Michelle Greenwood22nd March 2013
Michelle Greenwood is Tissue Viability Lead, Walsall Healthcare NHS Trust, Chair of the Wound Care Alliance and Associate Senior Lecturer at the Faculty of Health’s Tissue Viability Practice Development Unit, Birmingham City University
I’ve worked in tissue viability for 20 years, but came to Walsall Healthcare NHS Trust two years ago. Effectively my role is that of a strategic lead, which involves managing the team as well as moving the service forward. Recently, the trust have integrated my role to include the community and acute sector, so I am currently spending quite a bit of my time going out into the community to meet the district nursing teams.
I work long hours by choice due to the demands of the job. As I live 48 miles away I tend to head off early, getting to the trust for a 7.30am start. First thing in the morning I like to catch up on emails and discuss the patients with the band 6 nurses, which provides the opportunity to raise any issues in service that might have arisen. I make a point of never attending meetings just for the sake of it, only going to those where I am chair or an agenda item.
The nature of my job within the acute trust is office-based, as I am involved in managing equipment contracts, writing tenures, and am currently working on the new wound care formulary with procurement which will need to be submitted as a business case to medicines management. Acute and community share the same formulary at my trust.
I also carry a caseload of patients, which is predominantly in the acute sector, as I tend to see the more complex cases. I am seeing many more patients than I should at the moment, which is partly due to reducing pressure ulcer rates. However, I am leading on setting up a new complex wound clinic in the acute organisation, which should help my caseload. The situation at the moment is that patients with recurring wounds will just turn up on an ad hoc basis, which is often totally unplanned and then has to be fitted into the day’s routine. It is hoped that by taking a more pro and reactive approach, the new complex wound clinic will put a stop to this. Also, the clinic can then charge for seeing patients, rather than treating them as a gesture of goodwill.
As said, with the new integrated service I also spend time in the community. This is very much an educational/supervisory role. The focus on pressure ulcers means that I am particularly involved in identification. The tissue viability team now have to validate every pressure ulcer and confirm its category, which has massively increased the workload. Often the patient’s report says it is a category III pressure ulcer, but when you go and assess, it is actually a grade II or IV. An element of education is needed around validating, as due to targets/financial penalties there is a real fear of getting it wrong. It is interesting to see that referrals have doubled year on year since 2011.
We do need to look at better ways of working though, such as with telehealth and using cameras so that the tissue viability nurses and myself do not have to physically go out, which can be very time-consuming in the community. I think that this is a problem common to many services.
I also work one day a week at Birmingham City University (BCU) as an Associate Senior Lecture. This is the result of funds secured from Worcester Acute Trust who have recognised that education is key. Staff find it difficult to access relevant education, so at BCU I am challenged with developing an interactive teaching package.
Another role that I have also taken on since November 2012 is Chair of the Wound Care Alliance (WCA).
My day, which is always varied and busy, finishes around 7.00pm, so I usually get home about 8.00pm.