RN, BSN, OCN, M.Ed
Wondering what a day in the life of a clinical research nurse looks like?
Think it might be a fit for you?
Let’s find out!
Did you know that an outpatient clinical research facility can have up to 200 clinical trials going on in a single day? Possibly more, depending on the facility?
For example, the facility I work in conducts trials on everything from cancer, HIV, mental health disorders, to heroin treatments, penicillin allergies, and more!
A lot of our facility’s oncology research consists of Phase I clinical trials; meaning these patients are the first humans to receive certain medications for their cancer.
But what exactly does this mean for me, as the clinical research nurse? Where does my role come in?
As a clinical research nurse, you must understand that every day in research is different.
Whether it’s a new chemotherapy regimen, immunotherapy, or a combination of the two, we carefully infuse the medications and monitor the patients closely for their first few cycles of treatment.
These trials almost exclusively work with patients who have stage III or IV cancer, so we sometimes represent the last possible treatment a patient might try before going into hospice care.
Some days, I have blood draws or screening visits to help determine if a patient is eligible to enroll in a clinical trial. Other days, I perform pulse wave velocity (PWV) tests on patients to check their cardiac status during heroin addiction treatment.
More recently, we’ve begun doing pediatric studies to see if children with a so-called penicillin allergy are actually allergic. When a pediatric patient is admitted to the hospital and the parent consents (with child assent, or agreement to participate), we challenge the child with penicillin: 10% of the total dose at first, then an observation period, then 90% with more observation.
To date, I have not seen one true penicillin allergy in this population and am very happy to have that allergy removed from patients’ charts so that they do not have to get stronger antibiotics later on in life.
Additionally, some days my team and I will visit both inpatient and outpatient units to collect data/samples on patients (blood, ECGs, vital signs, and so forth). Most commonly, though, we have the patients come to one of our two outpatient research units for a few hours with us before they go home.
Facilities that need healthcare providers will typically begin a partnership with a staffing agency in order to have ‘more hands-on deck.’
If you break your agreement, this puts one less person on the schedule; and in nursing, this can make a huge difference in patient care delivery.
Whether you are looking to join a clinical research nurse career or not, every facility has a different protocol and agenda. The following is what a typical day in my life as a clinical research nurse is.
First, gather all necessary supplies for the day.
Among other items, this includes signed doctor’s orders (yes, we still have paper orders and charting) and a paper flow sheet that documents time points like vital signs, blood draws, infusion times, and so forth.
If phlebotomy is required, I gather those supplies as well, including any study-specific tubes from the lab kit provided by the study sponsor.
Next, I set up the patient’s room for maximum comfort and efficacy. If I know the patient has a Mediport to be accessed, I add a port kit to my supply list as well.
When the patient arrives, I greet them warmly and verbally confirm their consent to continue in the trial, reminding them that they have the right to withdraw at any time and for any reason. From there, I obtain their weight and vital signs.
Safety labs come next. Usually, this is common blood work that ensures the patient is safe to be treated today.
Oftentimes, these labs include certain white blood cell counts like neutrophils, kidney and liver function tests, and others.
Upon receiving the results and getting approval from the principal investigator (PI), we can get started.
Oftentimes, prior to treatment, triplicate ECGs, pre-dose study-based blood work, and vital signs are checked. This latter lab work determines how much study drug is in the patient’s blood just prior to the next infusion, similar to a trough.
When using some medications, a few extra steps are required.
For example, if the drug given has a high potential for patient reaction, or if the patient has reacted to the drug previously, pre-medications like acetaminophen, hydrocortisone, and diphenhydramine are given about an hour prior to the infusion or ingestion of the study medication.
When it’s finally time for infusion, and in cases where this is a first-time patient, it is my job as the clinical research nurse to closely monitor them for reactions.
Typically, once the infusion is over, there is another blood draw (called pharmacokinetic, or PK, sample) that determines the amount of drug circulating in the patient’s body, the same concept as a peak sample for other medications.
Usually, we keep the patient for over an hour for observation, ensuring that there are no adverse events.
An infusion day for our clinical trial patients can vary from one to 16 hours!
Although this overview cannot cover everything I and my team do daily, there is one constant.
Each day, I am in awe of our patients.
They are brave and helpful, among some of the first humans to ever have certain medications circulate through their blood.
In the fight against cancer, they are truly pioneers. I cannot count how many times I have heard the words, “Well, if this doesn’t help me, maybe it’ll help someone else later on.”
I am so grateful to our patient population, as they generally try to maintain positive attitudes throughout the potentially long and draining study process.
Of course, much like any healthcare profession, there are not always happy endings as a clinical research nurse.
Ultimately, most patients will go off our trials for one reason or another. Most often, it is because the study drug is proving ineffective and/or the patient’s cancer is progressing.
Other times, sadly, our patients die before they can get their next treatment regimen.
However, there have been instances where we have seen some patients experience either partial or full remission!
This is one of the many reasons why so many of us are dedicated to our research.
There is truly nothing better than being a clinical research nurse. We see that what we’re doing can and does shrink tumors and heal patients from stage IV cancers. It gives me hope that we can still find ways to be a most formidable foe.
Since no two days in research are ever the same, I am happy with the great variation I experience professionally. We work with pediatric and adult oncology patients and everyone in between!
I also encourage everyone to visit www.clinicaltrials.gov, where you can be matched with any study that might pertain to your health.
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