Heather Dudley, my job as a thromboprophylaxis nurse specialist

Heather works as a band 5 thromboprophylaxis nurse specialist. She gives us an insight into the differences between the NHS and the private healthcare sectors, and how the NHS could cut wastage.

What is your current job title, what band are you, and which hospital department do you work in?

I am a thromboprophylaxis nurse specialist, but still only a band 5 as my managers say they do not have a vacancy for a nurse specialist in the thrombosis clinic!

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You don’t need to tell us the exact name, but what kind of organisation do you work for?

NHS acute trust

You worked in other industries before decided to become a nurse. How did you decide nursing was the career for you?

I felt that a professional career was the way to a secure future.

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What was your first role as a newly qualified nurse and how did you feel going into it?

My first position was in a community hospital but it was permanent nights, which I did not really like and there was little back up for a newly qualified nurse in this position.

How did you get into the role you’re doing at the moment?

A vacancy arose in the DVT clinic within the MAU (medical admissions unit) dept, I applied for the specialist role was offered it and had the training paid for by a drug company.

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What’s the most challenging part of your current role?

Trying to get time for teaching new nurses to work in this department.

With hindsight, do you think it was easier or harder for you to become a nurse having worked in another career prior to nursing?

Life experience and dealing with people who are in a stressful situation was easier, but I still find that management in commerce is much better organised than in the health service.

What are the major changes in nursing practice you’ve seen introduced since you qualified as a nurse?

Increased patient numbers with no more staff to cope, more red tape, less time to spend with patients, paperwork / IT confusion.

Do you think standards of care have improved or declined over recent years and why?

I think nurses still care very much about the quality of treatment and the care they give to their patients, but the way some managers run their departments makes this difficult and stressful.

Managers say that the patient must come first but are also under pressure to meet bed occupancy and discharge targets, which is not always in the patient’s best interest. So I do not think that the standard of care has improved, nor is it likely to if present methods stay in place.

Can you elaborate on any inefficiencies you have experienced working in the NHS?

Inefficiencies can cover a whole range of things, from products used to time management. The items following are not necessary to patient care but take up large sums from ward budgets; Paper tissues; toothbrushes; toothpaste; combs; shower gel; hair shampoo; shaving foam; razors; to name but a few. All these items can be provided by relatives, friends or carers, in an emergency soap is the only basic item that needs to be provided by the hospital.

Huge amounts of money is spent on paper even in areas where computers are used, copies are made on paper.

Print-outs are used, items get lost so are re-printed, printers break down so for example, a discharge letter may be 3 pages long and be sent to 3 different printers before getting the job done, then when the printer is fixed the memory is not wiped and can spend time and paper printing unnecessary work.

Staff use clean paper or request slips for scrap. Every request has a separate form, but one multi purpose form could replace these. These changes are very basic but could make a big difference to budgets so that more important items may be purchased.

The NHS is top heavy with senior and management staff, yet there are days when there aren’t enough senior staff members and decisions have to be made by junior or inexperienced staff. Another shift can have too many senior staff, and they do not always want to do basic nursing tasks.

Managed well, there is the potential to save management hours, support junior staff better and balance the number senior staff members on the wards.

Any of these changes could be put into practise with very little effort and would reduce the pressure on budgets, make more budget available to increase staffing levels therefore improving staff morale.

What are your thoughts on working as a nurse in the private sector?

Private hospitals are in the money making business, and as such are better run than NHS hospitals. Their clients expect an exceptional standard of care, but every little thing used down to a cotton swab is charged for.

Visitors are welcome to have meals and tea/coffee but are charged for this, as are the patients themselves. In general, length of stay is much shorter, therefore reducing costs - but discharge planning is arranged almost before the patients are admitted, and discharge medication is minimal. However the nurses are valued by the management and are well trained, which also helps keep costs down as even specialist nurses are cheaper to employ than doctors.

At the hospital I worked at the patients and visitors paid for meals, but nurses had free food - whatever shift they were on. This saved food waste and was good for staff wellbeing.