“I realised at a young age that simple conversations, listening and reassuring people…”

“…could provide real comfort and have a positive effect on patients.”

In this blog, Advanced Nurse Practitioner, Iain discusses his experiences in nursing, shares his advice for newly qualified nurses and highlights key issues faced by nurses and the nursing profession.

When did you first realise you were interested in working in healthcare?

Health and medicine has always been part of my life. Until retirement, my dad was a GP and my mum a neonatal nurse, so I grew up seeing the realities of working in healthcare on a daily basis. I realised at a young age that simple conversations, listening and reassuring people could provide real comfort and have a positive effect on patients.  

At 17, I travelled to southern India where I volunteered in a medical programme. This was my first practical experience of healthcare and it was truly eye opening. 15 years later, the suffering I saw is still a vivid memory. Whether it was a farmer suffering the agony of having a patch of gangrene excised from his leg under weak anaesthetic because an amputation would condemn him to poverty through an inability to work, or a man with a severe eye infection because leprosy made it impossible for him to close his eyes,  I realised that helping people by providing healthcare was my passion.

What made you choose nursing?

My mum showed me what a difference nursing could make and I wanted to play my part in that.  As cliché as it sounds, I simply want to help; to do what I can to make someone sick feel better, to make a frightened person feel safe, to ease the pain of someone suffering.  I knew that nursing would give me the best opportunity to do this. I did consider other roles within health but I was always drawn back to nursing, I think because to me, nurses are the universal constant within healthcare, nurses are the people that patients and families see most often and they are the people therefore most able to help.

I think the other main attraction of nursing for me was the universality of the job.  I loved that one job could cover almost, if not every aspect of healthcare. There didn’t seem to be any area or speciality which didn’t feature nursing.  The prospect of a job which could take me in so many different directions and open so many different opportunities and experiences was extremely appealing to somebody like me, eager to see the world and broaden my horizons.

How did your career begin?

I trained at the University of Liverpool, graduating in 2009.  My training gave me the chance to experience many different areas within both primary and secondary care, but I knew that acute and emergency care was where my passion lay.  My first job was as a staff nurse in a very busy Acute Medical Unit. Those first 6 months were both exhausting and terrifying in almost equal measure. To say it was a steep learning curve would be a supreme understatement. By the end of my second week I was almost ready to throw in the towel.  I felt like I was always playing catch up with myself and everyone else, always caught between what I wanted to do for my patients and what I felt I had the time and resources to do. However, while it certainly didn’t become “easy”, I found that as the months passed, I became steadily more able to cope and by the time the next intake of new nurses arrived 6 months later, I found that I was able to help them and answer their questions, the same questions I had asked 6 months before.  This proof that, contrary to my feelings, I was actually growing in confidence and skill was extremely encouraging and spurred me to continue and become the best nurse I can be.  

Who has inspired you throughout your career?

I have been inspired by many people at every stage of my career.  I have had the privilege of working with some truly amazing people who encouraged and inspired me from my very first day of training with the skill, care and compassion they show each and every day.  Each day I continue to be inspired by the dedication and hard work of the staff nurses I work alongside, doing such a fantastic job, often underappreciated, in incredibly difficult circumstances. 

My goal from the early days of my career was to be an Advanced Nurse Practitioner / Nurse Clinician preferably in A&E, this was because of the people I met early in my career. The existing A&E Nurse Clinicians showed that an experienced A&E nurse can independently assess, diagnose and treat A&E patients at a very high level of competence, covering every presentation from dealing with cuts and scrapes to responding to cardiac arrests and major trauma.  Seeing fellow nurses working at the clinical level of Registrars and Consultants was truly inspiring and set me on the path to my current role.  

What are some of the difficulties that you have encountered as a nurse?

I think the difficulties I have encountered have been the same as I imagine every nurse has, the fear and self-doubt which comes with qualifying, dealing with the inevitable errors that we all make along the way and trying your hardest to do the best for your patients even when the time and resources aren’t there to enable you to do so.  While those personal difficulties do improve with time, experience and expertise, it can often feel like the “big picture” problems never do. As a nurse you are part of bigger team and you can influence that team to change how “the system” works in so many different ways. Just as no individual healthcare professional can manage a patient’s care single-handed, neither can one person on their own change a system, it is through working together with colleagues that we can make a change and improve outcomes for our patients.   Speaking personally, I know that the challenges and obstacles I faced through my career were restricted and ultimately overcome purely and entirely through the support of my colleagues. They are the people who really understand, they truly are your work family.

What would you say to a newly qualified nurse?

If I had to give one piece of advice to a newly qualified nurse, it would be to slow down! Whether it’s preparing that IV medication or planning your career – just slow down. Just take 60 seconds to step back and check what you’re doing, check you’re prioritising things properly, check you aren’t being pushed into making a bad decision because of either how you’re feeling (e.g. tired, hungry, annoyed), what you feel you “should” be able to do or what someone else is expecting of you. No one will notice you taking that extra 60 seconds, but it might just make the difference between a safe and a risky decision.  

What are the main qualities needed to be a nurse?

Being competent and caring are the two qualities integral to nursing, without which you simply can’t do the job. 

Having empathy not only for patients but also for relatives and colleagues is vital in my opinion. For me empathy means being able to put yourself in someone else’s shoes and understand how they must be feeling, only then can you appreciate how best to help them.  

Resilience is something which I don’t think you know you have until it’s tested. It is the inevitable counter balance to the need for compassion and empathy. Resilience is the ability not only to hold it together during those tough shifts when you just want to run away but also to be able to leave all that stress and strain at the door when you leave.  Being able to leave work and not think about what you’ve seen during the day doesn’t mean you don’t care, it just means you can care for yourself too.

If you could change one thing about the health system what would it be? 

I can only speak about the UK and I don’t pretend to be an expert. I think we need to worry less (ironically) about the front door, about A&E and worry more about what happens after people have left A&E, even after they’ve left the wards. Yes hospitals need more staff, yes they need more 24 hour inpatient services but ultimately what we need is less people needing to come to hospital and more people being able to leave. My A&E department will routinely have almost all of its cubicles occupied by patients who should be on wards, if they were, there would be no A&E waiting time to speak of. A&E is not where the problem is, it’s the symptom of the problem.  If there was more and better targeted investment in the “less sexy” side of the healthcare system, intermediate care beds, community social care, residential social and nursing care, the hospitals would be able to discharge medically fit people from wards to where they can be best cared for. This would then enable those patients in my department to get to the wards and the specialist teams best able to treat them. I think this also requires a better appreciation amongst healthcare professionals and society at large for the people who work in the social care sector. The community health professions and most importantly, the care workers, whose dedication and hard work in difficult circumstances and often with little recognition, allow people to continue living in their own homes.  

Why is it important for governments around the world to invest in nurses?

Nurses inhabit every area of healthcare.  It makes sense to ensure that our biggest resource is managed well because it has the biggest reach. Our universality makes us almost a microcosm for the whole health system. If you have well-educated, well-resourced, well-respected and yes, well-remunerated nurses you will inevitably get the best possible service from them.  If your nurses are on top form they will energise and lead your healthcare system. The history of the NHS in the last twenty years is the history of nurses (and other healthcare professionals) stepping outside their traditional boundaries into roles previously thought beyond them and using their wealth of expertise and ability not only to improve the care and well-being of patients but also the effectiveness and efficiency of the system.  With the proper investment nurses can be a large part of the solution to the problems we now face and lead the way to better care and better outcomes for our patients, which after all, is why we get out of bed at 5am in the pitch black of cold February mornings.