Interview: A Life in Nursing

To mark International Day of the Nurse, PGS Librarian, Dr Carol Webb, interviews Diane Standring, who has nearly forty years' experience in the nursing profession, from London to Bangladesh to Saudi Arabia, as a nurse and a lecturer, with a particular specialisation in Intensive Care Nursing. 

Intensive Care Unit

What do you most enjoy about your current role as Senior Lecturer Intensive Care Nursing and Academic in Practice at University of West England?

The contact with students, specifically giving support during practice.  It is at this point they really emerge as individuals, no longer hidden in the sea  of lecture theatre faces.  Teaching theory is all well and good but practice makes the nurse. Learning in the hospital setting how to manage their fears, deal with problems and the inevitable stumbles they will experience along the way, is so important.  If this is not effectively supported they can become disillusioned, quit or become a nurse who does not have the ability to manage their own ups and downs.

If we travel back in time to when you started training in 1982, what did that look like?

I did a pre-nursing course in Canterbury, now called a Health and Social Care degree.  I then joined Medway Hospital in Chatham at 18 where I lived in halls of residence with other trainee nurses.    For our second year we were moved to Barts in Rochester and into the nursing accommodation there, before finally returning to Medway for our third year.  With each move the quality of the accommodation improved!  It would be very rare for someone to not live in.   Owning your own car was simply not possible at that time nor were there any food shopping deliveries or even take-away food.

In those days at Christmas, each ward would take on a different theme for decorating and one of mine was Victorian.  Not difficult to achieve when we were already wearing as part of our uniform a large cape which had to be worn when moving around on hospital grounds.  It was reversible, navy on the outside and red on the inside.  The design dated back to an earlier era where nurses would reverse their cape to cross a battlefield to tend the wounded, so that they could be clearly identified, in the hope of not being shot. 

What happened after Medway once you were qualified?

I took a job at Oxford Hospital, now known as the John Radcliffe, it had a good reputation and I wanted to gain experience.  I spent time on both surgical and medical wards before moving to Greenwich Hospital where I chose to specialise in intensive care nursing.  It was challenging, one learnt huge amounts, it was more advanced than general nursing.  It was an opportunity to really give the care you were trained there to do.  On general wards, nurses were spread so thinly, one would often come away feeling frustrated that you were not able to give your best.  The sense of camaraderie in the team was also really important.  I moved to the London Hospital in Whitechapel and joined a project which was directly funded by the Dept. of Health and the Daily Express newspaper to see if a medically staffed helicopter could save more lives.  Until that point accidents were attended by ambulance crews, not the paramedics we have today.  This was the HEMS project, Helicopter Emergency Medical Service and its success went on to be replicated around the country.  We did prove medically trained staff attending saved lives. Of course the consequences were, that we were then caring for patients who were more ill than ever seen before, in ICUs.

A post came up to teach ICU nursing at University College London.

This is the beginning of your role as teacher?

It was but I was far from enamoured with it during this experience.  I trained as a teacher and worked in eight different London hospital intensive care units.  This was at the time when nurse education was politically separated from the NHS and given to academic institutions to manage.  It did not sit comfortably in that arena which revolved around an academic year.  The academic leadership did not take into account the demands made on nurses during hospital practice.  Clinical teaching was reduced to just two days in six months and had to take place in any hospital setting, regardless of relevance and this formed part of the assessment.  It did not feel like a sound education and it was an ineffective teaching process.  I felt teaching was not my purpose and I wanted to return to ICU nursing.

It’s at this point you begin to work abroad, can you tell us a little about that?

I became self-employed by doing a flight course with the Royal College of Nursing so that I could work for insurance companies to provide medical evacuation services.  The jobs ranged from simply accompanying someone who felt poorly to providing intensive care support on a helicopter or jet.  In those days a Learjet would be chartered, it would be staffed by two nurses and two doctors.  They transform to provide very good ICU conditions.  As  soon as we landed, the patient would be loaded and we would turn around and immediately return to the UK.  I was enjoying the travel aspect and the idea of working abroad began to appeal.

The World Bank Hospital in Bangladesh advertised for a nurse specialist as Head of ICU to help open the first cardiac hospital in Dhaka.  The aim was to help tackle the high rate of heart disease.  A team was formed and we met up in London before travelling out to begin work.  Shortly into the project there was a political coup and the new leadership blocked the licensing of the hospital which meant we could not continue to recruit and open.  A compromise was reached which involved an army colonel, who was a cardiac surgeon, being appointed as Medical Director and so it became a medical school too.  Creating an intensive care unit and a cardiac catheter lab (where invasive treatments take place to deal with blockages in the heart) was hugely challenging.  The hospital was built without a knowledge of how to design for the control of infection.  Visiting state hospital intensive care units was a shocking experience, the re-use of syringes and no ability to control infection.  They were light years apart from what we were used to at home.  It proved very difficult to get the necessary kit into the country.  We resorted to sending staff home who would pack equipment into their own luggage to bring back with them.  Corruption beleaguered the project.

The Director of Nursing in Bangladesh advised I take a 2 year contract in a British Council health post.  I then worked in Saudia Arabia in an armed forces hospital on the border with Yemen in the mountains.  This meant living in a Western compound cut off from the outside culture.  Accommodation followed both the hierarchical structure and was also strictly divided along racial lines.  As Lead Nurse I had my own villa but staff nurses had to share living space in a ‘female house’.  The Westerners were given better living conditions than the Indian, Bangladeshi and Filipino staff.

In 1999 I returned to the UK as Lead Nurse for two ICUs in Peterborough.  This was probably the least happy part of my career.  Peterborough was poorly managed, there was a lack of continuity and also corruption in terms of abusing the system, which pervaded all the way down to ward level.  The move to Trust status in 2004 exposed the severity of its problems.  In 2003 I moved across the country and went ‘on the bank’ for Gloucester and Cheltenham hospitals providing NHS ICU coronary care.  ‘On the bank’ means I could choose when and where I worked. Then an opportunity came up to design a curriculum for critical care and I re-joined the world of teaching.  It was also a lifestyle choice.  Being a nurse and bringing up children do not go well together as childcare for shift work is hard to find.

Over a career of 38 years you must have seen so many changes?

Knowledge and understanding change.  1985 in Medway we looked after the first AIDS patient in Kent.  The fear that surrounded the case was tremendous. Our families did not want us to work on it. In Whitechapel at the London Hospital which is now part of Barts, in the early nineties we nursed people in the ICU as a result of violence during the race riots and due to  gang violence.  Terrible cases of child abuse were also brought to us.  Nowadays adult and child intensive care units are separate services.  Every system and part of intensive care nursing has changed from keeping eyes moisturised while patients are unconscious through to which choice of IV fluid to use for resuscitation.  The technology and our understanding of its impact, ventilation has become so much more sophisticated so that we are able to minimise potential for damage and maximise its advantages.  Drugs that were used routinely have been re-evaluated.  Intensive care is like an economy, change to one part causes ripples throughout.  Now we have more control over the ripples, whereas before it was like dealing with a tsunami.  

Of which part are you most proud?

All of it, each experience trumped the last and added to the overall, I suppose I feel most passionate about the HEMS, by being at the scene we saved lives that would not normally have been saved.  Surviving in it for 38 years, nursing takes a hard physical toll.  I used to lift patients on my own who weighed 70 kilos.  This physical cost has decreased as more technology has been introduced for lifting and turning patients.  Some conditions of working have been slow to change despite the technology.  For the longest time we had to wear laced up shoes, hard soles on hard concrete floors, which means lots of nurses suffer from joint problems.  Shift work is debilitating.  There is still a gender in-balance, 70% of nurses are female, yet the majority of leadership roles are male.  I always hope more of my students will make it through to that level and bring about greater changes in the profession.