A Trust perspective – Advanced Practice Week

Normally awareness weeks in this trust would involve banners and cakes, this year however, as we are all very aware, things are a little different.

But we do still want to raise awareness of the exciting role that is Advanced Practice, so we will do so from a distance, definitely a social distance.

If you want to join in on the week on social media, share using hashtags #AdvPracWeek20 and @uhp_nhs.

To help celebrate, a range of staff in Advanced Practice roles have given their experiences and thoughts about what this role means to them.

Tasha Kendall and Kim Pauling, Advanced Paediatric Nurse Practitioners (APNPs).

We both started within Paediatrics as the other APNPs were leaving, and therefore it was down to the two of us to pave the way for how APNPs could work within the department in the long term. We now have a trainee in post and we are hoping to recruit more to expand our team and to meet the demand on our services. Between us we cover: the Children’s Assessment Unit, Woodcock Ward, Wildgoose Ward, Paediatric Outpatients and hold the crash bleeps.

We work autonomously and alongside the paediatric medical team, whilst supporting the nursing team too. Our job within paediatrics is extremely varied, one day we could be teaching on medical inductions or departmental nurse training days, or creating patient information leaflets. On another we could be clinical and doing our prolonged jaundice and faltering growth clinics, seeing patients on CAU or helping in ED resus. We love the opportunities our role has and continues to present to us, and as a team we are passionate about driving quality improvement and change for our colleagues and the children that we see. It is a real privilege doing this job, and helping the children and their families in doing so.

Anna Jones, Advanced Clinical Practitioner (ACP) Lead for Acute Medication.

The role of the advanced clinical practitioner in acute medicine began when I qualified six years ago and now we have five others currently in post, with some of those qualifying very soon.

We cover the Medical Assessment Unit (MAU), the Acute Assessment Unit (AAU) and the Acute Frailty Unit (AFU) working alongside the medical team. We work independently alongside the consultants and aim to promote same day emergency care (SDEC) pathways, especially in the AAU.

We thrive on looking at new ways of working to ensure the best patient Journey is given to the patient. We are all able to prescribe and arrange diagnostics which means we can work more independently Working as an ACP in acute medicine means I am able to support the doctors who are rotated as we provide sound knowledge of the pathways like SDEC as well as the services we offer to try and discharge patients the same day. We also work closely with the emergency department to ensure patients who require a medical review can have this the same day, preventing a need for a bed. Having a nursing background really does provide diversity to our patients and enables us to also support the team holistically. We can also provide teaching to our nursing colleagues improving their clinical knowledge thus improving clinical decision making and patient care.

It’s a very rewarding job and each day we are learning new skills and knowledge which we can share with each other.

Diane Keeling, Advanced Neonatal Nurse Practitioner (ANNP).

It is almost 20 years since a team of ANNPs were founded at Derriford. As we celebrate Advanced Practice week, we have a well established team of eight ANNPs with an additional trainee ANNP and a MSc ANNP pathway to secure our future workforce.

As ANNPs, we work across the four pillars of advanced practice. Adept in enhanced clinical skills, across a wide range of gestational ages, form those born as early as 23 weeks gestation to those born at full term; whilst having comprehensive knowledge, clinical reasoning and complex decision making capabilities, enabling us to lead in the management of neonatal care and interventions.

The team practice across several areas of neonatal care from delivery room resuscitation, within the Neonatal Intensive Care Unit (NICU), Transitional Care ward and postnatal wards and transportation within the south west peninsula, supporting our medical, nursing, and midwifery colleagues in providing a high standard of care to our smallest, most vulnerable patients and their families.

Rosie Forbes, Trainee Advanced Clinical Practitioner (ACP) in Oesophago-gastric.

I am a Trainee Advanced Clinical Practitioner with the Oesophago-gastric (OG) team at the Trust.

Prior to progressing into the advanced practice field, I gained experience in surgical and critical care nursing. I am currently studying for a Masters in Advanced Clinical Practice which enables me to assess and examine patients, formulate a working diagnosis, request investigations and prescribe medications to support efficient and timely care for patients. 

My day-to-day role involves requesting and interpreting investigations, reviewing and prescribing medications, and assessing deteriorating patients who are under the care of the UGI/OG team across the surgical wards. I also frequently spend time with the surgical on-call team on the SAU; assessing, diagnosing, and commencing treatment plans for surgical patients. From time-to-time I attend outpatient clinics, theatre, and MDT meetings to enhance my knowledge and broaden my skills in the field of UGI/OG surgery.

I plan to finish my MSc in 2022. I am also keen to continue improving my skills in assessing and diagnosing surgical conditions, both in the inpatient and outpatient clinic setting. Furthermore, I hope to undertake training in surgical skills so that I am able to assist my surgeon colleagues in theatre.

Louise Walker, Advanced Nurse Practitioner (ANP) in Plastic Surgery.

There are three ANP’s within the Plastic Surgery Team (currently two trainees and one qualified). Working primarily within the remit of Trauma our role was originally used to take the on-call bleep away from the junior doctors so they would be able to attend theatre for training.  

When we are on-call we receive referrals from all over Devon and Cornwall from a variety of practitioners. On a day to day basis we speak to people working in ED’s MIU’s, GP practices as well as dealing with referrals from inside Derriford. It is a wide and varied job; we make clinical decisions about treatment and follow up, deciding whether the patient needs to be seen immediately, at some point that the same day or within the next couple of days in our trauma clinic. We are also the first point of call for any patients in our own Emergency Department who need a Plastic Surgery input. The role also includes being part of the trauma meeting and ward round (if possible) each day.

As part of our work to develop the Plastic Surgery service one of our ANP’s implemented a telemedicine system for burns referrals in the Southwest. We were the first Trust to use it and it is now being utilised in other areas of the network. We would like to develop the role further with the implementation of a minor ops training programme so patients with less complex injuries do not have to go to main theatre, and the trainees are moving forward with Non Medical Prescribing to provide further autonomy to the role. 

Ash Lowther, Advanced Clinical Practitioner (ACP) in Emergency Medicine.

We are a good sized team and have literally gone from strength to strength over the last five years, we still have two of the original ACP’s that started at the inception of the project – Emma and Becky.

We have 17 in total made up of one Senior ACP who has already credentialed and was the first ED ACP in Devon and Cornwall to credential with RCEM. Four senior ACP’s (post masters and NMP and in the third year of the RCEM portfolio), 10 trainee ACP’S (a mix of year one, two and three), and three military trainee ACP’s and varying levels on the programme. Our ACP’s are from both a nursing and paramedic background.

The ACP team now cover an almost 24/7 service and we hope that one day there will be a senior ACP on every shift in ED and that we will all have a core set of skills such as US skills, advanced resus skills, experienced decision making skills with the ability to work at the front door of the department and leadership skills to be able to manage individual areas within the ED. We work alongside the medical team in ED and are expected to see the next patient in the queue regardless of their presentation, we are really well supported by an excellent ED consultant and senior doctor team. The senior ACP’s closely supervise the trainee ACP’s to develop them in readiness for their year 1 ACAT (end of year sign off).

Some of the things we do but not an exhausted list; Majors Clinician, START Clinician, Trauma Primary Survey, Trauma Team leader, Cardiac arrest team leader, Ultrasound in trauma and for venous access, Chest drain insertion, Paediatric ED, Covid ED Clinician, Nurse education, Governance presentations, Management Meetings and Quality Improvement projects We hope to increase our team at a steady rate to what the departmental needs are, we are excited to be involved in helping to shape the future of the department which includes assisting with focus groups around the new department, teaching and mentoring the workforce both nursing and medical, but mostly we look forward to continuing to see patients as there are plenty of them in ED!

Wanna know more come and find one of us for a chat. We are so excited about the UHP celebrations for Advanced Practice Week 2020.

Tissue Viability are helping to #stopthepressure

Tissue Viability are helping to #stopthepressure

The Tissue Viability Team at UHP are here to work with patients who have particular needs in terms of skin integrity, wounds and pressure ulcers. Lead Tissue Viability Clinical Nurse Specialist, Siobhan Mccoulough, writes about the different models of care and the importance of aSSKINg ahead of Stop the Pressure Day on 19 November.

Two of the Tissue Viability Team – Siobhan and Emma

The SSKIN bundle has been identified as a key process/intervention in pressure ulcer prevention which has been tested widely since its development in the Ascension Hospital system in 2004 in the USA and more recently across the UK in programmes such as the 1000 Lives campaign, Transforming Care in Wales and Stop the Pressure Collaborative across the Midlands and East of England. The bundle methodology was designed to facilitate consistency in practice.

This developed a blueprint for change in pressure ulcer prevention. Part of this blueprint involved defining and prioritising best known evidence and practices, into a ‘bundle of care’. 

The original SSKIN care bundle focusing on four key aspects of preventative care: Surface, Skin inspection, Keep moving, Incontinence, and Nutrition.

This above model has been in use as a gold standard for prevention and management of pressure ulcers. Initially brought over to the UK in 2004, it was launched first in Wales in 2009, Scotland in 2011 and adopted by NHS England in 2012. It has slowly been incorporated into acute settings in England . It has shown great results for not just reducing the amount of pressure ulcer incidences but raising awareness of the main components needed to be risk assessed and monitored for the at risk resident/patient.

This model is often benchmarked while investigating pressure ulcers as routine, such as root cause analysis. If any of the above SSKIN care components were not included in the individual’s care plan, or there are clear gaps in this model, it may indicate improvement is needed in the care setting.

As a CQC specialist advisor it is this model that I use first as a benchmark when checking care records and practices.

I have been completing root cause analysis for pressure ulcers in the community and long-term care settings for many years. As a tissue viability nurse and investigator clear emerging themes and gaps come up time and time again. When meeting with colleagues here in the UK and looking at international research, these challenges are similar. 

One of these challenges is that the risk assessment completed may not have been holistic and did not incorporate all of the above model of prevention. Whilst the Waterlow, Braden are tools for risk assessing, the research shows that they do not allow for individualised care planning and our dated assessment tools. The updated Purpose T assessment tool developed in Leeds University by Dr Suzanne Coleman uses up-to-date research methods to develop its tool.

However none of these tools will tell you that your resident will refuse to be repositioned due to pain or not wanting to lie on their side etc, or that they tend to lean on their left elbow for most of the day. This must come from your observations and interventions explored. 

The other is where the resident has full capacity or reduced capacity and there is an informal or formal carer in place that information must be given to them so that they understand their own risks to their skin, thus being able to make informed decisions with their care plan. Or that the carers fully understand how to prevent a pressure ulcer and know the early stages, such as non-blanching erythema (Category 1 Pressure ulcer), so that they can report.

It is great, therefore, that the NHS improvement updated recommendations have included two more letters to the acronym SSKIN, namely A – Assessment and G – Giving information.


The new recommended guidelines therefore are as below:

A – ASSESSMENT

S – SURFACE

S – SKIN INSPECTION

K – KEEP MOVING

I – INCONTINENCE

N – NUTRITION AND HYDRATION

G – GIVING INFORMATION

ASSKING

NHS trusts in England have been implementing the SSKIN bundles since 2012. The aSSKINg update has been implemented at UHP and the below video explaining these principles will be mandatory for all clinical new starters as part of their mandatory training.

A aSSKINg UHP video by the Tissue Viability Team can be found below:

The full brief of the NHS improvement recommendations including the ASSKING model is found below:

Whatever stage you are at for pressure ulcer prevention care planning, don’t forget to share your journey and successes at #stopthepressure on Twitter which is the national # for improvement, support and sharing of information.

World Radiography Day is celebrated on 8 November each year

The date marks the anniversary of the discovery of x-radiation by Wilhelm Roentgen in 1895.

This year we are celebrating WRD with blogs from our UHP Radiography colleagues.

Helene Baudains – CT Radiographer and CT Head Reporting Radiographer

My favourite thing about being a radiographer is the variety of patients you see and multidisciplinary teams you work with on a daily basis. We work in every part of the hospital, day and night and are always in demand. Being a Radiographer is more than just taking x-rays and although you are with a patient for often a short period of time the impact you can have on them and their care can be huge.

I am lucky enough to have been able to train as an Advanced Practitioner in CT head reporting whilst clinically being a CT Radiographer. This had allowed me to actively engage in helping to diagnose abnormalities found on a CT Head, and when working clinically, scanning patients from a large variety of backgrounds, ranging from GP, oncology trial, paediatric, major trauma and acute stroke patients, to name just a few.

I work with a fantastic team who are highly skilled in what they do and support each other really well.

Although some days can be challenging, I wouldn’t change the job I am in.

Chris Bowen – Radiotherapy Services Manager

I graduated from the South Wales School of Radiography as a Therapeutic Radiographer in 1993 and started work in Plymouth shortly after in 1994. Since qualification I have worked at all levels of the job and gained a wealth of experience over the years, working with many wonderful colleagues and patients. My job is very varied and no two days are the same. One day I could be attending a full day of meetings the next I could be donning a uniform and helping out with clinical work.

Over the years Radiotherapy has developed at a great rate offering many development opportunities and fulfils the profession ethos of lifelong learning.

There are many varied roles in Radiotherapy including:

· External Beam Treatment Delivery
· Brachytherapy Treatment Delivery
· Patient Support Services
· Pre-treatment Radiographers performing CT scans
· Clinical Site Specific Radiographers
· Radiotherapy Planning

The best thing about my role is being able to manage and develop our passionate and dedicated group of Therapeutic Radiographers.

Their skill and commitment to provide exemplary treatment delivery and outstanding patient care to improve the patient experience is truly inspiring and I am proud to be able to work with such a brilliant group.

Louise Hancock – Lead Practice Educator, Diagnostic Radiographer and University Clinical Tutor

After graduating from the University of Exeter in 2010 I started my career as a Diagnostic Radiographer at UHPT within the X-ray department as Trauma and Plain film radiographer. I studied to be a radiographer as a mature student, knowing I wanted a more fulfilling career. Diagnostic radiography offered that, as it gave me the opportunity to work as part of team with patients and carers to deliver high levels of patient care, whilst providing a diagnosis to support treatments and aid recovery.

The part of my role I enjoyed most was teaching others. This led me to pursue Post Graduate study in Clinical Education and I now have a dual role as the Lead Practice Educator within the Plain Film Imaging department and a University Clinical Tutor for the University of Exeter Medical Imaging programme.

I love the opportunity both my roles present in shaping the future of the profession by educating the radiographers of here and now, and tomorrow. I have the privilege of working with passionate radiographers and students who feel proud of the role they play in the healthcare system.

As a team we have shown ourselves to be resilient, adaptable and compassionate.

Sarah Hitchcock – Band 6 Urology Lead Therapeutic Radiographer

My Name is Sara Hitchcock. I’ve been qualified for just under five years and the best part of my job is the patients. As we see the majority of patients for an extended period of time, being able to build a relationship with them and knowing that you are there to help is so rewarding. In our role we are involved with the planning and delivery of patients radiotherapy treatment, as well as providing pastoral care for them throughout.

As the Urology Lead I work particularly close with the Consultants and Specialist Nurses to continuously improve and advance our care for this specific group of patients. I found out about therapeutic radiographers when I was in Primary school, as my auntie had cancer and I would go with her to some of her radiotherapy appointments.

The kindness and support the staff gave my auntie through this tough time inspired me to become a therapeutic radiographer myself.

Michelle Kapoor – Trauma Plain Film Radiographer

Hello, my name is Michelle, and I am a Trauma Plain film Diagnostic Radiographer performing X-rays, who circulates through the general imaging department which includes;

  • ED
  • In-patients, Out-patients and GP patients which includes orthopaedics and oncology
  • And Theatre and Mobile imaging.

The role is very varied and I can find myself working with a huge range of different patients in any given week. I have been a radiographer for just over a year, I always been interested in anatomy and working with people, and found radiography through work experience at this hospital.

My role entails not only delivering high quality diagnostic imaging and patient care but also teaching and supervising newly qualified radiographers and students. 

I feel like I have learnt so much in the last year working on the front line and COVID has definitely made this year interesting to say the least.

I feel so lucky to have such a great team who have supported me through this unique experience. Plymouth is such a lovely place to work and while it is home for me, I can’t say it has ever been boring.  

Jeanette Owen – Lead Radiographer Theatre and Mobile Imaging

I am a Radiographer with 30 years’ experience, leading a team of radiographers delivering the Mobile Plain Film and Theatre Fluoroscopy Imaging service to 33 theatres and 40 wards, including four ITU’s. My patients are at the centre of what I do.

Every day is different, requiring me to simultaneously spin a multitude of plates. Today I start with imaging an acutely unwell ITU patient with head and severe bilateral leg injuries in trauma theatre. The four hour operation requires skill and special accuracy to manage complex imaging using an image intensifier, enabling the surgeon to align and fix the patient’s fractures. During this time I am also answering my bleep; wards requiring urgent mobile plain film chest x-rays on sick patients, theatres requiring unanticipated imaging, other theatres changing the order of their lists and altering the times that imaging is required. The fluctuating demands need constant management and co-ordination of the imaging service, continuous liaising with different services and staff groups – it’s all about excellent communication.

Amongst other tasks: incidents to investigate, equipment requiring fixing, job references, appraisals, audit, bookings to organise, equipment trials, and looking after my work tribe.

It’s challenging, insanely busy, fulfilling and I still love it.

Janet Villars – Sonographer

I have always wanted to work within the medical profession and after spending time in a radiography department at age 16 I knew that this was the career path for me.

Post qualifying, I started rotaring through fluroroscopy, mobile and theatres, general and orthopaedic Xray, with my most favourite in ED Xray. After 3years I specialised in paediatrics which involved neonatal mobile Xrays, MDT meetings, skeletal surveys and educating colleagues in paediatric issues. During this time I also worked in Ugandan and Kenyan hospitals, which was where my love of ultrasound began.

When a training post came up, there was no doubt that I wanted to apply!

I have the privilege of sharing in people’s life experiences, whether it be the joy (or sometimes sadness) of baby scanning, assessing ongoing treatment in patients, including abdominal, gynaecology and fertility specialities.

I enjoy meeting people from different walks of life and putting them at ease whilst trying to find a cause for their symptoms.

I was once told that I’d never regret training in ultrasound and that I really can make a difference to someone’s life and make or break their day. This has never yet proved me wrong!

If you want to join the day on social media, share photos using the hashtags #myradcolleague #WRD2020, and tagging @uhp_nhs on Twitter.

Occupational Therapy Week: What do occupational therapists do?

Occupational Therapy Week: What do occupational therapists do?

Small change, big impactThe 2nd to the 6th November is Occupational Therapy Week. Normally, we’d be enticing you to find out more about Occupational Therapy (OT) with an information stand and cakes at the main entrance of the hospital, but the current situation sadly precludes us from doing so. However, as a department, we wanted to take this opportunity to shout (from a distance) about what we believe to be the best profession in the world!

To understand what an occupational therapist does, it is important to first understand the meaning of “occupation”. In our role, an occupation refers to any activity that our patients want or need to do to function throughout a normal day. Although everyone’s occupations vary, they generally fall within the categories of work, leisure, and self-care. For example, each morning we wake up and have a shower (self-care), drive the car or ride the bus to our jobs (work), and come home to have dinner and watch television or read a book (leisure). We often take for granted how challenging it can be for our patients to complete these seemingly basic occupations if they have a physical or psychological barrier to overcome. As acute occupational therapists, we can assess our patients to identify their barriers to occupation and provide creative solutions to overcome them through the provision of adaptive aids and equipment, packages of care, referring onward to the appropriate community services, and educating families and carers.

At University Hospitals Plymouth, we work in a number of specialities including hand therapy, health care of the elderly, general medicine and surgery, trauma and orthopaedics, stroke, neurosurgery, and admissions avoidance within emergency care. Although each of these specialities has a unique impact on a patient’s journey, we all share the same core principle: to utilise a holistic (physical and mental) approach to enable a patient to achieve their full potential and remain as independent as possible. Whilst occupational therapy is only a small part of the patient journey, a small change can create a big impact on health, wellbeing, and reduce the number of hospital admissions.

An Employee App for our #1BigTeam

**The app is currently in testing phase, so some functions are incomplete. If you install the test version, it will automatically upgrade you to the live version upon launch. Please share your thoughts on the test version under ‘Your Feedback’ on the main menu – Thank You**

We’ve worked on staff feedback to bring together some of the most popular information and functions via your smartphone. You can expect to be able to:

  • Access the UHP Support Hub
  • Get the latest jobs and training listings*
  • Book annual leave and manage rosters
  • Access eLearning and payslips
  • View Trust news, bulletins and updates**

Apple_store_web

Apple (iPhone 7 and up): Copy and paste the follow redeem code into the Redeem Code section of the app store to unlock the app download: X3JYEXMXJK6X

google-play_Web

Android (v4.4 and up): Visit the Google Play store to download

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20 October is International Pharmacy Technician Day

20 October is International Pharmacy Technician Day

My life as a Pharmacy Technician

My name is Lesley, and I work as a pharmacy technician at University Hospitals Plymouth.

When you work in the NHS the job is ever-changing. Being part of the pharmacy family, we integrate with these changes to always improve systems of work and processes that lead to better patient centred care.

My technician career has spanned over 30 years and even now, the role is evolving. In the last year alone the pharmacy technician role has changed to a two year apprenticeship with college providers.  

Pharmacy technicians, in the not so distanced past were not recognised by the General Pharmaceutical Society. That has all changed and we are now registered professionals. I would highly recommend anyone seeking a career in the NHS to have a look at the challenging varied and exciting role of pharmacy technician. As a Mum and Grandma (my daughter is a pharmacy technician) I would endorse anyone seeking a fulfilling career in healthcare to look at pharmacy services.

Previous to this I worked as an auxiliary nurse and as a physio aid at St Peters Hospital in Surrey. On relocating to Plymouth I decided to pursue a change of career. I still wanted to be involved in healthcare so I researched other healthcare roles. Looking at all these exciting roles, the job of a trainee pharmacy technician appealed to me. I was under no illusions and knew that studying to be a technician would be challenging, as I also had a young family at the time.

I successfully applied for a trainee technician job in a retail community pharmacy. This period of learning consisted of in-house training over three years. The skills I learned were first as a counter assistant, which included labelling and dispensing prescription medicines, over the counter sales and consultation skills. I found the patient contact very rewarding; helping and advising patients with their medication regimes (within my capabilities and professional boundaries).

Having completed my counter assistant’s course and gaining experience, I progressed to trainee technician. Part of this role is to train to check and sign-off dispensed prescriptions. I was aware that training to be the person responsible for signing off patients medications before they left the pharmacy was a massive responsibility. These were skills that I embraced. I developed not only as a pharmacy technician but also as a person. I get a lot of job satisfaction that has stayed with me throughout my career processing people’s medications.

Although working in the community pharmacy was a brilliant job, I wanted to seek other opportunities and skills that pharmacy technicians could have in their portfolio. These opportunities were predominately hospital based. I then made a career decision to move from retail to hospital services.  Once again this was a decision that was not easy for me to make as my family were still quite young and moving into the hospital environment taking on new skills and challenges once again was something I wanted to embrace.

My decision was rewarded as I took on new roles such as medicines management controlled drugs processes; I also trained as an inanimate keyworker assessor.

Other responsibilities that I have been involved in are taking our pharmacy services from a centralised system to ward based. This involved training staff to work on the wards which I had vast experience from my medicines management role.


Pharmacy is a fast-paced ever-changing environment and no two days are ever the same. This keeps the role interesting and fulfilling as we are constantly learning new skills. I enjoy being a Pharmacy Technician and feel we have a positive impact on patient care by providing an efficient service and enabling a smooth transition back into the primary care setting. 

I have been a Pharmacy Technician for around three years but have worked in pharmacy for over 10 years.

I started my journey in community pharmacy and made the transition into hospital pharmacy 18 months ago to broaden my skill set. The two year pharmacy technician course is not the end of the training process as we are continually learning every day and there are several further courses available for our personal development. I completed the Accuracy Checking course whilst still in community pharmacy enabling me to relieve the pressure on the pharmacist(s) by conducting the final accuracy check on prescriptions before they leave the pharmacy department.

Since joining the amazing team at Derriford I have also enrolled onto the Medicines Optimisation course which enables me to spend time on the wards with the patients ensuring any medication they have brought into hospital is suitable for use and facilitating inpatient supply requests and preparation of TTAs. I am also able to be part of the Medicines Reconciliation process which ensures patients are prescribed all of their regular medication prior to admission whilst they are a hospital inpatient.  Although the bulk of my day consists of spending time on the wards fulfilling my Medicines Optimisation role and labelling, dispensing and accuracy checking prescriptions there are several other aspects to my role.

I could be involved in the dispensing of specialist hospital only medication that requires specific monitoring, such as clozapine or in stock management to ensure stock levels are correct in order to fulfil requests in a timely manner. I may also spend time in the controlled drugs room dispensing medications that have the potential for abuse and thus specific legal requirements for dispensing. I also contribute to the dispensing of medication for specific outpatient clinics such as Dermatology, REI and Neurology. 

The History of BAME Nurses in the United Kingdom

Rez Rodgers, Vice Chair of the University Hospital Plymouth BAME Network, pens a blog about the influence of overseas workers on the beginnings of the NHS

The post-war labour minister Aneurin Bevin believed that society should collectively contribute to a healthcare system with equal opportunity and availability to all, and thus the foundation of the Nation Health Service was born in July 1948. However, due to the impact of World War I and II on the British economy, medical professionals were hard to recruit; men returning from the war did not want to fulfil a job requiring long working hours and women, after performing men’s jobs whilst at war, discovered more career opportunities and developments outside of the traditional marriage and domestic roles.

After World War II had left the British economy depleted, the government advertised to 16 of the then Commonwealth and former colonial countries, including Poland, Ireland, Malaysia, India and the Caribbean, to recruit nursing staff. Between 1948-1961, almost half a million people living in England and Wales were born overseas, the majority of which included the Caribbean Islands. Senior nursing staff travelled from Britain to Barbados, Jamaica, Trinidad and Tobago to recruit individuals between the ages of 18-30 years who were willing to commit to a three-year contract. Following the next two decades, steady streams of nurses were recruited to meet the demands of the UK and improved patient health conditions and staffing shortages within the NHS.

Upon arrival in the UK, only a few were met at train stations and taken to their contracted hospital, and many were left to find their own way. The nurses were grouped together in housing blocks next to the hospitals they were placed at, and were often placed with nurses from other Commonwealth countries. As one former nurse reported, “when anyone new came and brought food, the girls got together, sitting on the floor…like a big family…dividing it up between all of us.” This provided a support system and community whilst living away from their loved ones. 

Two types of qualifications existed for nursing: the internationally recognised State Registered Nurse (SRN) and the State Enrolled Nurse (SEN) which allowed practice solely in the UK. After achieving and qualifying as a practising nurse, many could not progress higher and would not be promoted at all. Job roles were restricted to areas of the highest need, including psychiatry, geriatrics and hospitals for those terminally ill; overseas nurses were also more likely to be given anti-social hours and night shifts which were poorly staffed. During such shifts, nurses reported having to be wholly in charge of patients with no adjustments made in pay. Moreover, nurses were exposed to many discriminatory attitudes, racial slurs and even violence from patients who would throw their possessions at them; one nurse stated, “we were treated differently…but we didn’t worry because we know what we wanted to achieve and what we had to do and we did it.”

Nursing authorities argued that racial characteristics limited intellectual capabilities and motivational levels to achieve the international nursing qualification, thus many overseas nurses were forced into the state-enrolled nursing qualification which limited their options even further if they wanted to leave the UK.

In the 1960s, health minister Enoch Powell championed overseas recruitment as it provided ‘cheap labour, reduced wastage and undermined the [NHS staffing] shortage argument’ however this simultaneously strengthened his campaign against nurses’ pay claim, thus used the influx of BAME Nurses in 1960s as a weapon against unequal unequal/discriminatory pay.

References

Policy, H., 2020. Immigration And The National Health Service: Putting History To The Forefront. [online] History & Policy. [Online] http://historyandpolicy.org/policy-papers/papers/immigration-and-the-national-health-service-putting-history-to-the-forefron [Accessed on: 28/09/20].

McDowell, L. (2018) How Caribbean migrants helped to rebuild Britain. In British Library. [Online] bl.uk/windrush/articles/how-caribbean-migrants-rebuilt-britain [Accessed on: 28/09/20]

Ali, L. (2018) Caribbean Women and the NHS. In B:M 2020. [Online] blackhistorymonth.org.uk/article/section/windrush-day-2019/Caribbean-women-nhs/ [Accessed on: 28/09/20]

My experience: St John Ambulance volunteer at UHP

There are lots of people from different organisations who make up the extended #1BigTeam at University Hospitals Plymouth (UHP). Abby Williams is an Emergency Medical Technician (EMT), trainer and assessor who has been part of St John Ambulance for nearly three years. St John Ambulance volunteers have been helping out at UHP since July this year supporting the Emergency Department at Derriford Hospital and helping to transfer patients.

Abby Williams volunteering at UHP for St John Ambulance

“I joined St John Ambulance while I was at university studying to become a teacher. I love volunteering and being able to help people and I understand how important it is to know first aid. St John Ambulance does all of the above. Like most people at St John Ambulance I joined as a first aider and progressed through the roles to EMT, which means I have a wider scope of practices and can now crew ambulances through St John Ambulance. I also work with the training team, which brings my love of teaching and first aid together. Recently, along with a colleague, we’ve been busy training a new course to allow members to volunteer in hospital. This is where my experience at UHP comes in handy.

“Normally at this time of year, I would be offering first aid support at large events. Since lockdown these have obviously all been cancelled, which has been really odd. COVID-19 has meant that we have been able to support the NHS by going into hospitals, like Derriford, which has been an amazing experience. 

“When we are doing a shift at Derriford, we arrive and introduce ourselves to the Nurse in Charge, saying hello to everyone else on the way. Once they know we are there we have a look and see if there is anything we can do straight away such as any call bells going off. We are able to offer a huge range of skills such as observations, personal care, providing tea and coffee. We also support transfers to other parts of the hospital. One of the most important things we do is give time to the patients. The Emergency Department gets really busy and there is always loads to do. We are happy to spend time talking to the patients, which is wonderful. No two days are the same and this keeps us on our toes! 

“Outside of volunteering for St John Ambulance (most members of St John Ambulance are volunteers and hold full-time jobs) I am a primary school teacher and work for a local charity that helps special children. I like to keep busy, however, and during the summer holidays most of my time has been spent volunteering with St John Ambulance and supporting the NHS.

“The role has certainly changed over recent time, but it has allowed us a more diverse experience and I’ve learnt loads about medical terminology and been able to enhance my skills. It’s a change being stood in a hot Emergency Department rather than a field when it’s pouring down with rain! 

“The experience of working in the Emergency Department has been brilliant. I’ve learnt so much and have enjoyed every minute whether it be putting skills into practice or simply having a chat with a patient. The Emergency Department staff do an incredible job and have been so welcoming and made us feel at home. 

“The diversity of the role is certainly one of the best bits. I also love the fact that even when the Emergency Department is really busy, we are able to spend the time talking to patients, reassuring them and making their time in the Emergency Department that little bit better. 

“For me, as a teacher, school is starting in September so the time I am able to give will be reduced. I hope to be able to do a few shifts on the weekend. I’ll also continue to train our members to enable them to support the NHS in hospitals and ensure they are ready for events when they start again.”

“Since reopening we have successfully transplanted 10 patients across our region”

The Southwest Transplant Centre (SWTC) is a regional centre which offers a service for kidney patients across Plymouth, Cornwall and the South of Exeter. We provide both a deceased and living donor programme and currently follow up approximately 400 patients who have been transplanted. National statistics show we have one of the lowest waiting times in the country with most patients waiting around 18 months before receiving a kidney transplant.

COVID -19 presented the centre with many challenges; intensive care beds normally used to care for our donors were potentially needed for vulnerable patients requiring specialist treatment as a result of COVID-19. In addition newly transplanted patients who are given a high level of immunosuppression were extremely vulnerable if exposed to the virus.

In April following extensive discussions with other centres, our own referring centres and NHS Blood and Transplant we made the decision to temporarily close our programme in the best interest of our patients.

Two months later we began to tentatively re open the programme, activating patients back onto the transplant waiting list in phases with national guidance. Under the direction of Dr Imran Saif Director for Transplantation, the medical, surgical, immunology and nursing staff have worked incredibly hard to ensure the programme was reopened taking into consideration the safety of the patient.  The transplant waiting list has been growing week by week and since reopening we have successfully transplanted 20 patients across our region which is an incredible achievement for all those involved in the programme and for those patients returning home with a new transplant and the prospect of not returning to or starting dialysis.

This has been a combined effort from many different services across the hospital, the renal unit (Mayflower ward) and support from the Trust management has ensured a safe environment for patients returning to the ward following surgery. Other services such as microbiology have been working hard in the background to swab patients and staff both routinely and in emergency situations to minimise the risk of infection from the virus. The support of the theatre and radiology departments has ensured the timely assessment and transplantation of patients. 

Linda Boorer, Lead for Transplantation, would like to thank the on call team in conjunction with the immunology team in maintaining  the on call rota during this period,  still taking potential screening offers which although did not directly affect patients in our region they did benefit patients  listed in other centres Also the transplant team have pro-actively managed both the suspension and re-activation of recipients in a short space of time and provided reassurance and information to anxious patients and their families.

Patient, Trudy said: I was sitting in the sunshine sipping a glass of white wine when I got the call. It was Wednesday, 29th July at 5.30pm.  Owing to Covid19, the transplant list had been suspended. I had been reinstated on the newly opened list just two days beforehand.  A rush of excitement and tears of joy ensued.  I had been waiting for this call for almost three years owing to antibody issues.

“Arriving at the Mayflower Ward, firstly I was tested for Covid19.  I am so grateful to the team who operated on me and everyone who continues to take care of me post-op.  The high levels of attentive care surely must be the best and is administered in the most testing of Covid times.  In the early days I had several clinical interventions daily, where Covid regulations were strictly adhered to throughout.  What more could I ask for?  In these dark Coronavirus days, to date I am one of the patients at Mayflower who unexpectedly has been given this exceptional life enhancing opportunity.”

Patient, Clive Sandercock and his wife Julie have also shared their feedback of being able to have telephone appointments during the COVID period:

“For us it is a 3 hour round journey to attend Derriford plus our time in the hospital,” said Julie. “It has worked really well Clive having his bloods done at home by our District Nurse and then we get them taken to Launceston and then onto Derriford.  A weekly appointment is then made for a call from one of the Renal Team to discuss the bloods and alter medications if necessary. This has obviously cut down on the stress of us having to attend the hospital weekly for several months. We must stress that the Renal Team have been excellent throughout this difficult time and someone is always available to speak to should we have any problems.

“We think this is the way forward to cut patients having to attend hospital for appointments that can be dealt with by telephone.  We certainly are happy if this continues. We would also like to thank everyone in the Renal Unit for your care and support throughout.”

If you would like to know more about transplantation in your local area please visithttps://www.odt.nhs.uk/transplantation/kidney/kidney-transplant-units/

If you are interested in living donation please contact either Gemma McCullough or Philip Isaac the Living Donor Coordinators on 01752 439955

My COVID experience: Unwitting Warriors

2020 as a third-year student nurse has been a roller coaster, the kind that throws you about, bruises your ears, pretends to stop and then the person controlling it sends you on another relentless loop. Anyone that’s been on the mine train on a quiet day at Alton Towers will understand.

We went into lockdown with some vague rumours that there would be an extended paid placement or early graduation, but nobody really knew and anyone we asked was equally none the wiser. So we sat in limbo knowing only that we weren’t going to finish as normal. Then one day while watching the soap opera that was the Government’s daily update, it was announced that 18,000 third year student nurses were ready to deploy. We weren’t. We were sat on the sofa in our PJs wondering if chocolate chip cookies and a glass of milk would meet the tea time nutritional requirements of our children.

So, a few weeks, some rather dodgy TikToks and some hastily scheduled employment checks later we were off out in the wild. Not a nurse or a student but an “Aspirant Nurse”. That title lasted as long as it took us to realise that nobody knew what it was and as we really didn’t know either we just went back to saying “student”.

I was lucky enough to be assigned Braunton ward in the red zone. I say lucky because actually if I’m going to have my life turned upside down by a brand-new disease, I want to meet that disease head on. Plus, I’m also really risk adverse and wanted all the PPE so deemed Braunton to be the safest place in the hospital. Turns out most of Team Covid had similar rationale and I found my people.

Not without some nerves (read “bricking it”) I went for my first shift in “The Red Zone”.  With the first goal of locating the changing room, appropriate size scrubs and making it back to the ward completed (thank you fellow student for showing me) I began to feel a little better.  And so my Covid, not- quite-nursing journey began.

I can honestly say that I’ve never met a more welcoming group of staff. “Are you here for the shift? We’re so pleased to have you.” Was a phrase that was often used, not just for me but for everyone on the team. As a newly formed team I soon found out that people were meeting people for the first time everyday and so it was actually easy to fit in and not be ‘the new girl’, while actually being the new girl. Working in full PPE is an experience. What I hadn’t considered before donning for the first time was that I’m actually quite claustrophobic, so that was an interesting internal chat to myself, thankfully I won that war and didn’t run crying from the ward in fear of someone putting a visor on me. As an aside, I can now go snorkelling because covid PPE cured me of the fear of the mask.  

What also struck me is the levelling capacity of scrubs. Team Covid really was a team, one working towards the same agenda of keeping each other safe and doing the best for our patients. We had roles to fulfil but the hierarchy was essentially gone because everybody’s job was important, they always are, but if you don’t know if you’re talking to consultants or house keeping staff it opens the ground for communication, plus everyone has the same inhospitable working conditions, “It’s too hot” and “I need a wee” being the two most used phrases.

A short blog isn’t enough to express my student experience of Covid. But I’ll finish by saying I’ve made some amazing friends. I’ve had shifts that I’ve laughed until I cried, as well as shifts at the other end of the happiness spectrum. I genuinely can’t think of a better introduction to my nursing career. To my fellow 2020 graduates……we’ve got this.