Nikki
Age at interview: 34
Brief Outline: Nikki is a research physiotherapist working in critical care and peri-operative medicine. She continues to work one day a month clinically, which she sees as beneficial for maintaining her skills and fostering the research culture amongst colleagues.
Background: Nikki is a research physiotherapist. She is in a relationship. Her ethnic background is White English.
More about me...
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.
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.
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.
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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.
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Nikki felt that some of the paper-based systems used to screen for potential eligible participants would be improved by being made electronic.
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Nikki felt that some of the paper-based systems used to screen for potential eligible participants would be improved by being made electronic.
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Nikki had a fellowship year to develop a PhD proposal which helped her access research jobs. She was due to start a new post managing a research team shortly.
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Nikki had a fellowship year to develop a PhD proposal which helped her access research jobs. She was due to start a new post managing a research team shortly.
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But I'm still really grateful for that year, and it was - you know, I definitely, I definitely got so much from that year. And, and I think that then led into the jobs that I'm now doing. So, you know, it all- doors open, don't they, I think.
Although Nikki wasn’t awarded doctoral funding in the end, she had been worried about the arrangements for holding her job open if she had pursued this route.
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Although Nikki wasn’t awarded doctoral funding in the end, she had been worried about the arrangements for holding her job open if she had pursued this route.
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And certainly people that had gone through before me, had had their posts held open. So I think their plan was to go back to the sort of therapies department and say, 'look, we have precedent for this, people have done this before, and posts have been held open'. You know, 'realistically, you will be able to place her in three years time somewhere - yes, not in her current role'. And I think that was the way the conversations were going to go.
Nikki had varied experiences with the amount of engagement from Chief Investigators (CIs) or Principal Investigators (PIs) and study centres.
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Nikki had varied experiences with the amount of engagement from Chief Investigators (CIs) or Principal Investigators (PIs) and study centres.
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But I quite- I find it- I find it a better experience if they are the types that engage with you as you sort of go along.
Nikki negotiated for her research physiotherapist job to be a substantive contract, as she felt fixed-term was too risky.
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Nikki negotiated for her research physiotherapist job to be a substantive contract, as she felt fixed-term was too risky.
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I couldn't really afford to take that risk. And I felt the same with a year. Because although it's clearly twice as long as six months, it's still, it would still fly by. And I think you'd still have to sort of go into that job almost sort of thinking 'right, what is my back-up plan, and where am I going to go in a year'. And I just didn't want that kind of pressure. And I kind of- I think I kind of knew that if I kept, if I kept bargaining that I'd probably get what I want. Or, and if I didn't, I think I was happier to stay in a clinical role that I still enjoyed, as I said to you, on a substantive contract. Rather than take the risk, and make the move to move into a research role.
And then luckily, I suppose, or eventually they were like 'fine, we'll just give you a substantive'.
Nikki felt the flexibility in her research physiotherapy job was two-way. She sometimes worked hours outside her usual ones but could take time off if she needed to.
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Nikki felt the flexibility in her research physiotherapy job was two-way. She sometimes worked hours outside her usual ones but could take time off if she needed to.
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So, there was that sort of side of things. Which was quite a, quite a big plus. Though I do feel like research will sort of tend to move in the direction of being more 24/7. And I don't, I can't foresee a time where we'll be asked to do night shifts or anything like that, but even now they're starting to trial weekend working. And occasionally we are expected - or not expected, but a study will demand that we do need to sort of skew our hours a little bit. And you know, that's fine. I, you know, I don't have any problem with doing a ten to six shift, or you know, staying later when we need to or whatever. So I think- And I think probably that's a right, you know, the right thing to do, in terms of flexibility does need to go both ways, doesn't it. That as an employee, if you're asking if you can flex your time to sort of accommodate sort of your life stuff, then perhaps it's right that it's the other way round as well. And that you know, equally you can be flexible to cover the studies when they need to be covered, and yeah. So I think it's probably a changing, changing environment, in terms of research. We'll no longer be the sort of you know, eight to four sort of pattern, and no extra hours.
Nikki thought there was a lot of support for clinical-academic posts at a high level, but that there were major barriers to overcome.
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Nikki thought there was a lot of support for clinical-academic posts at a high level, but that there were major barriers to overcome.
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That they just couldn't support me, in fostering these other interests. That they just needed me to come in and see patients. And I get- And I get why they needed that, and I understand the pressures that they were under to deliver a clinical service. And I think that was probably why I then in the end ended up leaving, because I just felt 'you know what, there's a whole team here that are going to support me in what I want to do, and you aren't able to do that'. But in terms of developing a clinical academic pathway, we need to overcome that somehow, and I don't know how we do that. You know, you look at- Perhaps the medical model is the right way to do it, in that, you know, they have posts don't they, that are certain grades that they go for. And some are pure clinical, and come are combined clinical and research. And you can apply for what pathway you want to, but the pathways exist. And it's kind of built into that role. But it's trying to get someone to fund that, and fund the research time that's attached to clinical time. Because I think that's probably the only way you're going to get clinical teams to be able to, to cope with- You can't suddenly give everybody you know, half time study leave. You can do that, on the funding that's currently available. So it probably does come down to money.