Looking After Your Team Case Study: Lead Practice Nurse

Role and Context

The participant is the Lead Practice Nurse (in their terms, ‘the nominal Lead, as that is was the Senior Partner tells me I am’) in a GP practice based in London. They are part of a small team of practice nurses, and they cover respiratory needs and infection control. 

They work two days a week in the practice and they are the longest serving member of staff in the surgery. The participant described the practice as ‘recently being a very busy and challenging place to work’ but the staff are very caring of each other and there is a relatively flat structure. 

The participant also works in a nurse leadership role for their local CCG, which includes linking up information to Public Health bodies, putting forward the voices and opinions of practice nurses in the area, and filtering down messages from public bodies to practice nurses. They also help run practice nurse forums, HCA forums and clinical supervisions.

Challenge of Covid-19 on the team

The start of Covid came at a challenging time for the participant, as their retirement travel plans were disrupted, and they were also experiencing difficult circumstances personally. The way in which the five GP practices in the local Primary Care Network (PCN) operated under Covid also changed. The five surgeries opted to minimise the venues where face-to-face consultations occurred, and consequently the practice with the largest waiting room became the local ‘Covid cold hub’. The participant opted to work in the cold hub throughout the pandemic to treat patients who required essential dressings, injections, and baby immunisations.

“It was all of a bit of an unknown future when it came to GP practices when Covid kicked off… I volunteered with a few other nurses to work in the cold hub, which for me meant working in a different practice, working with different practice staff, and seeing patients from all five surgeries face-to-face.”

There were also a range of logistical differences, especially in relation to the technology and getting the computer systems to work, and these complications had an impact on the timeliness of patient care. The participant believed that those who worked in the cold hub were able to come together well even though they may have worked in other practices. However, communicating at work was near impossible because of social distancing. They mentioned it was very difficult to even take short lunch breaks with each other because of restricted numbers of staff being allowed in the staff room at one time.

What did become difficult for the participant was the level of work that their two roles produced. There was a feeling that staff were becoming increasingly stressed, and although staff were seen to be ‘buckling down’ there were many frustrations arising.

“We as nurses and clinicians just had to get on with it… we were stressed everyday… it was difficult to see a lot of people as social distancing meant that only a few people could be in a room at any one time… in the CCG everyone was just sent home, and people were struggling because of the isolation.”   

How accessing the Looking After Your Team coaching helped

The participant found themselves struggling having two jobs and the amount of work that they generated, going far over the working hours that they were contracted for. They signed up for the coaching with the expectations that they would be able to deal more effectively with their workload, but also how they worked with others within the team.

“Through the coaching I am finding ways to make sure that the changes are being managed better, and having the confidence to, some may see it as being bolshy, to make sure that right procedures are put in place.”

The coach was able to listen to the concerns that the participant had and ask questions that helped them to take a step back from the busyness of work and think more objectively about what needed to be done and what was occurring. Although recognising that they were not the lead nurse in the cold hub, they were the most experienced, and so felt it important to gain the confidence through the coaching to recognise and speak up when team practices could be improved so staff did not have to work over-hours and to communicate more effectively when changes were being made.

“The coaching gave me the permission to say my piece, to question confidently, to articulate how I felt. I found myself thinking ‘what would my coach say in these circumstances’, and now I don’t panic about my workload… I am getting a better perspective over issues.”

Team impact of the coaching

The participant had recommended the Looking After Your Team to other nurses and GPs in the cold hub as they had gained a lot out of the service. Importantly, they also noticed when others in their team were working too hard and have since provided them with snippets and tips that they got from the coach.

“I am in a better place and definitely more confident at protecting myself. But I am also seeing the impact that my coaching has had on the team. I am able to give others advice about how to look after themselves better.”

The coaching provided support for the participant that they could use to help their team, in ways that had not previously been possible. They felt they were now being more proactive in looking after team welfare, and not maintaining the culture of ‘gritting your teeth and getting on with it’. They believed that it will still take more time for the culture to change fully, and for the coaching to become embedded, but there had been some change to help accelerate this, for which the participant was pleased about.

“I am in a better place because of the coaching, and I am more confident about protecting myself and others… I feel it is really important for me to filter down what I have learnt to other people.”