Name: Charlotte Hamilton
Role: Contraception and Sexual Health Nurse
Location: West Yorkshire - six different surgeries
Wage: £23K-£31K (band 6)
Previous job: Staff Nurse in Gynaecology
There is no such thing as a typical day in my role. When I wake in the morning I have to think for a moment what day it is, and where I am based today. It has been a difficult choice but I have settled on Friday because it encompasses two very different clinics.
I am a Contraception and Sexual Health (CASH) nurse. Formerly known as ‘family planning’ this service has incorporated sexual health, which makes sense as it is impossible to separate the two. I start my first clinic in a Health Centre at 8am. This particular clinic is a GUM clinic. Appointments start at 8.45am. We grab a quick drink just before the first arrivals. We often have extras ‘squeezed in’ who need to collect treatment or have an injection before they start work. This clinic is different to all my others because it is consultant-led.
When I started in 1998, the job did not resemble my current role. Qualified as family planning nurses, we were mere doctors’ assistants. Today we are running nurse-led clinics, sometimes alongside the doctors, and are much more autonomous. This has been a gradual move with the introduction of Patient Group Directions and then more recently Independent Nurse Prescribers. With additional training nurses are now screening, diagnosing, treating and following up clients.
Today my clients include several ‘worried well’ and several symptomatic people who want screening for STIs, a man with confirmed gonorrhoea, wart treatments, and a homosexual man for Hepatitis B vaccination. There are a couple of 'walk-ins' and we try not to turn anyone away. eg. acute attacks of Herpes can be very painful, and some clients may turn up needing emergency contraception.
Much time is spent following up positive results (including ‘Partner Notification’ and the recording of statistics for the Department of Health) and obviously promoting safer sex. We try not to miss an opportunity for health promotion.
Lunch today is a quick sandwich during a meeting. This service planning meeting is about GP practices delivering sexual health services. Traditionally few GPs have offered this service. But times (and funding arrangements) are changing and more GPs are providing specialist services. Our consultant offers training to these GPs and the queue for her time is seemingly endless.
After lunch I drive to my second clinic of the day. I have been employed by a forward-thinking rural GP Practice, to provide a drop-in clinic for teenagers twice a week. After checking my email and post I have a few clients booked in for routine screening, cytology or contraception before my drop-in session begins. Today my clients include a 15-year-old girl and her boyfriend who want a pregnancy test (which is negative) and free condoms. After a long chat about their options, I am sure she is competent to consent to treatment. She chooses to use oral contraception.
My next visitor is a teenage girl needing emergency contraception, which she takes in the clinic. We arrange her follow-up. Once again condoms are provided and legal/ethical issues discussed. She is not ready to begin another method of contraception and wants to discuss it with someone at home first. I back up what we have discussed with leaflets. I am mindful of the law when dealing with minors, and our 'child protection procedures' are never far from my mind.
A typical afternoon also involves screening asymptomatic people opportunistically for chlamydia. Up to one in ten young people are testing positive for chlamydia when screened this way, so we have a lot of work to do.
Any of my clinics can cover any of the above issues, and may also involve counselling, eg for HIV screening or unwanted pregnancy. Work isn't over for me when I leave work either. I have created a website www.teens-r-us.co.uk aimed at teenagers but useful to anyone who needs information which I maintain in my own time at home.
So would I recommend this role? Yes without hesitation. There is never a boring day, and work is challenging but rewarding. I like the fact that my hours are fixed and this works well for me. I work in a supportive team, despite the fact that we have had to deal with many changes recently.
So what for the future? It is a good time to be involved in CASH services as it has recently been identified by the government as a priority and funding is being made available. After many years of being underfunded and unfashionable I think things are improving. Many nurses are now prescribers, and this means they can see the patient through to a conclusion and this is very rewarding. I am currently working towards this end. Undoubtedly the job has evolved and is changing continuously. That for me is the best thing about it.