Nikki

Nikki is a research physiotherapist working in critical care and peri-operative medicine. She is part of a mixed discipline team which also includes nurses and physiologists as well as professors from related backgrounds. Nikki has been in post for 14 months and is about to move to a new job with additional leadership responsibilities for a research nurse team. Before being in research, Nikki was a physiotherapist in intensive care for six years. She completed a Master’s during this time – an undertaking which was difficult to fit with her clinical work. She enjoyed the research experience and went on to be awarded an NIHR fellowship to write a doctoral research application over a year. Although she didn’t receive funding for a PhD, the fellowship was “an amazing opportunity […] to basically sit and read and write, and meet people, and absorb as much as you can”. She returned to clinical work for a while but found “that was no longer what I wanted to do” and so applied for her current research post.

Nikki felt it was quite a big move to go from being a clinical to a research physiotherapist, but found it reassuring that a friend she had trained with had made this move and really enjoyed it. Nikki had lots of training when she started in the post, including a four-day course which covered various aspects of taking consent, managing site files and writing study protocols. Nikki was originally offered a fixed term contract (for six months, revised to 12 months) but felt “I couldn’t really afford to take that risk”. Eventually it was agreed that the post would be permanent, which Nikki accepted. A benefit for Nikki of her research post is having flexible hours and the fact she is no longer on-call for late shifts. Sometimes she has to go into work early or stay late to cover study activities, but she can then take the time back as and when she needs.

The studies Nikki has worked on have included CTIMPs (Clinical Trials of an Investigational Medicinal Product) and observational studies on a wide range of topics, from sepsis, to the impacts of low oxygen states, to respiratory viruses. Although some of the studies are not primarily about physiotherapy, she finds there are angles which fit with her background and interests. For example, whether it is best to sedate and ventilate some patients or wake patients and encourage them to move. She has helped with assessing feasibility of potential studies, study set-up, screening for eligible patients, and approaching patients or relatives about study participation. In terms of data collection, some of the studies cater to Nikki’s skills as a physiotherapist – for example those around exercise which involve “physical assessments or the strength assessments or the function assessments”. In addition, Nikki finds her research team very supportive and, providing she “deliver[s] on my day job”, there is encouragement to pursue extra pieces of research of her own – for example, on muscle wastage in intensive care. This sometimes means working extra hours but Nikki is happy with this arrangement.

When she first started in research, Nikki was surprised to find that most patients or their relatives were happy to give consent to take part in research studies. She had expected the decline rate to be high because relatives have “been told, often very short notice because it's often emergencies and an admission to critical care, that their loved on in a life or death situation” and so have “an awful lot to cope with”. Although research opportunities are generally well-received, Nikki feels strongly that “a really important part of our role” is to support patients and their families if they have concerns about it not being right for them. Although she would never “pressure” a patient to say why they declined a study, Nikki finds that these reasons are often volunteered. She thinks it can be useful to know, “just to see if we’re getting patterns” as problems in the research design could potentially be amended.

Within her research post, Nikki has arrangements in place to work clinically one day a month. This helps her “keep in with the team […] and to not feel that I’m out of the loop”. It also “keeps you visible within the clinical team which then helps our relationship with the clinical team and it helps us deliver a study”. On these days, Nikki runs a journal club and sees it as a way of “promoting research” amongst her physiotherapy colleagues. Nikki thinks there’s an assumption among clinical staff that allied health professionals (AHPs) don’t work in research delivery and that this is a role taken up only by nurses. She hopes though that, with time, her hospital will “embrace more and more professions” in research roles. She thinks it is important for her discipline of physiotherapy to engage with research activity. Nikki feels that the evidence base in physiotherapy is “a long way behind”, which can make it hard to justify the value of the discipline as “a necessity and not just an extra”.

Nikki would like to “go the clinical academic route” and plans to pursue funding for a PhD. She feels there is top-level support for such pathways but finds “middle managers” more resistant or inflexible. Nikki’s message to other physiotherapists is to not feel “confined by the traditions of a clinical career pathway”. She had herself feared that, by moving to research, she “would lose something” but now feels “you stand to gain an awful lot”. Nikki feels strongly that she remains a physiotherapist but “with extra skills”, and highlights that physiotherapists can always go back to clinical posts if they find research is not for them.