For the nurses, midwives and allied health professional (NMAHPs) we spoke to*, becoming involved in research had sometimes changed how they or other people perceived their professional identities. This experience was described by people who were primarily employed in research delivery roles as well as those who were leading research studies (in their job or through pursuing a qualification). Reflecting on this change in identity could be a major part of a broader adjustment process but it was often also an ongoing consideration many months or years afterwards. Two key issues related to professional identity were wearing uniforms and professional revalidation/registration.
Many people were very clear that they continued to identify with their health profession. As Simona explained, ‘I was still a nurse and I’m still gonna be a nurse’. For these NMAHPs, working in research did not detract from their professional identity and instead could enhance it. Nikki saw herself as ‘a physio with extra skills rather than no longer a physio who can do less’. However, other people struggled with feeling that they no longer a ‘proper’ nurse, midwife or AHP. Often this was related to the comments and attitudes they had encountered from other people, including their non-research colleagues*, patients and the public.
Some people, such as Gavin (a podiatrist) and Graham (a paramedic), came from professions where they felt there had not traditionally been a strong research culture. They were keen to showcase the potential benefit of research to their professions, such as helping to build the evidence base. It was also about demonstrating the skills and insights that their profession could contribute to research studies.
Libby and Nikki, both research physiotherapists, were keen to emphasise that research delivery roles were suitable to health professionals like themselves – not only nurses. Libby’s job had been advertised as a ‘research nurse’ post and she felt it would be good to have job titles that were more inclusive of research AHPs. She thought this would also make it easier to understand job adverts, including around banding, rather than having to ‘wade through the muddy waters to think ‘is this me? Is this my level? Is that, should I go there? What’s that title?’ But within this Trust, it’s another title, and in that Trust, it’s something else completely’.
Using or losing professional skills?
Many people felt passionately that their clinical background was a major asset to contributing to high-quality, ethically-sound and patient-centred research. They were bringing skills, knowledge and values from their previous experiences into their research roles. As such, for some people, working in research was a continuation and extension of them being NMAHPs and carrying out clinical work. For example, Paul highlighted that ‘you have to use your nursing judgement’ when deciding whether and/or how to approach patients about research opportunities. For Helen, ‘you’ve still got all those nursing skills [e.g. interacting with patients], we’re just probably utilising them in a different way’.
However, there was also an acute awareness that NMAHPs working in research were often seen by others to become clinically de-skilled. Some worried about this and tried to minimise the chances of it happening. Working in clinical non-research role (as a split or in a separate job, including bank shifts) helped. However, for some, it remained challenging because of rapid changes in healthcare technologies and practices in use. For some, the sense that they were losing or had lost their clinical skills, or that others thought this about them, was distressing because they felt ‘less’ of a ‘proper’ NMAHP. Changes in how NMAHPs in research saw themselves was not always seen to be a problem, and some people felt they had a new identity which struck a good balance between being both a NMAHP and researcher.
Some people disagreed with the idea that research NMAHPs become clinically de-skilled. Some cited the many opportunities to carry out procedures and tests, including taking blood, in the course of data collection for research studies. A number of people emphasised that their work remained clinical in nature, and that this was reflected in many of their job titles (e.g. clinical research nurse). Others highlighted that they had been trained in new clinical skills as part of studies. Alison learnt to centrifuge and process samples in her research midwifery role, which she saw as ‘another feather in your cap’. Jisha felt there were ways to maintain skills in various activities if research NMAHPs wanted, such as a shadowing a phlebotomist for a day. For her, this was about refreshing skills as ‘once that skill is obtained, that is there. You just need to maybe do it in between’.
Wearing uniforms in research
Views on uniforms were divided. For some, they were important symbols of identity and affected how other people (including colleagues and patients) related to them. Those who typically wore uniforms as clinicians, such as hospital-based nurses and midwives, sometimes saw wearing a uniform in their research role as helping maintain an element of their professional identity. Some people felt there was status attached to uniforms, and that this could be important for other staff and patients. Although Ellen’s official title as specified on her name badge was ‘Clinical Trials Officer’ (CTO), she felt that emphasising her background as a nurse through her uniform was important: ‘it means something to patients’. However, she also recognised that there were non-health professionals in similar roles to her own who were not permitted to wear the uniform and felt ‘there needs to be some sort of shared identity with the [other] CTOs’.
Other people felt it was important to make a distinction between research staff and non-research clinical staff by the former not wearing uniforms. Mel thought it was good that research nurses in her department didn’t wear uniform because being plain-clothed signalled a separation from the non-research clinical nurses, which could help patients feel more comfortable. Likewise, Julie made ‘a conscious choice’ not to wear hers every day because ‘when I put my uniform on, I feel more of a sense of responsibility to the unit and I feel like I could be called on at any time’ at the cost of her research activities.
There were also differences of opinion on what type of uniform should or could be worn by research NMAHPs. Where Jisha worked, all the research nurses wore the same colour and style of uniform which made it possible to see other research nurses around the hospital. Nikki felt it was important that both nurses and AHPs in research delivery wore the same uniform, and could help challenge the notion that only nurses worked in these roles.
Some people were from professions or settings where uniforms were not typically worn for clinical work. In these cases, the question of whether to wear uniforms and what type in research roles often seemed less significant.
Professional revalidation and registration
For nurses and midwives, there is the process of revalidation every three years through the Nursing and Midwifery Council. As a relatively new requirement, some worried about being able to complete this if they were working fully in research (rather than having a split with, or separate job, in a clinical non-research role). Some people had completed revalidation based on their research role and did not see this as an issue.
For AHPs registered with the Health and Care Professions Council (HCPC), there is a renewal process every two years. It operates through an audit selection process whereby a proportion of AHPs will be chosen to demonstrate their professional competence and development record. Whilst undertaking his PhD, Jed continued to work a few hours in each of his two art psychotherapy roles (in a Mental Health Trust, in a hospice) to maintain his registration. Research activity was a big part of Graham’s re-registration portfolio of Continued Professional Development, and he felt the process was easily ‘tailored to your particular situation’. However, Abi had some concerns about whether she could meet all the criteria based on her activities of leading research.
*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).