Nicky

Age at interview: 52

Brief Outline:

Nicky has worked as a research nurse for eight years. For the last five years, she has been the lead research nurse responsible for a team of staff. Her current role includes setting up and overseeing studies, including assessing feasibility.

Background:

Nicky is a lead research nurse. She is married and has children. Her ethnic background is White British.

More about me...

Nicky has been a research nurse for eight years, with the last five years as a lead research nurse. Nicky specialises in diabetes trials but has also recently taken on metabolism and endocrine studies. Nicky was working as a district nurse when she first saw an advertisement for a diabetes research nurse post; although she didn’t know what to expect from the role, she “liked the idea of it, thought it looked interesting”. The post was part-time which suited her having young children, as she could work within school hours. However, because she had previously been working nights as a district nurse, school holidays presented a new challenge for childcare arrangements. Nicky was initially put off by moving from a permanent to short-term contract but felt confident that she could find a job in another part of nursing if needed. 

When Nicky first started as a research nurse, she worked on two or three studies. She found research a confusing area to be in for the first couple of years. Although she had Good Clinical Practice training and a session on informed consent when she started her post, most of the learning had been “on the job training”; as a result, she “always felt like there were bits of the jigsaw missing”. After three years, Nicky was encouraged to apply for a lead research nurse position which had opened up. She felt reluctant at first because there were still “pieces of the jigsaw that didn’t quite fit in”, but took the role. Her confidence and expertise have grown with time. As lead research nurse, Nicky now sets up and oversees studies, including assessing feasibility of potential studies by taking many different factors into account. Nicky is keen to keep up patient contact but has to balance this with managerial responsibilities for the team she leads. Nicky’s team are currently involved in about 15 different studies, which can be a lot to keep on top of. Nicky would like to increase her hours as she finds that she often ends up checking emails or taking phone calls on her days off anyway. 

Nicky likes the variety of her work and that “no two days are ever the same”. She thinks the variety also “keeps your skills up ‘cos you’re doing lots of different things”. For example, she has had training in various clinical and lab skills required for data collection and management, because her team carries out these tasks themselves, including cannulation, centrifugation, and performing DEXA scans. Nicky and her team have access to a research unit with beds, equipment and storage space; their office spaces are located separately but nearby. Having this dedicated space for research “makes life really easy for us when we see patients”. She sometimes does home visits to include patients who could otherwise not have travelled to the research unit. There are times when Nicky misses being a clinical nurse, as she doesn’t feel “needed” by patients in the same way in research. However, she likes that her role means “you’ve actually got time to spend with people, so you can treat people the way you would have liked to have treated them when you didn’t have the time [in a busy clinical role]”.

For Nicky, research is about helping “move forward” the care of patients: “without research nurses and without research, then these patients are never going to get those opportunities”. Nicky highlights organisational and communication skills as important for research nurses. Her key message to nurses interested in a research role is to speak to current research nurses, but she also suggests that they should have “a certain amount of clinical experience first”. This is because she thinks it is common for research nurses to lose some clinical skills in the role which makes going back to a clinical post difficult, and that this might be even harder for a nurse with only limited previous experience. Nicky also thinks that having well-established clinical experience can be helpful in research, for example, when recognising adverse events and deciding how to respond. 

Nicky speaks about the career options and trajectories available to research nurses. She feels this is an area which is improving but that, in nursing in general, these tend to be managerial and involve less contact with patients. With this in mind, Nicky is not sure what her options are for career progression: “it feels like everything would be a sideways move”. Nicky is currently undertaking an MSc and is planning a small study for her dissertation. Nicky would eventually like for her research team to design and run their own studies.

A study Nicky was involved with offered patients the opportunity to try a technology otherwise inaccessible to most. Both patients and the nurses caring for them saw this as having a lot of potential benefit.

Cos I think, I think it’s changing the mind set a bit about research, cos I think people sort of think ‘oh research is something that, I don’t know, using people as guinea pigs or whatever, and there’s nothing in it for the patient’. But we’ve since had a few studies where there is something, a lot more in it for the patient, in that one of the studies we do we’re giving the patients an opportunity to try a continuous glucose monitoring system that they wear on their arm. Which means that they don’t need to finger prick so much to test their blood glucose. And so, and it’s a device that’s available on the market to buy, but it’s, you know, relatively expensive and not everyone can afford to buy it, and it’s not at the moment available on the NHS. So we were able to, we were getting quite a lot of people onto this study, so we were asking the diabetes nurses to refer people. And so, I think they began to see that actually this is a study which is really nice for the patients, they’re getting to try something that’s really helping them, you know, for a couple of weeks, and it can, you know, really help with their diabetes, and all the rest of it.

Nicky had to learn lab skills when she started in her first research nurse post eight years ago. She was mainly shown what to do, but this taught her some mistakes and inefficient practices. In contrast, new staff attend a course.

And there’s also a lab skills course, which again there wasn’t when I first started. And one of the things I do in my job is we do all our own-, we don’t have any lab people, so when we get the samples we do all our own centrifuging and pipetting of plasma and what have you. And I’d never done that before, so again someone just showed me how to do it. And then I think I’ve since discovered a couple of things I’ve been doing wrong for, [laugh] for five years, you know. Because you don’t, if someone just shows you, it just gets passed down the line and, you know. So once people started going on the lab skills course, they were able to feedback and say, “Well, you know, we should have been doing this for the last however long.”

So yeah, so I think it’s a lot better, and I think there is a lot more now. And the workforce development team have kind of constantly trying to, you know, find out from research nurses what it is they need to know and trying to sort of add more things into, into that training. So yeah, so as I say when I first started no, there wasn’t very much, but it definitely has improved a lot since then.

Nicky had previously been under pressure to recruit patients to studies, but felt that voluntary participation was important.

There is quite a lot of pressure to get patients into studies. I mean obviously, if you kind of decide on a target at the beginning, I mean I think just personally you quite like to do what you said you’re gonna do, so that’s one thing. But you do get, I mean there is a certain amount of pressure to meet those targets anyway. I think we, I would say mostly when we get patients on studies in [City] we do generally keep them on the study, we do have quite a good record of sort of, once people are on it, they stay on it. But then we do sometimes struggle to recruit, but then I think perhaps because we’re not pushing people that perhaps aren’t necessarily appropriate for the study, then we’re getting the right people, and then they are staying on the study throughout. But I think, I mean I think that’s one of the hardest things in research is recruiting [laugh] people, recruiting people to studies because you don’t want, you don’t want to persuade people to do something, you know. You, I think especially as a nurse, you want to be an advocate for that person and, you know, if someone has got reservations about it then you don’t want to, you know, you don’t want to push them to do something that isn’t really right for them [cough] for whatever reason. So it’s sort of finding a balance between sort of, you know, trying to sort of be positive about the study but equally not, not forcing people to do something they don’t want to do.

Nicky liked having the scope in research to “treat people the way you would have liked to” if time had been permitting in clinical non-research roles. However, she also missed the relationships built with patients in this context.

So, I think sometimes the sort of view of research nurse is that kind of we’ve got plenty of time to sort of sit around having cups of tea, and that sort of thing. So, but then I sort of think ‘well I’ve been a nurse for years, I’ve, you know I kind of know I’ve done all that other stuff as well’, so I kind of, and I usually say to people if I see them at study days, I say, “Well you should give research nursing a try, cos actually I think the thing that’s nice is you’ve actually got time to spend with people, so you can actually treat people the way you would have liked to have treated them when you didn’t have the time when you were doing one of your other roles.” You know, you can really spend the time talking to people and trying to, you know, sort of help them out and that sort of thing. 

Then I, but then I think there is a part of me that misses kind of being a clinical nurse, where you’re the person that’s kind of helping somebody, as it were. And, you know, and I suppose that’s why I became a nurse in the first place. So there is a part of me that misses, misses that side of it, sort of being the person that, you know, I don’t know, a patient kind of, you get that relationship where you know you’ve sort of helped somebody and, and you’ve sort of built up a bit of a relationship through that. And, although you do build up relationships with research participants sometimes, if they’re there over time, it’s different.

Nicky described her experiences of the relationships between Principal Investigators (PIs) and research nurses.

You do work really very independently in research, so, usually have a PI [Principal Investigator] for the study, a Principal Investigator, so but often that Principal Investigator is a clinician, so particularly in, where I work, I mean [cough] the Principal Investigators there, they’re consultants, they’re out you know busy in the clinical area. So really, I would say we kind of pretty much, as nurses, pretty much coordinate and run the studies. So you do have to be able to work very much, you know, take on board a lot of the responsibility. Obviously they’ve got the overall responsibility and you have to, again you have to be able to pick out what are the things, you know, you have to make sure you’re constantly communicating with them to feed everything back, and make sure they’re kind of aware of what’s going on the study and if there’s any issues with patients, then they’re aware of it. But actually, you are making a lot of the decisions. And actually there are a couple, well one study where I’m the PI myself. And I think that’s happening a lot more now, that nurses are becoming PI’s for more studies. So again on that study, you know, it is just me, I’m kind of the person that’s in charge of it, and obviously I’ve got people on my team working on it.

Nicky’s move into research meant daytime hours and having bank holidays off. This worked well for her with a young family during term-time, but proved trickier in the school holidays.

Yeah so well because previous to this I was working on evenings in district nursing, so I was doing six till, six till midnight, but only two evenings a week. So, I did one day, cos I was managing that team, I did two evenings but then I also did one day, I sort of had an admin day during the day. So yeah, it was, it was quite a change. So, then I went from that to, and then when I first started on the research I did, I only did 18 hours, so I managed to fit that, more or less, around school hours. But then of course, because I’d always worked evenings, I’d never had to worry about school holidays before for my children because they, you know, I’d always been working in the evenings. So of course, then I was working in the day, then I had that sort of in the holidays to manage. But I mean now my children are old enough I don’t have to worry about things, you know, they’re still at home but they’re older so [laughs] so I don’t have to worry. But yeah, but in some ways it’s nice working, one of the things that was particularly nice was when I worked evenings, you know, we still had to cover all the sort of bank holidays and Christmas, and all that sort of thing. And I have to say it was very nice when I, and I still appreciate it every Christmas when I don’t have to work Christmas in this job [laughs]. And I have to say that is a big treat to know that I can have Christmas off every year with my children.

Most of the studies Nicky works on are carried out at a research unit, which “makes life really easy for us when we see patients”. A new study in a different setting has presented several difficulties.

So this one that we’ve got going at [hospital] is going to be a lot more difficult because I don’t even know if-, how easy it’s going to be to book a room [laugh] when we get a patient, let alone, and certainly if we do book a room we’re going to have to bring a car full of equipment over with us. And then, you know, again in our research unit we’ve got an ECG [Electrocardiogram] machine, but this at [hospital] I had to-, you know, I spent probably the best part of a day trying to find someone that could lend me an ECG machine. And eventually I found the cardiac research department said they’d lend one but, you know, it means going over and getting it, and then taking it to the, to the antenatal clinic, and then taking it back again. So it’s not quite as convenient as having it next to your bedside. So, you know, things like that, and also we have to-, I was saying we have to spin the samples, and over at [hospital] we don’t have the facilities to do that. So then it-, we’re trying to decide ‘do we take a portable centrifuge with us, or do we just bring the samples back to the, or, to the [research unit] and spin?’ you know, so there’s all those kind of practical considerations when you’re working out of different centres.

Nicky said that, in her experience as a research nurse, “no two days are ever the same”. She enjoyed this variety and the relationships with various teams and individuals that develop.

I would just say-, I mean it is-, I think it’s a really, really interesting job, and I just think there’s lots and lots of opportunities out there. What I would say is come and sort of see what it’s all about. I would say come and, come and sort of speak to research nurses, and see if you can come and, and sort of spend a day working in research and see if it is the sort of thing that you want to do. But it’s, for me, I think one of the things that I really like about it is the variety, because you, no day, no two days are ever the same. And, you know, you get an opportunity to try some different things, so there’s, there’s a lot of liaison with sort of the R&D department but then you’ve got the patient contact, you’ve got sort of even just doing the labs, so sort of seeing the patient right through from start to finish, I think is, is the thing that I really like about it. And you do build up relationships with the patients over, over time. You know, sometimes you’ve got a patient coming in for a year and you really have the time to spend with that person. And, you know, I’ve got a couple of patients that have taken part in research three or four years ago that I’m in still in touch with now. Because we, we’ve sort of built up that relationship and we, you know, and they’ve perhaps come back for a couple of different studies and then they’ve got involved in some Patient and Public Involvement stuff with us as well, so I still see them from time to time at things and, you know, and I think that’s, that’s one of the things I really like about it.