NQHV: the bigger picture

11 April 2019

The transition to health visitor was difficult – the pressure of the responsibility is huge.

I had always been interested in working with children and families so when I saw the post advertised to return to education and work towards a postgraduate diploma in specialist public health nursing (health visiting), I jumped at the chance.

As a result, in January 2017 I embarked on a new career path in health visiting with excitement and some apprehensiveness. For the past five years, I had been working as an adult critical care nurse in my local hospital. Although I thoroughly enjoyed the clinical side of the job, I felt worn down by the daily grind of the ward environment because I did not have the time to provide the high-quality care the patients deserved.

Rollercoaster ride

My journey through the one-year course at university felt like a rollercoaster. I had lots of self-doubt and uncertainty. Did I make the right decision? Will I make a good health visitor? This related mainly to the vast amount of study that health visiting requires and the in-depth knowledge needed to do the job.

Nevertheless, I was determined to succeed and seized every opportunity to learn the role.

As a student, I don’t feel that I fully grasped the bigger picture of health visiting. For example, I did not enjoy the research module, nor did I understand the great value of such in-depth study of research.

My favourite module was enhancing health visiting practice, which focused on the practical aspect of being a health visitor and our role in working with vulnerable families. This element of study I could relate to practice and I understood how I would apply this in day-to-day work.

Re-assessing research

However, my view of this soon changed when I became a health visitor. I took part in a test-of-change project led by the Scottish Government. As a group, we picked an area of health visiting that required improvement and focused on what was required and how to lead the change and motivate staff to join the movement. To ensure the project was effective, we had to explore how to measure the change to prove that it worked. The sudden realisation kicked in that this was based on the principles of research. And guess what – I was enjoying it!

My thoughts around the ‘bigger picture’ started to click into place. The basis of the aim for the health visiting role is driven by current Scottish Government policy. Research is crucial in understanding how we make Scotland the best place for children to live and grow up. I am passionate about working to make positive changes to benefit the lives of children and families.

A tricky transition

Being passionate and motivated does not prepare you for the difficult decisions and conversations around safeguarding of vulnerable children. Within weeks of starting as a newly qualified health visitor, I met with a family I was immediately concerned about with regards to the wellbeing of the children. This was a particularly challenging family with intergenerational patterns of neglect. I very quickly felt out of my depth dealing with the documentation needed to evidence the chronic neglect and the risk to the children.

Luckily, I have great support in my area and was able to seek advice from the local child protection adviser, team leader and my colleagues. What I found difficult was the family’s unwillingness to work with me as health visitor, and I had to accept that I would be unable to establish a therapeutic relationship with them.

However, the family have agreed that there are wellbeing requirements and continue to work with a local charity. So I can rest easy in some way, knowing the children are being seen and the family have taken positive steps to effect change. I was also given positive feedback about my approach from other agencies, which I was grateful for.

On reflection, the transition from student health visitor to health visitor was difficult – the pressure of the responsibility is huge. I have also learned to accept that many situations are out of my control, and best practice policy and guidelines which are designed to support us as professionals through difficult situations are not always applicable in a straightforward manner. Despite this, I have broadened my view and have a greater understanding of our role as health visitors.

Now more than a year after obtaining my diploma, I can conclude that going into health visiting was the right decision for me. I love my job. The working day can be fast-paced and the record-keeping can be frustrating, but I love the fact that the wellbeing of each child is always at the heart of what we do.

My next step is to return to university in May, and carry out a research project to complete my masters in public health nursing.


What I’ve learned: my top three takeaways

  • Reflection and feedback is invaluable in being able to debrief and learn from experiences.
  • Being organised and prioritising workload is key. However, it pays to keep in mind that there may be unexpected work arising from safeguarding cases.
  • There is never a silly question – there is always someone listening and able to answer.

Want to share your experience? If you’re a newly qualified community practitioner, and you would like to write on any aspect of your training, practice or personal journey, please email [email protected]

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Scottish Government. (2010) Growing up in Scotland: health inequalities in the early years. See: https://www2.gov.scot/resource/doc/310476/0097973.pdf (accessed 20 March 2019).