WICM: Inspiring Careers in Critical Care – Alice Coulson

Introduction from the interviewer:

My time working in Intensive Care as an ACCS-EM trainee was one of the most influential periods of my career so far. I worked with a truly incredible team.  During the lockdown period, I was able to reflect on my time in Intensive Care and my role as a woman in medicine. As part of this, I approached eight women in the Intensive Care team to share their inspiration and their perspective. It was a privilege to hear their stories. Thank you to WICM for this platform and to the women you will read about, for their time and their words.

Dr Jasmine Medhora

What was your path to nursing in Aberdeen?

I did my four year Nursing degree in London and then went on to work in Intensive Care units and Emergency Departments in different London hospitals for four years. Following this, I moved to Australia and worked in St Vincent’s Hospital in Sydney at the lung and heart transplant unit. This led me to take on a job as organ donation coordinator in New South Wales covering 26 Intensive Care units. I worked alongside different Intensive Care teams including rural teams made up of lots of locum healthcare workers. When I moved back to the UK, I worked in a non-clinical role with the Scottish Trauma Audit Group. I knew I wanted to get back to clinical work though, and this is what led me to becoming an ACCP trainee.

What made you choose to become an ACCP? As opposed to an ANP in another specialty?

When I returned to the UK, I knew I the only way to develop my knowledge in the way I desired was to become an ACCP, but I thought it was too late for me to do the training especially as I now had kids. Instead I worked as a bank nurse and then self-funded my ALS course and realised I still had a good clinical knowledge base. An advert for the ACCP role then came up and the training was full time. Luckily my youngest child was at school at this point which meant I was able to apply for the job.

As a student nurse, I had been involved in an organ donation case in the Emergency Department and this made me want to become an organ donation coordinator. The path to this role was through Intensive Care. When I got to Intensive Care, I realised I liked ICM and I liked being a generalist and I got to use a blend of my clinical skills and all the monitoring to treat patients, which I found really interesting. When I eventually came to apply for an ACCP role, I knew it would be the right fit for me because of my prior Intensive Care experience.

How has your transition from nursing to ACCP affected your family life?

I have always worked, even throughout having kids. However, the transition from nursing to ACCP has pretty much turned life upside down. This is mainly because of the requirement to work full time to complete the ACCP training, whereas previously I have been part time. We live rurally and so there are not many options for childcare. I have gone from being the primary care giver to our children to now being more transient in their lives. My experience has been that by taking a career progressive role, something else had to give. That something was my role as a mum. This was a real change for all of us – my husband now does the childcare runs on days we are both working and has to fit work in between drop off and pick up. He has experienced negative comments in his workplace; mostly ‘banter’ about not being in the office as early as everyone else and comments about his commitment to working hard. And I do miss being the primary care giver, but my work pattern means I get days off during the week which are important to me for spending time with my kids.

What have been the challenges for you when integrating as a trainee ACCP into the ICM team?

Integrating into the ICM team has been both great and really challenging. I find the medical team very supportive and inclusive. I think that comes from regularly changing the people that you work with and having to form new working relationships every six months. On the other hand, I have often felt intimidated by the extensive knowledge that medics have from their training, that we do not get in nursing.

At times it has felt like the chasm between my life and that of my work colleagues has made it difficult to really be myself. I have only worked with one other mother during my two years of training and it was so refreshing to have someone understand that some days you feel like you are failing at everything just because of having to divide yourself up between so many people each day.

How can we encourage more women into the ACCP role?

Even within nursing, which is a female predominant workforce, men are more likely to hold a senior position than women are. I know several highly skilled women in various professions who have not been able to get back to the workplace since having children – the lack of flexibility in work hours for both mums and dads, and deficiencies in childcare are key factors. By not including flexible shift hours and options for less than full time roles/ job shares, we exclude many well qualified people from the healthcare workforce. Several studies have proven that part time or flexible workers are more efficient and productive. Embracing flexibility will encourage more women into senior roles.

What differences have you observed between the UK and Australian health care systems? What can we learn?

I always held the UK healthcare system on a pedestal, whilst living overseas. Having been back in the UK for four years now, my views on healthcare, local boards and government policy have changed significantly. There is so much repetition in the NHS and we are entrenched in systems and processes that are holding us back. My Australian experience taught me that if we are all doing the same thing, why do we all come up with our own ways of doing it? Standardising practices, systems and processes across Scotland would ensure that we are all doing the right things, in the best possible way. This leads to better and more consistent patient care.

We also seem to have an alarming number of non-clinical nursing positions being paid at higher bands such as band 7 or 8. Whilst a number of these colleagues do a fantastic job, I have seen plenty of roles that do not seem of value. We should place more value on clinical skills rather management skills.

What reflections from the pandemic situation will you take forward with you?

As the pandemic approached, I saw individuals working incredibly hard to get critical care COVID ready, and the lack of systems and channels for communication were exposed. What I would like to see in the future is more cohesive multi-professional working groups who spread the workload and capitalise on the widespread experience and expertise available.