Osi

Osi has been a research midwife for just over one year. The first few weeks in post were a big adjustment as she was new to both research and the Trust. Osi is passionate about research and describes research midwives as the oil to the system.

Osi has been a research midwife for just over one year. She mainly works on studies about women’s health and reproduction, but she has worked across other specialities because our team is rather small at the moment [‚] so it’s just helping out where I can. Osi has not always enjoyed research it was introduced horribly during her undergraduate midwifery training. However, Osi became interested in research when she was working on labour ward. Here, she noticed stickers on some patients maternity notes to say they were enrolled in a study and keen to know how clinical guidelines were produced. Osi was advised to complete a Master’s to qualify as a health visitor. During this time, she applied for a research midwife role. She didn’t expect to get the post as she had not yet completed her Masters, but was delighted that someone actually just gave me the chance by offering her the job.

The first few weeks in the research midwife post were a big adjustment as Osi was new to both research and the Trust. She was the only research midwife at the Trust, as the person whose post she was covering was on maternity leave. Osi had some guidance from the Clinical Research Network (CRN) research champion midwife it was informative and encouraging (a pat on the back). Osi learnt new skills, such as spinning bloods, and had training on managing site files. She completed online Good Clinical Practice training and then repeated the course in a face-face format six months later just for a top-up. Osi learnt about informed consent through shadowing a research nurse who she was due to work with on a non-maternity study. At first, Osi was very nervous about being asked questions by patients and worried she wouldn’t know the answers. Her first experience of study monitoring was very scary but helpful.

Osi describes research midwives as the oil to the system they make things happen and happen smoothly. Osi screens for patients, approaches them, takes consent (providing that the study does not involve changing the plan of care), and carries out different activities (such as obtaining samples and filling in questionnaires). Sometimes patients assume she is recruiting for a personal/pet’ project, and she thinks this might also be related to the fact she is quite young. Osi has been involved in finding new studies to take on as well as setting up and closing down studies. When she first started as a research midwife, Osi used to do bank shifts at another Trust to keep up my skills [and knowledge of guidelines] and for extra income. She saw this as a good way to keep getting hands-on clinical experience, which could guide her thinking about what issues to explore in research.

Osi felt there was initially resistance to research from some staff, in part because studies had been hard to recruit for. Osi just kept on going back and investing energy into streamlining screening, for example. Osi tries to foster good relations with clinical staff: I know that my role within [the hospital] is to work as a research midwife, but then when I go on the ward I try to let them see me as a midwife first, that does research, as opposed to a research midwife, cos that just helps with the integration. She sometimes does basic jobs to help out the things that don’t require too much patient care. Osi is keen to keep fostering the research culture at her Trust. She thinks all staff, not only designated research staff, should have opportunities to be involved (to some degree) in research. She would have liked this option previously, without having to completely remove yourself and be[come] a research midwife.

Osi is CRN-employed. Being on a fixed term contract was scary initially, but Osi came to accept that this is just how it works within all areas of research. Her preference has always been for shift work, rather than nine to five hours, so this was another adjustment in the research midwife role. Osi also has a long commute to work, but is willing to accept the extra time as well as financial costs involved. She has recently changed her hours to do longer shifts over fewer days and, now that her colleague is back from maternity leave, this has had the added benefit of expanding the coverage of when they can recruit to studies.

Osi would like to carry out her own piece of research in the future either through a PhD or another arrangement with her Trust. Osi thinks that a research midwife should be a good sales person, knowledgeable about the studies, flexible, and genuinely enjoy research (otherwise you’ll get bored in the recruitment process). One of Osi’s key messages to new research midwives is to ask if they’re not sure what something means, including acronyms like CRF’ (Case Report Form).

Osi enjoyed writing a dissertation in her first degree and wanted to do more research. She applied for a research midwife post but worried she wouldn’t be offered it because she hadn’t completed her Master’s yet.

Age at interview 27

Gender Female

So I worked as a midwife on the labo-, done a lot and then ended up on the labour ward which I absolutely loved. But so we used to work from clinical guidelines and I was just like ‘it would be better for me to-‘, I would want to be the person that is participating and actually writing those guidelines as opposed to just the person that’s kind of doing them. So I done my dissertation, usually with the degree shall I say. And I hated it to start off with, but then by the end of it I loved it cos I was just like ‘oh my gosh, I’ve just found out why-. It was a hands-off/hands-on the perineum and I was just like ‘I can justify why I would do what I do. So I just thought I wanna to be able to do that and everything, and actually be able to almost do that for everyone. So not only my practice but more generally like other midwives’ practice.

So, I actually went out-, I talked to some senior midwives and they actually advised me to do a more general Masters. So actually went into public health, which I’m still completing; just finishing off my dissertation now [laugh]. But that then broadened my view in terms of nought to five-year olds, which was really, really good. However, I think I just had a love for midwifery so I kind of went back. And then I randomly applied for a research midwife role. I know that you’re meant to have a Masters and had experience in it, but I literally sold myself like crazy cos I really wanted to do it. And then someone actually just gave me the chance, so it was not the normal way to go in, but I was very lucky. And I worked well within it.

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Osi was happy to help her clinical colleagues. However, after being caught up in a medical emergency once, she preferred to do the things that don’t require too much patient care.

Age at interview 27

Gender Female

So I learnt quickly to stick to the basic, basic, basic jobs. So there was one day where they are chock-blocked and they asked me to help to transfer a lady upstairs. She delivered ages ago, there was just no beds upstairs, “Could you just put her in a wheelchair and just put her upstairs and the midwife’s going to hand her over?” So I said, “Okay, I can do that.” And cos there was like so many different things going on. So, I was waiting to a consent an [trial] patient, which I think had just delivered and they were kind of just suturing and stuff, so I was just-, just had to bide time with it. So I was like, “Okay.” So we put her in the chair and she had a-, she had a vasovagal and she literally-, it was like emergency buzzer, and I was just like-, it was just of all the ladies-, I was just like why. So after that I was just like I think I should just stick to-, just stick to just doing the stuff, picking up phones. So I pick up phones and I can do some of the equipment that I’ve-, I helped to introduce, so the fFN machine, I trained them up to do the daily checks. However, if I’m down and they’re chock-blocked and-, but it hadn’t been done, I don’t mind doing it. I would just say to them, “Well I’ve done it today cos it wasn’t done, just thought I’d help you guys out,” but just little stuff. “Osi, can you get-, can you get that midwife for me?” or just the things that don’t require too much patient care or anything else like that.

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Osi found her job very rewarding and encouraged other midwives to consider working in research.

Age at interview 27

Gender Female

Go for it [laughs]. I think it’s one of the most amazing things I could probably done in my life, so yeah [laughs]. But it’s amazing. It’s definitely-, it’s so rewarding. You’re discovering care for like what’s best, whether it’s for that lady or for like the people to come kind of thing, or potentially like your own babies to come, you just don’t know like what you’re going to discover. And just changing-, like ladies-, one of the things as well, the fact that one of the latest lady’s that’s I’ve recruited, she was just like, “Oh yeah, I’m really, really interested,” and then it just came to my mind. I thought ‘actually, you’re going to be one of like-,’ you know when you read guidelines and it says three hun-, 3000, something like that. So you’re going to be one of those 3000 people. I was like, “You should get those guidelines cos you’re-, like you’ve participated,” and she was just like, “Actually, yeah,” like. So, it was very-, it’s not only rewarding for myself, but it’s rewarding knowing that I’ve made someone else feel rewarded also.

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Osi’s first monitoring experience was informative.

Age at interview 27

Gender Female

Yeah. So at first I was very-, the first one I’ve had was very, very scary cos I-, it was for a commercial study as well which is probably one of the hardest ones, and we were the only Trust in the UK to have actually opened up that-, that study at that point in time. So I was just like ‘oh my gosh,’ and I was very new to research so everything was just all very-, it was a massive study and I thought ‘oh. And it was nothing to do with midwifery either, it was to do with like women’s health which technically, I wasn’t trained in you could say cos I was always-, I was never a nurse to start off with. However, it was very helpful. I would love for them all to come as often as she does, although she gives me a massive list to like complete. You know that everything is like up to date and nothing’s going to shock you, and like where you’ve got to sort out the problem that happened two years ago, you know that within two months or whenever she does come, it’s regular updates which is helpful. It is a bit, as I said, nerve-wracking, someone checking your work. But I think I’ve learnt through my Masters that you want everyone to check your work [laughs]; you’re going just give it to everyone to have a read.

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Osi found that being a physical presence on the ward and encouraging staff to tell her about potentially eligible patients was the best approach for some studies.

Age at interview 27

Gender Female

So the best way I would say is literally when I’m-, I go to the ward. Each day they’ve got their own handover sheet, so I walk onto the ward. I’m usually like, “Morning guys,” and they’re like, “Oh, what-,” go like, “There’s no blood pressure ladies here for you,” cos that was one of the main studies that I was always looking for. But then I-, I’d say, at the same time when I’m looking at like the handover sheet, I’m always ex-, I’m explaining to them that I’m also looking for pre-term ladies and everything else. So as well as myself screening for them-, so they actually know that now it’s blood pressure ladies, but now hopefully, in time they’ll be like, “Oh yes, we’ve got premature ladies- labour ladies as well for you,” and stuff like that. So, I would say not only shall I say, just screening the actual physical paper, but just every-, I’m like-, I walk on and they’ll know that I’ve came on to the ward today [laugh]. And then talking to doctors so, thankfully now the doctors actually flag up when they’ve seen a patient. For example, in clinic they’re like, “Oh Osi, we saw a-, I saw a lady in clinic,” and they can remember their names, it’s usually great. They’ll give that to me and then I can source out that lady – when’s the next time she’s coming in or what-, maybe she’s actually ineligible and stuff like that. We’ve-, we’ve had a commercial study which was looking at fibroids and reducing heavy menstrual bleeding, and within that study we-, I -, cos-, so there’s many clinics where they could potential-, there wasn’t a set clinic for fibroid ladies, it’s fibroids are usually found in the secondary problem. So I just introduced like a screening sheet and I left it with the head nurse on the clinic, and just said to her that every-, “If you guys remember,” cos the information leaflet was right by it, so I said, “When you guys take an information leaflet to give to the lady, if you can just pop her name down and her number and then I can get in contact with her on a future date”, or they can give me a call and if I’m around I come up and speak to them directly.

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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.

Age at interview 27

Gender Female

So Clinical Trials Day is coming up and so, I’m pretty inventive. So for Clinical Trials Day which I’ll explain randomisation, so I don’t know if you remember the Wheel of Fortune?

Yes [laughs].

[Nods] So, I’ve actually -, what we’re going to do this year is use a Wheel of Fortune to explain generally. So and it’s going to have the Wheel, and patients will come over and they’ll turn it around and it’ll have like A, B, C, D, and then they’ll have four jars and have A, B, C, D with like I don’t know, sweets, chocolate, empty kind of thing just to explain. So you get-, you-, randomisation is actually random, so it’s an allocation that was not predicted by anyone. And then A would represent etc., but for the particular-, when I explain to them about the study I don’t use the Wheel of- randomisation; that’s just for clinical trials day, so having a bit of fun. I would explain to them that it’s done by a computer, so it’s not done by anybody in partic-, as a person, to reduce bias. And therefore, you going into the trial I can’t tell you what you’re going to be randomised to. And I just explain to them that it’s-, it’s not being based on any aspect of yourself kind of thing. I’ve had to put your details into create like a study number, but the random-, the actual randomisation bit is not specific to-, it was not created that-, so let’s say you get randomised to B, it was not created specifically, because, to B because of anything to do with you, if that makes sense?

Some people have been a bit hesitant on that though, cos they’ll be like ‘oh, computer’s gonna -, gonna destine what I’m going to be doing. And it’s-, we just have to explain that’s the safest way to do it cos if a human being was to do it they would be-, there would be some part of bias at least. And they’ve always got the option to withdraw if they don’t want to actually participate.

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Research practice was not presented favourably when Osi was training as a midwife. Even so, she enjoyed her dissertation and wanted to do more research.

Age at interview 27

Gender Female

So in midwifery, only in the last year, when we had a dissertation, and in fact it was introduced horribly. In fact, I remember the lecturer at the time said, she was just like, “I’ve picked this short straw and I’m going to have to teach you guys research.” She goes, “I hate it and you’re going to hate, but we just have to do it.” And I hated it. Once she said that I was just like ‘oh, my gosh,’ and I was never really one-, very good at like sitting and listening and staying awake, that was my problem. But as time went on I just thought ‘well, I’m just going to have to do it anyway,’ and then I thought ‘I’m just going to pick a really easy subject,’ so I-, easy to what I thought to myself, which was hands-on or hands-off the perineum. And then as I began to read the research and as you’re writing the rationale like why you’re doing the dissertation-, why you’re doing the study, it becomes so-, it became very personal and very relevant, so I was just like ‘oh, my gosh. So I then grew an interest in it and I always knew that I was going to do some-, I didn’t know what in research, but I was just like ‘I want to do something like this again, whether it’s to write a journal-,’ I thought at the time.

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When unfamiliar research terminology was used, Osi would ask for clarification.

Age at interview 27

Gender Female

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.

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Not only did Osi have to adjust to being a research midwife in an unfamiliar hospital, she also found there was not a very research-active culture; it took time and persistence to build this.

Age at interview 27

Gender Female

Yep. So I would- because research wasn’t that active at the Trust at the time, which was a bit sad, so I’d introduce myself as, “Hello, I’m Osi and I’m covering for XYZ,” and they’d just look at me to say I had no idea who that person is, no idea who you is and we don’t do researchers. So it was very difficult to start off with because it wasn’t- I wasn’t only myself new to research, but I felt like everyone else that I was introducing myself, was also. So I had to-, I remember when I followed one of the other research nurses in for my orientation and they just felt-I felt like they knew the protocol back to front and anyone can ask them any question. They were just amazing, and I’m just thinking oh my gosh [laughs], I don’t think my knowledge is this great. But it did eventually come with time, so I literally had to-, I was going home and I was just reading the protocol. So that when I do speak to them I’m able to not only explain it to them, but they’re going to ask me questions. And some of the people that was asking me questions would be PIs and it’s just like ‘oh, that was a question I wanted to ask you,’ so I’m like I have to make sure that I’m clued-, I was clued up. So there was a lot of reading, a lot of getting out there, I got a lot of doors shut in my face but I just kept on going back. I was just like you’re not accepting me now, but you will’ [laughs]. And I just kept on going back in. It’s definitely paid off; they absolutely love it now. People want to get involved. So it was-, it was a hard-rocky road, but we got there [laugh].

Was that clinical staff that were sort of closing the door and not interested?

So, yeah, clinical staff. The actual-, some of the actual PIs for some of the studies were a bit difficult to start off with. I think it’s because there was just no activity on their trials, so it was just out of mind and out of sight; absent, out of mind should I say. But they’ve-, I think it was-, and they probably just didn’t have that much of a -, because it wasn’t active there was just-, in fact no activity, so they’d already put it to rest kind of thing. But I’d just started a new job and I was excited, so-so yeah [laugh].

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Osi described the activities of research midwives, making them the oil to the system.

Age at interview 27

Gender Female

Research midwives so, they’re almost like just the everything, they’re the-, they usually know the protocol inside out, they’re the ones that find the patients, keep the patients, approach the patients sometimes. And I think they kind of bring-, they’re almost like the oil to the system they make things like happen and happen smoothly, although it doesn’t actually happen smoothly, they kind of keep things going. And very good at bringing all the different specialities or things that need to-, the different departments together, in order to actually complete it. I think they’re pretty good.

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