RCNi Emergency Nursing Award 2018 recognises the importance of research in the emergency department

The emergency department (ED) sees a spectrum of people and health problems from newborn to end of life, major trauma to sprains. But despite millions of attendances each year, it has historically had one of the poorest records of getting patients involved in research.

‘Recruiting patients for research in such a pressurised environment is difficult,’ says Heather Jarman, consultant nurse in emergency care at St George’s Hospital in London. ‘People have seen what our environment is like in the TV show 24 hours in A&E. Our department was not involved in research and I wanted to change that.’

Watch: RCNi Nurse Awards 2018 Emergency Nursing winner Heather Jarman describes her winning project

Nurse-led research

Over the past four years she has turned her aspirations into reality and is now clinical academic lead in one of the highest recruiting EDs for patients into research in the country.

The nurse-led research team she has established is recruiting for 13 studies and has participated in 26, including adults and children, covering diverse subjects ranging from mental health to nosebleeds.

In recognition of her efforts to establish and develop the research unit, Ms Jarman has won the prestigious Emergency Nursing category of the RCNi Nurse Awards.

Tenacity

She was nominated by Phil Moss, clinical director of the ED at St George’s Hospital.

‘Heather was the sole driving force,’ he says. ‘Her tenacity, attention to detail and her ability to engage with the multidisciplinary team were the main factors in the success of the project. 

‘She has developed the team personally to ensure the highest standards of research governance are achieved and has taken novice researchers and trained and mentored them. The reputation of the unit has reached well beyond the ED and the trust, and has resulted in international research teams asking us to join their studies.’

It was not easy, says Ms Jarman, in fact she calls it ‘the toughest thing I have ever done’. 

‘I started from nothing. I recruited one patient to a study and it was the best feeling ever. I began thinking about how we could find lots more. 

‘So I made a logo, set up a twitter account and wrote a strategy. I then held a coffee morning where the trials team talked about the possibilities of research.’

She secured funding for the secondment of ED nursing staff into research roles culminating in a team of four whole time equivalent nurses who provide cover from 8am to 10pm, seven days a week. 

Dealing with the sceptics

‘There were lots of research sceptics in the ED,’ Ms Jarman recalls, ‘and some of the biggest ones were the consultants, so I made several of them principal investigators.’

In its fourth year of operation, the unit recruited more than 500 patients to a range of National Institute for Health Research studies. She is directly helping smaller EDs in the region to set up and develop research units of their own. 

Ms Jarman is proud of the effect the research unit has had on patients, the department, the ED and its staff.

‘Patients have had the opportunity to participate in research and continuity of care and the department is known nationally for being good for research.

Leading the way

‘Research promotes nurses. They make decisions and work autonomously. They collaborate with other professionals and external organisations. Nurses are principal investigators and chief investigators.

‘Key to the project is that emergency nurses have been developed to work as embedded researchers.’

She is proud of every study the unit has participated in:  ‘All the studies we have been involved in will have an impact on patient care or how staff might work in the ED in the future. We are undertaking such a wide range of research and it has the potential to benefit a wide range of patients.’ 

Breaking down boundaries

Ten ED nurses have had the opportunity, through secondments, to become active in research and confident in recruitment, consent and follow-up of patients.

One of those nurses is Sarah Rounding, senior clinical research nurse in the clinical research facility at St George’s Hospital. Her career flourished after being mentored by Ms Jarman in the ED. 

‘Heather is an inspiring nurse and leader,’ says Ms Rounding. ‘She breaks down boundaries to advance nursing practice, recognising the huge capabilities nurses have and the increasing scope for nursing practice. She is incredibly strong, brave and diligent. 

‘While working at a very senior level, in various roles – more than I’ve known any other senior nurse to have – she manages to maintain her clinical skills and excellent working relationships with junior staff, inspiring future nurse leaders. She thoroughly deserves this award.’

How Heather Jarman transformed my emergency nursing career

Sarah Rounding is senior clinical research nurse in the clinical research facility, St George’s Hospital 

I  joined St George’s Hospital in 2010. I first worked in the emergency department, which was where I met Heather. 

I became an emergency care nurse, a new ED nursing role specialising in resuscitation that was pioneered by Heather. 

My first taste of research came when Heather offered a part-time secondment running a clinical trial investigating the use of tranexamic acid in gastrointestinal bleeds. 

Bringing academia to the ED

Combining academia with clinical practice and the level of detail required to conduct research gave me the job satisfaction I was seeking. I was promoted and gradually increased my research hours. 

After a couple of years, I was working as a full-time senior clinical research nurse and line managing the expanding team, which only existed due to Heather's success in establishing research in the department. 

Research can be challenging but I love the extra time it allows you to have with patients. I like being at the forefront of advancing medical and surgical practice and inspiring clinical staff to engage in research.

Being able to do research in the ED has improved my practice. It is immensely rewarding to be able to break down barriers to ensure controlled research can be conducted in an unpredictable environment. This helps me to plan how to run new clinical trials in a variety of hospital settings and integrate research into clinical areas that haven’t previously been exposed to it. 

Extra level of care

Research makes a difference to patient care. Patients who take part in clinical trials get an extra level of care as they attend the clinical research facility for trial visits where they are reviewed by NHS research doctors and nurses. These visits are above the NHS standard of care, as they are additional to routine appointments, and research patients generally do better, despite some of them having placebo treatment. 

The work we do dictates future treatments available on the NHS and international healthcare practice. The quality of our work is vital to ensure we answer research questions precisely and maintaining quality research practice is a key aspect of my role. 

Meet the other finalists for the RCNi Emergency Nursing Award 

• Julie Reeve and the emergency nursing team, Yeovil District Hospital NHS Foundation Trust
  The team has transformed performance and patient care in Yeovil Hospital’s emergency department.
• Nicola Davies, Barts Health NHS Trust
  Nicola Davies has produced a film called Code Red, about the care of haemorrhaging trauma patients. 
• Sarah Charters and the vulnerable adult support team, University Hospital Southampton NHS Foundation Trust
  The team addresses the psychosocial causes of the health problems of people attending the emergency department. They offer interventions for adult vulnerabilities, including domestic abuse, honour-based violence, substance use, homelessness, sexual violence and human trafficking. 
• Steffan Simpson and Emily Jones, Cardiff and Vale University Health Board
  Emily Jones and Steffan Simpson developed a pathway for referral of bereaved relatives of children and young people up to age 25 who die suddenly in the paediatric emergency unit.