I (BW) joined a critical care department early on in my career after only a few months of registering and qualifying as a nurse. My plan had been to remain in my first post, which was in an inpatient elective orthopaedic ward, while completing a master's degree. So I would work there for 3 to 4 years and then consider looking at the likes of a trainee advanced nurse practitioner role or perhaps a specialist nurse role. However, at 5 months' post-registration, I moved to intensive care, the most critical area of the critical care department.
This move seemed appropriate at the time as I had been working in COVID-19 admissions and seeing some very acute patients at that time, having to develop my skills such as using the National Early Warning Score (NEWS) 2 and ABCDE assessments, among other skills and abilities.
You will often hear that nurses need many years of experience before working in critical care, something I had been told both by university staff and the nurses I had reached out to in other critical care areas across the UK. However, today, more newly registered nurses are being offered roles in critical care areas, as well as in theatre, anaesthetics, community nursing and research. Whether that is a good or bad development will be open for much debate.
Is this new approach due to the staffing issues we are seeing across the UK NHS or an appreciation of the skills and qualities newly registered nurses can bring to these areas?
I have always been drawn to a very clinical role. From a young age, I was interested in the idea of acute and critical care, such as in an emergency department or intensive care unit. The NHS also needs nurses working in research, care homes, care of the elderly wards and academia, and of course, as managers, but these roles are not for me. I worked in intensive care for over a year and although I absolutely love the skills, experience, exposure, and opportunities this gave me, I have recently moved roles to an area of practice I had never really considered earlier – community and district nursing.
‘In Scotland there are some fantastic advances and commitments to nursing…to help attract, retain and develop the nurses we have and help them f lourish’
Unfortunately, many crises face the NHS and the country, including the recent COVID-19 pandemic, the staffing crisis in the NHS, and the cost-of-living crisis. It is a time for much-needed reflection – something I have been doing recently. I have realised that nursing is vast and fluid. As mentioned, there are so many avenues and opportunities in nursing, and here in Scotland there are some fantastic advances and commitments to nursing by the likes of NHS Scotland and National Education Scotland to help attract, retain and develop the nurses we have and help them flourish.
One of my influences has been reading the book Health is Made at Home, Hospitals are for Repairs, by Nigel Crisp (2020), which gave me the inspiration to move into community nursing. I recognise the opportunities that community nursing creates, not only for health professionals such as nurses but also for people living in the community. Community nursing allows people to stay at home and have healthcare provided in their own surroundings and environment.
As we move away from medical models of healthcare and even away from hospital healthcare and start to think about the movement to health at home, my critical care ‘blinkers’ are starting to fray. I am starting to see that there is more to nursing than secondary care in a busy hospital environment. I am also recognising the number of opportunities that nursing in Scotland has to offer. As noted in my previous article (Webster, 2020), nursing in Scotland can be challenging, due to the geography of the country, but this brings the ability to gain unique experience and exposure that working in other UK countries might not offer.
I work at NHS Tayside and asked my co-author and the executive director of nursing, Claire Pearce, her views on why nursing in Scotland offers unique opportunities and experiences to nurses and why they should consider a career here, along with her experiences and perspectives. This is what she said:
‘Since I qualified as a nurse in 1989 the nursing profession has changed significantly, it is now a highly skilled graduate role. Nursing is the beating heart of our NHS. We are the largest single profession that cares for people from birth to old age in a variety of settings, not just in hospital wards, but in GP practices, homes, and care homes, across the country.
‘I was a haematology nurse working with people who had haematological malignancies or bone marrow transplants. I loved my job, although at times it was demanding both emotionally and physically. The emotional rewards nurses receive from caring for patients at their most vulnerable is one of the most rewarding parts of the job.
‘Through kindness and compassion, all nurses develop a connection that helps support the people in their care on their journey. It is such a privilege to be part of someone's life and the emotional rewards are significant.
‘Now as the executive nurse director of the board, I can influence so many people's experiences by ensuring all the nurses in the board are highly educated, feel supported by the organisation, and practise in a kind and compassionate way.’
As Claire said, community nursing offers so much potential. And it excites me to think where I might be in the next 5 to 10 years.