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My journey back to front line nursing

Ali Richards had been away from clinical practice for more than two decades when she decided to take a job as a staff nurse on an acute ward. She has discovered she has a lot to learn, but also plenty to offer

Ali Richards had been away from clinical practice for more than two decades when she decided to take a job as a staff nurse on an acute ward. She has discovered she has a lot to learn, but also plenty to offer

Ali_Richards©NOC
After years away from the ward, Ali Richards says patient care is still ‘deeply satisfying’. Picture: Neil O’Connor

After 25 years working in leadership and management in the NHS, the private sector and across the UK and Ireland, I decided to return to being a staff nurse on an acute clinical ward.

‘Why on earth would you do that?’ is the usual response I get when I tell people about my career change, quickly followed by comments about my bravery.

To answer the question, I need to explain that I nursed my mother while she lived with me through her last year of advanced Alzheimer’s and negotiated care and community services for my father as he battled cancer and deteriorating health in his last year.

It gave me insight into services for people who are old and frail in the community, as outpatients and in hospital, and rekindled my respect for my profession.

Safe route back

The media image of acute nursing certainly doesn’t tempt those of us thinking of a return to practice. We all know the horror stories: short staffing, long days, too much paperwork, no time for patient care and an NHS culture of bullying and command and control.

And for nurses like me who have maintained their registration but not their clinical skills, where is our clear and safe route back?

A nurse who has been working in non-clinical management or leadership positions, education or for that matter running a social enterprise and facilitating community nurse development, needs training and support to return to a front-line clinical role.

‘I worry about a lack of awareness of how much exists in nursing outside the ward and how much is possible’

Nursing is a broad church – that’s what makes it such an incredible career and profession. We should embrace not only moves up or down but across our career ladder, in and out of NHS care, and in and out of acute clinical practice. There should be structures in place to enable the whole scope of practice, not just one-way traffic up or out.

The first question new colleagues ask me is what I have been doing all this time. I worry about a lack of awareness of how much exists in nursing outside the ward and how much is possible. The second and perhaps more interesting issue is how things have changed.


Ali Richards with patient Betty Bennett at the Royal Lancaster Infirmary.
Picture: Neil O’Connor

What struck me first is that the patients are at least ten to 15 years older in general. This change goes hand in hand with more complexity of care. The mental pressure has increased. The scope of practice is wider for an adult nurse and more challenging in terms of decision-making and responsibility for patients.

Supportive attitude

Registered nurses now do less of the administration work or tasks that can be done by others, such as restocking and reordering or taking the tea trolley round. Their time is spent as it should be, with their patients or making decisions about care. Yet on the wards where I have worked they will step in and do these other jobs if required. I have yet to meet a nurse who says it’s not my job, not my patient or not my responsibility.

While there are clearly shortages of nurses, my experience so far is that every measure possible is being taken to meet this challenge. The attitude of senior nurses and of my colleagues has been incredibly supportive.

Our profession appears to have become closer and less hierarchical from the level of staff nurse to senior nurse and deputy director. I have been supported by colleagues, and their understanding has made my journey not only more pleasant but safer for me, the patients and the organisation.

‘This is a job that offers so much to anyone who likes a challenge and wants to make a difference’

I have not taken on this job change lightly though, and have gone home and wept more than once. It is humbling to go from expert status to someone who needs hand-holding for the most basic of tasks.

I am having to learn and re-learn so much, including medicines management, care planning on a computer, using medical devices and early warning scores. The depth and breadth of my lack of knowledge upset me deeply and shook my confidence.

Yet some skills and knowledge I have retained and even improved. I am a skilled communicator and know when someone needs more information and support. On my second day on the ward I recognised a patient having a heart attack, which would have been missed by the support worker with me, and got help straightaway while commencing a set of observations.

Greater empathy

I can tell good practice from poor in a heartbeat and I know when something isn’t safe. So-called basic care is unchanged and deeply satisfying. Clean, comfortable and well cared for patients make me happy.

The route to discharge and what is available in the community is much clearer for me now. I suspect that my empathy and understanding of the positions of patients, relatives and families nowadays is miles higher than it was 25 years ago.

I have so much to learn and so much confidence to regain. But I know that my colleagues and profession will support me and that with help I can pave the way for others like me to return to a job that offers so much to anyone who likes a challenge and wants to make a difference.


Ali Richards is a staff nurse at Royal Lancaster Infirmary Frailty Unit and director  at Community Healthcare Innovation, a community interest company.

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