Cathanna Smith is an Advanced Nurse Practitioner working in the small harbour village of Tarbert in Argyll and Bute, where she feels privileged to be at the heart of the local community.
I was born and raised in Stornoway in the Western Isles. When I was just three years old, I injured myself in the eye with a pair of scissors and I ended up in Raigmore Hospital in Inverness for 12 weeks. At that time, I couldn’t speak a word of English because Gaelic was my first language, and the nurses on the ward couldn’t speak a word of Gaelic. All the equipment back then in the hospital was sterilised individually because it was metal – the nurses found me one day washing all the equipment in the sink and they used to say to me ‘you are going to be a nurse’. They gave me a wee apron and everything.
I can remember since I was very tiny that it is always what I wanted to do and at the first opportunity I left Stornoway to go and train in Glasgow. I then went on to work in accident and emergency in the city for two years but I knew I was going to be moving back to a rural area as I had become engaged to my husband who was from Tarbert.
To work in the community then in a rural area you needed to have midwifery, so I also completed that training before I got married. We then moved to Tobermory in Mull where I worked as a district nurse and midwife for 18 months until we left and moved back to Tarbert. I started working in bank community nursing and midwifery combined with providing holiday cover for the practice nurse in the local surgery. Over the next 12 years, I gave birth to four sons and continued to work in the bank nursing and doing hospital shifts at weekends and evenings which suited us as my husband was working as a teacher. By 2003, I was able to get a part time job as the practice nurse in the practice where I work now. I did this role until I completed my non-medical prescribing and my undergraduate certificate in unscheduled care – that led me to becoming an Advanced Nurse Practitioner (ANP) in 2013. For the last five years I have been working in Tarbert full time as an ANP.
We have around 1,800 patients at the practice and I have my own clinic and appointment system, so I can see anyone, whatever their age or presenting problem.
I do a lot of chronic disease management as well as supportive nursing like helping people to stop smoking, to manage their weight or discussing drugs and alcohol use. I do specialist clinics such as asthma, diabetes or stroke. I can have children coming in who have fallen and injured themselves, I could have an adult walking in with chest pain or abdominal pain.
I do most of the telephone triaging of patients who call needing to be seen that day. I never know who could walk through my door. Today, I have had someone with asthma, a young person with hypertension, a man whose foot was numb, a woman with breathlessness, somebody with diabetes, another lady with chest pains and a man coming for COPD check-up. And that was just the morning.
No day is the same, you are on a rollercoaster all the time, but I love the variety.
In 2004, I was given the honour of being voted the citizen of the year for my contribution as a nurse to village life. This was an enormous shock, but it was lovely and it made me realise how much the community valued me. I never thought of what I was doing as exceptional, but the community thought it was because they felt I had gone above and beyond what was expected of me as a nurse.
In a small, rural area you very much become part of the community – everybody knows you as the nurse. You become an important person in someone’s life as you work alongside people from the cradle to the grave. As an ANP I have the privilege of dealing with everybody – you get to know the whole community and they get to know you.
I am on a mission to showcase the role of the ANP to the public but also to advance knowledge within healthcare as well.
To do this, I have produced a video showing a snapshot of what I do in a day and explaining what an ANP is. I hope it can open up communication and I would like to set up meetings with other disciplines in primary care to explain the ANP role. This came about as my issue for development through the Queen’s Nurse programme because I find I really struggle with people not knowing what an ANP is.
We are not GPs, we are not trained as GPs but we are very highly qualified nurses. Our role is to support our GP colleagues by seeing people whose care can be best delivered by an advanced nurse practitioner and letting them look after the patients whose needs may be more complex. I can do clinical tests which I think are appropriate to reach a diagnosis, I can refer to other specialties if required, I can prescribe medication, I can send for x-ray or ultrasound or I can admit to hospital if that is required. It’s a complimentary role within a team setting and it works well.
I love my job, I love coming to my work, helping people and trying to make a difference. You need to be a bit of an adrenalin junkie to like the pace – it can be happy, it can be sad.
The Queen’s Nurse programme has been life-changing for me as it has changed how I think and altered my outlook on life. I feel invigorated to fulfil the rest of my career, supported by a network of community nursing colleagues. I feel equipped for the challenge I have set myself in raising the profile of the important role that ANPs can play in providing high quality primary care.