Glangwili Acute Kidney Injury (AKI) Nurse Specialist is first in Wales

Hywel Dda University Health Board has appointed an Acute Kidney Injury (AKI) nurse specialist – the first role of its kind in Wales.

As a Wales first, AKI Clinical Nurse Specialist (CNS) Paula Davies, who is based at Glangwili Hospital, Carmarthen wants to improve health outcomes for those with acute kidney conditions.

Paula, who has nearly 40 years of renal nursing experience said: “Acute Kidney Injury is a term which covers a spectrum of injury to the kidneys and historically, AKI management in Hywel Dda had been dependent on local non-specialist teams and visiting consultant nephrologists.

“In my new role my main aim will be to improve the outcomes for AKI patients in Glangwili Hospital. Early detection and intervention of AKI is so important. With my experience and advanced clinical practice skills, we will hopefully help prevent progression to single organ failure and reduce the need to transfer patients to Intensive Care or unnecessary transfer of patients to the specialist renal unit in Morriston Hospital.

“I will also be looking at introducing early follow-up appointments for patients who have been treated for an AKI and to deliver high-quality training to nurses and clinicians across all health care disciplines in the hospital.”

In August 2023 an AKI in reach service was established in Glangwili and was initially delivered by Dr Sharan Chugani, a nephrology specialist registrar (SpR) who had secured one-year funding for an out-of- program fellowship in value-based healthcare from Health Education In Wales (HEIW). Dr Chugani was supported by the two visiting consultant nephrologists. The appointment of the AKI Nurse Specialist post is phase two of the service.

Paula is very excited to take up this new and innovative role – a 12-month post funded by the health board.

“My renal background is extensive,” said Paula. “I was a dialysis nurse in the renal unit in Swansea for many years until I moved away. My husband joined the Metropolitan Police force and that took me away to London for eight years.

“I continued to specialise in renal care in King’s College Hospital, London, initially as a Senior Staff Nurse on one of the renal wards/high dependency unit before becoming a practice development nurse as part of the renal education team.”

On returning home to Wales from London Paula returned to the renal unit at Swansea Bay University Health Board, having been appointed as the First Renal Vascular Access CNS in the health board.

“Part of the role was the Advanced Clinical Practice element,” Paula explained, “Central Venous Catheter line insertion for patients requiring Haemodialysis treatment. I was the first one in Wales and, like my new role, it was innovative and challenging.

“I set up and established a robust service and I remained in the role for 18 years before I retired. On retiring I didn’t feel I was ready to hang up my uniform, so I returned to work as a renal dialysis nurse part time in the Carmarthen Dialysis Unit

“When I heard of this new and innovative renal post in the Health Board – I felt it was an excellent opportunity for me to amalgamate my years of renal experience and so returned to the NHS. I felt I had a more to give,” said Paula.

“It’s been a very busy few weeks,” said Paula. “I’ve got lots of challenges ahead and obviously I need to prove the value of my role and the service because we’d like to expand the service across the health board.”

Paula is Welsh-speaking, and she feels this is important when it comes to treating patients in the Hywel Dda area:

“It does make a difference for patients, I notice, when we see them on the ward, especially the patients from West Wales, many of them are Welsh speaking. A lot of our patients are the older generation, and they are a lot more comforted when they know that we can chat to them in Welsh. It’s important to make the patients feel at ease and communication is so important.”

As well as bringing her advanced clinical skills and knowledge to this new role, Paula is keen to provide mental health and wellness support to the patients having experienced an AKI and has been working with the charitable organisation the Paul Popham Fund, to support this.

“Educating patients to stay well is very important. Patient information leaflets will support the information given when they come to the post AKI clinics. It’s about keeping them healthy and informed, both patients and their families.”

Paula says it has been important for her to network and get to know the hospital and staff so that they understand her role and how she can support them in the early detection of AKI in patients.

“I’ve never worked in Hywel Dda – when I trained many years ago it was East Dyfed Health Authority in Llanelli Hospital, – my nursing career started back in 1984. I have never worked in this hospital but I have to say everybody has been receptive of my role and I have had a very warm welcome.

“It’s a big chapter, it’s a big challenge, but it’s very exciting, as I know I can make a difference,” said Paula.