Independent Nurse – how does that work?

Joanne Haws is a Registered Nurse who held a variety of roles within the NHS before setting up in business as an independent consultant in 2010. In this article Jo shares her story and provides insights into the practicalities of working as an independent nurse in the UK

WHERE IT ALL BEGAN

An Independent Nurse…. How does that work?’ A question I am frequently asked! Sounds odd, but in reality, I’m doing same kind of work I’ve done for years – just in a different way.

My initial 15-year career in the NHS began in critical care and ended up in a manager’s chair, via cardiac specialist nursing and primary care.

I found my love of cardiology very early in my career… in fact my interest started at around 8 years old when my father had his first admission to our local Coronary Care Unit. Thankfully, with good secondary preventative care and more than his ‘five a day’ he is still with us and is my go-to case study at over 80 years of age. While I loved working in Critical Care, I really felt I needed to focus further upstream – and see what I could do to support the fight to stop children and families losing their loved ones to cardiovascular disease when we knew that so much of it could be prevented.

After completing specialist cardiology training and helping out with our Cardiac Rehabilitation service I moved to primary care and my first specialist nurse post. In this post I developed a real passion for education and later become a trainer, and then clinical lead, for Education for Health. I found, and still found, such great pleasure in simplifying complex information and seeing those ‘penny-drop’ moments when people finally get it! During this time, I became increasingly involved in professional societies in cardiology where I loved having the opportunity to get involved with national projects, and work with others who wanted to make a difference in the world of cardiovascular disease.

BREAKING AWAY

After several ‘restructures’ in primary care I ended up with a 'day job' as a Service Manager for a large community provider and was becoming disillusioned with where my career was taking me. I had responsibility for specialist nursing services and community matrons, and there was increasing pressure from above to deliver financial savings alongside meeting the demands of the workload. As the conduit of information to the frontline teams I found that I spent most of my time making a hard job even harder by asking for more and more, while giving less and less. I realised during that time that management was just not for me. But how do you go back to being a ‘proper nurse’? Following one too many difficult conversations with my own line manager the words in my mind came out of my mouth – ‘I’m done’. I walked out of the building with no plan, apart from writing my resignation letter, and no job to go to. Of course, I worked out my notice period for the job, which gave me a couple of months to make and execute a plan!

FINDING WORK

Initially I contacted the regional Cardiac Network, with whom I had worked closely as a specialist nurse and was offered some project work for a couple of days per week. We agreed a daily rate and that I would invoice monthly for this. I was also ‘on the books’ of Education for Health as a clinical trainer, so continued to deliver courses and study days on CVD management. This kept me pretty busy and also provided lots of opportunities for networking and finding new opportunities both locally and nationally, within and outside of the NHS.

I’ve never actually ‘advertised’ as such, the vast majority of my work has come through contacts and introductions that have been made while undertaking various projects and assignments. I do engage with social media and have made some great contacts that way, though I can’t say I have had much in the way of attractive propositions for paid work.

It’s worth mentioning that being independent and self-employed doesn’t mean you can’t then take an employed position if a suitable opportunity arises. I’ve had a couple of part time employed roles during my time as an independent nurse, you just need to make sure you get your taxes right – and for me, that is what accountants are for!

SO, WHAT DO I ACTUALLY DO?

‘Clinical Education, Training and Consultancy’ were the words I used on my first business card, not sure what I would use now in all honesty – how do you put a label on it? If it feels right, uses my skills, and pays enough I’ll consider it. The ‘feels right’ bit has become increasingly important to me over the years, if I feel something doesn’t sit with my values then I won’t do it. Being values-led has come at a cost, financially, but I feel the cost to my own wellbeing would be greater if I forced myself to do things that didn’t feel right, or just sat completely wrong with me – back to how I ended up here in the first place! I have made the decision to decline, or terminate, work assignments on several occasions and it is really difficult when you have bills to pay, but protecting yourself and your registration has to be the priority beyond the end of the month.

My workload is a mix of paid and unpaid work: I try to earn enough from the paid work to allow me to do the things I love. A case in point is my current role as the the Clinical Director of Learn With Nurses, a Community Interest Company providing online clinical education that is accessible to healthcare professionals around the world. Last year we won The Burdett Trust for Nursing Award for Supporting Resilience and have delivered almost 500 free webinars to over 25,000 healthcare workers in 88 different countries. It’s probably the thing I’m most proud of, though it hasn’t earnt me a penny. I’m also a member of the Clinical Practitioners Special Interest Group of The British and Irish Hypertension Society and have been involved with several professional societies in the CVD world. Again, this work does not bring any income but is invaluable in terms of my own education, professional development, and professional networking opportunities.

Most of my paid work currently is from the delivery of clinical training, and my work with the National Association of Primary Care where I am a Non-Executive Director and a facilitator on the CARE programme. At the height of the COVID-19 pandemic I returned to Critical Care as a bank nurse to help, which was a bit of a culture shock after 18 years away! I’ve also been a specialist advisor to the Care Quality Commission for the past ten years. Over the years I’ve set up new clinical services, managed clinical projects, written lots of articles, recorded educational videos and podcasts, spoken at conferences, set up and run public screening and health education events. It’s often the kind of thing that organisations have a little pot of funding for but nobody to do the work, and it’s not something you can advertise as who would apply for a job that only lasts a few weeks? There are rules around the use of consultants as an alternative to employed roles, but it does give flexibility to organisations as well as to individuals for short- to medium-term arrangements.

HERE ARE THE BEST BITS

So, what are the pros? Well, back to making a difference… I’ve delivered training and education to thousands of healthcare professionals throughout the UK and beyond, undertaken research, been involved in policy development, led service redesign, and have had many publications. The reach of my work is pretty broad, and I hope this has made a difference to patients and the wider population. I can say no if something doesn’t feel right and can say yes without asking permission. The paid work I do gives me enough flexibility for unpaid work that I feel is important, be it chairing professional working groups or giving talks to the local WI.

THESE ARE THE CHALLENGES

The cons? Well, you can’t really separate life and work. You can’t sit back and assume the work will still come, and there is no guaranteed pay day. You have to be nice to everyone, keep up with the invoices, and hope they get paid on time. I’m still waiting on payment for some work I did in November last year. The taxman is always around the corner, so you have to be prepared, not always easy at quieter times – or when invoices haven’t been paid. The struggle to manage the work-life balance will be all too familiar to all nurses I’m sure, whatever their role. A couple of years ago my friend and colleague, Michaela, introduced me to an initiative she was working on called ‘WIN’ that was looking at the issues around nurses achieving and maintaining a healthy weight. I was asked to join in and was part of a group of nurses who co-designed the ‘Nursing You’ app that is now being offered free to nurses to help them look at their own health and wellbeing – something that is definitely close to my heart and very much needed.

One major challenge is the lack of a safety net in terms of sick pay, and of course no paid holidays or study time. It’s really important to think about things like critical illness cover and income protection, and of course pensions. It’s great to make hay when the sun shines but we all know that there is a risk of darker days around the corner and it’s always best to be prepared.

WHAT ABOUT REGISTRATION, REVALIDATION, AND INDEMNITY?

Maintaining my registration and revalidating has not been a problem and won’t be for you, providing you can demonstrate that you meet the range of requirements (Box 1).¹ The NMC Practice Log Template lists multiple options for work settings and for scope of practice, beyond direct clinical care. Education, leadership, and consultancy are probably the three I use most and will be using again when I revalidate this year. Practice related feedback usually comes from evaluation of training I have delivered and testimonials, and I work directly with other nurses with whom I can have reflective discussion and who can act as confirmers. Your confirmer does not need to be your line manager, it can be any other Registered Nurse. And as an independent nurse you can also act as confirmer for colleagues.

All registered nurses, midwifes and nursing associates are legally required to have a professional indemnity arrangement in place and if you are self-employed you will need to arrange this for yourself. If you are a member of the Royal College of Nursing, which I am, you may be covered by their indemnity scheme, but it is essential that the terms and conditions of cover are confirmed to ensure the service provided is included. Independent cover can also be obtained through a number of other organisations including the Medical Defence Union and Medical Protection Society.

CAN ANYONE DO IT?

The short answer is yes! Hopefully I have given a realistic reflection of the pros and cons, but this is of course my journey and yours will be completely different. Whatever direction your career takes, just be sure you are in the driving seat. You are a nurse, and the options out there are unlimited, should you wish to find them and take up the challenge. If you are not happy with what you are doing, think about if and how you can make it better. If you feel that’s not possible then consider whether you will be content to stay as you are. If the answer is no, do think about what other options might be out there for you and what steps you can take towards making that dream job a reality.

WHAT’S NEXT?

Who knows? I love what I do and plan to keep on working and doing my little bit to reduce the burden of CVD on our population and support people to be the best version of themselves. I never rule out the option of getting a ‘proper’ job – if the right position came along and all the stars were aligned, it would be great. Like many nurses, I often think a nice little job in a local shop or café would make a change and be less stressful… but nursing is part of me, and I still feel there is more to give.

So, would I change it all? Definitely not. I love our NHS and admire all who keep it going on a daily basis and do feel I still play my part. When people ask my Dad what I do, he proudly replies ‘she’s a nurse’… and that’s what I am, and always plan to be – though perhaps slightly unconventionally.

REFERENCES

1. Nursing and Midwifery Council. Revalidation. https://www.nmc.org.uk/revalidation/

Accessed 5th January 2024