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Day in the Life of a Consultant Nurse, Older People

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Name: Jonathan Webster
Role: Consultant Nurse, Older People
Location: University College London Hospitals NHS Foundation Trust
Wage/ Band: 8a – 8c
Previous job: Practitioner/clinical team Leader for a community stroke rehabilitation service

I’ve been a consultant nurse working with older people since 2001 and have been at UCLH since 2005. The role covers the four domains of nurse consultancy:

• Expert practice
• Professional leadership and consultancy
• Education, training and development
• Practice and service development, research and evaluation

My role is within an acute London hospital that has seven sites. One of the key challenges of the post is the scope and depth of the role, specifically the older person’s agenda as it doesn’t sit within a neat, disease-specific box.

Older people access the majority of services within my organisation with the exception of midwifery and paediatrics. A key part of my role has been to develop links with the local boroughs/ PCTs that directly work with UCLH (three in total) as looking at the needs of older people in their entirety. This is vital to the person’s journey through acute hospital services.

In my previous consultant nurse post I was a joint appointment between an acute trust and PCT. This was good as it enabled me to have ways in which to influence both organisations. However there were challenges as at times I didn’t feel part of either organisation. Also, leading such a vast agenda proved highly challenging on 2.5 days in both trusts!

The key to my role is to lead and influence care for older people. I achieve this by either seeing older people on a 1:1 basis (predominantly but not exclusively on our Acute Admissions Unit) or by working through and helping others with professional advice related to specific aspects of therapeutic nursing care.

Work that I am currently leading within the trust includes:

• Safeguarding vulnerable adults
• The dignity agenda

Practice development is central to my role and I have recently jointly secured money from the Foundation of Nursing Studies to take forward two programmes of practice development aimed at improving the older person’s experience of dignity in care within the trust. Helping practitioners to question, challenge and subsequently change practice is really exciting. However on my part this needs determination, resilience (to deal with the highs and lows) and a belief in the importance of helping practitioners to grow and evolve.

Research is also a key component to my post (although it frequently gets ‘squeezed’ due to competing pressures). I have strong links with one of our local universities which is enabling me to work collaboratively with the research agenda. I also work closely with the Senior Nurse for Nursing Research within the trust.

In my role I don’t have any operational responsibility which means I’m not tied to the day-to-day challenges of managing services: a danger is that unless I work closely with the operational service I could sit within a ‘vacuum’ with little influence. Within the division I am based at, I am currently involved with developing a model of rapid response focused on helping patients to avoid unnecessary hospital admission and therefore enable the transfer of care back out into the community from A&E and the Acute Admissions Unit.

Writing for publications and presenting at conferences while developing a national profile is really important if I am to influence the broader older person’s agenda. For many nurses this seems a world away from day-to-day practice. However I believe it is really important if we are to ensure that the needs of older people are kept at the forefront and visible at all times of national health and social care reform and change.

Being a consultant nurse for older people is great as no two days are the same and the potential to work in partnership with older people to develop and shape both care and services is huge. However it isn’t a post for the faint hearted. Being an advocate for older people’s nursing (within a speciality that historically, in my view, remains under-resourced compared to other specialities) can be challenging as you are often questioning not only the values and beliefs of individuals but at times the broader organisation.

It strikes me that in these posts organisations can have very differing views as to what the roles is about (this might be reflected in the value they place on nursing and expertise in practice). Similarly the skills and back ground and academic level needed to step into consultant nurse posts.

I completed a Masters Degree in Nursing before moving into my first post in 2001 and have recently completed my Doctorate. I do believe a Masters qualification is essential for these roles as this level of study provides individuals with the depth of critical appraisal skills needed not only to critically understand and evaluate practice at the immediate level, but the broader level too.

A real danger to the future of these role in my view is when consultant nurses do not demonstrate real value within cash-strapped, target-focused organisations. We have to demonstrate why we provide added value and why the scope of our roles is different, say, from clinical nurse specialist posts. I don’t believe there is any room for complacency!

Career progression from these posts isn’t well defined. The job market is changing along with the type of nurses being recruited into a smaller, more competitive pool of senior executive related roles. Similarly the same could be argued for academic posts. The scope of the consultant nurse post is such that there are many opportunities for development within the role. However I would argue that there need also to be clear opportunities for those consultant nurses who want to develop further. After all, isn’t this healthy for the future of nursing?

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