Our Nurses Stories - Lisa Maclean

Lisa trained as a Registered General Nurse in 1980 and later qualified as a registered mental health nurse in 1986. She specialised in adolescent and forensic mental health and held senior lecturer posts in Hertfordshire and Northamptonshire University, before a period in A&E as an emergency nurse practitioner. She then spent seven years as consultant nurse for HM Prison Service from 2000 to 2007. From 2012-2018, she held a series of director posts, including for a military charity, the Secure Forensic Service, a Clinical Commissioning Group and a hospice, before joining NHSP in 2021. 

Lisa’s thirst for knowledge and experience meant she also obtained a degree in education, as well as qualifications in neuro-linguistic programming, hypnotherapy and interior design.

It all started… 

…when I was young, I witnessed an accident where I was first on scene and felt that if I had the skills, I would have been able to help the victim. My teachers at the time were not keen on any female students forging ahead with what were seen at the time as ‘male’ careers (such as doctors). I was guided to be a nurse and told I would then ‘marry a rich doctor and be able to give up work’! Needless to say, that didn’t happen!

Before my nurse training, I spent time as a volunteer in the local general hospital and my first vivid impression was how busy it was, the odd smells and the confusing array of uniforms and ‘ranks’ of the different staff groups. The language was technical with many shorthand expressions, which was all a bit baffling at the time. However, this experience underlined that I wanted to pursue a nursing career. 

I remember…

Sisters 

…Sisters in the early days were to be obeyed and tended to be very strict with routines. It included practices such as: when making a bed, ensure you remained at the bottom of the bed until all the corners were correctly placed (for economy of movement), and having the sheets so flat and correctly placed that one could bounce a ball on it. The pillowcase opening had to be placed away from the entrance of the ward - this was historical from the Crimean War, when there used to be sandstorms raging outside the hospital tents and sand would get into the pillow. I was in leafy Hertfordshire at the time, so not a common occurrence, but we did it nevertheless, along with making sure patients were ‘tidy’ in their beds and their bed wheels were aligned, especially prior to a consultant’s round in the morning.

Breakfast

…one elderly man was very agile and fit, but he had become increasingly confused during his stay in the ward. He used to run around naked and try and climb into other patients’ beds. He always demanded porridge for breakfast, would eat a mouthful and then fling another spoonful across the bay to hit other patients. This became his regular routine, so other patients used to take cover under their sheets. I decided that, on this occasion, I was not going to get splatted with porridge on my uniform again, so I went up to him with the bowl and knelt down on the floor by his bed, raising the bowl up above my head, shielding myself from any potential onslaught. I gingerly handed him the bowl and ducked. He said: “Nurse, what are you doing down there?” I suddenly realised his confusion had passed and he was ‘back in the room’. Big smiles.

Drinks 

…on my evening round, I used to empty the catheter bags, put the urine in bottles and pop them in the trolley. This was an excellent opportunity to check in with all of the patients at the close of the day and assess their condition. One evening, as I was completing this round, a patient suddenly reached into my trolley and to my horror picked up a full urine bottle. He promptly drank it and said: “That’s a good year!” I was just about to intervene, and in an instant, he picked up another bottle and swallowed the lot and said: “That’s an even better year!” I managed to stop him sampling the rest of the trolley and it was then that I decided I need to know what was going on in his head and went on to train as a psychiatric nurse. Being dual-qualified really strengthened my nursing skills as I felt I could assess the patient and support them on many more levels than I had previously.

Prison

Part of my role as consultant nurse for the Prison Service was educating the prison officers in mental health awareness because there was, and remains, many vulnerable prisoners who are struggling with serious mental health conditions. As a training tool, we decided to make a film about how mental illness could manifest itself in prison - it involved using actors staging a fight scene in an empty wing of a high-security prison. They were all padded up and rehearsed it at half speed, but when it happened in real time, it was so realistic it made the hairs stand up on the back of my neck.
The film went onto win awards in London and New York due to its authenticity. 
 
Prison is such a unique environment. Things can change in a second. I learnt the use of humour, teamwork and real courage from my prison officer colleagues who had a very challenging role. With experience, you come to know when the environment is safe or potentially unsafe. The key, when walking onto the landing around the cells, is to observe the interactions between the prisoners and listen to the background noise. If the landing is too quiet, it can mean there is tension in the air and perhaps something is going to happen.

Courage means…

…stepping forward to do something for someone else when you don’t have an idea of the outcome; as opposed to bravery, where you may know the potential outcome and what you are getting into. 
To be courageous means having a strong self-belief and confidence that it is the right thing to do to change the situation, maybe against other perspectives at the time. Courage also means having ‘stickability’ to pursue actions, despite how long it may take or how rough the terrain becomes. 

It comes in many guises - it can be forthright, demanding, or silent, each with their merit. Courage is also admitting to one’s own vulnerabilities in this time and reaching out to other colleagues, friends and loved ones for support. In my personal view I don’t believe nurses should be seen as ‘heroes’ or ‘angels’, which are thoughts commonly expressed. Instead, I believe we should be viewed as consummate professionals who develop, grow, and become stronger with the right support and experience. 

Courage has been demonstrated across the board by all my nursing (and other healthcare professional) colleagues in dealing and caring for patients in the Covid pandemic. Nurses have stepped forward willingly to care for others, with the knowledge that this may seriously affect their own health or those of their loved ones. They’ve managed all the uncertainty the situation has thrown our way, but remained doggedly determined to do the very best they can in heart-breaking circumstances. 

I’ve seen courage…

…when AIDS was beginning to be a real concern for health professionals and communities in the mid-1980s. Fear was mounting and it was believed at the time that AIDS would be as transmissible as Covid-19 is today. There was huge stigma and hatred developing against the homosexual population - a wretched time. 

I was sent to London to complete a week’s course run by a man whose partner had died of AIDS and who himself was HIV positive. He didn’t know how much longer he had to live and was exceptionally courageous and compassionate in how he delivered the course material. 

On the third day, he told us they had just worked out how to test for AIDS with a saliva sample and that, after lunch, he had arranged for us all to be tested. This information sat in our minds throughout the morning and in the coffee break, participants began to question if they wanted to know; what impact it would have on their lives; how would they tell their partners? Would they be able to continue to nurse if they had a positive test?  

By lunchtime, the anxiety in the group had risen to epic proportions. We were sent to lunch and a couple of the participants did not return after the break. He then gave out a lab stick and asked us to put saliva on it…but as we were about to do it, he told us not to bother. It was not true, there was no such test, but he wanted us to experience that fear, panic and uncertainty about stepping forward for the test. He achieved his objective and we all left feeling we needed to change perceptions of AIDS and HIV at every available opportunity.

Nurses need courage…

…because they are the advocate for the patient and family. We are to assess the situation as presented and ensure, as far as possible, we have the best outcome, whatever that may be. It takes courage to know when to ‘step back’ and support the patient in what they want to do, as opposed to forcing them to do what you think may be best. It takes courage to listen and witness a patient’s pain and really understand their perspective, when all you want to do is ‘make it better’. 

It takes huge courage to examine one’s own motivations for wanting things to be different and acknowledging that your role is to enable the patient to come to their own decisions and conclusions about what is best for them. Without courage, a nurse is not giving the best of what can be given, and without courage, the patient will not be given the person-centred care they deserve. 

 

What I’ve learnt over the years

• Excellent nurses develop excellent nurses. Everything I have learnt in my career is from my exceptional elders, who dealt with adversity using grace, intelligence and largely, good humour. Have the courage to always align yourself to those that you admire, and desire to be as a professional. Watch, observe, model and learn the skills you need.
• Have the courage to communicate with confidence. This means listen, listen, listen, as if your life depends upon it, and assess body language. The more you listen to others, particularly your patients, the more you will come to understand what is really going on and find that conclusion so much more quickly. Don’t listen by planning what you are going to say next - listen with the confidence that it is OK to not know what to say, and take your time. 
 

Final thoughts

My years in nursing were a humbling experience where I came to understand the vulnerabilities felt by patients and families and what amazing courage, humour and love they had. I felt and still feel very privileged to have witnessed what I have in my career. 

Being part of a team has been one of the highlights in my career - sharing the good, the bad, the ugly and sometimes, the completely random! Having the ability to laugh until you cry at the end of a shift was always the best antidote.