Not to teach you to suck egg…

Becoming a nurse in the UK is not a clear path. It can take many different routes. I see nursing through the prism of my training. A similar view but slightly distorted, with the light bent I see it a new.  Through conversations with staff members and through my own induction training I am learning a great deal what it means to be a nurse in England.

First, being a nurse in the UK does not hold the prestige as in the USA. We are literally blue collar workers. The task hands of the doctor. Professionalism in nursing is a new but growing concept. People choose nursing not for the money or benefits but for the desire to help. To learn the science of caring. And you hear that spirit in the nurse humming a favorite tune to her patient or when everything is stopped to make a strong cup of tea for a patient knowing, that is what truly what they need. I am surrounded by kin and it feels good.

Like most things in life right now COVID directed my induction training. Computer base modules dictated most of the mandatory training except for one in person day.  Even though computer training was grueling, I did learn new things. And familiar topics were presented under new light during the in person training..

What is Safeguarding?

Safeguarding is a new topic that may not have a US equivalent. Safeguarding is a term used in the United Kingdom and Ireland to denote measures to protect the health, well-being and human rights of individuals, which allow people — especially children, young people and vulnerable adults — to live free from abuse, harm and neglect.  If your internal alerts goes off you are required to fill out an online form that activates necessary resources to the person in need. I did not mind the long online training. I have come to view it as a safety net created by the government for those in need. The concept took rise after the death of Maria Cowell at the hands of her stepfather. Gaining traction with United Nations Convention on the Rights of the Children in 1990 which states that children are treated as human beings with a distinct set of rights.

Six Principle for Protection

The UK government created six principles to better guide the protection of not only children but vulnerable adults. First, empowerment: supporting and encouraging people to make their own decision. Second prevention, highlights the importance to take action before harm occurs. In the A&E we monitor harm such as such as neglect, obesity or tooth decay. Third, and perhaps more obvious, is protection. Protect child or vulnerable adult from violence, physical or emotional harm including providing support and appropriate representation if needed.  Protection not only from their parents or family but anyone that comes in contact with the person. Fourth proportionality, taking the least intrusive response to the risk presented, you will only get involved little as needed. Fifth and sixth are accountability and partnership. Working together and allocating responsibility to everyone involved or in contact with person in question.

Safeguarding lies not only in the hands of health care providers including paramedics but police, social workers and teachers, a collaboration for the vulnerable. The system itself consists of a team of agencies which work together giving children the childhood they deserve. Does this exit back home?

UK parliament in 2015 added another branch to safeguarding. Part of the Counter-Terrorism and Security Act 2015. It states “healthcare providers have due regard to the need to prevent people from being drawn into terrorism.” It’s designed to tackle the problem of terrorism at its’ roots. Preventing people from supporting terrorism or becoming terrorists themselves. An added layer of responsibility for healthcare workers but one I personally welcome.

The safeguarding system and process has intrigued me. And will continue to research and hope to bring that knowledge back home.

What is good end of life care?

A sliver of new material was the mandatory training about end of life care. A reminder to health care providers of all levels that death is a normal, gentle process if allowed to occur naturally. The course focuses on reclaiming the dying process. We learn fifty percent of death occurs in hospitals but not fifty percent of the population want to die in a hospital.  Most people want to be in familiar surroundings with family and friends.  The ice is broken on this difficult topic creating an ease for further discussion.

Checking for Life

Basic Life Support (CPR) traditionally trains you to check for breathing by placing your cheek against the victim’s lip, simultaneously looking for rise and fall of the chest wall.  We are in COVID times now. You wear a gown, a mask, face shield and must attempt to maintain a safe distance from the unknown victim. Therefore instead looking to see if a patient is breathing, you place your hand on their chest and “check for signs life.” Years of training out the window.

Moving and Handling

Another case of years of training out the window. The hands on training started with images of how not to move a patient. All the methods I have used for years assuming were best and safe practice. How was I supposed to “properly” move patients? Since I had arrived, according to the instructor, I had been man handling patients by pulling them up with a draw sheet. The training impressed me. To protect the nurse focus is given to the autonomy of the patient. The instructor reminds us that the moment you give a patient a gown they become ‘sick.’ By handing them the gown you confirm and add to their belief that they are helpless and ill and hence less inclined to help themselves. As healthcare providers we must remind them of their capabilities by simply asking them “how do you get around at home?” and “Show me.”

We learned how to guide a patient to lift themselves out of a chair. First their bum comes to the edge of the chair. They ground their feet. We next provide a gentle push to their lower back and stabilizing them by putting pressure on the opposite anterior shoulder. Another process we learned was how to guide a fallen patient off the floor into a sitting position without any physical help from the nurse. If you want to know these methods send me a message and I will share the magic. The underlining message from the training is parallel to the British healthcare, give power to the patient, let them do as much as they can on their own.

Nurse’s education

Talking to colleagues I learn there are many ways to become a nurse in the UK. Most people finish their formal education around age 16 after taking a general certification of education examination. At 16 you can take further education at “college” that offers vocational training, preparation to attend university, or nursing school. The majority of nursing schools are 2-3 years and unlike the US do not require prerequisites. Anatomy and physiology are taught along with nursing education. You can also become a nurse through an National Health System funded apprenticeship diploma through a mix of on the job training and classroom learning.

Nurses education is divided into four branches that do not intersect, adult nursing, pediatric nursing, midwifery or mental health. The qualification tests and educational requirements is distinct to each branch. A fellow emergency department (ED) nurse stated she prefers mental health nursing but understood the limitation if she only studied mental health. Her ultimate goal was to be ED nurse where you see patient in acute mental health crisis so she obtain her adult nurse degree as a primary and completed her mental health nursing as a secondary degree.

Emergency Nurse Practitioner

Emergency Nurse Practitioner (ENP) is a registered nurse who can assess, diagnosis, and prescribes treatment for patients who present with minor injuries and or illness. To become an ENP you require 3 years’ experience and must be a band 5/6 nurse. After a qualifying test, an interview that includes a presentation you get hired into the position. The training in our Trust is completed via Wessex Health Education England. Training is more of an apprenticeship with additional book learning. In the process you create a “portfolio” which verifies your depth of knowledge. The role of an ENP is subject to local variation in education and practice provision.  A fellow American nurse, Kyla Payne, recently completed the process and tell her story here.

Advance Clinician Practitioner

An ENP has a limited scope of practice compared to an Advance Clinician Practitioner (ACP).  Our version (American) of a nurse practitioner here is call is Advance Clinician Practitioner (ACP) ,Advance Critical Care Practitioner (ACCP) or Emergency Care ACP. Anyone registered as a healthcare professional with critical care experience and a bachelor’s degree can become an ACP. You apply to the ACP program via the Royal College of Medicine. ACPs trainee must complete a two-year program that leads to a postgraduate diploma or Master’s degree. Trainees are also employed by an NHS organization for the duration of their training. Teaching within hospitals is overseen by a local clinical lead that is responsible for the delivery of the clinical components of the training.  The education requirements are similar if not more than a US nurse practitioner.

What Band are you?

The band levels are another nuance I am still deciphering. All I can gather at this time is the higher the band the higher the authority and responsibility. And the hierarchy is palpable. I am a band 5 nurse, a standard staff nurse. Nurses with the knowledge base to triage or be in charge are band 6. I am very happy in my current pecking order.

One of the idioms I have come to learn, which was repeated by the respiratory therapist giving his lecture on noninvasive ventilation, is “I am not going to teach you to suck egg.” It translates to “I am going to tell you something you already know,” or do not offer advice to someone who has more experience than oneself. And even though the training is similar, I do feel I walked away with a bit more than I started, so maybe they will teach me the proper or just a different way to suck an egg?