First few months actually was quite a challenge, cos there was really big study that was waiting for the role to start. And it was completely different role and I found it quite a challenge at first. And there was another midwife that was employed with me at the same time, there was two of us to work on this study. Her, her hours were less but actually once I got into it, it was fine. It was just a really massive learning curve, and I think back now, if I had to do it now I’d be absolutely fine, I really would, but, but then it was quite hard. But I got there. The university that was running the study was like, you know, Why aren’t your numbers this? And, you know, could do better sort of thing. But in the end they were quite happy with our recruitment, and actually there was a sub-study and we recruited one of, one of the best hospitals to that sub-study with a really good retention, so in the end it was fine. But at first it was quite a big learning curve, but it was fine.

Yeah I definitely think that’s because I sort of had that to start with because as a nurse in a clinical environment you definitely feel differently when you go into a research post and it’s like oh, you know, I’m not a proper nurse anymore’ and there is that side to it. And I think that and, you know, and like I said before that is why, you know, you can, you’ve always got the option of going back and doing the odd clinical shift here and there if you want to but I think that its recognised in the value clinically you are tremendous value as a nurse but also as a research nurse there is also inner value in that too. And I think it took me a little while to adjust as, as I imagine it would do you know, other nurses that have been used to working clinically for many years that, you know there is, you know, there’s more, there is more roles out there, isn’t there?

Mm, how long do you think it took you to adjust to that?

Oh I’d say probably best part of a year if I’m honest. Yeah the sort of, because in the clinical environment you’ve just, you just present it, you know, it presents itself doesn’t it and then you just, you go on that and that’s what you do and you don’t, you know, you’ve got a ward full of patients to look after and sort out and you just get on and do it. Whereas this you know, you have a different, it’s very different, you know, you create your own workload, you look at what you’re gonna take on how you’re gonna do it, you know, it is a very different role.

And I think the biggest thing for me was, you know, people when you transfer, when you move across from- which I was, was a clinical nurse, into that, I had no reference point. So for me, if I’d moved from one ward to another, I still had, there was still basic things there, I knew what I needed to do. But within research, it was- people said, Are you enjoying it?, and I thought ‘actually, do you know what, I don’t know. Because I don’t know whether I’m doing it right, I don’t know whether I actually know what I’m doing. I didn’t. So it took-, I think it took 12 months before I could look and think have I learnt anything? Have I, can I do this? And am I enjoying doing it?’ So there was two very different things that I just had to be-, I just had to ride it out. Whereas I’m very much one with you think, you know, you get a, I get a very strong gut feeling of ‘yeah, I’ve happy at this, this is great. I didn’t miss my clinical work.

So, that was the my thing of ‘well, I’m not missing that, so I must be quite liking this’ [laughs].

[laughs]

And it took a long time, really. I think family were a bit worried, because I couldn’t- I didn’t talk about it, because I didn’t know how to talk about it, because I didn’t really know. You know, I was just every day, was a massive learning curve. And it was interesting, there was an article* that I’d, that somebody gave me when I started the job. About that, from expert to novice. And it’s a brilliant, it is actually a really good article, I’d recommend it for anybody that’s transferring across specialities or into a diverse bit of your career path with whatever it is. It’s a very good reflection that they’ve done on, you know, from something that I could have run a hospital basically with my eyes shut, to being in a situation where I thought ‘I don’t even know what you’re talking about.

You know, ‘What is GCP [Good Clinical Practice]?’ You know [laughs] all these lingos and sort of term-, abbreviations that are used that I had no idea about.

*Gleason, K. (2011) Role Transition’ when becoming a Research Nurse, available at https://clinfield.com/role-transition-when-becoming-research-nurse/

Yeah, so it’s interesting when you see people become a research midwife or nurse, there’s this sort of extraction thing that happens and they’re used to doing all the struggling, and then they perhaps join a study team and the role’s quite different; it sort of floats above, but it’s everywhere. You need to know who’s who, you need to -, how to get involved in different pathways and get behind the scenes. So, that’s -, that’s kind of taking yourself out of the clinical role, but then as you ease into whatever study you’re working in you realise you’re very much still connected to the patient facing world in a distinct and different role. But as I mentioned, like the [trial name] study there’s huge continuity, and I’m really hot on that cos I -, when I became a midwife I directly went into what’s called case loading, which is where you know your midwife and you have your midwife throughout your pregnancy and then hopefully she or her partner, or someone that you’ve already met, attends your birth, and that’s how I thought midwifery should be, and there’s just such value in that.

And, and even the Department of Health recognises that; there’s massive initiatives in building continuity for women. It’s always going to be a hot topic and we’re just spending life times figuring out how to provide it for women. But anyway, my point was that, sometimes in research studies you see that little continuity package happening and that’s so cool. So, in [trial name] it was like, gosh, we’re giving this whole additional continuity thing where the women, the participants, have really good access to a midwife and a doctor by email, by phone, by visits; set visits or even some last minute visits. What an addition to the maternity care that perhaps doesn’t feature the continuity. So, I’d like to -, I think it’s really complimentary.

Yeah

And as a midwife it’s not just this nice thing that women maybe get by joining the study, it’s also really rewarding for the clinician.

It was my colleague. And I think she was absolutely right to say you know, You need to take some time to realise that you’re not a clinical physio anymore. That’s not what you’re, you know, employed to do. You are, you’re a research physio and your, your job is to carry out the research to the best of your ability. And sometimes that involves, for example, having a straight face, not engaging in conversation while somebody is carrying out a test. Not giving feedback on the results because it might skew the data in some way. And I would say it took me a while, but I, you know it is a realisation and I think for anyone whose thinking about moving from a clinical role into a research role, that is one of the areas that I would say think about that. And whether you want to work it in that way, before you take the jump. But once you’ve taken the jump realise that it might take a while to mentally shift from the clinical head to the research head, because it’s a different mind set.

I like the research mind set and I’m very happy that I’m there and in it now, but I think it is, it is something that kind of takes you by surprise a little bit and you know needs some thought really in the early days. But I mean there was no issue, it was just that, it was, when I say it was made clear to me, I, she, she brought it, my colleague brought it up and I then became aware of every time I did something I thought, Ah, no, research head. Not clinical head. You know. Especially I think as a physio, part of being a physio is about encouragement and support and helping the patient to achieve a goal and when somebody doesn’t do so well then, my role as a physio is to build them up and to, to give them that encouragement and to talk them through it. So, that sort of talking through, coaching, empathising, you know it’s engrained really but you have to switch it off. Not always, not always but I think I was probably too switched on at the beginning.

It’s a totally different world. And it’s a totally different, it’s a different language, it’s a different time scales, it’s a different way of thinking. The paramedic, paramedic practice is very immediate, very hands on, very one patient, what’s in front of me, what do I do, what do I deal with it, how, you know, what do I do for this one patient? Take them to hospital. Hand them over. Onto the next one. It, you know, it’s, it’s short, defined chunks of time which, as I say, can be quite charged, not always, but it, it’s very defined points of time. Research is a whole different ball game. There’s a totally different language, there’s a whole different set of laws and regulations, ethics underpinning it, which is, is brand new to us unless you’ve been exposed to it, and actually, thankfully new paramedics are getting some exposure. But when you’re, the paramedic students that I’ve dealt with are concentrating on learning how to deal with the patient the ethics and the research is a sort of secondary concern to them. But for us, when you get into this, it is a new, it’s a new world and it’s a steep learning curve which is where having that mentorship and those people to guide you through that is very important. But once you get, once you get involved in it then you start to get the hang of it. But you also then start to ask more questions and start to look into things more.

I didn’t realise how much admin there was going to be done. And how much physical desk work and paper work and actual research, as I understood it, was searching through documents and things that I would need to do. Inclusion, exclusion criteria. Again, at the very beginning I just thought this is never ever going to sink in. I had, at that time I had ten trials and I just thought I am never ever going to understand this. Again, the team were fantastic, saying that you don’t have to, you do not have to understand every single aspect of the trial, you don’t need to know that protocol from front to back, what you need are key words and you need to be able to understand how to read a protocol. So it’s not, I imagined it’s a bit like a bible, you don’t read it from front to back, what you do is you go into the area that you need to do, inclusion criteria, exclusion criteria, assessments, dates when chemotherapy is, so you need to be able to find them, and once you, you accept that and realise that you literally cannot know everything, it makes your life a lot easier. And that you then don’t need to worry about something until it’s there and it needs to be done.

So there would be like CRF and I’d be like, ‘What on earth is CRF?’ [laugh] I would-, I stop people and I’m just like, “I’m so sorry, CRF?” and then they’re like, “Oh, Case Report Form,” or whatever. So I’m-, I think just because of my character and person that I am, if I don’t understand there’s no point asking to continue- continuing on with the conversation because I’m just thinking ‘we’re not going to go anywhere’ and I’m going to leave just thinking-, feeling worse and regretting that I didn’t just speak up. So cos I-, I used to be very shy and I used to not speak up, and I used to just sit there in the dark for life basically. So I became-, as I grew up and stuff I would just-, I’m still shy I would say, but I’m-, I can just stop people and just be like, “I’m so sorry, I’ve no-,” I’m not afraid to not know. Because it’s worse not knowing for life as opposed to just knowing for those couple of minutes and find out the answer. So, I usually just stop people and was just like, “What was this? What was that?” or-, then you’re like, “Oh okay, yeah, you can continue saying it now,” but [laugh] initially yeah, it didn’t work.

And then in the, so the sort of challenges that come up in a research role are you, you need to often when you’re doing clinical research you need to adhere very strictly to a research protocol and that sometimes means you can’t use your clinical judgement to say, Oh I think that I might prefer to do things this way for this scenario. So you need to carry out x, y, z assessment, you need to carry out therapy according to this set of you know predefined things, so that it can then be testable and you can make clear assertions about how it works across a group of people if it’s applied consistently.

So that can sometimes feel, there’s, there’s an element of sort of sitting on your hands when you’re doing clinical research that you don’t have when you’re doing clinical practice in the same way. But that can also be, that can also be quite liberating because it, it frees you of the, the clinical judgement, the sort of clinical decision making where you might get it wrong or right, you can sort of relinquish that and say, Okay I’m following the protocol, and this is how it has to be, and I’m just going to see how it happens. And it means you don’t need to necessarily make any pre- you don’t need to necessarily have any preconceptions about how it’s gonna go, or who it’s going to be best for. Or if you do then you might be proven wrong and you can be proven wrong for instance about things.

So an example might be that my research is largely with older adults who’ve had a stroke. Which obviously contrasts to paediatric clinical work, but in my research I work with older adults who’ve had a stroke and I work on the effectiveness of computer based therapies, and they’re, certainly for me coming into it and a lot of people who I’ve explained my role to, they have preconceptions that older people won’t get on with computers, or wouldn’t be able to use or it wouldn’t be a suitable treatment to offer to somebody who’s older and maybe hasn’t been used to using a computer throughout their life in the way that some younger people might have. But actually when we have to meet everybody who takes part in the research and present them with the same opportunities and then do the therapy with them, it challenges that and has shown me that it isn’t the case, that actually lots of people can get on with computers if the if the scenario, if the intervention is appropriate for them and if it offers them something that they that they can benefit from.

I’m so used to being-, having to account for every single thing that I do, and- whereas I have much more freedom to sort of plan my time and the workload and that. Which when you work clinically as nurse and midwife, you don’t. I mean, it’s very- it’s very rigid, you’ve got to do this, this, this and this, in this order, and hand over to this person. And, yeah, I think I was sort of telling my manager every little thing I was doing and it was like-. And I realised I didn’t have to. They’re just, you know. You have, you have more freedom to kind of work independently, I think, and-. Which is nice. But, yeah. It took a little bit of getting used to.

I was thinking what on earth have I let myself in for. It was a bit chaotic in the respect of I didn’t really enjoy not knowing what I was going to do. And the time restraints or conditions were very different to what I’d been used to being in a busy unit, to going to research where there could either be nothing or everything. So it was the two extremities of that, I did get to go out with a couple of other colleagues to begin with so as I could see them doing it, get a feel for how it works, they could see me do it. So, we all felt confident we were doing it in the correct way. But back then there wasn’t really a lot of training, so it was a case of you learnt about that study, but you didn’t really learn about the bigger picture. I did have to do good clinical practice training, but it wasn’t a pre-requisite that I had to do it before I started. So, I’d been doing it for six months before I’d done that training. It is obviously now. But when I went I was like, Oh my goodness, there’s all these things that I didn’t really know about, and but I used that then as a way of learning what I could improve and what to do better next time. And actually, when I went to the second one, I was like, Oh yeah, I’m doing that, I’m doing that. I can cross those off my list. I knew I’d improved, but every time, I started going every year then cos I knew I was keeping myself on track and improving things all the time. But yeah in the beginning there was lots of time where I perhaps didn’t have any patients to see, and that was quite a hard adjustment, and there were, there were boring bits. There’s no point pretending there’s not, there are lots of boring bits. But I learned to see that the other things that I enjoyed, so the health promotion, and also the fact that I was making a difference for tomorrow, not just for today, and not for, I’m not firefighting, I’m actually hopefully going to find something that eliminates the fire in the first place.

No, I went in like a sort of completely open minded not knowing what I was going to do, where I was going to be, who I was going to be working with. What was really lovely was that I’d gone sort of from working within primary care in district nursing obviously to work primary care in research so it was home from home, I was used to the environment being with patients of the same elk and staff and that sort of thing so it was really lovely just to have that sort of transition over from the same place to the same place but doing something completely different with a whole new language, you know. So I can remember my first study and they were coming out with lots of acronyms and when I started nursing we sort of had lots of acronyms and I’d be like I don’t understand it and research was like start, like starting a new job like completely like starting nursing, you know, totally new language but, but great [laughs].

So because I was talking to people, some people didn’t have any gastroenterology problems, but people with Barrett’s Oesophagus or reflux I could talk to, if they said things about their condition or their symptoms I could say to them, Oh well you could try this, you could try that, you know, Have you thought about this? But always allowing them to, you know, It’s your choice but these are some options you could try. And also if I found people who perhaps they seemed more unwell than I’d been led to believe from the information I’d got about them in advance, that I could point them back to other health professionals. So, I’d say, Well actually I think that probably does need looking at, you could go back to, you should go back to your GP. Or if their medication, they were saying they had side effects from the medication I could say to them, You know, well there are other options for this type of medication on the market, so go back to your GP, they’re not always keen to change for whatever reason, but you could go ahead and see if they can make other suggestions, and then leave it with them, but it was a good opportunity to give them that one to one time. And no rushing, you just took as long as it needed to take, and it was nice for them cos they felt they could actually ask you things, cos you weren’t in a rush.

I think still it’s having that rapport with women. I don’t think that goes. I think as a researcher, you’re looking for promoting better standards of care. And I think that’s always what you would aim to achieve on a daily basis, in clinical area, is the care that you’re given. And, and it should be paramount, you know, that you’re doing as best you can for that person. And I think that applies in research. Because you’re looking at promoting better maternal and fetal outcomes for women, that’s what the research is about. This early detection and management, as we’re doing now, is just such a wonderful thing. Because in the clinic we would be looking for that, you’d be looking for the signs and symptoms. We do the blood pressure and urine checks every antenatal check. And as well as blood tests if they need to be done. It’s about referring people on. And suddenly it runs hand-hand. It’s quite symbiotic, really. Because what you’re applying in the clinic, you’re actually doing in that research really, indirectly.

And so I don’t see the difference. And I think it’s tremendous value. Because all of the midwives I talk to on the clinic areas just think it’s amazing.

I think, I don’t I don’t really remember a day where I felt confident all of a sudden I think it came with time and it was just one step every day maybe six months to feel to get into a routine or normal okay so these are the people that would help me develop, people who would help me a bit less’ you know, and I think it just it just kind of developed every day. Probably yeah I would say six months but you never feel fully confident [laughs] I think there’s always room for improvement in your practice there’s always something that you need to learn every day so it’s hard to say that even now I don’t feel like I’m a 100% confident in anything I am very, I’m probably reflective as a person so time to reflect on my practice quite a lot.

I was, initially I, I actually thought it would be a lot easier than it, it was. And for all the people that I’d spoken to they said, you, it is totally different. It is, it’ll be nothing you’ve ever experienced before. And I thought, I’m sure it’ll be alright, I know head and neck, I know urology. And it was just totally different. So, it was very overwhelming for about six months. And I think within my first six months I probably thought twice have I made the right decision because protocols and paperwork and e-CRF’s and sponsors and industry, they just baffled me. I have a portfolio now of eleven trials that I currently look after. So, and it’s took me probably up until Christmas, which was just about my year, that I, I started to feel secure in what I know. And my background in nursing has helped, be it, for the language mainly. I understand when they’re talking about tumours and things like that, but it’s been a massive learning curve. It’s been really, really interesting and I still love it, and I’m so glad that I made the, the change.

And I think the team were amazing. Because everybody just said they had no-, you know, they just said, Don’t expect anything, just be a sponge, just see as much as you can, ask what you can, if you don’t understand just ask. And they had no expectation to put pressure on me for any length of time, until you felt ready to do it really.

So I think it was- and that was difficult, because in a ward, you know, we’re not quite so patient when a new nurse comes on the ward [laughs]. Because you’re like ‘come on, really need you to go and do that admission, and we need that admission done really efficiently and really quickly because there’s another one needs doing. And that, that- there wasn’t that. That certainly was not the atmosphere. It was a very supportive, and just you know, Just take as long as you need, there’s no, you know, You’ve just got to, you learn this as you do it really.

Try to change the way that you think about you don’t have to know it all now. Do you know, take it back to when you were doing your nursing career as a, the first six months of being a student and you were just thinking, Oh my god, what have I done? You know I’ll never, what’s this I don’t understand that? And research is very much like that. You just come with thinking, Oh I’ve got ten years of knowledge, this is going to serve me well. And it, sometimes it does, sometimes it doesn’t. But just give yourself time. Give yourself at least six months before you make any rash decisions and give yourself at least twelve months to say, I think after twelve months you would know whether it was for you or not. I think that the cat in the headlights is going to be there for six months, don’t worry about it. Easier said than done. I worried about it. And then suddenly you just realise that things are clicking without you even realising. And what you worried about last week, you don’t worry about anymore now because you’ve, it’s there, it’s embedded. It’s that knowledge that you can call upon without thinking. You know, go and find me this protocol, What’s a protocol? You know, Which protocol? To suddenly going, Oh yeah, it’s in the filing cabinet C, second drawer, right at the back. You have to squeeze round because it’s really full, but it’s there, and you can do it. There it is. And you do that without thinking, and that is a personal achievement you don’t realise, and I am probably just talking to you realising more about how I’ve moved on in 15 months to where I am now, to thinking that. Yeah. It was very, very scary. But as long as you’re prepared for that, and you don’t let it overwhelm you so much to just think I can’t do it. You, it might not be for you but give it a go, definitely give it a good go, give it a good six months and then give it another six months after that to say, Am I sorted? Is this really for me? Because it might not be, but at least you’ve tried. And that’s the same with anything in life.

So I always reassure them, that’s the main thing I have, seeing people- when the nurses after joining after many years of experience, they think ‘oh my god, I don’t think this is for me. Because I really struggled. And I, and think maybe I’m thick, they’ll tell me I’m very slow. But I will tell them, No, don’t worry, this is just how I was feeling when I joined, but it takes time, so you will enjoy after that. But they have come back to me and said, You were right, so it’s just like, you know, learning that from their practical experience, then gradually doing one study. Maybe one-, you know, the first patient when they are recruiting, they will have a little bit of an idea how it’s run. But when they do the second and third patient, they will be expert. And, you know, with that process. And with the legal issue, like ethics and approvals and things like that. You know. We do still struggle, and because the policies are changed and new other authorities will be joining, HR will be joining, all those things. You know, you just learn as it goes. So that will be different.

But you know, the nurses, after one year, they just run the study by themself. I don’t have to help them much. But I just, you know, put a little bit of effort, you know, help with the team, but. Otherwise once they are happy with the trial, they are comfortable.