Induction, training and supervision/mentorship for research nurses, midwives and AHPs

The nurses, midwives and allied health professionals (NMAHPs) employed in research delivery roles* that we spoke to had many different experiences of induction, training and mentorship. Some had a grounding in research activities before starting in their first post, like Tabitha who had completed a research internship and was in the process of finishing a Master’s degree. Others felt they arrived into their first post with little knowledge or practical experience of carrying out research. Many described the process of adjusting to their first research post as a ‘big’ learning curve.
NMAHPs employed in research delivery posts had learnt about their role and the skills, knowledge and activities it would involve in various ways. These included: training courses (online and face-face, sometimes with role-playing exercises), shadowing colleagues (on the same or a different study, within their own team or another), orientation (visiting other units, potentially other Trusts) and being mentored/supervised. Lots of studies ran their own training specific to the tasks entailed, which supplemented core skills and knowledge such as taking consent and Good Clinical Practice (GCP) for research.
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The terminology and abbreviations used in research were often baffling at first. For Sian, it was ‘a whole new language’. Melanie downloaded a glossary of research ‘jargon’ which she stuck to her wall. Whilst moving into research might involve learning new and unfamiliar things, many people also emphasised that it could involve transferrable skills they already had developed (e.g. in their previous clinical roles*) – although, as Alice highlighted, these might require adapting somewhat.

Ginny highlighted that all nurses and midwives take consent from patients as part of their role, and that this is not only in research.

Age at interview 53

Gender Female

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Well I suppose that’s the other thing I should have said about being a nurse midwife I guess it’s, you know, that’s part of what you do anyway really so consenting’s not a, not an unusual thing, it’s not alien to us at all really so I think that’s probably helpful knowing, you know, being able to do that anyway. I’m sure the nurses do it all the time and midwives have quite, some quite complicated consents, so they do things like ante-natal screening and things like that which is really complex.

So or rather it’s really complex information, whether they do it very well or not I’ve no idea and [sigh] consent’s funny actually because I think I, so I’ve just said that, just said nurses and midwives do that all the time and lots of people in their roles do consenting, again other health professionals would do but whether we do it very well or not is a different matter. So I did one again and I have been on a consent training course at some point which was just a couple of hours and partly I felt a bit eye rolling about well of course, you know, I’ll make sure everybody puts the same date that they sign it and all the rest of it but actually some things to do with consent are quite interesting because clearly it’s often that things are to do with how you present information aren’t they and whether you believe people and. In some ways this is another big philosophical question isn’t it because, because the thing about consent which is the idea that it’s informed consent but kind of that’s not really a real thing, I don’t think so you can tell people as much as you can in the hope that they understand it because you never really know.

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The use of abbreviations and their meanings was unfamiliar to Sugrah when she started in research.

Age at interview 48

Gender Female

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When I first ever came to research, it was horrific. Because as a nurse, you’re taught not to use acronyms, and then you come to research and you’ve got-, at the beginning of the protocol, like a couple of pages of just-, it’s like oh my god. And we used to laugh about it. Cos in my previous job, I was Clinical Research Facilitator, then you had your Case Report Forms, which were also CRF’s, then we had a Clinical Research Facility, which also a CRF, so we used to laugh about it. Okay there’s a CRF in the CRF writing a CRF.

[laughs]

[Laughs] So it was like, how many CRF’s are there? Case Report Form, Clinical Research Facilitator, Clinical Research Facility, and then there was all of the others. And still to this day there’s some that I get tongue twisted with.

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Although not covered in this section, those pursuing research via qualifications (such as Master’s or PhDs) often saw the endeavour as a form of training in itself and often attended additional courses on particular methods and research tools. They also spoke about their supervisors and mentors. For those who had first worked in research delivery roles, senior members of the research team sometimes went on to become their PhD supervisors.

Graham didn’t have any official training when he started as a research paramedic, but he had good mentors who also supported him in pursuing a doctorate.

Age at interview 40

Gender Male

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[Laughs] I went from working my shifts to Monday morning starting in research and right, here you go. And sort of learnt a lot as I was going, but that’s, I was lucky to have people that looked after me and guided me through that sort of process. And that’s why I think we need more paramedic sort of academics who can then help people to make that jump and get involved and give them an opportunity to get involved in research in a sort of safe and protected way.

I think I’ve been very lucky. I’ve had some very good mentors. Primarily from outside of the paramedic profession. They’ve, I think, shown me that research-, shown me what difference research can make, shown me how-, if I’m going to get involved in it, how I can get involved and who I need to talk to, what I need to do. Because really, I came into this blind with, with no plan, no career plan, no-, it was something interesting and new and I didn’t know where it would lead or what it could lead to. They’ve sort of really taken me under their wing and supported both with development academically for research but also encouraged me to keep involved clinically, and shown me that, through what they’re doing, that this is possible to actually do, and the sort of influence that they have and how they can change things, and hopefully make things better. What you can aim for. So and because of-, there is certain people within our profession who’ve helped and acted in that way as well but, as I say, they are very few and far between. But it’s, [sigh] I think they’ve been, [sigh] they’ve been very valuable, it’s difficult to sort of put into words how valuable they have been. But I really don’t think I’d be doing what I’m doing now, which will hopefully lead onto better things, without, without their sort of guidance and protection and [laugh] mentoring.

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The changing provision of training and support

Many people felt that the induction, training and mentorships provided to new research NMAHPs had become more extensive in recent years – including through the National Institute for Health Research (NIHR) Clinical Research Network (CRN). Those who had started many years ago had often found training lacking or inconsistent. Simona had worked in research for seven years and recalled that, at the start, ‘I had to find things out for myself’. Helen felt she was ‘just thrown into it’. As a lead research nurse, Claire had worked on various packages of training to support new research NMAHPs; she had also designed a package for research nurses who had worked in their role for some time but who hadn’t initially received formal training. She described a recent Tweetchat where research nurses across the UK relatively new to the role ‘were amazed to hear there was little support only a few years ago as they were reporting all sorts of supervision, teaching, training and buddy systems’.

Simona didn’t have much training or support when she started in her first research nurse post. Now that she leads a team of her own, she provides new staff with more support.

Age at interview 48

Gender Female

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So I think I was-, the first thing when I came into this new post it was what can I do different so then nurses do not go through what I went through. And we have a very structured way of inducting any new staff member, they shadow, they have all the training, I set up mandatory training that they should help them to understand the whole thing. And then depending on the person you have from four to six weeks where you’re kind of supernumerary in a way, so we don’t expect them to do things without being fully comfortable and fully understanding what they do. When we recruit someone new and we know the start date of that person, we already set the start-, we set already training dates for them, they are not done internally.

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Sandra described some of the training, checklists and approaches used by the Clinical Research Network for research nurses.

Age at interview 43

Gender Female

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There’s been training on and off I think for many years, and there’s different things and they get reinvented, don’t they? But a couple of years ago now the network, so we need to have a standardised document that when we’ve got new nurses coming in they can see what things they need to learn. What kind of conversations we need to have, what training they might need, and we can, we need to sign off to say that we feel that they understand it and they’re competent to do that. And that power then means that you, you know, I know I’m doing a good job, and I can do all of these things. And there’s no areas of concern. Obviously if there was a problem, if you couldn’t do something, then we need to address it, and see what the training is out there. So, the network does lots and lots of training, it’s one of the best organisations to work for, cos I just get loads of opportunity. And all the things like Good Clinical Practice training, we do that, but we also have bite size pieces of it, so two hours, two, three-hour sessions of individual aspects that you can go in and learn more about. So, you can go to one of those, so for instance if you wanted to know more about consenting people lacking capacity, we have a session on that, so you can go along to that, ask any questions, find out the information, and it, you can develop your skills. And then we’d use the competency document, have a conversation with the individual, talk, get them to talk about their experience, what they’ve done, what training they’ve done, and then we can say, Okay, yeah, I feel you really understand that now, we can sign you off on that section. Or if they came and they still didn’t really get it, we could say, Okay, what I think we should do is go out and see a few people together, you watch me, then you can have a go, and we can see what you’re doing. So, it means that we’re all on the same page and we’re giving the same level of service and standards of care to our patients.

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Vicky joined a university unit as the first research nurse they had employed. It required her to think carefully about her role and training needs.

Age at interview 47

Gender Female

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So I was the first person, the first nurse really to work in our unit. So it was quite a unique post, that had been created specifically for study that needed more research nursing input than could be provided from perhaps research networks that might normally support studies. So I was the first one really. So I had an induction as a researcher but not as a research nurse directly. But that provided the opportunity to develop the role myself, and to look at perhaps what training needs I might need, and how the role fitted alongside other existing roles.

And I guess that was probably quite a scary point, really. So moving outside the NHS and being used to having qualified nurses, registered nurses, around you at all times. It was quite a, a, a thing really to step away from that. And to understand that the responsibility really to develop those, that role, those training needs, rested with me. Obviously in conjunction with my line manager, and other members of the research team. So I looked sort of at other research nurse roles and responsibilities and what sort of training they might have. And the sort of competencies that might be involved in their role. And then looked at how I might incorporate some of those into my role as well.

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Inductions and orientations

Inductions and orientations varied widely. Libby had three: one induction for the Trust, one for the department and one for working in research. Some people had moved to a new clinical environment to take up a research post (a different hospital, department/specialty, or another setting such as primary care). A Trust and/or department induction could help them learn more broadly about the processes and practices, both clinical and research-based, in that setting.
Another type of induction, sometimes called an ‘orientation’, was into research activities and the research team. These often included observing others carry out research activities and visiting other teams/locations. Osi felt this helped her to ‘find out what a research midwife looks like. what do they do? What’s their day-day?’ She was also given examples of some blank paperwork, ‘as a skeleton’, to help her understand the paperwork for studies at her own hospital.

In addition to inductions to the Trust and department, Libby also had a research induction. With hindsight, there were topics that she wished had been covered in more depth at that stage.

Age at interview 45

Gender Female

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One thing that I would say at the time that was missing from my induction was research-based knowledge. It came later, but it wasn’t there right at the very beginning, you know, how research works and you know things like GCP [Good Clinical Practice] and governance things, and those things that once you’ve been working in research for a while become second nature, but you don’t know, you don’t know what to ask if you don’t know you know.

It’s all very well to say any questions ask me, but you kind of don’t know what you don’t know, do you? So, you, and there was a little bit of maybe learning by making mistakes, and that is, I hate that. I really hate that. I’d much rather be told what’s, what’s possible, what’s not possible and then you know work within it, rather than have to do something that is, turns out to be wrong. And then you know, hmm, I don’t like that at all. So, but, but you know so I would say that research, research specific induction although it did happen, could have happened sooner.

I could have actually been a lot clearer, I think we spent a lot of time talking about SAE’s [Serious Adverse Events] and AE’s [Adverse Events] and things like that, and you know I, to me there’s more important, well not more important, more everyday relevance things that we could have spent a lot more time talking about.

And which would have been helpful.

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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.

Age at interview 31

Gender Female

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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.

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Training courses
Many people had undertaken training on a range of topics, including:
  • Good Clinical Practice (GCP);
  • taking informed consent for research (from adults and/or children);
  • communication skills; and
  • site file management.
GCP is an internationally-recognised ethical and scientific standard for clinical trials, and GCP training is intended to ensure that these studies are designed, carried out and reported in a way which meets the quality standard. Several people had undertaken both an online version and a face-face GCP training course. Many felt the latter was more helpful; for example, Nicky liked the opportunity to discuss issues with other attendees and felt it helped to ‘put the theory into practice’. Paul thought it was good that he could do some types of training online. It meant he could do it from home or fit it into days which were quieter in terms of research study activities.
Julie and research staff in her team had undertaken a course specifically focusing on doing research in intensive care, in recognition that this involves ‘families in very sensitive and tricky situations’. Layla felt there was a lot of extra/optional training available to her when she started in a post as a research midwife. She soon realised she would have to ‘narrow it down a bit’ so she could keep up with the research activities too, and has taken up training to help build her expertise in areas she is particularly interested in. Some people highlighted that undertaking training was useful as evidence of Continued Professional Development and for professional revalidation/re-registration.

Some of the key tenets of Good Clinical Practice training for Sian were that research must be ethically-sound and not be forced on patients.

Age at interview 48

Gender Female

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So Good Clinical Practice to me means that the way that we do research today isn’t like it used to be and we have learnt from the past such as the Nuremberg Trials and oh there’s another lady that Henrietta Lacks. So we’ve learned from that and the way to do research the best, that we’re not gonna put patients arms up their back and make them take part, but it’s a journey that we go on together and you know, if they went to take part they do, if they don’t that’s fine as well they’re well within their rights [Laughs]. And it is, it’s the whole of the study, the protocol, everything just coming together and making sure that you’re able to deliver that appropriately.

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

Age at interview 34

Gender Female

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

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Ginny felt that bad’ practices in health research were not always prevented through insisting staff undertake Good Clinical Practice, and that tight governance sometimes inhibited research unnecessarily.

Age at interview 53

Gender Female

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So we all go along to these things and of course that’s turned into this big thing about everybody has to have GCP [Good Clinical Practice] training and it’s kind of, you know, it seems to be the same thing and it never changes and it’s always, you know, the thing about, you know, protecting patients and making sure that you do XYZ which is all good and great but I don’t think it changes the way that people work particularly and I think maybe we ought to do something a bit more radical to try and get some of these groups that just don’t, just don’t get involved in research I think. And I don’t think it’s, it’s not good enough anymore to talk about the you know, the sort of scandals of the past really that have happened you know, I know Alder Hey is not that long ago and things like that but you know, it’s not, in all, you know, you have this thing about the, you know, do you talk about Nazi experiments and things like that and really awful things that have happened in the name of research but it’s kind of more subtle than that now I think.

And so I think, you know, it’s a sort of double edged sword really in some ways I think it’s sort of, it’s inhibited the way that people could do research because we’re all so careful about not, you know, approaching people when we shouldn’t and saying the wrong thing and, you know, and so on, you know I’ve just said the thing about it’s quite difficult to even be able to ask somebody a question without it somehow having to go through committees and having huge amounts of paper and so on. So that becomes very difficult and yet you still do see or you can do or I do anyway bad practice research, you know, people, people can still get away with that.

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The timing of training varied. Some people were required to take courses (online or in person) as soon as they started in the post, others found there was a delay. Most felt that undergoing training sooner rather than later was good for someone new to research. Laura X wasn’t trained to use the computer systems at her hospital for research purposes until she had been in post for a month, by which time she had already worked out for herself how to use them.
Some people had been on ‘refresher’ courses. James and Dawn both repeated GCP after a few months, as they felt it helped consolidate their learning. Julie felt it was important that research NMAHPs should ‘always be constantly reviewing our practice’, even if they have been doing an activity (like taking consent for research studies) for a long time.
Study-specific training included learning about technologies/devices that research NMAHPs would have to demonstrate to participants and various lab skills, such as centrifuging/spinning bloods. Some people had also attended study days or professional conferences, where they learnt (from talks or informal networking) about skills or picked up ‘tips’ to use in their roles.

Dawn completed Good Clinical Practice training online first and then again, out of choice, at a later date in a face-face session.

Age at interview 55

Gender Female

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I did the online training for consent for both the adult and paediatrics, which meant I could dip in and dip out which was easier than going to a study day. The GCP [Good Clinical Practice] training I think initially I did it online, and although I didn’t need to do it for three years, I felt in the interim period, when I, when I first started within a few months that I would benefit from doing face-face so I actually did both. But that was because that, I felt that I, that was my need to do that.

I think face-face, well you’re with a group of people. And I think I wanted to just consolidate what I’d learnt initially online, and then just revisit really. Yeah and especially because, although I work in a team, I’m the only paediatric nurse within that team. So when it came to consent, obviously I had the consultants as a point of support, but for some studies it’s my responsibility to discuss the studies and consent. And so for me, I felt I needed to know as much as I could about that process to be effective in what I do.

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Nicky had to learn lab skills when she started in her first research nurse post eight years ago. She was mainly shown what to do, but this taught her some mistakes and inefficient practices. In contrast, new staff attend a course.

Age at interview 52

Gender Female

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And there’s also a lab skills course, which again there wasn’t when I first started. And one of the things I do in my job is we do all our own-, we don’t have any lab people, so when we get the samples we do all our own centrifuging and pipetting of plasma and what have you. And I’d never done that before, so again someone just showed me how to do it. And then I think I’ve since discovered a couple of things I’ve been doing wrong for, [laugh] for five years, you know. Because you don’t, if someone just shows you, it just gets passed down the line and, you know. So once people started going on the lab skills course, they were able to feedback and say, Well, you know, we should have been doing this for the last however long.

So yeah, so I think it’s a lot better, and I think there is a lot more now. And the workforce development team have kind of constantly trying to, you know, find out from research nurses what it is they need to know and trying to sort of add more things into, into that training. So yeah, so as I say when I first started no, there wasn’t very much, but it definitely has improved a lot since then.

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Sian said there wasn’t a lot of training about research when she started, but study-specific training was helpful.

Age at interview 48

Gender Female

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Okay I think because it was six nearly seven years ago there wasn’t a great deal of training, so it tended to be that if it was in the clinic environment you went out with another nurse who had experience in research nursing and you watched her, another nurse, so you obviously you had your GCP [Good Clinical Practice] training and then you had your sort of in clinic training and then on some of the studies we had training from the study teams which was really valuable because I think it makes it less like a production line. If you’ve got the study team telling you why you’re doing the study, where it’s come from, where we’re going it makes far more sense than just kind of filling in the paper work because, you know, it’s about the whole picture isn’t it and that helps just to embody what we give to the patients.

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Supervision, mentorship and peer support

Some research NMAHPs had mentors who guided them in learning activities when they were first in the role or had changed to a new team and/or specialty. Osi had support from someone who was a research champion (a role appointed to raise awareness of the importance of clinical research in a particular area or profession, e.g. midwifery); she found this ‘really helpful’ in terms of learning processes like maintaining site files as well as for reassurance: ‘it was nice just to have a pat on the back to start off with’.

Osi’s first monitoring experience was informative.

Age at interview 27

Gender Female

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Yeah. So at first I was very-, the first one I’ve had was very, very scary cos I-, it was for a commercial study as well which is probably one of the hardest ones, and we were the only Trust in the UK to have actually opened up that-, that study at that point in time. So I was just like ‘oh my gosh,’ and I was very new to research so everything was just all very-, it was a massive study and I thought ‘oh. And it was nothing to do with midwifery either, it was to do with like women’s health which technically, I wasn’t trained in you could say cos I was always-, I was never a nurse to start off with. However, it was very helpful. I would love for them all to come as often as she does, although she gives me a massive list to like complete. You know that everything is like up to date and nothing’s going to shock you, and like where you’ve got to sort out the problem that happened two years ago, you know that within two months or whenever she does come, it’s regular updates which is helpful. It is a bit, as I said, nerve-wracking, someone checking your work. But I think I’ve learnt through my Masters that you want everyone to check your work [laughs]; you’re going just give it to everyone to have a read.

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Ella had a mentor for a couple of months in her first research role, which involved working on paediatric vaccine studies.

Age at interview 56

Gender Female

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Oh, could have been three months, I, maybe- that’s when I felt maybe comfortable to do it on my own. Because the first few months- the first month obviously you kind of observe and ask questions, learn by observing.

Then you start now doing it and they observe how you’re doing it, they supervise you doing it. Then by third month you feel you’re ready. But they used to ask you, “Do you feel comfortable now to go?”

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Many people described learning ‘on the job’ through colleagues. For some, this worked well. Being able to ask questions was a great way to cement their learning. Sarah and Helen both found it helpful to shadow colleagues taking consent, and thought it was interesting to see the different styles between people and professions. Michael was able ‘to see how they organised a clinical trial, to learn their little tricks as to how to get a scan quickly’. Ella liked that she had people to learn from, until ‘you felt ready to do it on your own’. Rachel X started at the same time as another new research midwife, and they ‘figured it out together as we’ve gone on’.
Others found the coverage of information from colleagues patchy and, on occasion, even incorrect. Nicky had attended some training and been under the instruction of a colleague when she first started in a research nurse post eight years ago. However, the instructions she got could be quite ad hoc and unclear: ‘I found the whole thing very confusing I always felt like there were bits of the jigsaw missing’. Some people had little or no contact with other research NMAHP colleagues. Simona was the only research nurse when she first started, so ‘attached myself in a way to other research groups where they were a bit bigger and had some experience’.
In turn, once they were comfortable and familiar in their role and the research activities involved, some people helped teach and/or mentor new research NMAHPs. They often found it rewarding being able to share their knowledge and it could also affirm their expertise. As Sian said, ‘it becomes second nature’. Those in leadership/managerial roles had sometimes designed induction and training resources. Imogen had developed an induction pack, drawing on national resources but ‘bespoke to our team’ based in the emergency department.
Footnotes
*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).