Creating Opportunities to Become a Community Clinical Researcher

Undertaking clinical research presents a wealth of opportunities for today’s community nurses.

In my view, we need a new generation of community-focused nurse researchers to help identify and answer clinical questions, which best reflect patient and family needs and concerns in the home environment.

I hope to inspire other community nurses considering a clinical academic career, through sharing some learning from my own research journey so far.

Becoming a researcher alongside being a clinician is no easy task. At times it can feel like you are speaking a different language: especially when trying to convince managers to release your time to undertake research when services are overstretched. Nurse and interprofessional colleagues can be highly supportive and facilitative. Sadly, it can also be hard to convince some nurse colleagues that we should be research active. However, it is well worth persevering and keeping to your goals.

Three tips when starting out as a clinical researcher:

1. Contact, meet and get advice from established researchers in the field you want to move into. If they know you are interested and have ideas, then all sorts of opportunities will open up.
2. Keep a close eye out for clinical fellowships and project calls which provide funding or backfill your clinical time to undertake projects (often for 1 to 2 days a week for a year). Check some examples at the end of the page.
3. Create and make the most of opportunities! The saying ‘If you don’t ask you don’t get’ is apt. Reasonable and well-thought-out research projects, or partnerships which benefit employer organisations and are likely to improve patient care are hard to argue with.

My own experience

As a Community Nurse and Palliative Care Nurse, I became very interested in why we routinely prescribe injectable medications ahead of need (known as anticipatory prescribing) to provide symptom relief for patients at the end of their lives in the community. After successfully convincing a reluctant GP colleague to prescribe the medications for someone I felt was likely to die soon, I thought, ‘hang on, in whose interests is prescribing the drugs if they may never be used?’ This was the start of my research journey.

I undertook a research study investigating Community Nurses’ anticipatory prescribing decision-making as my Masters degree major project. To help me develop and make the most out of this opportunity, I made sure I was not allocated to a supervisor who may never have done field research themselves.

I, therefore, approached a very knowledgeable nurse academic who was active in research to be my supervisor. With their dynamic guidance and coaching, I was able to step back and think about practice in new ways. Being analytical about decision-making proved challenging as a clinical researcher – we quickly get indoctrinated into certain ways of thinking in practice and it is difficult to step back from perceived wisdom and think in new ways.

With the help of an excellent and inspiring leading GP clinical academic in palliative care, alongside a very supportive manager and peers, I then successfully secured a CLAHRC Fellowship. The Fellowship gave me one day a week protected time out of clinical practice, alongside bespoke research training, to help me understand how effective and acceptable anticipatory prescribing practice is to all parties involved. Reflecting on the Fellowship, it gave me confidence in my own skills and potential to become a clinical academic. It also helped me to meet like-minded peers who were travelling the same path.

During the Fellowship, I completed a systematic review, recently published in Palliative Medicine, showing that anticipatory prescribing is based largely on the beliefs of healthcare professionals that it will reassure patients and their families, control symptoms effectively and prevent hospital admissions. But these beliefs are based on insufficient evidence. The actual views and experiences of patients and their family carers have not been adequately investigated; neither has the clinical effectiveness, cost-effectiveness or safety of anticipatory prescribing.

Being thorough and reviewing the evidence-base was key to opening further funding opportunities. As a result of understanding the gaps in the evidence, devising a robust research proposal and publishing my Masters project in a high impact research journal, I was awarded a NIHR School for Primary Care Research PhD scholarship to take my research further. I am now researching community anticipatory prescribing practice and patient and family carer views.

This is an abridged overview of my journey to becoming a School for Primary Care Research PhD Student. There have been plenty of dead-ends, frustrations and ‘what am I doing?’ moments along the way. I’m sure there will be plenty more. My advice to those thinking of developing as a clinical researcher is, you can do it and it’s worth it. Find the right people to support you, listen to the advice and guidance of those you admire, and persevere. Fortune favours the bold (and tenacious)!

Even if it’s not a journey you want to pursue, consider sharing and publishing some of the excellent work you have already done.

Read the systematic review: Anticipatory prescribing of injectable medications for adults at the end of life in the community: A systematic literature review and narrative synthesis. Palliative Medicine, 05 December 2018

Ben Bowers is a NIHR School for Primary Care Research PhD Student with the Cambridge Palliative and End of Life Care Group, Primary Care Unit, University of Cambridge.

Ben is happy to be contacted for advice

Email: bb527@medschl.cam.ac.uk or Twitter: @Ben_Bowers__

Some research training and support resources:

• National Institute for Health Research (NIHR) Pre-Doctoral Fellowships
• Florence Nightingale Foundation Research Scholarships
• Collaboration for Leadership in Applied Health Research &Care (CLAHRC) Research Fellowship (Note: Each English region has its own CLAHRC and related scheme)
• Health Education England (HEE) Research Internships
• Queen’s Nursing Institute (QNI) People living with Frailty Project call
• FoNS Centre for Nursing Innovation Programmes (Note: Multiple options)

Photo by Burst on Unsplash.