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Meeting the challenges of returning to practice

Return to nursing can seem daunting, but the core values of the profession are unchanged

Return to nursing can seem daunting, but the core values of the profession are unchanged

Return to work
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I had worked in nursing for 20 years before I left and had acquired a wealth of experience in the role.

When I returned to practice 12 years later, I brought with me maturity and a level of confidence about interacting with people, as well as experience of other work settings.

I left nursing in 2005 because I could not reconcile the increasing demands of the service with the needs of my family. I had felt I was failing both and something had to give.

I had intended to return to nursing after a short break but, when a local school offered me a part-time job providing learning support for children with special needs, I chose to work in education. 

However, my role in education began to change and I began to think about restarting my nursing career. My eventual decision to return to the profession was reinforced by press coverage about the shortage of qualified nursing staff.

The first hurdle was completing an online application form for the return-to-practice course. This was significantly more time consuming than completing written application forms had been, but the interview process at the university was familiar.

Anxiety

My first day in university was a cause for anxiety until I discovered that the rest of the class felt the same.

Most had been out of nursing for similar lengths of time to me, often in similar circumstances, and we were all concerned about the technology that has come into use since we last practised.

The course comprised numeracy tests, clinical practice updates, theoretical updates covering policy and a clinical placement.

I had expected the numeracy test to be daunting but, with regular practice tests and the use of an online learning tool provided by the university, I achieved a 100% score.

One frustrating area of delay was access to occupational health services for vaccinations and immunity screens to be checked, which affected when clinical placements could start.

Early identification of clinical placements helps return-to-practice students assimilate into their care environments. It allows them to shadow members of the clinical team and to familiarise themselves with ward equipment, especially the IT systems, and the ward routine, before starting their first shift in a clinical role.

Basic skills

As return-to-practice students, we have the basic skills of patient care but need updating on the newer drugs and their administration.

Many of us have experience of leadership in different roles but need guidance on specific areas, such as complex discharges, initiating planning from admission rather than from point of discharge and negotiating the complex web of interagency referrals.

I found that a clear introduction to the roles of team members was essential. The healthcare assistant and extended roles are different from the nursing auxiliary role, for example, and there are also now discharge co-ordinators, ward cleaners who provide meals and drinks for patients, and other staff who restock clinical and domestic supplies.

I have noticed that, while extending nurses’ role into areas such as cannulation has benefited patients, it has reduced the amount of time nurses have to provide supportive and emotional care.

There have also been changes to practice in the clinical ward environment since I left nursing. Practices encouraging service users to be independent and get dressed every day rather than adopt a passive ‘sick’ role, for example, have encouraged speedier patient recovery.

Also, the supernumerary role of students, which allows them to develop their learning without being relied on to provide care in ward teams, is more established now.

However, some of the return-to-practice participants need guidance to maximise their learning experience because, having never worked in a supernumerary capacity on wards, they can become immersed in providing care rather than learning.

Welcome

Overall, we were welcomed as return-to-practice students to the ward environment and staff were keen to support us.

Greater insight is needed, however, into the competencies required by staff mentoring return-to-practice students and how long it takes to acquire them.

Additionally, the IT aspects of care offer return-to-practice nurses their greatest challenge and addressing this early would enable them to enter their clinical placements with greater confidence.

This would enhance their performance and the care they can offer from the start of their placements.

Many of my cohort were offered roles on the wards where they completed their placements and we discovered many of our earlier anxieties about achieving the learning goals were groundless.

Returning to practice has shown me that nursing offers many opportunities and it is still a job I love.


About the author

Barbara_EdwardsBarbara Edwards is a Macmillan support nurse specialising in malignant bone disease at University Hospitals of North Midlands NHS Trust

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