In our latest Day in the Life of Series, we are showcasing the diversity of nursing roles within the 111 telephone triage service.  In the first of our three blogs in this series, Ms Rebecca Malin tells us about her role as a Clinical Nurse Advisor with NHS 111 Wales. 

(1) What is your job title and your main role/responsibilities?
I’m a Clinical Nurse Advisor for NHS 111 Wales. The NHS 111 Wales service was launched in 2016 as a completely free way to access the NHS in Wales for health advice, information and access to urgent care. A Clinical Advisor is an autonomous role with a team of Senior Clinical Advisors and Professional Practice Educators for support. My main role is using my clinical assessment skills to advise the people of Wales who have accessed the service on a wide range of ailments, injuries and conditions.

(2) How did you get into your current role/line of work?
I started my role as a Clinical Nurse Advisor in November 2018. Since becoming a qualified nurse in 2004, I have held previous roles and worked in renal medicine, stroke, rehabilitation care, district nursing and a brain injury unit. I was at a crossroads in my career and was intrigued by the Clinical Advisor role as it’s not a role you come across in your nurse training. It is not a role you have much exposure to as a qualified nurse until you are in the role or accessing the service yourself personally. I was an experienced nurse when I started the Clinical Advisor role but the lack of previous exposure to telephone triage previously meant I did feel a little overwhelmed with the level of responsibility. I acutely recall feeling expert to novice. But my apprehension was fleeting as I was encouraged by the credibility of support from the professional practice educators and the senior clinical advisors. This support, along with working alongside other health professionals in the clinical contact centres, incentivised me to advance in the role.

(3) Can you tell us what a typical day in your role/line of work involves?
The highest demand for our service is in the evenings and at the weekend so a typical evening or weekend shift is fast paced and with high demand. There is no typical day at NHS 111 Wales, no two hours are the same assessing for 111, let alone two days. It is a role that spans a wide range of urgent health care needs. I can use my clinical assessment skills to advise approximately over 20 calls a day during a 7.5-hour shift. An excerpt from my day can be as follows:

• A call that appears on face value to be a health care professional with dermatitis type rash exacerbated by the necessity of handwashing – but few calls are one dimensional with one need – the caller’s rash has caused such discomfort that it has affected her sleep, her ability to work, her quality of life and in turn in her mental health. Things can escalate and can be more deep rooted than they seem at first. In this case, the healthcare worker suffered to a point that she is at a crisis point in her mental health needs.

• Next, I take a call from a vulnerable new mother with no support network. It is the middle of night and her infant has a fever. With compassionate communication and caller participation, I can educate and empower the parent to deal with the issue for the present and future. You can start the call sometimes speaking to a distressed caring parent and end the call with a relieved empowered parent who is confident in the plan of care. You feel you have reached down the phone into their home reassuring them and providing them with compassion and knowledge. You are using your expert clinical knowledge to advise remotely over the phone and as demonstrated needs are varied and multifaceted.

(4) What would you say are the ‘best’ or most rewarding parts of your role?
The calls received at NHS 111 Wales can be an insight or a snapshot of society’s health at that exact moment in time. We are the first to see a pattern if a demographic is calling about mumps symptoms or food poisoning or, as we have seen more recently, Covid symptoms – it is a fascinating role. The call to a Clinical Advisor at NHS 111 Wales may be the first step a caller makes towards getting help with a healthcare need or advice. Your assessment with participation of the caller can result in actions and advice that can lead to better a quality of life of the caller. Many callers feel an initial face to face consultation too daunting or anxiety driven, or that they feel they are wasting people’s time. In speaking to them, we break down barriers for the most vulnerable in our society.

(5) What advice would you give to others who would like to follow a similar pathway?
My advice would be to give it a go even if it is done alongside a face-to-face role. The listening skills that you will gain are invaluable for any situation, professional or personally. The knowledge of the expanse of health and social concerns you will gain is boundless. I would also advise to look after yourself and reach for your colleagues who are experienced in clinical triage. When you are new to the role, the distress heard over the phone can be overwhelming. When you are accustomed to using your body language and face to face skills to reassure a person, hearing and speaking to them alone can be unfamiliar but that passes as your skills grow and the team around you support your growth.

Rebecca works as a Clinical Nurse Advisor for NHS 111 Wales (@NHS111Wales and @GIG111Cymru).