Nikki

Age at interview: 34

Brief Outline:

Nikki is a research physiotherapist working in critical care and peri-operative medicine. She continues to work one day a month clinically, which she sees as beneficial for maintaining her skills and fostering the research culture amongst colleagues.

Background:

Nikki is a research physiotherapist. She is in a relationship. Her ethnic background is White English.

More about me...

Nikki is a research physiotherapist working in critical care and peri-operative medicine. She is part of a mixed discipline team which also includes nurses and physiologists as well as professors from related backgrounds. Nikki has been in post for 14 months and is about to move to a new job with additional leadership responsibilities for a research nurse team. Before being in research, Nikki was a physiotherapist in intensive care for six years. She completed a Master’s during this time – an undertaking which was difficult to fit with her clinical work. She enjoyed the research experience and went on to be awarded an NIHR fellowship to write a doctoral research application over a year. Although she didn’t receive funding for a PhD, the fellowship was “an amazing opportunity […] to basically sit and read and write, and meet people, and absorb as much as you can”. She returned to clinical work for a while but found “that was no longer what I wanted to do” and so applied for her current research post.

Nikki felt it was quite a big move to go from being a clinical to a research physiotherapist, but found it reassuring that a friend she had trained with had made this move and really enjoyed it. Nikki had lots of training when she started in the post, including a four-day course which covered various aspects of taking consent, managing site files and writing study protocols. Nikki was originally offered a fixed term contract (for six months, revised to 12 months) but felt “I couldn’t really afford to take that risk”. Eventually it was agreed that the post would be permanent, which Nikki accepted. A benefit for Nikki of her research post is having flexible hours and the fact she is no longer on-call for late shifts. Sometimes she has to go into work early or stay late to cover study activities, but she can then take the time back as and when she needs.

The studies Nikki has worked on have included CTIMPs (Clinical Trials of an Investigational Medicinal Product) and observational studies on a wide range of topics, from sepsis, to the impacts of low oxygen states, to respiratory viruses. Although some of the studies are not primarily about physiotherapy, she finds there are angles which fit with her background and interests. For example, whether it is best to sedate and ventilate some patients or wake patients and encourage them to move. She has helped with assessing feasibility of potential studies, study set-up, screening for eligible patients, and approaching patients or relatives about study participation. In terms of data collection, some of the studies cater to Nikki’s skills as a physiotherapist – for example those around exercise which involve “physical assessments or the strength assessments or the function assessments”. In addition, Nikki finds her research team very supportive and, providing she “deliver[s] on my day job”, there is encouragement to pursue extra pieces of research of her own – for example, on muscle wastage in intensive care. This sometimes means working extra hours but Nikki is happy with this arrangement.

When she first started in research, Nikki was surprised to find that most patients or their relatives were happy to give consent to take part in research studies. She had expected the decline rate to be high because relatives have “been told, often very short notice because it's often emergencies and an admission to critical care, that their loved on in a life or death situation” and so have “an awful lot to cope with”. Although research opportunities are generally well-received, Nikki feels strongly that “a really important part of our role” is to support patients and their families if they have concerns about it not being right for them. Although she would never “pressure” a patient to say why they declined a study, Nikki finds that these reasons are often volunteered. She thinks it can be useful to know, “just to see if we’re getting patterns” as problems in the research design could potentially be amended.

Within her research post, Nikki has arrangements in place to work clinically one day a month. This helps her “keep in with the team […] and to not feel that I’m out of the loop”. It also “keeps you visible within the clinical team which then helps our relationship with the clinical team and it helps us deliver a study”. On these days, Nikki runs a journal club and sees it as a way of “promoting research” amongst her physiotherapy colleagues. Nikki thinks there’s an assumption among clinical staff that allied health professionals (AHPs) don’t work in research delivery and that this is a role taken up only by nurses. She hopes though that, with time, her hospital will “embrace more and more professions” in research roles. She thinks it is important for her discipline of physiotherapy to engage with research activity. Nikki feels that the evidence base in physiotherapy is “a long way behind”, which can make it hard to justify the value of the discipline as “a necessity and not just an extra”.

Nikki would like to “go the clinical academic route” and plans to pursue funding for a PhD. She feels there is top-level support for such pathways but finds “middle managers” more resistant or inflexible. Nikki’s message to other physiotherapists is to not feel “confined by the traditions of a clinical career pathway”. She had herself feared that, by moving to research, she “would lose something” but now feels “you stand to gain an awful lot”. Nikki feels strongly that she remains a physiotherapist but “with extra skills”, and highlights that physiotherapists can always go back to clinical posts if they find research is not for them.

Nikki went on a course which covered a lot of practical information about clinical research, which built on her knowledge from undertaking a Master’s degree and a fellowship year.

But this ‘Fundamentals’ course, they- They do- I guess they go a bit deeper into the background of GCP [Good Clinical Practice] and where it came from, and you know, the atrocities in the war and that type of thing, and. But it's also bits like, you know, how to manage a site file, and how to keep a site file up to date, and what needs to be in it, and what doesn't need to be in it, and you know, how to manage a difficult PI [Principal Investigator], and . You know, sort of how to manage up the chain, and. So, sort of those kind of elements that were very relevant to someone going into that sort of research delivery post. It was about a four day course I think, from what I remember. So there was an awful lot of content. And it did just give you a really good grounding in. Because obviously up to that point I'd sort of been used to- So I was used to the ethics process, and I was used to sort of writing protocols, and I was used to the sort of approvals processes that you have to go through. But I certainly wasn't used to how to, the practicalities of delivering research, and how to sort of take a protocol that wasn't yours, and unpick it and then decide 'how am I actually going to make this work, and how am I going to deliver it'. So, that course was really useful in terms of moving into the current role.

Nikki felt that some of the paper-based systems used to screen for potential eligible participants would be improved by being made electronic.

In critical care, we screen everybody every day for, you know, the number of studies that we have. Surgical patients tend to be a bit more difficult, in terms of you know, trying to- It sounds crazy but they still make paper lists for surgical patients. Which is just baffling to me, why it's not done electronically on an electronic system. But literally, the surgeon will make a paper list and hand it to the booking clerk, who then books all these patients. So we have to sort of somehow get hold of a list, so that we can then screen for patients. So, that's been a bit of a, a nightmare. Emergency patients are weirdly easier to find out about than the elective. Which to my mind is just a bit crazy, but anyway. So yeah, so we'll come up with a system of, of screening patients and making sure that we're not missing patients. And then we'll approach.

Nikki had a fellowship year to develop a PhD proposal which helped her access research jobs. She was due to start a new post managing a research team shortly.

And then I got the opportunity to do what they call a fellowship year. So I did apply for the NIHR CDRF [Clinical Doctoral Research Fellowship] scheme. So then I had a year, they paid me a year to basically just write an application. Because it was such a massive application. So I was really lucky [laugh] actually. Unfortunately I didn't get it. I did get to interview, and then didn't get through the interview process. But for me, like what an opportunity. I mean, no one ever gives you that chance to just have a year, just to basically sit and read and write, and meet people, and absorb as much as you can. And like - an amazing opportunity. And although the outcome, the desirable outcome was obviously that I would get the PhD grant, then go on and do more stuff, but. And at the time, I was gutted. Because you put your- You know what it's like, you put your life and soul, don't you, into writing these research proposals. And I didn't get- And I think they told me like two days before Christmas, [laugh] and I was just like 'oh'.
 
But I'm still really grateful for that year, and it was - you know, I definitely, I definitely got so much from that year. And, and I think that then led into the jobs that I'm now doing. So, you know, it all- doors open, don't they, I think.

Although Nikki wasn’t awarded doctoral funding in the end, she had been worried about the arrangements for holding her job open if she had pursued this route.

And the same for my, when I was applying for my PhD. I was being asked from my physio managers to leave my job, to then go and do this PhD. You know, if I'd got that funding, that was what they were negotiating. You know, they weren't prepared to hold my job open while I went off and did my PhD, to then come back from my PhD. So I was then left in the position where I was discussing with the research department - I don't want to go and do a PhD, even though you know, an amazing opportunity, and you know, all your training's paid for, all your travel's paid for, your course, everything is paid for. And your salary is matched, and all of that. I don't, I don't- I'm not prepared really to step away for three years, to then not have anything at the end of it. Like I need you to guarantee me that there will be a role for me at the end of this. And obviously we never actually got to the point of having to make a final decision. But certainly the initial chats we were having was that they would do that, because they could understand that position.
 
And certainly people that had gone through before me, had had their posts held open. So I think their plan was to go back to the sort of therapies department and say, 'look, we have precedent for this, people have done this before, and posts have been held open'. You know, 'realistically, you will be able to place her in three years time somewhere - yes, not in her current role'. And I think that was the way the conversations were going to go.

Nikki had varied experiences with the amount of engagement from Chief Investigators (CIs) or Principal Investigators (PIs) and study centres.

I think it depends on the study. I think-, I'm sure probably most people find this, that if you've got a CI [Chief Investigator] on site you tend to have much-, it's a much more sort of two-way, probably much more frequent conversation isn't it, about what's going on, and what's happening. And if you're a site delivering someone else's study, it's probably less so. Because you're just, just much more remote aren't you, from that I think. And I think it, I think it depends on the, on the CI, as well. And, and the site. You know, I've certainly had studies where you feel much more engaged, you know, the CI often checks in with you, or checks in with the site. He's, “How are you going?”, and sending newsletters, gives you updates. And that's quite- it's quite motivating. Whereas I've had some studies, you're literally given the information to start up, and then check back in in a year's time, and- It feels quite disengaging, I think, from a research delivery team point of view. It feels like you've been forgotten about. Which I'm sure isn't the case.
 
But I quite- I find it- I find it a better experience if they are the types that engage with you as you sort of go along.

Nikki negotiated for her research physiotherapist job to be a substantive contract, as she felt fixed-term was too risky.

I remember saying like 'I really want to take this job and this is really what I want to do, but I just - I can't leave a substantive role, to move across for six months, because it will fly by, you know, I've almost got to start looking for a new job, or some kind of back-up plan or something straight away, and as much as you can sit there and tell me I'm sure your contract would be renewed, I'm running the risk of it not being renewed, and then what do I do'. And suddenly I've left a profession - not a profession, I've left a pathway or a clinical job that you know, I could, that is substantive and I could carry on for years, for- And then it did kind of feel like I'm trying this out, I don't necessarily know for sure that this would be what I like, to then step into a role that I'm only going to have for six months and you know, I can't - I felt like I couldn't really afford to do it.
 
I couldn't really afford to take that risk. And I felt the same with a year. Because although it's clearly twice as long as six months, it's still, it would still fly by. And I think you'd still have to sort of go into that job almost sort of thinking 'right, what is my back-up plan, and where am I going to go in a year'. And I just didn't want that kind of pressure. And I kind of- I think I kind of knew that if I kept, if I kept bargaining that I'd probably get what I want. Or, and if I didn't, I think I was happier to stay in a clinical role that I still enjoyed, as I said to you, on a substantive contract. Rather than take the risk, and make the move to move into a research role.
 
And then luckily, I suppose, or eventually they were like 'fine, we'll just give you a substantive'.

Nikki felt the flexibility in her research physiotherapy job was two-way. She sometimes worked hours outside her usual ones but could take time off if she needed to.

And then I suppose that's one of the appeals of research, isn't it, is that there is the certain flexibility that you get, in that environment which I would never have got in, in physio. And things like, I don't know, having to, you know. Hospital appointments or doctors appointments, that kind of thing, it's much easier to flex around that. Whereas when I was physioing, there was no way I'd be able to sort of - I'd have to take annual leave to go to sort of appointments, or whatever.
 
So, there was that sort of side of things. Which was quite a, quite a big plus. Though I do feel like research will sort of tend to move in the direction of being more 24/7. And I don't, I can't foresee a time where we'll be asked to do night shifts or anything like that, but even now they're starting to trial weekend working. And occasionally we are expected - or not expected, but a study will demand that we do need to sort of skew our hours a little bit. And you know, that's fine. I, you know, I don't have any problem with doing a ten to six shift, or you know, staying later when we need to or whatever. So I think- And I think probably that's a right, you know, the right thing to do, in terms of flexibility does need to go both ways, doesn't it. That as an employee, if you're asking if you can flex your time to sort of accommodate sort of your life stuff, then perhaps it's right that it's the other way round as well. And that you know, equally you can be flexible to cover the studies when they need to be covered, and yeah. So I think it's probably a changing, changing environment, in terms of research. We'll no longer be the sort of you know, eight to four sort of pattern, and no extra hours.

Nikki thought there was a lot of support for clinical-academic posts at a high level, but that there were major barriers to overcome.

I think there's a lot of focus isn't there, at the minute, on clinical-academic careers, and. And sort of providing infrastructure for non-medics. In that the medics have had those sort of structures in place for a while. And non-medics really struggle with that. And I think, I think- And I think there's a bit of a disconnect between- And I'm talking sort of Trust level now. Between sort of director level, there's a lot of chat about you know, clinical academic careers, and we need to support this as a Trust, and we need to see, you know, this needs to be supported by the Trust, and this is going to help put us on the map, and this is going to help us build our relationships with university, and this is going to help us promote our sort of university hospital name, and we want to be seen as a centre of excellence for a clinical academic career, and this is hopefully what's going to draw people to us. And help us from an employment point of view, and a recruitment kind of retention point of view. And, and will also ultimately help us you know, develop leading researchers, and which will then generate income for the Trust. So I think they are looking at it over a much sort of a longer term plan. But to try and then get your middle managers to try and tap into that vision, and- And I guess understand how on earth they can deliver that is much more difficult. You know, certainly for- And I guess this is one other reason why I left clinical, is that the direction that I wanted to go in was really pulling against what they wanted from me as a clinical physio.
 
That they just couldn't support me, in fostering these other interests. That they just needed me to come in and see patients. And I get- And I get why they needed that, and I understand the pressures that they were under to deliver a clinical service. And I think that was probably why I then in the end ended up leaving, because I just felt 'you know what, there's a whole team here that are going to support me in what I want to do, and you aren't able to do that'. But in terms of developing a clinical academic pathway, we need to overcome that somehow, and I don't know how we do that. You know, you look at- Perhaps the medical model is the right way to do it, in that, you know, they have posts don't they, that are certain grades that they go for. And some are pure clinical, and come are combined clinical and research. And you can apply for what pathway you want to, but the pathways exist. And it's kind of built into that role. But it's trying to get someone to fund that, and fund the research time that's attached to clinical time. Because I think that's probably the only way you're going to get clinical teams to be able to, to cope with- You can't suddenly give everybody you know, half time study leave. You can do that, on the funding that's currently available. So it probably does come down to money.