Nurses, midwives & allied health professionals in research
Professional identities for nurses, midwives and AHPs in research
For the nurses, midwives and allied health professional (NMAHPs) we spoke to*, becoming involved in research had sometimes changed how they or other people perceived their professional identities. This experience was described by people who were primarily employed in research delivery roles as well as those who were leading research studies (in their job or through pursuing a qualification). Reflecting on this change in identity could be a major part of a broader adjustment process but it was often also an ongoing consideration many months or years afterwards. Two key issues related to professional identity were wearing uniforms and professional revalidation/registration. I know in some places research staff don’t wear uniforms but I feel quite strongly that we do wear uniforms because I think that I’m a nurse and in fact in the past we had lots of discussions with my manager at the time about perhaps we all just wear the same, the same uniform and it’s a specific research uniform. And I’m a nurse and I’ve trained to be a nurse, I’m a Sister and I don’t want that taken away from me because that’s how I identify myself and that’s what I want to be. So to me, your uniform is very important and also by wearing a uniform I think you are seen as part of the clinical team. When all my Band 6’s wore the CNS [Clinical Nurse Specialist] uniform they suddenly found it a lot better as well because I think what was happening before that was they were going onto wards and they-, obviously the ward staff would all be everywhere and then, you know, the doctor would come on or relatives would come on and start asking questions and we’d always feel we were going, “Oh sorry, I don’t know, I don’t know”, and actually now we’ve got the CNS uniforms the doctors know that we’re not part of the ward team because we’re CNS’s so we’re, you know, we’re coming in and doing what we need to do and then we’re going out, so that’s actually helped quite, quite a bit. But I do feel quite strongly about, about uniforms because I think it identifies us.
Many people were very clear that they continued to identify with their health profession. As Simona explained, “I was still a nurse and I’m still gonna be a nurse”. For these NMAHPs, working in research did not detract from their professional identity and instead could enhance it. Nikki saw herself as “a physio with extra skills… rather than no longer a physio who can do less”. However, other people struggled with feeling that they no longer a “proper” nurse, midwife or AHP. Often this was related to the comments and attitudes they had encountered from other people, including their non-research colleagues*, patients and the public.
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”.
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”.
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.Julie thought that her day-to-day work activity was not what others (including the general public) would recognise as nursing.
Julie thought that her day-to-day work activity was not what others (including the general public) would recognise as nursing.
Abi sometimes struggled with her professional identity as a speech and language therapy researcher.
Abi sometimes struggled with her professional identity as a speech and language therapy researcher.
And I guess over time my feeling is that I feel that I can be more effective, that I can contribute more, I personally can contribute more to the profession by feeding into the research side than I might be able to were I entirely in the clinical setting. So Yeah, I think that’s evolved, but I, I do, I do have a, a big sort of what’s the word? A big sort of imposter syndrome sort of fear that I’m not a real speech therapist, at the bottom of it, even though I have my clinical competencies, even though I’m registered with the allied health professionals, even though, you know, I, every year when I sign the thing off that says you know I pay money to the HCPC, Health Care Professions Councils to say that I do use the skills that I trained clinically with, within my role. I still have that bit of me going, “Yeah but I’m not doing it in the hospital ward, so maybe it’s not real, maybe it’s not genuine,” That’s a bit weird, isn’t it?
Libby and Nikki, both research physiotherapists, were keen to emphasise that research delivery roles were suitable to health professionals like themselves – not only nurses. Libby’s job had been advertised as a ‘research nurse’ post and she felt it would be good to have job titles that were more inclusive of research AHPs. She thought this would also make it easier to understand job adverts, including around banding, rather than having to “wade through the muddy waters to think 'is this me? Is this my level? Is that, should I go there? What’s that title?' But within this Trust, it’s another title, and in that Trust, it’s something else completely”.
Jed thought differently about his professional identity at different times during his doctorate. He reflected on some of the things that art psychotherapists could bring to health research.
Jed thought differently about his professional identity at different times during his doctorate. He reflected on some of the things that art psychotherapists could bring to health research.
We are quite a misunderstood profession and we spend quite a lot of our careers, all of us, explaining what art therapy is and isn’t. And I think what I’d like to do is to kind of be able to explain, not only what art psychotherapy is and isn’t as a clinical intervention, but what the, what art therapists have as skills that are useful in their own research world. So how we could be helpful for research teams in facilitating workshops in a safe, ethical way, with vulnerable groups particularly. So I’ve been asked to, you know, get involved and support other people’s studies because they’ve wanted a bit of that. So, you know, where I’ve got a colleague who’s a nurse, and she said, “Will you co-facilitate,” because then I’m kind of almost covering that bit if you like, I’m covering that, that side of things that so that’s quite interesting ‘cos, you know, it’s not traditionally what we’ve done, but absolutely what we could do.
A part of what we could do.Graham talked about the importance of paramedic practice being based on evidence, including the outcomes for patients once in hospital.
Graham talked about the importance of paramedic practice being based on evidence, including the outcomes for patients once in hospital.
Many people felt passionately that their clinical background was a major asset to contributing to high-quality, ethically-sound and patient-centred research. They were bringing skills, knowledge and values from their previous experiences into their research roles. As such, for some people, working in research was a continuation and extension of them being NMAHPs and carrying out clinical work. For example, Paul highlighted that “you have to use your nursing judgement” when deciding whether and/or how to approach patients about research opportunities. For Helen, “you’ve still got all those nursing skills [e.g. interacting with patients], we’re just probably utilising them in a different way”.
However, there was also an acute awareness that NMAHPs working in research were often seen by others to become clinically de-skilled. Some worried about this and tried to minimise the chances of it happening. Working in clinical non-research role (as a split or in a separate job, including bank shifts) helped. However, for some, it remained challenging because of rapid changes in healthcare technologies and practices in use. For some, the sense that they were losing or had lost their clinical skills, or that others thought this about them, was distressing because they felt ‘less’ of a “proper” NMAHP. Changes in how NMAHPs in research saw themselves was not always seen to be a problem, and some people felt they had a new identity which struck a good balance between being both a NMAHP and researcher.
Jo planned to start working bank shifts to keep up her clinical nursing skills.
Jo planned to start working bank shifts to keep up her clinical nursing skills.
When she first started in a research post, Ellen found it “hard to resist nursing people”. Eventually, she stopped when her time and abilities to do this “got less and less”.
When she first started in a research post, Ellen found it “hard to resist nursing people”. Eventually, she stopped when her time and abilities to do this “got less and less”.
Sian described a number of skills and experiences of working with different patient groups she had developed as a research nurse.
Sian described a number of skills and experiences of working with different patient groups she had developed as a research nurse.
So simple things like I’d not done an ECG during district nursing, I’d never been in a position as a student nurse where I’d had to do an ECG and it is just something that’s really simple but one of my studies that I’ve worked on required it. I’d never worked with patients with severe mental health so I’ve learnt skills of talking to those patients and that, again that’s improving me as a nurse and giving something back to them as well.
We learnt how to do the spirometry and I’d never done that before and I’m sure there will be, you know, new things that we will learn. I’d never used the scales in the elderly study that I’m doing at the moment that measures your bone density, fat mass, muscle mass so all these things are new, innovative and fresh and, you know, keep me focused and enjoying my job.Simona didn’t think research nurses ‘de-skilled’, and instead she highlighted changing skills as an evolution process.
Simona didn’t think research nurses ‘de-skilled’, and instead she highlighted changing skills as an evolution process.
At the end of the day, I had this debate with other people who keep telling us that we, de-skill and no, we don’t de-skill, you learn a new set of skills. We do, why can’t we say that consent, for instance, gaining consent is not a clinical skill? It is a clinical skill but it pertains to our area. We do collect samples, we do take bloods, you know, we have developed an array of lab skills that also come with this with our job description. So I wouldn’t say you de-skill in any way and I would always argue with that. Yes, but it’s again do you have the same skills as you had in your first year of-, you know, it’s just developing more and I don’t believe that those skills that you had there already are lost, you build on them.
Views on uniforms were divided. For some, they were important symbols of identity and affected how other people (including colleagues and patients) related to them. Those who typically wore uniforms as clinicians, such as hospital-based nurses and midwives, sometimes saw wearing a uniform in their research role as helping maintain an element of their professional identity. Some people felt there was status attached to uniforms, and that this could be important for other staff and patients. Although Ellen’s official title as specified on her name badge was ‘Clinical Trials Officer’ (CTO), she felt that emphasising her background as a nurse through her uniform was important: “it means something to patients”. However, she also recognised that there were non-health professionals in similar roles to her own who were not permitted to wear the uniform and felt “there needs to be some sort of shared identity with the [other] CTOs”.
Other people felt it was important to make a distinction between research staff and non-research clinical staff by the former not wearing uniforms. Mel thought it was good that research nurses in her department didn’t wear uniform because being plain-clothed signalled a separation from the non-research clinical nurses, which could help patients feel more comfortable. Likewise, Julie made “a conscious choice” not to wear hers every day because “when I put my uniform on, I feel more of a sense of responsibility to the unit and I feel like I could be called on at any time” at the cost of her research activities.
Ellen opted to wear a uniform when she was first in a research delivery post, in part because she “was struggling with not being a nurse any more”. Over time, the uniform situation for research staff at her hospital has changed.
Ellen opted to wear a uniform when she was first in a research delivery post, in part because she “was struggling with not being a nurse any more”. Over time, the uniform situation for research staff at her hospital has changed.
Some people were from professions or settings where uniforms were not typically worn for clinical work. In these cases, the question of whether to wear uniforms and what type in research roles often seemed less significant.
Helen and her research team recently started wearing Clinical Nurse Specialist uniforms. She thinks this has been beneficial.
Helen and her research team recently started wearing Clinical Nurse Specialist uniforms. She thinks this has been beneficial.
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.
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.
For nurses and midwives, there is the process of revalidation every three years through the Nursing and Midwifery Council. As a relatively new requirement, some worried about being able to complete this if they were working fully in research (rather than having a split with, or separate job, in a clinical non-research role). Some people had completed revalidation based on their research role and did not see this as an issue.
Ginny thought revalidation had helped challenge notions that research midwives had to “show that you’re doing ‘proper’ midwifery work”, an attitude she had encountered in a previous system of supervisions.
Ginny thought revalidation had helped challenge notions that research midwives had to “show that you’re doing ‘proper’ midwifery work”, an attitude she had encountered in a previous system of supervisions.
But they started becoming a bit more kind of, you know, form filling again, similar sort of thing to research really and they, my supervisor in particular used to, right towards the end, sorry I’m making this really difficult, supervision stopped with midwifery a few years ago but, when they brought in revalidation. Just before it was ending she started saying ‘Oh Ginny do you do any, you know, when was the last time you worked on the delivery suite, you really need to do some proper midwifery work?’ And I always used to go ‘What do you mean, I’m still employed, I’m employed as a research midwife, I’m, this is my job, that’s what I am, I’m, I’m a midwife, I’ve done the training I’m on the register I don’t need to do any, you know, it doesn’t matter how many babies I’ve delivered’ or whatever like that. But they, she started getting sort of quite a thing about this sort of going you’ve gotta show that you’re doing ‘proper’ midwifery work and I always used to argue very, you know, what I thought was quite strongly that your job is, you know, you’re a midwife if you’re employed as a midwife in whatever capacity then whatever your job is that, that should be enough. Anyway and we used to have to do things like all the research midwives they’d, again because of this mandatory study days we used to have to do things like emergency obstetric workshops which were kind of, you know, as you can imagine what happens in an emergency and you join this role play and things like that.
I haven’t delivered a baby for years and if I ever had to go back and work as a midwife I would obviously have to do some re-training I wouldn’t just walk onto a ward and do it but I can assure you I’d be able to learn how to do that again and I’ve learnt how to do it so it’s, I can’t see it as being a big problem but I don’t think I need to do it as, you know, in a hospital base now because it’s silly. And anyway so revalidation came in and I think it’s really good because it’s kind of made, it made it really clear to everybody that that’s exactly what, exactly what I’ve just had, I don’t really mean that but it is what I just said, so anybody employed in whatever capacity it doesn’t matter, if you’re a nurse or a midwife that’s what you are but you work in education or something, you’re still a nurse or a midwife and that’s your revalidation just is saying are you doing your job, whatever your job is, properly.Carole had no shortage of evidence for her midwifery revalidation, including activities undertaken for Continued Professional Development or feedback from patients.
Carole had no shortage of evidence for her midwifery revalidation, including activities undertaken for Continued Professional Development or feedback from patients.
Anything that you think is appropriate. And then we also have to have people to, that interview you. And it could be another midwife or management, and they put you forward and they write about you. Or it could be from the women themselves. And I've got some that have personally sent me letters. Or I looked after one lady who'd had an intrauterine death, for example. And that's within the last three years. And I looked after her right the way through until she delivered, and she sent me the most beautiful letter. So, you know, you can - because it's all confidential and it goes to the NMC, we can scan those and put them on as evidence of, of how we've operated in our work. So, that- mine's coming up in February.If she was audited by the Health and Care Professions Council for re-registering, Abi was unsure whether the documentation would be suited to her role as a speech and language therapy researcher.
If she was audited by the Health and Care Professions Council for re-registering, Abi was unsure whether the documentation would be suited to her role as a speech and language therapy researcher.
So this goes back I think to what I was saying about having that pathway set up, there isn’t necessarily a clear pathway set up for you to integrate clinical work and research work. So, it’s interesting to think about why, you know how, everybody who I know is a researcher and a clinician has sort of cobbled together something and found their way and uses their skills and enjoys using their clinical skills, whether it be within delivering a clinical intervention, whether it be in supporting students to train, or informing research methods so that they’re appropriate for people with communication needs. Yeah, it’s, there’s no clear cut path and it, it can be a bit of a challenge to identify how you fit in it I suppose.
*The people interviewed for this website were mostly research NMAHPs (i.e. those employed in a research delivery role). However, we also interviewed some NMAHP researchers (i.e. those leading research as independent researchers). The latter group included people who were undertaking or had completed academic research qualifications, such as PhDs, and many had previously been in (or continued to also be in) research delivery roles. For more information about the distinctions between these roles and the sample of NMAHPs interviewed for this project, please see the Introduction section.
*Many research NMAHPs and NMAHP researchers felt strongly that they continued to be clinical within their research roles. As such, the wording of ‘research’ NMAHPs/staff and ‘clinical’ NMAHPs/staff can be problematic for implying that research is not also clinical activity. Where the wording ‘clinical staff’ is used on the website, we mean for this refer to non-research clinical staff (i.e. those who are not currently employed to carry out research or enrolled to pursue research through an academic qualification).
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