Dawn

Dawn has been a paediatric research nurse for two and a half years. She started to feel more confident in her role about eight months into the post, but emphasises that it’s an ongoing learning process.

Dawn has been a paediatric research nurse for two and a half years. She also does bank shifts to maintain hands-on care in children’s wards and neonatal units. Dawn was drawn to a research nurse post because she wanted something different to do. She had been involved in auditing and initially, naively, I thought that research would be something quite similar. However, Dawn found it was quite an adjustment: it’s like learning a new language [‚] all the protocols, policies, all the legal requirements, all the ethical requirements. She undertook training, including an online Good Clinical Practice (GCP) course which she could dip in and dip out of; she later opted to also attend a face-to-face version of the GCP course. Dawn recalls feeling more confident after about eight months in post but emphasises that it’s an ongoing learning process. Her contract started as one year fixed-term and this uncertainty made it a difficult decision to take the job. Now, she wouldn’t like to think I was doing anything other than this. I definitely feel like this is my career pathway now until I retire.

As the only paediatric research nurse in her Trust, Dawn works across several hospital sites. Travelling between the hospitals can be time-consuming and costly, so she tries to pool my appointments and my visits to either one or the other hospital. She initially had some IT problems in the different sites, although this is easier now that she has a work laptop. Dawn’s role involves helping assess feasibility of potential studies, identifying patients/families to approach, gaining consent, and collecting data during visits. As well as paediatric studies, she has also been involved in a number of adult-focused studies which included children. Dawn feels it is important to go into detail when consenting patients/ families to a study, and she worries that sometimes people do not realise research is voluntary. She explains, you’re still the advocate [for the patient]. Dawn thinks her broad knowledge base as a paediatric nurse has helped in her research role, including awareness of how to navigate various electronic systems and locate equipment. Dawn would like to be involved in writing up data and maybe become a Principal Investigator for studies in the future.

For Dawn, teamwork and working well with colleagues is essential to the success of studies. She can screen for patients electronically but likes to go onto the wards: it just keeps that relationship between the research nurse and the ward staff. Dawn often helps out her colleagues and sees this as a reciprocal arrangement which can benefit research. If the ward is busy, she will weigh children and check their blood pressures. In return, sometimes ward staff will help her; Dawn remembers a time when she was at the wrong hospital to see a patient and the nurses at the correct hospital took the child’s blood samples, as she couldn’t get there in time. However, at times, Dawn has felt torn between her commitment to supporting clinical colleagues and to research. This was a particular concern with the winter pressures, and she heard some staff comment that research nurses should be relocated to the wards. Dawn feels strongly that we are contracted as well to our studies and that’s important. Even so, she sometimes feels a bit guilty [‚ And] that’s why when I’m on the ward, I do try to help out if they really are busy. Dawn also helps other research staff in her office and covers holiday/sickness leave for some research nurses. She is in the process of getting similar cover arrangements in place for herself.

Dawn enjoys her job and feels she is at the forefront of future patient care. She sees research as an extra service for patients and she would like to widen this opportunity to more people. One example Dawn gives is patients with health conditions who do not regularly have hospital appointments, meaning that they might be overlooked when screening for potential participants to invite to a study. Dawn sometimes talks to patients about research when in her (bank) staff nurse role and is happy to signpost anyone to studies of interest, not just those in the area of paediatrics. Dawn’s message to nurses considering a research nurse job is to speak to those currently in research roles to find out what it’s like. She thinks it is important to have ownership and the drive to want to succeed as well as the ability to think out of the box.

Dawn described tensions when there are major pressures on clinical staff. She is employed by the Clinical Research Network, rather than her hospital Trust, but expected that research staff might be pulled in to help.

Age at interview 55

Gender Female

I know that there was a comment made on, on a, on an adult ward when I was on there and, and it was during the crisis time at Christmas when the, there was a crisis right across the UK. And one of the sisters suggested that during crisis, should we be doing research and not be relocated back onto the ward? But actually within our Trust, if they wanted the support in any department during crisis, we know that we would, would be asked to go and help. And we do help, I would-, I did help more during the crisis period but I didn’t go onto the ward and do a full shift as a, as a ward-based nurse. But what I did say was-, so I did explain that to her, that we would if we were needed, and if she felt that while I was on the ward she wanted-, the staff needed a bit of help doing anything and I was quite happy to do, to help out, within my capacity for what my knowledge base. But I did say, suggest to her that she, we are contracted as well to our studies and that that’s important too. And that it may be that we have a responsibility to find the patients and consent the patients onto the studies, but balancing that against if somebody, if nurses on the ward are really struggling then of course our Trust is going to pull us off and put us onto the ward, yeah. But I don’t think they realise that that would be the case.

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

Age at interview 55

Gender Female

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-to-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-to-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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Dawn had a role in deciding which paediatric research studies to run at her Trust. This was challenging without access to the protocols and could mean finding unexpected issues at a later date.

Age at interview 55

Gender Female

I do get involved in the feasibility stage. I get involved from the expression of interest stage. All the emails for paediatric research that is coming up, all the new, the new research comes to me. And then I’ll read it and if we don’t see that patient population and I know we don’t, I will reply, we will reply to it and say, We couldn’t consider it here. If it’s a population that I’m not sure whether we would definitely have that, because I don’t know everything, then I would forward it to the consultants. But if it’s, if it’s a study and I do think we could run it, I would roll it out and forward it to all the consultants in the Trust, not just the ones that are research active, to everybody, cos it maybe that one of the other consultants it’s their specialised area and they will be wanting, the ones that are interested in it.

And then I help with the expression of interest forms, we do them together, the consultants, myself and the R&D [Research & Development] department. And then when the feasibility we would all, once we-, and the sooner we can get hold of the protocols, the better. I don’t think they give us enough information at the expression of interest point for us to be able to make a, a decision about whether, or we would feasibly be able to run the studies.

And it may be at that point, you get the protocol and you think it’s not, I can’t-, there’s no way we can run this’, or we’ll, we will pick out areas where, of weaknesses within that, where we may not be able to, we might be able to say, Well actually we can do all this, this, this, this and this, but actually this part we, no we can’t provide that here, or, Are you going to provide it? or, or Actually we won’t be able to do that because we don’t have the out-of-hours pathology support to provide that, to be able to collect that sample at that point in time. And then we could negotiate, so there’s a, you can negotiate with the study team at that point.

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Dawn felt it’s important that we are ambassadors for research, but encountered some resistance from a consultant to a monthly/bi-monthly stall she had been running.

Age at interview 55

Gender Female

I was doing that event and I went to, so we targeted, so we figured the best benefit to do and then we wanted to target the outpatients clinics that the patients might go to that would be interesting for us. So we targeted the diabetes clinic. And one of the consultants at one of the hospitals we went to wasn’t happy that we were talking about research and to her patient population, cos she felt that we were breaking confidentiality. Cos there was other patients for different depart-, for different consultants in the same department. And we were saying, Well we’re only talking in general and giving them the information-,

Yeah.

And we’re advertising not just that particular research study. So as a result of that she asked us not to do any promotional at that hospital. So then I felt that I shouldn’t be doing it. So I really took a step back and didn’t do as many, and I haven’t done them for a while. But when I went to the study day yesterday, I decided-, I spoke to their we’ve got our management team well some of our management team were there yesterday and we were talking about and I said, I feel now I need to revisit that, I need to go back and do that again, and what I need to do is, I need them to go back to the consultant and say we, you know, We’re, we’re planning on doing this, and have you got some concerns still about doing it? And if I can’t address her concerns for her to be happy for us to do it, I’m cascading it. So the management team can get involved.

Yeah.

Because I think that we, the patients should be given the opportunity to.

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Dawn had heard about research suggesting that research-active hospitals generally give better care overall to their patients, not just those enrolled on studies.

Age at interview 55

Gender Female

I feel that we’re providing-, the patients we get on our studies you know get better care. And hospitals that provide research to their patients and research studies to their patients generally give better care overall to their patients. Not just the patients that are on the study. And so I think for that reason as well, I want my, my patients and my hospital and my, and the wards that I work alongside, to provide the best care possible for the patients. And that’s important. And I feel as if we’re changing what’s gonna happen in the future. And that actually some of the studies we do might have a different outcome to what, what we would want, but that’s information still really important. Really important.

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Dawn felt her familiarity with clinical environments was an asset in helping research studies to run smoothly.

Age at interview 55

Gender Female

I think it’s knowledge. For me in my role in my Trust, and it may be different in other Trusts, so it’s my knowledge of not just nursing children, whether it’s on the children’s ward or in the neonatal unit. I think it’s a knowledge of processes, whether that is electronically, how-, where to get information from, which system to use, cos we don’t just have one system for one thing. Or it’s a process of if you’re wanting to do swabs for example, where is the equipment? If you wanted to do a throat swab and the study team provide everything, they might provide a swab but they might not provide a tongue depressor, so if you’re on the ward and you think-, or outpatients, and you think where’s the tongue depressors?’ rather than asking other staff and the knowledge of where. Just little things like where things are kept. Where the lab is? What kind of bottles to put-, which bottles to put in what, what samples for bloods and things? Where to get that information?

When-, it’s because if I do bloods on children for studies I always contact the consult-, we liaise. So for the diabetes children, so we liaise with their consultant, because we’ve got a window of time to get the bloods for them. So the consultants may have bloods that they want doing within that six-month window. So and we liaise with the consultants then we do our bloods and I do their bloods alongside our bloods. So, but some bloods- so I might need to go off on a morning before 12 o’clock because of where they’ve got to go to. So it’s a, it’s about knowing like all, I can’t know everything, I’m not saying, I don’t know everything but it’s, it does help knowing how the wards run, what time the handovers are, where certain people will be at certain time, specialist nurses, which specialist nurses do what and work in which areas.

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