Twists, turns and persistence: my path from nursing to research

by Dr Cindy Mann, Research Fellow, Centre for Academic Primary Care, University of Bristol

Cindy Mann, a former nurse and now Research Fellow at the Centre for Academic Primary Care, University of Bristol, shares the twists and turns in her career, and encourages nurse colleagues to consider research as a future path and not be put off by setbacks.

A long and varied career

I have had a long career, starting in 1975, when I did my nurse training at Leeds General Infirmary. In 1977 I got married and after completing training followed my husband to Oxford where I took a job as a staff nurse at John Radcliffe Hospital in Oxford. I then decided to do a Philosophy degree in Oxford, and really enjoyed the peace and quiet of working in a library, in contrast to ongoing shifts for the nurse bank. In the following years, up to the early ‘90s, I worked as a practice nurse in Oxford, then Bath and had two children.

In 1991, I made the first of my most significant career moves by working as a Relate counsellor and trainer, latterly combining this with a further education teaching qualification.

In 2002, I left Relate due to burnout. Instead I took up a post as a Research Assistant with Paul Dieppe at the School of Social and Community Medicine at the University of Bristol, collecting data for a community musculoskeletal project for the Somerset and Avon Survey of Health (SASH). Paul, a renowned rheumatologist, was my first mentor. He got me interested in doing research. Then the Labour government re-invested in the NHS and created senior clinical roles for nurses, including nurse consultant roles, that combined research and clinical work. This attracted me back into nursing.

I did a return to nursing course and took a job as a staff nurse on a rheumatology ward at the Royal National Hospital for Rheumatological Diseases (RNHRD) in Bath. Part of my drive in this new job was that it provided me with an opportunity to combine what I had learned through Relate about couple relationships with exploring how living with long-term illness affects those relationships. I took a course at the Tavistock Institute in London on attachment theory to further inform this.

I then developed my own research project, with the help and support of Candy McCabe, the first of three inspirational and supportive nurse consultants I encountered on my path to being a researcher. The project was funded by the Royal National Hospital for Rheumatic Diseases research development fund, and explored the effect on a couple relationship when one partner has rheumatoid arthritis, supervised by Paul Dieppe. This resulted in my first published paper and presentation at an academic conference.

This is the experience that sold me on research, because the people I interviewed taught me so much about what it was really like to live with rheumatoid arthritis.

In 2005 I tried unsuccessfully for further research funding and switched again from hospital to practice nursing. During my time at Hanham Health in Bristol, I tried to set up practice nurse-led arthritis clinics as a locally enhanced service. This was also unsuccessful but it opened a door into my first senior clinical nursing role as a rheumatology clinical nurse specialist (CNS) at North Bristol Trust. This coincided with moving to Bristol. I had a lot to learn and did a course on the management and self-management of arthritis at University of the West of England (UWE) and subsequently published a paper on managing arthritis in the community.

In 2008, another door opened when I was awarded a Royal College of Nursing Barbers’ Company Clinical Nursing Scholarship, which helped me fund an MSc in Rheumatology. This was led by a second fantastic nurse consultant, Sarah Ryan, at Keele. Another research project resulted, funded by North Bristol Trust, exploring the potential of nurse-led clinics in primary care to improve care for people with osteoarthritis. This helped me get a job as a senior research nurse on a joint replacement research project in the Musculoskeletal Research Unit at the University of Bristol. It was during my time there that I resolved to pursue my research career and, as a first and necessary step, find a way to do a PhD.

My long-time mentor, Paul Dieppe proved the key to this ambition. In 2011 he helped me secure a visiting scholarship to a prominent arthritis research group in Boston, USA. I was still trying to find a way to pursue the idea of arthritis clinics in primary care and Paul put me in touch with Chris Salisbury at the Centre for Academic Primary Care at the University of Bristol. During my time in the USA, I unsuccessfully applied for a PhD studentship with him. On my return, I took up a post as a CNS at Bristol Royal Infirmary but was still wanting to develop my own research. Chris was then preparing an application for his own study to trial a new intervention for person-centred care for people with multimorbidity in GP practices. He generously accepted me as a co-applicant and in so doing opened the way for me to do a PhD at last. Since gaining my PhD in 2018, I have been working on developing new projects that have grown out of the work on the 3D study, focusing on aspects of managing patients with multimorbidity in primary care.

I am hugely grateful to everyone who has helped me on my journey. I have, at last, found my happy (work) place and can see the end result of a lifelong interest in helping people to find their way to better health and wellbeing.

Reflections on the challenge of nurses getting involved in research

It’s still very difficult for nurses to get involved in research, but it’s about becoming aware of the opportunities. The NIHR is actively trying to engage more nurses in research and there are now opportunities to do a Masters in Research or to get allied health professional PhD fellowships through the NIHR.

I think changing the healthcare culture would help too. Often, doctors and allied health professionals are trained and do research in separate institutions. This may be a bit of a missed opportunity to bring to research the richness of whole health teams working together. Universities, such as Bristol, could offer allied health professional scholarships, and identify a person who could discuss ideas with allied health professionals and introduce them to researchers working in their area of interest. The practice nurse network, clinical research network and lead nurses in CCGs and hospitals could then share this information in their networks. It might also help nurses who don’t have research experience, but do have ideas, enthusiasm and drive, to find opportunities and mentors.

Mentors who recognise and share your enthusiasm and are generous enough to support and guide you are essential, and you also need to be on the lookout for opportunities, be determined and keep pushing at doors. Eventually one will open!

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