Fiona Ralph
Locality Manager DN & RES, Renfrewshire HSCP
Greater Glasgow and Clyde
My job now is to make sure that the nurses in my team have the right support, access to education and training. I want the staff around me to feel supported in decision making and when approaching challenges to promote better health outcomes those they support. This move into a formal leadership role has been really inspiring as I am able to see the great achievements of others. A network of changemakers making a difference in communities. I have always kept my hand in with direct nursing care and frequently go out on home visits. I want to demonstrate that I am prepared to do anything I would expect from others. The team and I have mutual respect and understanding which allows me to focus on digesting updated policies and clinical decision making.
What I love is being able to influence change in district nursing. In previous roles I was implementing the changes made by others but being a locality manager, I can now help shape those changes too. I am just so passionate about district nursing, and I see the advances all around me. By looking at developing a career pathway I can create a place and a voice for district nurses on the route to leadership roles. I let staff know that I recognise their concerns, that I understand them. There is a balance between positivity, acknowledging people’s fears and convincing them that I’m truly listening so that I can make changes, even if progress will be slow.
The variation in the role is huge – from providing end of life care to visiting housebound patients with significant wounds. You get in your car and drive between patients all day but to each patient, you are their first and most important visit. I want to champion the professional district nurse and all that they achieve despite the fact that their office is their car. I remember turning up the radio in the car to help me process cases between visits and thinking, this is like no other job in the world.
The Queen’s Nurse Programme is easily the most positive experience of my life. It enabled me to address an event from my life that I hadn’t even realised I needed to process. The first residential week has given me fifteen years of my life back in just five days. There was a cloak of negativity around me that just dropped off my shoulders as I picked up the skills to manage my own anxiety. Whilst the past will always shape and influence me, I am in control of my memories and the narrative of my life going forward. The residential was a safe environment to explore me, the right questions asked at the right time. And to think, all this in a room with perfect strangers. Sometimes you need someone unconnected to point out that although you have become your story, only you have the tools to write the next chapter. I have to say, I was both energised and emotionally drained when I came home.
If you go into the programme with an incredibly open mind knowing that this is a one-off experience, I think it makes you try everything. Clare herself is an amazing inspiration to me. Here is an intensely professional executive getting the jungle music going on a Thursday morning and encouraging a room full of adults to dance! There is no judgement and no fear. Even if all it does is makes you laugh you feel safe to laugh, that safety is the lesson.
I’m a calm and collected thinker. I find it more helpful to listen to the concern and then take it away before reacting. As a leader, I think it’s important not only to be knowledgeable but to be approachable. You have to be willing to share your learning and I think that I am good at balancing my availability and my own workload. Prioritising my day, much like a caseload, is a real skill. Recognising what is immediately urgent and taking the rest away and building it into my schedule for the day. I have learned when to speak and not to speak. I’m not always confident to speak up at meetings but that it hasn’t stopped me…in front of teams, board meetings and many important people and nothing bad has happened to me yet!
My biggest challenge was starting a new role as COVID began to take hold. We didn’t yet understand what the impact would be on nursing. For a long time, staff were working outside their comfort zones. When you’re delivering an abnormal day, you still need to do it with confidence, sometimes at the same time as processing new developments yourself. I was finding my feet as a manager and at the same time sending district nurses out to do their visits with the limited information available on PPE (Personal Protective Equipment) and in what situations they should and shouldn’t be wearing masks. You’re trying hard not to heighten anyone else’s anxiety which means a lot of managing your own anxiety! The coaching was amazing. My coach told me “Believe in yourself! They wouldn’t ask you to do this if they didn’t believe in you.” She had me ask myself “What kind of person are you?” and I learned that objectively believing in yourself helps tame the gremlin. I now know how to find any negativity, tame it and train my brain that it’s not always worth listening to. I’m a keen runner, it gives me the time to switch off and process. Just having the freedom to take time away or put something into the back of my head without guilt is so cathartic. My poor miniature schnauzer Meg is getting walked to within an inch of her life these days!
