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A day in the life of...A Royal Navy Nursing Officer

Thirteen years ago I resigned my position as a district nursing sister to join the Royal Navy as a nursing officer. At the age of 34 this may have appeared reckless; however, it fulfilled a lifelong ambition to serve in the armed forces, and satisfied the need to find a challenging new career.

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With a background in community care as both a primary care nurse and midwife, I have spent a large part of my naval career overseas caring for service personnel and their families. However, one of the most rewarding periods has been working alongside the instructors here at HMS Raleigh, the Royal Navy's training establishment. In this job I've needed to use all my primary care nursing skills and develop some new ones. Working with young recruits as a health educator has generated a passion for teaching, and last year I graduated from Plymouth University as a postcompulsory education teacher.

HMS Raleigh is situated in Cornwall and is near to the city of Plymouth, a traditional naval port. Each week 60-70 new recruits aged between 16 and 37 enter the gates of HMS Raleigh to commence an eight-week basic training course that will convert them from "civilians into sailors".

The HMS Raleigh medical centre is located centrally within the establishment along with a rehabilitation suite that provides care for trainees and staff recovering from illness or injury. The two facilities are staffed by a mix of military and civilian personnel from a number of disciplines. Employed within the centre are: three medical officers, one civilian medical practitioner, five nurses, two physiotherapists, two remedial physical training instructors, seven medical assistants, five civilian administrators, and a practice manager with a community mental health nurse, chiropodist/podiatrist and NPFS social worker visiting to provide weekly sessions. A comprehensive range of services are provided onsite that are comparable with a civilian general practice. In addition, the medical centre houses: a pharmacy, a casualty room and a 10-bedded ward providing 24-hour inpatient care. Registered within the practice are some 2,500 patients; however, the practice is not typical of a civilian general practice, the population being young, transient and needing flexible and responsive services. Within the practice there is an emphasis on the training and development of our staff. In addition, training support and placement is also offered to trainee military medical assistants, nursing and physiotherapy students, autonomous healthcare nurse practitioners and general practitioners.

As the practice nursing officer, I am responsible to the senior medical officer for the management and delivery of nursing services and act as the clinical governance lead. I am supported by a team of three experienced civilian (MOD) nurses who provide inpatient care, healthy lifestyle advice (eg, smoking cessation), travel health/immunisation services and specialist nursing skills (eg, wound care), and nutritional advice. In addition to this team, an occupational health nurse, who is employed four days a week, provides the nursing lead for chronic disease management and the establishment "Fit-Club", and delivers occupational screening services.

While the medical centre activities are centred on the establishment training programmes, the clinical work is varied as the new recruits pass through the practice doors every week, each presenting with differing health needs. Clinic sessions commence each day at 7:45am, and evening surgeries conclude at around 6pm. "Out-of-hours'" emergency and inpatient care is provided 24 hours a day by a duty-watch team, of which I am a member.

On the second day of basic training, all new recruits visit the medical and dental centre for a morning. During this time they undergo a full medical and dental examination and are delivered basic healthy lifestyle and sexual health advice/screening. At the same time their immunisation status is checked and any outstanding routine vaccines normally given in adolescence are administered. Female trainees return in the second week of training to attend a well-woman consultation during which I discuss women's health issues, including smears, breast awareness, contraception, sexual health and healthy lifestyles. For many of the young recruits the initial adjustment to naval life can be challenging as they leave friends and families to commence their first job. Homesickness in the first few weeks of training is anticipated in the younger trainees. However, with good support from the training, medical and chaplaincy support teams this usually resolves by the third or fourth week of training. Maintaining a "duty of care" for new recruits is central to the establishment ethos, and all instructors are required to attend a "train the trainers" course to support them in this role.

My job is clinically, administratively and managerially busy. For three sessions a week I work alongside the two vaccination centre nurses undertaking Mantoux testing, BCG administration and the vaccination of some 210 new recruits against those diseases that they may encounter while deployed at sea or on overseas operations. For the nurses this is a challenging task requiring knowledge, skill, sensitivity and humour as they deal with new recruits, many of whom will be terrified of a hypodermic needle despite proudly displaying their tattoos and body piercings! The remaining sessions are focused on other clinical duties, including coordinating health education activities, delivering sexual health screening services and assisting the medical officers in the delivery of contraceptive and maternity services. Interspersed with these activities, I attend clinical governance, carer's committee and weekly practice meetings, teach new recruits and conduct my duties as a naval officer. It is not unusual to be teaching a group of 70 recruits about sexual health in the early morning, returning to the clinic to deliver well-woman clinics, attending a passing-out parade as inspecting officer in the afternoon, and in the evening hosting guests at an official function. Quick changes of roles and uniforms become a way of life for a military nurse.

HMS Raleigh has been an exciting and challenging place in which to work. The highs of the job have definitely involved working closely with young people as a health educator and naval officer. There is no greater satisfaction than watching a passing-out parade and seeing confident, able young sailors leave the establishment to commence their naval career. While at HMS Raleigh, I have also been given the opportunity to design and develop, with the medical centre team and our civilian partners at the Royal Cornwall Hospital Chlamydia Screening Service, a sexual health strategy that focuses upon sexual health education and screening. This has been nationally recognised, receiving a Nursing Times commendation in 2005 and the British Journal of Nursing/Defence Nursing Services "Defence Award" in May 2006.

If you would like to know more about the Royal Navy, visit
www.royal-navy.mod.uk