Are you new to general practice nursing?

Even as an experienced nurse with a wide range of roles behind her, moving into general practice nursing was not an easy one for this newly qualified GPN. In the latest in the Diary of a General Practice Nurse series Jane Coomber asks: why is it such a difficult role to get into from other types of registered nursing roles and, what more can we do to encourage and support nurses or healthcare workers from primary and secondary care who do make the transition in their first few years as a GPN to help retain these vital primary care staff?

How did you get into general practice nursing, and how did you find accessing the training and job for this role? I struggled for years before getting my foot in this particular door, and this is something that I think needs some discussion.

I recently spoke with a patient who is an A&E nurse, who told me about the level of stress in his work and the hours not being family-friendly. I asked if he’d ever considered practice nursing? He was intrigued, and we agreed to discuss more about what it involves at another time.

This led me to thinking about why this role is often tricky to get into. It’s not getting any easier. When our numbers are dwindling, and when our role is, in my opinion, such an essential part of primary care, what are the barriers?

Finding my feet

My own route from secondary to primary care was quite a complex journey, and I’ll explain this briefly so you can see how we all bring different experiences and previous job roles into this work, and how it’s not always straight forward, which is what makes each general practice nurse unique.

I’ve had a lot of different roles as a nurse. I’d qualified in the mid-80s as a State Enrolled Nurse; I did my EN conversion to become a Registered Nurse and have completed various courses at university levels and DipHe over the years to upgrade my practice.

I worked in NHS operating theatres for many years and progressed professionally. I worked in the community with young people with physical and learning disabilities in both residential and educational facilities. I’ve been part of the estates and facilities team at a South East London hospital trust in a non-clinical, corporate nurse role, as part of a cost improvement programme (CIP) and assisted during the trust’s merger.

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With all this in mind, I thought I was well equipped to start a new professional adventure in general practice. I’d looked into the role a few times, but then when I heard that the government were funding GP surgeries to take on GPN trainees a various universities I thought okay, now’s the time!

Before the pandemic, I got a job as a healthcare assistant with a practice for the experience and hoped to be able to get on a GPN training course, though that did not materialise. Then Covid 19 hit.

I had a steep learning curve during the pandemic doing ward work for the first time on a post-acute rehabilitation ward, as I just couldn’t sit idle, and then used my managerial and triage skills at Special Point of Access.

After the pandemic, I applied for and got a job as lead nurse for a company to manage their extra hours hub within a hospital as they agreed to fund me for the GPN Fundamentals course. I embarked on the six-month general practice nursing course through Greenwich University, but the company I was working for lost this contract and I had to find another work placement to complete my course. It was very much a chicken and egg situation: no job, no training; no training, no job.

Meanwhile, the cohort I’d joined had moved on and I was entered on another one. In effect, I had completed my cervical screening part of the training and been signed off, but had yet to complete the rest of the course.

Luckily, I was now supported by a lovely advanced nurse practitioner during the training who found me a new placement at an inner-city health centre where I finished the course. I signed a contract agreeing to work there for a fixed term if I passed. As they only employed two locum nurses one day a week each and neither had agreed to be my practice supervisors, one of the practice partners agreed to sign-off parts of the competencies on the placement. To complete the rest of my documentation, the ANP kindly spent time with me at the practice, and we thrashed out the competency documents in time for it to be submitted along with the written assignments.

I passed! The relief was palpable. I was offered a job there straight away. In the meantime, I found a second one, which is where I still work today, very happily.

How have I found general practice?

I am proud to be working as a general practice nurse and have now been in the role for almost three years.

I love this job. I feel I have found my place as a nurse in this role. I was attracted to practice nursing for its autonomy in practice as much as anything else, but what I have found too, is that I’m working in isolation.

What I was not prepared for – and do still miss – is not having the everyday support of working side by side with other nursing colleagues.

I haven’t often had another nurse to discuss things with if there were problems and id made mistakes and needed advice, or if you want to phrase it more positively, talk about some learning experiences.

That’s not to say I haven’t reached out and had some input here and there, but I’ve not had the opportunity of regular consistent supervision, which I think we all need when new to any role, however experienced as a nurse one might already be.

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I admit that I have found this stressful on many occasions – the weight of the responsibility as a GPN is heavy, isn’t it. I’m aware of often being overly careful as a practitioner, possibly to the point where it’s almost restrictive. I made mistakes in those early days without support and it would have been nice to have a more experienced colleague tell me: ‘Jane, this happens to the best of us; learn from it and move on’.

In secondary care, I valued having someone else to bounce my thoughts and ideas off; to ask questions of; to gain knowledge and ideas from in the moment. There were a variety of medical and ancillary support colleagues to get feedback and validation from: ‘Am I doing well?’ or if I was in need of redirection or support.

I do feel that not having a certain level of support in practice, especially in the early days, has slowed down my learning, and on reflection, this has had a knock-on effect of reducing the confidence that I could have gained if better supported.

How did you feel when you first came into general practice? Did you find this too? Did your previous working background support your new role or hinder it? What pitfalls or issues getting started did you find?

What have I learned?

My current lead GP once told me, ‘You have good instincts, follow up on that’. I do now – a couple of years into practice nursing and having gone through a few rounds of hard knocks, mandatory training online and a range of workshops – realise my worth in this role. I understand that I’m developing a decent knowledge base, have good gut instincts, and time and again my good people skills and empathic nature, and years of general nursing experience are my strengths.

I know that I do my job well, but I also acknowledge that I will continue to improve and learn from everyone I come into contact with. I would still like to have colleagues around me daily to discuss patients with. Because of this I now belong to many ‘wassap’ chats and attend forums when I can to gain knowledge, discuss different ideas and ask lots of questions of my peers. I started writing this diary as a way of reaching out to all of you.

Tell me, how did you first find it in general practice? Are there things you would have done differently at the onset of your GPN career?

Are you also now working mostly in isolation? What help and support from peers or mentors have you had? What advice would you give your newly qualified self today?

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Is there more we should be doing to support our new to general practice colleagues and attract more nurses to this rewarding career? Do you have any advice for other nurses in this situation? I would love to hear from you.

Jane Coomber is an RN, GPN working in a small SE London general practice

Diary of a General Practice Nurse is a regular series and Jane welcomes your feedback and responses. If you would like to comment on the above or want to write your own Diary article, please contact the editor at [email protected]