Sharel Cole, QN, RGN, Advanced Nurse Practitioner (ANP)
What is your nursing history?
My nursing formally began in 2004 after I completed my nurse training at Kingston University, London. I then practised as a Community Staff Nurse in Wandsworth, South London. In 2007, I wanted to start District Nurse training, but my trust had stopped funding the course. Nevertheless, this did not deter me; I considered any other opportunities to enhance my professional development. I undertook a MSc in Advanced Practice and became a Community Matron on the ‘Community Virtual Ward’ Pilot in Wandsworth, which provided intense case management to patients with complex co-morbidities.
I also had a special interest in diabetes care and left community nursing for a short period to become a Diabetes Specialist Nurse at King’s College Hospital. I returned to Community Nursing, as an Advanced Nurse Practitioner (Band 8a), an exciting new role on the community wards. My new role is managing the community ward, providing clinical leadership to community nursing teams, and engaging in the acute home visiting service in order to reduce the number of avoidable hospital admissions.
This year I proudly celebrate a decade of dedicated and committed service to Community Nursing, and am honored that I was awarded the prestigious title of Queen’s Nurse last November.
What or who inspired you to become a nurse?
Care and Compassion
“Nursing is an art: and if it is to be made an art, it requires an exclusive devotion as hard a preparation, as any painter’s or sculptor’s work; for what is the having to do with dead canvas or dead marble, compared with having to do with the living body, the temple of God’s spirit? It is one of the Fine Arts: I had almost said the finest of Fine Arts.”
Florence Nightingale (1820-1910)
Nursing has always been and is still my ruling passion. From a tender age, I had a strong desire to serve, to care and to enhance the quality of life for those who were unwell. Undoubtedly my first clients were my pets and siblings. My career was greatly influenced by my life experiences and interactions with the elderly. Growing up in a rural village in Trinidad, I would often accompany my mother to visit the sick and those who were housebound. Taking a meal, reading, talking and praying with them made a lasting impression on my career choice. I still remember a blind lady who lived alone. She had lost her sight as a result of poorly controlled diabetes. The touch of her soft hand and the joy that our visit brought nurtured my decision to be a nurse.
The role of the nurse demands much more than administering drugs, wound care, personal hygiene needs and end of life care. It is basically characterised by the 6 Cs (Care, Compassion, Competence, Courage, Communication, and Commitment). My aunt, an Intensive Care Nurse was inspirational. Initially, I had a short stint as a primary school teacher in Trinidad. Not long after, I moved to London as I wished to study paediatric nursing. This however did not fulfil my expectations of nursing or give the job satisfaction I envisaged. Now here I am, one of the most senior clinical nurses in the community. Nursing gives me a combination of everything for personal and job satisfaction: care, compassion, lifelong learning, teaching, new skills, integrated working, challenges, new technology etc. What I enjoy most about nursing is caring for patients, learning new skills and realising how much more there is to learn. In fact, each day is different. I agree with Florence Nightingale: Nursing is an art!
Why did the community appeal to you?
My 8 week placement as a second year student nurse with a District Nursing Team in Battersea gave me a new vision of nursing. I was impressed by the role of the District Nurse and realised that working with clients at home was a huge opportunity, and one that suited me. It was a university open day which reminded me that community nursing welcomed newly qualified nurses. I felt this would allow me to deliver personalised care and use a range of skills. I had an ‘a-ha’ moment and the rest is history!
What made you decide to apply to become a QN?
I learnt about the QNI when I read the publication '2020 Vision'. I had a desire to be a QN but at that time, I was focused on my MSc and did not look further into it. In 2011, I read more about the QNI. I was deeply moved by the work they were doing to improve care for patients at home and support community nurses. After my short experience back in the acute setting, I knew my heart was in community nursing and that is where I felt could make a bigger difference to patient care. On reflection, working in secondary care gave me more insight into their decision-making when patients are acutely unwell in hospital. I “won’t be pulling my hair out” when patients are discharged as much as I used to. As a community nurse, so many times when we visit patients post hospital discharge, we wonder: “How could they discharge a patient in this way or why didn’t they refer to us or thank goodness they referred to us”. It asserts the fact why community nurses and follow-up at home is crucial to enhancing patient care and ensuring safety for those who are housebound or recovering from a critical condition. Nursing patients at home allows you to identify what is needed to improve their care or understand why there are problems with medication concordance etc. For example patients prescribed more than 4 medications requiring to take it more that once a day – it is the community nurse who may be the first to recognise if there is a problem with literacy, poor vision or poor memory. The turning point for me was reading the ‘Right Skills, Right Nurse’ campaign. I share the QN values and longed to get involved in some of these campaigns and the work they are doing.
As a nurse, it is challenging at times. Working in my role as a CM and ANP could feel isolating at times. Together with staffing recruitment and retention problems at work, staff morale was low. I felt that being part of one of the best professional organisations would be a great opportunity to share best practice ideas and meet other community nurses who are also committed to improving patient care despite these challenges and the demanding needs. The QNI was the answer!
Can you briefly outline the application process and what you thought of it
New QNs are announced every spring and autumn. The application process was less daunting than I anticipated! In fact, I should have done it years ago. To become a QN, you must have at least 3 years experience as a community nurse; you write a personal statement and explain why you would like to be a QN. Your line manager and two patients complete a feedback form which is sent off independently. A panel processes the applications and a decision is made. Farida, the QN Network Facilitator was very helpful in clarifying any questions, and I was delighted when I received the letter last August that my application was successful and looked forward to being a QN!
How has being a QN enabled you to improve care?
Becoming a QN has opened up many new opportunities for me. It is very special and a great achievement to be part of the QNI. With respect to my current role and previous roles, I feel community nurses’ aren’t being heard enough as the frontline nurses in the primary care. As a QN, I feel more confident to represent community nurses as I have a stronger voice in influencing managers, commissioners and national policy. Recently I attended a meeting with NHS England and the National Housing Federation; I highlighted the challenges encountered in practice where housing has a significant impact on patients quality of life. I have also attended a meeting with the London Health Commission in my locality to represent nursing and point out the need for: more investment in community nursing, the need for senior clinical leadership out of hours and need for more proactive care.
In my opinion, community nursing will benefit from having Practice Educators and more exemplary Senior Clinical Leadership. Community Nursing Team Leaders ought to be supernumerary so they could really support and develop their junior staff. I believe this additional support will impact positively and enhance the performance of community nurses and empower them to deliver safe care feeling more competent and confident. As a QN, I have gained more support to develop my skills, raise the profile of community nurses, promote high standards of care and share evidenced-based practice. QNI facilitation workshops and access to scholarships for example, will provide me with additional support and confidence, essential to improving patient care and achieve best practice.
I am just at the beginning of my journey as a QN. I hope to highlight the need for more community ANPs and community nurses. Due to the dynamic nature of nursing, senior community nurses and community matrons in my opinion would benefit from joint working/performance management from ANPs and nurse managers. This would support them with developing physical assessment skills and case managing more complex patients and achieving their competencies. I lead by example in my current role and hope to inspire other community nurses to become a QN. Being a QN reinforces what nursing means to me: treating the whole person not treating a disease or bed number. Instead having compassion, wisdom and skills to support patients and their families in some troubled times at home is a privilege.
I try to promote being proactive and preventative in care delivery. My 3 Es: ENGAGE, ENCOURAGE AND EMPOWER patients to self-manage and take responsibility for their health. It is great to be part of a professional organisation which understands the implications of moving patient care out of acute hospitals and into the community. The Frontline first campaign by the QNI highlighted these concerns and subscribes to the belief that more community investment is needed to facilitate this shift. This will most likely ensure safety where it is clinically appropriate. It is also an opportunity to meet other nurses who are passionate about their role and committed to improving patient care despite the challenges!
Would you encourage other community nurses to apply to become a QN? What attributes would they need?
Being a QN is a brilliant opportunity to profile the excellent work that community nurses are providing. Community nurses have the knowledge and skills to achieve person-centred care and improve the health of the clients we see at home by engaging and working with carers in their own home environment. I share Prof Viv Bennett’s (Director of Nursing, Department of Health) drive to improve population health and prevent disease. I would encourage all community nurses who are committed to aiming higher and inspiring confidence in the care they provide by making a real difference to patient care to become a QN. It is a fantastic opportunity to celebrate being a community nurse, and reinforce our commitment to continuously improving quality and promoting person-centred care. With all the changes and organisation restructuring, I trust that the government, commissioners and the NMC would recognise how precious our ‘Nurse’ titles are; it is our identity and am sure patients would agree.
At times, many colleagues ask me ‘Why don’t you do become a doctor, Sharel?’ as my role as an ANP involves advanced physical assessment and non-medical prescribing. However, as much as I have a great respect for my medical colleagues, I enjoy being a community nurse. I am proud to be a nurse. Even though I am using more advanced skills and not practicing daily scheduled nursing care such as medication administration, wound care etc I am demonstrating more senior clinical leadership and assessments to work together with our community nurses to ensure we are providing a high standard of care. The wealth of knowledge and experience I have developed throughout my career is an asset to offering true holistic care. I can assess patient’s health, diagnose conditions and treat appropriately within my sphere of competence as a Non-Medical Prescriber.
Nurses play a pivotal role in supporting and promoting better co-ordinated care. As an autonomous practitioner with advanced physical assessment skills, I can identify patients at home who are acutely unwell and am able to arrange for patients to receive the right care that they need as soon as possible for example being able identify patients in acute renal failure, suspected malignancy, suspected stroke – arranging admission to hospital or arranging services at home for a rapidly deteriorating patient who maybe entering the terminal phase. It is like putting the pieces of a puzzle together. Patients and carers are so grateful, expressing their surprise at my high level of professionalism as a nurse: “you are very thorough” are the common remarks I hear. I say this is holistic care and one of the benefits of integrated care: looking at the whole patient. One relative burst into tears recently, thanking me for listening, saying it is the first health professional they met that truly empathised! This is why I am a nurse and why I return home feeling satisfied as I offer the best care I possibly can. Achieving the QN title is one of my greatest achievements ever!
If you weren't a nurse, what would you be?
I cannot imagine myself being in any other profession but if I weren’t a nurse, I probably would be in primary school education or involved in education. Though every year when I look at Strictly Come Dancing: I wish I could be a professional dancer J but that is only a dream….nursing is where my heart is!
In light of the recently announced review of nurse education, what would be your recommendation?
With the global drivers for change such as rising patient need and the demand for care to be delivered closer to home, I look to the review of pre- and post-registration training for nurses and midwives in England to improve standards of patient care and encourage others to join our profession. Admittedly, the community nursing workforce is already under tremendous pressure due to work place shortages, downbanding of nursing roles etc. This would be an opportunity to improve pre-registration training to include more community placements, with modules to improve the transition for new nurses into primary care. With the huge reduction in the numbers of district nurses, the massive growth in the population and the increasing numbers of people with complex conditions comes huge implications for community nursing. Community nurses are managing many patients with complex co-morbidities at home without having enough senior nursing support on the weekends and unsocial hours – so we need to re-think the term ‘basic nursing care’. Instead we need to focus on the 6 C’s and ensure patients are receiving high level of skilled care with their safety being priority. However, for the UK to be successful in moving care out of hospitals into the community we need a whole revised system and mind set change at the policy, practice and education levels. I believe the community nursing workforce should be valued more as they are very critical to such a change.