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Inspirational, meaningful care: quality nursing across Scotland

To mark the RCN’s centenary year, Nursing Standard is celebrating modern nursing roles across the UK. Here, Alison Whyte talks to three nurses whose challenges include mountains and far-flung communities
Christopher Rice

To mark the RCNs centenary year, Nursing Standard is celebrating modern nursing roles across the UK. Here, Alison Whyte talks to three nurses whose challenges include seas and far-flung communities

In Scotland, geography and social conditions are placing demands on nurses ingenuity. As RCN Scotland Director Theresa Fyffe says: Nurses in Scotland are constantly overcoming the challenges thrown at them by our health and social care system and diverse geography.

The nurses featured here, like many across the country, through dedication and innovation are putting the needs of their patients and clients first.

In this article we celebrate Kay Cordiner, who inspires hospital nurses to deliver first-rate care; Chris Rice, who works in remote doctor-free islands and Iona McKay, who ensures that care home residents live healthier, more meaningful lives.

Kay Cordiner, senior charge nurse at the respiratory unit of NHS Highlands

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To mark the RCN’s centenary year, Nursing Standard is celebrating modern nursing roles across the UK. Here, Alison Whyte talks to three nurses whose challenges include seas and far-flung communities

In Scotland, geography and social conditions are placing demands on nurses’ ingenuity. As RCN Scotland Director Theresa Fyffe says: ‘Nurses in Scotland are constantly overcoming the challenges thrown at them by our health and social care system and diverse geography.

‘The nurses featured here, like many across the country, through dedication and innovation are putting the needs of their patients and clients first.’

In this article we celebrate Kay Cordiner, who inspires hospital nurses to deliver first-rate care; Chris Rice, who works in remote ‘doctor-free’ islands and Iona McKay, who ensures that care home residents live healthier, more meaningful lives.


Kay Cordiner, senior charge nurse at the respiratory unit of NHS Highland’s Raigmore Hospital, Inverness, is 2½ years into her role and has improved patient care through meticulous attention to detail.

‘Safety is the beating heart of our unit. It underpins everything we do.

‘Our patients have cystic fibrosis, asthma, lung cancer, chronic obstructive pulmonary disease and fibrosis. We have patients with respiratory failure requiring home ventilation, oxygen assessment, and patients at end of life.

‘Early in my role, a patient who was nil by mouth was given a meal and died. I was determined to learn from that. I introduced mealtime protocols that are solid, safe and sound; a red table mat for nil-by-mouth patients and meals given under supervision. A meal round for 29 takes just 11 minutes!

Kay Cordiner
Kay Cordiner

‘Some things are easy goals. We say to all patients “Here’s your call bell. Can I see you using it?” Anyone who can’t is checked at least every hour. I introduced ward safety huddles day and night, with doctors and nurses, so everyone knows who is poorly.

‘By charting falls we found that most occur between 2am and 4am, so now a staff member accompanies every at-risk patient to the toilet. We reduced medical errors through education sessions, ensuring no other activity is carried out during drug rounds and by having a ward pharmacist.

‘We use the National Early Warning Score system for all patients. Our hospital has triggers for referral to medical emergency teams, and we were a pilot site for the Scottish Patient Safety Programme’s Deteriorating Patient workstream.

‘All patients have a treatment escalation plan in place. We’ve had 365 days without a cardiac arrest call, and a 75% reduction in patients transferred to medical high dependency.

‘I introduced nurse-led discharge where the consultant sets parameters to be met for each patient, then the senior nurse makes the decision.

‘In 7 months, without impacting on readmission rates, we reduced the length of stay for 68 COPD patients from 8 to 5 days, saving 300 bed days.

‘I want my team to feel valued, happy and engaged and to deliver the highest standard of care for every person, every time.

‘You can put things in place and lead, but working as a team is the most important thing.’


Chris Rice, NHS Shetland community nurse on Bressay, moved to Shetland from Liverpool in 2014. His community nursing role on a ‘non-doctor’ island is unique to Scotland.

‘The Shetland Isles have the Northern Lights, amazing scenery, wild weather and stunning wildlife. There are 350 people on Bressay who support each other in times of illness.

‘I’m contracted to work full-time here, but I will go to another island when needed. Bressay is one of 5 “non-doctor” islands, which are only accessible by boat or plane. Each has a resident nurse, so a 24-hour serviceis provided.

‘I would go to another island if a colleague is on annual leave and a nurse from the community team in Lerwick would cover for me.

Chris Rice
Christopher Rice

‘As the service is based on clinical demand, I have a flexible working day. There is just you, so you have to prioritise; you could have several calls or more than 1 emergency during the night, but most of the time it’s quiet.

‘I deal with slips, trips and falls, chronic disease management, first contact and emergency calls, such as trauma and cardiac arrests. We are supported by a GP who relies on the nurse’s clinical diagnosis.

‘GP visits can be hampered by the weather. If I have to get a patient off the island the ferry crew is on call 24/7. If the weather is really bad, we call the lifeboat.

‘It can take up to 40 minutes to get to the nearest hospital in Lerwick, depending on the weather.

350

The number of people who live on Bressay, one of 5 Shetland islands accessible only by boat or plane

‘We do an annual BASICS course to keep us up to date with trauma and medical care and I teach advanced life support and advanced paediatric life support to colleagues across Scotland.

‘Bressay now has a defibrillator and training is being developed to support cardiac arrests too.

‘Shetland is unique in that it has no nursing homes.

‘I work closely with the Shetland Island Council’s care at home service to try to keep people at home as long as possible.

‘I enjoy the challenge of remote and rural nursing, the flexibility to work autonomously, and managing my own caseload without limitations on time or resources.

‘I’m doing a clinical doctorate at the University of Stirling on recruitment and retention of nurses who work across remote community islands.

‘I hope my work will feed into strategic planning of service delivery as part of the2020 vision.’


Iona McKay, home manager at Thistle Healthcare’s Greenlaw Grove, Glasgow, is commissioning a new 113-bed care home and giving clinical support to staff.

‘Greenlaw Grove is first and foremost a home and it feels like one. We have a coffee shop, a cinema and a hair salon, but residents also need a strong, committed team of nurses and care staff when they’re unwell.

‘Most of my career has been in the NHS, so moving to the private sector was a big leap of faith. It’s a huge challenge but I absolutely love it.

Iona McKay

‘The complexity of care home nursing is not recognised by nursing colleagues and I want it to be acknowledged as the specialty it is.

‘You’re not surrounded by the NHS and there are no doctors on hand, so autonomous decisions are made by nurses every day.

‘I’m in a management role, but I see myself as a clinician first. I make sure mine and the staff’s skills are up to date.

‘We offer training including palliative care, advanced care planning, urinary and bowel care, wound care, nutrition and dysphagia management and the care of people with Alzheimer’s.

‘I tell my staff: “Use the fantastic skills that you have. I’ll support you.”

‘Change management and leadership is essential to this role, and I have worked for many years as a clinician, manager and educator. As lead nurse for dementia at the NHS National Waiting Times Centre Golden Jubilee Hospital in Glasgow, I was responsible for ensuring the goals for acute care in the Scottish National Dementia Strategy were met, and for delivering a rolling education programme.

‘Yes, we’re a care home but we’re also a real home – with a coffee shop, cinema and hair salon’

Iona McKay

‘The biggest challenge is balancing high quality care with ensuring that residents are engaged in what makes their lives meaningful.

‘We are involved in the RCN “space project” and a Scottish Government project My Life, My Way to improve the lives of care home residents with dementia.

‘We want to make sure people have choices. For example, a resident who is a trained opera singer suggested we form a choir. Other residents were interested, so we did. Our care staff organise individual activities for residents too, such as shopping trips.

‘We are caring for the frailest, oldest people in our community. Palliative care and advance planning are essential to good end of life care. When we do this well all our hard work has been worth it.’


Alison Whyte is a freelance journalist

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