Nursing students will work in a variety of clinical areas and experience a range of nursing roles. However, what you may not experience as a student is what it's like to nurse in NHS Blood and Transplant (NHSBT). It is quite likely that you have donated blood yourself, but do you know what a nurse working in the Blood Donation Directorate does?
Nurses in blood donation are responsible for leading blood donation sessions, delivering high-quality care for donors and ensuring that the blood supply is safe for patients. Unlike those encountered by nurses in many roles, our clients are healthy volunteers: they are members of the general public. They are the first step in providing safe blood components to patients in need. To put things in perspective, NHSBT nurses collect around 5000 donations every day across England.
Nurses working in blood donation have great job satisfaction and feel proud knowing that lives are improved and saved as a result of the work they do. The role of nurses in blood donation is unique and suited to individuals who enjoy working autonomously. In addition, the service provides a range of opportunities to develop management and leadership skills for nurses who aspire to become effective leaders.
Regulations
Because the blood components collected are manufactured into therapeutic transfusions for patients, under UK law, NHSBT has to comply with the Blood Safety and Quality Regulations.
The Joint UK Blood Transfusion and Tissue Transplantation Services Professional Advisory Committee provides donor selection guidelines. These set out the requirements for deciding whether an individual is eligible to give blood.
NHSBT is licensed to operate as a blood establishment by the Medicines and Healthcare products Regulatory Agency (MHRA). As such, inspection visits are done by the MHRA every two years. To ensure the safe collection of blood components staff follow robust standard operating procedures and protocols, such as good manufacturing practice, which are guidelines that set out minimum standards (MHRA and Department of Health and Social Care, 2019).
Mobile collection teams and donor centres
There are 23 static donor centres and 50 community-based mobile teams across the country. The donor centres, which are based in large towns and cities, tend to have a more constant working environment than the mobile teams because their equipment does not need to be transported to a different venue every day. The composition of the donor centre and mobile unit teams is shown in Figure 1.
Donor centres
The main difference between the static and mobile teams is that the centres are permanent sites for the collection of whole blood and also for ‘component donation’, where individual components such as platelets and plasma are collected, while the mobile teams only collect whole blood, which is then transported to our processing centres and manufactured into the individual components.
Component collection takes place by a method called ‘apheresis’. This is a process whereby whole blood from the donor is passed through a cell-separator machine that contains a centrifuge, where the components of the whole blood (eg red cells, platelets, plasma) are separated. The machine enables the required component(s) to be collected and the remaining components are then returned back to the donor.
Donors can spend up to 90 minutes attached to a cell-separator machine during the procedure. This process means that we can maximise donations according to specific component and blood group need. A comprehensive training programme is provided in the management of the donor, the donation and the apheresis machine for staff undertaking the procedures.
Donor centres collect components according to blood-group mix, which is dictated by the usage and demand from hospitals. The yield of platelets that can be collected from each donor is calculated by the session nurse.
Mobile units
A typical day on the mobile team starts with the senior nurse, session nurse and donor care supervisor arriving at the team base. Staffing levels are reviewed and, when required, extra staff are contacted or the number of pre-booked appointments are adjusted. Staffing levels and appointments are reviewed for future sessions, to mitigate any problems. There can be last-minute logistical issues for a mobile team, such as venue concerns, traffic congestion and vehicle breakdowns. The senior nurse works with the area matron/manager, planning and transport departments to ensure the session goes ahead where possible.
The session nurse's day is varied. The nurse will ensure that the team is aware of any changes to practice, key messages are communicated, and any immunisations are ordered and administered to staff (such as hepatitis B and flu vaccines). The nurse works with the team using observation of behaviours and skills, training and audit to ensure that the highest standards of safety and quality are maintained. The team is updated at daily briefs on collection targets, revised policies, new initiatives and organisational changes. It is an opportunity to feed back and positively reflect on how well the team is doing. For example, the team's donor satisfaction or collection results may be exceeding target; this gives a morale boost and provides a positive focus for the team.
Mobile collection venues vary. Walkarounds are therefore carried out both on arrival (to ensure venue is appropriate and safe) and after set-up (to check safety for donors and staff and that the layout will facilitate good session flow and adhere to principles of confidentiality. At the end of the day, the team ensures the equipment is packed away safely before travelling back to base
Adverse events, significant occurrences or medical queries are escalated to the senior nurse, who will contact the clinical support team if the query is beyond their scope of practice. All unwell donors are reviewed by the session nurse.
NHSBT has a dedicated Quality Department, the core purpose of which is to maintain patient and donor safety, providing advice and guidance to ensure quality and regulatory compliance. The nurse may contact the Quality Department for advice, especially if there are any concerns related to process errors or policy and procedure non-compliance. There is an open, transparent culture for reporting any risks to donors or blood safety, with robust procedures to follow.
Nursing care quality team
Regional lead nurses (band 7) are part of a national nursing and care quality (NCQ) team. This team is led by a directorate chief nurse, supported by a deputy chief nurse and three regional matrons and includes a team of training and practice supervisors (band 5), covering the 73 mobile teams and donor centres.
The NCQ team leads and inspires collection teams to improve practice, while managing new initiatives, projects and induction training. Induction programmes for new nurses typically last 8 weeks and take place at regional simulation training centres. The programmes incorporate clinical decision-making, donor selection and session management skills. Nurses are supported in consolidating their experience by shadowing colleagues in other departments and directorates, participating in projects, leading on team training and clinical audits.
The NCQ team supports collection teams with quality assurance, using tools such as a care quality walkaround, clinical audit, root-cause analyses and internal quality checks with feedback. The team also collaborates with collection teams to troubleshoot and facilitate the achievement of key performance indicators (KPIs).
Placements are offered to pre-registration nursing students in conjunction with a selection of universities. Nurses employed by the Ministry of Defence can join NHSBT for placements to practise apheresis skills, in readiness for tours of duty.
Research nurses collaborate with specific universities to conduct studies in order to identify methods to improve donor experiences. The aims are to generate evidence for reducing the risk of donor adverse events, optimising donation collection and evaluating the effectiveness of post-donation haemoglobin testing.
Clinical support team
The clinical support team (CST) include senior nurse practitioners (band 7), specialty doctors and donor consultants, based in our main processing centres. They are available for session nurses to contact by phone or email.
When the blood components, samples and donor health check records have been transported to the centre, the CST reviews any donation that has been ‘flagged’ with queries or anomalies from collection teams. These donations are placed on hold and cannot be processed or issued to hospitals until the query has been resolved. In some instances, the donor is contacted directly to gather more information. The CST makes a clinical decision as to whether to release or discard the donation, thus maintaining blood safety.
Donor adverse events, such as delayed faints, suspected nerve injury or possible arterial puncture, are reviewed, and a root cause analysis may be undertaken. This collaborative meeting includes representatives from the CST, the senior nurse for the team, regional lead nurse and the Quality Department. The root cause and/or contributory factors are identified; plans for improvement and learning are put in place locally or nationally. The donor is also contacted by the CST to check their wellbeing, and post-donation advice is provided.
Donor risks
The session nurse may defer a donor on session, due to clinical information being required from their GP or medical specialist. Consent to contact a donor's GP for information is followed up by the CST. The clinical information received is used to determine a donor's eligibility to make a safe donation. Donors with positive results for blood-borne infections (such as hepatitis B, hepatitis C, hepatitis E, HIV, syphilis and human-T lymphotropic virus) are contacted by the CST nurses working in microbiology services.
A post-test discussion is completed with the donor to identify the infection risk and other epidemiology data, which helps with future policymaking. Onward referral is made to the appropriate medical specialist or GP for further advice and treatment.
Key performance indicators
KPIs are important measures across a range of activities. The senior nurse for the collection team reviews monthly data, alongside the team's continuous improvement plan, in partnership with the area matron/manager.
The KPIs include donor satisfaction, collection targets, donor adverse events, recruitment to platelet donation, and recruitment to the British Bone Marrow Registry (https://www.bbmr.co.uk).
Conclusion
There is a variety of roles for registered nurses at all levels within the Blood Donation Directorate in NHSBT. These roles interact with each other to ensure the safety of blood components, as well as our blood donors, and to ensure that patients receive the blood components they need.
Nursing in blood donation is unlike any other clinical experience in the NHS. It is challenging and rewarding, with many opportunities to progress and develop. This is supported by in-house development programmes to facilitate leadership skills, and opportunities for wider career progression.