Anne Maclean
District Nurse
Ardgour, NHS Highland
Despite training in Edinburgh and working in acute neurology, when I moved home to the Highlands an opportunity to work in the community arose. My first instinct was that community nursing might be monotonous as I had perceived it to be all about tasks as a student. Yet I was immediately gripped by the autonomy of the role. I find I have more meaningful relationships with those I care for and it is a fantastic team to be part of. Every day is different, and I like the challenge of not knowing what to expect. The complexities are huge; those which are about individuals and their multiple conditions, their families, and the potential lack of access to services, especially in a rural setting, really strikes one of my core values – equity. Working with limited resources whilst delivering complex care can be really challenging, but enormously rewarding.
I enjoy how small changes can make a massive difference in people’s lives. When I look at a person, I see them as being a combination of different shapes, it might be that only one of those shapes relates to their health, and sometimes that is the easiest to fix! Working in the community means you don’t need to do things in a certain order, the person you’re caring for dictates the order. Sometimes you’re solving other pieces of the jigsaw before dealing with the health condition, holding a space for the person. Community nursing is not the repetition of simple tasks, it’s methodical, creative, collaborative problem solving, with advanced clinical skills.
The phrase I always use is ‘district nurses will be there when you need us, but you might not know when you need us’. The historic expectation of the district nursing service means some people might think they need a nurse to visit every day, but I work hard to give them back the confidence and skills to care for themselves or access appropriate support. I have a strong focus on enabling people to be confident in their own resilience and abilities so that they always feel safe and comfortable. I listen deeply to what matters to them and support them in achieving those goals. There is no limit to the number of cases, and district nurses have no limit to their caseloads, so being able to prioritise effectively is vital. Ensuring we are able to dedicate ourselves to the most complex situations as they arise.
District nursing might not be glamorous or showy but it’s an integral part of my community and society in general. It is too important to be overlooked. I like to think of district nursing as the secret service. I’m advocating for people whose voices are seldom heard and championing care at home, even if that means working under the radar.
Logistics! My caseload covers 5 communities and around 500 square miles. I have to be very creative when mapping my route each day to ensure I’m in the right place to support those who need me most. I have huge faith and trust in my nursing colleagues, and I delegate and support the development of the skills in the team. We’re all open to learning and as a small team, it’s important to be in constant conversation.
When I picture some of the complexities of my role, I see myself travelling enormous distances, being in someone’s home, building a relationship; organising beds, equipment, and care; arranging support from others in the wider community. I work hard to bring together outside support with the clinical care required. I can be assessing symptoms, pressure sores, lymphoedema, setting up a catheter – and all of this in a cramped room with the cat jumping on me at 3 in the morning. It’s all part of supporting people where they really want to be – at home. You only get one chance to get it right.
Before I commenced on my Queen’s Nurse journey, I thought my role was ordinary, that what I was doing was normal. What I know now is that the value I place on myself directly reflects the value my team and those I care for are able to see in me. My own self-belief creates stronger trust, which enables those around me to improve their own lives and health choices. For the first time in my career, I felt valued as a district nurse and that appraisal came from myself.
As a district nurse, I deliver advanced clinical care to the most vulnerable in our community, behind closed doors, silently and unseen. Because of the Queen’s Nurse programme, I am now confident in my leadership, purpose, and my unique ability to care for my community. As a clinical leader, the programme has made me more courageous in exploring and understanding the whole system. Not only do I say it to myself, but together with my team, we push these beyond thought and into action.
I am geographically remote and as a lone advanced practitioner even more isolated. I am really benefiting from the new confidence in my abilities that has stemmed from connections made during the programme.
PPE in the wind, rain, and snow! That aside, everyone has their own tolerance level for COVID-19 and what is acceptable varies between each patient and clinician. Navigating personal anxieties and government restrictions was challenging as a small team. When COVID put pressures on our services I had to address the changing priorities. Luckily, district nurses in remote locations have a history of doing things outside of their normal remit. We are adaptable!
As far as keeping going, the “problem” is that I love my job. Nothing beats hopping into my car to go and assess a complex scenario. I love the feeling I get when bringing all my knowledge and skills together to solve a problem that makes a difference in someone’s life. My team is the biggest support to me, and our healthcare assistant has such a wealth of local knowledge. My family is so patient and very understanding of my career choice, and further still my passion for it. Without those solid structures behind me, I wouldn’t have been able to take on the challenges of COVID in quite the same way.
Since this interview, Annie has taken on a new role, as Advanced Practitioner District Nurse – Team Leader for West Lochaber, which includes her own area and also responsibility for Mallaig and the Small Isles.
