IT’S a complicated cocktail Catherine Morgan has to try to take on board.

She’s just a month into her new job as director of nursing at the trust which runs Colchester General Hospital – a role which in her words "is about helping staff on the front line".

But it is far more complex than her donning her pinny and treating patients Mother-Teresa style.

The NHS is under more pressure than ever before and Colchester's hospital trust knows pressure.

It's in special measures, has struggled to retain enough staff, some of whom don’t have English as their first language, and balance the books.

Most recently talks are underway for a merger between Colchester and Ipswich's hospital trusts spelling further uncertainty over how Colchester General Hospital will operate on a daily basis.

Catherine’s attitude is this.

“You have to got to think ‘I am either going to participate and try to make it better or get out’.

"My direction is yes there are lots of challenges and stick with it. You have got to be quite resilient and positive or it would get you down.”

“There is no point in changing the world, we need to focus on changing the bits we can,” she added.

Catherine’s last job as director of nursing at Queen Elizabeth Hospital, King’s Lynn, for three years has meant she's well versed in managing staff at a troubled trust.

That hospital was in special measures for two years until 2015 when health regulator Monitor said it "significantly improved" patient care.

Catherine's role in that was to lead the nursing and midwifery team.

She explained: "Key areas of work that I led on included a ward improvement programme to ensure high quality care was provided consistently - mainly achieved through giving confidence to staff and empowering them to come up with solutions and I could support to put these in place.

"I supported the senior nurse and midwifery team by commissioning a bespoke 18-month leadership programme so they were able to sustain change and be resilient to deal with challenges ahead, I led on all workforce reviews and developed new roles and different approaches to improve recruitment and retention.

"Investment in nursing and midwifery workforce and reduced reliance on agency nurses was achieved; retention improved and student nurse experience also really improved.

"The softer stuff is always so important, being out and about, listening to staff, saying thank you, being really sighted and in touch with their concerns but also being clear if care or behaviours fall short."

So how has Catherine started to make her mark in Colchester?

Each day she will start by touching base with some of the senior nursing team to establish what the priorities are for various wards.

Factors which need to be considered will include the workforce – both in number and experience - and are any particular areas under pressure.

Catherine explained: “I will talk to people about how we can drive things forward and three to four times a week I will walk around the different clinical areas talking to staff.

“I try to go to clinical areas because if you go to staff at all those areas you get a really good idea of what’s going on.”

In Colchester, having an adequate supply of nurses has been a challenge for some time.

As of January there were 981 full-time, qualified nurses - but that was still a shortfall of 243.

In the last reporting period, 16.62 per cent of the trust's nursing and midwifery staff identified themselves as not being in the “white UK” category.

Coupled with that, this winter has seen Colchester's A&E department put under intense pressure.

That can have a knock-on effect on high patient numbers in wards with many unable to be released home because the support is not in place.

So how do you deal with high patient numbers and limited staff resources?

Catherine said: “You have to break it down and consider who have you got on? What’s their skill set?

“How many patients do you have? Has everybody got a plan? Things can look chaotic but can be quite organised.”

Coupled with patient pressure has been a fairly modest average salary of £23,000 for nurses.

But Catherine said to a degree, she didn't think this was putting people off a career in the profession.

"I think the majority of people who work in healthcare are less motivated by money. I think you find a lot of nurses are motivated by good career opportunities and being able to learn."

So a challenge for the likes of herself is to ensure those nurses stick with the job.

"The research I have read says the strongest factors are around feeling valued, like you can do a good job and having career development opportunities."

Nurses are typically given 37.5 hours a week encompassing a number of shift patterns but a number work longer than this in order to complete their duties.

For that work, they’ll be paid overtime.

To help boost staff numbers at Colchester, nurses have been recruited from Spain, India and the Philippines.

But Catherine insisted any overseas staff must pass a “really challenging” English language test before they can work and is among many hoops they must go through before being a registered nurse in this country.

She said it was not the language or medical knowledge that perhaps made it harder for them to do the job, but explaining how our infrastructure, with its different care systems and clinical commissioning groups, differs from their homeland.

And if recruiting and retaining staff wasn’t enough of a challenge, staff face more uncertainty with those talks of a merger between Ipswich and Colchester hospitals.

Catherine said: “Change whatever it is, will cause an element of anxiety so it is up to us to ensure we communicate well with the team. There needs to be a hospital in Ipswich and Colchester. Demand is high and we can think about how working together might afford opportunities.

“In terms of nursing on the front line, they know here they are not going to be asked to go to Ipswich in the future because we need them over here.

“There are some people in some specialities who might be thinking what does the future look like but we haven’t got to that point yet.”

Catherine's predecessor Barbara Stuttle retired in December after being called in to help the trust in 2014, in the midst of it being placed into special measures after damning reports from the Care Quality Commission.

But Catherine said she knows there will be no quick fix for Colchester.

She added: "To get a lot out of a role and really see things through, you really need to stick around. And change that is sustained takes a long time."