Last year was busy for Nia. It included being involved in creating a policy paper on the future of Primary Care Nursing in Wales, attending the Senedd twice - as a guest speaker with RCN Wales 鈥� and, more recently, supporting us by giving evidence at the inquiry into the Future of General Practice in Wales. She鈥檚 done all this while juggling a part-time PhD in Health Sciences, being a mum-of-three and carrying out her much-loved day job with Wales's largest health board Betsi Cadwaladr University Health board. We asked Nia about her career and advocacy work and why she flies the flag for primary care nursing and encourages others to do the same in 2026.
Tell us about your advocacy work with RCN Wales
In January 2025, I participated in the development of 天美传媒 policy paper around the need to lobby for more consultant nurses in Wales and I was invited to the Senedd for 天美传媒 Wales event to do a talk and presentation. The reason I participated was because I鈥檓 the only formal Primary Care Consultant Nurse in Wales and I was keen to increase my opportunity to influence health care policy nationally.
In the past, I didn鈥檛 know about lobbying and influencing, as a nurse, we don't routinely get taught this. I was grateful to represent RCN Wales on the panel and give evidence to the Health and Social Care Select Committee Senedd Inquiry into General Practice. I was genuinely terrified at the prospect, but I thought what an amazing opportunity it was to fly the flag for nursing and really put a spotlight on Primary Care Nursing.
Colleagues in RCN Wales had recognised that I'd led on a paper around the Future View of Modern Primary Care Nursing - it was a subject dear to my heart and that I would be keen to contribute.
For the inquiry imposter syndrome did loom large. I thought who is little old me from Colwyn Bay in North Wales to sit before the Senedd and tell them how I think things should be. But the RCN Wales Political Leadership Programme (PLP) which I've attending previously was fundamental in building my confidence.
The PLP helped me understand the basics and how we can lobby and influence on a national basis to really improve our systems and process and ultimately achieve better outcomes for our patients.
What other experience do you have of campaigning for change in nursing?
I chair the All Wales Primary Care Lead Nurse Network. Before RCN Wales asked me to give evidence at the Senedd inquiry into The Future of General Practice, the network had previously agreed collectively to produce a briefing paper around what we saw as the future vision of modern Primary Care nursing - the vision for 2035 to meet modern patient need. We'd started that piece of work when we heard about the Inquiry. It was predominantly exploring the views of GPs and it would, it was an inquiry into the future General Practice but often that鈥檚 the issue we face as primary care health professionals - general practice is conflated with GPs and fails to take account of the fact there is a really diverse team of healthcare professionals providing that service provision. Within that mix, nursing makes up the biggest slice of the workforce. There are around 1,000 general practice nurses in Wales and by comparison the 1,600 GPs. We (the All Wales Primary Care Lead Nurse Network) thought it was very important to contribute to the Senedd inquiry to enable us to explain the nursing lens on the world. For example, Primary Care nurses are responsible for about 98% of diabetes care and 86% of respiratory care. We drive the long-term conditions agenda in the health service, so the Welsh Government needed to speak to us nurses and understand what we need to continue to evolve this provision to reflect the community by design approach and modern patient need. Unfortunately, we have got a bit of a looming crisis because 50% of the primary care nursing workforce are over the age of 50, so we are working to develop legacy mentorship schemes that we need to support nursing in this area in the future.
What exactly is Primary Care Nursing?
Primary care nursing in its truest sense encompasses much more than just general practice nursing, i.e. working within a GP practice. There's care home nursing, there's prison nursing, there's the wider community nursing, district nursing, health visiting. All sorts, but it鈥檚 essentially the type of nursing that happens outside of a hospital setting.
Why should someone choose Primary Care nursing as a career?
There is a common misnomer in nursing that primary care and community nursing require fewer technical skills than secondary care, including critical care, and I rebuke that. Expert generalist skill sets span the life course and enable truly holistic care. They are exceptionally difficult to master and demand significant commitment to maintain.
Aside from the opportunity to progress stimulating career pathways, there is so much wider reward from working within Primary Care. The continuity of care and those relationships that happen with patients often on a multi-generational basis. I鈥檝e done it long enough now that I鈥檓 immunising the babies of the babies that I immunised. To be cemented in the community and hold such an important role in positively improving the lives and the well-being of that community is just such a privilege. I would not change my career given my time over.
The relational care nurses provide in Primary Care, is like magic fairy dust. It's the lever upon which you can bring so many improved health outcomes at both individual and population health level.
Who inspired you to take up nursing in particular Primary Care nursing?
It was my mum. I'm a second-generation primary care nurse. My mum hasn't long retired, she nursed for pretty much 40 years in primary care. I knew I wanted to go into nursing and not just nursing, but primary care nursing. I qualified and worked as a Staff Nurse in A&E with a wonderful team, many of whom I still consider my friends today. Ultimately, I recognised, from my Mum鈥檚 experience that primary care was where I wanted to be, so once the opportunity presented itself, I took on my first trainee practice nurse job in 2003. That was not the done thing for nurses in their mid-20s, and unfortunately, even now, we still struggle to position primary care as an early career destination, which is such a shame. I am an example of the huge opportunity there is for personal development and lifelong career progression.
I've been very fortunate because I have had such a varied career within primary care. I followed in the footsteps of my mum and went to work in the loveliest supportive GP practice in North Wales. It was actually the same surgery as my mum, she was not working there at that point, but they remembered my mum and me as a little girl.
That surgery enabled me to transition into primary care and supported my formally accredited qualifications. Soon after coming into post, they facilitated a postgraduate degree in health studies with the specialist practitioner qualification in general practice. I undertook extended roles in long-term condition management, with diabetes being my favourite. At the time, the surgery was a front-runner in injectable insulin therapy in primary care. I also completed additional training in minor illness, which led to my Masters in Advanced Clinical Practice and my prescribing qualifications.
What drives you as nurse?
It sounds clich茅 but it鈥檚 just such a privileged role. I鈥檓 so fortunate 鈥� some of the people and the patients I work with have had such incredibly tough lives and this impacts on all aspects of their health and mental wellbeing. Primary Care Nursing enables me to support some of the most vulnerable people in our community in having far greater control over their health. Being able to improve the lives of them and their families is just the most wonderful feeling, of which I will never tire.
How would you encourage others to get involved in speaking up for and shining the spotlight on nursing?
I鈥檓 surrounded by incredible nurses that do this day in day out. I often say if you list all the skills primary care nurses have, tenacity, bucket loads of empathy, relatability, the skills are vast. Patients relate to us in very differently to the way they do to other colleagues, and they often see us as one of them. We live in their communities and we get to know them on a multi-generational basis. Our expert generalist skill set means we understand every disease profile as well as the wider, non-medical determinants of health and that means that we鈥檙e able to truly holistically assess our patients and support both the unmet need and primary prevention agendas.
I should not be the only Consultant Nurse in Wales, but often primary care nurses do not recognise the skills they have within themselves or they don鈥檛 have the confidence to put their head about the parapet. I say to my primary care nursing colleagues 鈥� you鈥檝e got to believe in yourself. Often people don鈥檛 have the self-belief or the forum to speak out. Sometimes primary care nursing can be isolating, however, with the community by design transformation agenda in Wales and the advent of clusters and professional collaboratives there is more opportunity than ever before for nurses to get involved and to take on leadership roles. Currently we have only a handful of nurses that head up clusters. There are 64 clusters in Wales and historically these have been headed up by medics, but there is no reason why these clusters cannot be headed up by nurses.
This is a bit of a call to arms really, nurses don鈥檛 always see themselves in these primary care leadership positions, but they should be as they are the right people armed with exactly the skills and attributes needed to advocate for our patients and communities and to influence the health policy here in Wales.
Tell us about a career highlight outside of your advocacy work.
In 2021, I won the RCN Wales Nurse of the Year award for Advance and Specialist Practice for my framework document around the skills education and training needs for Primary Care advanced practice.
Before that there wasn鈥檛 any formal education framework that covered each of the skills and knowledge required to practice effectively within Primary Care. I was very fortunate to win that category and I am still exceptionally proud of that.
Since then, I've remained as part of the alumni of Nurse of the Year winners. Three times I've also been honoured to be involved in the judging panel. It is just amazing to immerse yourself in all these incredible examples of gold standard nursing care in Wales.
