A Day in the Life of…a Senior Clinical Nurse Advisor with 111 Wales

In the second of our current ‘Day In the Life Of…’ blog series on diversity of nursing roles, Ms Abby Howells talks about combining her responsibilities in clinical care and leadership in role as a Senior Clinical Nurse Advisor with NHS 111 Wales. 

(1) What is your job title and your main role/responsibilities?
I am a Senior Clinical Advisor (SCA) for NHS 111 Wales. My role is divided into Operations and Team management. During Operational shifts, I will supervise and manage the service for that shift. Ensuring safety and high standards of care across the service by providing clinical support and professional leadership to NHS 111 Wales Clinical Advisors, Dental Health Advisors, Call Handlers and Health Information Advisors. I also monitor the systems and processes utilised throughout the service ensuring clinical integrity, patient safety and efficient use of resources.

When I am not operational, I lead and support a team of Clinical Advisors and ensure they have the tools to undertake their own roles effectively. Within this role I participate in clinical quality audits and ensure my team’s work is evidence based and consistent with national guidelines, current trends and developments within Nursing and the wider NHS.

(2) How did you get into your current role/line of work?
I qualified as a Registered General Nurse from University West of England, Bristol in 2000. After 14 years broad ward experience across numerous specialities, I applied to work within, what was then NHS Direct Wales as a Nurse Advisor as my passion for ward nursing was waning and I was looking for a new direction. After extensive training I started to perform Remote Clinical Assessment. I was able to use my expansive general knowledge and fell in love with Nursing all over again. After four years assessing calls and developing my skills, I applied to become a Senior Clinical Advisor as part of my career progression – a path I highly recommend as I have the benefit of remaining in a clinical role as well as pursuing team leadership experience. The variety within my role keeps me challenged and there is always much to learn. I am currently working through a Team leader and Development Programme provided by the Welsh Ambulance Service Trust (WAST) that equips the management students with theoretical and practical solutions within management.

(3) Can you tell us what a typical day in your role/line of work involves?
Typical days are hard to come by in these unpredictable times, but Operational shifts generally start with reviewing the current position of the service at hand. This would include available staffing, number of calls waiting to enter the service and monitoring the calls already in the ‘Queue’ awaiting assessment, to ensure clinical appropriateness and safety as well as noting the health of IT and telephony systems. As NHS 111 Wales is hosted by the Welsh Ambulance Service, NHS 111 Wales assess lower acuity ‘Green calls’ as well as calls entering the service via 111. Typically, less than 18% of these assessed calls are returned for a 999 response thus relieving the intense demand on the 999 service. Time is spent liaising with Ambulance Control Clinicians and Non-Clinicians to determine the type and severity of calls transferred between the two services.

I also work closely with GPs, pharmacists and support staff working within the Health Boards to provide the Out of Hours GP service for whom we call handle and undertake remote clinically assessment of patients. I am always available to all staff within the service as a source of clinical and practical support.

Within my Team Leader role, I am there to provide as much support as team members require with their wellbeing, training, and professional development, managing absences, and signposting to services such as Occupational Health, Human Resources, payroll, and Resource planning for example. I may spend a day undertaking call audits, attending sickness absence meetings, meetings surrounding service improvement or in one-to-one meetings with team members. Call auditing is a vital part of the role as it ensures that established and evidenced based procedures are followed in order to provide high quality and effective care.

As part of the management role, Senior Clinical Advisors (SCAs) will frequently undertake additional projects with the target of improving the service for both staff and service users. I have been included in Clinical Workstreams regarding developing the Decision Support Soft wear utilised by the clinicians, involved in groups improving auditing procedures and developed procedures surrounding telephony usage.

(4) What would you say are the ‘best’ or most rewarding parts of your role?

My working relationships are by far the most rewarding aspect of my role, in being able to support the staff within NHS 111 Wales perform their role to the best of their ability with the aim of excellence in service provision for our patients. My, and my SCA colleagues, goal is to provide high quality patient care. The most appropriate care is to be provided at the right time and place as per Prudent Healthcare principles.

(5) What advice would you give to others who would like to follow a similar pathway?

We employ both nurses and paramedics to be our Clinical Advisors but from whichever area they originate, it is essential to have a wide variety of clinical knowledge as no two calls to the service are ever the same and could be for any reason imaginable. My advice would be to experience different specialities, through working on a nurse bank or agency, ensure Continuous Professional Development is up to date and varied, and undertake additional study in disease processes and remote clinical assessment.

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

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