Connecting, learning and reflecting through COVID-19 – Ashleigh Pullins

Nurses have always had a special part in the life of Ashleigh Pullins and when asked what she values most about being a nurse, she will say, “It’s quite simple; I like to make a difference to people’s health”.

In our Nightingale Blog this week, Ashleigh tells us about her role as a community nurse and the immense responsibility she feels, caring for people at home when they are at their most vulnerable.

She also highlights the invaluable learning and networking opportunities gained through the Global Leadership Development Programme.

Nurses have always had a special part in my life, particularly the district nurses in Larne who have cared for my family when needed throughout the years.  When I decided in sixth year at school that I was eager to study Nursing, my mum said, ‘I think we will get you some experience young lady’.  At the grand old age of 17, I started my first formal caring role, working as a summer relief care assistant at Muckamore Abbey Hospital in Antrim, and I just loved my time there.  I learnt to communicate effectively, recognise what was important to people, including an introduction to the music of Daniel O’Donnell, as it was a firm favourite of the residents.  After these short few months, I was still unsure of what area of nursing I would study and took the opportunity to explore mental health nursing and then emergency medicine.  Adult nursing at Queens University Belfast was my chosen route and on qualifying, jobs were few and far between.  Initially, I took up a temporary post in Cardiology and spent a short time in acute medicine in the Belfast Health and Social Care Trust before I joined the fabulous team in Antrim Area Hospital’s Emergency Department, where I began a fast paced learning journey of highs, lows, emergencies and triage.

In 2015 I gave birth to a beautiful baby boy who steered my career away from the flashing blue lights of the Emergency Department to community nursing.  I quickly recognised community nursing was an immense responsibility, providing the best care I could, in the most efficient manner in a person’s own home, to support people to remain in their own home if appropriate and reduce reliance on acute care.  I worked in a team of nurses who had an unbelievable wealth of tacit knowledge.

The community nursing team will very often become part of a person’s family, with regular visits and focused attention on the most sacred, highly emotive and private periods of one’s life.  Care planning with patients and their families in a person’s home environment requires critical and logical thinking, to ensure important stakeholders are involved to provide a positive experience, whether it is short term, long term or a final journey.  My role as a District Nursing Sister is a privilege; I am responsible for community nursing needs for service users who live across a wide geographical area, from Larne town and far along the beautiful coast road to Carnlough in County Antrim.

When I am asked what I value most about being a nurse, it’s quite simple; I like to make a difference to people’s health.  It is a privileged opportunity to spend time with patients when they are at their most vulnerable.  I know through my experience in the Emergency Department I have an accomplished clinical skill set which I have further developed working within a community setting. Along with my natural curiosity and problem solving skills, I practice every day to ensure the patients on my caseload, and their families, get the best experience possible.

Global Leadership Development Programme

The Global Leadership Development Programme opened up a new arena for me to gain a deeper understanding of how the healthcare system worked at a ground breaking time in politics in Northern Ireland.  In January 2020, the launch of the Year of the Nurse and Midwife, and the restart of the Northern Ireland Assembly – seemingly, a positive start to a new decade with mighty progress for Northern Ireland to now have a Health Minister – little did we know in January how important this leadership would be.

At Minister Robin Swann’s first engagement, I got to tell him about the importance of District Nursing.  Being a local man he understood the large geographical area where my team provide care and we discussed the skill, passion and dedication we give to our patients and his constituents.  In his speech, he gave recognition to the role district nursing plays in the provision of health care and I hope I inspired his thoughts.

Early in the Global Leadership Development Programme, I remember being surrounded by great leaders in nursing from Northern Ireland and beyond, and thinking ‘wow’.  It quickly dawned on me, it was time to stop being ‘star struck’ and take opportunities to network and learn.  I was most intrigued by how nurses could influence policy, not just at a local level, but on an international and global level.

Attending the Royal College of Surgeons in Ireland (RCSI) Conference in Dublin was a real highlight for me.  I learnt about the importance of having an elevator pitch, as a method to communicate.  I found that I was beginning to gain confidence when talking to senior nurse leaders from local to global scale.  I had the opportunity to discuss many aspects of nursing in Northern Ireland with Heather Finlay, Deputy Chief Nursing Officer, Department of Health, and I watched how she networked with an Advanced Nurse Practitioner from Orlando, USA.

At this event, the disruption that COVID-19 would cause could not have been anticipated.  Dr Catherine Hannaway, Global Health Consultant had organised an opportunity for me to shadow Elizabeth Iro, Chief Nursing Officer with the World Health Organisation, at the annual Triad (ICN-ICM-WHO) meeting in Geneva in May 2020.  Triad is a global forum of government chief nursing and midwifery officers, leaders and representatives of national nursing associations and midwifery associations, together with the International Council of Nurses (ICN), the International Confederation of Midwives (ICM), the World Health Organization (WHO) and key partners.

I introduced myself to Elizabeth Iro at the RCSI conference in Dublin, and we made plans for my visit.  We took a selfie and as a young nurse leader in Northern Ireland, I felt empowered by her charisma.  Unfortunately the global pandemic meant that instead of celebrating the Year of the Nurse and Midwife by attending Geneva and other events, I would have the opportunity at ‘home’ to show the significant contribution a District Nursing Sister  can make.

Whilst I developed new skills leading rapid service changes to ensure that patients received safe care in their own homes, the Global Leadership Development Programme gave me confidence to build relationships and identify at an early stage the actions required to keep those I care for as safe as possible.  Working with General Practitioners, care home managers and palliative care teams, I worked across the community to support care homes to remain free from COVID-19 in the first surge, and to ensure that my patients received timely care on the correct pathway, first time.

Connecting with peers and senior nurse leaders

The whole community was nervous, watching devastating scenes from the hospitals in Italy.  Each news bulletin increased the anxiety of the community and the healthcare professionals who I work with.  The introduction of Personal Protective Equipment (PPE) in a community setting was initially challenging, partly because the messages were constantly changing, and the challenges of donning PPE in homes helped make my team feel overwhelmed at times.  We initiated daily team briefs, creating an opportunity for effective and supportive communication exchange.  At a vulnerable time back in April, I had a reflective conversation with my mentor, a senior professional lead from the Northern Ireland Practice Education Council (NIPEC) and from this conversation I became involved in a Department of Health communication video with the Chief Nursing Officer. This experience was a valued opportunity to observe the processes used to ensure clear messages were delivered to health care professionals, patients and their families on the use of personal protective equipment.

The global programme has taught me about the importance of being connected to peers, and senior nurse leaders, particularly in challenging and rapidly changing times.  We have been working and connecting in new ways, with a huge increase in the use of virtual platforms, so instead of going to Geneva, I celebrated the International Day of the Nurse by organising a socially distanced zoom for the district nursing teams in East Antrim.   We joined together with the senior professional nurses from our community division, and the Northern Trust Executive Director of Nursing, to celebrate the unique contribution of nurses.  Our Nursing Director spoke about the importance of the language nurses use to describe the unique contribution they make in delivery of care.

In my role as District Nursing Sister, I am the Palliative Care Key Worker.  This is the most privileged and precious aspect of a district nurse’s role, ensuring that the end of life needs of service users and their family are fully met.

During the pandemic we found that the number of COVID-19 positive patients was not as high as expected, but the impact of minimising the risk of spread, fear and other service reductions dramatically increased our referral rate.  Increased demand from newly established ways of working by the healthcare system meant that district nurses had the opportunity to respond to client groups not usually in receipt of their services.

I have learnt a great deal since the Global Leadership Development Programme began.  I imagined a year of learning from global nurse leaders through travel, and in person meetings. However as the full reality of COVID-19 became apparent, I learnt even more about myself, my team, rapid transformation, innovation and resilience.  Most importantly I grew as a compassionate leader protecting the vulnerable, supporting the sick and promoting positive mental health at a time when we all have concerns for our loved ones.

Ashleigh Pullins, District Nursing Sister, Larne Integrated Care Team and participant in the Global Leadership Development Programme

Ashleigh is one of  five Northern Trust nurses participating in the Northern Ireland Global Leadership Development Programme which is part of the Nightingale Challenge, launched by Nursing Now, to enable the next generation of nurses and midwives to play a bigger role in multi-disciplinary teams, working together to improve health and influence policy.  The campaign encourages healthcare employers to support at least 20 nurses and midwives to develop their leadership skills during the 2020 International Year of the Nurse and Midwife.  Nursing Now is a programme of the Burdett Trust for Nursing to improve health globally in collaboration with the International Council of Nursing and the World Health Organisation.  

@NHSCTrust #NorthernNightingales
@NursingNow2020 #NursingNowNI #NightingaleChallenge
#InternationalYearoftheNurseandMidwife

Other Northern Trust Nightingale Blogs

Gemma McClean, Hospital Diversion Nursing Sister
Judith Shevlin, Community Mental Health Nurse
Denise O’Donnell, Acting Ward Manager, Covid-19 assessment ward
Eleni McCrea, Community Midwife, Whiteabbey Hospital
Stacey Barclay, Midwife, C2, Antrim Area Hospital
Vanessa Best, Community Mental Health Nurse, Oakview House
Kirsty Wallace, Staff Nurse, Antrim Area Hospital
Christine Beare, Staff Nurse, Neonatal, Antrim Area Hospital
Laura Smith, Midwife, Causeway Hospital, Coleraine
Mandy Young, Deputy Sister, Laurel House Chemotherapy Unit, Antrim
Nerell Browne, Practice Development Nurse, REaCH Team, Northern Trust
Chantelle Crowe, Deputy Ward Manager, Causeway Hospital
Michelle Angelone, Community Learning Disability Nurse
Catherine Middleton, Rehabilitation in Mental Health, Holywell Hospital
Lauren Campbell-Withers, Staff Nurse, Whiteabbey Hospital
Lindsay McNinch, A4, Respiratory Medicine, Antrim Area Hospital
Rebecca Leckie, Staff Nurse, Ward A3 Respiratory, Antrim Area Hospital
Bronagh Smiley, District Nursing Sister, Ballymena

26th October 2020