Looking back on a 50-year career in nursing
Tina Fear explores how nursing has evolved over half a century, and why she is not ready to retire
Nursing is an amazingly flexible career and, looking back over my 50 years in the profession, I would do it all again.
It was September 1966 when I started a two-year orthopaedic nursing certificate course at the Robert Jones and Agnes Hunt Orthopaedic Hospital in Oswestry.
I remember worrying about aftercare at home for children with 'plaster spicas' and older adults with fractured femurs and how they were ‘inventive’ about their home environment in order to ensure they would be discharged. Community nursing was different then but I now realise that all my training, education and experience were leading me to follow that pathway from the outset.
After my general training in Bath I was committed to emergency care as I enjoyed the unexpected. I became competent at facial suturing and intubating while working in accident departments in the UK and Canada, in setting up IV drips for patients as part of a 'flying squad' in Derbyshire, and in dealing with mafia shooting activities in Montreal.
A high percentage of patients entering accident departments went straight home afterwards and I saw that these departments were vital community services. Whatever treatment we gave had to survive the environment to which patients were returning. This was particularly pertinent for dressings and bandaging skills.
I hoped as nurses we realised the importance of collecting and giving the vital information to our patients on their discharge, if only to ensure they did not become a victim of the ‘revolving door’ syndrome.
Family influences your perspectives in nursing. My grandfather informed me that ‘I wasn’t a proper nurse until I qualified as a midwife’. So I completed the first integrated midwifery course at Southampton and I returned to midwifery after the births of my two children. Nursing can be flexible to fit with family life.
Choice of pathways
Nursing also allows access to many pathways. A move to community nursing from emergency care seemed natural. My interest in family care and health lead me to train as a health visitor, which provided a rounded perspective of health prevention and promotion. I worked for a while as a triple worker – district nurse, health visitor and midwife – a frustrating role to fulfil.
While my children were young I moved between midwifery and health visiting. Practice nursing emerged as a career option in 1990 and I became a part time practice nurse and health visitor. Both roles enabled me to be a health educator and clinical nurse.
How has community nursing evolved?
Changes have come about due to technology and patient access to knowledge and treatment, which has resulted in greater expectations. Nurses have been enabled to expand their training and expertise, resulting in the creation of many specialist roles that were not available in the 1970s and 1980s. We gained the clinical skills but not the wider specialist extended role training.
However, I wonder if we have lost the generalist nurse in becoming clinical specialists – a debate that many now consider.
Practice nurses have evolved from being the ‘doctor’s nurse’ to independent practitioners, working autonomously in general practice and in care homes.
I became a lecturer at the University of the West of England to influence courses for community nurses. I have been given time and funding to work on my two passions of primary care and older adults in care homes through developmental and research projects.
Developing student placements in primary care and nursing homes has benefited students, residents and patients in all aspects of care. It has also highlighted exciting career opportunities for workforce and succession planning in community settings.
I have had a varied career. My passion remains firmly in community and specifically in primary care. I have learned much over 50 years and adapted to constant change. I still have much to learn and to give to the rewarding career of nursing. Would I do it all again? Of course, and I am not ready to retire yet.
Tina Fear is lead for the independent sector and associate postgraduate dean for nursing at Health Education South West (Severn). She is a lecturer at the University of the West of England.