Analysis

The case that stays with me and how it’s changed my practice

Of the many patients a nurse sees, some have an impact that’s career-affirming – or altering

Among the thousands of patients or service users a nurse sees, some have an impact thats career-affirming or altering

  • Nurses from a variety of backgrounds and career stages talk about the patient that stays with them and why they made such an impact
  • Lessons learned throughout their careers, from the power of a smile and saying hello to the vital importance of nursing the whole patient
  • How an unexpected patient interaction can shape a career or steer a student or experienced nurse towards a new specialty

Of the thousands of patients and service users nurses meet in the course of their careers, there will always be cases that stick in their

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Among the thousands of patients or service users a nurse sees, some have an impact that’s career-affirming – or altering

  • Nurses from a variety of backgrounds and career stages talk about the patient that stays with them and why they made such an impact
  • Lessons learned throughout their careers, from the power of a smile and saying hello to the vital importance of nursing the whole patient
  • How an unexpected patient interaction can shape a career or steer a student or experienced nurse towards a new specialty
Photo/illustration showing a nurse sitting, holding a patient's hand
Picture: Helen Bennett

Of the thousands of patients and service users nurses meet in the course of their careers, there will always be cases that stick in their minds, sometimes for decades.

These could be interactions that altered their career path or prompted them to reflect on or change their practice. Or it might be a person whose situation reminded them of why they went into nursing, or chose the path they did.

Nursing Standard has spoken to nurses from a variety of backgrounds and at different stages in their careers about the patient that stays with them – and why they had such an impact.

A rare glimpse into how we touch people’s lives

Crystal Oldman
Crystal Oldman

Queen’s Nursing Institute (QNI) chief executive Crystal Oldman worked for the NHS for two decades, mostly in community nursing. Dr Oldman then spent 18 years in academia before joining the QNI in 2012.

‘As a health visitor in a deprived part of London, I was caring for a family who were technically homeless but housed by the council in the grottiest privately rented flat I’d ever seen. It was tiny. She was a single mum with twin babies and a toddler and had suffered the most horrific domestic violence.

‘We did lots of work together and I remember sitting on the floor with her (because there was nowhere else to sit) and thinking, wow, this young woman has so much potential for life. What really impressed me was the vision she had for her children. She was an amazing mum, incredible – everything about her was how she could support her children, but she was up against all these barriers.

‘The woman said I’d given her the confidence to be a good mum. It wasn’t because of me, it was because of her… But it really shows what you can do as a health visitor’

‘We lobbied long and hard to get her other accommodation and she moved on and I moved on to another job. Around 15 years later I was at an event and I walked straight into her. She told me her older daughter was about to go to university and the twins were doing well at school. The woman had become a social worker – it was amazing what she had achieved. We hugged and we cried and she said it was due to the help and support she’d had.

‘She said I’d given her the confidence to be a good mum. It wasn’t because of me, it was because of her; she was amazing. But it really shows what you can do as a health visitor – you can touch people’s lives, and you rarely know what the outcome is, especially not 15 years on. You can enable people to have the confidence to do it for themselves.’

Articles by Crystal Oldman

‘He needed someone to ask if he thought he was dying’

Rosemary Russell works for the Marie Curie Nursing Service in Northern Ireland in the community rapid response team.

Rosemary Russell
Rosemary Russell

Ms Russell qualified in 1995 before taking up a post at the Marie Curie Hospice, Belfast in 1999 where she worked for four years before taking a career break to raise her family. She returned to Marie Curie four years ago and joined the nursing service, visiting people’s homes at the end of life to provide expert care and support.

‘It was around Christmas two years ago and I was visiting a patient who was nearing the end of life. Over two to three months I got to know him and his wife, visiting quite a lot in the evenings. He was a quiet man, very self-contained. But one night he said he felt “different”.

‘In rapid response, you have to remember that although you might have another couple of calls to go to, when you are with your patient it doesn’t matter what’s going on elsewhere, you might need to stay. So I said let’s talk about this.

‘A colleague who wasn’t a palliative care nurse asked me why I’d stayed so long, and I just said that was what my patient had needed. He was scared, he felt different, and he needed my support’

‘I asked if he thought he was dying, and he said yes, he felt he was. I asked if there was anything in particular he wanted to do and he said he wanted to talk to his family, so we called them and they came round.

‘After he spoke to them, he just looked at me expectantly and asked what would happen now. I said it was getting late, so how about having some supper then going to sleep. He didn’t die that night – it was a week or so later. But he was prepared, he’d spoken to everybody.

‘One of my colleagues who wasn’t a palliative care nurse asked me why I’d stayed so long, and I just said that was what he had needed. He was scared, he felt different, and he needed my support. He needed someone to ask if he thought he was dying and to take it from there. I think that’s why I remember him. In my job you’re not just there to do the tasks; you’re not just nipping in to give medication. He felt different that night – and he needed my help.’


The reason we work hard to give people a second – or third – chance at life

Anthony Clarkson is NHS Blood and Transplant director of organ and tissue donation and transplantation.

Anthony Clarkson
Anthony Clarkson

Mr Clarkson qualified as a nurse in 1994 and in 1997 joined the National Blood Service, initially in both blood and live tissue donation. He went on to become the head of clinical development before taking up the post as assistant director for organ donation in 2009 and received a permanent appointment to his current post in 2019.

‘Many years ago when I was assistant director for organ donation, we were doing some media promotion around organ donation. I was working with a patient who had a heart transplant many years ago. He was in hospital because he was quite poorly waiting for a second transplant, but he was an incredibly articulate and engaging gentleman with a young family.

‘We know that three people a day die waiting for a transplant, but I don’t meet many of them. I did meet this man, and he stays with me to this day’

‘He was very grateful that he had had the opportunity to have the first transplant, and that he had, as he saw it, had a second chance at life. We had a great day working together and promoting donation, and I met his wife and children. He really made an impression on me – he was so grateful to the original donor family and hopeful for his next transplant.

‘About ten days later, I found out that he had died. We didn’t get him the organ he needed, and he was counting on us to get it for him – he didn’t get that third chance at life.

‘It was quite a shock when I heard – I don’t know why it was such a shock, because three people a day die while waiting for a transplant. I suppose it was at the back of my mind that it might happen, but he was so upbeat, so positive – we had a great day.

‘Yes, we know that three people a day die waiting for a transplant, but I don’t meet many of them. I did meet this man, and he stays with me to this day.’


An early lesson in my career about patient-centred care

Amanda Croft is the newly-appointed chief nursing officer for Scotland. Professor Croft qualified in 1992 and worked across a number of settings before becoming director of nursing, midwifery and allied health professions with NHS Grampian, then chief executive.

Amanda Croft
Amanda Croft

‘It was in my early days as a newly qualified nurse when I met that one special patient who stayed with me during my clinical career. The patient came into hospital for end of life care after they had a stroke. The staff were determined to give all patients high quality end of life care and in this case, I helped to draw up a personal plan to tailor the care on offer to the individual need.

‘After nine months on our ward, the patient was able to return home and was able to walk and get dressed themselves and continue to live independently.

‘This made me realise early on during my career in the NHS how important the team and person-centred care are – it really does need to be about the individual.

‘On the day of discharge from the hospital, the patient told me how our discussions about their care made a huge difference and how they realised that they needed to take some responsibility for their own health’

‘This experience shaped me as a nurse. This patient taught me how important it is to communicate and deliver care with a patient’s needs first and foremost. On the day of discharge from the hospital, the patient told me how our discussions about the care they were receiving made a huge difference and how they realised that they needed to take some responsibility for their own health.

Over the years, as a nurse on NHS wards, I have learned that the power of a smile and saying hello is invaluable. As a nurse with many years of experience I cannot stress enough how vital it was, and still is, to build meaningful relationships with people that I cared for and continue to care for during my clinical career. Showing respect and being civil to every patient is really important.’


The person who made me think differently about forensic patients

Alex Richardson is a final-year mental health nursing student at Canterbury Christ Church University

He started work as a healthcare assistant on a mental health acute admissions ward when he was 18 because he wanted to work with people; he quickly fell in love with healthcare. He decided to study mental health nursing because he wanted to progress in his career and ideally move into management, where he feels he can potentially make a bigger difference.

‘My last placement was in the forensic sector. I met one particular person who really made me think differently. What I’ve learned is that when someone is unwell, they are a different person to when they are well. You read someone’s notes and you read a horrific crime they’ve committed and then you meet them in real life, and see how genuinely kind and caring they are, and it makes you think “you didn’t commit that crime; your illness committed your crime”.

‘It really stuck with me because this person’s crime involved children, and when I met them, they were so lovely and bubbly and kind and I thought they couldn’t possibly have done this thing. My mentor said to me “but when they are unwell, they are not in control”.

‘I’m now looking at forensics for my first nursing job. Meeting that patient made me challenge my own perceptions’

Alex Richardson
Alex Richardson

It changed my perception of forensic patients. I used to look at them and think “you are dangerous, you will always be dangerous”. And part of me would think that if they were able to commit such a crime, then maybe they did have a bit of nastiness about them.

But meeting this patient really widened my view. I sometimes have arguments with people who talk about those who commit certain crimes, saying we should lock them up and throw away the key. And sometimes I say that these people might be acutely unwell and disturbed and instead of locking them up and throwing away the key it’s about treating them, because I don’t think people are born wanting to be like that.

I’m now looking at forensics for my first nursing job. Meeting that patient made me challenge my own perceptions and I’d like to look at that further.’


Nursing is about more than treating a disease, it’s the whole person

RCN general secretary Dame Donna Kinnair* held a variety of roles before this one – including clinical director of emergency medicine at Barking, Havering and Redbridge University Hospitals Trust, executive director of nursing, Southeast London Cluster Board and director of commissioning at London Borough of Southwark and Southwark Primary Care Trust.

Dame Donna Kinnair
Dame Donna Kinnair
Picture: Justine Desmond

Professor Kinnair started out in nursing in the early days of HIV/AIDS. ‘I was working on a haematology ward as a third-year student in the mid-1980s, and there was an 18-year-old patient who had contracted AIDS through a blood transfusion. It was a harrowing time – he wasn’t far off my own age – and its impact on him was horrendous: his tongue had swollen to almost the size of his head. I’d never seen anything like it.

‘I was on night duty and was running the ward, and the anaesthetist came to show me how to do a tracheostomy should he stop breathing. You can imagine how terrified I was, as a student, but I think what has stayed with me is how terrified that young man was.

‘I know that his body was rapidly deteriorating, but could I have helped his mental well-being? Or is it just that I respected his wish that he didn’t want us to go there?’

‘He was a terminally ill 18 year old, and even if I’d done that tracheostomy he wouldn’t have been saved. I went to sit with him, to speak with him. He could barely speak, but he was also too terrified to enter into any dialogue.

‘I was a young nursing student without the experience I later went on to gain. I don’t know whether he was being passive, or whether he expected death, or what he needed, and I didn’t enter into that conversation with him either. This is what I’ve reflected on for years. I think I did what nurses sometimes do to defend themselves – you separate the mind and the body [of the patient] and you look after the body. I know that his body was rapidly deteriorating, but could I have helped his mental well-being? Or is it just that I respected his wish that he didn’t want us to go there?

‘What I’ve learned in over 30 years is that the art of nursing understands that any patient we’ve looked after is more than a disease: it’s the whole person, it’s the human experience, it’s the struggle with the suffering and the consequences of any illness they’ve had. For me, nursing is about addressing the uniqueness of everyone’s experience. That young man – and many other patients over the years – helped me to learn that.’

*At the time of publication, Professor Kinnair is on extended sick leave following a cycling accident.

Articles by Dame Donna Kinnair

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