I met Jane for her interview at my home after we struggled to find a mutually acceptable location. The interview with Jane was relaxed and she said she felt comfortable. We sat at my dining room table and I had offered Jane a drink to help her to feel at ease.
Jane qualified as a learning disability nurse in 1989. She had undertaken a health and social care course and been placed for work experience in a special needs school. There, she realised that she would like a career in caring and so the careers officer pointed her in the direction of nurse training. Jane describes her time starting out as a student as a positive time in her life:
‘So I embarked on this three years’ training, that I didn’t really have a clue what I was really going in to, I suppose I didn’t know much about institutions, I didn’t know much about the care that was provided at the time, but I saw it as a positive thing, a positive time in my life’.
This positive time was also linked in her narrative to leaving home and moving away from family circumstances that she had described as difficult. Jane described some difficult times during her training when she was challenged by what she saw and questioned whether this was the career for her. After qualifying, Jane stayed within the hospital environment, working initially as a D grade (Whitley grading structure) and then, within eight months, an E grade (Whitley grading structure); applying for deputy sister post some two years later. In early 1999, Jane moved from within the residential services in the hospital to a community-type job in outreach services, as a G grade. However, she was unhappy in this role, there were some challenges with staff and when, in the summer of 1999, a post had become available in the community nurses team she joined them. Jane has worked there ever since.
I had known Jane professionally for a number of years. Jane was very relaxed telling her story, and told a linear story starting from when she left school. She described her home situation but also seeing embarking on her nurse training as an adventure. Jane’s narrative had a balance of descriptions of what she was describing as some very difficult times for her to examples of her work with people.
Although Jane approached the narrative with a relaxed approach, around two weeks after the interview had taken place I spoke to Jane unrelated to the research project and she said she had been left with some challenging thoughts following the interview. These particularly related to reflecting upon her family situation and some of the reasons she had given in her story about leaving home. We discussed this for a while, as I wanted to be sure she had the opportunity to share how she was feeling.
My interview with Narisa took place in a room within the Trust she was working in. It was the first time I had met her but she was open and friendly and told her story easily, sharing both professional and personal aspects of her narrative.
Narisa had worked in jobs other than health care until she was around 34 years of age. Then, after spending a prolonged period of time with her son in hospital, who subsequently died, she saw what the nurses did. After giving birth to a daughter and being at home with her until school age, she was inspired to start her training in adult nursing in 2001. She decided that learning disability nursing was for her during a short placement in the early part of her nurse training, working with people with learning disabilities. After an interview, Narisa was allowed to change branches and continue her nurse training as a learning disability nurse. Narisa acknowledges the role her family played in supporting her to undertake her nurse training but also her ex-husband and his family being a catalyst for change in her personal life.
‘My mum was all for it as, like I say, my mum’s obviously a social worker and follows a similar thought process as myself, no it was my ex, well he’s now my ex-husband and his family, his father and mother, are of an older generation than my parents and they were, they thought, there was no point to people with learning disabilities and had indeed lots of different names for them, my husband had obviously been brought up in that arena and carried those views also, although tried to be quite liberal, couldn’t and so he didn’t see the point of it. very offensive things going on, but I got rid of him when I qualified (laughed.’
After qualifying, Narisa went to work first in a long-stay challenging behaviour unit and then an independent sector brain injury unit, finally becoming ward manager in 2008. Wanting to get back to working with people with learning disabilities and having an interest in issues around accessing health care, Narisa applied for and secured a post as an Acute Liaison Nurse and has been working in that environment since. At the end of the interview, Narisa said it had been ‘cathartic’ and she had felt ‘counselled’, suggesting that the narrative had been a story she was waiting to tell but also the technique had allowed her the opportunity to share the aspects of her story she chose to.
Meeting Wendy for the first time was with a little nervous anticipation, as we had been emailing each other in the weeks prior to the interview as Wendy had said she would like to be part of the study but had not been working for a while as she had a diagnosis of a terminal illness. We discussed via email whether she would like to be part of the study and I explained that she could withdraw at any point, and would see the transcript prior to data analysis. We also discussed the nature of the learning disability nursing community and some of the difficulties in maintaining anonymity. Wendy was keen to be involved, but I remained nervous when meeting her. Wendy chose the meeting place close to where she lived; a quiet pub, and we found a corner to sit undisturbed. She was friendly, open and used humour throughout her telling of her narrative. She had lived this story. It was me hearing it for the first time.
Wendy started her nurse training in 2009 after working in catering for some years. She had some experience of illness, both physical and mental, in her close family and decided she would like to be a nurse. At the time of the interview, Wendy had retired from nursing on ill-health grounds after being diagnosed with terminal cancer. She had had a difficult period during her training and on the first day of her new job post-qualifying collapsed, was admitted to hospital and was later diagnosed with cancer. Her journey into learning disability nursing had been like many other participants, a journey first into nursing and then, after working with people with learning disabilities, a choice to train as a learning disability nurse. Wendy had also been determined to ‘prove her father wrong’ as he had told her she would never become a nurse. At the time of the interview, she described a difficult relationship with her father, with little or no contact for a number of years. Wendy also separated from her husband during the period of nurse training and was then managing her nurse training whilst raising her children. There were many challenging times for Wendy during this time, including serious illness, her marriage breakdown, and managing teenage children on her own. She also describes the negativity of others towards a career in nursing, more specifically learning disability nursing, starting with her father when she was around 16, and then with those working in
care services, suggesting that learning disability nursing was ‘going nowhere’. Wendy’s story was, however, one of determination and she describes this as ‘almost killing her’ as she ignored the physical health problems she had in order to continue with her training. A key memory of the interview for me was when Wendy talked about ‘giving up’ nursing due to her illness:
‘then it proper sunk in and I did more and more research and realised that I had no option I had to get a surgeon to operate because I was dying, and I couldn’t breathe. I was getting really laboured breathing, was in and out of hospital because me stoma weren’t working and stuff like that. It was just a nightmare and was liaising with work, trying to sort of be upbeat, they were like oh .. had me in and I think that was the first time I cried and then I realised I was totally obsessed with this job (laughing) because I never cried when I found out I’d got cancer but when the thought that when they said look you’ve really probably need to just concentrate on getting well and your contract finishes in March, so you seriously you know we’re 100% behind you if you want to retire on ill health……And our advice to you is to enjoy what time you’ve got with your family, I was like you have got to be joking (laughing) you’ve got to be joking, and it’s the only time I cried, just the thought that I couldn’t go back to work.’
The narrative around becoming a nurse ends for Wendy upon qualification and retirement on ill-health grounds some months later. At the time of interview, Wendy was still on the nursing register, had had major surgery and was hopeful that she would be able to go back to work sometime.
My reflections upon this interview were, at the time and when re-reading the field notes and transcripts, a mixture of emotions. Wendy had described risking her health and potentially her life to be a nurse. She had also reflected at the end of the interview that this may all have been to ‘prove herself,’ as her drive to actually practice had waned once she had achieved her qualification. The focus of her narrative was on the personal aspects of her story; divorce, bringing up teenagers, and ill health could have created a very sad and potentially negative narrative, but Wendy told this with humour and positivity.
Postscript note: Wendy had major life-saving surgery and treatment five years cancer controlled and working occasionally as a carer.
My interview with Paula took place in an office in her workplace, a large long-stay hospital. I had known Paula in a professional capacity for many years and, during her narrative, this led to assumed understanding of local issues. It was a relaxed interview as Paula told her story, and, even when we had to move location because someone else needed the room, the story flowed naturally and easily. Paula appeared reflective when discussing her initial experiences of learning disability prior to applying for her nurse training. She was aware of how her narrative at the time of the interview may be based on years of experience and, making sense of those experiences over 30 years previous, with hindsight. At one stage when discussing her friendship with a child with learning disabilities when she was young she said:
‘It was still like a mix, when I think back actually it was quite…. in many ways ….I think it was probably quite advanced I suppose, ….I went to grammar school in 73 so I’m talking about the mid 70s, which is early on, and I guess there were a lot of things going on and perhaps I wouldn’t register that they were having things done to them …..it felt and it still feels that we very much did things together and it still was very much that element of friends’.
Qualifying as a learning disability nurse in 1984, Paula had originally wanted to work with horses. Having a family friend who had a learning disability and, after doing some voluntary work with people with learning disabilities in a social environment, led Paula to feel that learning disability nursing might be for her. Starting her integrated course in 1981, Paula had decided quite early that learning disability nursing was her goal, but she also saw the integrated course (dual qualification in learning disability and mental health) as an opportunity to gain more than one qualification. After qualifying, Paula took up her first staff nurse post in the hospital where she trained. She worked on a range of wards until 1986, when she got her first community nurse post at sister/charge nurse level within the Trust’s community learning disability team. Moving from a county to a city-based team in 1989; Paula gained further experience as a community nurse. In 1995, Paula moved into a management post, managing community areas and, although the nature of her role has changed a number of times in terms of whom and, geographically, where she manages, Paula has stayed in this management role.
Interviewing Paula felt as if I was with a natural storyteller, her story flowed easily and she appeared to have no concerns with the interview technique. Like other participants, I had known previously in my local area there was an assumed knowledge of the local health provision and an expectation of shared understanding.