What does resilience mean to me?

We often hear the word “Resilience” these days. Nursing as a profession is facing many changes and resilience seems to be the key word, but what does it mean?

If we are talking about an object, we think of resilience as toughness, throw what you like at it, drop it, submerge it and it will not break.

But humans aren’t like this, being resilient does not simply mean that we have to “toughen up” be stoical and ‘just get on with it’ because we are all different. Not everyone has the ability to do this and personal life experiences vary how we cope with situations.

It’s not about having the ability to deal with bigger, more complex workloads and challenging people without being affected. Human resilience does not mean being able to tolerate anything and remain unmarked.

To me, resilience means building our support structures, having a voice, feeling as if we are listened to and being able to develop better ways of working and having access to learning and development opportunities to develop confidence.

Rather than simply toughening up and accepting difficulties, resilience is about being empowered and confident enough to say “I’m struggling” and having the support to find better ways of working. It’s about nurturing other staff, supporting them to reach their potential.

Resilience is accepting that we all have good and not-so-good days and having people around us who recognise our not-so-good days and are there to support us.

Resilience is being comfortable to ask what we might think are silly questions, to ask when we don’t understand and most of all to be able to ask for help.

Resilience is about learning from mistakes and sharing this learning and making any changes needed.

In my opinion it’s very difficult to be resilient alone, we need resilient teams, teams that understand each other’s differences and embraces the team diversity, using these very differences to build the strength of the team as a whole.

Resilience is about care, care for each other, looking out for the ones who are struggling because one day that may be us.

Resilience is about empowerment and confidence building and being the best “us” that we can be. Our strength comes from each other, together we are stronger, together we can make changes.

Resilience is about belonging, feeling valued.

This is what resilience means to me.

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What are the biggest changes that I’ve seen in nursing since I started?

I started my nursing journey in 1989 when I was only 19, so much has changed since then, including me. I have changed beyond recognition, not only has my 80s perm and naturally dark hair changed but I’ve found confidence, resilience and I’ve learned to be comfortable with myself. Here is the teenage version of me, with my flatmate and fellow nurse. I had no idea what was ahead of me.

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Not only have I changed, but the profession that I have loved since day one has also changed dramatically.

I have witnessed nursing change from hospital based, very hands-on training to university based academic education. This has truly made nursing a profession in it’s own right.

Nurses can now do things that in 1989 seemed impossible, nurses can (when appropriately educated and competent) diagnose, treat, prescribe, work autonomously. Nurses can carry out procedures such as endoscopies, even surgery.

There are far more career opportunities for nurses now than I could ever have imagined back in the 80s. Patient care is moving more into community and and hospital admission avoided wherever possible. Hospitals are no longer central to patient care but part of a whole system of care.

There is much more emphasis on quality now, the reporting of incidents and sharing of learning from these events to prevent reoccurrence. Sharing of learning is key to patient safety.

There are many more opportunities for our patients now, a huge amount of new medication and treatments to save lives and increase quality of life. This means more complex decisions are being made with these medications and treatments and multi disciplinary teams work closer together to support each other.

I have seen nursing change from the days of paper hats and following instructions from a doctor to a valued profession where with the right education and competency, nurses can be autonomous.

I have seen nursing change from being unable to administer IV antibiotics, never mind prescribe them, to being able to deliver care in many specialist areas and general practice. I have seen a great deal of change over the last 30 years, it’s exciting to think where nursing will be in another 30 years.

I have seen the career I love, grow and develop and this makes me even more proud to be able to say

“I’m a nurse” 😊

How did I get here???

The weeks and years fly past so quickly, when I look back on my career, the beginning feels like a lifetime away. I often sit at my desk, surrounded by a fabulous team in a relatively modern, open plan office and wonder how I got here. When I started as a student, NHS Clinical Commissioning Groups (CCGs) did not exist, the NHS was a very different place, I could never have imagined the role I have today. 

My nursing journey started in 1989 in Scunthorpe General Hospital 

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I’d grown up in Doncaster and wanted to train somewhere far enough away to be independent but close enough to get home when I needed to, so Scunthorpe it was.  We didn’t train in university back then, it was to be another 15 years before I went to university. I have never been academic so this journeyhas never been easy but has taught me that with the right support anything is possible. Our cohorts were small, around 15 students, we had fabulous support and encouragement and this was just what I needed. Back in 1989, I had little confidence and very low self esteem, I found my first couple of placements extremely challenging, even answering the telephone petrified me…. “What if they ask me anything??? I don’t know anything!” But with the guidance of fabulous mentors, my confidence grew.

I thrived around the patients, I’ve always enjoyed caring for others, making people comfortable and making them smile. I’ve had much support from people who believed in me and this has made me firmly believe in supporting others. If we take care of each other we can care for our patients better.

My nursing career has taken me all across Yorkshire as a staff nurse, mostly in orthopaedics and A&E and bits of everything as a bank staff nurse when my children were very small, until I found my love of primary care in 2004 in a busy GP Practice, where I spent many happy years and learned so much. I faced several steep learning curves and by now, I developed a love of learning.

This experience was to be a huge asset when I became an Inspector for the Care Quality Commission in the Primary and Integrated Care directorate. I faced another steep learning curve, understanding not only the Health and Social Care Act, but the legal processes and Inspection skills. Having a strong belief for high standards of care together with the confidence I’d built over the years, this role was something I’d never imagined doing but thoroughly enjoyed.

It was a mixture of my passion for primary care and my strong belief for high standards of care that led me into the role I have now, in my home town. I support quality care for a population that I care very much about. This makes me proud and I get to work alongside many strong teams with shared goals and values.

I’ve never had a career plan, just a series of lucky collisions, I’ve worked in areas such as the CQC and CCG which are not the first places people think of if they are asked “where do you think nurses work?” But every step of the way, I have worked with some amazing people, I have seen such commitment, dedication and true passion for patient centered care. I have been fortunate to have met people who inspired me, supported and believed in me and that has made me who I am today. I have been taught by many knowledgeable people who took the time to figure out my kinesthetic learning style and had the patience to show me, often more than once, until I was comfortable. I will always be grateful for that.

So…. How did I get here? Because I’ve been fortunate to be inspired, supported, taught, challenged, empowered and believed in…. All the things I aim to do with others. If we support each other, we can do so much more.

 

My thoughts as a Queens Nurse about the unique benefits and challenges of working in the community?

Why should a nurse choose to come and work in the community? Why am I so passionate about the General Practice Nurse (GPN) role? What are the unique challenges that nurses working in the community face? Well here are my thoughts about this very rewarding area of nursing.

When people think of a community nurse they often think of the “district nurse” who visits patients at home, but there are other nurses in community. There are mental health nurses, school nurses, learning disability nurses, health visitors, midwives and children’s nurses. The area of community nursing that I will focus on here is General Practice Nurses (GPNs) as this is where my experience lies.

The first thought that comes into my mind when I think of the benefits of community nursing is the unique relationships that we not only build with our patients, but their families too. When you’ve worked in a community for any length of time, you get to know who’s related to who, who their neighbours are, who supports who. This information helps us to see the bigger picture and understand who will be affected by any events. This helps us to see who is resilient and who may need extra support. To me this unique relationship that we build with the community is a real privilege, an honour to be involved in people’s lives. Of course we do have the one off patients, but making their experience of primary care a good one, also leaves you with a huge feeling of job satisfaction.

Working in a community also means that we get to know the other services available and we can signpost people to these, such as dementia support cafes or children’s playgroups, food banks and befriending services. This enables our patients to build support structures and improve resilience.

A challenge of this unique relationship is the bonds we develop, based on mutual trust and understanding. These bonds encase these therapeutic relationships and enable us to influence and inspire our patients, empower them to self care where possible and educate them around when they need to seek advice. But these bonds also mean that when any of our patients die, we can’t help but feel sad. But we can balance the sadness with the thought that we did our very best to ensure that they had the best possible care and advice while they were alive and that they were supported to make, and included in, decisions about their care.

Community nursing is autonomous and carries much responsibility but the impact that we can have, not only on the lives of our patients but our community as a whole, is vast. As a general practice nurse,  we work with all generations, from babies and children coming for immunisations, to young families, those who have retired and the elderly. Everyone has different needs and the services have to develop to meet these needs in the best ways that they can. This can be challenging, it’s not easy to fit around everyone.

In a nutshell, nursing in the community is challenging but incredibly rewarding. It is a role that has a wide impact and is a valuable platform for health education and proactive care, preventing avoidable hospital admissions and caring for patients in their own homes and maintaining their own routines.

It has been a real honour to be involved in the lives of my patients and I truly hope I have made a difference in the community. It was due to this passion for great care that I proudly became a Queens Nurse in 2008. The title of ‘Queen’s Nurse’ is available to individual nurses who have demonstrated a high level of commitment to patient care and nursing practice. This brings together community nurses with common values in a network where we can develop and grow with each other’s support for the benefit of our patients.

As a nurse of almost 3 decades it was a holiday on the Greek Island of Lesbos in 2015 that really opened my eyes!

 

As a nurse I thought I’d seen it all, but one of the most heart wrenching times was with my family in 2015.

We arrived in Lesbos in August 2015 just as the refugees from Syria and other countries started to arrive. It was scorching hot! As soon as our beautiful air conditioned coach left the airport we saw people sleeping at the road side. There were families, children, elderly people, huddled together for comfort.

We arrived in our comfortable appartment and unpacked for our holiday but the picture of these people stayed in my mind.

I spoke with my husband (who also a nurse) and our then teenage children and together we decided to try and help as many people as we could.

We hired a jeep and filled it with bottles of water and biscuits (the most dense calories in lightweight form that we could find) it was scorching hot as hundreds of people were landing exhausted on the beaches.

Life jackets were strewn at the side of the roads, hundreds of them, all signs of how many people made the perilous journey.

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We met so many people, from war torn Syria as well as other countries such as Eritrea, teachers, doctors, professional people, pregnant ladies and those carrying tiny babies, walking in the midday sun. We came across a family with two daughters climbing down a steep hillside and I went to climb up to meet them with water. The father of the family was more concerned that I would fall and told me not to climb. This family had trecked hundreds of miles and faced fear that I could never comprehend, but they didn’t want me to fall. Many were also concerned about me burning in the sun (I am very fair skinned).

One family with children had paid the same amount of money for the crossing in an overcrowded inflatable boat that we had paid for our lovely holiday! I felt very humble. Sheer desperation had led them to risk everything to find a better life for their children.

We made sure everyone was at least well hydrated before they made their way to the refugee centres and wished them well. My  children were fabulous and the experience certainly made them see how fortunate they are, not only for their comfortable beds but that they had freedom of movement across Europe, they were safe at home and have access to an excellent education.

We collected clothes and sun cream for the refugee centre and although we didn’t do as much as I wish we could have done, I hope we made a small difference to those landing on the beaches after a frightening journey into the unknown.

The people of Lesbos were amazing, Greece was in dire straits financially but the people shared what they had to help the regugees. In the past, many Greek families have had ancestors who were refugees themselves, so they really try to understand the plight of the people arriving on their shores.

It was during our time on this island I saw humanity at its most basic. I understood the huge importance of sharing water, the impact of a smile, a hug and a handshake. I saw what “just being there” really means.

Lastly, I met the most beautiful little girl who was about three years old called Mariam. She had a smile that will stay in my mind forever. I hope that she and her family have found the safety and freedom that they risked everything to find. I hope that they are treated with kindness and understanding wherever they may be.

https://www.thornegazette.co.uk/news/refugee-crisis-doncaster-council-agrees-to-open-its-doors-to-syrian-asylum-seekers-1-7449403

 

A brief history of General Practice and the ever evolving role of General Practice Nursing

Prior to 1948 most General Practitioners (GPs) worked independently, usually from a room in their own home. There were few, if any, staff and the duty of answering the phone usually  fell to the GP’s wife (most GPs were male at that time) or housekeeper.

When the NHS was first formed, back in 1948, GPs were appointed as independent contractors. This meant that GPs work for the NHS but as an independent contractor rather than an employee.

There was a framework already in place, Lloyd George’s National Insurance Act of 1911 gave limited health cover for working men but this did not include their families. Anyone not covered by the scheme had to pay to be seen by the GP and for people who could not afford to pay, they would leave conditions until they became unbearable or often fatal (although I have heard stories from my grandad that locally, the GP would see family members for payments in kind, such as, putting a new tyre on his car or in my grandad’s case, doing some building work).

The scheme at this time was run by local insurance committees who held a panel (or list) of doctors who were prepared to work under the scheme. These doctors worked under “Terms of Service” which were later lifted directly into the NHS GP contract. The NHS also adopted the medical cards which were issued by the local insurance companies and the record system which was made up of a set of cards in a “Lloyd George envelope” which interestingly are still found in the filing system for any paper patient notes.

Overnight General Practice was given the responsibility of providing medical care for the entire population from birth to death. This also involved being the gateway into hospitals and specialist care. Within a month 90% of the population had registered with a GP. The GP was responsible for the care of their patients 24 hours a day, 7 days a week and 365 days a year. Any failure in that provision could result in fines or “withholding of remuneration” from the Medical Service Committee.

It’s hard to imagine the immense pressure on GPs and this was highlighted in the Collings Report of 1950, which showed  conditions for GPs were not good and they were isolated from other professionals. At this point there were very few nurses in general practice, besides the occasional GPs wife with nurse training. Understandably some of the care provided was described in this report as being poor.

It wasn’t until 1966 that the first contract between GPs and the NHS were drawn up. This included funding for support staff, including nurses, so the role of General Practice Nurse was born.

In the early days, nurses were usually employed to work in treatment rooms. Often alongside reception and administration work.

They undertook general tasks such as dressing wounds, taking observations such as weighing patients, taking their pulse or temperature, obtaining specimens and testing urine (Cartwright and Scott 1961). These tasks will have been as instructed by the GP and it was unlikely that nurses were at this stage involved in the holistic care of the patients.

It was thought that any extra training was not required as none of the skills required exceeded those of any Registered General Nurse (RGN) and this was mainly the case until the 1980s. The role continued to evolve to include screening and health promotion.

With changes in the GP contracts with the NHS, both in 1990 and 2004 the role of the General Practice Nurse began to develop further. The management of long term conditions such as asthma, chronic obstructive pulmonary disease and diabetes became central to the General Practice Nursing role. This brought with it the requirement for additional training and support.

General Practice Nurses have embraced this rapid expansion of their role and developed new skills, knowledge and networks.

The Royal College of Nursing (RCN) Practice Nurse Forum lobbied for specialist practitioner recognition from the United Kingdom Central Council (UKCC) in 1994, however although accepted this did not result in a recognised qualification.

As the General Practice Nurse role continued to develop, many developed skills in managing patients with undifferentiated diagnoses and patients needing urgent care. This led to the development of Advanced Practice Nurses and Advanced Nurse Practitioners, examining, diagnosing, prescribing medication and referring to secondary care and other services.

In only a couple of decades, the roles for nurses in primary care have grown beyond recognition. There is now a wide variety of nursing roles within primary care, working alongside the rest of the multidisciplinary team.

The introduction of the Health Care Assistant (HCA) role into the multidisciplinary team in General Pratice has contributed a great deal to the care of the population and the development of the multidisciplinary team. The Shape of Caring review (2015) chaired by Lord Willis describes the intention to improve the capabilities of Health and Social Care Assistants and to promote structured career development for these increasingly important members of the staff team. This began with the introduction of the Care Certificate.

https://hee.nhs.uk/our-work/shape-caring-review

http://www.skillsforhealth.org.uk/standards/item/216-the-care-certificate?gclid=EAIaIQobChMIhaGi8_v23AIVAp7VCh0WMQKlEAAYAyAAEgKuy_D_BwE

From being quite isolated in the 1950s, GPs are now surrounded by a whole multidisciplinary team. Besides other health care professionals (such as paramedics, Emergency Care Practitioners (ECPs), Physiotherapists, Pharmacists, Physician Associates and many more) there are various nursing roles, treatment room nurses, general practice nurses, advanced nurse practitioners, minor illness nurses, triage nurses and nurses with an array of skills that are far too many to mention.

Stronger regulatory and governance mechanisms were introduced with a requirement to register with the Care Quality Commission (CQC) by 2011 and to show evidence of compliance with the Health and Social Care Act 2012.

The Health and Social Care act of 2012 brought the introduction of Clinical Commissioning Groups (CCGs) led by GPs responsible for the commissioning and delivery of health care. Nurses are involved in the commissioning of services and monitoring quality of services, something that could not have been imagined in 1948.

The Five Year Forward View (2014) describes the need to change the ways that care is delivered and suggests new ways of working.

In March 2017 Health Education England (HEE) published it’s General Practice Nursing Workforce Development Plan. This recognises that General Practice Nurses have a vital role in driving innovation to meet the changing needs of people in their communities. This document looks at four key areas, including raising the profile of General Practice Nursing as a first career choice and dispelling the myth that newly qualified nurses cannot work in primary care, improving access to training, supporting career progression and standardising training and career pathways.

The NHS is 70 years old this year and general practice has evolved So much in this time. The role of a nurse in primary care has grown into a selection of roles. Nurses hold a key position within primary care, often reducing the stretch on GPs. Along with all these changes and expansion of skills for nurses, it has to be acknowledged that the GP’s role has also evolved and developed to allow patients with more complex needs to be cared for in primary care. Care is being provided by General Practice that even only a decade ago would have been carried out in hospitals. The population is living longer and for most, the quality of life has improved, although this can be attributed to the care available because of the NHS, this also adds extra pressure on the service.

General Practice Nursing is, in my opinion, the most rewarding, patient focussed role with a variety of exciting career development opportunities.

What does the future hold? I imagine the use of technology will become more common such as virtual consultations. I am in no doubt that nurses will continue to develop new skills to support practices and benefit their patients and that primary care will remain an exciting place to be.

References.

Baird B, Charles A, Honeyman M et al. (2016). Understanding pressures in general practice. King’s Fund, London

Cartwright A, Scott R (1961). The work of a nurse employed in a general practice. Br Med J 1(5228): 807-13

Queen’s Nursing Institute (2017a).Transition to general practice nursing. https://www.qni.org.uk/wp- content/uploads/2017/01/

The King’s Fund (2015). The NHS five year forward http://www. kingsfund.org.uk/projects/nhs-five- year-forward-view?gclid=CL Kx6eqv7sYCFYvHtAodIhcLSA

The Kings Fund (2011) The evolving role and nature of general practice in England.

 

A reflection on the last 30 days of the Perceptions of Nursing and Midwifery Blog Challenge.

Well, the first challenge is over. As an ambassador for changing perceptions of nursing and midwifery, I started this blog a month ago. I’d never really thought about attempting to write a blog but now I’m so glad that I did. This challenge enabled me to write about some really exciting aspects of my career, I’ve reminisced, reflected and even shed the odd tear, but above all I’ve thoroughly enjoyed it. I hope anyone who has read my blog has enjoyed it and if my ramblings have made one person want to be a nurse then I’ll be really happy.

I’d like to thank everyone who has supported me with this, my wonderful work colleagues at Doncaster CCG (Thank you Rachael for encouraging me), Bev Matthews, Transformation associate at NHS Horizons for all her support and endless encouragement as well as the rest of the NHS Horizons team. I’d like to thank my friends who have sense checked my ramblings and my children for helping me to set up the blog account in the first place (teenagers do come in useful after all). I’d also like to thank my fellow ambassadors for all their support and encouragement. Last but certainly not least I’d like to thank everyone who took the time to read my blog.

I’d like to thank all the people (I’ll never be able to thank them enough) who have inspired and encouraged me over the last three decades, everyone who has believed in me and saw potential that I couldn’t see. I’d like to thank past colleagues and everyone who has taught me and pushed me out of my comfort zone.

This blog and the different daily challenges have allowed me to show the exciting journey that my career has taken.  The awkward teenager with no self confidence who grew up in a mining village and who was told by a teacher that she wasn’t clever enough to be a nurse is now the happy, positive Lead Nurse for Primary Care Quality at Doncaster CCG. Anything is possible with the right support, encouragement, inspiration and challenge!

I can honestly say I have never regretted my choice to be a nurse and I’ve met some amazing people along the way. I’ve met some of the strongest people I have ever known because my job, both staff and patients, I’ve been humbled so many times.

I made friends for life with the nurses that I trained with and many people that I have worked alongside over the years. I’ve learned so much from so many people and writing this blog has really made me see this.

So thank you again and most of all thank you for the challenge.