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A day in the life of ... A lecturer/practitioner

Kirsty Armstrong

As a lecturer/practitioner I need to maintain my clinical skills. This requires me to do a minimum of 5-10 hours per week in the clinic: seeing patients, working out their problems and treating or referring them appropriately. When I first started lecturing, this was the easier part of my week as it was something I had been doing for many years, but now, as I no longer find students so daunting, it is on a par with teaching.

To keep up-to-date with clinical work I read extensively, attend at least one study day per month on topics relevant to clinical skills, and am currently studying for the Extended and Supplementary Nurse Prescribing qualification at Surrey University. This forms part of my MSc in Learning and Teaching, which I am doing by learning contract at Kingston University. The cycle of lifelong learning is exactly that - it is a continuing process. I work the other four days in the faculty, but as I am often out in the community teaching or liaising, my car is often my office!

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My clinical area is in general practice, where I work as a nurse practitioner. At the faculty I teach skills such as physical assessment (eg, chest, cardiac and abdominal examination) and practice nurse skills such as ear care and syringing, travel health and child immunisations, smoking cessation and diabetes, to name but a few. I also have a role in the pastoral care and support of preregistration nursing students (diploma or degree) and will liaise with their community placements and mentors for audits and problems.

8am. I leave to take my son to school, and although I get caught in the usual London traffic I still manage to arrive in plenty of time for the beginning of my day.

8.40am. I find somewhere to park my car and remember that I must ask my line manager to get me a permit for the car park as it can be expensive. When I am not doing the school run I go by bike - it takes the same time as the car!

8.50am. I start answering my many emails (about 20-30 a day) and answerphone messages on courses in the faculty and the locality and arrange meetings with training and development coordinators in various primary care trusts.

I also look at student queries and check some draft assessment work (eg, patient logs and profiles). I can check the drafts (not the final submissions) and advise on critical appraisal depending on whether they are level 2 or level 3, as well as referencing and plagiarism. There are also some queries from placements and problems with students so I categorise and prioritise these and talk to a few people.

9.15am. I grab a camomile tea and take this with my acetates and photocopies up to the designated teaching room. Today I am teaching on module 2 of what used to be the N97, now renamed Diabetes in Primary Care. This morning I am talking to some community nurses (practice and district nurses) about how to run a diabetes clinic. I describe a scenario involving a newly diagnosed patient with diabetes and what collaborative referrals the students might make. Then we do a bit of practical examination on each other's feet. We palpate for the dorsalis pedis and posterior tibial and test vibration sense with a monofilament. Then we have some fun doing ankle and knee jerks and checking Babinski's reflex - all of these can be abnormal or reduced in patients with diabetes, indicating nerve damage. This examination does not replace the podiatrist's but is in addition to it, and illustrates to nurses how important foot care is in diabetes and why it should be emphasised.

11am. During the coffee break I call my clinical place of work in Fulham as they have a query on a patient's referral to colposcopy (close ­examination of the cervix). Although I have not got her records in front of me, it is a case I remember and so I advise a telephone call to the colposcopy clinic to expedite a referral. In addition I call her mobile and leave my telephone number and a brief, and hopefully calming, message - she can call me if she wishes.

I am still closely involved in the cytology caseload and am a cytology and family planning trainer for Thames Valley University. As clinical placements are rare and sought after, I often have a student sitting in with me during my clinical sessions to observe, learn and ­practise under supervision.

11.30am. I talk and simultaneously demonstrate on visual acuity using Snellen and Rosenbaum charts and various other pieces of equipment, and then get the students to practise on each other. I get my equipment from the long-suffering media services at St George's Hospital Medical School, who always seem to drop everything to help when I have forgotten to order the ophthalmoscopes or reflex hammers.

12.30pm. I drive (eating lunch in the car) to a general practice about 15 minutes away that takes preregistration students for health visiting and district nursing experience. Here I have a long and sometimes heated discussion with the district nurses and health visitors who are mentoring students in the community, about the student handbooks and information packs that they should have been given ages ago. We discuss the differences between the formative and summative assignments, competencies and gobbledegook that we tend to use in assessments.

I ensure that all the mentors involved understand the books and encourage them to contact me should they have worries about any students - nurses cost £30,000 to train so we would rather know about their suitability for nursing at the beginning of their training rather than at the end.

2pm. I head back to the faculty in time to teach abdominal assessment to our students from the physical assessment module. I give a talk on the anatomy, physiology and pathophysiology of the gastrointestinal system, having started with a quiz to check levels of knowledge. After that we all have a poke around at each other's tummies and practise the golden rules of physical assessment - inspection, palpation, percussion and auscultation. It takes a little time for the students to get used to baring themselves to someone else - but we always expect the patients to strip off ­without a murmur! At the end of this session I answer queries on the OSCEs (objective structured clinical examinations - in other words, vivas) and practice assignments.

The students come from primary care (practice and community nurses), acute care (sisters and staff nurses on the pre-op, day surgery and general wards) and our pilot project of paramedics, who are learning physical assessment skills such as respiratory and cardiothoracic assessment to use in the London Ambulance Service. I find this mixed bag of students has its advantages, as their learning needs to be applied to practice and the diversity makes learning much more interesting.

4.30pm. Off to do the school run again - where did the day go? I take home some reading - on competencies of nurse practitioners - to mull over and agree or disagree with! The question is, can I read it while I walk the puppy in the park or should that be my time to relax?!

Teaching is very different from nursing and took me some time to get used to. Patients are immediately grateful, but students often take a while to use the knowledge and skills that they have learnt and to realise how useful these can be. My MSc dissertation will hopefully discuss some of my findings and provide some food for thought.