James Hill
Advanced Nurse Practitioner within Addiction Services
NHS Ayrshire and Arran
My inspiration came from supporting and caring for my sister. My mum was the main carer, but I took her to see doctors, specialists and to her hospital appointments. Research says that people recover better at home. In a more relaxed environment, they are also more susceptible to accepting help – that’s where my passion for the community came from. The initial trust of being allowed to enter someone’s place gives you a good grounding to build a relationship but it’s not always simple. Working with addictions many of our clients are chaotic and vulnerable. Sometimes we have to question whether the environment is safe for the practitioner. You don’t know who else will be in the home you’re visiting or what circumstances you’ll be working in. But just as importantly we also need to know if the environment is safe for the client, there may be drug paraphernalia lying around or a lack of amenities. I think it’s so important to be able to assess risk in the places in which the people you care for spend the bulk of their time.
For my clients the biggest challenge they face is stigma. Addiction services and charities give people a voice. The general public often believes the negative stories they hear, and that unhelpful perception can be life-destroying for someone suffering substance abuse. There is an assumption that users don’t take care of themselves or aren’t capable, but often that’s not the case. Sometimes I even see poor management of symptoms that can exacerbate problem behaviours. I hope to help challenge the existing stigmas, particularly that addiction is an unsolvable problem. I want to promote the physical and mental wellbeing that comes from being drug free.
Drug deaths in Scotland are shockingly common and as a nurse, I am committed to reducing that number. I am here to help people find a level of normality they can cope with and encourage their hopes and aspirations. Nobody deserves death because they made a bad choice. Various clinics and needle exchanges share safe injecting protocols, and another wide range of psychosocial interventions are now available too. We all have an unhealthy coping mechanism to block out difficult issues, bad days or arguments, it is a strong temptation for everyone. But sometimes those coping mechanisms are dangerous and harmful. I see home pressed tablets made widely available as they turn a profit for dealers. When other factors like housing and finance impact health we must collaborate to tackle these. As nurses, these social determinants of health are our business and I work closely with housing and social services in an integrated team.
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 the Integrated Team Leader for West Lochaber, which includes her own area and also responsibility for Mallaig and the Small Isles.
