"It can be extremely rewarding. Public health can offer good career development and progression opportunities for nurses."
Sarah is a Tuberculosis (TB) nurse specialist and lead nurse for a TB contact tracing project in London. TB is caused by an airborne bacterial infection. It can affect any part of the body, but most commonly the lungs.
I was studying for a degree in human sciences at the University College London (UCL), when my interest was sparked in public health and health inequalities. My dissertation was about the HIV epidemic in Thailand, and, after my degree, I volunteered in Brazil for an HIV organisation.
When I returned to the UK, I realised I wanted more practical skills, so I decided to train as a nurse. After I qualified I did a rotation in infection and immunity at Bart’s and the London. This involved spending time in HIV and infectious diseases inpatient wards, and HIV and sexual health clinics.
After I completed my diploma in tropical nursing, I wanted to gain further experience in the topics I had studied. I started working at UCLH (University College London Hospitals) on the tropical and infectious diseases and HIV inpatient unit. I then got the opportunity to become a TB Nurse Specialist. I absolutely loved this role, which combined local care (primary care), hospital care (secondary or acute care), public health and working closely with patients and their families to help them successfully complete treatment.
After a few years, I took the opportunity to work in Public Health England’s National TB Section as a TB nurse specialist. This role involved providing advice to healthcare professionals about the management of TB cases and incidences. I learnt a lot in this role and really developed my public health knowledge; however, I missed direct patient contact. That is what I thoroughly enjoy about my current role at London TB Extended Contact Tracing Team (LTBEx): I am able to combine patient skills with clinical skills and public health knowledge – it’s fantastic.
I am the lead nurse and Tuberculosis (TB) nurse specialist for the London TB Extended Contact Tracing team (LTBEx). The LTBEx team is multidisciplinary and consists of a consultant in health protection (doctor), health protection specialist (scientist), clinical nurses, an administrator and information officer. My role has both clinical and public health aspects. I lead on, or assist with, all aspects of investigating and managing TB incidents in London. To do this, I work closely with colleagues in Public Health England’s health protection team and NHS TB services.
Once we have been referred a case of infectious TB who attended an institutional setting, for example, a nursery, school, workplace, hostel, we work closely with the managers at the location to carry out a risk assessment to identify people who have had significant and close contact with the person with TB whilst they were infectious. This is known as contact tracing and is one of the cornerstones of TB control. We inform these people and then offer screening in their location, by doing a health assessment and either a mantoux skin test or blood test.
Communication is an important part of my role. We work closely with healthcare professionals and also with people in education, local authorities and the community. When we are arranging screening we also offer TB awareness sessions for students, parents and staff. It is a good opportunity to address some of the stigma and lack of knowledge about TB, both of which can be barriers to people seeking healthcare.
Once the screening has been completed, we collate the results to check we have done everything necessary to protect the public’s health. Those people who require further investigation or follow-up are referred to NHS TB services.
My role involves combining clinical and public health experience relating to TB, so it is essential that I am an experienced TB nurse. I am skilled in caring for those with TB, and I am aware of screening pathways and treatment options. Through being a specialist nurse, I have become used to working on my own initiative and working together with different healthcare professionals.
I have not undergone any formal public health training, but have gained public health experience and skills from working in the national team and LTBEx, being trained by health protection specialists. I plan to complete a public health Master’s qualification soon.
It is exciting to work on an innovative project and to see fantastic results so quickly. By offering on-site screening, we’ve greatly increased the number of people who take up the offer of screening. This has resulted in finding a higher number of people with either latent TB or active TB disease, both of which can be treated. We are able to screen a large number of contacts efficiently, and able to detect transmission and possible outbreak situations quickly and prevent transmission.
I am extremely proud that LTBEx won the Public Health Nursing Award at the 2014 Nursing Standard Awards.
Public health is a fascinating and important area to work in. As a qualified nurse, there are ways to combine your clinical experience with public health knowledge. It can be extremely rewarding. Public health can offer good career development and progression opportunities for nurses.