The research nurses, midwives and allied health professionals (NMAHPS)* we spoke to emphasised the importance of good working relationships with colleagues in direct clinical care roles* (and, in the context of studies in nursing homes, care staff). For some, these relationships were very positive and they felt research was well-integrated into the environment – in recognition that it was ultimately about patient benefit. Other times, situations were less than harmonious and there had been barriers or ‘resistance’ faced – either in relation to research generally, around specific studies, or stemming from negative attitudes about research NMAHPs. Often there had been changes over time; as Ellen said, relationships with ward staff can have ‘ups and downs’.
The distinction between ‘clinical’ and ‘research’ roles was complicated, and many research NMAHPs emphasised that there were still clinical even though they were not currently in a direct care role. With this in mind but without a clear alternative, we use the term ‘clinical colleagues’ (and sometimes ‘clinical non-research colleagues’) in this section to refer to those employed in direct care roles without a specified research component to their jobs.
Clinical colleagues were often involved in helping research NMAHPs identify potential participants, gain access to patient records, deliver interventions, collect samples, and find appropriate spaces in which to see potential participants. Their attitudes and willingness around these activities could impact on carrying out the study. Good relationships could make studies run smoothly, whilst tense ones could lead to a number of obstacles. Tabitha recalled a study where the clinical midwives mentioned her (as a research midwife) to patients before she saw them, and having a good relationship helped with this: ‘if they saw the women before me, they’d talk about me and just say, ‘Oh she’s really nice,’ or, you know, ‘She’s very approachable, would you mind?’ And it felt a bit better me going in, if they’d heard that I was going to approach them’. In contrast, some people found that clinical non-research staff acted negatively as gatekeepers by preventing access to potential participants.
Many research NMAHPs acknowledged that research-related activities could (or were perceived to) disrupt or add to already busy clinical workloads for their colleagues. They recognised that this could be a source of tension and often described trying to minimise disruption. Carole described the importance of being ‘unobtrusive’, and this included fitting around the sometimes unpredictable timings and pace of other clinical activities.
Some research NMAHPs invested considerable time and effort into overcoming various barriers between clinical and research staff. This included finding ways to embed a positive attitude to research into the setting (such as through staff training and education). Claire described this as ‘the ‘hidden’ work, which is engaging teams and departments within the hospital, and supporting them to both understand the importance of and engage in offering research studies to their patients’. Sandra recalled conversations in which she had emphasised that research was (or should be) about patient choice and, ultimately, for patient benefit through building evidence.
Many research NMAHPs emphasised that being generally friendly and personable helped build good working relationships with clinical staff. Other examples included minimising disruption when carrying out research activities, doing ‘favours’ and being a visible presence. Sometimes there were also reward systems with prizes in place, and many people talked about making cups of tea or bringing in cake as part of a ‘soft’ process of building relationships. Involvement with research activities was sometimes also offered to clinical staff as part of their Continued Professional Development.
‘Working around’ clinical staff and doing favours for them was seen by some as having reciprocal benefits. Sugrah sometimes stopped to help ward staff when they were very busy and, in turn, they helped to keep study activities going when research staff were not there. For Dawn, ‘helping out’ on the ward was not just about fostering good relationships with staff but also about patient benefit – for example, ‘reducing the length of time that patients are in’ by taking blood pressures or blood samples. She felt that there was usually flexibility in her role to do this extra work, although other times the research needed to be prioritised. A few people described being selective about the tasks they felt comfortable doing and the need for clinical colleagues to understand the limits of this.
Whilst favours could mean relatively small and quick tasks, some research NMAHPs had also been asked or expected to do more substantial clinical work. This was a controversial topic regarding staff shortages, particularly in relation to winter pressures and crises. Some research NMAHPs had chosen to make formal arrangements to carry out clinical non-research work. In Imogen’s team, all the research nurses did a monthly supernumerary shift – this helped ‘maintain the skills’ and she ‘found it was the best way to try and integrate the two teams’.
Some research NMAHPs did favours out of a sense of ‘guilt’ or because they found the adjustment into a research role and the impact on their sense of professional identity challenging. For some, this helped them to retain and demonstrate a shared identity with clinical non-research colleagues at the same time as acknowledging differences in the role. Vicky described relationships with clinical colleagues as being different in research: ‘understanding that you’re not part of the clinical team directly but obviously you need to work with them very closely’.
Those who had moved from a non-research clinical role to a research role within the same working environment found that their relationships with colleagues could change. Colleagues sometimes said or did things which made research NMAHPs feel like they had become ‘outsiders’. When James moved into a research post, he recalled ‘people [I used to work with on the wards] saying, ‘Oh, didn’t you used to be a nurse’, and things like that to me’. Familiarity with particular working environments could be helpful though. Dawn found it was a strength that she knew many of the nurses and clinicians already, and how things worked (including where to find medical supplies), at her hospital when she moved into research.
A few people commented that, as the research culture and the working relationships between clinical and research staff improved, some of these strategies were less necessary. Imogen initially spent a lot of time ‘helping out on the shop floor’ which she thinks helped raise the profile of research. With time, she felt that the clinical team gained a good understanding of the value of research and were now very supportive of it. Jisha was also pleased that research was now seen positively in her unit, whereas previously it was primarily deemed to be ‘extra work’.
Several people highlighted that it was also important to have good relationships with the administrative staff who booked appointments for patients, including for scans. Michael joked that, ‘in my experience, an Irish accent, a wink and a smile goes a long way’. He found that building relationships works best ‘if you go up in person, a nice friendly face, I have been known to bring a coffee in the past, a bit of bribery, it works wonders’.
*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).