I’m Becky Bonfield and I’m the acute kidney injury clinical nurse specialist at University Hospital Southampton NHS Foundation Trust. I’m in a unique position because my role sits within the patient safety team.
I work closely with the renal team, but sit outside of it, focusing on patients within the Trust with AKI.
This is what my working day looks like.
Every morning I receive the AKI electronic alerts from pathology that highlight the patients who have had AKI within the last 24 hours. I then review the list to see which patients have had AKI stage two and three so that I can review them.
I always start my day on our medical admissions wards because, due to the nature of the work, these patients require urgent input for their AKI. When reviewing the patients I undertake a complete physical assessment, take the patients’ history and review their observations and fluid balance chart.
I look at the patients’ blood results and their prescription charts. Although my job title says clinical nurse specialist, I am a qualified advanced nurse practitioner and non-medical prescriber. This training allows me to complete my own holistic review of patients, independent of the medical teams caring for them.
I work closely with patients’ teams to discuss cases and give any recommendations I may have. I provide education at the bedside for improving the care of patients with AKI.
I see all of the AKI stage three patients within the Trust on a daily basis. Those patients who get better with treatment I see once, those who do not respond I see as often as required. I work closely with the renal consultants and the critical care outreach team, ensuring that patients whose AKI does not improve are referred to the appropriate speciality.
I carry a bleep and a mobile phone and take referrals from all specialties and levels of staff, from HCAs concerned that their patient has an unrecognised AKI, to consultants who are unsure of what other management is required for their patients. I see any patient who has an AKI, regardless of the stage.
Around 20% of my role is non-clinical and this is dedicated to completing audits and education. I also sit on a number of groups; alongside my AKI work, I am also part of the Trust mortality review group and the medication safety group. For me these are just as important as patient interactions as they are the methods of feedback and lead to trust-wide improvements.
Sitting with the patient safety team gives me a unique insight into other aspects of care within the Trust that have an impact on patients and teams, which allows me to assist in implementing wider change across the trust.
Something else that is different from some other AKI nurses is that my background is not renal. I’ve been a critical care outreach nurse for the last eight years and have some experience in cardiology and elective surgery but, prior to outreach, I was a medical high dependency nurse.
My critical care background means that I look at all the patient systems and not just their renal function, for me its about treating the patient as a whole & improving their renal function through management of their acute illness.
Becky Bonfield
Becky has been a nurse for 16 years. She trained at Southampton University and has worked at UHS for 14 years. During this time she was worked in a number of areas, including acute medicine, Medical High Dependency and working part time at Southampton University School of Health Sciences assisting in the delivery of the History Taking and Physical Assessment course . For the last 8 years she has worked as a Senior Sister in the Critical Care Outreach team, and is currently seconded to the role of Acute Kidney Injury Clinical Nurse Specialist. Becky is an Advanced Nurse Practitioner and non-medical prescriber. Her role is to assist in the delivery of the AKI CQIUN and to see, assess and treat patients within the trust who have a stage two or three AKI. Becky is involved in a number of AKI related audits and patient safety improvement projects. Since qualifying Becky has completed her nursing BSc and MSc.