An incredibly diverse team works behind the scenes to keep the RECOVERY Trial running, all with very different skills and roles. At one end of the spectrum are the epidemiologists and data analysts, whilst at the other are the doctors and nurses who care for the hospital patients taking part. Clinical research nurses play a vital role in crossing this divide. Emma Moakes, a research nurse at Chesterfield Royal Hospital, gives us an insight into her job.
Can you summarise what a research nurse does?
Clinical research nurses help deliver health studies involving NHS patients. This includes recruiting patients to clinical trials, explaining to doctors and nurses how to administer treatments, and making sure that data is collected and recorded properly.
How did you become a research nurse?
I came into nursing by chance; I happened to hear a radio advertisement which made me first consider trying it. I started as a community care assistant, mainly working with elderly people who were quite isolated and didn’t have family nearby. It gave me a lot of job satisfaction to help them with things they could no longer manage themselves, and to have a positive impact on their wellbeing. I then studied nursing at Derby University and started working on hospital wards at Chesterfield Royal Hospital in July 2012.
When the pandemic first broke out, I was working on the critical care wards at Chesterfield. It was a horrific time and towards the end of 2020 I was feeling totally burnt out. At this point, I volunteered to do some extra shifts to help collect data for the REMAP-CAP trial. I was intrigued by it, and found that I really enjoyed being involved with an actual research trial. I’ve always loved working with numbers, and maths was one of my best subjects at school. But until then, I’d never considered it as something I could do as part of my job. I found it very satisfying to see the data we collected as nurses each day on the hospital wards being used for a greater purpose.
So when I saw a four month secondment position as a research nurse to help with urgent public health studies, including the RECOVERY Trial, I applied and started in January 2021.
What do you do on a day-to-day basis?
No two days are the same, but generally it is a roughly equal balance between engaging with patients on the wards, and doing the data entry and background checks for the trials.
In the morning, I screen new hospital patients to see who could take part in the RECOVERY Trial, or any of the other research studies we are engaged in, such as REMAP-CAP, GenOMICC or PIM-COVID. This involves collecting the information needed for the eligibility checklists, such as recent blood test results, information on kidney function, any allergies, and, for women, whether they are pregnant or not. I then consult with the ward doctor to check that they agree before approaching patients to see if they wish to participate. Because research nurses do these checks, it means we don’t need to take up too much of the doctor’s time, which is very important if you want to recruit a lot of patients.
My afternoons tend to be spent recruiting patients, collecting consent forms and entering their details onto the computer system. There are many other jobs of course, including ordering the treatments drugs from the pharmacy, making sure the nurses in charge of each participant’s care know which treatment they need to be given, checking data have been recorded properly, and so on.
What does recruiting a patient to the RECOVERY Trial involve?
First, I introduce myself and ask the patient what they prefer to be called – little touches like that are important! Then I tell them about the RECOVERY Trial, and explain what the aims of the study are and why they are being invited to participate. I make it clear that taking part is completely voluntary, that they can withdraw at any point, and that all the data collected will be kept confidential. I also talk through the drugs being investigated and the potential side effects, and tell them how participants are randomly allocated to the treatment and control groups.
I explain that there is no evidence yet that they will benefit from any of the treatments they could be given, however we know the drugs are safe to use because most are already used to treat other conditions. But even if the study finds that a treatment doesn’t work against COVID-19, it is still important information because it means the drug can come off the trial, and a different treatment be added instead.
The time needed to recruit a patient varies massively. If they are very keen, it might only take 45 minutes, but others prefer to think it over for a day or two, and perhaps talk to their family about it. Most patients are really positive, saying they would do anything they could to help patients in the future. But even if they definitely want to join the trial, I always give them at least half an hour on their own to make sure they have fully considered it.
What does the RECOVERY Trial mean to you?
When I was working on the critical care unit, I saw for myself just how bad COVID-19 can be. Normally there would be a range of patients with different conditions, and many would be almost ready to be stepped down to a normal ward. But at the start of the pandemic, we were just swamped with COVID-19 patients, all of whom were really unwell and unstable. We didn’t have any proven treatments to give to them, and it felt like nothing we did for them worked. It made us feel so helpless and defenceless.
For me, the RECOVERY Trial represents hope and a chance to do something positive. I’ve always been really driven to recruit patients to the trial because I knew that research was the only way we would get any definite answers about whether any treatments worked or not.
What have been the highlights of working on the RECOVERY Trial so far?
A particular high point was in February 2021 when the trial discovered that tocilizumab was an effective treatment for COVID-19, particularly for the sickest patients who needed a ventilator to breathe. I felt proud because I had helped recruit patients to this part of the study. It felt like there was a bit of light at the end of the tunnel. I made sure that all the doctors on my wards were aware of the result, even printing out the administration guidelines for tocilizumab and putting them up on the walls! It has been very satisfying seeing the treatment given out to patients since then. When I approach patients now to recruit them to RECOVERY, I always say ‘Did you see it on the news?’
I only wish we had had these treatments when I was working in critical care, but it is wonderful to know that people who are taken to hospital with severe COVID-19 are now getting more effective treatments and are much more likely to get better.
What are your career plans for the future?
I definitely want to continue as a research nurse, because it’s the job I have enjoyed the most so far. Within the first few weeks of starting this role, I had more energy and was feeling much happier – I had my love of nursing back. I am currently doing a development post so that I can reach the next band. This will let me be more involved in commercial drug studies.
Find out more about clinical research nurses on the National Institute of Health Research website.