The image of nursing is a central issue for Ms Malone and the way to improve it, she argues, is to give nurses more autonomy.”The whole idea of nurses is that they receive instructions. We have got to have nurses making the decisions, working in collaboration with colleagues. Frontline providers need to be more involved in decision-making.”It is probably what she hoped for herself: to be more involved in driving nursing on to the national agenda and less with keeping the RCN council off her back. She says she was “surprised” when she was offered the job – “they were incredibly bold to hire me” – and has given herself “three to five years” to deliver on it.

That means she could be gone in another 18 months.It has been a difficult and lonely task. A black woman who has made it to the top is celebrated in America but here in the UK we enjoy nothing so much as seeing a high-flyer brought to earth. I asked her what had been the worst aspect of the job and she paused for a long time. “Being away from my support network of family and friends and nursing colleagues. Building up relations with all those that is required for this organisation to flourish has been a big task,” she said.It would have been a big task for anyone. For a foreigner lacking the contacts a home-grown leader would have relied on, it is a mammoth task. After nearly 24 months at the RCN, 18 of them as general secretary, Ms Malone remains an outsider.And where next? The World Health Organisation and the UN were on her target list when she got the RCN job.

But the lure of friends and family in the US – she is divorced with grown-up children – is also strong. “My children have been murmuring about having babies and may tempt me to go back and behave like a respectable grandparent.”With a rueful laugh, she adds: “I bet you didn’t notice but I’m not from here.”. “Why Susan?” It was the first thing that I asked her, though I’m not too sure why. I think it must have been because “Susan Hedges” sounds like one of those names a real star jettisons, once she’s decided to pursue a career as Dorothy Lamour, or Patsy Montana, or Madonna. “I was born three months premature; I was being kept alive in an incubator and the specialist told my dad to go down to the register office straightaway. When he asked them why, they said, ‘Because if you don’t you will find yourself registering a birth and a death at the same time, and that is mentally a very bad place to be. So go now.’ It was only when my dad was standing in front of the registrar, and she said, ‘Name of child?’, that he realised he hadn’t got one.

And he asked her: ‘What’s your name?’ And so I was Susan, like her.”We’re sitting in Susan Hedges’ bedroom at her parents’ house in Little Neston, on the Wirral, just outside Liverpool There’s nothing in the room that’s not to do with music. On the wall, there are a handful of posters from her gigs that Susan, who is 17 and has been blind since birth, can’t see. There’s a keyboard, wired to an amplifier and a small set of speakers Hundreds of CDs are stacked on shelves. Most of them are by singers she’s too young to have any right to have heard of: Steve Earle, Nick Drake and Lucinda Williams. She’s also collected more than a hundred recordings by Jerry Lee Lewis.It’s here, in this small room, that she wrote the songs for her own extraordinary albums, Myron Angel and her latest CD, Crimson Love on Velvet Black. The new-country legend Nanci Griffith plays Hedges’ records on her tour bus Emmylou Harris has performed with her. She’s been making guest appearances with the Texan country star Tom Russell since she was 10.