By Sarah Wanless, Matthew Brooksbank and Victoria Bright
Sarah Wanless – perceptions of a new practitioner in role
“I have recently transitioned from my role as a ‘triage nurse’ into a ‘junior nurse practitioner’ at the Urgent Treatment Centre.
Previously I worked in Edinburgh and Aberdeen in medical admissions, medical day case, ambulatory care and the A+E observation ward before returning closer to home to work at SSU/EAU and then finally UTC.
Whilst there have been a number of challenges in establishing myself as a new practitioner at UTC I have ultimately enjoyed the experience until now and would recommend UTC as a place to work for anyone beginning in their career.
One particular challenge was navigating the Covid-19 pandemic. This period resulted in my redeployment twice at a time when I was trying to consolidate clinical skills, balance university study with full time employment and learn the requirements of my new role. Although this was difficult at the time it has helped me to manage my time better and allow me to more readily adapt to changing circumstances within the service.
There is a great deal of support at the UTC and for anyone within the team starting out in their career.
Colleagues are encouraging with regards to supervised practice and developing clinical knowledge and experience for both minor illness/injury of both adult and paediatric patients. For example, there is the opportunity to undertake the adult and paediatric clinical skills course, ILS, PILS, prescribing, IRMER training and clinical supervision/shadowing with the GPs.
Once settled in my new role my own goals looking forward are to complete the minor injuries and minor illness course, complete the non-medical prescribing course and also go on to achieve a master’s degree and ultimately a band 7 post.”
Victoria Bright – an experienced junior practitioner ready for promotion
“I am a Band 6 Junior Nurse Practitioner in the QE and Blaydon Urgent Treatment Centres. Our service is made up of Nurse Practitioners, Band 5 Triage Nurses and Health Care assistants. We are a very busy department, and no two days are the same, our friendly team work closely to support each other in such a fast paced and changeable environment. We work 12.5 hour shifts and see patients in appointment slots. Appointments were recently introduced to the department to bring us in line with the NHS Urgent Treatment Centre standards and also assist during the covid pandemic with social distancing.
Our goal as a service is to provide quality, safe, evidence-based patient care and to work to continually improve our services for patients.
Patients can obtain an appointment prior to arrival by calling 111, those with injury presentation are given telephone triage by a UTC nurse and an appointment booked. Patients who self-present ‘walk-in’ will be assessed by one of our Triage nurses and given an appropriate appointment slot, this may involve leaving the building and returning, which helps us maintain space in our waiting room and protect patients and staff with social distancing.
The main conditions seen are suspected broken bones, sprains and strains, minor burns and scalds, minor head injuries, we also see minor illness including simple UTI, sore throats, ears. We work alongside General Practitioner colleagues from GatDoc to see and stream patients with illness presentations requiring GP assessment, during covid this has involved telephone callback appointments as well as face to face appointments to safely manage the patient workload in keeping with infection control guidelines.
As Nurse Practitioners, we work in an autonomous role and are constantly learning and developing our skills and maintain our own learning portfolios to demonstrate competence and experience within the four pillars of advanced practice. We develop ourselves professionally and gain extended qualifications which allow us to assess and examine patients, use clinical decision making, request and interpret x-rays and prescribe medications which enhances the patient journey in providing timely care.
As a department we encourage continual learning and development and take part in audit and clinical supervision, personally I have continued to extend my own learning and have recently completed a MSc Advanced Practitioner with Teesside University and have been supported by our Clinical Lead Practitioner to do this with a view to career progression to a Senior Nurse Practitioner role.
A typical journey of a patient presenting with an injury would involve Triage assessment where a patient would be given any essential first aid, such as pain relief, slings/splinting, history taking and examination by a Nurse Practitioner, the journey may then involve x-ray examination, meaning that as Nurse Practitioners we manage several patients at one time in order to maintain our appointment times. As a Nurse in UTC good organization and time management and the ability to prioritise is essential. The patient would then be reviewed, and any treatment required, such as wound closure, including suturing, wound dressing or referral to speciality for example orthopaedic review, before discharging the patient with any advice and follow up needed.”
The patients we see in UTC present with increasingly complex needs, particularly with significant past medical histories and complex underlying conditions and pathology therefore we are constantly learning and advancing our skills and knowledge. As Nurse Practitioners we also see injury in children over 1 year old and undertake extended training in Paediatric clinical skills as part of our development.
As part of our role as Nurses we take opportunities within our consultations to empower patients with knowledge of services and basic first aid skills, for example which services to use and when to guide patients to the correct level of care and treatment and helps us to deliver the right care to the right patients first time.
Matthew Brooksbank – a reflective practitioner nearing the end of his career
I have been a qualified nurse for 37 years and my background has largely centred around Accident and Emergency, General Medicine and Cardiothoracic Surgery. I have worked in a number of Accident and Emergency Departments across the country as well as a period of working as a member of the Trauma Response Team in Northern Ireland during the days of civil unrest. I have worked for Gateshead Health NHS Trust since April 2015, in the role as a Senior Nurse Practitioner based in the Urgent Treatment Centres at Blaydon and the Queen Elizabeth Hospital. Since December 2020, I have acted up as the Interim Lead Practitioner for the Urgent Treatment Service.
Taking on the role in these very challenging and uncertain times has enabled me to build on my inner resilience to lead and shape our service through significant changes in our delivery of care. Since the onset of Covid 19, we had to close our remote service at Blaydon for 8 months to support our service on the Queen Elizabeth site, and in addition, support other critical care areas through staff redeployment for a significant length of time. We have also developed, in partnership with our primary care partners, Community Based Care and NHS 111, an appointment service and telephone triage service undertaken by both Nurse Practitioners and General Practitioners for patients with injury and illness. This has been a total change in our working practice and has at times been challenging, but has been met with a ‘can do’ attitude.
The past two years have been a period for us all to reflect on our lives both personally and professionally. I feel blessed that I have had job to go to every day, when other people have lost theirs. I feel privileged to work with a team of people who work hard and I feel grateful to have worked for the NHS for so long in an autonomous role where it has allowed me to study to Masters level in Advanced Clinical Practice and Business Administration and has also allowed me to qualify as a teacher and become a Fellow of the Higher Education Academy. The Nurse Practitioner role opens many doors, and as the years keep on rolling by, the role will mutate over and over again. My work ethic has always been to work hard. I will always be a clinician before a manager and I always try to do what’s right and not what’s easy.”