My first voyage into research began in earnest as a clinical research fellow based at Leicester Royal Infirmary. In 2003 there was no clinical research network and little concept of NIHR funding for Ear Nose and Throat (ENT) research. However, forerunners of the Integrated Research Application System (IRAS) existed such as COREC. My time spent as a clinical research fellow involved both running existing projects, such as developing a clinical olfactometer, and applying for new studies to continue the next steps. Although I was at this stage only a principal investigator, it gave me invaluable experience, both positive and negative about the process of applying for ethical approval and research governance.

In 2006, as a specialist registrar in ENT, I attended a sinus course in Philadelphia and was struck by one of the presentations that identified the lack of epidemiological studies for chronic rhinosinusitis. On my return I vowed to set out to address this and with the help of the Research Design Service at University of Essex, I developed a bespoke questionnaire. Other than addressing the research question, I was struck by the frustrating experience that my peers and I had of trying to initiate any research at one site before being rotated on to the next hospital. In the days before the CRN and research collaboratives, I saw this an opportunity to provide one study that all trainees in the region could participate in as they rotated around. With the agreement of my consultant, this study, now known as the Chronic Rhinosinusitis Epidemiology Study was my first attempt at taking on the role of chief investigator. Although the study started well initially, it faded in my absence abroad on fellowship. I returned in 2009 and attempted to revive it on commencing my post as senior lecturer in 2010 at UEA. A year later, I took on the role of CRN lead for ENT for Norfolk & Suffolk (now Eastern) and soon an opportunity presented itself to get the study adopted to the CRN portfolio. Within 12 months, the study had run at 30 UK sites and recruited to target and by doing so moved from a near failing study to being the most successful CRN study in ENT up to that point. 

This study was a defining moment. It helped me to develop my role as a CI, to develop links with other sites and principal investigators and achieve a good outcome through multi-centre collaboration. The resulting data collected enabled 10 publications running from 2014-2020 and provided a platform for subsequent studies and collaborations.

So why did I become a CI? I’m not sure I chose that role consciously, but rather grew into that role through virtue of leading the development of a research project. From that point onwards, studies I have led the development on have been studies that I am the CI on, ranging from observational to interventional studies. As my time in training preceded academic pathways, such as those now available through NIHR, a lot of what I gleaned about being a CI was done through a process of trial and error. I would not recommend this as an effective method of learning the role within the current infrastructure, especially with opportunities such as the Associate PI Scheme and Green Shoots initiative, as there are more defined ways for those with a research interest to learn about being a CI and to get involved.

With the CRN and academic training pathways now available, I would recommend that research interested trainees seek experience of active studies in their region through the API scheme, being mentored by an existing CI or PI. This can involve attending trial management meetings where trainees can learn about the research governance and nuances of running a study from the research team and their mentor. In ENT, the trainee collaborative INTEGRATE, also provides and excellent platform for trainees to engage with research activity in a collaborative fashion.

Being involved in research governance and the responsibilities of a CI is not to be taken lightly. Perseverance is a key attribute, as sometimes the processes will take longer that expected and new challenges will come along that perhaps weren’t apparent at the beginning of the study. The main reward that I see from being a CI is to make a contribution to writing the next chapter of evidence for your specialty, that may in turn help develop knowledge or change clinical practice. 

Taking on the role as a PI has been extremely rewarding, an opportunity to develop professionally as well as to support advancing evidence-based practice.  As a senior pharmacist in Critical Care, most of my career to date has been very operational and managerial.  I was always aware of clinical research trials taking place on my units but was only involved when I had to ensure operational feasibility and safe clinical delivery of a medicinal products during drug trials.

I had very little knowledge of the full process of delivering clinical trials or how to get involved.  I approached the Research Lead of the Department and expressed my interest in wishing to get more involved. I was subsequently invited to the divisional research operational meeting led by our ACET Research nurse team.  The first meeting I attended provided an overview of all active trials within the Division and gave insight into operational challenges and recruitment figures.

I subsequently spent some time with the Research Lead to understand the process from how clinical studies move from a proposal and feasibility stage to practical implementation.  What I found conspicuous was that all PI roles were held by medical professionals. In my mind this limited the number of studies the Department was able to take part in. That is when I thought to myself: “Why are we as Pharmacists not taking up PI roles, especially when dealing with CTIMP studies?”

As a professional group we are in a very advantageous position regarding research, due to our in depth knowledge of medicines, our expertise regarding governance and regulations of medicinal products and due to our central role within the MDT.  I increasingly realised that with my years of experience as Specialist Critical Care pharmacist I would be well equipped and capable to support the research workforce and act as a PI.

I completed my Good Clinical Practice (GCP) training, reached out to my pharmacy network and spoke to a pharmacist PI in another Trust to learn from his experience.  I shadowed research nurses who were leading CTIMP studies to understand their role and what their daily duties involved.  After discussion with my line manager, I took on the role as the first pharmacist PI in my Trust with mentorship from my Research Lead.  

I highly encourage other professionals especially nurses, AHP and pharmacists to consider these PI roles.  My advice would be to first meet the local research team in your department to get a better understanding of the structure of the service and gain insight into the portfolio of studies that are being conducted. I would encourage research interested colleagues to attend operational research meetings as an observer; what may appear daunting initially, may transform into a keen interest and passion, as in my personal view clinical research is a truly multidisciplinary activity with a common goal and purpose.

Having a mentor in any discipline who has PI experience should be a prerequisite.    Dedicated job planned time, to conduct or collaborate in research activities is frequently lacking, hence it is important to have the support of the relevant line manager and with assistance of the Departmental Research Lead.

The NIHR Associate PI scheme is an ideal starting point to start supporting a study as it enables one to get in contact and network with other new Associate PIs; the scheme provides guidance and key tools to be successful in the role.  

The PI role enabled me to develop my research knowledge & skills and allowed me to expand my research network. I was also able to present my experience of setting up my first study as a PI, at a National Critical Care Conference.

This role has given me good insight into how to conduct research and hopefully one day soon I will be well equipped to be Chief Investigator of my very own multi-centre clinical research trial.

As a student nurse, I didn’t get involved with research in a practical sense, only theory in the classroom. I commenced my nursing journey after qualifying, looking after really healthy patients in the day surgery setting, then incredibly sick ones in intensive care. Following a geographical move within the UK I needed a new job and wanted to try something new. There was a Rheumatology Research Nurse post. Now that sounded interesting, trying out new treatments on the debilitating Rheumatology diseases. These conditions were close to my heart as my beautiful Auntie suffers terribly with multiple rheumatological conditions and this became my way of helping. I refreshed my memories of the research taught in the classroom as a student and applied for the post… I was so lucky to be successful! 

And so my Research career was born. 

Being part of a patient journey, where hope and optimism is the driving force, for changing treatments / improving practice; you cannot help but get swept up in the emotion of it all. To this day (20 years later *cringe*) this remains the crux of why I remain in this field and would never leave. 

Following starting in Rheumatology research, another geographical move, overseas this time to Australia, I attained a position administering Chemotherapy in a Haematology and Oncology setting, and whilst incredibly fulfilling, I was desperate to move back to my passion. I found an exciting job with a super University Professor researching a new ‘Bioimpedance Analysis machine’ assessing if this device could measure Lymphoedema quicker than physical measurement and I was back in the game. Delighted at being back in the world of discovery. 

Unknowingly pregnant with my first child when I took the role, it was short lived post, but soon after her birth my quest continued to return to research and achieved a position in GynaeOncology Research; with the main trial evaluating abdominal verses laparoscopic surgery for ladies with early-stage Endometrial cancer. The latter procedure has subsequently been adopted as gold standard practice by NICE!

Returning to the UK in 2010 now with two daughters; I have worked in many wonderful driven teams gathering evidence in many specialities; Haematology, oncology, Nephrology, Cardiology and Orthopaedics. I even left the NHS environment in 2018 and worked in the Medical Devices Industry, running small volunteer trials assessing new prototype dressings and learning to be a project manager of large multinational studies to try something different and harvest more skills.  

Now, back in the NHS, I work in the NIHR at the local Clinical Research Network: North East and North Cumbria. We are a new team who have converged as an agile research team to provide research support to the wider care and community settings. Whereas there is a strong infrastructure in primary and secondary care for performing research, there are many underserved communities in social care. With my diverse experience I believe my skill set is perfect for this role. Research is so diverse it can lead in so many directions – it is superb.

The enthusiasm of colleagues when you work in research (in any specialty) is infectious. Everyone is working towards the same goal to improve the lives of patients, living with acute / chronic diseases. Patients who take part in studies, whether short or long term, are special individuals. Research empowers them, often when they are at their most vulnerable. But being able to take in research gives them something that they can control… and we as research staff, are fortunate in our role to be able to support them. 

If you see a Research Nurse on their travels – stop them and ask about their role. Ask for a shadowing opportunity. 

Once you are bitten by the research bug, there is no going back… Look at me!

Caroline Fletcher,
Research Nurse and Direct Delivery Team Officer

Becoming a Research Nurse did not feature in my overall career plan.  Indeed, I happened upon it perchance when my Mum was requiring elective surgery.

I started my career at age 18 by training to become an Enrolled Nurse and soon after was accepted to study to become a Registered General Nurse.   My nursing roles for the next 20 years included theatre, endoscopy, health promotion, school nursing and community which was interwoven with bringing up a family and pursuing a family business. 

The use of research was evident in my clinical practice, and I was very happy to use it to benefit patient outcomes, however, being involved in the nitty gritty running of scientific research studies was alien to me.  This all changed for me in 2012.

Mum was admitted a couple of days prior to her elective surgery, so I popped in to visit and while there a Research nurse approached Mum to see if she was interested in taking part in a clinical trial.  The nurse discussed the details of the study, answered questions and left Mum with some information which we read to see what it was all about.  The study was looking at whether administering a one-off steroid the night before surgery helped with post operative pain.

After consideration, Mum was happy to consent to the study the next day and was administered the steroid the night before the surgery.

The result? She was comfortable and happy to report she’d had the best night's sleep she’d had in a long time.

Observing the Research Nurse in practice and how the whole process was handled with Mum, supported the notion that I could in fact be involved in research having previously mistakenly believed that research was for academics only. I am not an academic.

Soon after Mum was discharged from hospital, I discovered that there was a vacancy for a Clinical Trials Research Nurse in my local trust.  Google became my best friend as I searched for articles relating to research and clinical trials which could potentially help me secure the position.  In addition, I contacted the R&D department. to chat to members of the team.  I certainly did not have all the requirements for the post however, the chances of me being successful were 0% if I didn’t apply.  

Happily, I was successful and have enjoyed working on many studies in secondary care although I am now working within the Clinical Research Network, NMAHP, Primary Care team.  Every day is different with new experiences, challenges and like-minded people to meet.  I particularly enjoy engaging with study participants who join me in seeing research as essential to improving healthcare for future generations. I am fulfilled by my work and intend to remain in Research until I retire.

I hope this blog demonstrates that career opportunities in the NHS and health sector including research are wide and varied and can be combined with a full and active personal life.  I have found that with my colleagues and friends’ mentorship and support it is always possible to give something else a try, and if it’s not for you it is within your power to move on.

For anyone who wishes to become a Research Nurse have a look at the NIHR website https://www.nihr.ac.uk/ as a starting point and contact your Research and Development Department to explore experiential opportunities and meet members of the team.  

I would like to leave you with this inspirational quote:

'The only way to do great work is to love what you do. If you haven't found it yet, keep looking. Don't settle.' - Steve Jobs

Christina Tanney
Research Nurse