Making the transition from NHS to flight nurse: Fasten your seatbelts!
JOANNE MAYHEW says the challenges are part of the fun - here's her take on moving into a new field of practice.
I was so excited about starting my new position as an in-flight nurse that I hadn't even considered the challenges of coming from the NHS to the private sector and into a completely different aspect of nursing. It all soon became clear what I was to encounter!
The main difference I have found from the NHS is that you are more autonomous. On a repatriation no-one else can see the patient. They are relying on your judgements so can only offer advice based on your findings (for example, the company doctor by phone), but at the end of the day it's your decision and your actions that determine the patient's outcome.
For me this is part of the excitement of the job: being autonomous gives you more responsibility although it can also bring additional stresses.
One-to-one care
On the positive side you are able to do a lot more for your patient on a level that is not possible on a busy ward. You have time to care for your patient on a basic level and listen to their worries and concerns.
The culture abroad is different and in a lot of countries, the families are expected to do the basic care. So especially if your patient is alone, there is so much you can do for them that will make a big difference to how they feel - for instance, you can help wash a patient, wash their hair or even just comb it.
Another significant difference is that patients are always pleased to see you and so appreciative of your work, even if you feel like you haven't assisted much. It means so much to them to be able to go home. I have had patients say to me, "Thank you so much for coming all this way especially for me!" As we all know in the NHS, more often than not it is the complaints that we hear about most!
Getting to grip with logistics
Issues that may arise on the repatriation are often logistical rather than medical. NHS work does not prepare you for this - it comes with experience! Much of the time you cannot do what you would ideally like to and an alternative or compromise needs to be found, which can be especially tricky when dealing with authorities.
Also a lack of equipment or resources results in having to improvise to achieve the best level of care possible. Things that are readily available to you in the NHS are not there on repatriations so you have to put your thinking cap on.
Insurance is not the same as National Insurance
The other side of flight nursing is the office-based assistance. We are governed by what the patient's insurance policy covers them for and this can limit what you can do for them. This can be extremely difficult, especially when you have relatives crying down the phone to you, begging you to do what they wish for their relative, whereas in the NHS we will be doing everything we can for the patient regardless.
Tying in with that is having to deal with clients who for some reason or another are not covered at all by their policy - for example, they didn't realise they had to declare their past medical history or were injured or became ill under the influence of alcohol or drugs.
Also in the office, one of the main differences from the NHS is the amount of computer work. The whole day in the office is computer based so you need to have basic computer literacy skills. In the NHS we know how hard it can be sometimes to track down a doctor - now, as an in-flight nurse, I have to factor in thousands of miles and foreign languages!
Yes, this is an extremely challenging area of nursing and once you get the doctor on the phone you have to make sure you ask all the relevant questions to enable the case to move forward, anticipating what information our doctors require.
Now where was I ...?
Another area that NHS work does not prepare you for is the geographical requirements. Co-ordinating evacuations and repatriations can be a challenge, but just how much of a challenge may depend on how good your geography is. Needless-to-say this was my weakest area!
So it's been a huge learning curve for me, especially when an evacuation needs to take place, to decide where the nearest centre of medical excellence is, knowing what facilities are available and where. Now, thankfully, a few months later, it is becoming a whole lot easier.
But of course the challenges are all part of the excitement of taking on the role of an in-flight nurse. I have enjoyed every minute of it so far and look forward to many more adventures in the future!