As I am nearing the end of my two-year GPN Fellowship, I felt that now would be a valuable time to reflect on my experience as a GPN and my progress from Newly Qualified Nurse (NQN) to now.
Reflection is a key attribute of a nurse and is part of Continuing Professional Development. I recognise the importance of this process is to be able to highlight my strengths, limitations, opportunities and threats and to be able to develop an understanding of my learning needs. This ultimately ensures safe and effective care for patients. The skills and knowledge I have gained over the last two plus years is huge (and continuously evolving). Through reflection I have acknowledged that my GPN role and completing the GPN Fellowship has supported me to progress as a Nurse and to secure a position as a community Diabetes Specialist Nurse (cDSN) alongside my GPN role.
Student Nurse Training
So, where do I begin? It is important to mention that I feel very lucky to have had the opportunity to experience a placement in General Practice during my Student Nurse training. Prior to my placement in General Practice (in 2018), I had not necessarily considered General Practice Nursing as an option. Perhaps, because I didn’t really know what a GPN was, what their role was or indeed the vital contribution they make to patient care. (Shouldn’t primary care be more visible to increase awareness of the GPN role – to ensure it is seen as an early career option?) I hope this is something that begins to increase in time and that General Practice placements are more accessible so that everyone can experience this unique, specialised and autonomous area of nursing, because you don’t know what you don’t know.
During my placement, I was able to work with the General Practice team and it was during this time that I developed my interest both in the GPN role and diabetes care. I found it so interesting; complex and multifactorial but ultimately rewarding. From childhood immunisations and health promotion through to wound care and supporting patients living with long-term conditions or indeed a terminal diagnosis. Following my placement in General Practice I knew that I wanted to support people living with diabetes (PLWD) when I qualified as a Nurse. I recognised that General Practice and GPNs have a huge role to play – and I knew the GPN role was for me.
Throughout my training, I took every opportunity to learn more about General Practice Nursing by attending conferences, talks and by reading more about this area of nursing. I also continued to develop my interest in diabetes and specifically diabetes in primary care – applying this to my academic work and learning more about this during my placements.
My GPN Fellowship
I qualified as a Nurse in 2020; what a year to qualify! The world was certainly a different place and as I had spent the majority of my final year as a Student Nurse either in ‘lockdown’ or ‘socially distanced’ this meant I worked in the hospital for my final placement as an ‘Aspirant Nurse’ on a Medical Assessment Unit to achieve my competencies and to be ‘signed off’. I remained in the hospital setting after qualifying for around 6 months before moving to General Practice and soon started my GPN Fellowship.
My GPN Fellowship included a 9-month ‘Foundations in General Practice Nursing’ course. This involved developing the knowledge and skills to be able to create a professional portfolio of clinical competencies relevant to the GPN role and General Practice. These were ‘signed off’ by an experienced assessor in practice. The competencies covered core skills such as: communication and consultation, health promotion and immunisation as well as specific competencies relevant to my GPN role. This included diabetes care, hypertension and wound care to name just a few. These competencies provided me with new areas of learning, challenges and ultimately increased my awareness and knowledge of the vast scope of General Practice Nursing. In turn, I was able to cascade the knowledge I had gained within my team, by developing resources regarding wound care/dressings, hypertension and emergency equipment checks, as well as teaching sessions regarding diabetes and specific areas such as foot checks for PLWD – this has ensured patient safety and effective care.
General Practice Nursing is an autonomous role, and although as a GPN I am part of a team, we often work alone with support from colleagues as required. This means GPNs are required to have the necessary skills to assess, plan and carry out care for patients autonomously; escalating as required and being aware of their scope of practice. As a NQN, support and guidance is essential, as is the ability to discuss and reflect on experiences – how else can you develop and learn? Beyond the taught elements of the ‘Foundations in General Practice Nursing’ and clinical competencies, I have had the opportunity to have Clinical Supervision and support from a Queen’s Nurse (Angie Hack) for the duration of the two-year GPN Fellowship – this has been invaluable to me!
The GPN role has been an amazing learning opportunity (albeit a steep learning curve) and I have been able to develop the skills of an autonomous practitioner in a relatively short period of time – with support and guidance. Although diabetes has remained my absolute interest and the area of nursing, I am keen to develop and progress in, the GPN Fellowship required me to gain a greater understanding of the wider team and Primary Care Network. I have taken opportunities to work with pharmacists, GPs and my nurse colleagues to gain further insight, knowledge and understanding of primary care and General Practice as a whole. These experiences further highlighted to me that although GPNs are autonomous practitioners, it is vital that we all work together. The wider team is so important to ensure safe and effective patient care, and equally is essential to be able to learn and support one another.
Community Diabetes Nursing
Towards the end of my GPN Fellowship, a fantastic opportunity came my way: a community Diabetes Specialist Nurse position. I knew that, beyond supporting PLWD, an aspect of this role involved working with GPNs to increase their knowledge, skills and competence in supporting PLWD – through education and offering advice and guidance. As a GPN, I have been able to increase my knowledge, skills and competence with regard to supporting PLWD – I recognise this is because of the support I have had from my specialist nurse colleagues, pharmacists, GPN team and opportunities such as learning events and training. I wanted the opportunity to provide this support to other GPNs myself. I had already started my MSc in Diabetes Care during the second half of the GPN Fellowship and I was increasing my role in supporting PLWD as a GPN. Applying for the cDSN role felt like a natural progression for me in my career.
I was successful following my interview and accepted the position of cDSN, starting in September 2022. I now work both as a GPN and cDSN. Completing the GPN Fellowship has equipped me with the skills to be an effective, proactive and able GPN. I am now utilising these skills in my role as a cDSN when working with nurses (including GPNs) who are supporting PLWD – which is great!
As I continue to work towards my MSc in Diabetes Care, I hope this will continue to provide me with further knowledge, skills and intrigue to continue to support PLWD in the best possible way, and that ensures I can offer guidance, support and advice as a result. I recognise the fundamental skills and knowledge I have gained as a GPN and completing the GPN Fellowship has been invaluable to me and my career.
By Sonny Dixon
NOTE
The GPN Fellowship https://www.england.nhs.uk/gp/the-best-place-to-work/gp-fellowship-programme/ is a 2-year pathway for nurses who are new to General Practice. The funding supports nurses in practice, paying for the Foundations in GPN academic programme. The Fellowship is designed to encourage and support development of the GPN nursing workforce.
