Thank you to those encouragers who have commented on and shared this blog and helped me see the value in sharing my story.
I know that there will be some people reading this who are thinking about becoming a nurse consultant as a future career and see the opportunity in my giving an insight into the role and sharing experiences of the challenges and celebrations of what I do.
It’s important to me that this is a realistic and honest account. Also, important to recognise that there are many other nurse consultants working in different ways and under different pressures. The role is varied, nurse consultants are specialists in their fields working with partners who have expectations and experiences that shape some of the direction of the role. The role is very personal and flexible with scope for change and progression. The importance of interacting with and contributing to the evidence base and the future develoment of the learning disability nurse role is paramount.
How did I become a nurse consultant?
Around the time I started my training Valuing people was published (2001), this was huge and the mantra of Rights, Independence, Choice and Inclusion has informed my practice throughout the years, I naively did not know there was any other way of thinking about how people with learning disabilities should be valued and recognised in society. At this time there was a small cohort of learning disability nursing students and we had intense teaching, a huge influence on me was Dr Marie Gressman who impressed on our group so much the need to specialise, to find our star and shine in it.
When I discovered positive approaches to challenging behaviour, progress without punishment (Lavigna and Willis) and the ‘challenging behaviour team’ (CBT) as it was known at that time, I knew this was where I wanted to be. Treat people how you would like to be treated, seek to understand what someone’s needs are and why the environment they are in forces them to use ‘challenging behaviour’ to meet those needs and work with the person, their family and carers to smooth over that fit and make that environment work for them. This was the job for me!
It took me a couple of years to get there (and sadly a few failed driving tests) I worked in a residential setting and then an assessment and treatment setting before I was in a position to apply for the ‘CBT’. After two years of qualifying I got to work in the team I dreamed of and completed behavioural assessments, interventions focused on improving quality of life and teaching skills and I loved it. Of course there were moments, sometimes disagreements about the assessment, the recommendations, timescales, the occasional injury or frustration about a team wanting to re-refer when previous recommendations hadn’t been implemented etc.
The turning point for better joint working and smoother flow was the introduction of a care pathway and the dissemination of the specialist team into the community learning disability team and with that the introduction of the clinical nurse specialist role. The CNS post was a dream come true for me, I was able to work closely with colleagues and support their knowledge and understanding of the pathway and functions of behaviour, working with community nurses to develop their skills to support the children and young people we worked with.
The journey to nurse consultant will continue in my next blog!
Small acts of kindness and saying thanks
I was prompted after posting the second blog to reach out to one of my mentors, who later became a colleague and worked on the pathway implementation as described above. I felt it was important to share with her and let her know how much the time she gave me influenced my development and helped my progression in nursing. This is likely to be a recurrent theme in this blog, no-one is an island, we are shaped and influenced by our experiences every day and we have the power to do that to others.
I’m seeing the personal value in writing this blog too, it’s a space for reflection, a time to think through the things I’ve said and done. Sometimes I find my role can be challenging and open to misunderstanding, there are existing ways of working and it can be difficult for others to see the benefit of including other clinicians, well, me, in those existing processes. Particularly if I’m going to bring a new perspective, open up a conversation about doing something differently, or if I ask lots of questions, which I almost always do.
In building a new way of working and influencing cultural change it is really important for me to think about messages through my behaviour, my interactions and how I make others feel.
We have all heard that communication is 93% non- verbal, haven’t we? Actually, those studies carried out in the 60’s looking at facial expression, body language, what people say and how we match that up with the message has actually become more myth than fact with the author (Mehrabian, 1971) highlighting that unless the message being communicated was directly related to thoughts and feeling then the data of the time:
- 7% of a message is given in what we say
- 38% of a message is given in the way we speak it
- 55% of the message is in the facial expression
may not mean what we think it does!
What we say really does matter, the words we use are important. How we say those words is also crucial in getting across the message and if our behaviour does not match what we say, this can lead to an unsafe interaction where trust and working relationships are compromised.
I’ve been working on the idea of ‘setting the tone’ of my day, a meeting or discussion, opening up a positive mind set, starting with a story that generates humour, warmth, openness and giving a clear message about how we will treat each other in this interaction. I’ve heard positive feedback already about how this has felt for some people, in the knowledge that sometimes others in the room aren’t comfortable to speak openly and honestly about their issues or concerns, this may be because that’s not who they are, they don’t feel safe and supported to be able to say what they really feel or that they fear they will be a lone voice where others will shout them down, disagree or embarrass them.
There is vulnerability at every stage in these interactions, by acknowledging and sharing my own vulnerabilities, acknowledging that I sometimes worry about what I have said or my ability to influence something my hope is that this encourages colleagues around me in finding the strength to recognise and value their own feelings of vulnerability in interactions, which can bring more openness, honesty, professional challenge and cultural change. Younie, (2016) explores this from a leadership perspective and gives examples of the value of others sharing their vulnerabilities and acknowleding the human impact of the work we do and recognising the humanity that we share.
Acknowledging the challenge we face as professionals in finding connections with each other and openly communicating our thoughts about how it can be hard to find a way to be seen and heard in interactions can only lead to improvements in the care experience of people who use our services. Seppala (2016) describes what I want to say perfectly: finding the courage to be yourself in a leadership role exposes vulnerability and reduces professional distance.
Learning Disability Nurse Consultant 