Angela diMambro is the QNIS Prizewinner for PostGraduate studies at Robert Gordon University. She is pictured receiving the award from Jane Walker, Honorary Secretary for QNIS alongside Heather Bain, Academic Strategic Lead: Academic Programmes, School of Nursing and Midwifery at RGU, and QNIS Fellow. In this blog, she discusses moving to the community from acute, and completing a Masters course in District Nursing.
I received notification from the academic lead at Robert Gordon University that I had been awarded the QNIS postgraduate community nurse prize following completion of the MSc in Advanced District Nursing Practice this year and I was very surprised. I had completed the course alongside other community nurses who had excelled and I, at some points throughout, really had no self-belief that it could be achieved.
I qualified as a staff nurse 23 years ago, completing the ‘traditional’ RGN training which I very much enjoyed, however, there were no assignments and certainly no dissertations spoken about back then. I developed professionally through experience in the various areas I worked in, including acute surgical, high dependency and palliative care, before entering the land of community nursing 6 years ago. I had worked in the community as a student nurse on placement, and this was a long distant memory, so I was anxious regarding the change in career path.
I had completed a module on pain management whilst working in palliative care and had found the academia side of things very challenging (referencing??? What’s that all about?? I am not an academic!!). I was very lucky to have support from colleagues and the fantastic Dr Sally Lawton who encouraged me constantly to have belief in my abilities and I was delighted when I passed with great feedback.
My start in community nursing was daunting and I took some time to settle into the role. This was very different from a hospital environment, as a lone worker, with a great many things to learn. I was fortunate to work in a very supportive and caring team and found that it was a privilege to care for patients in their own homes and I also became aware of the complexity of situations that could arise. This made me consider the possibilities of not only continuing in community nursing but whether I could take on the challenge of a Masters course in district nursing? My nursing friends and colleagues all thought I definitely should, however I was not so sure. With some persuading I completed the application and then was immediately terrified when I was accepted on the course.
I cannot pretend that it has not been the most challenging thing I have ever done, at 43 years old, commencing studying at a level I had never done before, and certainly always being an ‘average’ student at school. My poor husband had a lot to contend with over the two and a half years (“I CAN’T DO IT” – the most common phrase being used throughout).
As the course went on and I passed the modules, with constructive and supportive feedback, I began to gain confidence in my abilities in writing at Masters level. Our class all worked together, through varying struggles, supporting and boosting each other to continue. A ‘study buddy’ is a must in my opinion and I wouldn’t have got through it without mine!
The decision to continue with the dissertation was not taken lightly, however, I felt that all the modules had been achieved at Masters level and this spurred me on to continue. My study was a service evaluation concentrating on long term conditions, specifically Chronic Obstructive Pulmonary Disease, and how care could be improved in the primary care setting. It focused on patients who did not attend their annual reviews and investigated possible reasons why, concluding that many had multiple co-morbidities and varying priorities. The study found that within the multi-disciplinary team in primary care, the community nursing team led by the District Nurse should become more involved, by being supported in improving education and working together with all specialists, to give further support to the housebound patient.
The phenomenal amount of work involved in completing this dissertation cannot be underestimated, however, my personal tutor was a rock throughout and guided me through each stage to completion with patience and I will always be grateful for this support. I truly believe that if I can complete this dissertation with distinction then anyone can if they are determined to achieve it. I now have a greater appreciation of the undertaking of research to inform practice and the knowledge and experience gained throughout the process will enable me to lead a team by inspiring and motivating them to consider improvements in practice.
We are working in a very demanding and high-pressured environment at times and it has been a longstanding ambition to shift more healthcare to the community setting from hospitals, focusing on becoming more proactive and encouraging early intervention. Due to the rapidly changing population demographics and health issues within Scotland, responsive services are required to meet present and future challenges. This is still very much a work in progress and there certainly needs to be more support and encouragement within NHS trusts to give community nurses the incentive and drive to become advanced district nursing practitioners and be passionate about delivering high quality, person-centred care that our patients all deserve.
I am honoured and feel privileged to receive this QNIS award which I feel inspires me to be an effective clinical nurse leader with a focus on the future, leading a team to engage in a shared values culture by enhancing nursing practice through research and being intent on delivering the highest standards of care possible.