A Queen’s Nurse in the Ambulance Service

In the first of two blogs from staff at South East Coast Ambulance NHS Foundation Trust, Queen’s Nurse Rachael Skates shares her personal career journey from hospital to community to IPC and the ambulance service.

From acute to community

I started my nurse training in 1986 at Guys Hospital in London, I always wanted to be a nurse as long as I can remember. After my training I moved back down to Sussex and started working in a busy Outpatients department at the local acute Hospital. Looking back and reflecting this started my passion for caring for patients in the community. I worked in a range of different clinics gaining knowledge in a wide variety of specialities. I undertook nurse led dressing clinics and nurse led flexi cystoscopies which then led me into the role of the continence nurse specialist for the Trust. This role was under the umbrella of Infection Prevention and Control (IPC).

While working for this team I started my BSc in Health Protection and became an IPC specialist nurse. I stayed at the acute hospital for a further two years in this role before moving out to the Community Trust and gaining my MSC in Public Health and management. This course gave me an in-depth knowledge of the challenges the NHS faces with the management of health inequalities in community settings, and this is where my dedication to working in community nursing really took off.

Queen’s Nurse title

I had not heard of the Queen’s Nurse (QN) title before, and it was only by chance that I found out about it. I had a meeting with the deputy chief nurse as part of my induction and I noticed the badge that she was wearing with pride, she took the time to explain all about it and what the title meant to her. I was told that you had to be dedicated and have been in the community for at least three years (NB: Queen’s Nurses now need at least five years community experience). Having been a Queen’s guide I wanted to be a Queen’s nurse as well, to feel her pride, to have an invaluable network and to improve care for our patients in their own homes.

As soon as I had been at the Trust for three years, I stared my application with support and sponsorship from other QNs at the Trust. I realised that there were quite a few of us in the end.

I became a QN on the 9^th of November 2015 with 6 other staff from the Trust, it was an amazing evening with such a buzz within the room and a real sense of achievement.

Back in the heart of the Community Trust for the Pandemic

While working at the community trust I was offered the opportunity of a secondment in an Integrated Care Board (ICB) as their IPC lead. This covered an area population of approximately 170,000 patients and I worked with over 20 General Practitioner surgeries as well as working with my colleagues in the Acute, Community and Mental Health settings. This again expanded my knowledge and understanding of community challenges from a different perspective. I undertook this role for 18 months.

Then came along the pandemic and my speciality of IPC was needed more than ever, this was what I was trained for, my work phone never stopped ringing, and I worked all the hours I could to support the teams I covered at the community Trust, working weekends and cancelling annual leave. We all learnt together as this was unprecedented times. We relied on our networks even more for clinical advice and emotional support.

IPC at Mental Health Trust

Even though this was the hardest and emotional time of my career it was also the time I grew with confidence and halfway through the pandemic I applied to the Mental Health (MH) Trust as their IPC lead and successfully became their Deputy Director of Infection Prevention and Control (DDIPC). There were certainly different IPC challenges within a MH Trust, however there was still a community bond with fellow QNs at the Trust. I was also able to support a member of my team to become a QN. As the severity of pandemic began to decrease due to the uptake of the vaccine, the MH Trust started to go through an organisational restructure and I decided to take my 1995 pension, have a better work life balance and leave to find new challenges. However, I was not ready to give up a nursing career I love so much.

Joining SECamb NHS Trust

So this is how I have now become part of  South East Coast Ambulance (SECAmb) NHS Trust, working within the IPC team, using my knowledge that I have gained from my career to support our staff working with the patients across a geographical area of 3,600 square miles (Brighton & Hove, East Sussex, West Sussex, Kent, Surrey, and North East Hampshire). We have over 4,000 staff working across 110 sites in Kent, Surrey and Sussex. Almost 90 per cent of our workforce is made up of operational staff, caring for patients either face to face, or over the phone at our emergency dispatch centre where we receive 999 calls. Our patients range from the critically ill and injured who need specialist treatment, to those with minor healthcare needs who can be treated at home or in the community. As well as a 999 service, we also provide the NHS 111 service across the region.

I am the only nurse within our small team of 5 practitioners, with the other members of the team being Paramedics with a vast experience and knowledge including Make Ready (this is the process where the vehicles are cleaned and prepared ready to attend patients) and the Hazardous Area Response Team (HART) who deal with all High Consequences Infectious Diseases (HCID).   I wear the green uniform and am proud to do so, and this also makes it easier for me to engage with our front-line staff. I can say that no two days are ever the same and I am loving this role.

We have 161 nurses at the Trust in a variety of roles.

They include the lead in safeguarding, deputy director of operations, clinical safety navigators, clinical advisors, mental health nurses to name a few. We have a yearly nurse conference where we can come together to share our experiences and give a voice to nurses working at the Trust.

At present I am the only Queen’s Nurse at this Trust but working with the Chief Nurse and Deputy Chief Nurse we are on a mission to change this, and we hope this blog will inspire others to apply.