Leanne Kenny, Advanced Recovery Practitioner. Registered Nurse Learning Disabilities (RNLD).

I had wanted to be a nurse in Alder Hey (AH) since the age of six. I studied hard at college. I was successfully offered a place on Project 2000. During my time at college, I started working. I started earning money. I envisaged myself as a poor student nurse and reluctantly, decided not to take my place on the course. Everything happens for a reason.

Following on from this I gained an insight into the world of health care. This insight included experience of working in a variety of health care settings. A nursing home for people with dementia, a residential home for the elderly, support worker for people with mental health conditions, autism and/or learning disabilities. I loved each and every one of my jobs. Throughout all of these jobs and sat tucked away, in the back of my mind, remained my interest in pursuing nursing.

I decided to reapply during my time working for a well-known Learning Disability Charity. I had to give it another shot. Fingers crossed.

Originally, I applied to study children’s nursing. Unfortunately, I was unable to secure a place. I felt defeated. A few weeks later, University invited me for an interview for adult nursing. I was of the mindset ‘oh well, may as well go’. I had nothing to lose.

You may wonder why I am writing this?!

It was at this interview I was introduced to the wonderful world of Learning Disability (LD) Nursing. Like many people, I didn’t even know such a nurse existed. It didn’t and still doesn’t get the recognition other nursing branches do.

As I chatted with the interview panel about what work/life experiences I had and my job role at the time, the panel decided to introduce me to this ‘unknown’ branch of nursing. It sounded amazing. The interview went well. I was offered a place. I started my nursing in 2008. I qualified in 2011. I haven’t looked back since.

Since qualifying, I have worked in a variety of settings. Secure services, Learning Disabilities (obviously) and acquired brain injuries. As much as I loved it, I still felt drawn to my childhood dream. Working at Alder Hey Children’s Hospital. I was signposted to a job advertised for AH. The vacancy was for a Recovery Practitioner - Theatre Recovery Department. I thought about it. I wondered if I was skilled enough to fulfil the role. Did I have the clinical experience to work in a theatre environment?

As a LD Nurse, I consider it a role with an amazing ability to adapt. (LD nurses seem to be able to turn our hands to anything and think outside the box. Right?). I had picked up a lot of clinical skills in my previous roles both pre and post qualifying. It offered a supernumerary period for training. It sounded too good to be true. I had to go for it.

I applied.

Interviewed.

Succeeded.

The first couple of years in post as a Recovery Practitioner, I solely focused on learning the role. I provide immediate post operative care to paediatric patients following general anaesthetic. This includes maintaining a safe airway, dealing with factors such as blood loss, pain, nausea and vomiting.

As time passed by, the Government began to talk about initiatives to drive equal access to health care for people with LD/Autism. Funding became available for many Trusts across the United Kingdom to set up, introduce and provide LD teams. I interviewed for the post of LD nurse for the Trust. I was unsuccessful. It didn’t matter. I already had my dream job, didn’t I?

A fantastic nurse was successful at interview. During the process, it came to light we had a mutual colleague. A lecturer of mine from during my nurse training. We decided to link in with each otherand utilise the opportunity to raise profiles within theatres. I would spend time with the LD/ASC team at AH a couple of times a month and fulfil the Trust wide role there. Whilst still working in recovery. Perfect.

The Trust had (and still has) a huge percentage of patients coming through who have LD/ASC. Our main priority would be to raise the profile of the new team and get it fully established within AH. We would also visit/telephone patients/parents/carers to find out and ensure reasonable adjustments were made for the patients who needed our support. Whether that be during their hospital stay or at future outpatient appointments.

As time went on and theatre lists got busier, I went less and less to spend days with the LD/ASC team. I would still promote the service during my shifts in Recovery. I regularly liaise with the team and still to this day. We often link in with each other to ensure that our patients coming in for surgical procedures have their needs met accordingly. Ensuring reasonable adjustments are made as and when required.

In my department, I am constantly raising the profile of children with LD/ASC. I educate staff and students on the importance of ‘thinking outside of the box’. I have produced health care cards to enable staff to communicate with patients. Just because a patient is non-verbal does not mean we shouldn’t make reasonable adjustments to communicate with them via the method they use? By doing this contributes to communicate with them via the method they use in their day-to-day life? By doing this contributes to enhance their patient journey/experience. I have also produced an information board for staff in the department. I will email updates and factsheets to the department about various disabilities too.

If I know a patient who needs reasonable adjustments will be coming to theatre, I will try and visit pre op to reassure patient/parents/carers, gather some likes/dislikes to try to encourage a smoother wake up and to put a face to the voice the child will hear on emerging from anaesthesia.

I am a true believer of a ‘less is more’ approach in certain situations and especially with children with sensory processing needs. With regards to children who have the potential to challenge. I also encourage the presence of less staff around the bed space. I make every effort ensure there is someone around and waiting at a safe distance should extra support be needed to maintain patient/staff safety. My reasons for doing this is to avoid upsetting and overwhelming the patient as they wake up. I can imagine it to be a strange and frightening thing to wake up to see a bunch of strangers looking at them.

For this group of patients, their main carer is often brought to recovery earlier than usual. This is to ensure a familiar face is present when the patient is emerging from anaesthesia. This process in itself can be confusing, disorientating, delirious and scary time. A familiar face/voice/touch etc often helps to calm the patient.

When I work in the day surgery unit, I regularly link in with post operative nurses to advise on best practice. I also review patients and if they are upset/stressed by their environment and changes to routine and sensory overload, I will ask the parents/carer whether they would be happy to take the patient home.

What is observed sometimes, is a patient who is to upset because they're in a strange place. It is easily resolved by allowing the discharge process to happen sooner than usual. To do this, I will link in with the anaesthetist and request a ‘rapid discharge’. I try my best to follow all patients up later that day to ensure everything went well once home. If I don’t get a chance to do this, I will again, link in with LD/ASC team and request they follow things up on my behalf. Safety of the patient is the main priority.

During the coronavirus pandemic, I was redeployed to ICU. I loved it. I don’t like to say ‘loved’ as it wasn’t a pleasant time for anyone. What I mean is; I achieved so much there. It was rewarding and at the same time, heart breaking. There was a patient I was drawn to as I was made aware she had a LD. When I read her notes and knew more about her it came to light that she used Makaton to communicate. I made it a priority, in my own time to put together some coronavirus related information cards. These were left in her bed space for trialling weaning of sedation. I ensured everyone knew what they were for.

As time passes by, the throughput of patients at AH is growing and growing. The coronavirus pandemic has put so many patients' health care on the back burner. It is unfortunate that although we are seeing huge increases in our LD/ASC patients finally gaining the courage to consider attending appointments again. For some children, it is like the whole desensitisation process has started all over. We are back to square one.

There is so much more we could do to ensure a positive experience. All behaviour is communication. It is definitely worth remembering, there is so much more to language than the spoken word.

Leanne Kenny

Band 6 - Advanced Recovery Practitioner.

Registered Nurse Learning Disabilities (RNLD).