Some nurses, midwives and allied health professionals (NMHAPs) employed in research delivery roles* were involved in additional research-related activities. There were many different examples and the most frequently mentioned ones are covered in this section, such as: assessing feasibility for potential studies; study coordination; promoting a research-positive environment; profile-raising activities aimed at patients and the public; building research capacity; and involvement in study design.
For research NMAHPs, opportunities to be involved in these and other activities varied. It differed from place to place, team to team and study to study. Some people were employed in posts which specified both research delivery activities and additional responsibilities, including for trial coordination (for overarching trial documentation and/or liaising across recruitment sites, usually for one specific study). Others had become involved in extra activities when opportunities became available, as an addition to their main role. As Sarah explained, ‘I think if you meet your targets [e.g. for recruitment], then you should be able to do other things as well’. Those people in leadership roles had responsibilities for managing research staff and often for training/teaching about research.
Assessing feasibility for potential studies
Many research NMAHPs talked about the importance of having realistic participant recruitment targets in terms of numbers and timeframes. Some had input into deciding which studies would be carried out at their sites. The processes of assessing feasibility usually involved multiple steps. Nicky explained that one aspect would be checking databases for the numbers of patients likely to be eligible and then adjusting for expected uptake based on what the study would involve. She thought assessing feasibility should be ‘a team thing’ and involve all of the departments who would be affected to find out about their capacity for the extra work, their facilities and skills. In Carlos’ joint role as a trial coordinator and research physiotherapist, he helped sites assess their suitability via feasibility questionnaires and, ‘if there are still doubts, we can go on a feasibility visit’ to meet the team and discuss the study further.
Not all research NMAHPs were involved in assessing feasibility at the decision-making stage (i.e. when a site was choosing whether or not to take on a study), but many were still involved in planning out how best to reach targets once a study was due to start. Often their insights were based on their past experiences of other studies and of working with particular groups of patients (e.g. children, pregnant women, those with a specific health condition)
Dawn had a role in deciding which paediatric research studies to run at her Trust. This was challenging without access to the protocols and could mean finding unexpected issues at a later date.
Karen highlighted that, in very research-active environments, it was important to stagger studies.
Jo liaised with colleagues to plan out the best way to meet recruitment targets.
Some people had trial coordination in their job descriptions. Activities varied but tended to include input into seeking ethics approvals, liaising across multiple study sites, and offering support to sites with recruitment and retention issues. Some people, such as Claire and Nicky, were PIs (Principal Investigators) for studies and others aspired to take on this role in the future.A few people didn’t explicitly have a study coordination role but had been involved in aspects of related activities. Melanie explained that she was ‘not necessarily filling in IRAS [Integrated Research Application System – for research permission] forms, but certainly being part of those discussions and part of that planning’.
Promoting a research-positive work environment
Research NMAHPs were often involved in raising the profile of and support for research amongst their colleagues*. This could help overcome barriers, such as clinical non-research staff [link to TS15] gatekeeping access to potential participants or making dismissive comments about research in front of patients. Helen felt it was ‘a drip, drip, drip’ process to educate staff (including support services) about research activity. Simona pointed out that a high turn-over of clinical non-research staff makes this especially challenging. Examples of activities to promote a working environment where research would be integrated and viewed positively included:
- talking about research in meetings and training courses – disseminating findings, discussing upcoming studies, highlighting research secondments, and teaching on various courses for staff (including induction courses and mandatory training days);
- running a journal club open to clinical and research NMAHPs;
- presenting about research to student NMAHPs and/or offering student placements;
- encouraging clinical staff (especially new starters) to shadow the research team for a few hours or a day;
- nomination and reward schemes; and
- poster campaigns about research.
Some activities aimed to further convince staff of the value of health research for patients and the overall health system. Many of the activities to promote a research-positive environment were designed to be engaging and fun, and to incentivise staff to be supportive towards research. Helen described a rewards scheme in place at her Trust for colleagues who have ‘really supported research – that might be they’re more than happy to provide information for us or they might be a histopathology secretary who’s happy to [help]  We nominate them and then we do a little write up about them, and give them some cakes and biscuits and things like that, which is really nice actually’.
Julie ran sessions on various training courses for new staff. She thought this had helped develop a research supportive environment and working relationships.
Paul talked about mentoring nursing students on placements in his research team.
Profile-raising about health research to patients and the public
Many research NMAHPs were also keen to spread awareness about health research to patients and the public. For some, this was about widening access and fostering a ‘demand’ for more research to ultimately benefit more patients. As Alison explained, ‘that’s a public engagement thing, to create that element of expectation [amongst patients]’. Some research NMAHPs had set up social media pages to promote research taking place in their work setting. Those who also worked in a non-research clinical capacity sometimes ended up talking to patients about research if they showed an interest or asked about their ‘other’ job.
There were events for ‘awareness days’, such as the International Clinical Trials Day and World Cancer Day, and some people had also visited schools and local festivals. This included setting up and running stalls to highlight health research in general and specific studies. In addition to the often mentioned appeal of cakes at these stalls, there were examples of creative ways to engage patients and the public. Rachel X had heard about an initiative undertaken by research midwives at another Trust: ‘they have a trolley with all the [study] posters stuck around the side then they just fill it with sweets and cake and everything, and they literally wheel it round all of the ward’. Alison described a water balloon game for secondary school students which replicated midwifery-related activities, like palpating and ultrasound: ‘it perfectly encompasses a lot of those concepts around mystery, and researchers also use a lot of detective skills’.
As part of International Clinical Trials Day and to raise awareness of research, Osi was planning a stand to help engage people with the concept of randomisation.
Louise described a variety of ways she had helped raise awareness about health research to staff, patients and the public.
These activities also could spark useful discussions between research staff and patients, potentially overcoming commonplace misconceptions about research. Some examples were explaining that research is done on lots of topics (not only about cancer) and challenging the idea that research participants are ‘guinea pigs’. Some research NMAHPs found there were challenges in their outreach activities to patients and the public. For example, those who had set up social media accounts (or planned to do so) often found current ethical and governance regulations prevented them from using these to advertise studies.
Dawn felt it’s important that we are ambassadors for research, but encountered some resistance from a consultant to a monthly/bi-monthly stall she had been running.
Building research capacity
Many research NMAHPs were keen to encourage ‘home-grown’ research from their Trust or department, and for studies which would be profession-led (e.g. nurse-led). Initiatives to help build this research capacity included:
- secondments or relatively minor opportunities for clinical staff to carry out research;
- support to develop research ideas;
- support to present at conferences and/or publish articles; and
- support to undertake Master’s or PhD qualifications.
The types of support offered could include general encouragement but also practical help and financial assistance. However, funding could be a major challenge, especially in the context of short-term contracts.For some people, building research capacity was an explicit component of their job title and description. Sandra worked with ‘research na‚àö√òve’ settings such as hospices and care homes; it could be challenging but rewarding to persuade staff that research was a choice for patients, not a ‘burden’, and that it would complement rather than be ‘a priority over their [patient] care’.
Imogen would ideally like to grow a bit more nurse-led research in emergency medicine in her department.
Julie encouraged both research and ward staff in her unit to present at conferences and publish. There are various ways she supported this, including reviewing drafts of conference posters.
Research design, analysis and dissemination
Some NMAHPs in research delivery roles had input into research design, analysis and dissemination. For example, Layla wrote an article about one study she worked on, ‘looking at it from a midwifery perspective’. Louise had commented on a paper from a study she had helped to carry out and anticipated that she would be listed as a co-author. A few people talked about working with individuals or groups of PPI (Public and Patient Involvement) contributors, which had shaped the research design or implementation in important ways.
However, most NMAHPs employed in research delivery roles did not have input into the design, analysis or dissemination of the studies they were involved with. Some were fine with this and saw their strengths in the other activities (like recruitment and data collection) or felt it was an understandable situation with large trials involving multiple sites and staff. Others felt a sense of exclusion and unfairness that such opportunities weren’t readily available to them or that, more broadly, their names and contributions were rarely acknowledged in publications.
Libby would be very surprised if she were included in writing up study findings. Even so, the contributions of research NMAHPs like herself are there in the fine detail because we will have gathered good data.
Ella found it rewarding to see the published results of research, but felt that the input of research nurses often went unrecognised.
Rachel X felt there were limited opportunities to be included in the analysis and write-up of study findings. It is an activity she would like to do in the future.
Many research NMAHPs described issues with being notified of study findings. This included dismay at the length of time it took for findings to become available, the way that findings were announced (at conference they didn’t/couldn’t attend, through journals they couldn’t access), and the need to chase the study team. James thought the delays and inconsistencies with hearing about study findings ‘takes away the rewarding part’ of his role. Nikki felt it was important to pass on the outcomes of research to all staff who had supported the studies in some way, and Nicky thought it was a shame for study participants to not know the outcomes. Reflecting across her time working in research, Ginny described frustration when studies hadn’t led to improvements or had inconclusive findings.
The appeal of different research activities and NMAHP researchers
For some people, the appeal of extra research-related activities stemmed from feeling their research delivery roles were too limited. Ginny disliked that an emphasis on recruitment targets made her research nurse role into ‘a sales job if that’s all it is, it’s frustrating and also just not very inspiring really’. Mary had been in a research nurse job after completing her Master’s but also felt it ‘compartmentalised into a particular role’.
However, some people who were involved in extra research-related activities highlighted that it could mean missing out on or reducing others. In particular, it sometimes meant less contact with patients and ‘hands-on’ research delivery activities (like recruitment and follow-ups).
When she first went into a research midwife role, Alison expected to be more involved in study design.
Although Melanie had thought about writing her own studies one day, she enjoyed her role as it was and felt it suited her.
Some NMAHPs we spoke to had pursued academic qualifications as a step to establishing an independent research career. Some said they were spurred on to do so because they felt a research delivery role was too limited. Others had different reasons. In her role as a research team leader, Simona felt the extra research-related and managerial activities had reduced her patient contact: ‘probably that’s what determined me to go and do my PhD, to have that kind of exposure to again seeing some patients’.
Many of the NMAHPs who had undertaken academic qualifications had also retained their employed research delivery role and/or research team leadership role whilst doing so. This was the case for Ginny who completed a PhD whilst employed as a research nurse; she continued to be employed in this role but now saw herself as more (or also) a nurse researcher and she was keen to expand her post with other opportunities. Other people were no longer in, or had never been officially employed in, research delivery roles. This was the case for Mary and Karen, who had both established independent research careers in which they led their own research studies from design to dissemination.
*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).