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Once a nurse, always a nurse

As the latest return to practice campaign begins, Kathy Oxtoby looks at what it means to go back to nursing

Bridget Thobela always knew she would go back to nursing. ‘They say you’re a ‘nurse at heart’, and that’s the only way I can explain wanting to make a difference to someone’s life, to care for people, and make them feel a little brighter and a little better,’ she says.

Ms Thobela did her nurse training in her native South Africa before moving to the UK in 2001 to be with her husband. While she loved her job as a practice nurse, she found it difficult to balance work and childcare commitments after her second daughter was born. She left clinical practice 18 years ago – ‘but I always thought I’d come back to nursing’, she says.

When her children were older, in 2018, she embarked on a six month Return to Practice programme run by Kingston University London and St George’s University of London. Having successfully completed her course she accepted a post as practice nurse at the Old Court House Surgery in Sutton, Surrey where she did her course placement.

‘Going back to being a practice nurse was the best feeling – it gave me a glow and I felt rejuvenated. I thought: ‘This is where I belong ,this is who I am, this is what I love,’’ she says.

Having had such a positive experience on her return to practice course she didn’t hesitate when asked to take part in Health Education England’s (HEE) return to practice campaign. ‘I thought it was a fantastic opportunity for people to see someone like myself, who knew it was right to go back to nursing,’ she says.

‘Once a nurse, always a nurse’ campaign

Ms Thobela shares her experiences in HEE’s latest campaign to encourage former nurses and midwives to return to practice. Launched this March, the ‘Once a nurse, always a nurse’ campaign, run by HEE in partnership with commercial radio station Heart Radio, includes inspirational ‘return to practice’ stories from nurses and midwives who had previously left the NHS.

Data published by NHS Digital shows that there are 93,806 full-time equivalent vacancies across the NHS in England, a figure that has risen due to the pandemic. And getting more nurses and midwives back into practice permanently ‘is more important than ever following the wind down of the temporary register set up to support the NHS response to the pandemic,’ says HEE.

Nurses and midwives leave the profession for a variety of reasons, HEE says. ‘Some have children or start a new career, while others retire. Many want to come back but don’t know they can or where to start. Some are worried that processes may have changed and there might be new technology.’

The ‘Once a nurse, always a nurse’ campaign, a strand of the national ‘We are the NHS’ recruitment campaign, ‘aims to remind nurses and midwives that the fundamental qualities of being a nurse or midwife remain the same and are as valuable as ever. It’ll also support them on their journey back with useful information on the routes back in, the support available and tips on applications and interviews,’ HEE says.

NHS organisations can access a toolkit to support local return to practice recruitment drives, which includes leaflets, posters, and resources for social media, (see resources).

Commenting on the campaign, Mark Radford, chief nurse at Health Education England, says: ‘Returners bring back valuable expertise to the professions, and we want to enable them to complete the NMC requirements, return to the register and into roles within our clinical services.

‘Some of the processes may have changed and there might be some new technology, but the fundamental qualities of a nurse and midwife remain the same and are just as valuable as ever. These qualities never leave a nurse or midwife, and they are always needed in the NHS.’

Routes back into practice

There are three main routes nurses and midwives can take back into their profession including a return to practice (RTP) course either through university or directly through an NHS employer. Each course is fully funded, with the returner receiving £1,000 to cover costs such as books, travel and childcare. If employed by a NHS organisation while training, the returner will receive either a salary or £1,000.

Nurses and midwives can also return to practice through the NMC Test of Competence, which is also fully funded. Launched in January 2020, it involves an online test and an Objective Structured Clinical Examination (OSCE). And those who meet the NMC requirements can return to practice through a readmission process and can apply directly through the NMC website.

Tailored advice on returning to work and courtesy calls from HEE will be offered to all nurses and midwives who are considering returning to practice.

Return to practice course

A return to practice course involves a combination of classroom and placement-based learning. Nurses are assigned a personal mentor to support them through their studies. The course takes between three and 12 months to complete, depending on how long the nurse has been out of practice. The NHS careers website features a course finder for those looking for return to nursing programmes and there around 30 courses currently being run across the country, including courses in general practice nursing (see resources box).

It has been four years since Bridget Thobela completed her return to practice course at Kingston University London, and St George’s University of London, and she would ‘recommend it to anyone considering going back into nursing’. She says a few of her fellow course attendees had returned to nursing after a short period, but the majority had left the profession some time ago, including one who was returning after 30 years.

She explains that the course assessment was a combination of a Practice Assessment Document (PAD) and an end of course essay. ‘Writing essays was a challenge for me – my nursing assessment in South Africa was exam based so I’d never had to do essays. I found it stressful but I was given extra help with essay structure and referencing. The course leaders were approachable and I couldn’t believe how well I did in my essay,’ she says.

Any concerns during the course were addressed she says. ‘If you were struggling with, say, technology, the extra support was there. And the financial support was there too. Everything is done to make it easier for you.’

Courses and campaigns assisting and encouraging nurses to return to the profession are supported by nursing bodies. Dr Crystal Oldman, chief executive of the Queen’s Nursing Institute says: ‘The QNI welcomes the Return to Practice campaign by HEE as part of the multiple ways in which the shortage of nurses in practice is being addressed.

‘It is brilliant to see that the HEE campaign includes the allocation of practice placements in a wide variety of roles and settings, including community and primary care. The workforce can only be enhanced by nurses with a wide range of experience, capability and expertise being supported to return to the nursing profession.

Dr Oldman was recently in a setting with a nurse who returned to practice after more than twelve years away. ‘She had returned to a job she loved – working in the district nursing service – and was supported by a fabulous practice teacher throughout her return to practice programme.

‘The only challenge she had faced prior to starting the programme was needing to find her own placement for the programme. Once found, she has never looked back and is a highly skilled and valued member of the district nursing team, where she undertook her placement and where she was immediately employed following her registration with the NMC.’

However, she says the posts to which nurses are being recruited ‘will need to be attractive for the level of capability and sufficiently flexible to accommodate a work/life balance’.

‘Understanding why those returning to nursing left the profession is an important step in the process of recruitment, to ensure that they are retained and that they are matched to the most suitable nursing role available, with support, teaching and mentoring from the team they join,’ she says.

There are also concerns that this drive for returns is seen as a cure-all for addressing workforce vacancies, when in fact much more needs to be done to address staff shortages. RCN director for England, Patricia Marquis says: ‘This latest campaign to encourage those who have left nursing to come back to the profession is a positive step, but tens of thousands of nursing vacancies, with the number of vacant posts rising in the last year in the last year, means much more needs to be done to build the nursing workforce.

‘Ministers must do all they can to retain the experienced nurses we have and commit to investing in educating more nurses. One of the simplest ways to keep more staff is a fair pay rise that recognises their professional skill.’

To those considering returning to nursing, Ms Thobela says: ‘If you feel in your heart this is something you want to do then go for it - there’s so much support out there and you won’t regret it.’

And to nurses already in practice she says: ‘Thank you’. ‘When we’re going back into nursing these nurses are there to help us on this journey, and to take us through how things are done. My colleagues took me under their wing, and I’m grateful for all their support.

‘I was so excited to go back into practice. I’m a nurse at heart. And I love my job.’

Kathy Oxtoby is a freelance medical writer