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Practice nurses: underpaid and underappreciated?

The last couple of months at work have been the most stressful time Rhona Aikman can remember - and she knows she is not alone ...

Earlier this year, before the H1N1 epidemic, I enrolled for an advanced clinical assessment skills course at university. It runs from mid-September until Easter time, and I knew this would make the flu immunisation period even busier as I would be out of the practice a half day a week on the course. Had I known what was going to happen with the H1N1 pandemic there is no way I would have taken this on!

On top of this, I had done Implanon training and had to do my supervised sessions at a family planning clinic. Having completed these sessions I already had a list of patients waiting to have Implanon inserted. These require a 30-minute appointment, so you can see what the problem is - there are just not enough hours in the day.

We usually immunise approximately 1,500 patients for seasonal flu, and using the search codes provided by the trust, we had 2,000 eligible for H1N1 at the initial launch. If we have a 75% uptake for H1N1 immunisation this would be another 1,500 immunisations on top of the seasonal flu programme.

We had almost completed the seasonal flu programme by the time we had our first delivery of H1N1 and the thought of literally starting again was enough to make me want to retire. Allowing five minutes per immunisation and working seven hours per day doing nothing but immunisations, I calculated this would take 36 days to complete.

I work full time and my colleague works 26 hours a week. Even allowing for help from community nurses for the housebound, as well as the GPs doing a few immunisations, it is obvious the increase in workload is a problem. I know we are no different from other practice nurses, as everyone seems to be struggling under the strain.

The nurses at the sexual health clinic where I was doing my training were feeling the same and morale was low. Changes in working practice without consultation seems to be a common theme among nurses wherever they work. One recent example was sexual health nurses being "asked" to cover a clinic 27 miles away from their usual clinic but still in the same trust area.

This added 45 minutes minimum each way by car to their working day and no travelling time was given. By public transport it would add at least an hour. When they claimed the mileage allowance they were told the policy now was to pay the cost of public transport. This is just one example, and there are many others. Some will be challenged successfully but the effect on morale will be longer lasting.

A recent survey of practice nurses in Scotland by the Royal College of Nursing (RCN) highlighted that many practice nurses feel undervalued and not consulted in decisions affecting nursing in their practice. The RCN also undertook a UK-wide survey of nurses' employment and morale in 2009. They found an increased number of nurses consider their workload to be too heavy compared to 2007 (58% of all nurses and 61% of nurses in the NHS).

Being more involved in decision-making in practice and having a voice at board and governmental level would help to raise the profile of practice nursing and make it a more attractive career option. While there have been advantages to the unique way in which nurses are employed in general practice, gaps have emerged in working conditions between them and nurses who are employed by the NHS.

Agenda for Change has only been adopted by a small number of practices, so practice nurses have to negotiate terms and conditions themselves. Annual leave, study leave, pay and sick leave are just a few examples where conditions can vary. How are we as practice nurses going to improve this?  

I certainly don't have all the answers, but do feel strongly that many more practice nurses need to get involved, both at local and national level. I urge you to find out what is happening in your area, and support the nurses that are working on your behalf.