e.g. through his postgraduate studies).

Better working hours were an initial motivator for Michael in becoming a research nurse, but he continued because the role in cancer care was very rewarding. He explained that phase I cancer clinical trials are very patient-focused and draw on key nursing skills, including clinical assessment and communication. The studies were first-in-human, with many uncertainties and serious risks attached to the drugs used in the trials, so attention to detail was vital. Michael thinks good organisational skills are important because the role required forward-planning and coordinating various tasks with different people (e.g. taking bloods, arranging scans, letting participants know the schedule of activities). Although doctors were responsible for explaining these clinical trials to potential participants, Michael thinks that nurses (including research nurses) often play a crucial role in “translating that to patients”. In Michael’s most recent post, he didn’t lead any trials but had a key role in supporting other research nurses – for example, through mentorship and covering those on annual leave.

Michael described some challenges involved in being a research nurse on phase I cancer trials. This included when medical samples were lost or could not be processed (for example, if the blood analysing equipment broke) and times when he had to schedule scans for the patient within very tight timeframes. On occasion, some practical issues meant delays to the trial drugs being given to patients at the scheduled times; it occasionally meant Michael had to work night shifts in order for frequent blood tests and observations to be taken at set intervals afterwards. There was also a lot of paperwork involved – at first, queries from the data managers about seemingly minor aspects of the paperwork were off-putting for Michael, but he came to appreciate why this was necessary.

For Michael, his professional identity remained first-and-foremost as a cancer nurse. His research role was seen as an additional component. He described sometimes having to “forget about the research nurse in a way and become the cancer nurse” to focus on patients. This included supporting patients not just in terms of their medical needs but also the psycho-social aspects, their wider lives and their family/carers too. Michael felt that a nurse should always be “primarily the patient’s advocate” and the “art of being a research nurse” must involve supporting potential participants to choose for themselves whether to join (or stay in) a study. All the options must be laid out and many factors considered. Michael's experience of cancer nursing has been of a good team-work dynamic. He recalled many times when his clinical colleagues had helped him out, and vice versa.

Michael said one aspect which might put him off a research nurse job in the future was if it were a fixed-term post. He describes himself as “ambitious” and hopes to eventually hold a clinical-academic role so that he can remain closely involved with patient care and contribute to service improvement. Michael feels it is important that anyone planning to become a cancer research nurse should be clinically experienced, so that they have the skills in managing side-effects and serious events (including anaphylaxis).

Michael said he used his nursing skills and values in supporting eligible patients to make informed decisions about research participation.

And that in essence is the art of being a research nurse. It’s not all science because you know on paper this person might have a performance score of zero, they might have good social support, and they might feel physically not too bad, but if after three weeks of a clinical trial they’re exhausted and, you know, they might have bad venous access and their arms are getting really sore from repeated cannulations, and they don’t want a PICC [Peripherally Inserted Central Catheter] line. Then you have to decide ‘well actually it’s probably not appropriate because this is affecting your quality of life’. 

And I think as a nurse no matter where you are, no matter what ward you’re on, or whether you’re a research nurse or a nurse, you are primarily the patient’s advocate, you are there to look at the psycho-social holistic care, “How are you managing with life?” And if that’s becoming compromised it’s your job, I feel, to bring up that conversation of, “How is your quality of life? Is this something you want to continue?”

Michael had come across research nurses when working on cancer wards. He was initially drawn to the working hours but, once in the role himself, found it very rewarding.

If I reflect back on some AML patients we had, so acute myeloid leukaemia, there was a lot of trials called AML18 that ran all over the country, so I was involved in helping with those. So, I knew a little bit about clinical trials, but knew very little-. There would have been this research nurse that would have come up to the ward, maybe once every other day and taken some notes, had a chat with the patient, and then left again. And we were the one who was putting the drugs up. So I kind of thought the research nurse job was, to be honest, a job that somebody in their late 40s, early 50s, who’s worked a hard career and wants a bit of an easier job, that was my honest perception. Now that I’ve worked in that area, and particularly in the early phase clinical trials, I know that is not the case at all and it actually is quite difficult work. 

So motivation initially to go into the role was to get back into cancer care and to have a period of life where I could have nice working hours. Motivations now, having worked in it, is that I get to maintain all my clinical skills. If anything, my clinical skills are enhanced because you have to do the, the next level of intermediate life support because the drugs are so unknown and there is so many risks with them that you need to be fully trained and fully aware of what’s happening clinically, and how to manage that. but equally there isn’t really many night shifts. I have had to do two night shifts though. For some of the drugs where we didn’t get to start the drug until late, and then the series of blood tests that you take run on into the night. So there have been the odd night shift but we can, we can cope with that.

So motivations really to stay in it, is that I like the research side and really I get, I get to be a full-blown cancer nurse and in some respects a specialist cancer nurse.

Michael worked on a lot of phase I (first-in-human) clinical trials which involved administering drugs. He identified primarily as “the nurse, not the research nurse”.

I am a nurse, and my job is to make sure that my patients are well supported, are well cared for, that I have considered their whole life, given holistic care. And it just so happens that a clinical trial is the vehicle to do that. This is what the patient wants to have at that time, so I’m going to deliver that clinical trial and give them that drug but I’m going to be the nurse who’s doing it. So I’m the nurse, not the research nurse.

So, we do phase 1s, and some phase 2 trials, but mostly phase 1s.

So for me, that’s my preference, in the sense that I’m very much a nurse and my role within the clinical trial and with the patient is very much nursing focussed. It has some challenges in the sense of you’re giving a first-in-human drug, you’re giving a drug that’s never been used before, so we know nothing about it, so you can’t almost anticipate what reactions are going to be like. So you draw on all your clinical assessment skills as a nurse in that-, in that viewpoint. It’s very regimented, it’s very observational, you want to pick up on any little change that happens and document that clearly. But the benefit of that is that as someone who likes being a nurse and likes being with people, you get as much as the-, the patient-health professional contact in an early phase clinical trial, which you might not get in the later phase trials.

Michael praised the data management teams. At times, the queries had seemed finicky but he appreciated the importance of quality data.

So typically you’ll have data teams, who are administrative staff who will go through your notes scrupulously and ask you, “Why did you not write the date here?” “You scored that out and didn’t sign it.” And there can on occasions be a little bit of tension when you’re new to research, because you get really busy and you’re clinically very busy with often very unwell patients, so the last thing you’re thinking at that time is to-, when you score something out to sign it the correct way that the data team want it. And then the next day when they’ve gone through your notes, they come and grab you and say, “Can you fix this? Can you correct this?” You know, “This is illegible, and you haven’t written this, can you clarify that?” And you get to the point where you’re like, “Do you know what, I’m so busy, I’ve got the patient, just leave me alone, it doesn’t matter.” But of course, in research it does matter. But you learn that as you go along, the more experience you get with the clinical trial, you know that it’s easier in the long run to document it well at the time, and that becomes second nature after a couple of months, you get used to what the expectation is, cos it is different from a ward setting in terms of documentation. So you pick that up and then it becomes fine. The data team are fantastic. I don’t envy them in many respects because they trawl through doctors writing, which is notoriously difficult to read on occasion. And they’re the ones who really will make sure your data is exact and correct, and so they’re a real big support.

Being a nurse and helping patients was at the core of Michael’s plans for career development.

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.