Sarah

Age at interview: 31

Brief Outline:

Sarah has been a research midwife for two years. She has worked on a number of clinical trials, and is now in a new post as a coordinating research midwife for a large trial.

Background:

Sarah is a research midwife. She is single and her ethnic background is White British.

More about me...

Sarah retrained to become a midwife when she was aged 25. After qualifying as a midwife, she worked clinically for a couple of years. Sarah then took a position as a Clinical Research Network midwife and held a post which involved her working on around 20 different clinical trials. These studies spanned across many topics, different stages of pregnancy and clinical settings. Sarah enjoyed building up relationships with and providing continuity of care to pregnant women who took part in several studies, and felt it gave her a deeper insight into changes across pregnancies – including how a condition can develop over time. She is now employed on a different post as a research midwife which involves coordinating a large clinical trial.

In her first research midwife role, Sarah sometimes felt uncomfortable about the emphasis on recruiting participants. She knew that other research midwifes took clipboards with them when they approached a person for a study, but Sarah preferred not to take any materials with her initially. If a participant was interested in taking part, she would then go and get an information leaflet about the research. When she met with a potential study participant for the first time, Sarah thought it was important to ask what they understood about their situation. This helped avoid patronising the person and it gave her an opportunity to share some of her midwifery knowledge if there were gaps in the pregnant woman’s understanding. 

Sarah’s current job is to coordinate a clinical trial, and this involves her supporting research midwives at various sites to deliver the research. This means that she does not have a lot of patient contact on a daily basis any more, but she has a crucial role in connecting trial managers, researchers and clinicians involved in the study. Sarah explained that “[this role] allowed me to not just work on the trials, but actually hopefully shape the trial that I'm working on”. Sarah highlighted that ‘good’ research is about more than adhering to the ‘Good Clinical Practice’ guidelines. For example, she thinks there is potential to improve research practices to make them more effective and efficient, and to help potential participants “digest the information” more easily.

In Sarah’s experience, there are important differences between clinical and research cultures, and this can make working as a research midwife challenging. Sarah thinks there are also practical barriers as a result of differences between research and clinical ways of working, including around combining both aspects in employment contracts. She feels strongly that research and clinical experiences and skills can complement one another, and that the combination can have benefits for patients, but suggests that there needs to be more support for this to become a widespread reality. 

Sarah thinks it can be challenging to make sense of her professional identity as a research midwife: “you are still a midwife, you’re just a different kind of midwife”. She feels there is a strong emphasis in midwifery on completing physical and visible care tasks. In contrast, she explains that the work required of research midwives differs in various ways: “you need time to think about things and time for things to percolate through. You need time to communicate with people”. As a research midwife, Sarah thinks it can be difficult seeing clinical colleagues under pressure and “not helping out” to the full extent, although she sometimes does occasional tasks “to make the process more seamless”.

Sarah is not sure about her next job or longer-term career plans. She hopes to continue working on interesting studies and would ideally like a role which combines patient contact with shaping higher-level policy around providing quality patient care. In order to develop and sustain a strong workforce of research midwives, Sarah thinks there needs to be more of a career trajectory in place and opportunities for developing as well as recognising expertise. 

Sarah still sometimes had doubts about whether her activities as a research midwife were productive, as the way of working was very different to what she had been used to.

So I initially- I remember when I first joined as a researcher, because- Because you're not seeing patients in the same way, and you're not as overstretched. I remember hanging around clinics and just thinking 'what are we doing, what are we doing?' [Laughs]. There's this kind of a feeling of, there's this feeling that you're kind of wasting time. Or that you're not being, you're not getting stuff done. And I still feel that very, very strongly. Even now, kind of two and a half years later. I feel, you know, ‘am I, is this productive? Is this a productive use of time?’

You know, being a midwife or being, you know, I imagine probably in lots of parts of the NHS, you get things done and you can clearly see what you've produced. Whereas being a researcher, things take a lot more time. Maybe not so much when you're-, depending on the type of research midwife role that you've got , but you, you need time to think about things and time for things to percolate through. You need time to communicate with people. And things can take that, things have to take longer for them to be done properly. Whereas working clinically, it's what needs to be done.

When Sarah started in a new hospital and Trust, she had an induction. This was helpful in terms of giving practical information and affirming her professional identity.

We had quite a long induction process. So we had all of our clinical induction, which I think is really important. Especially if you're new to a Trust. You need to understand the clinical context in which you're working, in order to be able to know where your participants might be, know how they're being looked after. And also have that kind of 'you are a real midwife' [laughs], and you know, if something happens, that you can actually support your clinical-. So, if there is an emergency, then you actually know where, what to do, and where you're going. And also the context in which the woman's being seen, in terms of her actual care plan. So, how she might filter through a, through the system.

Sarah would ask potential participants what they understood about their situation, and she could then help “fill in the gaps”.

Because of what I do, I often ask them what they know about why they've come in, often. Especially if it's a particularly sensitive topic. So, yeah. Ask them about their understanding about what they-, why they're here. What they've been told already. And then try and see if I can fill in the gaps. And then explain to them how this study kind of fits in with where they are in the process.

People have very, very different understandings. And sometimes incorrect understandings, about why they are in the situation. Or they've misunderstood. Or somebody hasn't given them correct information about why they've been admitted, or something like that. What does that help, how does that-, what does that help me do? It helps me not patronise them. It helps me not tell them things that they already know. Which I just think puts people's backs up. It allows me to actually add something, possibly add something, which hopefully benefits them in some way.

Sarah had tried to combine more clinical work with her research job, but it had proven difficult to arrange.

To find a clinical and a research role combined is very, very rare. To work- so, you could, so you could say, “Okay, well I could work part-time clinical, and part-time doing research”. Well actually, most clinical jobs are shifts, doing shift work. So then you have to be that awkward person that kind of says, “Well I can only work, you know, I can't work Thursdays and Fridays, you know, I have to commit to a certain kind of-”. And most places, unless you've built up a very, very strong relationship, they don't want you to do that.

What about doing some clinical within your research role? Again, funding across departments is very, very complicated. So then, the clinical- the research might say, “Okay yeah, that's valuable to our research,” but does your- does your research add anything to your clinical? You'd have to again put forward a very, very strong case for that. And again, I don't think- unless you've got really strong relationships or really good senior support, there's no natural thing. That doesn't happen naturally.

I tried for a very long time to get a day a week clinical. Where I was going to be given the time to do that out of my research hours. And the clinical people just couldn't- even though I worked in the same Trust, they couldn't find a place for me, even though there's-. They couldn't commit to one day a week long-term, even though every single day there's bank shifts that go out.

So they couldn't say, “Yes, we'll do one day a week”. And there were things like, “Oh well, yeah, but what about your mandatory training? We don't do anything less than two and a half days a week, you have to do two and a half days a week”. And my research manager was like, “Well, I'm not- that's not going to happen, I don't want you to go down to two and a half days a week”. So it just- it's possible [laugh]. Don't get me wrong. It's possible. And people have done it. But it, it doesn't come naturally.

Sarah encouraged those who create and endorse the use of research documentation templates to ensure they are “fit for purpose”.

There are all of these research projects going on, where people are doing the protocol and doing, you know, the patient information leaflets. And there's a format. But is that format the right format? Are the templates-, is anyone looking at these documents? Is anyone really, really thinking about it? And actually- I think there probably is some kind of working group or something somewhere. But I think that, you know, the templates that you get on NIHR and stuff like that, are so old fashioned. The clinical trials units are very old fashioned. And people just need to think about 'is this actually fit for purpose any more? Does it do-, is it actually helpful to patients? Is it actually helpful to research?' And actually think about that. Because I think there's a lot of potential to streamline. Not just add more and more and more and more and more, all the time.