To mark International Nurses Day this month (12 May), we’re asking neuroscience nurses from across the field to share their typical working days, what inspired them to become a nurse and the challenges that are present in the field.
In this interview, we speak to Ismalia de Sousa, a clinical nurse specialist (CNS) in stroke in a London NHS hospital (UK). Ismalia qualified in Portugal as a general nurse back in 2009 and moved to London in the same year, where she started working as a staff nurse in a newly opened hyper-acute stroke unit (HASU). Whilst working as a band 5 staff nurse, she occasionally worked as a bank nurse in surgical wards. In 2013, Ismalia progressed to a CNS role as a band 6 and then progressed to band 7 a year afterwards.
How did your education and training lead to your interest in becoming a CNS in the stroke field?
When I qualified as a registered nurse I always knew I wanted to work in a busy and fast-paced unit where I could also see a degree of improvement in the patient’s condition with the care delivered. One of my three job interviews in London in 2009 was for a surgical ward. Whilst a student nurse, I had really enjoyed my clinical placements in surgery. However, I quite liked the idea of being part of something that was new and was being developed. The location was also a contributing factor at 21 years of age when you want to ensure that you enjoy your social life in London.
“The fact that not every person with a stroke is the same, as not every stroke is the same, but also the improvement that treatments such as a thrombolysis could have on patient outcomes was fascinating.”
There was a big investment in stroke care in London at that time so I thought, why not? When I started working in the HASU I absolutely fell in love with neuroscience. The fact that not every person with a stroke is the same, as not every stroke is the same, but also the improvement that treatments such as a thrombolysis could have on patient outcomes was fascinating.
I started to have a keen interest in brain anatomy and in developing the ability to diagnose patients based on the symptoms they were presenting to hospital. I would then match those symptoms with the location in the brain and the arteries that were supplying those areas.
In 2011, 2 years after started working in the HASU, I enrolled in a stroke management and care course at a London university but interestingly, I had already learned the vast majority of topics that were taught in the course, so I used it to consolidate by practice. Through self-learning, good photographic memory and a lot of time spent asking, “Why? How? What?”, I learned a lot with the doctors, especially when it came to basic brain imaging, and senior nurses.
There was a senior CNS in particular that I always felt in awe of with her knowledge and skills and, in some way, was the person I looked up to from early on and decided that she was the person I would wish to become one day. She mentored me in a project we worked on together around foot care in stroke patients, which resulted in my first poster submission and acceptance to a European conference. She also supported me when I enrolled in a part-time MSc at King’s College London (UK) in 2013 and when I published my first article in the only UK neuroscience nursing journal (the British Journal of Neuroscience Nursing) in the same year, after being ‘called’ to publish by Sue Woodward, the editor-in-chief of the journal but also the neuroscience masters pathway leader at that time.
What are the best aspects of your job?
“The best part of my role is that every day is not the same! If I were to divide my role I could divide it into five dimensions: clinical; quality improvement, audit and research; education; and leadership.”
The best part of my role is that every day is not the same! If I were to divide my role I could divide it into five dimensions: clinical; quality improvement, audit and research; education; and leadership.
I may be assessing patients with a suspected transient ischemic attack or stroke in the morning in the Emergency Department or in clinic, whereas in the afternoon I might provide some education and training to nurses in the unit, whilst attending senior meetings in between to review the service. I may be spending some time sitting in front of a computer doing an audit of a specific part of the stroke pathway or I may be sitting down with a patient and family discussing secondary stroke prevention strategies and self-management after a stroke before they are discharged from the units; and I may have patients that have been discharged home and come back to the stroke support groups that myself and my colleague run monthly, and they may have questions. It may not seem too much but trust me that I wish the day had more than 24 hours sometimes!
Then there are the other aspects of my role as a CNS in stroke, not funded, which are my role in the Royal College of Nursing (London, UK) as a steering committee member in the Neuroscience Forum, and as a member of the Editorial Board of the British Journal of Neuroscience Nursing.
What would you say are the biggest challenges as a stroke nurse? Are there any particular hurdles that the field is facing?
There are challenges in being a nurse today, whether you are a stroke nurse or not. There is a workforce that constitutes the larger healthcare group in the NHS and that is under pressure. There’s Brexit and the impact it will have on the workforce and this week (26 April 2018), we have heard the news of the significant drop in EU nurses and midwives leaving the nursing register. There are university applications to study nursing that have fallen, student bursaries for nurses that have been cut and a significant amount of unfilled nursing posts in hospitals across the country.
In addition, for those that are in the profession, it’s becoming more and more difficult to train and develop them because of the lack of funding. Complementing all of this, there is the pay cut that nurses have had to endure in the last years. These are difficult times for nurses in general.
“For stroke nursing in particular, I think there are challenges in the emerging treatments that require developments in the services and nurses; but also stroke nursing has not been seen as an exciting area to work in.”
For stroke nursing in particular, I think there are challenges in the emerging treatments that require developments in the services and nurses; but also stroke nursing has not been seen as an exciting area to work in. There is also a good proportion of stroke patients that require rehabilitation either in hospital or at home, in which stroke nurses can have a massive contribution, but we need to be supported not only to advance further education but also by Clinical Commissioning Groups. I also think that, overall, we continue to have to ‘roar’ much louder than other colleagues that work in healthcare.
How could these challenges be overcome?
For the general nursing issues I could spend a long time answering the question about what the government and Theresa May should do! For stroke nursing in specific, I think it’s fundamental that we promote this field of practice, which means we have to be out there and let the public know what we do. (Social) Media is a great way of doing that nowadays. There is also a lot that can be done in relation to the education and development of stroke nurses, for example establishing a national career progression for stroke nurses so we don’t have the disparity of roles, bands and pay that we currently have across the country.
What have been the greatest advances you have witnessed during your time in the field?
From a hyper-acute stroke phase, thrombectomy (mechanical removal of a clot in the brain) is what everyone is talking about at the moment. Since thrombolysis, there hadn’t been a treatment that had demonstrated larger benefits in reduction of patient disability. The number needed to treat for one patient to have better outcomes or a reduction in disability post-stroke in thrombectomy when you look at thrombolysis side by side is impressive. While in 2015 we knew with trials such as MR CLEAN that we could treat patients within 6 hours of symptom onset, this year the DAWN and DEFUSE trials just showed that it can be beneficial in a selective group of patients within up to 24 hours of symptom onset. I think we are just scratching the surface here.
I think that the next big thing in a few years after thrombectomy will be stem cell therapy!
What advice would you give to future students considering a career as a stroke nurse?
“It’s fantastic to be able to make a real difference in the first hours someone is having a stroke and see the results of the treatment provided.”
Stroke nursing is an exciting area to work in for the developments that have arisen in the last few years but also for the ones that we know will eventually come in the next years. It’s fantastic to be able to make a real difference in the first hours someone is having a stroke and see the results of the treatment provided. Equally, for those patients that require rehabilitation it’s fascinating to be able to see how they improve day by day. Whether you want to be a nurse in a unit with more acutely ill patients or a nurse that can be at the center of patient rehabilitation, stroke nursing offers you all of that and much more.
The opinions expressed in this interview are those of the interviewee and do not necessarily reflect the views of Neuro Central or Future Science Group.