Perspectives

In England, pre-registration nurse training consists of a 3-year Bachelor degree in one of four fields: adult, child, mental health, or learning disability. In the summer months of 2017, between my 1st and 2nd years of training to become a mental health nurse, I undertook a paid research internship at my institution’s medical school. We were a team of four exploring the relationship between early puberty, obesity and depression in a set of data from a cohort of around 300 young people who had been followed from 4 to 20 years old. My role was to write the report, including the background and methods, and run some of the statistical analysis. I was given an office, but worked mostly from home, meeting frequently with the lead investigator, who was my main point of contact. He had made the offer for me to participate in this investigation as a ‘safe space’ where I could learn about clinical academic research and make mistakes without fear of reprimand. He offered me regular formative feedback and, although we have not yet published the findings, the experience represents the crossing of an important threshold in my career, and has implications for early career nurse researchers across the country.

As with many opportunities in life, my involvement with this research internship was somewhat serendipitous. On the second placement of my 1st year, I had liaised with my host trust’s Mental Health Act office to allow me to facilitate and observe a tribunal for a person detained under Section 3 on the unit. Under the Mental Health Act 1983, Section 3 covers the detention in hospital of people with mental disorders for treatment. The initial detention is for 6 months, which can be renewed for another 6 months, and after that can be renewed for a year at a time. Following each renewal, the detained person has the right to appeal, which can be taken to a tribunal for a decision. The tribunal is typically attended by the detained person and their solicitor, a nurse, doctor and social worker, and a panel consisting of a doctor, judge and lay person. On this occasion, while the panel was deliberating, I spent time with that person and his solicitor. The solicitor, a former mental health nurse himself, asked about my career aspirations, and I explained my vision of a research career. He gave me the contact details for his wife, and told me to speak to her. It transpired that she is a consultant neurologist and experienced researcher at the medical school, and was keen to meet. Over the course of an hour-long meeting, she became a sort of sponsor to me, and put me in contact with the neurology research nurses at the district general hospital; with the research and development department for my host trust; with the researcher in the office next to hers; and invited me onto one of her own projects (her former research assistant, a medical student, had abandoned the project and taken the data with him). I agreed to everything, and the psychiatrist in the office next door was the one who offered me the summer internship.

I was flattered to have been recognised as someone worthy of all these offers, as someone who was eligible to work alongside consultants and professors. There was only a small part of my mind that considered why so many opportunities were being given to a 1st-year mental health nursing student. Initially, I carried the responsibility with pride, and held the other members of the team in the highest respect, not only for their accomplishments, but for their ability to treat me as an equal with valuable contributions to make. Ultimately, though, I fear that their respect for me was misplaced, and that I did not handle the responsibility as well as I might have done. On reflection, I feel I was too overwhelmed by the opportunity to produce my best work. Despite the promise of a safe space, I failed to meet several soft deadlines. By the point of our final meeting, in which we brought together the background, methods and results in order to form a discussion, it was clear there was still much to be done, but a new academic year was beginning. I felt a chance had been missed.

I want to return to the small part of my mind I mentioned previously: why was this opportunity, as well as so many others, given to a 1st-year nursing student? The only answer I can see is that ‘because she went looking for them when nobody else did’. Research is promoted to student nurses as something to consult and reference (Nursing and Midwifery Council, 2010), but not yet as something to actively engage in. The new pre-registration education standards that are due to come into effect in 2019 have the potential to change this, although the latest consultation did not include the possibility of increased research engagement (Nursing and Midwifery Council, 2018). Indeed, I encounter a range of responses when I tell nurses that I’m pursuing a career in research. I’ve been told that my training space should have been allocated to someone else, that I should have chosen to study medicine instead, and that it isn’t really nursing so I will probably lose my PIN. It adds an echo to the cry of ‘You’re not a real nurse’ that I already hear from having chosen the mental health branch. There is a sense that research, with its facts and spreadsheets, cannot accurately represent the messiness and complexity of nursing (Mulhall, 1998) and that ‘opting in’ to research means ‘opting out’ of the tough realities of clinical practice.

I am apologetic in telling people that I hope to continue studying when I graduate, that I intend to inform policy and treatments, that I will most likely sacrifice human contact with the people who need nursing support to be alone at a computer. And the grim reflection of that was the way I treated my research internship. After having apologised to the nurses for so long, and finally having the chance to be with research-minded people, I implicitly apologised to them as well for coming from a nursing background. The doubts of other nurses weighed heavily upon me, and I proved them right by failing to make the most of the opportunity. Readers may recognise the classic signs of imposter syndrome, ever present among nursing academics, high-achieving women and those who are underrepresented in their fields (Gill, 2018). Nobody is responsible for my inability to do my best work but me, although nothing happens in a contextual void. The benefit, however, is that I can now empathise with the fear that many nurses feel about becoming involved in research. We associate ‘that sort of thing’ with medics, but as long as we shun the opportunity to engage in research (Bassett and Bassett, 2003), and disparage those who do choose this route, we are ensuring our position in second place in this area. And perhaps it is an awareness of this second-class status that drives so many away (Black et al., 2015).

But I have not been driven away. As mentioned previously, this experience represents an important threshold for me. I have been fully exposed to the clinical academic research environment, and had the chance to prove myself. It is the greatest responsibility yet given to me in my research career and I now understand the weight of it, and the importance of time management and communication. I have learnt that the multidisciplinary team is found not only at ward rounds, but in universities too, and that there is danger in expecting the rest of the team to know the words and acronyms you use. But there is even greater danger in not asking someone to explain a word or acronym that you don’t know, to put yourself in second place when others are supporting you to reach first, and, ultimately, to not ask for help when it’s needed. I was given a golden opportunity and feel I did not make the most of it, but that will never happen again. If another research internship becomes available to me for the summer between my 2nd and 3rd years, I will take it. I will refuse to be intimidated by my own doubts, or by anybody’s job titles, and will ask the questions, ask for help, voice my opinions. The ability to reflect on what I have ultimately gained from this experience has enabled me to recover the confidence and enthusiasm that I previously lost.

Opportunities still abound for nursing students interested in research, and I have articles to write, statistical tests to run, and conference presentations to give. I am carving my path, and learning from mistakes as I go. A research career in mental health has been my dream since I was a teenager, when I began to experience issues with my own mental health. I opted to study psychology, and enjoyed the research environment that was cultivated for us as students. We were experimenting, running statistical tests, and participating in the research of others. It was exciting, and I felt I was at the forefront of psychological discovery. However, when my mental health began to falter again towards the end of the degree, I concluded that the pressure and intellectual demands of a research career would not be possible without compromising my health and wellbeing. I later applied to study mental health nursing with the view that, if I couldn’t work in mental health research, I could still help those using services. I didn’t even consider nursing research, until I spoke to faculty members and became involved in running focus groups, analysing data, writing literature reviews, and compiling reports with them. Add to that the connections forged for me by the consultant neurologist, and I now have the luxury of selecting which projects I wish to be involved in. The neurologist taught me that every opportunity must be beneficial to me, either through experience, prestige, or financially. Most importantly, though, and one of the main areas in which my nursing education differs from my psychology education, is that I have been taught to reflect and to seek supervision, and to make use of the sense of belongingness in nursing (Levett-Jones & Lathlean, 2008).

My experience has implications for early career nurse researchers in the UK and beyond. The psychiatrist explained that professors and consultants will often recruit medical students as research assistants, primarily because they work more closely with medical students than nursing students. Frequently though, as was the case here, the medical school and the nursing school are part of the same institution, and we students work alongside each other in practice. Every person I spoke to along this journey – the neurologist, the endocrinologist, the psychiatrist, etc. – was pleasantly surprised to hear from a student mental health nurse, which suggests that opportunities are there if students seek them out. There is a division in research between nurses and medics, but my experience suggests that this need not exist. Through participating in the Student Leadership Programme, joining Sigma Theta Tau International Honours Society of Nursing, and attending various conferences, I have had the privilege to meet some of the best nurse researchers in the country, and their affirmations and reassurances have enabled me to stay firm on my chosen career path. Many of them say they regret waiting so long to enter research, and I am lucky to have found my passion so early in my nursing career. They are shocked to hear that nurses on the wards often do not approve of my choice. Perhaps both sides of the table could benefit from spending more time in each other’s spheres and learning to appreciate one another’s choices and contributions. We are all nurses after all.

I can empathise with the fear some nurses feel about entering research, so I hope to see more interdisciplinary training opportunities to break down stereotypes and open doors (Carpenter, 2009; Verma et al., 2006). As a student nurse, I’m familiar with the supernumerary nature of placements, in which we are often only nominally members of the team. To be an intern, an equal member of the team, paid for your contributions, is empowering (Budgen and Gamroth, 2008). At a pre-registration level, I hope that medical students and nursing students will be recognised for the skills they bring to the table, and not (only) the degree titles on their certificates, and internship opportunities opened to all. As if in agreement, the acute hospital here, a teaching hospital for many years, where medical and nursing students rub shoulders, has been renamed a University Hospital Trust, perhaps in recognition of the contribution that students and academics of all disciplines make to modern clinical practice.

Biography

Felicity Allman is in her second year of BSc (Hons) Nursing (Mental Health) at the University of Plymouth. She received her BA(Hons) English Literature from the University of East Anglia in 2010, and her PgDip Psychology (conversion course) from Birkbeck University of London in 2015. She has completed the Council of Deans of Health’s Student Leadership Programme and the NHS Leadership Academy’s Edward Jenner Programme in Leadership Foundations. Felicity is also an expert by experience for the Royal College of Psychiatrists and the Care Quality Commission, and research and policy advisor for Beat Eating Disorders.