Pauline Buchanan

I always wanted to be a nurse and it’s what I set off to do starting my training at the age of 18. Over my 40-year career, I’ve tried other things such as lecturer, manager, researcher and sales person. However, I missed caring for people and so I always returned to nursing in primary and secondary care. I have spent a great deal of my time teaching in the community and I specialised in primary care dermatology, this included educating, training and mentoring community teams regarding the management of common skin conditions across Scotland.

My current role represents a new post in NHS Fife, which meant I was stepping out into new territory, meeting new people, building bridges and forging new relationships with key stakeholders. Finding my way across boundaries, and around obstacles and through bureaucracy is challenging. However, throughout my career it is perhaps these challenges I enjoy the most.

I hold 25 community-based dermatology clinics per month over 22 different sites across Fife. A typical day for me is a 9am-12 skin clinic in a GP practice, then two home visits, and another skin clinic between 2-5pm at another GP practice or health centre. Frequently, I have colleagues shadow me in my clinics to increase their knowledge of dermatology.

This post has been established so that people can get the expert dermatology care they need swiftly and close to home. The aim of the post is to establish a fully integrated dermatology service across NHS Fife which will provide equity of access to dermatology knowledge, provide on-going education and support for community colleagues and deliver a first-class service for patients and carers.

Prior to me coming into post, if GPs and community nurses were unable to manage a skin condition in primary care the only option was to refer to secondary care, which has long waiting times. Now, I can deliver care in community settings to patients. I can assess, educate and prescribe – allowing patients to be seen sooner and closer to home.

The impact for patients is allowing them to have a greater understanding of their skin condition and manage it day to day. The impact for clinical primary care colleagues, is enabling them to be confident and competent in managing uncomplicated skin conditions in the community, reducing the number of unnecessary referrals to dermatology.

I’m from Fife and I have a knowledge of the communities I am working in. I have a passion for improving the care for patients living with uncomfortable and often painful skin conditions. I aim to bring back quality to their lives by educating them to manage their own condition.

I have been part of a group of dermatology nurses who regularly teach and discuss the psychosocial aspects of skin disease and how nurses can assess psychological impact of a skin condition on a person’s life.

In helping others to make an impact I believe my main responsibilities lie in educating and enabling others to understand skin as a vital organ, that is, to help others understand skin from birth to old age, understand skin in illness and in health, understand the psychosocial impact of skin conditions on a person’s life.

Enabling others to understand skin can and will have an impact at every level of community nursing, from the very basics of fundamental skin care to assessment, diagnosis and prescribing for dermatological conditions.

 The best thing about being a community nurse is being with the patients in their own environment. I enjoy being able to see things from their perspective and working out together what can help their skin condition. I also enjoy the autonomy in making diagnoses and prescribing for the patient so that they receive effective treatment. I love professional development, so education is high up on my agenda. I am very happy when teaching other health professionals and patients.

My vision is to implement a ‘gold standard’ community-based fully integrated dermatology service across NHS Fife as a model for other areas. I hope to take this new person-centred dermatology service and build an educational programme that supports the work that has already commenced.

I strongly believe the dermatology nurse of the future will be firmly ensconced in the community.  Skin problems, dermatoses and even skin cancer does not carry a high mortality rate, therefore attracts little attention or funding. However, the burden of skin problems, including the psychological impact of living with long term conditions can have a profound effect on individuals, health services and society.

To have a fully integrated community dermatology service will be of huge benefit to patients and reduce the number of referrals to secondary care. Hopefully a community nursing workforce will be able to effectively manage common uncomplicated skin conditions really well.

I plan to continue my commitment to develop a competency-based dermatology educational programme for community healthcare professionals. I believe the Queen’s Nurse issue for development is the perfect platform on which to develop, implement and evaluate this proposed ‘gold standard’ within community nursing.

Perhaps it is my personality, my determination, my ability to ‘think out of the box’ and my belief that whatever it is we are trying do to is going to be worth it, that keeps me focussed.  My driving force has always been doing what is best for the patients. The knock-on effect of a satisfied patient is a satisfied health care worker and service provider.