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On duty with a Dales district nurse

Justine Crabtree
By Justine Crabtree

Justine Crabtree swapped Greater Manchester for the Yorkshire Dales in her job as a district nurse and clinical practice teacher with Airedale NHS Foundation Trust. Here, she tells CPRE about life as a key worker in some of the country’s most rural communities

What does your role involve?

I’m a qualified district nurse and a clinical practice teacher, which means I’m responsible for workforce development and educating newly qualified district nurses, visiting patients with them and making our services the best they can be. Before this I was a clinical change lead in Oldham with a less hands-on role, but I missed being on the ‘shop floor’ of nursing. In April I moved to this role based in Skipton and Settle. Our team covers a big patch: from Airedale Hospital up through Settle and the northern Dales, bordering with Lancashire and Cumbria.

a nurse leaning on a wooden gatepost next to a drystone wall with green countryside behind her
Justine is used to nipping into gateways and lay-bys to find a signal | Will Amlot

What sort of patients do you see as a district nurse?

There’s no typical patient. You’re treating people in their homes, and you have to be ready for anything. But we tend to see a lot of elderly patients, and the more rural areas we work in often have ageing populations. Some have lived and worked in the Dales for many years, if not their whole lives. They’ve always been fit and active, and they’re used to looking after themselves. They don’t want any fuss! Our job is to build a rapport with them and make sure they feel informed and in control of the care they’re receiving. Patients want to stay out of hospital, and we do everything we can to help them get the care they need at home.

How has the coronavirus crisis impacted on your work?

It’s obviously a very challenging time, and the situation is changing every day. I had to put some of the education work on the back burner and roll up my sleeves to help the team out. We’ve been seeing a lot of patients we wouldn’t usually visit, but because they’ve been shielding, we’ve had to treat them at home instead of in a clinic. Some of our patients are testing positive, and a couple of staff have been poorly with coronavirus. But nurses are very resilient. It’s like a Blitz mentality here: if a crisis hits, let’s pull together. I’m very proud of that.

a quad bike leading a flock of sheep along a country lane in hilly countryside with drystone walls
Sheep on the road – just one of the occupational hazards of nursing in the Yorkshire Dales | Wayne Hutchinson/Alamy

What are the biggest challenges of rural district nursing?

Probably tractors! I used to have a bigger car, but after my first week here I decided to get a Mini instead, so I could nip past them on country lanes. And if you get stuck behind a flock of sheep, you’re scuppered! Seriously, though, the places we’re working in can be very remote – district nurses up in Settle can be driving 100 miles a day. And the Wi-Fi connectivity isn’t always great for updating patient notes online. You get to know all the lay-bys that are signal hotspots.

Does that rural remoteness affect the way you work?

No – our service is all about caring for people who are housebound, wherever they are. We’re used to trekking up country lanes and farm tracks. The first thing my team told me was, ‘You’re going to need a good pair of boots!’ Some services are geared towards rural communities. They run a chemotherapy bus up to Settle, for example, so cancer patients don’t have to travel 30 or 40 miles to get to a hospital.

A nurse in uniform standing in a steep country lane with a town in a rural valley behind her
Navigating steep country lanes is part of Justine’s daily routine | Will Amlot

Is living in isolated places a challenge for patients?

When we do a patient assessment we try to look at things holistically. So we do consider social isolation and signpost any care they need. Are they having problems with shopping and eating properly? Do their family live a long way away? Airedale recently ran a campaign to raise awareness of social isolation and where you can go to get support or for a chat. Charities like Age Concern, and local churches, do a lot to help.

What do you find most rewarding?

Helping people to be as independent as possible. I like looking after people at the end of life. You’ve only got one chance to get that right, and it’s satisfying when the patient and the family are together, and everything you’ve done has helped keep the patient comfortable, calm and where they want to be: in their own home.

'My commute is over the moors via Colne. If you stop at the top of the hill, on the left-hand side you can see all of Lancashire spread out below you, and all of Yorkshire to the right.'

Do you ever have time to stop and enjoy the landscape?

I live in Burnley and my commute is over the moors via Colne. If you stop at the top of the hill, on the left-hand side you can see all of Lancashire spread out below you, and all of Yorkshire to the right. I like to pause there and just look – it’s absolutely beautiful!

What makes a great district nurse?

Thinking on your feet. You need competence and confidence to treat someone, miles from the nearest help. If you have a passion for caring for people, if you’re good at problem-solving and if you can handle autonomy, it’s a fantastic, challenging, varied career. I’m a Lancashire lass, and I’m a district nurse; and if I were a stick of rock, that’s what I’d have stamped right through me!

Florence Nightingale’s bicentennial year, 2020, is the first global Year of the Nurse and Midwife.

A version of this article was originally published in CPRE’s award-winning magazine, Countryside Voices. You’ll have Countryside Voices sent to your door three times a year, as well as access to other benefits including discounts on attraction visits and countryside kit from major high street stores when you join as a CPRE member. Join us now.

a hospital and car park with rolling countryside with trees and drystone walls in the background
The rural surroundings of Airedale General Hospital, West Yorkshire - part of a massive patch covered by Justine's rounds Paul Boyes/Alamy

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