I have been asked to share my story. My name is Joanne, but most people call me Jo. I have a beautiful daughter, who is seven, and a husband who is a children’s magician. I have recently celebrated my big forty with my sisters, who I share my birthday with as we are triplets.
This big birthday got me thinking that I have been a dental nurse for twenty-two years. I do not feel old enough to have this amount of years under my belt – I was around when we used to wear those elastic butterfly belts with our white dresses (as those other oldies among us may remember!). I was around when general anaesthetics were just being phased out of general practice and our steriliser was on the worktop in the surgery.
It amazes me how much dentistry has changed since I first started, and I feel privileged to see and experience the changes and how much things like cross-infection policies and our evidence base for preventative measures have improved. One of the biggest areas for me has been the development of extended skills for dental nurses. I love feeling more involved in patient care and working clinically with patients – I enjoy the collaboration and teamwork.
It all started for me when a dental nurse came into our school to provide our class with an oral hygiene talk and a demonstration. I'm not sure what made me think ‘I want to do that’. When asked what I wanted to be when I grew up, I just remember thinking that I wanted to be that lady who told us how to clean our teeth. I had wanted to be other things, like a graphic designer, clothing designer or artist, but the lady who made our teeth purple stayed in my mind. We used to have a dentist who visited the school back then as well, and that was how I became a dental patient of our community dental service. I was picked up on a screening due to my hyper-plastic 6’s. This was the age where all the ‘dodgy-looking’ tooth was removed and massive amalgams were placed. I was interested in what the nurse was doing, and I also had orthodontic treatment and loved it when the nurse mixed the materials. I had my mind set on wanting her job.
In the sixth form, I carried out my work experience in private dental practice for two weeks. The dentist knew my dad, and it had been arranged on the basis that I wanted to go into dentistry. I had never considered becoming a dentist; that job didn't appeal to me, as they just sat at the head of a patient all day. It was the nurse job I liked – being on your feet, getting the patients. The nurse seemed to be the one doing the most interacting with the patients, and I liked how varied the role seemed in community dental work.
During the two weeks of work experience, I got stuck in, and I loved every minute. These were the days before the CQC, risk-assessing etc., and I got to participate in practical dental nursing rather than just watching. I nursed for all the dentists in the practice and the hygienist, and spent time on reception and in the laboratory, as they had a technician on site. This was definitely the job I wanted.
I looked into what I needed to do and found that our local college ran the National Certificate for Dental Nurses. A job came up at the practice whilst I was on work experience, and after discussions with them and my family, we were in agreement that I should stay and finish my A-Levels. They did agree to allow me to work one day a week as a volunteer. This was my suggestion because I was keen to start working on the two years’ experience I needed to qualify, and I needed to be working in a dental practice to enrol on the course. It didn’t bother me that I was working for free because I loved it. Luckily for me, a job came up in the practice not long after I had completed my A-Levels – I didn’t have an interview, as I was offered it straight away.
I started the NEBDN course on the agreement that my certificate would be held back until I had reached my two years of equivalent experience. In 2001, I became a qualified dental nurse.
I stayed at this practice for almost five years. Having the lab attached made me consider becoming a dental technician. I spent some time at another local lab casting models and learning how to make bite blocks, and I got a place at Sheffield on the technician course. However, at the same time, a job in the community dental service came up, and I couldn't help but feel that it was this job that had made me want to be a dental nurse. I had to apply.
I couldn’t believe it when they rang me to say I had got the job. I decided to go for it, and I turned down the technician opportunity. Reflecting on this, it was the best decision I made. It was interacting with the patients that I enjoyed and in community dental work, this joy became even more apparent. I was given the role of community dental nurse but was asked to be involved with the oral health promotion team. I was ecstatic.
After my first week, I was not sure I had done the right thing. I had cried every night when I got home during the first week, as it was not what I had expected at all. I was used to a private practice, computerised notes and things like automatic processing for X-rays, capsules for amalgam and compules for the composites. I felt like I had stepped into the Dark Ages; there were paper notes with strange filing systems, and I had found myself chasing mercury across the worktop as we had to dispense the components from bottles into a mixer. I had to empty one spittoon from underneath at the end of a session and the chairs and equipment were all really old. I had to manually process X-rays in a darkroom with tanks of chemicals, and there were lots of strange quirks that I later realised were someone else's bad habits.
After the first few weeks, it started to get better. I worked with a special care dentist twice a week, and I enjoyed the complexity of the patients and domiciliary care. We carried out school visits and epidemiological dental surveys. Once I had settled in, I became more involved with the oral health team, producing leaflets and other materials, and I really enjoyed this. I started to love it, and looking back now, those practical old skills were very valuable in making me into the nurse I am today. I understand so much more about the processing of radiographs than I would otherwise have done, and I even used to cast study models for the orthodontist due to my lab experience. I loved how the job varied and how I was not working within the same four walls all week.
I became more interested in oral health and wanted to do some of the post-qualifying qualifications. My boss suggested that I start with oral health. I gained this qualification along with my radiography qualification in 2005. Around this time, I was also given the title of specialist dental nurse.
I found I enjoyed learning new information and putting into practice what I had learnt. In 2007, our building was getting knocked down and replaced with a health centre. The boss valued my input and that of a colleague who had started not long after me. Together, we had brought their service more up to date; we had upgraded the darkroom to a dark box initially and eventually to an automatic processor and electronic notes. In the new building, we had the opportunity to work with the development team and an outcome of this was a room designated for oral health promotion. It was a good time, as Delivering Better Oral Health had not long been published and commissioners were beginning to recognise the need for further prevention work, and our consultant in dental public health had started a review of oral health services.
The oral health room had two sinks for toothbrushing and was designed around providing preventative advice to patients. I used it to carry out one-to-one advice sessions with patients, and I was so excited. It was also great to become more involved with oral health. I remember one of my scariest moments at this time was making a presentation to local doctors and hospital staff about issues around oral health and how they could improve oral hygiene. My supervisor at the time reminded me that I was the one with the specialist knowledge and that the people there were attending in order to learn. It gave me the confidence I needed – although it was pointed out by my supervisor that I’d had the teeth model upside down the whole time! I didn't care – I was buzzing afterwards. It had been great being in a classroom environment with adults as opposed to children.
In 2008, I did my SAADs course, as I had started to work more with a dentist who carried out treatment on patients under sedation. We also carried out chairside GA and recovery of the patients. Every time I completed a course, it gave me the buzz to do another one. I wanted to know more about nutrition because in my clinics I discussed diet a lot, so I carried out a Level 2 certificate in nutrition and health. I think doing courses has become a bit of a hobby! As the industry progressed, legislation and policies were coming more to the forefront of practice, and I completed a VTEC in health and safety and occupational standards and a Level 2 course in health and safety in 2009.
In 2011, our local university sent out information that they were now offering funded dental courses. The one that interested me most was a pilot they were running which was a foundation degree in post-qualifying dental nursing. It incorporated The NEBDN certificates, and I could use APEL (Accreditation of Prior Experiential Learning) for the ones I already had as credits. The first module I carried out was Special Care Dentistry. This included a 3500-word assignment around an extended case as well as the criteria for the NEBDN.
I really enjoyed being at university. My next module was a work-based learning module in which we had to present a topic. I chose to deliver tooth-brushing techniques to patients with learning difficulties, and I enjoyed how my study influenced my working practices. I was able to utilise the skills I had developed in my clinics. The next modules included Dental Practice Management, Key Skills in Clinical Practice, Evidencing Personal and Professional Development, Work-Based Learning – Fluoride Varnish Supervising, Mentoring and Teaching in Practice, and The Policy Environment for Practice. I enjoyed all the modules but particularly those relating to supervising and mentorship and policy. The tutor had talked about taking the course to degree level, but unfortunately the funding was pulled and the dental courses no longer run at the university.
I had the bug now, though, for studying and wanted to complete to degree level. In the midst of all this, I also had a baby (in 2012). During this time, the oral health promotion role had expanded. Delivering Better Oral Health was well-established and on its third edition. After I returned from maternity leave, I took on the full role as an oral health promoter, and I was well-respected as a valued member of the team. We had extensive involvement with Public Health England and met with a consultant in dental public health regularly. Oral health promotion was fast becoming part of the wider health agenda.
I started the BSc in Health Professional Studies in 2014 and also gained my competencies in fluoride varnish and impression-taking. I graduated in 2016. The modules were Work-Based Learning – Making Every Contact Count, Perspectives on Public Health, Social Health and Policy, Research and Evidence Applied to Practice, Theoretical Principles of Conscious Sedation, and Working with Families and Communities to Safeguard Children and Young People. The university was helpful in helping me to choose a pathway that complemented my dental nurse and oral health promotion roles. I have enjoyed every module, and what I enjoy most about studying is applying what I have learnt to my practice. Other students on the course were midwives, health visitors and school nurses, and it was a valuable experience to learn with other professionals, some of whom I now work within my oral health role. It was a little crazy at the time to think that I was doing the same course as these professional types, but I could never advance into their roles as I was not a registered nurse.
Almost immediately after this, I started my PGCert Educator in Practice Level 7. I wanted a teaching qualification to support my oral health promotion role and hoped to use APEL to transfer the credit onto a master’s programme in leadership.
My role then was very much the early stages of what I do now. I am classed as dual-roled in our department; I am assigned to clinical duties for the community dental service for two days a week, and for the other two days, I am commissioned by our local authority to carry out community health promotion. This involves the planning, delivery and coordination of population-based oral health promotion initiatives using local and national oral health strategies and statistics. I liaise regularly with schools, colleges, healthcare services and residential homes in which I provide training and provide targeted oral health programmes. I have developed and delivered specific training programmes, and these include regular updates for school nurses, health visitors, and residential staff. I also deliver workshops on dental health and safeguarding. I am involved in projects to improve oral-health-associated risks in hospital and community settings for aspiration pneumonia and to ensure patients receive an oral health care assessment when deemed high-risk in hospital. I have developed a local online training site which includes the Making Every Contact Count initiative and is specific to dental professionals.
I love my job, and I love the balance between my oral health promotion role and my clinical role. I still carry out my one-to-one sessions and regularly used my extended nursing skills. Most of our patients have complex needs, and they often need lots of acclimatisation and behaviour management. I find this very rewarding. I enjoy that I get to put my study skills into practice by inputting into the development of our local oral health strategies and oral health policy.
I am still studying – I think I always will be. As I have said, I think it has become a hobby; I miss it when I finish a course. I completed the NEBDN sedation certificate in 2018 to complete the set of dental nurse post-registration qualifications most relevant to my role. This year, I started an EMBA in management and leadership. Having completed the first three modules, I have realised it is a very different world than the one I am accustomed to, but I am learning about strategic management and marketing. It is hard work, but I am enjoying it so far. I have been able to utilise some of the skills learnt already in my oral health reports for commissioners.
I am currently seventeen years into working for a community dental service, and I still thoroughly enjoy it. I love the diversity of my role and how not one day is the same. I believe that all the courses I have done have strengthened my practice.
I am pleased to have the opportunity to work for Dental Nurse Network and share my knowledge and expertise. Oral health is my passion, and not only do I have the clinical elements, but I also work within the community as well as strategically with our local key stakeholders.
It is a pleasure to work with students to develop their skills and practice and to advise and contribute to someone else's learning experiences. In the future, I would like to become more involved in teaching the skills and knowledge I possess and look for opportunities to further develop my leadership skills.
