Good leadership in the NHS depends on creating a culture where "everybody's voice counts", Scotland's nurse of the year has said.
Speaking to the Herald following her win at the Royal College of Nursing awards, Lynsey Russell, the senior charge nurse (SCN) for intensive care at Borders General hospital, said she was "absolutely dumbfounded" by the accolade.
As well as scooping the top award, Mrs Russell - who was nominated by her colleagues - also won in the category for clinical leadership.
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She said: "I've worked with a lot of them for a long time - they call me the gaffer, and I like that.
"I don't have a lot of hierarchy in the unit and I think that's good, because I've been in their shoes.
"I've done that job, I know how hard it is.
"For me it was important to create a culture where absolutely everybody's voice counts. I think that's what makes good teamwork.
"And I always make sure I do a clinical day every week. That's really important to me, because to be a leader you should never be too big to do the small things.
"One of my favourite jobs is still giving a man a wet shave."
Mrs Russell, 47, from Tweedbank, was inspired to purse a career in nursing after her grandfather was admitted to hospital when she was a teenager.
She had previously hoped to train as a PE teacher - admitting that she only stayed on until sixth year at school "to play hockey" - but was forced to reconsider when her grades fell short.
She found that she "loved learning about the human body" and after qualifying with a diploma in nursing and beginning her career as a theatre nurse at Borders General in 1997, she decided to further her studies with a degree in nursing.
One of the modules was in critical care, leading to a three-month secondment to intensive care.
"I never went back because I loved it so much," said Mrs Russell.
"[Intensive care] was joined onto theatre, so I used to come through quite a lot on the nightshift and mooch about to see what was going on.
"I loved the buzz about it, the high acuity, the fast pace. I loved looking after sick patients and seeing the difference that you make in their lives.
"Sometimes we get a lot of tragedy but a good percentage of our patients do recover and do well, and seeing them on that journey from being really sick to when they come back and visit us, it's so rewarding.
"We had a patient last year who was with us for 10 months, so you become quite attached.
"You become their family for that time."
Mrs Russell - who is married with two stepchildren and a 14-year-old daughter - put her passion for learning into practice were she was appointed SCN in August 2020, at the height of the Covid pandemic.
At the time, intensive care units across the UK were rapidly expanding their staffing with doctors and nurses redeployed from other wards in the hospital who were suddenly grappling with an unfamiliar clinical environment under high-pressure conditions.
In her own unit, Mrs Russell developed a critical care "cheat sheet" which became a surprise social media phenomenon.
She said: "We had new staff, redeployed staff, and it was really about trying to make things easier for them.
"People were scared and working in an environment unfamiliar to them, so we asked them - what would be beneficial to you?
"They were using ventilators and pumps and drugs that they had never used before, so they just wanted to know things like 'what would be normal values for patient results?'.
"We developed a 'cheat sheet' and put it on the wall and I put it out on Twitter and it just went viral.
"Suddenly critical care units were using it all over the country."
More recently, Mrs Russell has successfully lobbied for the appointment of a dedicated nurse educator within ITU to drive up the team's skills and professional development, while also spearheading a shift in intensive care from a medical-led to nurse-led protocol.
She said: "The project was all about sedation.
"It's been shown that if patients are more awake when they're on a ventilator they can be more involved in their care, and it actually reduces mortality and length of hospital stay.
"We've put all our staff on a critical care course and seeing them grow in confidence, that's what I love.
"In a district general we don't have doctors on site all the time, so it's given them a real boost, and actually the patients prefer the nurse-led approach."
The model has now been shared with three other intensive care units in Scotland and, in October, Mrs Russell will present the findings at the British Association of Critical Care Nurses (BACCN) conference in Aberdeen.
She added: "There's a lot of doom and gloom about nursing, but I think we have to rewrite the narrative and say 'actually, nursing is a profession and there are so many opportunities'.
"We have to get across the positives and attract the junior nurses in.
"If you give them the proper education and the tools and the staffing ratios to do their job - that's what makes them flourish."
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