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My Story as a Clinical HIV Nurse Specialist

Specialist nurses have become an invaluable asset of today’s healthcare model. Perhaps you must have heard already that there’s a plethora of specialisms to choose from. But have you heard or even considered HIV Nursing?

Meet Lovejoy, a nurse who works as a HIV (Human Immunodeficiency Virus) Nurse Specialist in a NHS Trust. She shares her journey of being a nurse in the Philippines, in Spain and later here in the UK. She tells us about her typical day, the tasks involved in this role as well as the benefits and the challenges that she encountered along the way.

How did you end up as a Nurse in Spain?

I qualified as a Nurse in the Philippines in 1994. My husband’s family moved to Spain in the 80’s and when my husband obtained his degree he had to leave the Philippines to help his parents run their family business.

I eventually flew to Spain in 2001 to join my husband. Armed with my diploma, Transcript of Records, and my PRC licence, I aspired to work as a nurse in Spain. But I couldn’t... just yet! These documents needed to be translated in Spanish so I had to send it again to the Philippine embassy in Madrid to be authenticated. I submitted these documents to the Ministerio de Educacion de Enfermería and waited for the result.

It took me about two years to get my Spanish Nursing license. Whilst waiting for my Pin number I worked as auxillar adminsitrativo/ health care assistant at a British surgery and when I finally received my PIN number, my supportive medical director employed me as a surgery nurse.

What made you decide to move to the United Kingdom.

As I was growing up I loved reading books about England - the Buckingham palace, the famous bridge and I have always been fascinated by the houses’ brick structures. We also come and visit England during hot summers in Spain, when the temperature reaches around 30 degrees.

We live in Lanzarote, which is a volcanic island with a subtropical climate. Temperatures are warm and show little seasonal variation. Coming from a tropical climate, I preferred the UK weather. I also have friends here from my previous workplace in Manila who have settled very well in the UK. It was an easy transition because I have a Spanish nursing license so I applied at the UKCC (NMC) and was given a pin number.

Why did you choose this area of nursing?

When I moved here in England, I worked as a court writer at the Queen Elizabeth Crown Court in Birmingham. You might probably ask why, but to be honest, I am not entirely sure either. I went for an interview and had a day test inside the courtroom and was able to get the job.

Whilst on the job in the courtroom, I always see a clinic that just looked like a house across from the Law courts. One day I just went to that clinic to ask for information leaflets.

Unknowingly, I found out that this clinic offers my dream of working in Sexual Health /Genito Urinary medicine. I applied for an Admin post in that clinic but when I arrived to get my uniform, the matron advised me to go straight into the nursing department. As there was no qualified post yet at that time I settled for a HCA post and applied as an RN after a few months.

My passion in this area of nursing has taken me to where I am now. My skills, knowledge and experience in this department has given me the opportunity to get this post.

How does your typical workday look like?

Just like a day of any nurse, each day can be very different and HIV nursing is no exception.

My typical day starts with checking my emails. Then I meet with the nurses to discuss the list of patients we need to review on the day. Afterwards, I do my patient’s consultations, discuss their results, give them follow up appointments and prescribe their medications that they require after the consultation.

Once my morning consultations are finished, I attend the end-of-clinic debrief where I discuss the patients I reviewed with the consultants and the rest of the multidisciplinary team.

Another task of the day is to check blood results of patients that have been previously requested and then prioritising the most deranged that requires immediate action. I also check telephone messages that have been left for me from other specialities or queries from patients.

Being the lead nurse in the pregnant HIV cohort, I also liaise with other hospitals and maternity units across England or whichever hospital these women are booked to deliver their babies. I also chair the monthly pregnancy viral load multidisciplinary meeting where our HIV colleagues (pharmacist, health advisers, social workers, Consultants/Doctors and midwives and Obstetrics and Gynaecology from other maternity units) attend.

What does it mean to be a HIV specialist nurse?

Being a HIV specialist nurse, my role is to help manage HIV-positive patients from when they are first diagnosed and manage their care long-term. With newly diagnosed HIV patients, we must assess the patient for risk factors related to lifestyle, educate on the disease process, discuss treatment options to include medications and laboratory tests, and provide emotional reassurance and counselling services if necessary.

We will support our patients to understand more about the condition. This will also include how to treat HIV and related conditions or other sexually transmitted infections, what they need to do to stay healthy and also how to deal with symptoms with appropriate treatments. We can also advise our patients about other local services and sources of support and information. The service will not just offer support to the patient but for the family, partner, friends and relatives as well.

What qualities and skills does a HIV specialist nurse should possess and acquire in the process?

Having the passion in this field of nursing, being able to show your interest, having the empathy and being non-judgemental should be your main qualities. There is no other nursing like HIV nursing as we are looking after all the aspects of patient care, both their physical and mental well-being. Psychological and emotional support is essential at all stages of HIV infection. Our patients come from all walks of life. Some of them are vulnerable and require more support.

In terms of the technical skills necessary for this post, I have to go through a series of courses and training to be deemed competent in this job. I had to finish my health assessment course, development programs, family planning and contraception training and qualification to be a certified cervical smear taker.

It is also a must to pass the Pharmacy Tests and Training and be an independent medical prescriber. Finally, I was also required to be signed off and pass the Final Lead Consultants Test to show that I can run a consultation.

Do you think you are making a difference as a nurse in this field? How?

Absolutely! When I obtained my pin number as cervical smear taker in 2010, I set up a cervical smear clinic in my department and I have also run the contraception and family planning clinic within the HIV cohort until last year. It has made a good impact on our patients as they felt more secure and confident coming to our service.

The nurse led clinics have given the nursing workforce the opportunity to deliver an increasing proportion of HIV care. It has enabled our services to meet growing capacity demands and to improve access to new patient assessments and routine review of stable patients as well as adherence support, psychosocial care, sexual health screening and health promotion activities.

As the lead of the pregnant HIV cohort, I am very pleased that to date, all the babies that have been born from HIV mothers have come back HIV negative results. When I first started in this job there was no U= U statement, meaning ‘undetectable’ is untransmittable. By that statement alone you know that HIV treatment and HIV nursing have come a long way. It is also evident that patient experience has improved as we get continued good feedback.

I am happy that I am able to help my patients regain their confidence and self esteem. These people are making improvements in terms of their viral load, adherence and they are maintaining a healthy life.

What are the benefits of working as a HIV specialist nurse ?

The role has broadened my knowledge of all the medication as I become a nurse prescriber. I also acquired specialised skills as I qualified to be a cervical smear taker. The role has provided good learning opportunities, participation in research and expansion of skills which is not limited to HIV nursing only.

What are the challenges of a HIV specialist nurse?

Having a patient who has not come into terms of their diagnosis is one of the main challenges as this will be a main determinant on how this patient will become adherent to their antiretroviral therapy. We have to be assertive and be aware that we sign post these patients which means referring them to a discipline that we think can help them.

HIV infection also represents a great public health challenge in this century. The stigma around HIV is still present in the community and has resulted in confidentiality being a major concern for infected people. Family members may be unaware of the patients’ diagnosis or their sexuality and nurses have a duty to respect the patient's wishes regarding disclosure.

It is essential that all members of the caring team are vigilant so as to avoid accidental disclosure of HIV status. Many patients have anxieties regarding their family doctor's attitudes and the possibility of confidentiality being breached, particularly in small communities. The best solution lies in an open and frank discussion of the ways in which confidentiality will be safeguarded and to be consistent in providing that service within the limitations of each practice.

How would you convince other nurses to consider a role in the HIV specialist nurse?

HIV has been around for decades and it is not going just yet. This is a long term medical condition. I would encourage the young generation of nurses to also start looking at Sexual Health and HIV nursing and consider the diversity of the role.

It is a rewarding career as you can practice holistic care being to make a difference to some else's life.

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