A day in the life of a newly-qualified Nursing Associate working in General Practice

Prior to working in primary care, I kept hearing from many other health care professionals that working in General Practice is something that you do at the end of your career when you want to wind down and have an easy life. Fortunately, this could not be further from the truth! I have found that working there is exciting and very rewarding, and no two days are the same because I see and care for a wide variety of patients and conditions in my working day.

About Me:

Prior to training to become a Nursing Associate, I was a Healthcare Assistant for many years. Although I really enjoyed this role, I felt I had reached the limits of this role and wanted to further develop my skills, knowledge and experience as a practitioner. Until the Nursing Associate role was established I felt there was no way to further my career except to undergo a 3 year nursing course at university. However, it was financially impossible for me to attend university full-time. I was so happy when the Nursing Associate apprenticeship was created because it gave me the best of both worlds. I could train “on the job” as a Nursing Associate apprentice, attend university and placements in a variety of settings ranging from the community, acute care and other health and social care settings and be paid a full-time salary!  There is no way I would have been able to become a Nursing Associate without this new career pathway.

My Career to Date:

I qualified as a Nursing Associate at the end of August 2021. I was the first qualified Nursing Associate in General Practice in Lincolnshire. When I qualified, I started a 2 year Nursing Associate Preceptorship Programme with the Lincolnshire Training Hub. This preceptorship has been really valuable in my view, because not only does it provide support in terms of being a “go to” place for clinical practice advice it also offers me additional training opportunities such as cervical cytology and chronic disease management courses. Also the Training Hub has been providing guidance and support to my practice manager and wider nursing team to help them to fully embed this new role in the practice.  I am currently undertaking cytology training and will soon be starting an introduction to asthma course.  This preceptorship is available to all newly qualified Nursing Associates working in General Practice.

My Working Day:

I typically work 8.30-6.30, three long days a week, with the occasional late night clinic and an occasional Saturday every couple of months. Working this type of pattern gives me a great work/life balance because I know well in advance what I will be working. In addition, I never have to work a bank holiday!

So for me, my typical day as a Nursing Associate starts between 8 and 8.30. I spend that time looking at my clinic list, gathering any equipment that is needed and ensuring that any paperwork needed has been completed prior to the patient attending their appointment, for example, needing a patient specific directive (PSD) to administer medications or vaccines. If no PSD are in place, then I ask either the duty Doctor or a Nurse prescriber to complete the PSD, for me.

My first patient of the day normally attends at 8.30am.  I see patients for all sorts of reasons. Some may require blood tests, others may also attend for chronic disease reviews such as Diabetes, Hypertension, Strokes and Coronary or Ischaemic Heart Disease. I also see patients for learning disability mental health reviews and carry out routine contraception reviews including administering contraceptive injections. I am also trained in wound management, performing routine wound care such as suture and clip removal, as well as managing more complex wounds such as chronic leg ulcers and complex post operative wounds that may require more intervention such as needing packing to promote secondary intention healing.

I also assist the GPs in minor operations and contraception fitting clinics. My role in these clinics is to set up all the equipment that is needed as per infection control policy, including supplying the GP with any equipment throughout the procedures undertaken. My other role in this is assessing and monitoring the patient throughout the procedure as well as reassuring them should they need it.

In addition to assisting the GPs, I arrange any follow up appointments with the patients and answer any questions they may have about self-caring post procedure such as providing after care advice including the importance of monitoring for post-operative infections. After every procedure undertaken, I am responsible for counting in and disposing of any equipment used.  I also clean down the procedure area between each patient and at the end of the clinic.

Typically, I see around 20 patients in a morning clinic, and 15-20 in the afternoon clinics. Appointment slots range from between 10-30 minutes depending on what is booked in. During the period between morning and afternoon clinics, I either go out on home visits to house-bound patients that do not fall under the remit for the community nursing teams, or complete patient referrals for them to be able to access additional care such as podiatry and weight management services.

Regards the practice supporting my preceptorship, the surgery has an open door policy regards patient care delivery. This means that when I need care guidance, I am easily able to seek support from any of the clinical staff throughout the day. The nursing team also has lunch together each day to catch up with each other regards the patient care they’ve been providing, obtaining follow-on care advice as needed. In addition, at the end of every working day, I have time allocated in my clinic for debriefing with my in practice supervisor talking through my day, discussing the care I have provided and signing off some competencies in my preceptorship workbook.

I also have some general administration to do, this includes restocking clinical rooms, checking fridge temperatures, and ordering any stock that is needed. Taking responsibility for this helps to ensure that the practice runs smoothly and that clinicians have all the equipment they need to provide effective patient care.

Other duties that I do:

Some of the work that I do within General Practice can be seasonal in nature, such as helping to deliver the annual influenza and the COVID-19 vaccination programmes. I really like this work because I enjoy promoting the importance of having these vaccines, explaining to patients how the vaccines protect them and the wider general public.  The seasonal influenza vaccination clinics are sometimes challenging, yet a lot of fun! At my surgery, we hold open clinics over the weekend. It is very fast paced, so it makes the day go very quickly. I also found the COVID-19 vaccination clinics very rewarding. It was nice to see so many patients who were extremely grateful for the care we have provided during COVID-19 as well as being pleased they are receiving the vaccination and saying that they are able to get their life back now and start seeing their loved ones.

I am also training to be a cervical cytology sample taker. Since qualification, my practice has been keen to extend my skills further. This is because the management team have seen the value of a Nursing Associate in practice from the very start of my NA journey. The advantage of this for me is that not only does it increase my skills and knowledge in areas that I would not have been able to carry out if I had stayed as a Healthcare Assistant, it also means I can support the nursing team even further and see more patients, easing their clinical burden. In addition, it also assists with the achievement of practice targets concerning cytology screening.

My Career Development Opportunities are Amazing:

It is important to mention that besides undergoing cytology screening training, there are so many other career progression opportunities in this role.  These include delivering children’s immunisations, and obtaining diplomas in chronic diseases such as asthma, COPD, diabetes. I have also recently taken on a new leadership role supervising and teaching other students and Nursing Associate apprentices as well as supporting other new staff to General Practice. I am also a highly proactive Nursing Associate Ambassador. In this role I work with practices, PCNs and potential Nursing Associate apprentices to support them in realising the huge benefits this role can provide in General Practice.

Being a Nursing Associate in General Practice is a very rewarding role, as you are very much part of the nursing team and very valued. Also due to the role being fairly new in General Practice, you will be directly involved in shaping its future.

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