Hidden Heroes of our Community

Wow, what a fascinating read. Truly an insight into the pressures some healthcare workers experienced during the pandemic. Well done, George, for putting pen to paper.

Jane Devonshire: British Chef and Winner of MasterChef 2016

George has beautifully captured the daily experiences of a community nurse, the emotional ups and downs we go through, and the lovely people we work so hard to help and support. The book managed to transfer our encounters into a funny, emotional and heart-warming read that was impossible to put down. A true reflection of the crazy, busy, diverse, black humoured world of community nursing that only those that do it can fully understand.

Allison Griffin: BA (Hons): DipN, RGN. Community Sister

Having read this book, I am left with a sense of profound admiration for George as an individual and his colleagues for all they have achieved during the pandemic journey.

Jane Barker: BA (Hons): DipN, RGN. Tissue Viability Nurse

HIDDEN HEROES

OF OUR

COMMUNITY

Reflections of a Male Community Nurse During the Coronavirus Pandemic

GEORGE HORNER

I dedicate this book to mum and dad and both my brothers. Thank you for all your support over the years. I wouldn’t be where I am without you.

I’ve written this book to be as readable as possible for the average person who has little relevance to nursing or other healthcare backgrounds. If you expect me to be blabbering on about health sciences every time I use any medical terminology, then you better read a book on anatomy and physiology. If you do read that type of book, then why not work towards a self-fulfilling career within the National Health Service (NHS), like me!

Foreword

The year 2020 was designated the International Year of the Nurse. Planned celebrations were put on hold as the COVID 19 pandemic reached the crisis point. This book celebrates the value of the role community nurses and their colleagues played during the pandemic.

I am a Tissue Viability Nurse with over 20 years of community nursing experience. I have worked with George and seen him transition from a healthcare support worker to a dedicated community nurse, demonstrated in some of his very personal reflections of interactions with his patients throughout the pandemic.

The book begins with George’s reflective journey to becoming a nurse and the many hiccups along the way. He discusses several high profile areas of the community nursing role, including complex case management, end of life care, wound care and patients with multiple comorbidities, before relating in diary form an honest and very personal journey, both through his patients and his own thoughts, of working through the pandemic and how this was affected by both political and local policies.

Rightly so, the media focus during the pandemic has been on acute hospital nurses, yet community nurses are often an unseen workforce delivering care behind closed doors. George’s personal recollections highlight the importance of the essential, unique and privileged role community nurse played during the pandemic in caring for a vulnerable and, at times, frightened population in their own homes when our frontline was the patients’ front door.

Florence Nightingale is quoted as saying, for the sick, it is important to have the best. George demonstrates the best in human terms, humour and physical effort through an era that will surely live in history.

Jane Barker: BA (Hons): DipN (Lond); RGN

The events of this book document my time as a newly qualified nurse during the years 2019 and 2020. To respect the privacy of the patients I cared for and the staff I’ve worked with who may not wish to be recognised, I’ve anonymised their names and changed all other personal information to maintain confidentiality. I have also gained approval for those who I’ve correctly named.

Copyright © 2021 by George Horner.

The right of George Horner to be identified as the author of this work has been asserted by him in accordance with the Copyright, Designs and Patents Act 1988.

All rights reserved. No part of this book may be reproduced in any form or by any means—electronic, mechanical, photocopy, recording, scanning, information storage and retrieval systems, without permission in writing from the author. The only exception is by using brief quotations and short excerpts for a review or article, which does not require the written permission of the author.

ISBN: 978-1-7395704-2-2

Cover designed by Adi Azudin

Book Formatted by Sophie Hanks

Contents

Introduction

1. Transition from Student to Nurse

2. A Bit About Wound Care and Holistic Assessment

3. An Insightful Example of Comprehensive Care

4. An Emotional Visit

5. What are the Most Random Encounters at Home Visits?

6. The Deadly Secrecy

7. The Preceptorship ‘Reflection’

8. An Introduction to Palliative and End-of-Life Care

9. Winter 2019

10. The Start of the Outbreak

11. Uncertainty in March

12. The Worsening in April

13. More Mayhem in May

14. The Protests

15. Are We Thanked in July?

16. Summer’s End

17. The Emergence of the Second Wave

18. Jolly Careful in December

19. The Year in Summary

Acknowledgements

Introduction:

The Career Move

Over 45,000 nurse vacancies, only 10 per cent of the workforce is male, low wages, and staff sicknesses mounting up… So why does a lad in his mid-twenties, who had recently accomplished a sports degree, then want to become a male nurse, I hear you ask?

Straight after completing a BA Hons degree in Sports Development at the University of Chichester, I found myself not knowing where to explore for a job within the sports industry. I didn’t feel ready and mature enough to conduct lessons for classrooms of kids as a PE teacher, and I didn’t feel confident enough to lead people into happier and healthier lives as a personal trainer. These were two popular occupations that graduates on my course exploited, which I wasn’t ready for, and on top of this, I hadn’t learned to drive a car, which would’ve made the eye-catching sports-related jobs much more accessible. 

Out of convenience, I worked in my first full-time job at a residential school just down the road from me, specialising for children and young people with physical and learning disabilities. This was to get my feet on the ground financially in full-time work. Little did I know that this would be the start of my career as a nurse. I ended up loving the job as a carer and teaching assistant and learning about the different conditions, such as cerebral palsy, spina bifida, and muscular dystrophy. Even with the students’ limitations from their debilitating conditions, they could still find ways of showing independence in their residential homes and have their periods of learning in their lessons at school. I grew an interest in the job’s health and social aspect while working alongside some of the school nurses from time to time. Essentially, I enjoyed looking after and caring for people—and to this day, it’s something I find rewarding and satisfying.

Despite the excellent students I met and the fantastic friendships I grew with colleagues, I found that within this inspirational and charitable organisation, there was also a lack of career progression in my role as a student support assistant, which met the minimum wage at the time. I then see an advert in the local newspaper, which interests me (at this point, I had started driving), and I applied and became employed as a healthcare assistant at the local community hospital. 

Over the course of my 10-month-long employment there, I was encouraged by my team to take on a nursing degree. There was a postgraduate degree on offer at the time, with an NHS bursary available, meaning I didn’t need a student loan. There was a warning that the upcoming cohort would be the last intake for claiming this bursary. I also found the NHS to be a highly undervalued and significantly understaffed organisation. With people like me adding to the workforce, we can help survive and stabilise this national treasure. Another good point was the many career development opportunities in nursing. Collectively, these were big factors for taking on the degree. 

During the nurse training, it wasn’t an easy ride. Based on how I felt at times and when other students discussed their experiences, at some point, you’ll feel the stress. You’ll think, What’s the point? Why did I start another degree? Why did I pick nursing? 

The difficulties of understanding the physiology and the theories behind nursing, as well as being thrown into a busy, clinical environment on a placement that you’ve got little background knowledge about, certainly made me feel anxious and at times inadequate.

For most students, it seemed like there was at least one placement where a mentor would be non-existent or would have minimal time to support you because of the business of their role. There’s bound to be at least one placement that you’ll hate because that nursing speciality doesn’t interest you. And because my course was only two years long, instead of the standard three-to-four-years for undergrads, I felt that the modules were more like whistle-stop tours. I had to grasp the principles and fundamentals of nursing practice within a matter of weeks before the placements started. Throughout the course, there was a lot of overlap between the theory and practical work.

Examinations and deadlines for completing coursework at the university would often be close to the completion dates of reflective assessments set on our electronic portfolios for each placement. The computer database ran all assessments on a timer, with deadlines made final and with no leeway or compromises, unless for exceptional, personal circumstances. Personal life did play a big part in restricting some students from achieving their goal, whether raising a family, living in a problematic relationship, or fighting with their mental health.

There were, unfortunately, the rare couple of cases where students felt bullied, harassed, and singled out. And more of other instances in which students were working in ‘clique,’ non-welcoming teams, or hearing a passing comment from an ignorant staff member that crushes your self-esteem. It’s imperative that if problems of this magnitude arise, the student must report them, and the program lead can change placements to other locations.

Future student nurses need to remember that horrible placement experiences don’t last forever, which may come with their 45-minute long bike rides or hour-long public transport journeys between the hospital and your student accommodation. You’ll also have exciting placements, which you’ll find enjoyable. Above all, the copious amounts of knowledge you’ll grasp, alongside the praise and appreciation from staff members and patients, will add to your confidence and will restore the belief that nursing is your destiny. 

Based on the service-user feedback forms that I gave out to patients I looked after on the wards, I received morale-boosting comments. These included; a delightful member that makes you feel at ease, a very personable, considerate and attentive student. Very impressed, and George is a good’un, keep him!

I’d also recommend plenty of self-care time for future student nurses, which I found vital for getting through the course. I’d be going for jogs around the local parks or cycle rides around the New Forest. I’d also sporadically pay for a massage when I had enough money to spare and meditate in my room, which involves focusing on simple but effective breathing techniques. In combination with fun, social occasions, all of these made me feel relaxed, revitalised, and focused.

By the end of the training, my friends in the cohort and I felt so relieved and pleased for getting through the degree. While waiting for my post to start, I received my pin—awarded by the Nursing and Midwifery Council (NMC). The pin symbolises my registration, a special moment when obtained. It recognises all that I've achieved already in my career journey, though, like a father leaving the postnatal ward and returning home with a new-born baby; it’s now something that I must protect. The full-time post I’m waiting to start is community nursing at the very same team I was a healthcare assistant. I’ve wanted that position the moment I started my training because I felt at home there.

I studied to be an adult nurse, a nurse that focuses on people’s physical health conditions in adult life. And regardless of having two years of intense learning in my postgraduate degree, I quickly realised that every day is still a school day as a newly qualified staff nurse. I was once told by a colleague on one of my student placements that it’s frightening how much you need to know to become a nurse, and they’re not wrong. Even the founder of modern nursing, Florence Nightingale, has stated, Let us never consider ourselves finished nurses. We must be learning all of our lives. 

Whether you aim to develop an understanding of long-term conditions, the physiology of how the body works, or the pharmacokinetics of how medicines work—it’s all a bit of a minefield. Starting now as a community nurse, in March 2019, I have to remind myself that it was only three years ago when I began as a non-qualified practitioner. Zero-knowledge in health sciences and no clue that starting my nursing training in a year would be on my radar.

Occasionally, in my training, I overheard comments of ignorance from people, especially those fixated on flourishing in other fields, saying, District nursing isn’t fast-paced enough for me; you just have coffee and cake and do a few visits. Well, for those people, I can assure you that community nursing certainly isn’t easy. 

Still, I’m not surprised that healthcare professionals in a hospital get burnt out. For some roles in the hospitals, such as staff in the emergency admissions unit, community nursing would be less demanding and stressful in comparison. And taking a drink with you in the car and not do 12-hour shifts makes my role more sustainable. That’s not to say that a district nurse doesn’t get burnt out, because believe me, at times we do, and this book will demonstrate why. 

I also had to laugh to myself during my graduation, when at this point, most of us were three months into our new posts. There were some newly qualified nurses chatting behind me about their jobs. One of them who’d started in a community job said how easy it was and how lovely the shifts were. I guess she showed a bit of bravado with her mates, but I had to stop myself from turning round to tell her that she can’t be doing it properly if it was that easy! She must still be doing her induction.

Chapter 1

Transition from Student to Nurse

Wearing my new uniform as a registered nurse for the first time symbolises how far I’ve come—transitioning from the naive, inexperienced student nurse, with the white tunic top, to the brave, assertive, and enthusiastic qualified nurse in the blue tunic top. After my induction, the face-to-face training was coming thick and fast, and I was starting to get my competencies for each clinical skill signed off. After two weeks of shadowing other senior colleagues, I was having my diary of patients each shift, which began with simple wound care, subcutaneous injections, and soon later, blood sampling and intramuscular injections. I got my first sense of apprehension, of leading care on my own (since my final student placement), making sure I put what I’ve studied into play and comply with the NMC Code of practice. The gaining of consent before every clinical intervention is also crucial. Every service user has the ultimate right to determine what happens to their bodies. For permission to be valid, the patient must have the mental capacity to make the decision. Cognitive ability can be affected by dementia, strokes, medicines, alcohol, learning disabilities, and pain. If that’s the case, then we must act in the patient’s best interests.      

The NMC Code is a set of professional standards that all nurses must follow in practice. It’s not negotiable or discretionary—written to identify the expectations within the role of a nurse, including the accountability towards their clients’ well-being—accepting the responsibility for the care delivered. Other responsibilities include delegating within the multidisciplinary team and prioritising all care needs within our caseload. When we delegate, we transfer a task to someone else who’s proficient in performing it in a specified situation. And from shift to shift, effective communication is an integral part, providing swift verbal handovers so that we can act without delay for a patient’s well-being in their desperate times of need.

Learning from the Francis inquiry report, published on 6th February 2013, is another reason for all healthcare professionals to raise the bar in their services’ professionalism. This report examined the causes of the failings in care at Mid Staffordshire NHS Foundation Trust between 2005 and 2009. 

Likewise, with the NMC Code, this report offers guidance on the fundamental standards for clinicians, which includes compassionate and committed care and stronger leadership in healthcare. The report makes 290 recommendations, including openness, transparency, and honesty throughout the healthcare system. It understands the importance of a statutory Duty of Candour—the legal obligation of a medical professional apologising to the patient (receiver) if there have been mistakes in their care journey that had led to significant harm.

Something else to also prepare for is navigating to the homes of our service users. To look for a house that doesn’t have a number or outside lighting. For that house that has a name, but it’s not displayed. For the person who wants help urgently but has turned off all the lights in their property, on a cold Wednesday night, in the dark... in a dense area with trees... and there’s a car tailgating you, as you scan the street. 

In one funny recollection of this topic, a nurse pulled over to the side of a road and phoned the client for directions. The patient responded, "Well, you turn left at the green