Being a Primary Care Nurse in a Secure Hospital – Laura’s Story

About Me

Hi, I’m Laura! I qualified as a general nurse in 2016 and then worked at the Bristol Royal Infirmary for 3 years. In January 2019 I made a move across to Hanham Health who had just taken on a new contract providing a Primary Care service at Fromeside Medium Secure Unit and Wickham Low Secure Unit run by Avon and Wiltshire Mental Health Trust. I work full time as the primary care nurse and we have a small team of GPs who rotate to cover two sessions per week. Together we have spent the past 2 years building up a service to ensure we are providing person-centred physical healthcare for our patients, in line with the services they would expect to receive in the community.

In January this year our contract transferred over to Hanham Secure Health and we have plans to continue to develop our service and build up a more robust team over the next year.

About Fromeside & Wickham

Fromeside is an 80 bed medium secure hospital caring for people with a mental illness and/or personality disorder who also have a criminal history or have risks and behaviours that mean they cannot be treated in mainstream mental health services. The hospital provides both short term assessment and longer term care with an ethos of recovery and service user and carer involvement. The hospital provides one ward for women and six wards for men, supporting patients who are acutely unwell through to those who are preparing for discharge.

Wickham low secure service has 31 rehabilitation-focused beds across three wards, each meeting the specific needs of vulnerable men with ongoing mental health issues who are at different stages of recovery and with different levels of independence.

Each ward has a psychiatric consultant, a specialty ward doctor, a ward manager and a team of mental health nurses and health care assistants alongside a central team of active life trainers, occupational therapists, activity coordinators, psychologists and therapists, pharmacist and dietitian.

About my Work

The primary care centre is based centrally within Fromeside Unit, with offices, consultation rooms and a clinic. We aim to see patients in the primary care clinic but also visit the wards to see patients who are unable to attend. It’s difficult to compare the environment to any other. The building is set up like a hospital, with different wards off a main corridor but security measures are more in line with a prison environment, meaning you need to be issued with keys and alarms before being able to enter the building and move between areas.

Working as a general nurse within a secure hospital is a challenging but rewarding role. No day is the same and the workload is interesting and varied.

“It’s amazing to see the patient journey from admission to discharge and to be able to see the progress people make with treatment and therapy.”

Question & Answer

Why did you choose a career in nursing?

“I had previously worked as an interior design stylist and commercial artist but found that having a creative job took away the enjoyment of art and design. I’ve realised I prefer having hobbies and being creative when I feel like it. I found the idea of nursing attractive because of the teamwork and supportive nature of the role and was excited that a career in nursing could take me in so many directions.”

What do you enjoy most about being a nurse?

“I feel that nursing is a journey and I am constantly learning something new.”

What do you find the most challenging?

“A switch from an acute general hospital to primary care within a mental health hospital has been a huge learning curve. The biggest challenge for the Primary Health Care team has been trying to change the culture of focussing on mental health and ensuring that physical health is given as much importance.”

Do you have a favourite memory of your time at Fromeside so far?

“I get to meet, work with and learn from so many interesting people. I also love that no day is the same.”

What would you recommend to other nurses considering a role in a secure hospital?

“People always ask me if I feel safe working in a secure hospital and the honest answer is yes. I previously worked in ED where anyone could walk through the door, intoxicated, abusive or in mental health crisis. The patients at Fromeside are risk assessed and you are never working alone with a patient, there will always be a mental health nurse or HCA with you. Since working a Fromeside I have felt safe and well supported by the ward teams.

I would also say that you don’t need to be an expert in mental health to work here. You’ll learn lots along the way. Although there is cross-over between mental health and physical health we are here to care for the physical health needs of our patients and if we need help or advice on mental health issues then the ward nurses, doctors and consultants here are always happy to help. The most important thing is to have good communication with our patients and mental health colleagues.”

What would you say are the essential qualities needed to succeed in working in a secure hospital?

“You need to be warm and approachable and able to communicate with patients to build confidence and rapport.”

Where do you hope to be in 5 years’ time?

“I am about to start the Advanced Clinical Practitioner apprenticeship which is funded and supported by HSH. This is a masters pathway that includes modules such as Physical Assessment and Clinical Reasoning, Non-Medical Prescribing, Leadership and Research. In five years’ time I hope to be a confident advanced clinical practitioner supporting the Primary Care team here at Blackberry Hill.”

Anything else to add?

“If you’re interested in a career in a secure setting but you’re not sure what to expect then we’d be happy to show you around and answer any of your questions so please get in touch!”