When I first started as a nurse consultant over 20 years ago many people did not understand the role.
My first post was in a community hospital and intermediate care service, with medical care provided by GPs who visited daily and a geriatrician coming in once a week from our local acute hospital. My job was to support medical and nursing staff in providing the best possible quality of care.
Yet GPs weren’t quite sure of my role and whether I was a manager or an educator.
“One GP said: ‘I’m not sure quite how we can use a creature like you’”
I did my best to explain I could support nursing and medical colleagues by seeing and treating patients and also had educational and other roles. One GP said: “I’m not sure quite how we can use a creature like you”.
But it soon became clear how I could help. I worked on the wards in my uniform and saw and treated patients. Each ward had a GP book where staff noted details of patients that needed to be seen. One day, a ward started a ‘Linda book’ and the others followed. Soon everything went into my book and the only person writing in the GP book was me.
Over the years we developed good team relationships. It wasn’t all plain sailing as some nursing, pharmacy and medical staff were openly hostile to a nurse practising at an advanced level. My work was audited and scrutinised in forensic detail. Some considered me overly academic because I continued to publish, teach in the trust and lecture at university. But I received amazing support from nursing and medical staff and over time things improved.
My second post as a nurse consultant in a community hospital was different. This time, GPs and university colleagues had been involved in drawing up the job description and were on the interview panel. I was to set up and run a nurse-led intermediate care unit, taking patients from the community and home, not well enough to be supported at home, yet not ill enough for an acute hospital.
The world had changed and I was welcomed and supported by medical and nursing staff in accident and emergency as well as GPs. Our chief pharmacist was supportive of non-medical prescribers, being one herself. I was also more confident and competent and had developed the hide of a rhinoceros so barbs about my role failed to have any impact. I supported and developed a team of nurse practitioners and helped all staff meet their potential. I did of course have a few detractors, one of whom in a meeting accused me of “practicing medicine without a licence”. I gave him my most dazzling smile and told him I was practicing first-class nursing, not second-class medicine. I continued to teach and publish and this was welcomed and appreciated.
I am now a nurse consultant in a mental health and community trust. My role is supporting medical and nursing staff in managing the physical health of people admitted to inpatient psychiatric units, as well as educating staff, doing audits and developing policies and procedures to support practice.
In many ways, this role has been the easiest probably because I had 14 years as a nurse consultant when I joined. I now have two nurse practitioner colleagues and advise on all aspects of physical health, with my advice acted on.
There is always one consultant who disapproves of nurses practicing at advanced level – he has excellent reputation but likes nurses to know their place. The doctor who on learning junior staff have asked my advice about patient treatment and care tells them to “obtain a proper medical opinion”.
Recently one such doctor emailed me for my advice on a patient. I reviewed them and he replied saying he’d asked his junior colleagues to implement my recommendations before asking me to review another. After seven years, it seems I’m now fully part of the team.
There are now 96,029 nurse prescribers (Nursing and Midwifery Council, 202). The number has doubled in the last five years. Advanced nursing practice enables nurses at all levels to provide compassionate life-enhancing care. Those of you starting on this journey will encounter detractors and people who may disapprove of your role. My advice is to build relationships with those who support you, find a mentor and continue changing the world one step at a time.
Linda Nazarko is nurse consultant physical health care at West London NHS Trust
Nursing and Midwifery Council (2021) The NMC Register Mid-year Update: 1 April–30 September 2021. NMC.