Communications and engagement manager Martin Machray wonders if he was right to leave nursing behind and why he’s now decided to return to practice.
As I have moved through my career in the health service I have developed skills and experiences broader than were ever envisaged in my initial training to be a registered nurse.
Indeed, so broad and varied that I have drawn less and less on my experience in practice and become more and more involved in challenges beyond my profession. Inevitably, I suppose, my nursing skills became rusted and I made a decision some years ago not to re-register when the paperwork dropped through the letter box. It didn’t feel like I was turning my back on the profession that I had chosen, but felt more like a natural progression. I was proud of my nursing roots, I always will be.
Then the pendulum of health service change faltered at the top of this particular arc and momentum shifted in the opposite direction. The movement is now away from the regime of central planning and control to greater individual choice and, perhaps, more dependence on clinical leadership. Time to rejuvenate my clinical skills, re-register with my professional body and in September of this year I began a return to practice course whilst continuing in my managerial role within the PCT.
Two nights last week illustrated the stark contrast that exists between the two roles I am playing in parallel. On the Tuesday I was out with my newly ascribed mentor, a district nurse in the south of the borough, knocking at the door of an elderly widow who had been receiving a care package from us for sometime. As we entered the flat, and spent some time with Ethel, a number of things struck me. To begin with, there is such a high level of trust in nurses and the nursing. Despite having never met me she welcomed me warmly into her home on the assertion from me (which she probably never heard due to being so deaf) that I was “the nurse come to do your tablets”. Secondly I was reminded how patient people are and how willing they are to invest their time in you. I was slow, hesitant and obviously uncertain as I worked my way through the drug chart and scrambled about in her kitchen cupboards looking for various bits and bobs. And in response? “You’ll get the hang of it duck, don’t mind me”! Finally there was a disarming willingness on her part to be led and advised. She may not remember my advice to drink plenty of fluids but she genuinely promised me she would do just that if that was my advice!
What a contrast to only a few days before when I was in front of our local Overview and Scrutiny Committee discussing the challenges of austerity and change that face us this winter. I was the same person, applying the same degree of integrity to my job and working for the same organisation, their local NHS. Yet the response of this small group of councilors could not have been more different to their neighbour later in the week. There was no trust in “management”, no time to listen to what I was saying and certainly no willingness to be advised by me despite my years of expertise in areas that were generally very new to them since their election in May. Of course I understand why it’s like this. People need to focus on the here and now. Railing against a person is much easier, and instantly satisfying, than taking exception to the national deficit of untold billions or to a white paper that proposes fundamentally changing the model of commissioning. Yet I am the same person and my clinical colleagues are, like me going to have to deal with these personal paradoxes and conflicts. GPs in particular but also nurse leaders and others are taking on more responsibilities for commissioning at a time of cutbacks and restrictions yet we want to make those decisions using our best clinical judgment. At the same time we have to maintain the level of trust and respect our profession has developed over centuries. A challenge for all of us indeed.
About the author
Martin Machray is a health service communications and engagement manager for NHS Islington. He began his career as a student nurse in the 1980s and was involved in frontline care nursing for a number of years until he moved into senior nursing management. From here he entered strategic and operational management posts, both in hospital environments and in national organisations before assuming his current role.