As 2020 is the Year of the Nurse and Midwife, it is important to celebrate our profession. I always wanted to be a nurse and I cannot remember a time when this was not going to be my chosen career. In July 2019, I turned 55. When I started my nurse training, 55 seemed a lifetime away. Now a lot of my nursing friends and colleagues have retired, or are thinking about retiring. I, however, cannot think that my nursing career is almost over. In my 37 years of nursing I have never wanted to be anything else, and I am not ready to slow down.
Nurse training
My school days were great, but I was never a high achiever. I had to work hard to gain my CSEs, but I achieved what I needed in the end. I loved being a pupil nurse and had so many wonderful experiences. During my training every person I met influenced my career, and affected how I was to shape myself as a nurse—good experiences, bad experiences, good mentors, bad mentors, kind patients, not so kind patients—all left a impression on me and made me understand the type of nurse I wanted to be.
The early years of nursing
On qualifying, I got a post as an enrolled nurse on busy 38-bedded medical ward. I have many fond memories of working on this ward and made some lifelong friends—I also met my husband who at the time was a 4th year medical student. I encouraged him to work as a nurse for two days which he did. He got involved with bed-bathing, medicine rounds, and he perfected the hospital corner—it was at this point I knew he was the man for me.
In 1990, I had to leave my position to undertake my RGN conversion course. This 12-month training was another opportunity to further develop my knowledge and experience, and on completing the course I gained a Staff Nurse post in intensive care.
I worked in ICU for the next 8 years, gaining my ICU degree and completing my BA(Hons) degree. During this 8-year period I also had my four children.
Primary care
For the past 16 years I have been a practice nurse in a semi-rural practice with 13 000 patients. The move to primary care was initially a result of having a young family. Moving from secondary care to primary care was not easy—the practice nursing role was still in development and varied depending on the GP practice. I had applied to be a practice nurse in 1990 before I got the ICU post. I remember going for the interview and the GP told me he expected me to see patients with long term conditions, to give immunisations and travel vaccinations, undertake phlebotomy, hypertension reviews, cervical cytology, health promotion, patient education and much more. I came away from that interview thinking he doesn't want a nurse, he wants a junior doctor. How little did I know!
It was difficult to move into primary care from secondary care as I didn't have the right experience, but I was not able to gain that experience! My introduction to primary care was working one day a week as a volunteer in the GP practice while still working nights in ICU. Within a couple of months of volunteering, a practice nurse post became vacant and I was lucky enough to be successful in getting the position. These difficulties in getting into primary care have influenced my thoughts on recruitment. We do not have the luxury of only accepting experienced candidates for interview and for many years I have been a keen advocate for employing those new to practice nursing.
I soon understood how this role was developing and what a wonderful job I had been lucky enough to secure.
Giving practice nurses a voice
The GPN 10-point plan outlines the future of nursing and the need to keep the profession strong and secure for the future. It talks of recruitment and retention. The last 8 years have been full-on and I have embraced my role. This has strengthened my commitment and enthusiasm for general practice. I have been a member of the locality steering group for the last 7 years—I felt passionate about there being a nurse voice around the table when key decisions were being made about our role and our patients. From there, I joined the local practice nurse forum and a couple of years later became Chair of East Lancs Primary Care Nurse Forum; a role I have found challenging but massively rewarding. It is a great platform to unite nurses, to share good practice and to support each other.
For the past 2 years I have been a member of the Pennine Lancs Care Professional Board, which provided clinical and care professional leadership and assurance to the Lancashire and South Cumbria shadow Integrated Care System (ICS). Again, I felt it was important to have a voice around this table as key discussions were taking place about the future of healthcare in Pennine Lancashire around system-wide care models, in which practice nurses will play a pivotal role.
Further development
I became a Queen's nurse two years ago and am very proud to have been able to go through this process, demonstrating my passion to improve patient care and promote the practice nurse role. While I have supported many student nurses, newly qualified nurses and junior doctors over the years, I had never undertaken a mentorship course. In 2019, I completed my mentorship training and have since gone on to complete the transition training to be a supervisor and assessor. I want to do all I can to encourage nurses to choose GPN as a first point destination career, an option which has not always been open to newly qualified nurses until recently.
For many years I was put off becoming a non-medical prescriber—I was told that the course is the hardest thing ever and has ruined many a good night's sleep; however, 2 years ago I decided that the time had come for me to meet the beast head on. It was the best thing I had ever done. I enjoyed going back to university 1 day a week, meeting new people, and learning a new skill which helped me consolidate all my previous learning. I wish I had done it years ago.
In 2019, I was successful in gaining the RCN Credentialing and am now an Advanced Level Nurse Practitioner. I am not, and do not want to be, an advanced nurse practitioner (ANP); however, it has been a great achievement and a very difficult process to prove that I work at a level of advanced clinical practice in my role.
Leadership
Last year I was privileged to gain a place on the bespoke Leadership for Quality programme. This was my first experience of understanding what leadership really meant. For many years I believed that I was a leader. I am the locality lead nurse and currently nurse lead on the Ribblesdale Primary Care Network (PCN), but does the title actually make you a leader? After completing the programme I realise leadership is not in the title, it is in the action. I have discovered the type of leader I thought I was, the type of leader others think I am, and the type of leader I want to be, and I now know that these can all be poles apart. I have learnt that good leadership skills are so important in recruitment and retention. The impact of our behaviour had a massive impact on the people we work with. This is particularly important when we mentor student nurses. I have come across some great mentors in my time, but I have also experienced toxic mentors who influence how you feel about that area of nursing.
Practice nurses have been identified as critical to the provision and co-ordination of an integrated approach to the delivery of quality care. My role is pivotal to the success of the new vision of care redesign and delivery in primary and community settings; a vision which requires general practice nursing leadership.
Education
I deliver in-house education for student nurses, newly qualified practice nurses, work experience students, medical students and colleagues. As I work at a training practice, I support and clinically supervise GP trainees and GP registrars. I have recently played a key role in a pilot to set up digital clinical supervision, which will shape future plans in Lancashire and South Cumbria. We are moving on to phase 2 of the clinical digital supervision pilot and I am excited to open up digital networks to support all practice nurses and their colleagues.
I mentor student nurses and am responsible for the student induction pack. I have also become a preceptor, supporting nurses new to general practice—this has made me more aware of the challenges faced by nurses new to primary care. I wish I had been able to join a preceptorship programme when I moved to primary care, as the support, advice and experience that can be shared between preceptor and preceptee is invaluable. My hope is to encourage more GPNs to be preceptors and this is a great way to ensure recruitment and retention into our profession.
As diabetes nurse educator I plan, deliver and evaluate group education sessions to patients. I am one of the first nurse digital champions in Lancashire and South Cumbria. This has enabled me to share health and social advice and education which is evidence-based via social media leading to increasing self-empowerment of patients.
Research
Evidence-based practice is paramount to me, working at an advanced level of clinical practice. I have completed research projects around women's health, diabetes, and pre-diabetes. This helps me to continue to develop evidence on which best practice can be based.
I was part of a successful bid securing £20 000 to pilot the use of digital technology in a service quality improvement for patients with cardiovascular disease—this will run for 12 months. This was a collaboration between a team of nurses from Lancashire and South Cumbria, and fellow GPNs on the Leadership for Quality Programme.
Following my most recent asthma update, I put forward a bid in collaboration with the Ribblesdale practice nurse team and Ribblesdale PCN for the purchase of a FENO machine which has proven to improve the management of patients with respiratory conditions.
In conclusion
It would be easy to take my pension and enjoy retirement; however, I still feel I have a lot to give. I have received ongoing support from my practice to undertake all of these roles. A supportive practice is essential and I have been well supported by mine. I know we sometimes lose our enthusiasm and motivation to carry on, and often feel that the system is against us. However, I truly believe that we must support each other to promote recruitment and retention. If we leave the profession how will we ever make a difference? How will our voices ever be heard? Practice nurses are so passionate, skilled, and dedicated to the role—they have so much to give but constantly feel that they are battling to get their voices heard. But we need to get our voices heard, shape the future and make practice nursing a profession in which we continue to be proud. Together we are stronger. Join your local forum or online forum. Is there a nurse in your PCN? If not, why not? Get yourself on there. Are you a mentor or preceptor? Ask about the preceptorship scheme or becoming a mentor. There are also opportunities to become an online mentor. I continue to look for new challenges and opportunities to showcase the practice nurse role and the wonders of primary care and you should too.