There is a common perception that agency nurses are ‘in it for the money’. But for Tim Bennett, who won this category – sponsored by MPS Healthcare and Montagu Nursing Agency – at the NT Awards last December, it couldn’t be further from the truth.
‘What many people don’t realise is that agency nurses suffered a 10% pay cut following Agenda for Change, as the government now dictates how much agencies can pay nurses,’ Tim points out.
He insists that his commitment towards his clients is his main motivation. Unlike many nurses who experience increasingly high patient turnover, Tim has worked with the same few clients for years.
An agency nurse with the British Nursing Association (BNA), he provides one-to-one care to just two clients with complex neurological conditions in their own homes.
‘I’ve worked with my main client Dennis for nine years. He has motor neuron disease, which was diagnosed 11 years ago. He was a consultant in psychiatry and psychotherapy in Leeds for nearly 20 years until he had to retire due to his condition. He was also a Labour councillor and hospital manager.’
Tim admits that working with such a formidable personality can be a challenge. ‘He used to give the nurses a hell of a time – he knows exactly what he wants and some nurses find that quite difficult. But he’s more relaxed now. Consistency is really important to Dennis.’
As his disease progressed, Dennis made it clear that he wanted to be ventilated rather than allow the condition to take its natural course and eventually paralyse his respiratory function.
‘As an ex-psychiatrist he knew what he could choose, and he chose to carry on living, to carry on breathing,’ says Tim. ‘He had to push for the decision with the local health authority as it costs them a fortune.’
Tim works three long day shifts a week at Dennis’ home, and one night shift with another client – a young woman who is also ventilated and completely paralysed.
But he came to this very specialised area of work via a rather unorthodox route, as he has been a full-time agency nurse for most of his career.
‘I started working full-time for the BNA in Leeds as soon as I qualified in 1998,’ he explains. ‘My girlfriend was living in Spain so I enjoyed the freedom it gave me.’
Initially, he worked across a wide range of areas including general medical, A&E, respiratory medicine, oncology, care of older people and neurology.
He then did some short stints on the Isle of Man, including working in A&E during the Tourist Trophy races – the island’s annual, high-speed motorcycle racing tournament.
Eventually, he held a post for three years as a neurology staff nurse at St James’s University Hospital in Leeds, followed by a year at a Leonard Cheshire nursing care home for adults with physical disabilities in Huddersfield. Experience in both of these roles proved invaluable when he moved on to care for Dennis full-time in 2004.
But wasn’t Tim apprehensive about taking on such intense one-to-one work? ‘I didn’t think about it at the beginning,’ he says. ‘It’s a bizarre situation, for a nurse who’s used to rushing around, to concentrate on one person. But it’s a great feeling to have the time to give really good care.’
Tim is responsible for every aspect of his clients’ physical care including hygiene needs, tracheostomy dressing, PEGs, administering medication and feeds, and dealing with suction.
In addition, Tim carries out all of the ordering, liaises with other healthcare professionals, supports and coordinates with Dennis’ family and even transcribes personal letters for his clients.
The BNA provides Dennis’ whole care package so, although a district nurse comes in twice a year, Tim is mostly left alone to organise the care.
‘You are not in a team like you would be on a hospital ward, although I do work with a carer for two hours in the morning. So I miss the comradeship,’ he admits.
But although the day-to-day care is down to Tim, he relies on vital back-up provided by local health professionals.
‘The equipment we’ve got is excellent and reliable, and we have spare machines and batteries from the respiratory team at St James’s. If the equipment fails, they send someone out straight away,’ he explains.
One of the difficulties of being a sole worker and agency nurse is that Tim does not have someone observing what he does or giving him feedback or support. ‘You have to find your own confidence,’ he says.
But he adds that Dennis would make it very clear if he was unhappy with Tim’s care. ‘I must be doing OK or he would tell me. One time I told him I was planning to leave and he spent the night telling me not to go. I did leave the job for a while but eventually came back – so what he said must have had an effect on me.’
But the trust and the strong working relationship that Tim and Dennis have built over the years has definitely been tested at times. ‘In the early days of working with Dennis, he had an expensive television delivered and I offered to move it through to the bedroom for his wife. I put it down on the bed and it bounced straight off and onto the floor and broke. Dennis had a reputation for losing his temper with staff and I thought, “That’s it, I’m fired” – but he just laughed,’ recalls Tim.
Communication is vital to any nursing role. But the amount of time Tim spends with Dennis, combined with Dennis’ inability to communicate naturally, means that making themselves clear becomes even more vital and challenging.
‘Dennis’ wife made a communication system using a board with the alphabet and a list of Dennis’ most used and important things. One time, the alarm went off on his ventilator and I presumed it was the sputnik [monitoring filter].
‘Dennis was not looking happy and had to use the board to slowly spell out ‘AIR’.
It was only then that I realised the tube, hidden under a towel, had disconnected.’
Although Dennis suffered no harm, Tim admits it is moments like this that highlight what it means to have sole responsibility for a client with complex needs. ‘It bothered me when I started. But the relationship I now have with Dennis and his wife means we work as a team.’
Despite the high quality and continuity of Tim’s care, winning the NT award for Agency Nurse of the Year still came as a shock.
‘I didn’t know I’d been entered by the agency until I was shortlisted. I wasn’t sure about the whole thing. I’m not particularly ambitious and it should be clear I’m just one member of an excellent team of nurses and carers that looks after Dennis.’
The judges of the category, however, had no hesitation in recognising Tim’s outstanding contribution. ‘Both [Tim’s clients] are paralysed and have extremely complex needs. Tim takes on a leading role in coordinating their care and ensuring that other professionals understand their requirements,’ they concluded.
‘He is highly valued by his clients and their families, who are full of praise for his commitment, patience and caring nature, as well as his excellent nursing skills.’
Tim plans to use the £1,000 prize money to invest in something completely outside nursing. ‘I want to take a course in traditional woodland crafts. I used to fell trees and do fencing when I was younger. I would love to get back into the woods. My job is intense and I find working with wood very relaxing.
‘I was very grateful to have won the award. It’s been really surreal and very flattering,’ he says. But he insists that winning is not about the money but what it has meant to his biggest critic and fan – Dennis. ‘He says he’s proud to be cared for by his “award-winning” nurse.’
Motor neurone disease
Motor neuron disease (MND) is a progressive neurodegenerative disease that attacks the upper and lower motor neurons
Degeneration of the motor neurons leads to weakness and wasting of muscles, causing increasing loss of mobility in the limbs and difficulties with speech, swallowing and breathing
It can affect any adult at any age but most people diagnosed with MND are over the age of 40, with the highest incidence occurring between the ages of 50 and 70
Men are affected approximately twice as often as women
In the UK, two people in 100,000 develop MND each year – but the number of people living with MND at any one time is nearer seven in 100,000
For more information on MND, go to mndassociation.org