What does your work involve?
I work in partnership with consultant rheumatologists as a clinician and nurse advisor, managing clinical nurse specialists to deliver high quality individualised care. A big part of what I do is educating, advising and developing patients, health care professionals (in a multi-disciplinary team and primary care), and enabling positive management of the condition.
I clinically manage inflammatory arthritis patients, predominantly in outpatients and across the health care interface via the advice line; it’s important to be accessible for patients and colleagues. I’m also involved in developing services tailored to meet patient and professional needs, writing and sharing protocols promoting and supporting patient-centred care.
What do you do in a typical day?
Before and after clinic I do admin work including signing letters, report writing, collating data, checking investigation results and acting on them. I am available to staff for clinical or professional support. I see patients in clinic managing and co-ordinating care, using many aspects of extended practice. I answer my bleep throughout the day. I see patients urgently, through GP or patient contact via the advice line. I liaise with consultants to update on complex clinical problems identified in clinic and usually attend meetings relating to education, research or service or self development.
Why did you choose to do this work?
Through professional and personal experience, I became interested in palliative care. This developed further while undertaking a degree in health care in the early 1990s. I view rheumatology as an area of palliative care requiring lifelong holistic management. Working closely with patients and facilitating care is rewarding. I have the opportunity to network, promoting best practice in rheumatology within the department, region, and nationally.
What’s the best thing about this job?
I enjoy working with patients and families from diagnosis and beyond. I do this by working with them on a one to one in clinic, talking about the disease, assessing its impact and treating symptoms. Patients and families are given time to ask questions and literature to back this up as well as patient support groups contacts; this allows a deeper understanding of disease management, increasing confidence levels to self-manage. I work with patients to make sure disease activity is stable and prescribe drugs when necessary as well as organising investigations (e.g. x-ray, bloods) or refer to other multi-disciplinary team members and education programmes. Close contact and accessibility is important; the advice line is clearly very reassuring and vital for our patients.
What’s the worst thing?
Insufficient resources to develop services, which would enhance patient care and meet national standards is very frustrating, but however challenging, this encourages resourcefulness and innovation.
How has research informed the work you do?
There is established evidence regarding impact of chronic disease on disability, pain and mood. Psychological distress contributes to dissatisfaction with consultation, leading to patients not listening to treatment advice, which affects how well the of treatment works for them, and on their wellbeing and quality of life. Lack of access to psychological support for patients with chronic long term rheumatology conditions is a common problem locally and nationally. Recent National Institute for Health and Clinical Excellence (NICE) guidance states that patients with rheumatoid arthritis should have access to psychological support. Cognitive behaviour therapy (CBT) is known to be effective. In order to meet local needs, I developed the concept of applying CBT to patients with rheumatological conditions where psychological distress affects health and wellbeing. Initial pilot data has won national recognition; and we are planning to develop this work further.
Lynda Gettings is a clinical nurse specialist in rheumatology at the University Hospital of North Durham.