Pioneering Nurses – Prof Julia Downing

Categories: Care, Featured, Leadership, and People & Places.

Encouraging nurses to find their voice and realise that what they say really can have impact

Julia performs multiple functions in her work which take her around the world and into the corridors of power and numerous universities. At the core of everything she does is a huge pride in being a nurse. Whether it’s as a  clinician, lecturer, advocate or policy maker, Julia is driven to share that pride in nursing and to empower others to realise their own potential to make a real difference, both to the lives of the people for whom they are caring and to the place in which they work.

“Each one of us can make a difference in the lives of patients, families and the system and we can bring about change. Don’t ever think as a nurse you are not in a position to do that because we can make a difference. And please don’t ever say, I am just a nurse; let’s be proud to be a nurse.”

Julia’s story

The premature death of a friend, who spent the end of her life at St Christopher’s Hospice, played a large part in dictating Julia’s career path. Having completed a Bachelor of Nursing at the University of Wales, College of Medicine Cardiff, she had to choose somewhere to complete her elective. While studying she’d come across a single room in which there was a female patient who was dying and no one ever seemed to enter the room. Julia wanted to learn more about palliative care so applied to do her elective at St Christopher’s. “While I was there I saw that things can be done differently and that you don’t have to hide people away when they are dying.”

After a spell working with cancer patients, Julia then gravitated to palliative care and now boasts a wide range of skills and positions as an academic, campaigner, advocate, teacher, and most dear to her heart, as a nurse practitioner. She says: “I am able to do a bit of everything and they each feed each other. I can bring in my experience from real-life clinical work and it keeps me up-to-date.”

Over the past 20 years she has worked alongside the World Health Organisation on numerous projects in an advisory capacity, currently being part of the Guidelines Development Group on ensuring balance for access to opioids.

Today, Julia is the Chief Executive of the International Children’s Palliative Care Network (ICPCN) and has been working as an Honorary Professor at Makerere University, Kampala (one of the first two Professors in Palliative Care in sub-Saharan Africa). Julia is also visiting professor at universities in Serbia, Wales, and England and visiting fellows in Scotland and at the Cicely Saunders Institute in London. She is engaged in research and travels the globe presenting at conferences. Julia is prolific in her writing for publication and sits on the editorial boards of the International Journal of Palliative Nursing (IJPN), cancer, and Annals of Palliative Medicine.

In her quest to improve systems of care Julia has also served on the Boards of several NGOs including the International Association of Hospice and Palliative Care (IAHPC), the Worldwide Hospice and Palliative Care Alliance (WHPCA), Hospice in the Weald, the African Palliative Care Association (APCA) UK, the Palliative Care Association of Uganda and the Palliative Care Research Society.

What drives you to make a difference and how do you inspire others?

Julia has a particular interest in the role of nurses in palliative care and children’s palliative care. In her work globally she tries to encourage and empower nurses and has led work on leadership in nursing and midwifery, particularly in Uganda. Empowering nurses and giving them tools and confidence to make the difference they are all more than capable of making provides Julia with her daily motivation.

Julia is not afraid to say that she’s proud to be a nurse because she genuinely is. She is determined to help as many nurses as possible to share her pride, to value themselves and to realise the power they have to change things for the better.

She quotes an old Ugandan saying: “If you think you’re too small to make a difference, try going to bed with a mosquito.”

Julia adds:

“Each and every nurse can make a difference in the situation we’re in. While we may not all work for the World Health Organisation or run the nursing service in our country, each one of us can make a difference. That’s the thing with palliative care; you can make a huge difference for someone and their family at the end of life and that’s a privilege, to be with someone when they are dying.

We’re all in different situations, in different countries with different resources, but we can all make a difference.”

How can nurses play a bigger role?

Too often, Julia says, through undervaluing themselves and being undervalued by others, nurses aren’t able to fulfill their potential. Too often also, she says, that’s because there is too much emphasis on the things that go wrong, rather than the thousands of things that the nurse has done well.

“We’re often very good at saying what we haven’t done well, and we made a mistake. It’s about recognising the value of nurses, especially in those countries where nurses really are not valued.”

There are some superficially menial tasks that Julia says exemplify the critical importance of good nursing and the difference it can make.

“People say that giving someone a bed bath is basic nursing care. But to me, giving someone a bed bath is much more than giving someone a bed bath. Spending time with them, assessing them, talking to them and seeing how they are moving; the result might be that the patient is clean and that’s a great result, but it’s not the only thing we’re doing and we have to make sure we don’t lose sight of that.”

A recent leadership programme Julia helped run in Uganda illustrates how clinical knowledge is not the barrier for palliative care nurses there. They’ve been taught about palliative care, but what they need is the confidence to lead because many of them, when they are sat around a table with doctors, won’t speak. Julia therefore encourages them to find their voice and realise that what they say really does matter.


This article was previously published in the UK issue of ehospice.


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