Working in general practice
Lucy Blevings Jan 2006-01-30
In the final year of my nursing diploma I had my career mapped out. Having spent my elective placement working in the Australian Outback in Emergency and Intensive Care, I was to start in A&E to get my broad experience and then work my way towards becoming a Nurse Specialist in Critical Care. How differently things were to turn out!...
All nurses will remember the feeling of anticipation before discovering the whereabouts of their next placement. At the beginning of my third year I was looking forward to consolidating some of my skills and building my confidence on the ward before qualifying. Imagine my surprise then on discovering that I was to spend the next 6 weeks working in a GP surgery! A far cry from the fast-paced, cutting edge of A&E. I would be lying if I said I wasn't disappointed at first, but then the thought of 6 weeks without nights or weekends?!...
My next surprise before even starting the placement was to receive (through the post from the Practice) a carefully thought-out timetable for the next 6 weeks. This was followed up by a welcome phone call from Ruth, the Nurse Practitioner at Millway Medical Centre who was to look after me for the duration of my placement. I'm sure I don't have to point out the differences between this and my first day on a ward on previous placements…. "Lucy who?"
Well I was right… it was a far cry from A&E but I loved every minute of my time there. I worked with each of the nurses (there are approximately 12 nurses at Millway) and consequently got an insight into all the different clinics that run in a GP surgery; child immunisations, travel, leg ulcers, asthma and coronary heart disease to name just a few. This placement was initiated by Barnet PCT in order to introduce substantive student placements into GP practices and I believe I was one of the first.
By the middle of the placement I was beginning to have second thoughts about my nursing career. What struck me most was the time I was able to spend with each patient. Fifteen minutes doesn't sound like long but imagine that time spent one to one with no interruptions - unheard of on the ward. And those fifteen minutes can be utilised in so many ways, sometimes you need every moment to do a complicated dressing, other times a quick procedure might be followed by a chat about the patient's diet or their smoking habits. No two appointments are the same.
By the time my placement was coming to an end I had decided that at the very least I would consider practice nursing in the future and that I would certainly investigate the possibility of going straight into it after qualifying. I hadn't ruled out critical care but my faith had been tested!
So I sought some advice from tutors, colleagues and friends. I'm sure you can imagine the common theme in the advice received… "Get some experience first" or "fine for those nearing retirement but not when you're young". But I wasn't swayed. My final placement was 12 weeks in a Spinal Injuries Unit and that essentially made my decision for me. I knew that Practice Nursing was my future.
I heard through Anne Jervis (Clinical Learning and Placement Coordinator who organised my initial placement at Barnet PCT) of a vacant position for a Treatment Room Nurse at St Andrew's Medical Practice in Whetstone, North London, and went for an interview. There was some trepidation, on both sides, about my taking this role. But after much discussion and encouragement from the two established practice nurses already at the surgery we decided (as a whole) that this was the right job for me.
And boy, have they been supportive! The learning curve is steep but the rewards have been plentiful. Just four months after starting at the practice I am running my own clinics in baby immunisations, travel and dressings. I am a level 2 smoking cessation advisor and am qualified to do ear syringing. I have attended a 2 day smear taking course and am well on the way to being able to take smears independently. I started in February on a 12 week 'Leg Ulcer' course at the University of Hertfordshire and will essentially be the leg ulcer specialist by the summer (strangely enough they are happy to leave this to me!). I am trained in phlebotomy and will soon be able to take blood from the patients at the surgery. I am in charge of health promotion and manage all the promotional activity choosing my 'theme' for the month or season.
But (and at the risk of this sounding like an Oscar acceptance speech) I could not have done this without the unfailing support of Jacqui and Kate, the two senior nurses at the practice. Not to mention the constant phone calls to the GPs and even the receptionists have come to my aid on a few occasions. It is thanks to everyone at the practice for taking the risk of employing a newly qualified nurse that I look forward every day to going to work and practice with confidence and the autonomy that I would not have had on the ward.
And it doesn't end there! Next year I hope to start the MSc in Community Nursing following the specialist pathway to GP Practice Nursing at the University of Hertfordshire. All encouraged and supported by St Andrew's of course. I also believe that the GP Practices that accept students benefit from this new initiative. Through mentoring students, GPs and nurses that may have been in their role for some time will be encouraged to question their practice and thus avoid getting 'set in their ways'.
So if you are thinking of embarking on a career in GP practice nursing then don't be put off by all those that tell you that it can't be done. Only last week on my University Induction day I was faced with a comment of, "You are newly qualified and already a practice nurse? I don't agree with that young lady, you should get some experience on the ward first!" I bit my tongue and put it down to ignorance. If a student being placed in GP practices during their training becomes the norm then I am sure that a newly qualified nurse will not be faced with such narrow-mindedness. Practice nursing is not for everyone - you work alone the majority of the time and have to accept your limitations. However, if you are interested in the role and can find a supportive and encouraging environment then I strongly recommend it to any soon-to-qualify nurse.