Interview with a Queen’s Nurse: Beverley Bostock (RGN, MSc, MA, QN).
Bev Bostock, works as a Nurse Practitioner in Gloucestershire. She is also an education facilitator for Devon Training Hub, Asthma lead for the Association of Respiratory Nurse Specialists, sits on the Primary Care Respiratory Society Policy Forum, and The Primary Care Cardiovascular Society Forum. She also acts as an expert witness for a clinical negligence company. If all that wasn’t enough she is the editor in chief of Practice Nurse Journal and a Queens Nurse since 2015.
General Practice
‘It’s really interesting how I got into general practice, because I went out with a district nurse when I was training, and we stopped off at a GP practice to pick up some dressings, and I saw somebody’s name up on a screen, and it said practice nurse. And I said to the district nurse, “So what’s a practice nurse? What do they do?” And she said, “Oh, they have their own list and they see their own patients, and they work a bit like the GP does, but with their own patients and their own areas of specialism.” And I just thought, “Wow!” I always enjoyed the idea of working autonomously. And even as a student nurse, I just thought, “Ooh, I think this works for me.” I found the hierarchy in hospitals sometimes quite difficult to deal with, so it really, really appealed to me. And I never lost the enthusiasm for general practice. So I qualified and did a year on the wards, and then came out into general practice, and have been there ever since. I love it, absolutely love it. The breadth of the stuff that you can do, the cradle to grave stuff that you can do. The fact that you maintain those relationships over years and years and years is really important to me. I think the fact that the role has changed so much… I can remember patients saying to me a few years ago, “What’s the difference between what you do and what the doctors do?” And I can remember as clear as anything saying to them, “The main thing that we don’t do is we don’t diagnose. So when somebody’s got a problem and we know what the diagnosis is, then we can come along and manage it. But we don’t diagnose.” And now, of course, that’s an absolute joke to think that we wouldn’t diagnose. Because even patients with established conditions can develop new problems, new symptoms, a new diagnosis, a comorbidity, so we’re always on the alert for diagnosing new presentations of things. So it’s really changed in that respect, I think. That whole, again, being able to manage somebody from first presentation with symptoms, to making the diagnosis, managing, moving up the treatment ladder, supporting them with lifestyle change, all of that stuff, continuing year after year after year, is just amazing, I love it. But certainly when it comes to long term conditions and also acute care, I really don’t like not knowing, so I’ll always go out and find out. I’m very curious. Somebody said to me once, “I think the biggest thing for you is your sense of curiosity.” And I love that, and I thought, “Yeah, it’s true.” I’m very curious about things.
Doing it My Way
I do a day, day and a half in general practice.. I do three days for Devon Training Hub. Then I’ve got all the webinars that I do. So I do lots of freelance training that fits in around the edges, and then committee meetings for the different organizations that I’m working with. So it all has to be pieced together very, very carefully. And my diary feels sometimes a bit like a jigsaw, that I’m trying to fit things in here and there. I’m self-employed, which is an interesting perspective.So the practice that I work at is absolutely lovely, they are just awesome. I’ve worked for some really fantastic practices, but I think this is a standout practice, quite honestly, because they are very flexible and they do recognize that I’m involved in other things, and they see that as a very positive thing, they think that there’s an advantage for them that I’m involved in all of these things. But when they advertised, they advertised for a nurse, literally they had an advert in a journal and it was for a nurse to work in the practice. And I phoned them up and said, “What sort of nurse are you looking for?” And they were like, “Well, you know, a nurse to work in the practice.” And I was like, “Okay. Let me just talk you through the different elements that you might want to consider.” So we ended up with me going in and working specifically on long term conditions, and then also doing some acute stuff. And they employed a practice nurse as well to do all the stuff that I’d got out of date with that was really important. So we work together really well, starting at the same time, it was really good.When I went there, I said, “Right, the easiest thing for me is to be self-employed, and that means I can be flexible like I need to be, and do things in the way that I know works, because I’ve been doing it for a long time. This is how long my appointment times will be. This is what this will be, and this is what this will be.” It was basically, “Hopefully that works for you? If not, then let’s see if we can negotiate.” But generally, they were very, very positive about it. And there’s real advantages to them for me being self-employed. So everyone was happy, basically. That gives me that autonomy again. So you can see this theme coming through.Everything I do is self employed apart from the Training Hub work.What I found was, it’s a strange thing, but I always feel like I need an anchor, so I need something where I’m not just me doing what I want to do and what I like doing, but actually I’m anchored to an organization where I have a clear role within that organization. That’s always been important to me. I’m not sure why, psychologically, I’m not sure why. But I feel like it legitimizes me. Working with the Training Hub has been fantastic in that respect, because it’s actually given me a whole new perspective on what happens with nurse and allied health professional training. Where does the money come from? How does NHS England and Improvement impact on the financial side, the quality issues and all of that. It’s been really, really interesting to see that from a different perspective from other roles that I’ve had before. I’ve worked in an academic role with the Open University and the University of Hertfordshire, so I could see where the universities funding came from. But now I’m actually looking as somebody who’s getting this funding in from NHS England. So the CPD funding that we know should be happening now, and has been very slow and very complicated to make happen, I can see behind the scenes as to why it’s not as straightforward as it should be, and where the little bumps are in the journey. But my main objective is to make sure that nurses know that that money is there and that they should be using it to support their ongoing development, really important to use that money well.
Creating Opportunities
I think there’s an element of part offering and part being guided. So certainly with the lead for the Association of Respiratory Nurse Specialists, I was always in awe of these guys because they are very specialised.
So when the asthma lead post came up, I saw it and just thought, “This is beyond what I do in my primary care role.” And then was actually approached by somebody within the organization to say, “Did you know that we’re advertising for this?” And I was like, “Yeah, yeah. Great. I look forward to seeing who gets it.” And they said, “Have you thought of possibly applying?” And I was a bit like, “Well, no, gosh, no.” And they were like, “No, you really should.” So I did. There were a few applicants, and we had to be interviewed, and it was scary. But I got it, and I’m just delighted to be part of it. I learn so much from my colleagues. And it’s not just a case of what you put out there, but it’s actually what you learn from your colleagues as well, and that real sense of camaraderie that happens. Similar thing with Primary Care Respiratory Society, that I actually spoke to their chief exec and the lead, so Carol Stonham, who’s the nurse lead, and I spoke to her and said, “I’d really like to help with the PCRS if there’s any way that I can, if I can offer any support. I don’t know what you’re looking for.” She said, “Well, we’re advertising these posts at the moment. Why don’t you apply?” So I did apply. And again, I was interviewed and got that post as well. It’s almost like, you put yourself out there and say, “I’m interested in helping”, and then you suddenly get guided towards where you might be the best help. Same thing happened with the Primary Care Cardiovascular Society as well. So yeah, it’s just really offering, I think, that’s key.
Proudest achievements
I think what set it off, was a bit of a joke originally, because I’d gone to work in the Cotswolds, and I was aware of the Queen’s Nursing Institute, and I was thinking, “Do you know what? I’m sure my Cotswolds patients would absolutely love me to be a Queen’s nurse. They probably don’t know what it is, and they probably think I am the Queen’s nurse, but they’d like it anyway.” So I thought, “I’ll look into it and see what’s involved.” And it is quite an involved process. You have to say why you give that bit extra, why you go above and beyond. I think, as nurses, we really struggle to say that, because we just think what we do is what anybody would do. In fact, it’s worth people knowing that when I applied the first time, they came back to me and said, “Right, you need to work on this. You’ve done a list of what you do. But we need you to say why what you do actually impacts on patient care so much.” So they said, “It’s fine. But just try again, rewrite it.”
I think that literally comes down to that thing of not wanting to big yourself up. It’s embarrassing, it’s not what we do in Britain. So I had to rework it. And also, you had to get something from your manager, so one of my GPs did it. And you had to get some patients to say some nice things about you. Of course, now, with revalidation, we are more used to getting that feedback. But again, at the time, I was going to patients, and maybe someone who’d sent me a thank you card, saying, “You don’t think you could just maybe write a little bit more? This is why, and this is what I’m doing.” And they were all delighted to do it. When I heard that I’d been awarded the Queen’s Nurse membership, I was absolutely over the moon. And I loved being part of the organization. The work they do is absolutely sensational, it really, really is. I am really proud of my MA in medical ethics and law, because it was not a topic that I’d studied before, but I was really interested in it. I am absolutely so passionate about patient focused care, on ethical healthcare, and I do believe that very often we are deliberately diverted from being ethical in our care, even though we know what’s right and we know what we want to do, we are pushed away from it, usually because of a cost issue. It’s usually cost issue rather than looking at the long term cost-effectiveness of what we’re doing. And it really bothered me.
I think that was the best course I have ever, ever done. It was awesome. It was a two year Master’s course. It was full-on even though it was part-time. There were loads of different people on there, so there were doctors, there were nurses, there were vets, there were all sorts of people on there, lawyers, obviously, as well.
And I did it at Keele University, and I’m very passionate about my time at Keele. If anybody is ever thinking of doing something, I could not recommend that highly enough. Just such a superb broad education on the ethics and legal side of healthcare, which I bring into everything I do now, everything. It really informs my clinical consultations, but it informs my teaching as well. And of course, it’s allowed me to get the role as an expert witness for the clinical negligence company, which again, really impacts on my practice when I see the cases I have to deal with. But the fact is that I love it. I love what I do. I’m really passionate about it all. I get paid for doing stuff that I get out of bed every morning and think, ‘Yes! What are we doing today?’ Every day is different, every day has different content, different focus: clinical, teaching, writing. But every day is one I look forward to.” So I think I’m going to be one of those people who’s still working when I’m my mom’s age, 84, and loving it.
Editor in Chief
What happened with that was, I actually met up with a lovely lady called Jan Procter King, some of you may know, she does a lot of motivational interviewing work. She was editing the British Journal of Primary Care Nursing at the time, and she asked me if I’d be interested in writing at all. And I said I really enjoyed writing, what did she want? She wanted me to write something on exception reporting in QOF. So I did it for the BJPCN, which I’m actually also editor in chief of. And then somebody else saw the article and came to me and said, “We like that article. Would you like to write something on this?” And then I got involved in editorial boards. So after I’d written for a while, I was invited to be on an editorial board, first of Practice Nursing, and then I moved to Practice Nurse. And then when the editor in chief of Practice Nurse stepped down just over a year ago, they said to me, “Look, with all the work that you’ve done, the suggestions that you make, it seems an obvious thing for you to move to the editor in chief post now.” So that’s what I did. I love the writing, but I love also the horizon scanning, “Okay, what do we need to know about? What needs to go in the journal?” And working with the editor, and working with the various people that have to come together to make an article happen, it’s been, again, a really interesting process to see how that happens.
But I do love writing, I really enjoy writing, I’ve always enjoyed that. So I know for some people, writing an article or even an assignment, my academic work, I used to see people who were so good clinically, you knew they knew their stuff, but they found it really difficult to get that down on paper, and I understand that that’s really not great for people who are like that. But for me, I’ve always enjoyed writing. So it was an obvious next step really.
I think it’s the way that you write that can really engage somebody. You can be talking about the Bristol Stool Chart, but if you actually put it in a way that engages people, then they will read it. I think the biggest issue that I see with the articles that we get, and also, going back again to when I was looking at assignments and marking assignments, was people just not being able to structure things very well. So with an article, it’s very much like an assignment, you want a broad introduction, you want the body of your work, you want a conclusion. You want the body of your work to separate out into clear areas like little mini chapters that follow each other and make sense. And you need to stop and think about how to structure that effectively, no matter what your topic is.
I would say, in order to write well, you need to read a lot. Because if you read articles and journals, then you see how they’re put together, and then you can mimic that when you actually write it yourself. I know that our editor would say, the biggest issue that she has is with people who just aren’t writing well. So read, read, read, and then replicate what you’ve read, and that’s honestly the best way. That’s what will get people going, “Oh, hang on a second, we’ve got someone where who can write.” Once you’ve got someone who can write, you can ask them to write on a whole range of topics. It’s actually the ability to write, to engage people, that is most important.
Ultimate Goal
I remember once being asked by somebody, “What’s your five year plan?” And me thinking, “Five year plan? Haven’t even got a six week plan. It’s just, see what comes up and decide whether to do it or not.” So I haven’t really had a big master plan. I think, I did really want to do the medicolegal stuff. So doing the MA was really important for me. And then being able to use that in my expert witness role has been key for me. So I’ve been able to go tick, tick.
Regrets
I think, if I had any regret in life, it would be maybe not being a lawyer. I would say that law is something that has always appealed. So I’m now able to do that. When I left school, originally, I was never one of these people who always wanted to be a nurse. It was a bit of a last minute decision. And my school was a bit horrified when I said that I’d decided I wanted to do nursing. They were very old fashioned. But I was going off to do French and drama at University. And I feel like I get the old drama bit out with the teaching that I do, the webinars, and teaching study days, and all that sort of thing, so I’ve fulfilled the dramatic side of my personality. I’ve been able to do the legal side of it with the MA and the other role with the expert witness stuff. And the clinical stuff is really important.
My overall aim with anything I do is to make it simple and easy for people to understand. So whether I’m trying to explain something to a patient or whether I’m trying to explain something to somebody who’s trying to learn about a particular clinical area, I try and simplify it. I get enormous joy from seeing people’s little light bulb go off, and suddenly go, “Is that it? I get it, I get it.” So that’s always been my aim.
So I think, from now on, it is just about keeping doing what I’m doing for as long as I’m able to, really. Because I love it, and I just cannot imagine a life where I’m not doing all of these things for many years to come. So fingers crossed.
EntrepreNurses
I have a company called Godiva Primary Care Training, which is literally just the name of the organization so that I can keep tax separate from the job that I’m actually employed in, which is the Devon Training Hub. So I don’t have any trainers as part of it, and I don’t have anything other than a name for a limited company.
I have many friends and colleagues who have businesses, whether it’s in training… I mean, I’ve seen a brilliant example of this recently with a colleague of mine, Julie Catchpole, who’s set up an organization called Rotherham Respiratory, which develops training for whole groups of people, but has now moved out from respiratory into other areas. She’s done that because she was a commissioner but she suddenly realized that she couldn’t get the courses that she wanted. She wanted them to be pragmatic, to be patient focused, to be relevant to people working in practice, to be not focused on academic achievement, but on clinical nous, basically. And she’s done that. And I think, all power to her for setting up a business like that, that actually responds to need.
I think that’s what all businesses do, basically. So I think, absolutely wonderful. If people look and say, “There is a gap in what would help me to do a better job in my nursing career, and I’m going to fill that gap with this business,” great, carry on, do it. I think it’s important to do that. We need our entrepreneurs, do we not?
Pearls of Wisdom for Nurses
It’s a tough time at the moment, and I think people are probably struggling. So I would say, it’s not always this hard. But actually, it’s about what you can achieve, because when things are tough, that’s when you often achieve the most.
I saw something the other day on social media where somebody was saying how they felt devalued because they weren’t particularly mentioned during, I think it was some coronavirus training that was going on, and the practice nurses weren’t mentioned once, and they felt devalued. I feel like I want to say to that person, in fact, I did, on that very social media post, “Don’t forget that the patients that you’re immunising will value you hugely. And that’s what it’s about. Don’t lock up yourself self-worth into something where you focus on a negative element of what’s happened. Think about the very positive impact you have on people’s lives day after day after day. I think general practice nursing does that so incredibly across so many areas. It’s an absolute privilege to work in this role. And don’t lose sight of that. Don’t get so bogged down by the tough bits that you forget the glorious bits of being a general practice nurse.”