I am a nurse, and my job is to make sure that my patients are well supported, are well cared for, that I have considered their whole life, given holistic care. And it just so happens that a clinical trial is the vehicle to do that. This is what the patient wants to have at that time, so I’m going to deliver that clinical trial and give them that drug but I’m going to be the nurse who’s doing it. So I’m the nurse, not the research nurse.

So, we do phase 1s, and some phase 2 trials, but mostly phase 1s.

So for me, that’s my preference, in the sense that I’m very much a nurse and my role within the clinical trial and with the patient is very much nursing focussed. It has some challenges in the sense of you’re giving a first-human drug, you’re giving a drug that’s never been used before, so we know nothing about it, so you can’t almost anticipate what reactions are going to be like. So you draw on all your clinical assessment skills as a nurse in that-, in that viewpoint. It’s very regimented, it’s very observational, you want to pick up on any little change that happens and document that clearly. But the benefit of that is that as someone who likes being a nurse and likes being with people, you get as much as the-, the patient-health professional contact in an early phase clinical trial, which you might not get in the later phase trials.

It’s always interesting, isn’t it? Like if somebody says to you, What do you do? I now say, I’m a nurse by background, that’s how I’ve started to address it, because I recognise I don’t function in the typical view of what a nurse does. And partly that makes me a little sad sometimes, cos I think I, I always love, I loved being a nurse and I am a nurse, in my heart I’m a nurse. But actually, that’s not what I do on a day-day basis now. And so I normally say, I’m a nurse by background, and I then say, I manage research projects. Cos it’s quite a hard thing to articulate what a research nurse does. And so I talk about managing research studies, offering patients the chance to take part in them, making sure they all run smoothly, and of course then that all raises, it usually raises the thing of like, Oh my god, you do research on really ill children. And it’s amazing the interpretation that people have of what that actually means. But in my own personal identity, I view myself as a, in my heart I’m a nurse but actually I recognise that that’s not how people would see me. So I now sort of say, Nurse by background, but I’m a, I’m a researcher.

I remember very early on when I was just about to go and qualify as a, when I was going to go and train as a speech therapist, I was working in a, I was working in a speech therapy setting as an administrator before I trained and one of the managers there said to me, Oh so somebody who had come and done their placement with us, was training to be a speech therapist, then went on and did research, and I thought oh what’s the point, we’ve completely, we’ve completely wasted all of our efforts doing clinical training with this person, cos she’s not going to be a clinician. And that really stuck with me. So ever since sort of I graduated and I’ve been doing research I’ve been thinking, you know, does everybody who works clinically think I’m a traitor for not using my clinical skills in research, in, in clinic, you know should I, should I be on the coal face in the NHS you know doing clinical work?

And I guess over time my feeling is that I feel that I can be more effective, that I can contribute more, I personally can contribute more to the profession by feeding into the research side than I might be able to were I entirely in the clinical setting. So Yeah, I think that’s evolved, but I, I do, I do have a, a big sort of what’s the word? A big sort of imposter syndrome sort of fear that I’m not a real speech therapist, at the bottom of it, even though I have my clinical competencies, even though I’m registered with the allied health professionals, even though, you know, I, every year when I sign the thing off that says you know I pay money to the HCPC, Health Care Professions Councils to say that I do use the skills that I trained clinically with, within my role. I still have that bit of me going, Yeah but I’m not doing it in the hospital ward, so maybe it’s not real, maybe it’s not genuine, That’s a bit weird, isn’t it?

I think for a while I felt like I’d sort of stepped outside of my professional identity and gone into a new one. And so I felt very much like a fledgling health researcher, and that wasn’t my intention, it was because I’d, you know, I’d set off with my research question which was about what an art psychotherapist might offer this particular patient group. And then in my first literature review found such a lack of research that it was like okay, well either I don’t do this, or I go, step, take some of the steps back and do some of that research that hasn’t been done. Which is what I chose to do, and I’m glad because it’s made me much more sort of, you know, it’s put me in contact with a much broader range of colleagues and professions and people and, than if I’d stayed very much as an art psychotherapy researcher, that would have been quite narrow, for me. But as the study has progressed and I’ve thought more about how I’ve collected data, how I’m analysing data, how I might bring the study together, how I might disseminate it, and bring, even write up the thesis, you know, the art psychotherapy part of me has engaged more and more and more. From ethics onwards really. So from sort of going to that panel and having to sort of think-, sort of reassure about the patient group but also then defend the methodology choices, it feels like the art psychotherapy bit of me has kind of re-engaged. And my intention would be, you know, if I could have my wish, [laugh] if you like, would be that I could go back into a clinical-academic art psychotherapy post. And be part of helping the, the kind the health and social care research world understand what art therapists can offer, beyond-.

We are quite a misunderstood profession and we spend quite a lot of our careers, all of us, explaining what art therapy is and isn’t. And I think what I’d like to do is to kind of be able to explain, not only what art psychotherapy is and isn’t as a clinical intervention, but what the, what art therapists have as skills that are useful in their own research world. So how we could be helpful for research teams in facilitating workshops in a safe, ethical way, with vulnerable groups particularly. So I’ve been asked to, you know, get involved and support other people’s studies because they’ve wanted a bit of that. So, you know, where I’ve got a colleague who’s a nurse, and she said, Will you co-facilitate, because then I’m kind of almost covering that bit if you like, I’m covering that, that side of things that so that’s quite interesting cos, you know, it’s not traditionally what we’ve done, but absolutely what we could do.

A part of what we could do.

For us as paramedic’s, research is quite a new thing. Pre-hospital research in general is quite a new thing, and research led by or involved paramedics is, is a relatively new thing. 10 or 15 years ago it, it really wasn’t happening, so it’s, it’s quite a recent development. So going out and talking to the paramedics, getting them involved, getting them interested, that’s been a bit part of a lot of these studies, now I’m doing a lot more in the background with the data and collecting data and collecting outcome data and linking up our data with patient outcomes, and certainly in my own work there’s been a big element of linking up the pre-hospital data with the in-hospital, cos often we, as I say, we don’t know what happens to the patient, we don’t know the final diagnosis, we don’t know the outcomes. But that’s what we need to actually inform our practice and trying to find those and build those bridges and build those links in, is what allows us to change and judge the effectiveness of what we do. So trying to work in that sort of arena has been a big part of what I’m doing at the minute.

One of the things that I’d quite like to do is pick up a few bank shifts and do, go back and do a few clinical shifts just to, just to sort of keep my skills up. So, I mean you do, it’s not the same as working in a clinical environment, you know, I mean I still, there’s, you know, you’ve still got that patient contact, you’re still doing, you know, taking blood samples and all those kind of things, observations and various, but it’s, you know, it is different, most definitely, you know, they’ve, the desk time is different and you know, and all the paperwork is, there’s much more but yeah I would, would, I will go, I have been planning to do it for a while but I’m definitely going to go back and do some clinical shifts and sort of see how I get on.

It’s difficult to help with nursing someone when you’re not- you’re not a nurse on the ward, so you haven’t had a handover for that patient. So you can actually do more harm than good, because you don’t know the full story, the full picture. And also, you gradually become deskilled, because they change the machines and they change all the policies, and. Little things like that. Like checking a blood sugar, you needed a log-in for the machine and you didn’t used to need all that. So it became less and less feasible for me to do any nursing. And I became more- more and more busy. It wasn’t as busy at first with the research. I was sort of finding jobs for myself. Which is amazing, now [laughs]. Cos I’m very busy with it. But it became more and more busy with the research, so.

That’s quite funny really because I think when you first come into research people think that you’re going to lose your skills and actually there are probably skills that I use less but there are new skills that I’ve learned to do as a result of being in research nursing that I perhaps, that I wouldn’t have done had I still been in district nursing.

So simple things like I’d not done an ECG during district nursing, I’d never been in a position as a student nurse where I’d had to do an ECG and it is just something that’s really simple but one of my studies that I’ve worked on required it. I’d never worked with patients with severe mental health so I’ve learnt skills of talking to those patients and that, again that’s improving me as a nurse and giving something back to them as well.

We learnt how to do the spirometry and I’d never done that before and I’m sure there will be, you know, new things that we will learn. I’d never used the scales in the elderly study that I’m doing at the moment that measures your bone density, fat mass, muscle mass so all these things are new, innovative and fresh and, you know, keep me focused and enjoying my job.

Well, clinical skills.

At the end of the day, I had this debate with other people who keep telling us that we, de-skill and no, we don’t de-skill, you learn a new set of skills. We do, why can’t we say that consent, for instance, gaining consent is not a clinical skill? It is a clinical skill but it pertains to our area. We do collect samples, we do take bloods, you know, we have developed an array of lab skills that also come with this with our job description. So I wouldn’t say you de-skill in any way and I would always argue with that. Yes, but it’s again do you have the same skills as you had in your first year of-, you know, it’s just developing more and I don’t believe that those skills that you had there already are lost, you build on them.

So, when I started, I was told it was a non-uniform job. But I could wear a uniform though if I wanted. So, I- because I was struggling with not being [laugh] a nurse any more, I did wear my nurse’s uniform for a very short while. But obviously became mistaken for a ward nurse, the whole time. So I went into non-uniform pretty quickly. And then that went on for several years. Probably- yeah, about five years. And then they put all the research nurses into ward sister uniforms. And that was nice. And it was nice to be-, I like to be in a uniform, that is my preference. And then after another sort of two or three years, they changed us because we were being mistaken for ward nurses and asked management type questions all the time, into specialist nurse uniforms. Which- and I think they decided we were specialists in research. So that’s what we wear now. We don’t get asked questions because it’s a specialist nurse uniform – we could be anything. You know, there are lots of different specialist nurses. But the CTOs, the clinical trials officers, aren’t allowed to wear a uniform because they’re not a nurse. And they- that’s difficult. They want to wear a uniform and I can see why. And they’re going out and doing exactly the same job as me. And it’s just as clinical. So personally, I think it would be nice if we all had the same uniform and it was just for the Research and Development Department. For when you go into a clinical area. But that’s your answer. At the minute, research nurses – yes, they wear a uniform. But the clinical trials officers don’t.

I know in some places research staff don’t wear uniforms but I feel quite strongly that we do wear uniforms because I think that I’m a nurse and in fact in the past we had lots of discussions with my manager at the time about perhaps we all just wear the same, the same uniform and it’s a specific research uniform. And I’m a nurse and I’ve trained to be a nurse, I’m a Sister and I don’t want that taken away from me because that’s how I identify myself and that’s what I want to be. So to me, your uniform is very important and also by wearing a uniform I think you are seen as part of the clinical team. When all my Band 6’s wore the CNS [Clinical Nurse Specialist] uniform they suddenly found it a lot better as well because I think what was happening before that was they were going onto wards and they-, obviously the ward staff would all be everywhere and then, you know, the doctor would come on or relatives would come on and start asking questions and we’d always feel we were going, Oh sorry, I don’t know, I don’t kno, and actually now we’ve got the CNS uniforms the doctors know that we’re not part of the ward team because we’re CNS’s so we’re, you know, we’re coming in and doing what we need to do and then we’re going out, so that’s actually helped quite, quite a bit. But I do feel quite strongly about, about uniforms because I think it identifies us.

When I started I had a conversation with somebody quite high up, who asked for my opinion about what allied health professionals should wear, because they had a set colour with a set trim for different levels within research nursing, and it worked for the nurses, but if you go in as something other than a nurse what do they put you in? I gave an opinion, I was told that they were thinking about it, it’s now nearly two and a half years down the line, and nothing has happened. And I am currently wearing the uniform of a) a nurse and b) a band lower than I am, because they don’t know what to put me in. So, and that is true for all my colleagues as well, so I spend a lot of time not only explaining that I’m not a nurse. But then people will say, Oh you’re a Band 6, are you? I didn’t know you were a Band 6. I thought you were a Band 5. So, I’m in an environment where there’s not a lot of people like me, and I’m dressed in something that is me masquerading as something else.

But when I first changed jobs midwives at that point still had this thing called supervision and which was, so a supervisor of midwives is meant to be somebody who’s not a manager they’re somebody often quite senior but they’re meant to be somebody who can talk about they’re meant to be protecting, protect the public really so they’re making sure that you do your job that protects the public but not in a kind of day to day, you know, you’re not doing that blood test very well or whatever. And they, similar to research actually started becoming more and more sort of well seemed to me anyway a bit more sort of procedure lead, so rather than it being a nice chat which it always used to be beforehand and they’d kind of go Yes Ginny, brilliant, tell me how your years been, ohh any problems? Lovely’ and, you know, Yes you’ve been working as a midwife,’ and then sign this thing and it was the supervisor of midwives who send your form back off to the to the NMC who are the regulatory body for the nurses and midwives and then that’s fine then you’d be on the registrar, my names on there, that’s lovely.

But they started becoming a bit more kind of, you know, form filling again, similar sort of thing to research really and they, my supervisor in particular used to, right towards the end, sorry I’m making this really difficult, supervision stopped with midwifery a few years ago but, when they brought in revalidation. Just before it was ending she started saying Oh Ginny do you do any, you know, when was the last time you worked on the delivery suite, you really need to do some proper midwifery work?’ And I always used to go What do you mean, I’m still employed, I’m employed as a research midwife, I’m, this is my job, that’s what I am, I’m, I’m a midwife, I’ve done the training I’m on the register I don’t need to do any, you know, it doesn’t matter how many babies I’ve delivered’ or whatever like that. But they, she started getting sort of quite a thing about this sort of going you’ve gotta show that you’re doing proper’ midwifery work and I always used to argue very, you know, what I thought was quite strongly that your job is, you know, you’re a midwife if you’re employed as a midwife in whatever capacity then whatever your job is that, that should be enough. Anyway and we used to have to do things like all the research midwives they’d, again because of this mandatory study days we used to have to do things like emergency obstetric workshops which were kind of, you know, as you can imagine what happens in an emergency and you join this role play and things like that.

I haven’t delivered a baby for years and if I ever had to go back and work as a midwife I would obviously have to do some re-training I wouldn’t just walk onto a ward and do it but I can assure you I’d be able to learn how to do that again and I’ve learnt how to do it so it’s, I can’t see it as being a big problem but I don’t think I need to do it as, you know, in a hospital base now because it’s silly. And anyway so revalidation came in and I think it’s really good because it’s kind of made, it made it really clear to everybody that that’s exactly what, exactly what I’ve just had, I don’t really mean that but it is what I just said, so anybody employed in whatever capacity it doesn’t matter, if you’re a nurse or a midwife that’s what you are but you work in education or something, you’re still a nurse or a midwife and that’s your revalidation just is saying are you doing your job, whatever your job is, properly.

Oh, I’ve got lots. I mean, I’ve attended pre-eclampsia days. Both at the colleges and in [City name]. Because we have so many days of CPD [Continued Professional Development] that we’ve got to do so many hours. And I’m well over my hours for the three years. We have mandatory updating that we do every year as midwives. So, that complements it. And then we have to-, as revalidation we have to do five reflections on different areas. It could be anything, basically. It could appertain to a clinical issue, or it could appertain to research.

Anything that you think is appropriate. And then we also have to have people to, that interview you. And it could be another midwife or management, and they put you forward and they write about you. Or it could be from the women themselves. And I’ve got some that have personally sent me letters. Or I looked after one lady who’d had an intrauterine death, for example. And that’s within the last three years. And I looked after her right the way through until she delivered, and she sent me the most beautiful letter. So, you know, you can – because it’s all confidential and it goes to the NMC, we can scan those and put them on as evidence of, of how we’ve operated in our work. So, that- mine’s coming up in February.

But it would be interesting, so I haven’t see the exact sort of criteria against which you have to provide evidence. But when you do your newly qualified practitioner competencies, so like when you’re a teacher and you spend your first year doing your newly qualified year, similarly when you’re a speech therapist you go from being a newly qualified practitioner and you sign off your competencies amongst a certain set of criteria, and then you’re able to, you know you’re a fully-fledged independent therapist, right? Certainly being able to fill those in for me in my research role, there are gaps that I couldn’t fill in, I’d had certainly loads of extra stuff to put in the blank space at the end that said, You might have additional things that you can add, but there were certain things about like maybe writing case reports, or different things, working in a multi-disciplinary team with different healthcare professionals, that I couldn’t fulfil with my research role. And I ended up filling those in when I was working clinically as a speech therapist, and in my other part-time role.
So this goes back I think to what I was saying about having that pathway set up, there isn’t necessarily a clear pathway set up for you to integrate clinical work and research work. So, it’s interesting to think about why, you know how, everybody who I know is a researcher and a clinician has sort of cobbled together something and found their way and uses their skills and enjoys using their clinical skills, whether it be within delivering a clinical intervention, whether it be in supporting students to train, or informing research methods so that they’re appropriate for people with communication needs. Yeah, it’s, there’s no clear cut path and it, it can be a bit of a challenge to identify how you fit in it I suppose.