Nurses, midwives & allied health professionals in research
What is it like to move into research delivery for nurses, midwives and AHPs?
Moving into research delivery roles had been a significant adjustment for some nurses, midwives and allied health professionals (NMAHPs) we spoke to*. Ellen recalled feeling “quite lost” in her new job to begin with. There were unfamiliar aspects to get accustomed to. However, many also highlighted similarities with their previous non-research clinical roles* – there were transferable skills and both were ultimately about helping patients. Some people continued to have, or later added in, a clinical role or job in addition to working in research.
Some people adjusted quickly, but most found that it took several months to feel more comfortable and confident in their first research delivery post. Jisha said, “In the beginning, everyone struggles but that is nothing to worry about”. It took Sandra about 18 months before she felt sure she was enjoying being a research nurse. Dawn had been a research nurse for two and a half years, and felt it was still an “ongoing learning process”.
First few months actually was quite a challenge, cos there was really big study that was waiting for the role to start. And it was completely different role and I found it quite a challenge at first. And there was another midwife that was employed with me at the same time, there was two of us to work on this study. Her, her hours were less but actually once I got into it, it was fine. It was just a really massive learning curve, and I think back now, if I had to do it now I’d be absolutely fine, I really would, but, but then it was quite hard. But I got there. The university that was running the study was like, you know, “Why aren’t your numbers this?” And, you know, could do better sort of thing. But in the end they were quite happy with our recruitment, and actually there was a sub-study and we recruited one of, one of the best hospitals to that sub-study with a really good retention, so in the end it was fine. But at first it was quite a big learning curve, but it was fine.
Yeah I definitely think that’s because I sort of had that to start with because as a nurse in a clinical environment you definitely feel differently when you go into a research post and it’s like ‘oh, you know, I’m not a proper nurse anymore’ and there is that side to it. And I think that and, you know, and like I said before that is why, you know, you can, you’ve always got the option of going back and doing the odd clinical shift here and there if you want to but I think that its recognised in the value clinically you are tremendous value as a nurse but also as a research nurse there is also inner value in that too. And I think it took me a little while to adjust as, as I imagine it would do you know, other nurses that have been used to working clinically for many years that, you know there is, you know, there’s more, there is more roles out there, isn’t there?
Mm, how long do you think it took you to adjust to that?
Oh I’d say probably best part of a year if I’m honest. Yeah the sort of, because in the clinical environment you’ve just, you just present it, you know, it presents itself doesn’t it and then you just, you go on that and that’s what you do and you don’t, you know, you’ve got a ward full of patients to look after and sort out and you just get on and do it. Whereas this you know, you have a different, it’s very different, you know, you create your own workload, you look at what you’re gonna take on how you’re gonna do it, you know, it is a very different role.
And I think the biggest thing for me was, you know, people when you transfer, when you move across from- which I was, was a clinical nurse, into that, I had no reference point. So for me, if I'd moved from one ward to another, I still had, there was still basic things there, I knew what I needed to do. But within research, it was- people said, “Are you enjoying it?”, and I thought 'actually, do you know what, I don't know'. Because I don't know whether I'm doing it right, I don't know whether I actually know what I'm doing. I didn't. So it took-, I think it took 12 months before I could look and think ‘have I learnt anything? Have I, can I do this? And am I enjoying doing it?’ So there was two very different things that I just had to be-, I just had to ride it out. Whereas I'm very much one with you think, you know, you get a, I get a very strong gut feeling of 'yeah, I've happy at this, this is great'. I didn't miss my clinical work.
So, that was the my thing of 'well, I'm not missing that, so I must be quite liking this' [laughs].
[laughs]
And it took a long time, really. I think family were a bit worried, because I couldn't- I didn't talk about it, because I didn't know how to talk about it, because I didn't really know. You know, I was just every day, was a massive learning curve. And it was interesting, there was an article* that I’d, that somebody gave me when I started the job. About that, from expert to novice. And it's a brilliant, it is actually a really good article, I'd recommend it for anybody that's transferring across specialities or into a diverse bit of your career path with whatever it is. It's a very good reflection that they've done on, you know, from something that I could have run a hospital basically with my eyes shut, to being in a situation where I thought 'I don't even know what you're talking about'.
You know, 'What is GCP [Good Clinical Practice]?' You know [laughs] all these lingos and sort of term-, abbreviations that are used that I had no idea about.
*Gleason, K. (2011) ‘Role Transition’ when becoming a Research Nurse, available at https://clinfield.com/role-transition-when-becoming-a-research-nurse/
People weren’t always sure what to expect from a research delivery role. While Tabitha and Nikki thought their Master’s degrees had prepared them well for working in research, others found that their initial expectations of a research delivery job did not match the reality. Sanjos had expected to have more clinical activity as a research radiographer. Claire, Alison and Ginny all thought there would be more scope for activities beyond or in addition to research delivery. Some posts did not have a clear remit or precedent, so researchers such as Vicky and Rachel Y were involved in helping forge their own job description. This could be interesting and enjoyable, but also placed a lot of responsibility on knowing how best to proceed in an unfamiliar territory.
Louise recalled that starting as a research midwife was “a really massive learning curve”.
Louise recalled that starting as a research midwife was “a really massive learning curve”.
SHOW TEXT VERSION
PRINT TRANSCRIPT
Jo said it took about a year to adjust to becoming a research nurse.
Jo said it took about a year to adjust to becoming a research nurse.
SHOW TEXT VERSION
PRINT TRANSCRIPT
Mm, how long do you think it took you to adjust to that?
Oh I’d say probably best part of a year if I’m honest. Yeah the sort of, because in the clinical environment you’ve just, you just present it, you know, it presents itself doesn’t it and then you just, you go on that and that’s what you do and you don’t, you know, you’ve got a ward full of patients to look after and sort out and you just get on and do it. Whereas this you know, you have a different, it’s very different, you know, you create your own workload, you look at what you’re gonna take on how you’re gonna do it, you know, it is a very different role.
Christine couldn’t tell whether she was enjoying working in research or not for the first few months. She was given a helpful article about going from “expert to novice”.
Christine couldn’t tell whether she was enjoying working in research or not for the first few months. She was given a helpful article about going from “expert to novice”.
SHOW TEXT VERSION
PRINT TRANSCRIPT
So, that was the my thing of 'well, I'm not missing that, so I must be quite liking this' [laughs].
[laughs]
And it took a long time, really. I think family were a bit worried, because I couldn't- I didn't talk about it, because I didn't know how to talk about it, because I didn't really know. You know, I was just every day, was a massive learning curve. And it was interesting, there was an article* that I’d, that somebody gave me when I started the job. About that, from expert to novice. And it's a brilliant, it is actually a really good article, I'd recommend it for anybody that's transferring across specialities or into a diverse bit of your career path with whatever it is. It's a very good reflection that they've done on, you know, from something that I could have run a hospital basically with my eyes shut, to being in a situation where I thought 'I don't even know what you're talking about'.
You know, 'What is GCP [Good Clinical Practice]?' You know [laughs] all these lingos and sort of term-, abbreviations that are used that I had no idea about.
*Gleason, K. (2011) ‘Role Transition’ when becoming a Research Nurse, available at https://clinfield.com/role-transition-when-becoming-a-research-nurse/
Change and continuity
Clinical research often felt like a ‘different world’ to that of clinical practice. Recognising the differences and learning how to negotiate them in their research role could be challenging. For some, it was a case of un-learning habits and practices they might easily ‘slip into’. However, for others, aspects of their NMAHP background were seen as a big advantage to making research happen and could provide more benefits for patients/participants.
Adjustment to research sometimes involved a careful negotiation. Vicky felt the “greatest challenge” was “understanding that you're not part of the clinical team directly, but obviously you need to work with them very closely, and, again, your ultimate goal is to make sure that the patients who are participants in your study are well cared for”. Becoming a research NMAHP, and others’ views of this (including clinical colleagues), could also affect individual’s sense of professional identity.
Yeah, so it's interesting when you see people become a research midwife or nurse, there's this sort of extraction thing that happens and they're used to doing all the struggling, and then they perhaps join a study team and the role's quite different; it sort of floats above, but it's everywhere. You need to know who's who, you need to -, how to get involved in different pathways and get behind the scenes. So, that’s -, that’s kind of taking yourself out of the clinical role, but then as you ease into whatever study you're working in you realise you're very much still connected to the patient facing world in a distinct and different role. But as I mentioned, like the [trial name] study there's huge continuity, and I'm really hot on that cos I -, when I became a midwife I directly went into what's called case loading, which is where you know your midwife and you have your midwife throughout your pregnancy and then hopefully she or her partner, or someone that you’ve already met, attends your birth, and that’s how I thought midwifery should be, and there's just such value in that.
And, and even the Department of Health recognises that; there's massive initiatives in building continuity for women. It's always going to be a hot topic and we're just spending life times figuring out how to provide it for women. But anyway, my point was that, sometimes in research studies you see that little continuity package happening and that’s so cool. So, in [trial name] it was like, gosh, we're giving this whole additional continuity thing where the women, the participants, have really good access to a midwife and a doctor by email, by phone, by visits; set visits or even some last minute visits. What an addition to the maternity care that perhaps doesn’t feature the continuity. So, I'd like to -, I think it's really complimentary.
Yeah
And as a midwife it's not just this nice thing that women maybe get by joining the study, it's also really rewarding for the clinician.
It was my colleague. And I think she was absolutely right to say you know, “You need to take some time to realise that you’re not a clinical physio anymore. That’s not what you’re, you know, employed to do.” “You are, you’re a research physio and your, your job is to carry out the research to the best of your ability. And sometimes that involves, for example, having a straight face, not engaging in conversation while somebody is carrying out a test. Not giving feedback on the results because it might skew the data in some way.” And I would say it took me a while, but I, you know it is a realisation and I think for anyone whose thinking about moving from a clinical role into a research role, that is one of the areas that I would say think about that. And whether you want to work it in that way, before you take the jump. But once you’ve taken the jump realise that it might take a while to mentally shift from the clinical head to the research head, because it’s a different mind set.
I like the research mind set and I’m very happy that I’m there and in it now, but I think it is, it is something that kind of takes you by surprise a little bit and you know needs some thought really in the early days. But I mean there was no issue, it was just that, it was, when I say it was made clear to me, I, she, she brought it, my colleague brought it up and I then became aware of every time I did something I thought, “Ah, no, research head. Not clinical head.” You know. Especially I think as a physio, part of being a physio is about encouragement and support and helping the patient to achieve a goal and when somebody doesn’t do so well then, my role as a physio is to build them up and to, to give them that encouragement and to talk them through it. So, that sort of talking through, coaching, empathising, you know it’s engrained really but you have to switch it off. Not always, not always but I think I was probably too switched on at the beginning.
It’s a totally different world. And it’s a totally different, it’s a different language, it’s a different time scales, it’s a different way of thinking. The paramedic, paramedic practice is very immediate, very hands on, very one patient, what’s in front of me, what do I do, what do I deal with it, how, you know, what do I do for this one patient? Take them to hospital. Hand them over. Onto the next one. It, you know, it’s, it’s short, defined chunks of time which, as I say, can be quite charged, not always, but it, it’s very defined points of time. Research is a whole different ball game. There’s a totally different language, there’s a whole different set of laws and regulations, ethics underpinning it, which is, is brand new to us unless you’ve been exposed to it, and actually, thankfully new paramedics are getting some exposure. But when you’re, the paramedic students that I’ve dealt with are concentrating on learning how to deal with the patient – the ethics and the research is a sort of secondary concern to them. But for us, when you get into this, it is a new, it’s a new world and it’s a steep learning curve which is where having that mentorship and those people to guide you through that is very important. But once you get, once you get involved in it then you start to get the hang of it. But you also then start to ask more questions and start to look into things more.
Differences and areas of adjustments
Alison thought there was often an “extraction” process as a midwife or nurse re-negotiated their role in research. However, she felt there can also be a lot of “continuity” in terms of values and relationships with patients.
Alison thought there was often an “extraction” process as a midwife or nurse re-negotiated their role in research. However, she felt there can also be a lot of “continuity” in terms of values and relationships with patients.
SHOW TEXT VERSION
PRINT TRANSCRIPT
And, and even the Department of Health recognises that; there's massive initiatives in building continuity for women. It's always going to be a hot topic and we're just spending life times figuring out how to provide it for women. But anyway, my point was that, sometimes in research studies you see that little continuity package happening and that’s so cool. So, in [trial name] it was like, gosh, we're giving this whole additional continuity thing where the women, the participants, have really good access to a midwife and a doctor by email, by phone, by visits; set visits or even some last minute visits. What an addition to the maternity care that perhaps doesn’t feature the continuity. So, I'd like to -, I think it's really complimentary.
Yeah
And as a midwife it's not just this nice thing that women maybe get by joining the study, it's also really rewarding for the clinician.
Libby appreciated that a colleague encouraged her to reflect on “the division between clinical work and research work” and alter her engagement with participants accordingly.
Libby appreciated that a colleague encouraged her to reflect on “the division between clinical work and research work” and alter her engagement with participants accordingly.
SHOW TEXT VERSION
PRINT TRANSCRIPT
I like the research mind set and I’m very happy that I’m there and in it now, but I think it is, it is something that kind of takes you by surprise a little bit and you know needs some thought really in the early days. But I mean there was no issue, it was just that, it was, when I say it was made clear to me, I, she, she brought it, my colleague brought it up and I then became aware of every time I did something I thought, “Ah, no, research head. Not clinical head.” You know. Especially I think as a physio, part of being a physio is about encouragement and support and helping the patient to achieve a goal and when somebody doesn’t do so well then, my role as a physio is to build them up and to, to give them that encouragement and to talk them through it. So, that sort of talking through, coaching, empathising, you know it’s engrained really but you have to switch it off. Not always, not always but I think I was probably too switched on at the beginning.
Graham described research as a “different world” to the one he knew as a frontline paramedic, and this took a lot of adjusting to.
Graham described research as a “different world” to the one he knew as a frontline paramedic, and this took a lot of adjusting to.
SHOW TEXT VERSION
PRINT TRANSCRIPT
The main types of adjustment people described were:
- learning about research activities, governance/regulation and research terminology/abbreviations (often through training, shadowing and mentorship);
- spending more time desk/computer based in an office;
- following protocols strictly (compared to scope for flexibility with clinical judgement);
Karen leads a team of research staff and explained the importance of precise data collection: “it’s not good enough to do the way you do it clinically, for this trial you need the patient to stand exactly on these markers and stand here, and you need to do it in this order, with these words, with no variation. Cos if you did that degree of instruction when you’re in your clinical role then you’d be having complaints from the patients about how bossy you were and how burdensome it was”.
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.
So there would be like CRF and I'd be like, 'What on earth is CRF?' [laugh] I would-, I stop people and I'm just like, "I'm so sorry, CRF?" and then they're like, "Oh, Case Report Form," or whatever. So I'm-, I think just because of my character and person that I am, if I don’t understand there's no point asking to continue- continuing on with the conversation because I'm just thinking 'we're not going to go anywhere' and I'm going to leave just thinking-, feeling worse and regretting that I didn’t just speak up. So ‘cos I-, I used to be very shy and I used to not speak up, and I used to just sit there in the dark for life basically. So I became-, as I grew up and stuff I would just-, I'm still shy I would say, but I'm-, I can just stop people and just be like, "I'm so sorry, I've no-," I'm not afraid to not know. Because it's worse not knowing for life as opposed to just knowing for those couple of minutes and find out the answer. So, I usually just stop people and was just like, "What was this? What was that?" or-, then you're like, "Oh okay, yeah, you can continue saying it now," but [laugh] initially yeah, it didn’t work.
And then in the, so the sort of challenges that come up in a research role are you, you need to often when you’re doing clinical research you need to adhere very strictly to a research protocol and that sometimes means you can’t use your clinical judgement to say, “Oh I think that I might prefer to do things this way for this scenario.” So you need to carry out x, y, z assessment, you need to carry out therapy according to this set of you know predefined things, so that it can then be testable and you can make clear assertions about how it works across a group of people if it’s applied consistently.
So that can sometimes feel, there’s, there’s an element of sort of sitting on your hands when you’re doing clinical research that you don’t have when you’re doing clinical practice in the same way. But that can also be, that can also be quite liberating because it, it frees you of the, the clinical judgement, the sort of clinical decision making where you might get it wrong or right, you can sort of relinquish that and say, “Okay I’m following the protocol, and this is how it has to be, and I’m just going to see how it happens.” And it means you don’t need to necessarily make any pre- you don’t need to necessarily have any preconceptions about how it’s gonna go, or who it’s going to be best for. Or if you do then you might be proven wrong and you can be proven wrong for instance about things.
So an example might be that my research is largely with older adults who’ve had a stroke. Which obviously contrasts to paediatric clinical work, but in my research I work with older adults who’ve had a stroke and I work on the effectiveness of computer based therapies, and they’re, certainly for me coming into it and a lot of people who I’ve explained my role to, they have preconceptions that older people won’t get on with computers, or wouldn’t be able to use or it wouldn’t be a suitable treatment to offer to somebody who’s older and maybe hasn’t been used to using a computer throughout their life in the way that some younger people might have. But actually when we have to meet everybody who takes part in the research and present them with the same opportunities and then do the therapy with them, it challenges that and has shown me that it isn’t the case, that actually lots of people can get on with computers if the if the scenario, if the intervention is appropriate for them and if it offers them something that they that they can benefit from.
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.
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.
SHOW TEXT VERSION
PRINT TRANSCRIPT
When unfamiliar research terminology was used, Osi would ask for clarification.
When unfamiliar research terminology was used, Osi would ask for clarification.
SHOW TEXT VERSION
PRINT TRANSCRIPT
Abi found that following a protocol left less scope to use her “clinical judgement” and make alterations. This experience led her to challenge some previous assumptions.
Abi found that following a protocol left less scope to use her “clinical judgement” and make alterations. This experience led her to challenge some previous assumptions.
SHOW TEXT VERSION
PRINT TRANSCRIPT
So that can sometimes feel, there’s, there’s an element of sort of sitting on your hands when you’re doing clinical research that you don’t have when you’re doing clinical practice in the same way. But that can also be, that can also be quite liberating because it, it frees you of the, the clinical judgement, the sort of clinical decision making where you might get it wrong or right, you can sort of relinquish that and say, “Okay I’m following the protocol, and this is how it has to be, and I’m just going to see how it happens.” And it means you don’t need to necessarily make any pre- you don’t need to necessarily have any preconceptions about how it’s gonna go, or who it’s going to be best for. Or if you do then you might be proven wrong and you can be proven wrong for instance about things.
So an example might be that my research is largely with older adults who’ve had a stroke. Which obviously contrasts to paediatric clinical work, but in my research I work with older adults who’ve had a stroke and I work on the effectiveness of computer based therapies, and they’re, certainly for me coming into it and a lot of people who I’ve explained my role to, they have preconceptions that older people won’t get on with computers, or wouldn’t be able to use or it wouldn’t be a suitable treatment to offer to somebody who’s older and maybe hasn’t been used to using a computer throughout their life in the way that some younger people might have. But actually when we have to meet everybody who takes part in the research and present them with the same opportunities and then do the therapy with them, it challenges that and has shown me that it isn’t the case, that actually lots of people can get on with computers if the if the scenario, if the intervention is appropriate for them and if it offers them something that they that they can benefit from.
- pace of work;
- working autonomously and organising their own workloads;
- working hours;
Rachel X, Imogen and Barbara all felt there was not much for them to do in their research delivery roles at first, which contrasted to the intensity they had been used to clinically. Reading paperwork for many hours could add to this sense of ‘slowness’. Once Layla had un-learnt the feeling she needed to “account for every single thing that I do”, she found it “quite rewarding” to have the freedom to plan her own time and workload.
Over time, Layla adjusted to working with more autonomy than she had been used to as a clinical midwife.
Over time, Layla adjusted to working with more autonomy than she had been used to as a clinical midwife.
Sex: Female
SHOW TEXT VERSION
PRINT TRANSCRIPT
Sandra felt unsure about her job for the first few weeks. The pace of the work was very different to what she had been used to.
Sandra felt unsure about her job for the first few weeks. The pace of the work was very different to what she had been used to.
SHOW TEXT VERSION
PRINT TRANSCRIPT
- relationships with, and ways of, supporting patients;
- ways of working with other colleagues (including individuals, organisations and departments such as Research & Development) and especially if the research NMAHP had not worked with them before; and
- for some, working on a new topic and/or within a new department, hospital, Trust or other setting.
While the amount of overall time spent with patients varied, many in research delivery roles felt the quality of rapport with patients had increased. Another part of their role involved working with multidisciplinary colleagues. As Alice recalled, “I remember clearly thinking ‘I don’t know anyone, I don’t know who these people are’. I remember meeting the trial coordinators, PhD students and the PI [Principal Investigator] and the CI [Chief Investigator], and I remember thinking ‘I just don’t know where to place these people’”. Many also commented on their relationships with (known and new) clinical peers as having changed and requiring adjustment. As Alice highlighted, establishing good working relationships with clinical non—research colleagues could be especially challenging if the new environment was not a very research-active one: “being the only person working in research in the department is always hard and especially if you’ve never worked in research before, it can be a bit stressful”.
It’s about, you know, if somebody is new in, so particularly if it’s somebody who’s been a clinician only, then they have to understand that the power relationship is very different. So when you’re treating a patient the power all sits with you really, and patients have come to you for your help and you are, you know, near enough telling them what it is you can offer and, you know. Whereas when it’s a research patient, you know, you are desperate to do anything to get them to help in the first place, and to stay involved, and you’re very aware that they are putting themselves out to help you. And so, it’s, there’s often quite a bit of training for people, and particularly for people who work in both roles because you’re almost having to swap at lunchtime from, you know, being very conciliatory to people and really wooing them and, you know, thanking them and nothing is too much trouble, you know, yes, you know, “If you want me to come out to your home and do this on a-”, you know, sort of, “We will do it cos we’re so keen.” To the next moment going, “Our opening hours are this to this”, and, you know, “No, that’s not reasonable to expect the NHS to do that,” so that’s a, you know, a difficult balance to cope with sometimes.
Yep. So I would- because research wasn’t that active at the Trust at the time, which was a bit sad, so I'd introduce myself as, "Hello, I'm Osi and I'm covering for XYZ," and they’d just look at me to say ‘I had no idea who that person is, no idea who you is and we don’t do researchers’. So it was very difficult to start off with because it wasn’t- I wasn’t only myself new to research, but I felt like everyone else that I was introducing myself, was also. So I had to-, I remember when I followed one of the other research nurses in for my orientation and they just felt-I felt like they knew the protocol back to front and anyone can ask them any question. They were just amazing, and I'm just thinking ‘oh my gosh [laughs], I don’t think my knowledge is this great’. But it did eventually come with time, so I literally had to-, I was going home and I was just reading the protocol. So that when I do speak to them I'm able to not only explain it to them, but they're going to ask me questions. And some of the people that was asking me questions would be PIs and it's just like 'oh, that was a question I wanted to ask you,' so I'm like I have to make sure that I'm clued-, I was clued up. So there was a lot of reading, a lot of getting out there, I got a lot of doors shut in my face but I just kept on going back. I was just like ‘you're not accepting me now, but you will’ [laughs]. And I just kept on going back in. It's definitely paid off; they absolutely love it now. People want to get involved. So it was-, it was a hard-rocky road, but we got there [laugh].
Was that clinical staff that were sort of closing the door and not interested?
So, yeah, clinical staff. The actual-, some of the actual PIs for some of the studies were a bit difficult to start off with. I think it's because there was just no activity on their trials, so it was just out of mind and out of sight; absent, out of mind should I say. But they’ve-, I think it was-, and they probably just didn’t have that much of a -, because it wasn’t active there was just-, in fact no activity, so they'd already put it to rest kind of thing. But I'd just started a new job and I was excited, so-so yeah [laugh].
Similarities and familiarity
Karen described there being different power dynamics with patients/participants in research.
Karen described there being different power dynamics with patients/participants in research.
SHOW TEXT VERSION
PRINT TRANSCRIPT
Not only did Osi have to adjust to being a research midwife in an unfamiliar hospital, she also found there was not a very research-active culture; it took time and persistence to build this.
Not only did Osi have to adjust to being a research midwife in an unfamiliar hospital, she also found there was not a very research-active culture; it took time and persistence to build this.
SHOW TEXT VERSION
PRINT TRANSCRIPT
Was that clinical staff that were sort of closing the door and not interested?
So, yeah, clinical staff. The actual-, some of the actual PIs for some of the studies were a bit difficult to start off with. I think it's because there was just no activity on their trials, so it was just out of mind and out of sight; absent, out of mind should I say. But they’ve-, I think it was-, and they probably just didn’t have that much of a -, because it wasn’t active there was just-, in fact no activity, so they'd already put it to rest kind of thing. But I'd just started a new job and I was excited, so-so yeah [laugh].
People also described similarities and continuities which carried through from their previous clinical experiences and into research. Examples included:
- values of patient benefit and patient advocacy – including opportunities to help patients with health concerns encountered in the course of research (e.g. through answering questions or signposting);
- transferable skills, such as: communication, reading body language, listening, clinical skills (including taking blood), problem-solving, translating information given by doctors into lay language for patients, and being able to navigate around medical notes; and
- transferable knowledge, such as of particular healthcare settings, how to signpost around these systems, and information about the study topic.
These aspects could be a major asset within research. As Carlos explained of his physiotherapy background, “that gave me a certain level of confidence to talk about the injury [being studied]. Like approaching the more clinical aspects of the injury, if patients have some specific questions related to the injury itself or the pathology”.
No, I went in like a sort of completely open minded not knowing what I was going to do, where I was going to be, who I was going to be working with. What was really lovely was that I’d gone sort of from working within primary care in district nursing obviously to work primary care in research so it was home from home, I was used to the environment being with patients of the same elk and staff and that sort of thing so it was really lovely just to have that sort of transition over from the same place to the same place but doing something completely different with a whole new language, you know. So I can remember my first study and they were coming out with lots of acronyms and when I started nursing we sort of had lots of acronyms and I’d be like I don’t understand it and research was like start, like starting a new job like completely like starting nursing, you know, totally new language but, but great [laughs].
So because I was talking to people, some people didn’t have any gastroenterology problems, but people with Barrett’s Oesophagus or reflux I could talk to, if they said things about their condition or their symptoms I could say to them, “Oh well you could try this, you could try that,” you know, “Have you thought about this?” But always allowing them to, you know, “It’s your choice but these are some options you could try.” And also if I found people who perhaps they seemed more unwell than I’d been led to believe from the information I’d got about them in advance, that I could point them back to other health professionals. So, I’d say, “Well actually I think that probably does need looking at, you could go back to, you should go back to your GP.” Or if their medication, they were saying they had side effects from the medication I could say to them, “You know, well there are other options for this type of medication on the market, so go back to your GP”, they’re not always keen to change for whatever reason, but you could go ahead and see if they can make other suggestions, and then leave it with them, but it was a good opportunity to give them that one to one time. And no rushing, you just took as long as it needed to take, and it was nice for them cos they felt they could actually ask you things, cos you weren’t in a rush.
I think still it's having that rapport with women. I don't think that goes. I think as a researcher, you're looking for promoting better standards of care. And I think that's always what you would aim to achieve on a daily basis, in clinical area, is the care that you're given. And, and it should be paramount, you know, that you're doing as best you can for that person. And I think that applies in research. Because you're looking at promoting better maternal and fetal outcomes for women, that's what the research is about. This early detection and management, as we're doing now, is just such a wonderful thing. Because in the clinic we would be looking for that, you'd be looking for the signs and symptoms. We do the blood pressure and urine checks every antenatal check. And as well as blood tests if they need to be done. It's about referring people on. And suddenly it runs hand-in-hand. It's quite symbiotic, really. Because what you're applying in the clinic, you're actually doing in that research really, indirectly.
And so I don't see the difference. And I think it’s tremendous value. Because all of the midwives I talk to on the clinic areas just think it's amazing.
The process and pace of adjustment
Sian moved from district nursing to being a research nurse in primary care. She liked that she had familiarity with working in these types of settings, but found the terminology of research tricky at first.
Sian moved from district nursing to being a research nurse in primary care. She liked that she had familiarity with working in these types of settings, but found the terminology of research tricky at first.
SHOW TEXT VERSION
PRINT TRANSCRIPT
Sandra described a study where she had opportunities to use her knowledge to help patients in addition to carrying out the study activities.
Sandra described a study where she had opportunities to use her knowledge to help patients in addition to carrying out the study activities.
SHOW TEXT VERSION
PRINT TRANSCRIPT
Carole felt there was good synergy between the aims of both clinical and research midwifery.
Carole felt there was good synergy between the aims of both clinical and research midwifery.
Sex: Female
SHOW TEXT VERSION
PRINT TRANSCRIPT
And so I don't see the difference. And I think it’s tremendous value. Because all of the midwives I talk to on the clinic areas just think it's amazing.
Adjusting to a research delivery role was often described as being “gradual”, making it difficult to pinpoint exactly when or how things became more familiar. Although some people had had doubts about whether the role was for them, having supportive colleagues who recounted their own experiences of adjusting to working in research was often helpful.
I think, I don’t I don’t really remember a day where I felt confident all of a sudden I think it came with time and it was just one step every day maybe six months to feel to get into a routine or normal ‘okay so these are the people that would help me develop, people who would help me a bit less’ you know, and I think it just it just kind of developed every day. Probably yeah I would say six months but you never feel fully confident [laughs] I think there’s always room for improvement in your practice there’s always something that you need to learn every day so it’s hard to say that even now I don’t feel like I’m a 100% confident in anything I am very, I’m probably reflective as a person so time to reflect on my practice quite a lot.
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.
And I think the team were amazing. Because everybody just said they had no-, you know, they just said, “Don't expect anything, just be a sponge, just see as much as you can, ask what you can, if you don't understand just ask”. And they had no expectation to put pressure on me for any length of time, until you felt ready to do it really.
So I think it was- and that was difficult, because in a ward, you know, we're not quite so patient when a new nurse comes on the ward [laughs]. Because you're like 'come on, really need you to go and do that admission, and we need that admission done really efficiently and really quickly because there's another one needs doing'. And that, that- there wasn't that. That certainly was not the atmosphere. It was a very supportive, and just you know, “Just take as long as you need”, there's no, you know, “You've just got to,” you learn this as you do it really.
Learning and adjusting was always ongoing in research jobs. As Paul said, “You learn every single day in research something new, something different that comes up”. Many people had messages of encouragement and support aimed at NMAHPs new to research delivery posts. Paul and Sian emphasised that, after a while, things “click” into place and become “second nature”.
Feeling more comfortable in her role was a gradual process for Alice.
Feeling more comfortable in her role was a gradual process for Alice.
SHOW TEXT VERSION
PRINT TRANSCRIPT
Paul now loved working in research, but there were times in the first year where he questioned whether the job was right for him.
Paul now loved working in research, but there were times in the first year where he questioned whether the job was right for him.
SHOW TEXT VERSION
PRINT TRANSCRIPT
Christine had supportive colleagues, which helped when she started her research job.
Christine had supportive colleagues, which helped when she started her research job.
SHOW TEXT VERSION
PRINT TRANSCRIPT
So I think it was- and that was difficult, because in a ward, you know, we're not quite so patient when a new nurse comes on the ward [laughs]. Because you're like 'come on, really need you to go and do that admission, and we need that admission done really efficiently and really quickly because there's another one needs doing'. And that, that- there wasn't that. That certainly was not the atmosphere. It was a very supportive, and just you know, “Just take as long as you need”, there's no, you know, “You've just got to,” you learn this as you do it really.
Some people acknowledged that research delivery jobs were not right for all NMAHPs. Helen explained: “you come into research and you either love it or hate it, and I think you pretty much know within about six months whether or not it’s something that’s for you”. Libby agreed that these roles don’t “suit everybody… there’s an awful lot of paperwork, there’s an awful lot of computer work, and you have to be able to see the long game”. However, most people urged new research NMAHPs to ‘stick it out’ for about a year before deciding whether to leave and change jobs or not.
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.
So I always reassure them, that's the main thing I have, seeing people- when the nurses after joining after many years of experience, they think 'oh my god, I don't think this is for me'. Because I really struggled. And I, and think ‘maybe I'm thick, they’ll tell me I'm very slow'. But I will tell them, “No, don't worry, this is just how I was feeling when I joined, but it takes time, so you will enjoy after that”. But they have come back to me and said, “You were right”, so it's just like, you know, learning that from their practical experience, then gradually doing one study. Maybe one-, you know, the first patient when they are recruiting, they will have a little bit of an idea how it's run. But when they do the second and third patient, they will be expert. And, you know, with that process. And with the legal issue, like ethics and approvals and things like that. You know. We do still struggle, and because the policies are changed and new other authorities will be joining, HR will be joining, all those things. You know, you just learn as it goes. So that will be different.
But you know, the nurses, after one year, they just run the study by themself. I don't have to help them much. But I just, you know, put a little bit of effort, you know, help with the team, but. Otherwise once they are happy with the trial, they are comfortable.
Several people who had moved fully into a research role (i.e. they did not have a split or additional non-research clinical job) felt that they had ‘lost’ something or were ‘missing out’. This feeling sometimes faded, but other times endured. From their previous clinical (non-research) jobs, some people missed the relationships with both patients and clinical colleagues, and felt it had been easier to see that their work was worthwhile/rewarding. Tabitha had felt a greater sense of satisfaction as a clinical midwife: “it’s more tangible and feels more immediate than research. And it’s a closer relationship, more intense, they need you and that feels good”. In addition to treating patients, Sanjos also missed learning about and developing skills in new radiotherapy techniques. Imogen felt she had lost the camaraderie with colleagues of working night shifts in the emergency department. Some people we spoke to had started, or planned to start, taking on additional non-research clinical shifts to gain more of these aspects.
Paul offered some advice to research nurses, midwives and AHPs struggling to adjust in their first job.
Paul offered some advice to research nurses, midwives and AHPs struggling to adjust in their first job.
SHOW TEXT VERSION
PRINT TRANSCRIPT
As a team leader, Jisha reassured new research nurses that it would take a while for them to adjust to the role and activities involved.
As a team leader, Jisha reassured new research nurses that it would take a while for them to adjust to the role and activities involved.
SHOW TEXT VERSION
PRINT TRANSCRIPT
But you know, the nurses, after one year, they just run the study by themself. I don't have to help them much. But I just, you know, put a little bit of effort, you know, help with the team, but. Otherwise once they are happy with the trial, they are comfortable.
Other people highlighted aspects that they were pleased to no longer contend with now that they were in a research role. This included various types of pressure/stress experienced in clinical roles and changes in the hours/shifts that they worked.
So, moving into research was really quite nice because it allowed me to be that person there with the patient, be in a sort of a medical environment where I could use the knowledge and the skills that I’d had, but I didn’t have the responsibility of clinically treating a patient and trying to make them well. And there’s something very freeing about that, you know, it’s not my responsibility to make you better, and I think that’s, you ask about was I passionate about MS when I was in clinical work, no, because I couldn’t, I couldn’t get any satisfaction out of treating something that I couldn’t really fix and couldn’t really make that much better.
Whereas now it’s not my responsibility to do that, it’s my responsibility to carry out the research, that will help in the long run, but you know at any moment in time I’m not responsible for that person’s wellbeing in the same way. So, I guess it, it did, was an identity change but a, for me a good one. But I think that’s a very personal thing to me, it wouldn’t necessarily be something that you could generalise across the board. Although having said that, I don’t think I’m alone probably in being you know a clinician of whatever discipline and thinking actually I’m not sure I really want to do this. But finding the, the academic side of it very interesting, but the reality of day to day treatment quite draining. I’m sure there are a lot of people like that. And I think for those types of people, like me, research is an absolute perfect fit.
Perfect fit.
Because you still get to make a difference, you just do it in a different way.
Footnotes
Libby liked that working in research delivery offered her opportunities to help patients without the expectation to “fix things”.
Libby liked that working in research delivery offered her opportunities to help patients without the expectation to “fix things”.
SHOW TEXT VERSION
PRINT TRANSCRIPT
Whereas now it’s not my responsibility to do that, it’s my responsibility to carry out the research, that will help in the long run, but you know at any moment in time I’m not responsible for that person’s wellbeing in the same way. So, I guess it, it did, was an identity change but a, for me a good one. But I think that’s a very personal thing to me, it wouldn’t necessarily be something that you could generalise across the board. Although having said that, I don’t think I’m alone probably in being you know a clinician of whatever discipline and thinking actually I’m not sure I really want to do this. But finding the, the academic side of it very interesting, but the reality of day to day treatment quite draining. I’m sure there are a lot of people like that. And I think for those types of people, like me, research is an absolute perfect fit.
Perfect fit.
Because you still get to make a difference, you just do it in a different way.
*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).
Copyright © 2024 University of Oxford. All rights reserved.