My name is Hannah Guest. I am a Band 7 Lupus Specialist Nurse at the Queen Elizabeth Hospital Birmingham (QEHB). This article is about my five year journey with LUPUS UK and what the next five years might look like, both for me personally and for the Lupus service at QEHB.

I graduated with a 1^st class Honours degree in Nursing from the University of Birmingham (UoB) in September 2013. Shortly afterwards I began my first Staff Nurse job at QEHB. I was unsure as to which speciality I wanted to work in at that point, but I had undertaken my final student nurse placement on one of the renal wards at QEHB and really enjoyed it so decided that would be a good starting point.  For the next four years I rotated around the renal unit, covering sub-specialties including acute and chronic kidney disease, the renal high dependency unit (HDU), peritoneal dialysis and renal transplantation. I enjoyed all elements of renal nursing but struggled to find my niche. Unfortunately in 2017 I found myself facing re-deployment due to a long-term mental health condition and it was at that point that QEHB (a LUPUS UK Centre of Excellence) posted an advert for a Lupus Specialist Nurse, supported by five years worth of funding from LUPUS UK. I was successful in my application for this post, and was subsequently taken under the wing of Senior Renal Research Sister Mary Dutton, and two wonderful consultants: Dr. Peter Hewins (Nephrologist); and Dr. Ben Rhodes (Rheumatologist). Together Mary, Pete and Ben gave me the belief, time and support that I needed to get well and to succeed in the role, together with invaluable guidance/leadership, knowledge and opportunities. I really couldn’t have asked for a better trio to rescue me from the low point that I was at in my career and in my life, and to set me on a new path where I would go on to achieve more than I (and many others) thought possible.

 For the first two years I worked alongside Renal Inflammatory Disease Specialist Nurse, and former LUPUS UK Specialist Nurse, Sarah Logan. Sarah then commenced a three-year secondment to undertake her PhD and I took over as the lead nurse for Lupus. Since then I have I brought the Renal and Rheumatology Lupus cohorts together to create one specialist service, contributed to the Lupus research portfolio alongside colleagues in the Renal Research Team, and engaged in continuing professional development.

Currently, I provide specialist nursing care for all Lupus patients at QEHB. This is achieved predominantly through participation in multidisciplinary clinics and by running a dedicated Lupus patient helpline. I have also been instrumental in the set-up and running of a weekly multidisciplinary team (MDT) meeting. This meeting fulfils the NHS England requirement for the use of biologics in the treatment of Lupus to be approved by a speciality MDT and also provides a venue to discuss complex patients, research developments and service change. I have worked hard to build a rapport with our large and diverse patient group, to earn the trust and respect of colleagues both internally and externally, and to achieve autonomy and independence in the role. I have supported my development of clinical knowledge and skills through the attainment of academic qualifications (including Health Assessment and Non-Medical Prescribing courses obtained from Birmingham City University) and clinical qualifications in Mentorship and Motivational Interviewing.

In 2018/2019 I participated in a national audit of compliance of Lupus care with BSR standards, which was presented at the BSR conference and published in the journal ‘Rheumatology’ (Pearce et al, 2021). I also led an audit of the Lupus service and relapse rates at QEHB in 2019 and presented this at the UK Kidney Week Conference (Guest et al, 2019). My research work currently includes being the lead nurse on a multicentre study and assisting with two other pioneering studies that will hopefully lead to new and improved treatments for Lupus patients in the future. As with my clinical work, my research work is underpinned by academic qualifications including the Birmingham Health Partners Clinical Academic Internship Programme and Research Governance and Project Management masters module, both obtained from the University of Birmingham.

In the summer of 2022 I liaised with my matron and consultant colleagues to submit a business case and job evaluation, ahead of the expiration of LUPUS UK funding in September 2022. Effectively we asked the Trust to take over the funding of the post, to make it a substantive one and to up-band it to reflect the experience and skills gained and to recognise my new qualification as a Non-Medical Prescriber. All of this was approved.

Alongside my achievements in the job, I have achieved stable remission from my mental health condition and grown in confidence and maturity. All of this culminated in me receiving four nominations for the Trust ‘Kind, Connected and Bold’ Awards in November 2022. Additionally, QEHB has maintained its prestigious status as a LUPUS UK Centre of Excellence, which is not only a source of pride for myself and my colleagues but gives our Lupus patients confidence that the care they receive is going to be of the very highest quality.

I cannot thank LUPUS UK enough for the initial five years of funding that made the creation of a Lupus Specialist Nurse post at QEHB possible. It is a privilege to carry out this very special role and I hope that in years to come many more nurses will have a similar opportunity as LUPUS UK endeavours to fund more Lupus Specialist Nurses up and down the country.

Over the next five years I hope to continue to grow the Lupus service at QEHB and to expand nursing provision to support this. I also aspire to complete an MSc in Advanced Clinical Practice. Above all, I will strive to ensure that as a service we continue to provide excellence in care to each and every one of our Lupus patients and their families.  

In loving memory of Mary Dutton (24/07/59 – 25/01/22)

References:

• Guest, H., Thomas, R., Chanouzas, D. et al (2019) A retrospective evaluation of SLE services and relapse rates of patients with Systemic Lupus Erythematosus (SLE) at the Queen Elizabeth Hospital Birmingham (QEHB): 2015-2017. Poster presentation at UKKW 2019.
• Pearce, F.A., Rutter, M., Sandhu, R. et al (2021) BSR guideline on the management of adults with systemic lupus erythematosus (SLE) 2018: baseline multi-centre audit in the UK. 60(3): 1480-1490.