From bedside to battlefield: 21st-century nursing offers a variety of roles

'I manage a team of 30 people and get great satisfaction out of developing them'

Chris Booth is director of the Greater Manchester Health Protection Unit, a role that until now has been exclusively held by a doctor.

"There are 28 Health Protection Units (HPU) across the country and they do what their title suggests – that is protect the health of the population from infectious and non-infectious hazards. That could be TB, environmental hazards, pandemic influenza, to name a few examples. We work closely with our partner organisations such as Primary Care Trusts – to both prevent danger and, with the things you can't always prevent like influenza, to plan what action to take when an outbreak happens.

I've been in my role as director for two-and-a-half years before which I worked for a health authority. There's never been anything written down to say my job had to be held by a doctor, but that's the way it has always been, so it feels quite exciting for a nurse to be holding the role now. Indeed, I have responsibility for the population of Greater Manchester – 2.7 million people.

Although my role sounds very general, I have a particular interest in non- infectious environmental hazards. I enjoy being able to focus on that interest. Another thing I particularly like about my role is managing people. I manage a team of about 30 people and I get great satisfaction out of developing them – ensuring they have maximum support to deliver what they need to. We have a lead for TB, a lead for sexual health, a lead for immunisation and so on – so each of their development needs is quite different. I enjoy the challenge of my role too and the fact that no two days are the same.

I wouldn't say it's been that difficult to climb the career ladder. I think people often impose their own glass ceiling in nursing. The reality is that the opportunities are there for nurses – it's just a case of identifying and seizing an opportunity if you see one. Certainly, I've found that people like my chief executive recognise that nursing can enhance roles like mine. I just wish more people out there in nursing would rise to the challenge, rather than see themselves as being stuck at a particular level.

I'm not suggesting high-level opportunities fall into nurses' laps. As in any profession, you have to work hard to get them. In my case, doing Manchester Metropolitan University's MSc in practice development for developing leadership skills and partnership working helped equip me with the knowledge needed to drive my career forward and lead the exploration of issues impacting on Greater Manchester's health.

I've been particularly impressed with the commitment of the HPU towards continuing professional development. In my role, I'm able to encourage staff to do a Masters or even a PhD. Admittedly, there are times when it doesn't wind up being possible because of financial constraints, but I would always bend over backwards for people to be supported to ensure they don't remain static. It helps that we are heavily involved with academic institutions to ensure the courses available are tailored to our needs.

In fact, part of my career has involved helping to run Masters courses. That's one of the great things about nursing – the variety of your workload can be immense. One of the things I've observed when running these courses is that some nurses are put off by fears of academic study. But in fact, I've seen many nurses who don't have an academic record really shine. The work they produce can be very high quality. It's just that they haven't had the chance to test the waters before."

'Military nurses work alongside NHS colleagues when we are not deployed'

Rachel Morgan is a nursing officer in the Queen Alexandra's Royal Naval Nursing Service. Her career in the Royal Navy involves changing roles every two years, with past roles having ranged from supporting soldiers working in sub-zero temperatures through to working on a hospital ship.

"I'm definitely not one of those classic cases of growing up knowing that all you ever want is to be a nurse. In fact, I have never had a traditional desire to hold the hand of someone at their bedside. I've always liked the idea of looking after people who are at the more fit and healthy end and I chose the military as an employer partly because of that. Also, I felt the military would offer more opportunities for adventurous training and a more outdoors lifestyle than perhaps working in an NHS centered career.

Having been accepted into the Royal Navy, I was offered the opportunity to go to university to study a diploma in nursing. Later, I added to my skills with midwifery and since then I've had an incredibly diverse career doing everything from practising midwifery for families working abroad to supporting the Royal Marines on winter deployment, which basically consists of looking after the health of soldiers in Norway, who work in sub-zero temperatures.

Another of my jobs involved working on the RFA Argus. One of the key roles of the medical services of the Royal Navy is to support this hospital ship, which is a primary casualty receiving facility – a 50-bedded unit afloat. More recently, I've also worked in Afghanistan. I was one of the medical liaison officers to the reconstruction and development team.

Military nurses work alongside NHS colleagues when we are not deployed and as such I've also worked in a Plymouth hospital in accident and emergency, where I've had the chance to refresh my skills. Currently, I'm working in the Royal Navy Command headquarters, supporting operations. It's a staff job and therefore a management office role.

I really enjoy moving around and have relished every step of my career. I suppose I'm just not the kind of person that would have been particularly suited to staying in my home town working in a busy hospital. With the Navy, I've got to change roles every two years, including working at sea, abroad, alongside other military like the Army and now in the Royal Navy headquarters. The variety is fantastic and the social life and camaraderie are key drivers too. You become very fond of the people you're working with – engineers, royal marines, pilots and warfare officers to name a few. If you're looking for something subtlety different to an NHS career, I'd recommend it. It's a very rewarding role, with fantastic esprit de corps.

Training and continuing professional development has been brilliant. We have an absolutely superb training operation and I would say once every two to three years, I have been offered university level updating for the particular roles I've been in.

Among the jobs that have most stood out in my career has been my work in Afghanistan. I had a very clear role in supporting local nationals in health in what is essentially a very poor country that has been exposed to war for 25 years. It was a really key experience for me in that it somehow put everything else into perspective. I also gained enormous satisfaction from meeting Afghan health care workers – doctors, nurses and others – on a daily basis in very remote areas where we haven't had Western workers for a very long time.

There are significant periods of time that I have to spend away from my family, but that is rewarded by having time to adjust when you come home. It's appreciated that six months in a war zone requires some time to adjust upon return."

'It's rewarding seeing people who come to us in a complete mess able to go home'

Nigel Mellors is an orthopaedic and trauma nurse at King's Mill Hospital in Mansfield. Previously, he was a postman and a miner before retraining during the mid-Eighties.

"Our ward deals mainly with traffic accidents, although it's for anyone with a muscular or bone injury. Generally, patients go straight to theatre upon admission and then come on to our ward for post-operative care and rehabilitation. It's my job to do the best for them – to get them up and moving as quickly as possible. It's very rewarding seeing people who come to us in a complete mess able to go home with things to look forward to.

That said, it's been a couple of years since I worked directly at the bedside of patients. I decided I wanted a change and I became a staff-side lead. It involves representing about 4,300 staff – nurses, physiotherapists, occupational therapists, porters, housekeepers, medical staff and others – from a consultation point of view and ensuring that staff are engaged at all levels.

A recent example is that we've just moved into a new building. That's been a major thing, not least because the new 24-bed ward is the first in the country to have 50 per cent single cubicles. The fact that these beds are not all easily observed requires a totally different way of nursing and it's been my job to make sure staff have been involved in the planning process from day one.

When I left school, I became a motor mechanic apprentice. I had no O-levels, so there wasn't much else on offer. I hated it. The pay was awful and the work didn't suit me, so I became a postman. I then decided to become a miner simply because that's where all the money seemed to be. But after working for a couple of years on the coalface, I realised the end of that industry was nigh and I decided, at 30, to retrain again.

I chose nursing because I thought I'd enjoy the hospital environment. Once I'd trained as a state enrolled nurse, I took my O-levels so I could do the state registered general nurse training – the predecessor to diploma.

I started out in surgical nursing and loved it from the start. I especially liked the trauma side of it – the blood and gore, as well as the emotional side of nursing. So I moved to trauma and orthopaedics and I've stayed ever since.

I quickly took to the hands-on contact with patients and the rapport you have with them. I'm not saying it was easy – a lot of the accidents in those days were from mining or motorbikes, in which many people lost limbs. That is horrendous. But I gained enormous satisfaction in helping them get over it psychologically and get used to it physically.

When I moved away from bedside nursing two years ago, I thought I'd really miss it. I actually wondered if I was making a big mistake, but I love my new role and I still see patients on a daily basis."

'Training and continuing professional development have been fantastic'

Carolyn Noble is a Parkinson's Disease nurse specialist for Peterborough Community Services. She also manages a rehabilitation team for people who have had traumatic brain injury.

"I see people with Parkinson's once they've been diagnosed. It's my job to help them adjust to the diagnosis, giving them as much information as is appropriate at the time and getting them involved in our four-week educational programme, which provides them with an introduction to what the condition is, how to have a healthy lifestyle and how they can control their symptoms.

I also see them on an ongoing basis in nurse-led clinics. I review their medication, refer them on to various therapists and manage symptoms. Because anxiety is a huge part of the condition, sometimes we offer them cognitive behavioural therapy (CBT), which we've found really successful. In fact, gaining a qualification in CBT was one of the first things I did after being employed in this role.

As well as working with the service users directly, I manage a team of two – a physiotherapist and a Parkinson's support nurse.

The other part of my job involves managing another team – one that provides rehabilitation for people who have sustained a head injury through trauma. This team includes a clinical psychologist, an occupational therapist, a speech and language therapist and two physiotherapists. I don't see clients as much as I used to in this role, but the management side of things keeps me busy enough and I enjoy developing staff – looking for their main qualities and getting them to realise they have these skills, as well as introducing them to new ones. I also love working out how to develop the service strategically. I really enjoy looking for new opportunities and ways we can use our skills to benefit service users.

In terms of working directly with service users, I think my main job satisfaction comes from helping to make such a difference to people's lives. By suggesting an intervention or even prescribing something differently, you can improve someone's mobility, for example. Or by doing some cognitive behavioural therapy, you enable people to get out more. One guy with Parkinson's who came to see me had become so introverted that he had stopped going out altogether. By the end of our therapy sessions, he'd done some public speaking. To him, that was a huge achievement.

I enjoy the autonomy I have. I set up both services and I got great joy from ensuring the services were person-centred. We still consult with service users as much as possible when we are thinking about changes.

After my general nurse training, I trained to be a midwife. I then worked in a special baby unit and as a school nurse. I took a break after that to have children, and after returning to community nursing and then staff nursing, I found I was becoming increasingly frustrated because I really wanted to focus on one particular area of practice. The opportunity for a Parkinson's nurse came up, which was great because there were only 23 in the whole country at that time, back in 1995. I quickly became an expert and have developed my role ever since.

Training and continuing professional development have been fantastic. My employer has funded me to do a Masters, as well as a postgraduate diploma in CBT. In addition, there are plenty of opportunities to attend conferences, both nationally and internationally, and I've done a lot of speaking as well as learning at those. In fact, I've travelled a lot in my job. One time, I went to Sweden to talk to nurses who were thinking of setting up something similar to our work with Parkinson's, which they've since done. I've published quite a lot too, writing chapters for books and journals."

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