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The first Helen Bishton knew about her Nursing Times Award nomination was hearing she had made the shortlist. Although delighted, she was convinced she would not win. She was wrong.
At the Nursing Times Awards 2020, held virtually in November, Ms Bishton picked up the award for nurse of the year – renamed the Florence Nightingale Nurse of the Year Award to mark the bicentenary of Florence Nightingale’s birth.
“It is unique. I never dread going to work; I love my job”
Colleagues who nominated her said she had improved patient experiences by introducing advanced nurse practitioner (ANP) clinics for offenders that helped reduce waiting times and resolved many day-to-day health concerns for individuals.
By spearheading these clinics, they said Ms Bishton had helped to “embed a nurse-led approach across the wider healthcare team, building on the skills of nurse practitioners and non-medical prescribers, and allowing GPs time to prioritise complex care”.
For the last 13 years, Ms Bishton has worked at HMP Lancaster Farms, a men’s prison in Lancashire, where she is currently an ANP.
She loves her job but said she did not think prison nurses won awards such as nurse of the year.
“Offender health is not the first thing people think of when they think of nursing,” she said. “So, to get into the final was a huge achievement.”
As the description of the winner was being read out, before their name was announced, her husband thought something sounded familiar.
“I didn’t know it was me,” said Ms Bishton. “It was my husband who said, ‘it could be you’. I said, ‘it could be anyone’.”
But the name duly read out was Ms Bishton’s.
She had spent 16 years on hospital wards before changing setting in 2007, after going to look around a prison. “I knew this was my job, I needed to get this job,” she said.
As her name was revealed, she was in shock and, she laughingly recalls, struggled to answer questions from the host, BBC Breakfast presenter Naga Munchetty.
Now it has sunk in, she said she felt “immensely proud”, noting that awards had a valuable impact beyond herself.
“I work in a prison so it can be quite isolating,” she said. “But winning this award has been a fabulous motivator for the staff I work with – offender health has been recognised.”
HMP Lancaster Farms is a category C prison – not the highest security level but not the lowest either. It houses all types of prisoners, including those serving life sentences.
By her own admission, Ms Bishton previously “didn’t have a clue” what it was like working in a prison.
“I think my preconception was that it would be hostile and not very well equipped,” she said. “Maybe this is the public perception too – that’s it’s a hostile place to work – but it really isn’t.”
In reality, aggression was rare, she said. “We have some amazing patients and establish a really positive professional rapport with a huge number of them.”
There is a full primary care service under one roof, a dentist, optician, physiotherapist, ultrasound scanning service and X-ray service, so they are well equipped, rather than being under-resourced.
There were sometimes tensions but it was the same for all parts of nursing, highlighted Ms Bishton, who is employed by Spectrum Community Health, a community interest company.
“It’s about understanding that everyone has their battles and demons,” she said, adding that there were also huge rewards.
“We’ve got a captive audience who are generally in quite poor health, so you can make such a big difference,” she said.
Prisons present specific medical challenges, she noted: mental ill health is widespread, and many patients are on multiple medications, have poor general health and often lack health literacy.
Ms Bishton’s award nomination was linked chiefly to her work developing the ANP model in her prison and a more-structured approach to pain management for prisoners.
“We’ve got a captive audience who are generally in quite poor health, so you can make such a big difference”
When she began ANP training in 2016, there were no ANPs in prisons in the North West and prison doctors were often locums who did not have much time to understand an offender’s health issues or build a rapport.
“I was already a prescriber and thought it made sense to do the ANP course. With such a shortage of doctors, it makes sense to have ANPs. I’ve got more time to provide education to these patients,” she said, noting there was a “direct link between health and reoffending”.
At the time, doctors had a mere 10 minutes (now 15 minutes) for each patient, but Ms Bishton can spend 20 minutes with them – and longer in more-complicated cases.
She is there every weekday and can see people at short notice so gets to know the patients.
At present, she is working with two men in their early 20s who have inflammatory bowel disease to help educate them about the importance of diet.
She also highlighted that the nature of prison life placed “huge” importance on safe prescribing and, with doctors in short supply, nurses – benefiting from better training opportunities – were prescribing more and more.
“There’s an awful lot more nurse prescribers now and that’s a positive move,” she said – prisoners get quicker prescribing on site and nurses have more autonomy.
She introduced a pain clinic a couple of years ago to look at getting prisoners off some of the most high-risk medications.
These were typically opioids at the outset but, more recently, have been pregabalin and gabapentin – often misused for their euphoric effects.
The clinics allowed face-to-face meetings with patients once a month but, unfortunately Covid-19 put a stop to that.
So Ms Bishton began holding online multidisciplinary meetings to look at the risk factors related to an individual’s pain relief – something, she noted, GPs in the community did not have time to do.
The impact of her work means waiting lists to see a doctor have been cut, but also goes further – prisoner frustration could be tackled.
Before, there was “a revolving door”, said Ms Bishton: patients had an appointment for one issue but had to book another if they had multiple issues. This sparked lots of frustration and problems.
The ANP model helped pre-empt this, as patients left the appointment feeling listened to. Ms Bishton explained: “I think there’s less aggression and, ultimately, less crime.”
Reflecting on her choice of career, Ms Bishton noted she was the daughter of a nurse. Her mother stopped working when she was born but photos of her career were around the house.
A key moment came when Ms Bishton was a child. “I read a book about a girl with a broken leg who went into hospital and the nurses looked after her,” she said. “I knew that was what I wanted to do. And I’ve never wavered.”
As with almost all health and care professionals, Covid-19 has redefined her working life.
Staff were not redeployed but work became “more challenging”, with less face-to-face patient contact.
“Offender health is not the first thing people think of when they think of nursing”
At the start, they saw only urgent patients in person and wore personal protective equipment. At the time of writing, however, she was back to her normal clinics.
Outbreaks of Covid-19 have occurred but were managed well and prisoners were cooperative, she said.
New offenders arriving at the prison were limited to mixing with each other for the first 14 days, and prisoners come to see her from one wing at a time to avoid mixing.
Nurses also go out to prison wings, doing more triage work. “They’ve been amazing,” said Ms Bishton. “I really couldn’t do my job if I didn’t have such a team.”
She described her typical day as starting with an 8am handover with nurses from the night shift, before she logs on to the computer in the consulting room to answer emails and attend to tasks such as prescriptions and filing blood results.
Patients come to see her throughout the day. Before lunch, she has a handover with other professionals, including nurses, pharmacists and administrators.
If an emergency response requires nurses, they will assess a patient in the wing where they are located.
For a bad case of self-harm with a deep cut, the prisoner may need to go to hospital, she noted but, in general, nurses did their best to minimise trips off site.
If the substance misuse doctor is away, Ms Bishton will cover for them. Usually, her day finishes at 4pm, but the health department is open until 7pm.
Asked what was next for her now she was nurse of the year, Ms Bishton laughed and said she was keen to keep her feet on the ground.
She would keep learning and was doing the RCGP Certificate in the Management of Drug Misuse Part 2.
The six-month training, due to finish shortly, would allow her to provide extra support when the substance misuse doctor was away.
Despite widespread staff vacancies across the NHS, Ms Bishton was optimistic about her own team.
“For the first time ever, we are fully recruited,” she said, adding that several accident and emergency nurses had joined, and they had “a good, happy team”.
She recommended others think about prison nursing and hoped her win would help to change perceptions.
“It is unique. I never dread going to work; I love my job,” she said.