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Nursing at Harefield Hospital: my NHS career

Carol Gadd, cardiothoracic clinical service manager at Harefield Hospital



Carol Gadd

4 July 2018


Harefield Hospital is an amazing place to work. It sits in the country, looks like a sleepy place from the outside, and people seem very relaxed.


Then you open the doors to the hospital and there is this incredible work ethic going on, in the operating theatres, catheter labs on wards and in departments.


When there’s an emergency, staff just click into place.


There is this true pioneering spirit here. Some incredible innovation has been introduced over the years and staff have  embraced it with a positive ‘can do’ attitude. There is a quiet genius at work.


Harefield Hospital has always been a very familiar place to me; I went to school locally, I did voluntary work here during that time, I started my nurse training in 1975 and as a student nurse I did my placements here.


At that time, Harefield was still a general hospital. As well as general surgery, we offered paediatric and geriatric services. It wasn’t the centre of cardiothoracic excellence it is today.


When a staff nurse position came up at Harefield in 1981, I applied. And I just never left.


As heart surgery really took off in the late ‘70s, Harefield began to garner a reputation for expertise. Over time it became a specialism and gradually, geriatrics and general surgery stopped. 


The heart of the matter


The first heart transplant at Harefield Hospital was performed in 1980. The first lung transplant was in ’83, I remember the patient well.  


We’d always been a centre locally for respiratory medicine, but this was putting us on the radar nationally.


In terms of this hospital, I believe that nursing here was both innovative and ahead of its time, but we didn’t recognise it back then.


This constant evolution is what has kept me here. About every three to five years there is major advancement or shift in the way we do things.


As well as the transplant programme, we have angioplasty (where a catheter is inserted with a small balloon, into the coronary artery to improve blood flow), which was introduced to Harefield by Dr Ilsley in the ‘80s.


It’s routine now, but I vividly remember the barbaric looking clamps which we used to place over the patient’s groin, to prevent bleeding. It might have looked alarming, but there’s no doubt this innovation saved many lives.


Fast forward to the present – we are now implanting total artificial hearts!  


Professor Sir Magdi Yacoub


Of course the one person who has become synonymous with Harefield Hospital is Professor Sir Magdi Yacoub.


The Professor was a maverick. He played a major part in building up the hospital’s reputation. He was doing ground-breaking work and these were historic times, both exciting and unpredictable. I feel privileged to have been part of the team during this time.


Things may not always have been approached in the conventional way – but problems got solved and paved the way for future services.


We only ever really realised how revered Professor Yacoub was when his pioneering work began being recognised nationally and internationally.


When I look back now, I realise I was working with someone special; he was always very softly spoken and polite to the nursing staff, always consistent in his manner.


Professor Yacoub rarely slept – he used to cat nap – he could on occasion be found catching 40 winks on one of the patient transfer trolleys! 


Nursing transplant patients


I worked with transplant patients for five years. It’s hard to explain how intense things were. In those days, transplant patients would be in an isolation room for six months and required one-to-one nursing.


Nurses had to remove all of their clothes and put on a full set of sterilised attire prior to going into the patient’s room. Absolutely everything that went into the patient’s room had to be sterilised first – including things like their toothbrush, slippers, newspapers – this was often trial and error as many items would shrink during this process!


Once you were in the room you’d stay the whole shift, as you’d have to repeat this routine every time you stepped out and re-entered the space.   


It could be claustrophobic both for the patients and the nurses.


The time of isolation and recuperation started to reduce as the transplant programme grew. Some patients can now be discharged from hospital within as little as 10 days.  


Changes in the NHS


The changes in the way hospitals are managed made us completely review the way we do things in the early 2000s.  


For example, we put two wards together and had one sister and one ward manager, rotated the staff teams more efficiently and also used the beds more effectively.


Matrons were re-introduced and all ward managers automatically became ‘modern matrons’. This nursing structure continues to work well.


Now of course we have specialist nurses and nurse practitioners – a new and highly-skilled breed of nurse with an incredible amount of specialist clinical knowledge – I think the patients love them.


Caring in nursing


I am aware that some people worry that today’s emphasis on high levels of education, will have a detrimental effect to nurses giving patient care.    


From my perspective, caring is integral to the training, although it comes more naturally some than others.


Project 2000 was introduced in the early 1990s which moved the training of nurses out of hospitals and into universities. Nurses used to be trained on the job, going to school within the hospital.


People did question as to whether treating them as university students was the best thing. After all, you still need to provide basic nursing care. It’s essential that patients in hospital feel cared for.


With the amount of technology involved these days, it can be hard to flip from clinical process mode to caring mode.


Every so often, we have to pull back and say: ‘Are we caring? Are we doing enough?’ That is not a bad thing in my opinion. It’s important not be complacent.


Things are evolving again, and coming around full circle. A new role is being introduced in England, the nursing associate, to bridge the a gap between health care assistants and registered nurses.


The structure of nursing along with the different kinds of nurses can seem quite complex now, but good basic care remains fundamental to each and every nursing role.  


Juggling nursing with life


I had both my children in my 30s. Both my children spent time at the hospital crèche, I was fortunate that it had just opened around the time I had my first child. I had always worked full-time and continued to do so following maternity leave. Paid leave was less back then, so I returned to work when my children were three months old –  it was tough and I used to get very tired, seems a long time ago now!


Perhaps it’s not surprising there is a nursing shortage. The majority of nurses are women, and some have career breaks to have families. We have a highly skilled work-force – we want to retain them. We need to ask questions in the NHS: is it about pay? Do we expect the right things from nurses?


In the old days, you just had to accept shifts. People are taught to question now. There are choices. Some people don’t like night shifts and over time many nurses will gravitate to 9-to-5 jobs. We need to look at ways to make things work for everyone.


Merging with Royal Brompton Hospital


I must be honest, we were a bit worried prior to the merger with Royal Brompton Hospital 15 years ago. We were friendly rivals before, and there was certainly an adjustment period.


At first, there was an attitude that we must be one Trust, so it should be absolutely seamless. But we do work in different ways, I think now we’re more complementary than exactly the same. I talk to counterparts at Royal Brompton Hospital, we share ideas, but it’s more relaxed – and we get the results we need for our patients. 


The patients


These days I am a service manager, looking after all ward areas, nurse specialists, cardiac rehab, and outpatient nursing staff –  I ensure that the patients and staff are safe, that we’re compliant and professionally competent, ensuring that they are up to date with current issues and I will support them in any way I can. I follow-up any concerns or complaints, I ensure that patients receive appropriate support and that we provide the best care that we can.


Although I worked for around 25 years as a ward nurse, it would be hard for me to go back to ward nursing now. Technology has changed the way nurses work, I have had my time and I am very happy and proud to support others during theirs.


One of the things I do miss is spending time with patients and I’ll always carry some special memories with me.


There were some amazing incidents of patients coming in, so ill, so poorly: You think, ‘They’ll never survive.’ And sadly of course, there were times this was true.


But more often, incredibly and miraculously, many of these very poorly patients would walk out after successful treatment and get on with their lives once again.


As I said, Harefield Hospital really is an amazing place.

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