Return to Practice: It May Be Tough But It's Worth It

Supporting and encouraging nurses with lapsed Nursing & Midwifery Council PIN's or wanting to get back into clinical practice is a not so secret passion, having completed mine nearly two years ago now.

I was pleased to see the latest #WeAreTheNHS campaign launched by Health Education England aims to inspire nurses to return by highlighting the fantastic opportunities and support that is available. Partnered with Mumsnet, the microsite is promoting the campaign and showcasing inspirational video stories from nurses who have returned to the profession.

It's been a real privilege for me to speak with each Return to Practice group at Birmingham City University with their tutor Chris Jones, who was also my former tutor. We often talk about common themes that emerge and the latest one we have been thinking about is when things aren’t going well. This can be about your clinical placement, the academic work or the changes in nursing from when you were last clinical.

Returners often put a lot of pressure on themselves. They can forget that returning to practice is not just about the essential care of patients, it is about immersing yourself in current practice, whether that is shifts, technology, nights or the "jet lag" you may feel on your days off. When things aren’t perfect there is a tendency to deal with things intrinsically, i.e. blame yourself, dig in and work through it and not sharing how you feel.

Here are some suggestions to help if you are considering returning to practice or currently returning to practice - remember it's ok not to feel ok:

• Set reasonable expectations for yourself.

It’s ok not to be perfect. You may make mistakes; things will not always go the way you planned, and you can’t always give the care you would like. This is life, not you being a bad nurse. 

Chris says "It’s important to remember that when we put labels on things, we then set expectations we can’t always meet. Sometimes good nurses provide bad care and bad nurses can provide good care - our label should be nurse not good or bad nurse"

Bev says "The best advice I had was to stay focused on what I was trying to achieve ie to get my NMC PIN reinstated. It's easy to get distracted into many things - don't! Stay focused"

• Think about the nurse you are now, not the nurse you were before your registration lapsed.

One of the best things about the Return To Practice course is the varying experience; there are senior managers in the NHS and people who were unable to take a job when they initially qualified; some have been away over 20 years, and some only recently have lapsed. 

Chris says "Try and remember that in returning we are not expecting you to be the nurse you were, but in working towards that sometimes this means starting all over again and working back up. Embrace being a student and give yourself time to shake off your rust with people around to support you."

Bev says "I enjoyed learning from the amazing people in my cohort. I had been working in commissioning and strategy roles so was able to talk confidently about The Five Year Plan and STPs for example, whilst others had been working in social care or the voluntary sector with some insights into parts of health and care that I was keen to learn about"

• Reflect

Reflection is a wonderful skill and isn’t just about being academic or when things go wrong. Part of returning is to know your strengths and address areas to work on and something we should be doing every day not just to pass an exam or part of revalidation.

Developing reflective skills is important in building resilience, job applications and personal relationships, and in identifying that you do something well isn’t big headed or arrogant, it is being fair and honest.

Chris says "When you are struggling it’s important to reflect on why, it may not be that you are not good enough, it could be that you are in the wrong place in the wrong time, misinterpreted verbal and/ or non-verbal communication, or something that is outside your control"

Bev says "I found it helpful to have a critical friend to talk things thorough and reflect on experiences. I would recommend you set this up before you start if you can and have regular check-ins with them during the course - and immediately afterwards too as completing the course is one thing, starting working in a blue uniform is quite another!

• Be honest

Whether things are good or bad, it’s important to be honest about it as dangerous practice flourishes when we get into a culture of silence.

If you make a mistake it is crucial that you acknowledge it, apologise appropriately and honestly, reflect on it (this ensures it remains one mistake, rather than a pattern of behaviour) and then aim for it to never happen again.

Chris says "Sometimes we make decisions in difficult circumstances and under pressure, inevitably sometimes they don’t go the way we want to and we have to honest in owning these decisions and learning from them. They are part of our autobiography and should not be our definition."

Bev says "It may not be you who makes the mistake, you may see something that leaves you feeling uncomfortable. I had an experience with a registered nurse who didn't seem to enjoy supporting and developing student nurses (especially returners!). I recognised that this was more about her anxiety and an imminent CQC visit and tried to build a relationship, but it was still difficult. I raised this with senior nurses and was delighted to see changes happen as this nurse is exceptional but perhaps not aware how she was coming across."

• Find different coping mechanisms to deal with problems.

Sometimes avoidance works really well; however as a long term strategy and in nursing it is not healthy to avoid problems, hoping that they go away (particularly in relation to academic work).

Try and be pro-active in addressing problems. For example, an honest and tactful conversation with a practice supervisor who you think doesn’t like you might clear up any miscommunication and make them aware of how they are making you feel.

Things aren’t always as bad as they feel in your head and sometimes one conversation can help you feel better. Asking for help doesn’t mean you are not good enough and demonstrates courage and honesty, how you feel matters so identify your worries and talk them through.

Chris says "Rather than not wanting to bother your tutor because you feel silly and discussing your anxieties about academic work might reduce that anxiety wall that builds up around assessment and enables you to get the mark you want and deserve."

Bev says "I left my assignment until quite late into the course, and with hindsight wish I had started earlier as I actually enjoyed writing it in the end but was running out of time. None of us are an expert in everything so please don't put off til tomorrow what you can actually do today - you never know you might enjoy it! 

• There is no disgrace if nursing isn’t for you.

It is easy to forget the reasons why registration lapsed and think everything will be different. You may realise that nursing doesn’t make you happy, fulfilled or is not what you thought it would be.

Chris says "There is no disgrace in this - if it makes you unhappy, ill or its not you want, you have to make a decision that makes you happy and well - find a career that does this for you."

Bev says "Nursing has changed, and the diversity of roles available has changed so much! Think broadly and be open to opportunities. I have a full time national role so know that I don't have the time to be able to competently lead a ward drug round for example so I am looking to be trained to join the Flu Vaccinators team at Russell's Hall Hospital - something I can do for a few hours in the evening or at weekends."

Finally…

Returning to nursing can be a roller coaster of ups and downs.  If you do decide to do it as well as updating your skills for delivering person centred care, you will learn a lot about yourself, including learning how you cope when things don’t go well as well as identifying strategies to ask for help.

The support is there but how you use it is down to you.

Anyone interested in a return to practice course can sign-up to for a free guide to coming back. The guide contains information on the course, funding options and tips for interviews and applications. More information can also be found at Health Careers.