Q&A Session – Junior Nurse Fellows
A question-and-answer session with our new Junior fellows working at the Lincolnshire Training Hub.
Recently, the Lincolnshire Training Hub (LTH) recruited for four fellowship positions. Two General Practice Nurses, Sarah and Lucy became fellows and joined LTH in September. Their working week involves them doing their normal day job alongside working at LTH. Their fellowship also has an educational piece. They are both working towards a Post Graduate Certificate in Clinical Teaching and Practice Education. Here is the Q&A session we did with them to find out a bit more about them:
So, how did we get here? Can you all talk about your background, did you do anything else prior to Nursing?
LUCY: I did not have the most direct journey into nursing. When I finished school I had a part-time summer job as a kitchen and domestic assistant in a nursing home. This role made me realise that I wanted to do something where I could work with and help people, but I had no idea in what capacity. I went to University to do an undergraduate degree in Human Communication Sciences and was offered a unique chance to be the first person to convert from a 3 year to a 4 year course and have a year working gaining employment experience. I took this opportunity and worked part time as a care assistant in a residential home and part time as a teaching assistant, both of which I loved. After completing my degree, I went on to do a PGCE with the intention of being a primary school teacher. After an unexpected bereavement in the family just before my final placement, I deferred, and then took a temporary job as a domiciliary care assistant whilst waiting to complete the final stage of my training. Although I went back to complete my course, I realised that I had found my vocation working in health care. From my personal experiences I had realised the difference that having ‘good’ health care professionals can make to patients and their families and I wanted to help to improve the experiences of others. Fortunately, my previous qualifications and experiences meant that I was able to embark on a 2 year post-graduate diploma in adult nursing and in 2014 I achieved my goal of becoming a registered nurse.
SARAH: I was late in to nursing, I originally did reception jobs or basic admin. I worked at City Hospital, in Nottingham on the Urology ward as a receptionist, I spent more time with the patients than I did at my desk, I loved being with the patients and helped where I could. I completed my access course and started Lincoln University in 2012 in adult nursing. I find academic study difficult but enjoyable.
What has been your career to date?
LUCY: After qualifying in November 2015, I worked in hospitals on medical wards until I started my practice nurse training in Spring 2019. Although I was initially full-time, I went part-time after having my children and then undertook other part time jobs to broaden my experiences. I began working for an agency providing nurse cover in nursing homes. I also worked as a long-distance tutor, marking work for health care professionals undertaking long distance learning modules. After looking for practice nurse jobs for a long period of time and only seeing vacancies for ‘experienced’ practice nurses I had almost given up on my dream of becoming a practice nurse. However, just before Christmas 2018 I discovered a job advert for a temporary trainee general practice nurse. The job role was a 9-month position which involved completing a Postgraduate Certificate in General Practice Nursing at university whilst working in a general practice. I jumped at the chance to apply for this and was successful in securing a position. After completing my 9-month course, I was offered a permanent post at the general practice surgery where I am now based.
SARAH: After qualifying in 2015, I started working at Kings Mill Hospital in the A&E department. Although I loved my job, I found it hard not spending time with my patients and moving on very quickly to my next patient without sorting out my first patient.
I decided to leave Kings Mill in 2018 and join general practice, but found it very difficult to get into. Every advert stated experience needed. I was then lucky enough to send my application form to a surgery and eventually got an interview with them, and although I had no experience, they said I would fit in with the team well and were prepared to train me. I have worked there ever since!
Why general practice?
LUCY: When I studied nursing, more than half of my placements were in the community and I chose to do my management placement with the community team. I loved working with the patients and helping them to manage their conditions at home in order to avoid hospital admissions. At the time I did my nursing training there were no placements available in general practice, but I was able to do some insight days with practice nurses. I had no idea about the wide range of areas that practice nursing covered and found my time with them fascinating. When I was coming to the end of my training and starting to apply for jobs, I was strongly advised that all newly qualified nurses should work in a hospital setting first before going into primary care. Following this advice I started my career in the hospitals and whilst I enjoyed my experiences there I knew that I wanted to be working in primary care, supporting people to manage their own health in the setting of their choice. Whilst contemplating making the transition into primary care I accompanied a family member to an appointment with a practice nurse. I was left in awe of the practice nurse’s knowledge and the amount of health education she was able to provide in a relatively short appointment. I was so impressed, that by the end of that day I knew what I ultimately wanted to do and was researching how to become a practice nurse.
SARAH: I love being able to spend time with a patient, asking questions and gaining knowledge about their health, enabling me to give the best advice. Although we have an appointment system, if I have a poorly patient, I can spend more time with them and give them help when needed. I love the variety of appointments and all the training in primary care.
What do you enjoy the most about general practice?
LUCY: I love the variety of work in general practice and the range of ways in which we provide help to people. There is nothing more satisfying than feeling that you have been able to make a difference to someone, however small it may be. I also enjoy being able to have one on one time with patients and being able to follow up with them to see how they are managing with their health conditions.
SARAH: I love the variety of work, getting to know my patients and extra training. I am also a big advocate for women’s health and try to promote it when possible. I love getting to know my patients and having a good rapport with them to help give them the best health advice.
Where do you think the main challenges are for general practice both now and in the future?
LUCY: Recruitment is a problem in general practice. Due to improvements in health care we have an ever-growing population with an increasing amount of health promotion, education and management needed. This requires an increase in staff and resources. NHS England research found that a large proportion of practice nurses are expecting to retire soon, and this will mean that we need an increased focus on recruiting and training new staff.
SARAH: As I mentioned when I was trying to join general practice it was very difficult, there are many practice nurses due to retire over the next couple of years. Unless we start recruiting and retaining our nurses we will end up with a massive shortage. Another problem we face is the varied pay and conditions from practice to practice. Unless standard pay scales, agenda for change and employment conditions are put in to force throughout general practice, I believe we will lose many more nurses.
You started the fellowships during COVID, how has it affected your day-to-day practice and fellowship activities?
LUCY: COVID has affected many things. It has led to new ways of working in practice. However, many things have become a new normal in the sense of wearing more PPE and increased cleaning and IPC procedures. I applied for and was accepted onto the fellowship when COVID was already a big presence in our lives, so it is hard to know completely how different the fellowship would be without COVID. I feel that the main effect that COVID has made to my fellowship is having to use different approaches to communication, and I have had to become more up to speed with technology to attend regular online meetings rather than face to face meetings and even to give online presentations.
SARAH: I am not very technical and find team meetings frustrating. I am a friendly person who enjoys meeting people and getting to know them face to face. I think it is a shame we could not all meet up and enjoy our fellowship working together. Fortunately, despite this, everyone at LTH have been very supportive and helpful when needed.
You are working on some projects during your fellowship, can you explain what they are and why they are important?
LUCY: My project is focussing on the provision of more placements for students in general practice. There are many misconceptions about practice nurses, for example that it is an ‘easier’ job, or that it is better suited to nurses coming up to retirement. Providing more exposure for students to general practice would help to break down some of these myths and raise the awareness more of what practice nurses do and the incredible amount of training, skill and knowledge involved. Recruitment and retention are ongoing problems in general practice and there is a need for more practice nurses. Enabling students to have placements in general practice can help to encourage more new nurses into primary care as they can gain insight into the range of things that we do. They can also see the potential for career progression within the role as there are so many areas that a GP nurse can choose to train and specialise in. Providing more placements can also help potential employers. Not only could it increase the numbers of potential new recruits, but placements also mean that we can provide the student nurses with some of that much desired experience in general practice. So many job adverts specify that a vacancy is for an experienced nurse, yet how can a nurse become experienced if they are not provided with such opportunities?
SARAH: My project is to research and design a new preceptorship programme for all newly qualified nurses going into general practice. In secondary care, every newly qualified nurse must complete their trust’s preceptorship programme before being allowed to fully be in control of their nursing career. General practice does not yet have such a programme. Currently nurses who are new to primary care do not have a standardised preceptorship pathway. LTH is working towards this to ensure that these nurses are fully supported and undergo a standardised, fundamental general practice programme to enable them to develop their clinical skills and knowledge and become competent practitioners.
Why should people choose general practice as a first destination for their career?
LUCY: General practice nursing is amazing and has so many possibilities! There are so many different aspects to general practice nursing, our day is never boring! You get to see so many different patients but also have allocated time to give them that one on one care that we as nurses strive to provide. There are so many areas that you can train in and so much knowledge to learn. I personally have found that there are so many fantastic training opportunities open to practice nurses, you can choose to specialise in the areas that you are interested in and passionate about.
SARAH: Many nurses working within the hospital allow their careers to become stagnated, with very little advanced training or new skills. General practice offers such a wide variety of skills and knowledge from day one, progressing and developing new skills. You learn to work autonomously in your practice but also have a team behind you if needed.
What are your plans for the next five years?
LUCY: I hope to have my own students to guide through general practice. I am also completing further training to be more involved in the supervision and assessment of nurses to carry out potentially life-saving cervical screening. I am also keen to continue to develop my own skills and knowledge and hope to complete more training in long term conditions such as diabetes. Through my fellowship I hope to complete a postgraduate certificate in clinical teaching and education which I hope will enable me to combine my interest in teaching and education with my love and passion for nursing.
SARAH: Firstly, complete my fellowship with the LTH and complete my Clinical Education PGCert. I will then be able to mentor and support the next cohort of fellows as and when needed. I then plan to complete a diabetes diploma. In addition, I will also complete any other courses available to advance my clinical skills, to help other students/nurses within general practice with upskilling.
For more information, please see the LTH website: https://www.lincolnshiretraininghub.nhs.uk/
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