DIARY OF A GENERAL PRACTICE NURSE
GPN Jane Coomber reflects on the title ‘nurse’, changes happening in general practice and how this is impacting on general practice nurses (GPNs) now and in the future
How will our job roles merge into each other’s, as primary care moves forward into the future? How are nurses perceived in general practice? How do we fit into the team, now made up of a wide range of professionals, levels and responsibilities?
I have spent some time in the past thinking on how it is demeaning to refer to nurse colleagues as ‘the Band 5’ or ‘my Band 6’. We all, of course, have names and a job designation that relate to our sense of identity as a professional and a person. Nurses and healthcare workers are people, not our pay grades, after all. And in GP land, we aren’t even this, as the Agenda for Change banding isn’t even part of our pay scale.
I have spent some time in the past thinking on how it is demeaning to refer to nurse colleagues as ‘the Band 5’ or ‘my Band 6’
So, let’s consider what do our titles and job roles mean to us in general practice.
To start, we know here is a great deal of controversy around the title of ‘nurse’. Personally, I find it really annoying when staff/reception/admin and our patients refer to our HCAs – however fabulous they may be (and majority I’ve worked with were marvellous and have taught me a lot in this new role) – as the nurse.
They are not a registered nurse, and after all the training and hard work we as GPN/RNs put into our qualification, I think we have the right to have this term protected. In fact, at some point it could play a part in how our pay is decided in the primary care sector.
What do you think?
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Next, I’m wondering, why did we go into this particular area of practice? What gave you the idea to be a GPN?
I think that for many it depends on when we started the role and how its evolved around us since. Talking to colleagues, their experience as a GPN does seem to be very different to how it was, back in the day, say 10, to 25 years or more ago.
It’s been tough, but two years in, I’ve gleaned quite a lot along the way
Someone I started my career with, left operating theatre nursing after a couple of years to join her local practice as their practice nurse. Being a registered nurse was all the qualification she’d needed for them to employ her. I don’t know for sure, but I think her training was just a handover by the nurse leaving the job; to learn as she went.
Was it like that for you when you first joined general practice?
When I joined, much more recently, I completed a short (and not in my opinion all that fabulous) fundamentals course. I was then was thrown in the deep end to learn on the job with little to no nurse support.
It’s been tough, but two years in, I’ve gleaned quite a lot along the way.
What drives us in our GPN career?
Then, I’m thinking, what drives us every day as GPNs?
Being a GPN can be seen by our colleagues in secondary care as a bit boring and repetitive, and a place where old nurses go to live out their final years? Though I know I never saw it like that. Of course, in fact, it’s often very challenging.
But I did think I would be working more with other nurses and HCAs, as well as the GP partners. In some of my jobs I have, but in other practices not so much.
For me, my motivation in this role is to empower my patient. I look to educate people to look after their own health; to care about what they do to their bodies and to demonstrate how with self-awareness and our clinical support, a person could for example go into diabetic remission. To do this I need to give a patient the knowledge that they can get on board with: enough information that they could understand; but not be overwhelmed by or feel ‘told off’ by the nurse. This takes time and needs to be pitched correctly to each individual.
I look to educate people to look after their own health
My approach, while non-judgemental, is honest. I don’t sugarcoat what I’m telling my patient as a nurse. I hope I’m never perceived as unkind, and the feedback I receive bears this out, but I will give them the facts and also tell my patient how I can support them. Together, we can get on track with their health and lifestyle challenges.
I’ll use all the resources available to me and signpost them to online diabetes education and support forums for example. Discuss lifestyle changes, dietary and exercise as well as a range of medication to support their health.
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These days, we have a huge selection of other care workers in most general practice teams, all of whom we can feed into for our patients care needs.
Who are you currently working with in your practice? How does this impact or support your daily clinics?
In-house pharmacy teams, physiotherapy teams, paramedic prescribers, nutritionists, HCAs, GP associates, ANPs and nursing associates – these are a minefield of potentially overlapping roles, each with a variety of limitations and people who can, if they are not careful, lay themselves open to litigation and risk of overstepping the boundaries of their role’s parameters as well as being a great help and support to us in our roles.
Having to supervise someone who is less experienced than you; aren’t trained to your level or as experienced, but has a higher pay than you can be galling, and many GPNs say they find this difficult to deal with.
How do we stand behind our boundaries without seeming to come across as unhelpful or not working as part of the team?
Though I suspect we have all been here too at some point: put under pressure to perform a task; a duty that’s above or beyond our remit or capabilities?
How do we stand behind our boundaries without seeming to come across as unhelpful or not working as part of the team, an ethos which we’re expected to be more about these days?
And how do we, and should we, as registered practitioners, advocate for those workers under our care; to support them in their practice?
I always remember being concerned about a healthcare support worker in theatres, who I felt was being taken advantage of by our anaesthetic team, as they would ask them to perform tasks outside their role’s remit. If I intervened, I was labelled a killjoy. ‘But they’re happy to do this; you worry too much. We’re keeping an eye on things, it’s fine. We’ll take responsibility’, was the response, more often than not.
Whistleblowing was a tough thing to do back then. Certain people held power, and it was difficult to be heard in this strong hierarchy.
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How do you advocate without belittling the strong supportive role our non-nurse colleagues play in general practice?
We’re all being classed as additional roles reimbursement scheme staff (ARRS). When this was rolled out in 2019, PCNs were expected to claim back on this scheme for funding practice nurse trainees. I remember being paid just under £17 per hour when I first started, a lot less than others on my training course or our HCA at the time. I wonder how things will change once NHS England bites the dust?
So, how will the GPN role change, given the differing responsibilities we have. Will it simply be absorbed into all the other ARRS roles, piecemeal, to save money? Will the practice nurse cease to exist in her/his current form?
Jane Coomber is a general practice nurse in south London. Look out for more in this regular column: The Diary of A General Practice Nurse
