Paul

Age at interview: 47

Brief Outline:

Paul has been a research nurse for 15 months. At first, the new post was overwhelming and it took about a year for him to feel more confident. The opportunity for patient contact and support is a key aspect of his job that Paul enjoys.

Background:

Paul is a research nurse. He is married and has children. His ethnic background is White British.

More about me...

Paul came to research nursing 15 months ago, following 14 years in a clinical post. Nursing was a career that Paul pursued through taking an Access course and going to university. When he graduated, Paul worked as a general surgical nurse, specialising in urology, and head and neck cancers. Although he had no background in research, a research nursing opportunity came up in Paul’s department and he got the job. Paul felt confident about the transition from clinical practice to research, as he had worked in the same area before. However, he was surprised by how difficult this was in reality and how different research and clinical nursing were. Paul described the first 6 months of his job as “overwhelming”. Navigating paperwork, protocols, medical concepts and language was challenging in the beginning. Paul found undertaking basic training in oncology as well courses on understanding protocol and giving consent to be really helpful. The support of his colleagues was also important to Paul as he started his post, and this strong support structure remains central in managing workloads. Paul learnt to accept the adaption process that comes with moving careers: “it was a little bit scary. But yeah, you have to not be hard on yourself”. After about a year, Paul started to feel more “secure in what I know”. 

Paul started research on a one year fixed contract. Whilst this concerned him, he also saw it as a “get out clause” if he decided not to pursue this career. Since then, Paul has been given a permanent contract. He currently works on 11 trials, with a range of responsibilities such as patient recruitment and ensuring patients understand the trial before giving consent. Paul was surprised by the amount of admin and desk work involved in research nursing. Paul deals with a lot of paperwork when organising and recruiting for trials, but hopes the shift towards electronic filing will make things “a lot easier”. Paul is also beginning to take on more responsibility supporting and mentoring student nurses. Since going into research, Paul feels he has lost some of his clinical skills. One way he maintains these is by doing things like taking patients’ translational bloods himself when working on a trial. 

One aspect Paul enjoys about research nursing is the opportunity to interact with patients. If a patient is in need of support, he is able to block off time to spend with them, which enables strong relationships to develop. He draws on skills he developed in his clinical background, for example: “the patient sensitive skills are always there, and you never ever lose them, and they are invaluable when you’re delivering bad news or whether you’re supporting somebody”. Paul has found his job particularly rewarding when he has been able to follow a project from the research through to the results stage, and seen how the results have been used to inform care pathways. Paul acknowledges that working with people with cancer means there is a lot of sadness and death in his job. What drives Paul is helping people; whilst curing patients is not always possible, “it’s about making the life that they’ve got the best it can be”.

As Paul works on multiple trials, balancing the workload can be challenging. Particularly, remembering the inclusion and exclusion criteria for different trials can be difficult, but Paul manages large amounts of information by using key words when recruiting. Another consideration Paul is aware of when recruiting for trials is the emotional state of patients, as many have just received news on a cancer diagnosis. Approaching patients is a “judgement call”, and Paul often seeks advice from colleagues around handling this: “it’s something that you learn through time, when you’re working with people is, when it is appropriate and when it’s not appropriate, regardless of what the protocol says”. 

Whilst Paul feels strong management is a positive thing, he is not looking to progress to a managerial role himself. However, he hopes to develop his career in research, whether in a private company or within the NHS: “I want to know more. I want to be able to do bigger studies”. His key messages to others relatively new in a research nurse post are to remember that this is a period of transition and to “give yourself time” to adjust.

At first, Paul felt overwhelmed by the amount of paperwork he was faced with. It took a while for him to work out how best to manage multiple studies and their protocols.

I didn’t realise how much admin there was going to be done. And how much physical desk work and paper work and actual research, as I understood it, was searching through documents and things that I would need to do. Inclusion, exclusion criteria. Again, at the very beginning I just thought this is never ever going to sink in. I had, at that time I had ten trials and I just thought I am never ever going to understand this. Again, the team were fantastic, saying that you don’t have to, you do not have to understand every single aspect of the trial, you don’t need to know that protocol from front to back, what you need are key words and you need to be able to understand how to read a protocol. So it’s not, I imagined it’s a bit like a bible, you don’t read it from front to back, what you do is you go into the area that you need to do, inclusion criteria, exclusion criteria, assessments, dates when chemotherapy is, so you need to be able to find them, and once you, you accept that and realise that you literally cannot know everything, it makes your life a lot easier. And that you then don’t need to worry about something until it’s there and it needs to be done.

Paul now loved working in research, but there were times in the first year where he questioned whether the job was right for him.

I was, initially I, I actually thought it would be a lot easier than it, it was. And for all the people that I’d spoken to they said, you, it is totally different. It is, it’ll be nothing you’ve ever experienced before. And I thought, I’m sure it’ll be alright, I know head and neck, I know urology. And it was just totally different. So, it was very overwhelming for about six months. And I think within my first six months I probably thought twice have I made the right decision because protocols and paperwork and e-CRF’s and sponsors and industry, they just baffled me. I have a portfolio now of eleven trials that I currently look after. So, and it’s took me probably up until Christmas, which was just about my year, that I, I started to feel secure in what I know. And my background in nursing has helped, be it, for the language mainly. I understand when they’re talking about tumours and things like that, but it’s been a massive learning curve. It’s been really, really interesting and I still love it, and I’m so glad that I made the, the change.

Paul offered some advice to research nurses, midwives and AHPs struggling to adjust in their first job.

Try to change the way that you think about you don’t have to know it all now. Do you know, take it back to when you were doing your nursing career as a, the first six months of being a student and you were just thinking, “Oh my god, what have I done? You know I’ll never, what’s this I don’t understand that?” And research is very much like that. You just come with thinking, “Oh I’ve got ten years of knowledge, this is going to serve me well.” And it, sometimes it does, sometimes it doesn’t. But just give yourself time. Give yourself at least six months before you make any rash decisions and give yourself at least twelve months to say, I think after twelve months you would know whether it was for you or not. I think that the cat in the headlights is going to be there for six months, don’t worry about it. Easier said than done. I worried about it. And then suddenly you just realise that things are clicking without you even realising. And what you worried about last week, you don’t worry about anymore now because you’ve, it’s there, it’s embedded. It’s that knowledge that you can call upon without thinking. You know, “go and find me this protocol,” “What’s a protocol?” You know, “Which protocol?” To suddenly going, “Oh yeah, it’s in the filing cabinet C, second drawer, right at the back.” You have to squeeze round because it’s really full, but it’s there, and you can do it. There it is. And you do that without thinking, and that is a personal achievement you don’t realise, and I am probably just talking to you realising more about how I’ve moved on in 15 months to where I am now, to thinking that. Yeah. It was very, very scary. But as long as you’re prepared for that, and you don’t let it overwhelm you so much to just think “I can’t do it”. You, it might not be for you but give it a go, definitely give it a good go, give it a good six months and then give it another six months after that to say, “Am I sorted? Is this really for me?” Because it might not be, but at least you’ve tried. And that’s the same with anything in life.

Paul described what support he had when learning about his role when he started as a research nurse. Over time, he found things “click[ed]” into place.

Initial induction, so it was getting to know the R&D [Research & Development] department, and the team in general. I worked closely with my now manager because it was their trials that I was taking over. We did a lot of SOP [Standard Operating Procedure] training, just finding out the, the lay of the land. I did a lot of reading on what research is, GCP [Good Clinical Practice], clinical governance, MHRA [Medicines and Health Regulatory Agency], all them sort of acronyms that I’m still getting my head round but are all there which says about why we do what we do, Good Clinical Practice, consenting courses. And then it was shadowing different people to see how they do it, how it’s done. I wouldn’t like to say properly because everybody does it properly, but you do find your own way and what used to, a follow up that used to take me an hour and a half to two hours, I can potentially do in 40 minutes now. Because it’s straightforward and I know where to find things, and that’s just learning, it just comes. You have to realise that research is very, very different to any nursing thing that I’ve done. And until you do it you will never know how different it is, but you just have to accept that you’re starting again from scratch effectively, and that’s very difficult when you’ve, you’ve ran a ward and you’ve been able to deal with any incident, and somebody comes up and say, “Fill this out,” and you’re like, “What is it?” yeah. So, it’s just a very, very slow process, but there’s no rush.

Paul drew on his nursing skills when telling patients about studies and checking their understanding.

The patient information leaflets come from the trials. But it’s, it’s your own communication skills it comes with, I’ve been nursing for 15 years now, it’s something you learn to do, and you work off their cues, their verbal cues, their non-verbal cues. And you talk in a language that they can understand. Some people are, are very, very knowledgeable and they tell you that this, and you’re discussing them and they take you off on a tangent about some other trial that was on. And some people just really don’t know very much about it and just need it in very plain basic English, and some people don’t want to know anything about it. They’re happy to take part, they know that it’s going to be a chemotherapy drug but they don’t really want to know too much. So, it’s all about the conversation that you’re having with the patient. It’s all about the discussion. And there’s no set rules or set laws, you have to gain an understanding that they know what’s going to be happening to them, and actually what they’re consenting to. But that level of knowledge you have to discern as a nurse to say that I have to sign to say that I am sure that they’re aware of what they’re doing.

And that’s just through conversation.

Paul talked about mentoring nursing students on placements in his research team.

I was, I was originally on the mentor register when I was on the wards. And research has only just started taking student nurses. At the moment from here. We’ve only had one student and they’re currently third year students. And we’re in the process of developing a training package for them because research is very, very intense. A lot of it can be quite boring and laborious, and it’s how we keep a student interested. So, I’ve been actively involved in setting up that, and we’re getting our second student coming, who’s going to be working with me, where initially my first student that I just had for three days on different times. I was more of a support mentor, this time I’m going to have them for two weeks so that we can actually be specific, and what we learnt from our last student in the feedback was that we’re not, we don’t need to be too broad. We need to be more specific. So, give them an overview of what’s going on and then say because they’re third year students, “Is there a particular area that you’re looking at? Are you interested in breast? Are you in bladder? Is it lung that you’re more interested in? And then try and be, to, to guide them into one protocol, understanding one protocol. Because protocols are all the same, they just say different stuff. But you follow it and they’re all, they’re all the same at the end of the day.

So, getting them to understand about why we do the paperwork, what it involves, why we ask the questions we ask, why is that important? Knowing and trying to explain to them the different types of studies. Why it’s important that we look at toxicities when people are taking drugs. Why, the one that I’m going to be working on at the moment is my bladder cancer one, cos it’s a questionnaire one, and it’s looking at people’s experiences from diagnosis to treatment, and how that works. How people feel about the moment they’re told the bad news, to how long it took to get that bad news, and how that works.

Paul initially felt that a one-year contract was “a wonderful get-out clause that doesn’t look bad on my CV”. He was confident he could find another nursing job if need be, and so it felt “like a secondment”.

Cos that’s one of the things that sort of worried me when I first came into research is that it was only a one-year contract. But on the backside, or on the good side of that was actually that if I went in and I didn’t like it, and I just couldn’t do it, I’ve got a wonderful get-out clause that doesn’t look bad on my CV. I’ve got 14 years of experience that gets me back into the ward, with a little bit of refreshing, so it was an ideal opportunity, it was a bit like a secondment I felt when I was going in, that I’ll go in, I’ll give it twelve months, yeah, and then I will make a decision. I actually love it, so it’s, it was very beneficial for me to get a permanent contract, but it didn’t really worry me that much, as much as I know it has worried other colleagues about not having a permanent contract. Everybody has a mortgage to pay and the bills, so things like that. But I always knew that I would be able to get a job if this didn’t work. I could go back to where I was I can travel, not ideally but I know as a nurse I have enough knowledge and experience to be able to go back into nursing.

So, this was like a secondment for me, and it would be an ideal way to see, put my foot in the water, and say actually, “You know I’m glad I give it a go, but it’s really not for me.” And research is not for everybody, it really isn’t. But fortunately for me, it is. It’s one of the best decisions or progressive decisions that I’ve made, it was the right time to move.

Paul somewhat missed the variety of shift patterns from his previous nursing job. His research job hours also caused problems with finding parking; going into work slightly earlier helped.

It was lovely for about four months but now you have two days to do everything. So, you have to do all your cleaning, all your washing, all your shopping on a Saturday. On a Sunday you’re getting ready to come back to work on a Monday. So, I do miss, I never thought I would say it, miss working shifts. I don’t miss nights at all, they can be gone. But I do miss 2 o’clock finish where I could go home, chill out, cup of tea, feet up, watch a little bit of crummy television. Have a bit of a nap, where now, and it’s very, very tiring, it is, I’m like most nights I am in bed by ten, cos I’m up at six. I only live well I live about, it’s about 25 miles away, so it’s about 25, 30 minutes away. And it’s not a bad commute, but parking is a nightmare, you don’t get parking privileges because you work nine till five, so that’s very, very difficult. I don’t have a, a very good bus route that would get me in for the times that I need to do cos I live in a, in a little country village now, so there was all that to look at, so what I do now is I arrive at work about quarter to eight every day regardless of whether I start at eight or nine.

And I find that, I can go and have a coffee, just chill out, have a hello to whoever’s around, and then from nine o’clock I’m ready for my day. When I first started I was looking 40 minutes for parking, you were stressed out before you’d even started work and it’s not a good way to be going in. It was new, it was all fresh and it was a little bit scary, but I was very, very anxious. So, parking is a very, something to be aware of. I think that’s in any hospital that I’ve worked in, parking has always been difficult.