Rebecca Bone has been a consultant nurse in heart failure at Oxford University Hospitals for two years, and throughout her research journey, she has received support from the NIHR Oxford Biomedical Research Centre (BRC).
Rebecca finished her Masters in 2017 and was encouraged by her dissertation supervisor to write it up and get it published. She came to regret allowing the chance to slip.
However, the opportunity arose again in the shape of short internships offered by the Oxford BRC. This allowed Rebecca to revisit her dissertation, a service evaluation looking at the practice of treating iron deficiency in heart failure patients admitted to the hospital.
“It was a three-month internship and the BRC funded two days a week away from practice. I got to meet loads of other people going through it and that was fantastic. I used the time to see if, since I did my Masters, the simple interventions we’d put into place had made a difference to practice.”
At the time of starting the internship, a Consultant Nurse post was about to be advertised, with an expectation that the successful candidate would pursue a PhD. The experience of writing a Masters dissertation whilst working full time and no dedicated study time, did not make this an appealing prospect to Rebecca, and she had decided not to apply.
“You’ve got to have that questioning mind to be able to work out if you are doing the right thing. What I’ve found has helped me is that I can perhaps ask the right questions.”
“All of a sudden, with the internship, I was able to find out what it’s like when you’ve got dedicated time away from clinical practice and you have time in your working week to look at these things.”
Around the same time, Rebecca attended a series of webinars by people who were finishing their doctorates, which she found hugely inspiring, and started thinking about what questions she had that a PhD could answer.
“All of those things together just combined at the right time, and showed me how I could make a consultant role work, and I decided to apply for the job.
“Having regretted not seeking publication for my work previously, I decided, ‘Right, I’m going to make sure I write up my findings now’. Again, it was really tough to find the time, but I was determined not to let it slip. And then I had another fantastic opportunity from the BRC.”
Rebecca applied for one of the BRC’s writing retreats, which gave her the time and support to make progress on writing up her research.
“I was able to make a big push during the writing retreat. I just felt inspired to write, without the distractions you would get at home. And having mentors on hand and being able to ask them the really silly questions – that support was invaluable, and I learned so much about writing for publication. It was amazing.”
Rebecca found the process of submitting her paper for publication daunting, and the first journal she submitted her paper to rejected it. “We chose another journal, rejigged the paper to fit with their criteria, submitted it in November and got feedback in February to say they liked it. After a few amendments, it has now been published.”
As a consultant nurse, Rebecca splits her time between clinical work, education, research and leadership. A project she is currently working on – to upskill clinical generalist pharmacists in primary care for heart failure management – is a good example, as it combines all these aspects of her role.
“These aren’t specialist heart failure clinicians but they’re dealing with very complex patients and making quite daunting decisions. By offering not just education but mentorship, drop-in sessions, clinical supervision, that’s made a difference to practice and improved patient outcomes. The pharmacists are telling us it is not giving them extra work, but it is giving them more job satisfaction. We are now designing the next round with the aim of getting better data out of it.
“The exciting thing for me about being a consultant nurse is I’m identifying how a pathway needs changing. In my head, I’m constantly thinking, ‘how do we improve this pathway, how do we trial it and evaluate it’. The consultant cardiologists around me are massively supportive of the role and really value it.”
“I’d like people to have the confidence to think, ‘I can do that. I’m not being asked to run a multinational randomised controlled trial into some new therapy. This is something that is relevant to my practice and is within my power to do’.“
Keen to encourage a research culture, she has set up an advanced practice forum within the cardiothoracic directorate. She also believes that the key to fellow nurses and allied health professionals engaging in research is confidence, and she encourages her colleagues to take on quality improvement projects that are relevant to their practice.
“Different people will have different desire to be actively involved. I’d like people to have the confidence to think, ‘I can do that. I’m not being asked to run a multinational randomised controlled trial into some new therapy. This is something that is relevant to my practice and is within my power to do’. There’s a great culture in the Trust for quality improvement, and that’s quite a nice gateway.”
Rebecca also acknowledges the importance of having time built into roles to focus on research, especially for advanced nurse practitioners, for whom it is one of the four key pillars of their work.
“In the current climate, there isn’t often that time. There are all these wonderful things in place that will make a difference, but you do need that freedom.”
Rebecca says that the research mindset – with its emphasis on evidence-based practice – has perhaps made her a better nurse.
“I think you’ve got to have that questioning mind to be able to work out if you are doing the right thing. What I’ve found has helped me is that I can perhaps ask the right questions, get the data and improve the service.