Career advice

From maverick to guru

WHEN GARRY Swann qualified as a nurse, his first job was in a coronary care unit, but he soon realised it was not for him.

‘It was just too quiet for me,’ he says. ‘On ward rounds they would debate one electrocardiogram for 45 minutes. I thought “I can’t do this”. Then I was asked to work in the emergency department (ED), and found it was something I enjoyed.’

Mr Swann began his career in Mansfield then moved to Derbyshire Healthcare NHS Foundation Trust in 2000. Five years later, he took up a consultant nurse in emergency care post at Heart of England NHS Foundation Trust (HEFT), Birmingham.

He is now clinical director for advanced practice but has other roles too, including as senior associate for the emergency care intensive support team, part of NHS Interim Management and Support, which offers managerial expertise to the NHS.

Throughout his career he has tried to ensure that patients receive care in a timely manner. ‘I understand why patients get frustrated when they have to wait. They think: “I am in pain, and you are making me wait”. So, as a nurse, I would do everything I could to get rid of queues, and would relax only when they were gone.’

Referring to the late 1980s and early 1990s, when large numbers of patients had to wait on trolleys in corridors, Mr Swann says: ‘It was a difficult time to work in emergency care. I thought maximising flow was important, as long as it was balanced with quality and safety. I believe that queues are about attitude, and we can do a lot to get rid of them.’

Although he did his best to eliminate waiting in the places he worked, Mr Swann always sensed his desire for quicker treatment meant he was out of step with the rest of the profession. This changed with implementation of the NHS Plan, he says, when improving flow in hospitals became a priority. ‘I had been seen as a maverick that couldn’t be controlled; suddenly, I was a guru,’ he laughs.

While working in Derby, in an attempt to improve care and minimise the need for medical locums, Mr Swann devised the advanced clinical practitioner (ACP) role.

‘The role was not intended only for nurses, but also for paramedics, allied health professionals and pharmacists,’ he says. ‘It was about developing permanent staff. It meant that we could attract great people and more junior nurses who wanted to work with them.’

When Mr Swann joined HEFT, the emergency care directorate was struggling with workforce problems. He helped to improve flow and patient safety at Birmingham Heartlands Hospital.

The programme involved recruiting non-medical clinicians and, as a result, more than half of all new attendances at the ED are seen and treated by this group.

Implementation of the ACP role is reshaping the workforce and making HEFT an attractive place to work, Mr Swann says, pointing out that staff who join the ACP pathway receive impressive investment in their training and development.

In January, Mr Swann became the trust’s clinical director. He has been leading an ACP workforce transformation programme to address chronic recruitment and retention problems at medical middle grade and above. Over the next five years, up to 250 ACPs may be employed across every directorate and specialist area.

In addition to this, Mr Swann has insisted on keeping a hands-on clinical role in the ED, although this summer he will begin to focus on older people’s care in HEFT. His role will include working with the wider healthcare system, including community care services, on ways to encourage older people to self-manage their care, thereby avoiding unnecessary hospital attendances.

This work will mark a return to Mr Swann’s first experiences in the NHS, before qualifying as a nurse, when he worked as a nursing auxiliary in an elderly care hospital.

‘I still work according to the principles the auxiliary job instilled in me,’ he says. ‘Patients are vulnerable and need care, but they also need nurses with compassion, and who love the job and the patients.’

Heart of England NHS Foundation Trust is an exhibitor at the RCN Bulletin Jobs Fair on July 2-3 in Birmingham. For details, go to

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