This week’s blog is part of the ‘Early Career Researchers'(ECRs) theme. Dr Gearóid Brennan is the Lead Psychiatric Liaison Nurse at the Royal Infirmary of Edinburgh. He is an early career researcher, having achieved his PhD in 2021. Gearóid reflects on his journey of being an ECR while maintaining a clinical career and offers some tips to others.
It might be because I was a big fan of Barbie the movie, or that I find Billie Eilish’s talented voice piercingly haunting. But the title of her song and the sentiment expressed is one I ask myself often as I try and navigate what can feel like the choppy waters of being on a ‘clinical academic’ journey as an early career researcher.
It’s rather existential. But often I do find myself asking ‘What am I?’ What does it mean to be a ‘clinical academic’ (mental health) nurse? Why do we need special contracts and schemes?’
The Scottish Nursing, Midwifery & Allied Health Professionals Research Unit (NMAHP-RU) describe a ‘clinical academic’ as a NMAHP who are “at one and the same time working in practice and involved in research. They spend part of their working week in a clinical or social care setting, and part undertaking activities related to research” [1]. This might sound very appealing. But the reality of achieving this can be rather more problematic.
For a start, you will be booking a trend, as it is estimated that less than 0.1% of the NMAHP workforce are clinical academics [2]. Yet, having more people in such roles is deemed essential to advancing evidence-informed practice and innovation. There are many different approaches to achieving this. Most people will say that my career journey so far has been a bit ‘wild’ to date and certainly not always traditional. It’s often involved finding my own path which has been exciting but at times daunting. This has seen me crisscross being employed by a university and the NHS on separate contracts of varying attributes simultaneously. I completed a masters and PhD while maintaining clinical work. Post-PhD I held part-time academic roles alongside a nurse specialist post in the NHS. For me, I enjoy research and the ‘academic’ side of things, but I’m not ready to give up patient care.
This is by no means the easiest role. Unfortunately, ‘clinical academic’ posts are rare and often developed ad hoc, depending on the needs of the NHS and the relevant university. I was determined for this not to get in the way. I’ve been very fortunate that lots of things have helped me achieve this. These have included boundaries, organisational support and mentorship.
1. Boundaries. This is such an underrated topic that we need to talk more about in nursing. But I think as an ECR it’s essential to learn them. Otherwise you will be pulled in too many directions, get overwhelmed, and feel like you are doing other people’s work. It’s well known that ECRs are in often vulnerable and precarious positions. I’ve tried to counter that narrative by reminding myself that as a registered nurse, I have several transferable skills and there is a global shortage of nursing. When you have that in the back of your mind, it can help in instilling them clear boundaries. They help in saying ‘no’ when needed.
2. Organisational support. For me, this was that both sides were supportive and could see mutual benefit. Part of this was being very transparent regarding my employment status, days of work etc. I was very fortunate that this was never an issue. NHS Lothian is a fantastic place to be a NMAHP interested in a research career. A lot of cultivating culture has gone on over the years, in large part due to having dedicated research leads for professional groups, including a Chief Nurse for Research and Development. The health board has collaborated with six universities to develop a NMAHP research strategy. This really shows that it’s important and valued.
3. Mentorship. I’ve been very fortunate to have been in receipt of both formal and informal mentorship as an ECR. This has been really essential to getting to where I am. It really does take a village, and you may find yourself pleasantly surprised just how welcoming and generous experienced academics can be. I will never forget before I started my PhD attending the RCN International Research Conference. I met all these very eminent nursing academics, whose work I had cited. I was embraced with such warm and genuine interest in my work. When I returned towards the end of my studies, I found the same. Similarly, I have met the same attending the Mental Health Nurse Academics UK research conference. It’s opened up so many opportunities. The mentorship I have received has often resulted in my network growing. It’s also meant I’ve received many gentle nudges in the right direction when needed.
Just like Billie Eilish, there are things that have caused me to just fall down. These have included identity issues, the actual ‘academic’ role within nursing and the impact of toxic culture and regulation.
1. Identity. I could probably write several blogs about the challenges of undertaking research as a mental health nurse! Indeed, reading Zoe Dodd’s blog really chimed with me. It’s really impacted on my identity, as I have found many mental health nurses were not interested in research and would look at me funny. Modern mental health nursing highlighted values such as compassion and recovery. But I find so few are interested in the evidence and rationale behind approaches to patient care. That might be because we don’t have the knowledge to answer the questions ‘what works’ and ‘what works best’ [3]. I think this is not helped that in Scotland we have very few mental health nurses as part of the professoriate. If there is a lack of research leadership, it’s really hard to occupy space and get that ‘leg up’ that is often needed as an ECR.
2. The academic role in nursing. What is an ‘academic’ nurse? This is another existential question but an important one. As much as nurses often struggle to describe their identity, and as much as the public perception of nursing is also skewed, I would say it’s worse for academics. I find most nurses equate ‘academic’ with teaching. This is despite the accepted definition of clinical academic roles being about research. Maybe because that’s what they were exposed to during their studies. Across most university disciplines, teaching is only 40% of an academic workload, with research being the other 40%. In reality most people do not get this level of research time, despite contractual dictates. As Professors Hugh McKenna and David Thompson have argued in their recent editorial, nursing departments are hiring more and more staff on ‘teaching only’ contracts [4]. I think this significantly impacts on the research culture and I found myself in the minority who had completed a PhD and wished to be research active.
3. Toxic cultures and Regulation. Related to the above, I have found the that nurses working in ‘academic’ roles who pursue ‘teaching only’ can become very focused on regulation. Again, I refer to another editorial by Professor McKenna, detailing toxic research cultures [5]. I have found that the endless pursuit of implementing NMC education standards significantly detracts from the research agenda. In particular, I struggled massively with the ‘academic assessor’ role which endlessly consumed my time and head space. There needs to be a serious evaluation of this process and how it is impacting on ECR development. If so few nurses have PhDs, then they need to be freed up to develop grant proposals and help provide that vital evidence that should be underpinning our clinical practice.
When did it end? All the enjoyment…
For me, the ends no longer justified the means as the ‘academic’ role has become too unboundaried and unruly. We spend a lot of life working and life is far too short to be doing stuff you don’t enjoy. For this reason, I made the decision to return to full-time clinical practice. I’ve recently been awarded an NRS Career Researcher Fellowship from CSO Scotland. This will allow my time to be ‘bought out’ one day per week in order to develop a programme of research. I’m really excited to be able to combine clinical practice with research. Importantly, mentorship is a key ingredient of the scheme and I will have the support of someone I’ve worked with previously and a new collaborator.
To answer Billie Eilish’s question, ‘what was I made for?’ I think I have come to the realisation that you can be an ECR within the health service. It won’t be without challenges. But I think we need to challenge our perceptions of what is a ‘clinical academic’ and there are more than one way to achieve that. But that’s the joy of a career in nursing: there is so much variety.
References:
1 NMAHP-RU. A clinical academic approach for nurses, midwives and allied health professionals-it’s a no-brainer! 2017.
2 Baltruks D, Callaghan P. Nursing, midwifery and allied health clinical academic research careers in the UK. 2018. www.councilofdeans.org.uk,@councilofdeans
3 Simpson A, Brimblecombe N, Hannigan B, et al. Mental Health Nurse Academics can help attain goals for mental health research and influence policy. Journal of Mental Health. 2023;32:1026–7.
4 McKenna HP, Thompson DR. Nursing research: On the brink of a slippery slope. Int J Nurs Stud. 2024;153:104721.
5 McKenna HP. Toxic research cultures: The what, why and how. Int J Nurs Stud. 2023;140:104449.
Author: Dr Gearoid Brennan, Lead Psychiatric Liaison Nurse at the Royal Infirmary of Edinburgh and Associate Editor, Evidence Based Nursing Journal. @gearoidbrennan