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A day in the life of ... a walk-in centre nurse

Jane Keane

As a sister at the NHS walk-in centre in Blackpool, I see a variety of patients of all ages who present with an assortment of problems. The walk-in centre serves both the local community and the large influx of visitors. My role consists of history taking, carrying out physical examinations, and treatment or referral. When I first took up the position it seemed very daunting - the fact that I sometimes had little knowledge of the conditions I was presented with meant that it has been a very steep learning curve - then again, that's nursing, isn't it, always learning something new? Since I started work here I have attended a course on physical examination techniques and have applied to do the BSc Nurse Practitioner course.

5.45am. Oh no! My alarm is ringing, it's dark outside and the last thing I want to do is get up, but I am due to start at 7am - so with much trepidation I crawl out of bed. Before setting off to work I must make sure that my children's uniforms are ready, that their schoolbags are packed, and that the dog is fed. With three young children I can often feel like I've done a day's work before I've left home!


6.40am. The children are up but it's time to kiss everyone goodbye and drive to work. The streets are quiet at this time of the day; in fact, this is probably the only time during the day that I get some peace! I pass the street cleaners and say good morning to the milkman, arriving at work just before seven.

7am. The shutters of the walk-in centre are put up and the first patient of the day has already arrived - a man who is having some fasting bloods taken. A lot of the early morning patients attend for bloods. I obtain them as requested and off he goes for his much-needed breakfast.

7.10am. The buzzer goes and another patient has arrived - a young lady with abdominal pain. I take her history and following a physical examination arrive at the conclusion that she has cystitis, for which I can give her trimethoprim. I provide her with the antibiotics, which are supplied under patient group directions (PGDs). There are a number of drugs that we can prescribe using PGDs, and the list is increasing. In addition, we have some nurse prescribers working in the centre, and we are aiming for all staff to train to become prescribers. This will benefit the patients as it will allow us to complete more episodes of care.

7.30am. I grab a cup of coffee and decide to check my emails while things are quiet. I have received an email with some suggested dates for myself and a colleague to give a talk to the student nurses. We talk to those students who are doing a community placement about the walk-in centre, about the role of the nurses and the services we provide. I reply to this email giving available dates.

8am. The next member of staff has come on duty, as well as a student for whom I am mentor. I enjoy being a mentor and teaching students and see it as a very important part of my role. The walk-in centre tends to have one or two students on placement throughout the year, and we take it in turns to mentor them.

9am. I am first in triage today and so I log onto the computer system ready for action. We operate a triage system between 9am and 5pm so that patients can be seen in order of need and, during busy times, poorly patients are not missed and left waiting for lengthy periods of time. It is also so that patients who we cannot deal with are directed to the appropriate service. My two hours on triage go quickly, and in total I have triaged 19 patients.

11am. I have a coffee and a bacon and egg butty before logging back onto the computer and calling in my next patient - a female with a cough. When the patient presents, it is evident that she is short of breath. I check her medical history, oxygen, saturation levels (92%) and her peak flow reading (below normal) and, after listening to her chest and hearing wheezing, decide to give her a salbutamol nebuliser. Following this she is no longer short of breath and both oxygen and peak flow readings are within normal limits. I then carry out a full physical examination, all the while explaining to the student what I am doing and why. I obtain readings for temperature, blood pressure and pulse. I listen to the patient's chest with my stethoscope for any abnormal sounds that may indicate a problem. I decide to book an appointment at the patient's GP surgery in the afternoon and send her home with instructions on what to do if her symptoms return before the appointment.

11.45am. Next I see a young man who has lacerated his arm. The wound is deep and requires suturing. I am still being supervised while I become confident and competent with my suturing, so I ask a colleague if she will watch while I do it. Some local anaesthetic is used to numb the wound and I insert three sutures. The wound edges come together nicely and a dry dressing is applied to the area. Before the patient leaves I provide him with instructions for wound care and suture removal. At the walk-in centre we also glue, ­steristrip and staple wounds. Therefore we can deal with a lot of the wounds that present to us.

12.20pm. I have my lunch before attending a meeting at the local hospital for tissue viability link nurses. I get to the meeting for 1pm. Today we discuss management of a variety of wounds and best practice. It is really useful to meet nurses from other clinical areas and discuss practice. The afternoon passes quickly, and before I know it 3pm has arrived and it is time to go home.

3.15pm. I arrive home and await the mayhem. My husband has gone to collect the boys and I have 15 minutes in which to have a nice cup of coffee and get ready for the brood coming home.

My days are always hectic, but I enjoy my job and the new challenges it offers me, and I love my busy - if sometimes chaotic! - home life. I really would not have it any other way.