May 7, 2020, by Richard Bates
Interview with Nicki Credland, Chair of the British Association of Critical Care Nurses
In the latest in our series of interviews with nursing leaders, Dr Jonathan Memel from the project team spoke to Nicki Credland, Chair of the British Association of Critical Care Nurses, which represents intensive care nurses. Nicki discusses about her own career as well as the particular pressures placed on intensive care units during the COVID-19 pandemic.
[Photo: University of Hull]
JM: Could you tell us about how you first got into nursing and developed your interest in working in intensive care?
NC: I stared my nursing career in 1999 at the University of Hull. I had a four year old and a one year old at the time so things were busy!! I absolutely loved it. Indeed I found that I loved every area of nursing, which made deciding which area to work in for my first job tricky. In the end I started on a gastroenterology ward, before moving to intensive care six months later.
Moving to intensive care was the best decision of my career. There was so much to learn. I spent the first year constantly reading and learning before I started to feel more confident. Being an intensive care nurse means that you gain an in-depth knowledge about your patient’s condition and management. You develop a relationship with their family and it is a true privilege to be a part of that. Watching extremely sick patients recover and return to the ward is brilliant. But even when patients do sadly die, there is a great deal of satisfaction to be gained when you know you have supported them and their family in the best way possible.
JM: What direction did your career take after gaining that experience on the wards?
NC: I completed a BSc (hons) Critical Care and gained the old E grade which I was so proud of. This spurred me on and I decided to apply for a Critical Care Outreach position. This is one of the best jobs in nursing! I did my PALS (Paediatric Advanced Life Support) and PILS (Paediatric Immediate Life Support) training and responded to cardiac arrest and trauma calls. I reviewed patients who were deteriorating on the ward and supported nursing and medical staff to instigate treatment and management plans. I led the implementation of the National Early Warning Scores programme—a tool for detecting and responding to clinical deterioration in adult patients—across my Trust, which I really enjoyed.
That experience led me to think about furthering my nursing education. In 2012 I gained a MMedSci in Advanced Nursing Practice. My dissertation explored the role of intensive care follow-up clinics, which are designed to help patients to make sense of their critical care experiences. After completing this study I was then able to set up these clinics in my Trust.
I have always loved teaching, and so I made the decision to accept a lecturer-practitioner job at the University of Hull. I still work here as a Head of Department, and I continue to teach and research for the BSc programmes in Critical Care and Paramedic Science, and the MSc in Advanced Practice.
JM: What about the BACCN: can you tell us about that organisation?
NC: Throughout my time in critical care I have been a member of the British Association of Critical Care Nurses (BACCN). At one point a colleague suggested I join a regional committee, which I did, and this eventually led to me becoming the National Chair in 2017. I am immensely proud of being able to represent critical care nurses nationally and internationally. I work with amazing people who are all as passionate and excited by developing critical care nursing as I am. We work hard but we have lots of fun too and our annual conference is the pinnacle of the year. Work hard play hard is definitely the motto!
JM: Do Florence Nightingale’s ideas inform you current interests at all?
NC: Yes, I am interested in Nightingale’s approach as part of my current PhD project, which examines how patients may deteriorate in hospitals and what can be done to improve this—or in other words, why we fail to recognise and rescue deteriorating patients. Nightingale thought of hospital design and operation as an extension of the Hippocratic oath—in her words, “The very first requirement in a hospital is that it should do the sick no harm”. It is a subject I have thought a lot about over the years, and one I feel that we still need to explore further.
JM: With the coronavirus pandemic: what pressures have critical care nurses been facing at this time of crisis?
NC: The nurses are facing a whole range of short-term pressure. For one, there’s the sheer volume of patients that the nurses have been having to deal with, which is far beyond the usual level. They are having to face new challenges caring for those affected by a condition, which, for the moment, has no cure. And they are adapting to entirely new working conditions and locations, wearing personal protective equipment to protect themselves from the disease.
From a longer-term point of view, the pressure will be felt in terms of the psychological impact of COVID-19. Looking after huge volumes of patients who sadly die, or supporting patients and families through critical illness are both psychologically challenging at the best of times, let alone in situations like this. So I think we will definitely see a psychological impact on NHS staff over the coming weeks, months, and beyond.
JM: How can the general public help?
NC: The public are vital to managing the outbreak by following the advice of staying at home. When taken together, the measures will reduce the amount of people requiring hospital treatment, which will in turn reduce the number of admissions to intensive care directly. All of this reduces the impact on NHS staff and allows us to focus our attention on looking after patients as best as we possibly can.
JM: The NHS have named their emergency hospitals in Nightingale’s honour. Have you any thoughts on what Nightingale means at this time, in light of the outbreak?
Nightingale would I think be proud of the distance that the profession has come. We are no longer considered secondary to the doctors, doing what they tell us to do, but recognized for our important roles in the hospital. We are a separate profession in our own right, with our own values and our own levels of accountability. We are prepared to meet this crisis, so I hope she would be proud of that.
JM: What are your top three tips for those wanting a career in critical care?
NC: Firstly, work hard and study hard. The more knowledge you have the better care you can deliver your patients. Secondly, be passionate. Once you stop looking forward to going to work it is time to move on to pastures new. Finally, never forget the position of privilege you are in at the absolute worst time of someone’s life. You will make a difference to patients and their families and often in ways you will not even realise.