My name is Mac de Guzman, a Band 8a Renal Matron in a remote satellite NHS outpatient unit. I want to share my career journey to hopefully inspire both the new generation of Filipino nurses and the more experienced colleagues who feel lost or stuck at their current roles to consider a role in renal nursing. My Nursing Journey I moved to the UK in 2010 to work for the NHS in England. Just like most Filipino nurses, I came here as a pre-qualified nurse (Band 4) and had to complete the Overseas Nursing Programme to be considered as a registered UK Nurse. My first 6 months were challenging. Adjusting to a new role and environment was tough and practicing to a limited scope was frustrating. The good thing was we received support from a number of people particularly from our Ates and Kuyas. They made us feel welcome in their little community. It really made the difference. In 2016, I ventured into private-patients-unit of another NHS hospital in London. From there, I transferred to work for a private healthcare provider before taking on my current role in 2018. I have gone around in full circle from the NHS, private sector and then back to the NHS. In all the units I have worked at, there are always other Filipino colleagues which made me feel welcome and empowered.
About Renal Nursing I feel renal nursing is equal parts challenging, satisfying and full of development opportunities. There are many dimensions to explore in this speciality. I took a number of secondment opportunities (signing a temporary contract to work elsewhere, with your manager’s permission, on the condition that your original post is ‘reserved’ for you upon completion) in various areas within renal nursing. I had ‘rotations’ in acute dialysis and renal ward nursing, renal vascular access coordination, renal research nursing and eventually, leadership roles within outpatients’ dialysis.
Career development opportunities are vast in this area. Within my current Trust, there are sub-specialist nurse roles at Band6, 7 or 8a in pre- and-post-transplant follow-up, plasma exchange, peritoneal dialysis and home therapies, renal anaemia, rapid assessment, day-case outpatients and conservative management. Of course, different band roles in the NHS reflect proportionate scope or practice and responsibilities therefore, it is always important to prepare as much as you can for a new role before you commence.
In both the UK and the Philippines, renal care in smaller units is integrated within medicine however, in tertiary or transplant units, these different subspecialty units exist. Each area is interesting and an exciting area of opportunity to explore. The nursing roles are varied, complex and rewarding.
My Role as a Matron
My post is an outlier from what conventional Matrons do. My work pattern is heavily clinical, involving haemodialysis, outpatients Chronic Kidney Disease (CKD) follow-up and Advanced Kidney Care or AKC - preparing patients for dialysis or going through the transplant work-up. Overall, I feel my role is 90% clinical and 10% admin which I think does not reflect the role a typical mid-level operational manager which may have the opposite clinical/admin ratio. I enjoy my role as there are elements of management, Advanced Nurse Practice ANP, and routine haemodialysis care in my day-to-day tasks.
Challenges in my role
I have extensive interaction with CKD patients at different stages and work closely with their GPs and renal consultants. I coordinate with them on changes in medications, requests for further assessments (from both sides) and more.
This function was new to me and admittedly, it is an area of practice I knew needed to work on even before. (I remember having to take IELTs twice because i scored below 7 in writing - pre- UK. Nursing memories! ) Hence, I made it a learning priority to continue to improve my writing and general communication skills. I sought feedback from our consultants on the quality of the letters/messages I sent to our primary care colleagues. One of the comments was the need to be more concise. I realised that the longer the notes are, the less likely colleagues will respond to it. It is helpful to know your strengths and weaknesses, and continue to develop.
Another challenging part of my role is its unpredictability with regards to Advanced Nursing Practice. This may be ironic and unusual for a typical renal outpatient service as chronic dialysis patients are usually stable and the clinical problems are quite common. For example, hypotension as a side-effect of haemodialysis can be as frequent as 1 out of 5 sessions. Another common problem is fluid and electrolyte imbalances for both AKC and established haemodialysis patients - around 15% are consistently fluid overloaded while 7% are constantly dehydrated after treatment. It is therefore important to have the skills to identify these problems promptly and have the skills to intervene which can make renal dialysis nursing both challenging and rewarding.
Although these are considered common clinical issues, it was extra challenging for our unit because we did not have permanent local renal physician cover for about 2 years until September 2021. Our day-to-day patient care became very nurse led. Our team rose up from the challenge and turned these challenges to opportunities. It allowed us clinically up-skill, and optimise technology to enable telemedicine – sharing care with UK based consultants.
It also justified a ANP service improvement initiative within the team in line with the NHS long-term plan. In the NHS, an ANP is usually a Band7 or Band8a role, depending on your scope of practice. An ANP in renal can mean being able to assess patients, diagnose through additional investigations and prescribe treatment with the right qualifications and NMC registration.
A nurse consultant, on the other hand, can be anywhere between a Band8a and a Band 8c role with additional higher-level influence on research, autonomous practice, and policymaking.
I think advanced nursing practice is a slightly worrying concept for some of us, nurses. The transition into a specialist post require processing complex clinical information and making critical decisions and accountability. And to add ember to the fire, not all nurses want to be seen as a ‘mini-doctor’.
However, it is important to know that there is training and support available should a nurse wish to head in this direction. A good start would be to look out for clinical specialist roles. Forward to the unknown.
In keeping with my aspiration to become a nurse consultant, I applied to be an executive member of the Association of Nephrology Nurses UK (ANN-UK). I wasn’t successful in the application, but I am pleased that they saw the merit of having a BAME/Filipino member on the senior team. I was offered a non-voting, 2-year executive board membership. I believe that this is a good opportunity to learn from very senior renal nurses in the UK and have some influence in the future of the specialist profession. My impression is that there are many Filipino nurses in renal nursing in the UK just like in other specialities but not enough representation at senior levels of the NHS. Although, the good work of the Filipino nurse communities in the UK on leadership, representation, inclusion, equality, and diversity is slowly getting more attention and recognition they deserve, I think there is more work to do on being represented and having a voice in the NHS. It is important to be involved, to network and access professional groups. After all, nursing practice is ever changing and evolving. I hope by sharing my experience as a renal nurse inspires others to consider not only this area of nursing but also encourage my fellow nurses to join Associations particularly ANNUK.
Advise to other Filipino UK Nurses
1. You can take charge of your own career. Progression is possible for those who seek it – you just need to recognise and grab these opportunities. These opportunities can be through courses or through secondment roles. Any opportunity that challenges you or puts you out of your comfort zone will offer you growth.
2. Yes, there are times where you would feel stuck or encounter barriers to progress, be creative! If you can’t go up, consider going sideways. Don’t give up. Keep trying. Continue learning and growing.
3. Be involved and network. Don’t be afraid to seek feedback and help. Ask support from your manager or find a mentor.
4. Persevere. There may be times when you feel that your life is just filled with hardships or challenges. I get you. Life as an OFW nurse can be tough and surely, this pandemic made it even tougher. Do not give up. Persevere. You can turn these challenges to opportunities.
5. Practice kindness at all times. Be kind to all especially to yourself.