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Case study: CRN Kent, Surrey and Sussex lead nurse on working on the COVID-19 frontline as a Research & Innovation Manager

CRN Kent, Surrey and Sussex spoke to Caroline Cowley about her time back working in a NHS trust.

What is the role of a Research & Innovation (R&I) Manager?

The role of the Research & Innovation Manager is to develop and maintain the trust’s research infrastructure as well as supporting the promotion and timely delivery of research projects to a high standard, whilst ensuring compliance with necessary governance and regulatory requirements to local and national standards. Managing the R&I department and playing a key role in supporting the Director of R&I in the formulation and delivery of the Trust R&I strategy.

What happened when the COVID-19 pandemic began?

When the pandemic was declared, myself, the research director Ms Jessica Evans, lead research nurse Ruth Hulbert and the research delivery team leaders worked very quickly and efficiently to put 170 open and running studies on hold. All this was done within two weeks (all studies were paused except for safety-critical urgent treatment studies) to release all delivery staff for COVID-19 study setup and delivery.

When the Urgent Public Health Studies started coming in quite rapidly, initially it was a bit hectic and our first COVID-19 study meeting was two hours long! But we soon got into the rhythm of things and weekly COVID-19 meetings that included intensive care unit (ICU) consultants, Principal Investigators, research delivery, lead nurse, director of research, pharmacy and myself, were taking only 45 minutes Each study was discussed in turn to assess how we could support it.
Within R&I we had to be quick off the mark to ensure all regulatory documentation was in place and contracts signed for each of the studies coming through, which included working closely and collaboratively with the research delivery teams and support departments to ensure capacity and capability was done effectively, but also at speed.

At the same time, Ruth Hulbert Lead Nurse was working with the delivery teams to put a rota in place to allow delivery staff to continue to work, ensuring that social distancing was followed and everyone remained safe. Whilst I was working with my team to get them set up to work from home and our director of research, Ms Jessica Evans was juggling her clinical role as a surgeon whilst being actively involved and huge support to all of us. As the COVID-19 research picked up momentum we had to relocate some of our team members from Kent and Canterbury Hospital to support the RECOVERY trial at the William Harvey Hospital in Ashford, as an acute Trust with a larger ICU than Canterbury they were receiving many more COVID-19 positive patients. This was all happening alongside trying to manage the anxiety of the staff as this situation grew.

How has CRN Kent, Surrey and Sussex (CRN KSS) supported you during this time?

Working for CRN KSS I know the team very well and during the COVID -19 crisis, my experience is of a very supportive CRN. From my perspective, I've had an important relationship with my CRN link manager and colleague, Helen Graham. I appreciated her weekly calls and finding answers to my queries quickly and being there as a point of contact.

I think the streamlined communication process from the CRN KSS study support service worked well and helped us on the ground. They coordinated communications from the sponsors to the trusts so we were not overwhelmed with information. I've learnt that it's important to keep channels of communication open between the CRN and the trust. I think the relationship between the trusts and the CRN seems to have shifted positively. It feels like we're all in this together and so let's help each other out. I feel that a lot of that has come from the focus not being on targets during this time but on getting the research out there to give our patients the best chance of recovery from COVID-19 and to be a part of the bigger picture of finding treatments and a vaccine.

What have you learnt from working in a trust?

Within the CRN our focus is on supporting 18 trusts across Kent, Surrey and Sussex, but just to be able to focus on one trust, get to know all the staff, and how they work to deliver a huge portfolio has been a real eye-opener. I come from a delivery background (initially working at East Kent as a research nurse in early 2000) but it has been five or six years since I was delivering research on the ground and research has grown exponentially everywhere since then, and especially in East Kent.

The teams are just incredible, they work so well together and they've been so determined to do the very best. It's been an amazing experience to be a part of such a large team working together for the best possible outcomes.

What positives have come from the situation?

It's the first time I think research has been on the top of everyone's agenda, especially with trust boards. We’ve also noticed that a lot of people in different departments now want to do their own research. Some of it is service evaluation, some of its audit, but there is quite a bit of home-grown research coming through as well. So, we've been supporting those people in writing protocols and obtaining the right approvals. There are now more NHS staff who have been exposed to research. Many junior doctors, who weren't able to do their normal jobs due to COVID-19, were pulled into doing data collection for the CCP-UK study. So, we've had a lot more interest from junior doctors about research. This can only be positive for the future.

What have you learnt about yourself in the last six months?

I've remembered that I'm very calm in a crisis. I had forgotten this as it’s been a while since I worked in acute settings where there is high pressure and you have to think on your feet. I've also recognised that I'm quite a strong leader as well.

What have you enjoyed?

What I've really enjoyed is the absolute enthusiasm of the delivery teams and support departments to get things moving, and to work together to come up with solutions for some tricky issues. I've also appreciated working closely with the new research director Ms Jessica Evans and with Ruth Hulbert, the lead nurse, and having that supportive relationship with them. I've even enjoyed how busy it's been, although it's been hectic.

Seeing the actual results of the research we have been delivering is an incredible feeling, because in research delivery you don't very often find out what the results of studies were. Finding out, for example, from the RECOVERY trial that Hydroxychloroquine does not make a difference but that Dexamethasone does help has been great to see. I feel very proud that I've been a part of a team that has worked hard to get the recruits in for the NHS nationally to make quick decisions about treatments.

What challenges have you faced?

Rather than put any pressure on ICU doctors and nurses to recruit patients our delivery teams went into the COVID-19 affected areas and recruited the patients directly. A consequence of that was a few of our staff became infected. That was really quite emotional and made it very real. Although everybody was worried, they still carried on. Thank goodness those people recovered and are back at work. The other difficult thing was seeing the numbers of positive patients and hearing colleague’s stories. We also lost one of our hospital nurses quite early on so it's been a very emotional experience for everyone

What do you think the next six months will bring?

In the last few weeks, we’ve been in the restart phase which has involved conducting capacity and capability reviews, negotiating with sponsors, and finding new ways of running studies safely and effectively. In the next six months, we will be continuing to prioritise the COVID-19 Urgent Public Health studies while restarting and supporting all studies within the trust as well as supporting the vaccine studies in the region.

As we don’t know if there will be a second peak of the virus we're very much working day by day and remaining as flexible as possible. I feel quite positive about the next few months although it will still be challenging. We have to just stay focused and make sure that we are looking after our staff and able to deliver research to benefit our patients.