We hear from a nurse who works with alleged offenders many of whom have addiction problems and we talk to a rural GP who says it’s still a “privilege” to be doing the job – nearly 30 years after first starting.
A “disgraceful sense of humour”, kindness and the support of a tight-knit team is what gets senior clinical forensic nurse Jess Davidson through a challenging day at St Leonard’s police station in Edinburgh where she delivers healthcare to people held in custody. But despite dealing with some of the Capital’s most underprivileged population, she is upbeat and enthusiastic about her role on the front line of police nursing.
She says: “The people we see often have unmet healthcare needs because they don’t seek out mainstream help.
“Some of them are in the care system or are seeking asylum or have drug and alcohol dependency issues and are so far down on their luck. Moving towards a nurse-led practice after 2011 has meant that patients see one person and tell one story and trust is established.”
Despite the inevitable dangers, Davidson, 50, says the corridors and cells at St Leonard’s are some of the safest places she’s ever worked. “It’s high risk, so everyone is more vigilant,” she says.
Davidson and her team carry out tailored person-centred evaluations of every patient and as nurse-prescribers can start alleviating acute panic and anxiety, as well as presenting health symptoms, straight away.
She says: “Person-centred treatment means that we understand and recognise the uniqueness of every individual when treating them.” But it doesn’t stop there, in creating a culture where the individual is promoted, Davidson’s 25 nurses who work across nine custody suites are afforded the same privilege.
She says: “It’s about being authentic to everyone you deal with. Working in a ‘dungeon’ can be a difficult environment and the team’s mental health and wellbeing is central. Really dramatic things happen down here and we’re exposed to some really sad stories.
“Stripping everything down to the basics and building relationships is how you give the best care.”
And her way works, as evidenced by the sharp drop in ambulance call outs and the volume of patients her team refers on to further treatment programmes.
She praises the support of the public health team at NHS Lothian for enabling her to drive forward her pioneering practices that saw her awarded a fellowship of the Royal College of Nursing in May for her exceptional contribution to nursing. She is also the proud bearer of the title Queen’s Nurse from the Edinburgh-based Queen’s Nursing Institute after being nominated for the prestigious community nursing award that recognises high standards of practice.
Davidson has been a nurse since 1994 and knows that so much of the issues she is faced with daily is down to social inequality.
She says: “The social side of people’s lives is what determines where they end up.”
Which is why she is a champion of the NHS. She adds: “One of the best things to ever happen anywhere in the whole world was the inception of the NHS. End of. All of the healthcare made available to people in this blanket way is just so much better than any alternative. All the people I work with, we know that we’re doing something worthwhile which is always underpinned by good practice.”
Dr Erik Jespersen, who has worked as a GP in Oban for the last 29 years says the job is harder and more stressful than it was when he first started in the 1980s but he still “loves it”.
He says: “I’m very lucky. I’ve had a wonderful job and have been in Oban for 29 years coming up for 30 next year.
“The job has changed a lot in that time. When I first came here we ran the local A&E and were on call for one in five days but I would say the job is much harder now and more stressful than it was back then. That is because of increasing demand and a failure to recognise how important general practice is.
“A typical day now consists of a 12-hour day and there’s seeing patients but what’s mushroomed a lot is the amount of paperwork we have to do – checking results and generally co-ordinating things.
“We still do home visits but less so than we used to do, they tend to be elderly people or palliative care patients. We used to see kids at home with a fever but that never happens these days – there’s much less home visits than there was before.
“We’ve got a Frailty Project going [in Oban] which involves a community nurse distributing care every week where we look at all the patients who have got morbid to severe frailty. Those people who are on the cusp of needing lots of hospital admissions and trying to intervene by reducing their medications and making sure they have decent social support and make sure that their healthcare is maximised. That has actually been a really positive thing.
“It’s harder than it was before but the patients are still lovely and I still love interacting with them and I think it’s a privilege to do the job we do.”
Dr Jespersen says that working in a close-knit community setting means he knows whole families and believes that is an important factor in providing a high standard of care.
He adds: “I’ve known these patients forever, generations and families and that’s what I love about the job. I love being a family doctor.
“I think you have that continuity and you’re part of the community.”