Recite Me

A day in the life of a Tuberculosis (TB) Nurse

A day in the life of a TB Nurse

TB Nurse

“My name is Debbie Alder and I’m a one-nurse service based in Long Stratton and Norwich and under West Place at NCH&C. However, I work all over Norfolk as the only other TB nurse in Norfolk and Waveney is based in Great Yarmouth.

“My job role is working with patients diagnosed with TB, which is a potentially serious infectious disease that mainly affects the lungs. The bacteria that causes tuberculosis is spread from person to person through tiny droplets released into the air in coughs and sneezes. It mainly affects the lungs, but it can affect any part of the body, including the stomach, glands, bones, and nervous system.

“TB can be cured if it’s treated with the right antibiotics. The immune system usually kills the bacteria and there are no symptoms. Sometimes the immune system can’t kill the bacteria, but manages to stop it spreading in the body. It remains in your body and you won’t show any symptoms. This is known as latent TB – you can’t infect others when you have latent TB.

“If the immune system fails to kill or contain the infection, it can spread within the lungs or other parts of the body and symptoms will develop within a few weeks or months. This is known as active TB.

“Latent TB could develop into an active TB disease at a later date, particularly if your immune system becomes weakened.

“In most low- and middle-income countries, TB is the deadliest infectious disease. In the UK we have made massive efforts to reduce TB rates, but we’re still to eliminate it. TB affects nearly 5000 people a year here, and many people are unaware of the symptoms and impact of the disease.

“I’ve worked in many different roles during my career, but I was a TB nurse specialist in London at the beginning of my career about 20 years ago (!). It was a very different experience in London with a much bigger caseload, but Norfolk has its own challenges. I started in this role 18 months ago, right in the middle of the pandemic! Sadly, we saw many patients that had delayed diagnosis of TB due to the pandemic so have had a higher number of patients since I started.

“I have patients with active and latent TB. The active TB cases in Norfolk are thankfully quite low but latent TB is very common throughout the world. I also support patients with Non Tuberculosis Mycobacteria which can affect people with low immune systems. I carry out contact screening for those in contact with TB.

“A typical day would see me running my clinics for patients with TB at the NNUH, and I have a nurse led clinic in Norwich Community Hospital seeing new entrants, and unaccompanied asylum seeking children.

“Screening includes assessment, a blood test and sometimes a TB vaccination. I also see some patients at home to review them and offer support.

“Some of my patients are quite vulnerable as they may not speak any English or are homeless. I often ring patients to review their situation over the phone, and I attend meetings with other involved agencies such as Public Health England, the lead TB consultant and the Looked After Children team. I also support GPs in the community when they are presented with a possible TB patient, which may be something they rarely come across in Norfolk.

“I’m just about to complete my Nurse Prescribing course so that will provide another facet to my role.

“I love my job because there’s great satisfaction in getting a patient through TB treatment. TB is almost always curable, but the treatment is long and sometimes can cause a lot of side effects. It can be really challenging to take up to 12 tablets a day for at least six months.

“I didn’t always want to be a nurse, but I am absolutely passionate about nursing and have loved my career so far. I’m incredibly enthusiastic about supporting other nurses and helping their careers as much as possible. I am a District Nurse and am a District Nursing Specialist Practitioner Assessor to help other nurses achieve this amazing qualification. I’ve always loved working in the community rather than hospital based working.  I really enjoy the unique relationship you can build with patients within their own home where they are more comfortable and therefore usually more empowered. I think we all love the more ‘unique’ homes too.

Debbie Alder, TB Nurse, NCH&C

Debbie received the Cavell Star Nurse award earlier this year. Pictured here with NCH&C’s Executive Director of Nursing and Quality, Carolyn Fowler.

“Being a specialist nurse is really exhilarating, challenging, and has given me an amazing insight into a specific disease/condition. It also gives lots of opportunities to make real changes to how services are run. There are increasing opportunities to move into specialist nursing and hopefully we will be recruiting to the TB team at some point soon. Often nurses looking to move into specialist nursing are encouraged to apply for secondments or development roles so you are able to gain experience while learning a new role.

“It’s World TB Day on 24 March and this year we are calling for anyone who has possible TB symptoms or thinks they may be at risk of having latent TB, to speak to their healthcare professional to get diagnosed and treated as soon as possible, to minimise the chance of long-term ill health and onward transmission.

“Please contact me if you would spend some time shadowing me or learning more about TB or my role. I’m always more than happy to speak to students or anyone interested in TB.”

Further information about TB: 

Stop TB Partnership