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  • Writer's pictureChristie Roberts

My first 6 months as a research nurse

Updated: Jan 22, 2023

In May of 2021, I had my first day working as a clinical research nurse for the University of Oxford, specialising in hepatology (currently sub-specialising in autoimmune liver disease and alcohol-related liver disease).

I've had to get my head around moving from bedside nursing in ICU to research nursing, and learn a totally new speciality as our ICU is not a specialist hepatology unit. It's been a steep learning curve, and sometimes very overwhelming when I think about how much I don't know, but I've loved the challenge and want to share 6 of my insights for anyone else considering moving into clinical research nursing. These are in no particular order, so here we go...

1. You're still clinical

Whether it's just misinformation, or a misunderstanding of what my role really is when I say I work in research, most people assume that I'm sat in a lab and have no patient contact. I've been asked why I bothered doing nursing training if I was going to go into research, and whether I miss 'actually helping people' compared to working on the wards. Research nursing is still nursing. On average, I have 1 patient visit a week- it's not a lot because my portfolio of trials is still small, but equally a visit can take an entire day and requires some significant prep and follow up. I also cover a fair few clinics for our clinical hepatology department (generally doing fibroscans) where I get to see lots of patients and have been able to do a lot of patient education about lifestyle changes and healthy alcohol habits.

2. Patient visits are good, but patient visits are sometimes stressful

For me, an organised patient visit is a chill patient visit. I'm an organised person at the best of times, and most of the time my visits will run like clockwork. My autistic brain is at its happiest when I can work through a solid list of before, during and after visit actions, and there's no relief like when the courier comes to collect your samples and you officially finish with the visit.

However, life throws curveballs in the form of Adverse Events (AEs) and Serious Adverse Events (SAEs). Most AEs will be minor and pretty simple to deal with. My first SAE made me cry, even though it was actually really easy to report and resolved easily- the most important part of the SAE process for me was keeping in contact with my patient and the PI (principle investigator) so that I was in the loop and could update details accordingly.

3. Monitoring visits are just stressful

I'm not sure there's really any part of monitoring visits that I enjoy. These happen a fair few times during each trial, when a representative from the trial sponsor comes to check all your source data and check in with the trial team (pharmacy, nurses, PI). They require a fair amount of admin work beforehand, and even more work afterwards trying to chase down missing signatures and results. The only really satisfying part is finishing all the outstanding jobs and going home afterwards, and they are useful for highlighting anything you may have accidentally overlooked- easy to do when you've got multiple trials running or in set up.

4. Lab skills

Personally, a favourite part of the job for me. I did biology and chemistry a-levels, which required a fair few practical skills and getting to revive some of those skills has been great fun. Nothing more satisfying than making a perfect blood slide. Nothing more devastating than dropping a freshly spun blood tube and destroying your beautiful buffy coat layer (although easily rectified by just spinning it again).

(arguably not the best blood slides I've ever made pictured above, but the only ones I seem to have photographed...)

5. Sometimes things are really hard, and it's not usually your fault- but it doesn't stop the Imposter Syndrome creeping in.

One of the things I have massively struggled with has been recruiting to a study. It was the first study that I was trying to recruit to, and I had a tiny window to try and get my first patient in due to delays in set up (thanks covid). Safe to say, I 100% spectacularly missed this deadline, and continued to be unable to recruit patients. This set off a wild episode of imposter syndrome, driven by feeling wholly inadequate to perform my duties, and only really got resolved by talking to members of my team. They helped me to realise that things that made recruitment hard weren't that I wasn’t trying hard enough of was crap at my job- but actually, it’s a rare liver disease (so small patient population), that we look after these patients so well usually that most are too healthy to meet inclusion criteria, that the ones who do meet inclusion criteria are not particularly motivated because they're asymptomatic and feel fine- so there's not a lot of impetus to inconvenience themselves to attend for study visits every 3 months and take medications with risks of side effects. Of the ~250 patients with the target condition, around 20 met inclusion criteria. I contacted 15, and one FINALLY SAID YES!

Things will always be hard work and the learning curve can be steep, particularly when you’re starting out in a new job, but the support of my team is really what made the difference here.

6. Avoid being pigeon holed into a sub-specialty

In an area like hepatology where there are sub-specialities (metabolic/fatty liver; cancer/HCC; viral hepatitis; autoimmune; alcohol related; advanced liver disease/cirrhosis), it can be easy to end up in a niche and become a specialist in that area- and there is absolutely nothing wrong with that. But when first starting out in research and hep, I was conscious that I wanted to experience lots of areas. I currently work mostly in autoimmune, with my first alcohol related study just starting up. I've come to realise that I don’t love the metabolic side, but do enjoy being able to refer people onto programmes or services that can help them, and I would love to try some viral hep work (I have wild plans to try and do some 'work experience' with our community hep team, who do viral hepatitis outreach in local prisons). I think being broad initially has massively helped with my general hepatology knowledge, which was lacking when I started, and is very much still growing.

That's obviously just a very breif snapshot of some things I've learnt over the last 6 months. I think it'll take me probably the next 6 months to start feeling properly comfortable and able to start branching out (e.g finding my niche of hepatology to make a home for myself, picking up Masters level modules in planning and managing clinical trials etc) but I've thoroughly enjoyed everything that I've learnt so far, and hopefully from this post you;ve learnt a bit about what my role as a clinical research nurse involves! Thanks for reading!

Christie x


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