As the nurse most responsible for protecting children in one area of the UK, Angela Baker is often asked whether she sleeps soundly at night.
Working in child protection a huge responsibility at the best of times but when something goes wrong - as it did with the well-publicized case of Victoria Climbie – health and social care professionals can now find themselves under intense scrutiny.
‘I do the job because I think it makes a difference to children and young people,’ states Ms Baker, who is the named nurse for safeguarding children and young people at North Dorset PCT.
‘I can see a change in the culture. Staff are more conscious of their responsibilities now. Yes, the buck stops at this desk, but I don’t have many sleepless nights – experience has helped with that,’ she explains.
Given the questions raised by the Climbie inquiry, it is surprising that there are still no statutory hours for named nurses (in fact the role pre-dates the inquiry). Baker is named nurse two days a week; for the remainder she is head of children’s services at the PCT. ‘I’ve always been more interested in prevention and in public health,’ she admits.
While working as a practice nurse with the armed forces overseas, she was impressed with the way that a colleague handled a cot death. ‘Her skills in dealing with that interested me – I thought, “that’s what I want to do”.’
She returned to the UK and trained as a health visitor, working for ten years as a health visiting team leader. ‘I supervised staff around child protection and built up a good knowledge base.’
Her experience of community nurse management and child protection on the front-line stood her in good stead for the role of named nurse. ‘The difference between health visiting and being a named nurse is the responsibility you have in the organisation, and the specialist knowledge you have around safeguarding children,’ she explains.
Supporting and supervising staff on the frontline of child protection work is a key element of the role. As these staff sometimes have to deal with the courts, she also ensures they have access to legal advice too.
If a child in the area dies or is significantly harmed by a parent and carer, the Area Child Protection Committee conducts a ‘serious case review’. In this scenario, the named nurse is responsible for collating evidence from health staff. ‘We have to collect every bit of information we have about that parent and child so we have a picture of what actually happened.’
This means getting staff to hand in their notes and reports on time, then going through notes and checking them. ‘It’s very time consuming,’ she admits. ‘But it’s a priority piece of work.’
‘We look to see whether we followed policies and procedures and whether there’s anything we could have done to prevent it, and anything we can change in our working practices.’
Ms Baker has been involved in only one serious case review, after a child died at the hands of their carer. ‘It was difficult from an emotional point of view, having to read through the evidence and support the staff involved.
‘The first thing the health visitor said to me was: what could I have done? Was it me? Could I have done something?’
In this particular case, the health visitor was blameless, but sometimes it is found that staff have not followed procedures. ‘People have to trust you, so you have to be fair to them. It means listening and not jumping to conclusions. People don’t tell you things if they feel they are going to be blamed. But you also have to be clear with them – it may go down the disciplinary route,’ stresses Ms Baker.
But equally management could be at fault. Ms Baker believes the Climbie inquiry found managers had put frontline staff in an impossible position, with inadequate numbers and resources.
That case and the legislation that followed it have focused the attention of health and other agencies on their responsibilities towards children – particularly at senior levels - and put the emphasis on co-operation between the NHS, local authorities and the police.
The named nurse is an important figure in these partnerships. ‘You learn a lot about networking.’ Ms Baker liaises with paediatricians in the acute sector and regularly meets with her peers across the county.
Another important part of her work is teaching child protection to NHS staff, first in induction training and then at more advanced levels. ‘I have a teaching qualification and it’s one of the most valuable courses I have done. In this post you have to have a very good understanding of how adults learn.’
Most named nurses are health visitors, like Ms Baker, or school nurses. Although some people believe community paediatric nursing may be another valid route in. Most are on H grade or equivalent, although some are I grades.
There is seldom a deluge of applicants. ‘Some people don’t want to take on the responsibility of doing it, but that is because they don’t have an understanding of the job,’ admits Ms Baker. ‘If you have the right support in place and good supervision you should not be scared to approach it.’
She recalls a colleague in a minor injuries unit who, suspicious about injuries to a child, informed the father she would refer the family to social services. ‘He was a big bully guy and was quite angry with her.’
Several months later the nurse met the man out shopping. ‘She saw him coming towards her and thought he’d punch her lights out, but he put out his hand to her and said, “I just want to thank you for what you did. The help that came has made a huge difference to me and my family”. That’s always lived with me, because they do get angry and upset, but it’s hugely important to change things. That’s the bit that keeps you going.’
How do I become…. named nurse for child protection?
Key skills: Listening and negotiation skills, knowledge of child protection, approachability, ability to gain colleagues’ trust of staff, empathy, supervision skills and a thick skin.
You need to have: A health visiting or school nursing qualification
You don’t need to have: A degree in health visiting or masters qualification in childcare law, although some named nurses have these.
Similar jobs you could consider: Working with Sure Start projects or at children’s centres.
Where to find information on similar roles: http://www.childcarecareers.gov.uk/