text: Seven nurses reflect on how the Welsh NHS has changed in seven decades - Wales Online
  From the uniforms to care, nursing has altered dramatically since the NHS was founded in 1948
  08:56, 7 JUL 2018
  Nurses have been an integral part of the NHS throughout its 70-year history.
  Not only are they a reassuring presence in hospitals, they also have a growing responsibility in GP surgeries, care settings and people's homes.
  But their roles, uniforms and most importantly the care they provide have changed immeasurably since the health service's formation in 1948.
  Here we speak to seven nurses at Cardiff and Vale University Health Board to find out how the job has changed since they first started their careers...
  Val Willmott, clinical nurse specialist in the paediatric ear nose and throat (ENT) team
  Val working in Cardiff Royal Infirmary in the 1960s
  Grandmother Val first started her training at Cardiff Royal Infirmary in August 1968.
  Aged 18, she was part of the first cohort of staff to work at the University Hospital of Wales (UHW) which officially opened in 1971.
  "We watched the hospital being built," she recalled.
  "It was amazing. Cardiff Royal Infirmary is a really nice-looking Victorian building, and when we saw the concrete going up [at UHW] we wondered what it was going to be like."
  For several years she even lived on the site.
  "It was a very different experience [living in the hospital]. Once we finished a shift we'd all go out together. I enjoyed it and the camaraderie was lovely."
  Val spent her two years of "state-enrolled" training on placements at several community hospitals which have since closed down, including Sully Hospital and Glan Ely Hospital.
  "It was very different back then as we had matrons and sisters who were very, very strict," she added.
  "When I was training I remember giving my first injection, and down the whole length of the ward the sister shouted, 'How are you, Mr Jones? Did it hurt because that was her first time doing an injection'. We certainly wouldn't have someone saying that now."
  Val in Sully Hospital in 1969
  She said putting on her new uniform for the first time and showing her family was a defining moment in her life.
  "We had capes and caps given to us, and I can remember walking home and my parents were so proud of me.
  "The scrubs these days are comfortable but do not look as professional and smart as the full nurse uniforms. You used to feel the part."
  After finishing her training she went into neurosurgery and spent time looking after patients in intensive care.
  "We were short-staffed even back then and that was quite challenging and upsetting at times," she added.
  After returning from maternity leave, she worked part-time as a bank nurse before taking up a role in the Ely Children's Ears, Nose and Throat Hospital.
  She now works in the Noah's Ark Children's Hospital for Wales
  She then had to retrain to become a fully-qualified children's nurse.
  "You have to talk to children on their level," added Val, who lives in Caerphilly.
  "You have to be relaxed with them and know what they like. I'm up-to-date with all the cartoons which does help when you're working with children."
  The 67-year-old said working in the state-of-the-art Noah's Ark Children's Hospital for Wales is wonderful.
  "It is all geared up for children," she added.
  "Previously paediatrics was sometimes part of an adult area – and the ward beds were squashed in a bit – but now the wards are so open and airy.
  "It means a lot more walking for the nurses, but the facilities, the play leaders and everyone involved makes it a much better environment for the children."
  Rebecca Aylward, director of nursing for the medicine clinical board
  Rebecca Aylward (centre) at the start of her NURSING career in the 1980s
  Born in Wales, Rebecca moved to London for nursing training in 1986 at the age of 18.
  For a decade she specialised in caring for people with kidney problems, before becoming a ward sister at the University Hospital of Wales in 1992.
  She now holds the position of director of nursing for medicine for Cardiff and Vale University Health Board where she is responsible for more than 1,000 nurses.
  "But I'm still that student nurse and staff nurse inside because I haven't lost those values of what's important – patient care," said the 49-year-old.
  She said she has fond memories of her time at the Royal London Hospital in Whitechapel where she honed her skills.
  "There were a couple of reasons I went there. One was because the uniform was absolutely amazing. They had the really old-fashioned uniforms with the puffed sleeves, the white apron and the hats," she added.
  When she first started her career, Rebecca said it was quite clear who was boss.
  "The sister ruled that ward, and if you let her down then you let down the patients," she said.
  "The standards and the personal care that was instilled in you stayed with me.
  "You can never be criticised as long as you have the patient's interests at heart."
  Despite being a champion for the NHS' values, the Merthyr Tydfil resident admits certain aspects of the service have declined.
  "I think the NHS has changed tremendously since the '80s," she said.
  "It's a much more complex organisation now. Everything seemed to be simpler and slower-paced 30 years ago.
  "You really did have time to spend with the patient and have that personal contact.
  "My concern is that the NHS is a fantastic institution – and I certainly wouldn't want to lose it and its philosophy and passion – but I think the patient has got a little bit lost."
  Rebecca is now in charge of all nurses on acute medical wards, including the A&E departments, at the University Hospital of Wales.
  Rebecca Aylward (right)
  She said the pressures on herself and her colleagues are now more intense than ever.
  "The NHS seems to get a little more difficult with each year that passes," she said.
  "There are pressures on our financial situation, and patients are much more complex than when I started.
  "We need to take the investment we get for our acute services and put them into communities so patients can be looked after in their own homes. I know that's where I would want to be."
  Despite the strain on services, she said she's still "very proud" to be working for the NHS.
  "I think the NHS needs to evolve but simplify in order to succeed. We just need to take everything back to basics."
  Karen Addis, trauma and orthopaedic theatre sister
  Karen Addis (middle far left) at the start of her nursing career
  The Prince of Wales Orthopaedic Hospital in Rhydlafar, just outside Cardiff, was Karen's first NHS stomping ground at the age of 17.
  She said: "When I turned up it was very scary. It was a very small hospital and the intake of students was very small too. There were only about six or seven of us.
  "But the camaraderie – straight away – was excellent. We lived in the student block for six weeks learning how to bed bath people and doing the basics like taking blood pressures and temperatures.
  "Once we went onto the wards it was pretty terrifying. Because it was orthopaedics some of the patients had been in hospital for a long time.
  "As well as looking after the patient you had to take pride in the ward and making sure it was clean.
  "All the beds had to be in a straight line and all the wheels needed to be turned in. It was that disciplined.
  "I will always remember when a consultant came on a ward round, the patients had to be in their bed, with a modesty garment on and a draw sheet across. Nowadays the consultant asks where on earth the patients are half the time.
  "I think there's a lack of discipline now. The wards were run by 'sister' and 'matron' and you did exactly what you were told.
  "I like the fact people are able to speak to sisters and have a disagreement, but maybe we need to grab back that discipline to a certain extent."
  The mum-of-two said while paperwork is required for legal reasons and patient handovers, there is too much of it.
  "Sometimes I think we're concentrating too much on the paperwork and not enough on the patient," she admitted.
  Karen, 53, who left school with no O-Levels, is now a sister in trauma theatre.
  "As much as I loved caring for patients I'd become too emotionally involved and I used to get attached to the patients," she added.
  "If they were to pass away I just found it very difficult to cope with that scenario.
  "I spent a lot of time in theatres in my training and I really felt drawn to it for some reason or another.
  "I think a nurse has an important role in theatre as you're the advocate for the patient while they're asleep."
  She said it is very exciting that UHW is set to become Wales' first major trauma centre.
  "I started in trauma theatre in 1986 – green behind the ears – and now I'm probably going to be finishing my career helping to set up a major trauma centre which is just amazing.
  "It's going to be stressful but I'm really looking forward to it.
  "I am still extremely proud to work for the NHS and I don't want to see it be privatised. I don't want to see that in my lifetime."
  Jean Hazelwood, community nurse team leader for Cardiff north and west
  On September 15, 1976, Jean was brought to the University Hospital of Wales by her father to start her nursing career.
  She began as a so-called pupil nurse and lived above the casualty department at Cardiff Royal Infirmary.
  "We had a set of about 25 to 30 of us who all lived in. We'd go out together to Cardiff in the evenings.
  "We were like sponges. We just wanted to learn. Our role was really hands on, and we'd go onto the wards and undertake patient care, then in the afternoons you'd have a staff nurse or sister teaching you the anatomy, physiology and showing you procedures.
  "In the daytime you'd have qualified nurses with you, but in the nights you would be in charge of the wards – even though you were still training."
  Jean, a Fairwater resident, later went on to convert from a pupil nurse to working in cardiology and intensive care.
  "I don't think I could work in intensive care now," she admitted.
  "There was a time in my life where I had my 'nursing world' and my 'home world', but as you get older the two merge. I couldn't do it now as it's too emotional.
  "You get a lot of critically-ill patients who have experienced catastrophic events, and those patients didn't always survive.
  "But the togetherness among colleagues made it fun as well as very distressing. We made sure we all pulled together."
  Jean is now a keen advocate for keeping people in their homes as much as possible
  Her role now entails working in the community and ensuring people have suitable packages of care in place after they have left hospital.
  She visits nursing homes in the north and west of Cardiff to ensure people are able to live there as independently as possible.
  "I'm a keen advocate of people living in their own homes as much as possible," she added.
  "Community nursing is very different [from hospital care]. You have to think on your feet and you can walk into any situation, so you have to be prepared."
  Jean said paperwork is now a "massive" part of her job and is a "tie on her time".
  "But I have met a lot of very interesting people, and many of the patients make a big mark on your life."
  NHS staff in Wales are set to receive a pay rise in line with their English counterparts
  Kirsten Mahoney, tissue viability nurse
  While her role is challenging and often exhausting, Kirsten says making a difference to patients' lives makes it all worthwhile.
  "My husband always says that if you cut me in half like a stick of rock you'd find the NHS in the middle," she joked.
  "I'm very proud to be a part of it. Sometimes we get criticised, but actually at the heart of the NHS is our passion to help our patients and improve their quality of life.
  "That's how it started – and those core values are still there."
  When she first qualified Kirsten worked in the intensive care unit at Swansea's Morriston Hospital.
  But she admits qualifying as a staff nurse came as a bit of a culture shock.
  "Going from a student nurse to a staff nurse was a big transition. One minute you were just somebody on the ward and the next you were expected to know things and be very competent and confident."
  Following six to nine months in Morriston, she made the decision to move to intensive care in UHW where she was put on an in-service training scheme for 18 months.
  Kirsten Mahoney, tissue viability nurse, in 1987 at the start of her nursing career
  This involved working for six months in casualty, followed by a stint on a general ward to get some much-needed experience.
  "When I moved onto the general ward it posed greater challenges as we were always short-staffed, and even as a junior member I was expected to take charge of the ward quite frequently," she said.
  When she first started she was told it was the doctor's job to diagnose, but as time has progressed nurses have become "advanced practitioners" which has enhanced their roles within the NHS.
  And now, in her key role as a tissue viability nurse in the community, she is responsible for ensuring pressure ulcers – also commonly known as bed sores – do not develop.
  They can cause pain, odour and in severe cases life-threatening sepsis in which the body's own immune system attacks tissue and organs.
  The Penarth resident, 53, added: "When I first started to work in Cardiff I was quite surprised at the number of pressure ulcers I was seeing and tried to instigate better practice in treatment in my patients.
  "I think things have improved immensely. I can remember fighting very hard to get equipment in to patients on both the ward and community, whereas now we have a total bed management contract which I oversee, which means all patients have access to appropriate equipment to prevent pressure damage.
  "We have invested a lot in prevention therapies, which include education for our nurses, and I think has been raised very high on Welsh Government agendas, so I think the raising awareness has helped to address and reduce the potential harms pressure ulcers create."
  She said the NHS is renowned worldwide and remains an institution many countries aspire to replicate.
  "It is a privilege to be in a position where you can make a real impact on our patients in many different ways," she said.
  "In nursing it is so important to stay positive, enthusiastic and embrace all of the challenges that working within a large organisation such as the NHS brings."
  Lisa Williams, deputy ward sister
  Within two weeks of starting as a student nurse in Birmingham in 1998, Lisa Williams was on a ward looking after patients.
  "It was hands-on straight away which I quite enjoyed and got me motivated," said the 41-year-old.
  "You always look back at your first day, your first patient, your first hospital. It was all quite scary and busy.
  "I hadn't really been a patient in the NHS before, and didn't have many relatives who'd been patients or been involved in the NHS. I just knew what it was like on the news and didn't know what I was letting myself in for, really."
  When she first came to live in Cardiff, the Scotland-born nurse worked in oncology care at Velindre Cancer Centre before moving to the University Hospital of Wales as a junior staff nurse in medicine.
  She now works as a deputy ward sister and works alongside therapists and doctors to help mainly elderly patients.
  "There's a lot in the press at the moment about Alzheimer's, dementia and lots of people living longer with cognitive impairments.
  "Those can be challenging in itself, without even considering diabetes, respiratory problems, strokes.
  "In medicine we're not a speciality so we tend to cater for anything and everything."
  She said it was always wonderful to get positive feedback from patients, especially during a particularly tough shift.
  "I think nowadays nurses are quite tough on themselves when it comes to standards. There's a lot more monitoring and audits just to know how we're doing," said the Caerphilly resident.
  "We are a bit more open to the public with regards to what we're doing well and how we can improve, and when there have been mistakes putting our hands up.
  "That has changed a lot even since I started 20 years ago."
  Even during the most difficult times in her job, such as the gruelling winter periods, she has never wanted to change career.
  "It's important for me to be a part of a team, and we've all got a voice in that team as well."
  Helen Bonello, ward manager
  Helen, who trained in Swansea University, qualified as a nurse in 2007.
  She said there were some significant differences between the hospitals in Abertawe Bro Morgannwg University Health Board, where she underwent her student training, and Cardiff and Vale.
  "The beds in Swansea were still all manually operated, so you'd get big calves from moving beds all day," she said.
  "A big part of my first placement [in Swansea] was being taught the fundamentals, such as the importance of bed making, keeping things clean and tidy, as well as infection prevention and control.
  "But coming to Cardiff I had a bit of a shock to find the way in which the sheets came all bundled up. I actually had a bit of a telling off for putting what I thought were dirty sheets in with dirty, when in fact they were clean."
  Helen always wanted to become a nurse
  She said it felt "overwhelming" to be given such responsibility as a qualified nurse on the medical assessment unit in UHW.
  "Some of the patients were quite unwell and needed your immediate attention. Consolidating everything you leant was quite challenging to begin with."
  She now works as a ward manager, caring for frail and elderly patients who require rehabilitation.
  "We try and have quite a quick turnaround. We try to keep our patients well, get them up, dressed and moving keep them well-fed and nourished and send them home with the appropriate support as soon as possible."
  Helen just after graduating from Swansea University
  She said she's had a "fair few" patients aged over 100 come into the wards.
  "It's quite nice to hear their stories and things that have gone on in their lives. Some people we find who are in their 90s and 100s have never been into hospital before. They can really make your day."