For a short working week (4 days one of which has only just started) I am feeling incredibly weary. Summer seems to have arrived early, which is no bad thing since we have suffered a miserable end to winter and most of spring; rain, hail, wind often all in one day. What is more my week has felt a little odd. From the person who found my blog through searching to purchase the ability to inseminate their chihuahua (you know that kind of small dog) which, while I know a variety of things, that is not one of them. Then there was a very strange dream which involved me flying off somewhere not too far away (it was a short flight) and then finding myself in the kitchen of Kim from Emergiblog where she was holding fort to a number of men eating breakfast (sorry kim, but that is the only bit I remember!)

Work is incredibly busy, as a number of projects I have been working on come to fruition. I have discovered the power of the director - I might email and phone someone till I am blue in the face but I will still get no where, while the director sends one email and gets a response so immediate it makes me want to cry! I know lots of responsibility comes with that kind of job, but oh to have that kind of power! My other observation is that a blackberry is incredibly useful if you are out and about a lot as I have been and will be today, but it causes your inbox to be a complete mess when you actually do get to the office. I definitely need to spend some time sorting it out since I can no longer find anything and I like to pride myself with keeping it spick, span and pretty lean.

So there we are as another weekend approaches, the questions to be posed are: will I be able to get my hubby into the garden to do some work there? Plus, will we go to the Apple shop to buy that new ipod touch I covert? Work is important, but I am happy to leave it at the office when it comes to 5pm ish this evening!

As little as 10 years ago who would ever have considered arranging their holiday / vacation themselves? At the very least we started off with a brochure, usually obtained from a travel agent (or occasionally requested by phone or a little form cut out of a newspaper). Then we visited our travel agent and spent an hour or two there while they checked availability, got us to decide on flights etc. and tried to sell us their own travel insurance. I do remember booking a holiday direct with a holiday company on the phone about 12 years ago, but for many people that was just not something they did. This kind of process is fine for those who want to travel for 2 weeks to the costa del whatever, stay in a hotel and then return, but less suitable for people for whom the holiday they want can’t easily be found on the page of a book.

Since I got my first computer the way in which people plan and book their holiday has changed beyond recognition, what is more, with sites like trip advisor you can find out what real people think of the places / hotels / resorts you have chosen. There is a wealth of advice out there, choice is one thing there is no shortage of. But it sure has turned into a time consuming business.

Hubby and I along with my parents, will be travelling to the west coast of the USA in October for hubby’s 50th birthday (you would think he would want to sit in a dark room but no) and he desires to spend the weekend of his birthday in Las Vegas. With 3 stages to the holiday there is a certain complexity. Even if I wanted them to, the brochures out there wouldn’t quite give us what we want. I have already done hours of reading my book about California (plus the book on Las Vegas I have now mislayed somewhere in the house but thats another story) and more hours looking at fligths to San Francisco, hotels in San Francisco, flights to Vegas and back and finally holiday houses on the coast. I have also spent time looking at the Vineyards of the Napa and Sonoma Valleys, because I would like to do a tour or two with a small amount of tasting thrown in.

Yesterday my parents came over for Sunday lunch, and between cooking roast beef etc. We went through all of my work to date, tracing the steps of the holiday and discussing exactly what would be our preferences. Now all that is left is to retrace all of these steps and actually book the thing. We are not rich people, and this is going to cost more than our average annual break, we will also be travelling pretty far from home so it is important to try at least to get things right.

The internet is a wonderful thing, it gives pleasure and freedom to do things like this, but you sure can lose hours of your day while trying to do something as simple as arranging a holiday. I must say though that now we have got this far, I am pretty excited about the prospect. Now all I need to do is get the 17 year old up to speed on his cooking and housekeeping abilities!

Welcome to the May Day edition of Change of Shift where we will be exploring the different origins of this day across the world and what is more linking (sometimes tenuously) to some great nursing (and medical) blogs along the way. Sean from Nurse Sean (dot) com set the bar extremely high in the last edition with his tour around Europe, so lets see if we can go some way to matching his standards (do you sense a competitive edge here?)

There are two distinct themes or origins for May Day which will become clear in the fullness of time, and it gives me the chance to start off with some of the more light hearted and frivolous stories that I have to share with you and then to move onto the more serious and thought provoking.

Did you know that May Day (1^st May) has been celebrated since ancient times to welcome in the end of winter in the northern hemisphere and to rejoice in the first day of summer. May day was traditionally famous for dancing around the maypole and for celebrating the Queen of the May. So let us celebrate this time of year with some great posts from the Blogsphere.

Mother Jones suggests the use of a book she has found called The Joy of Yiddish as a way of managing some of your more difficult patients (and managers for that matter). In her post Yiddish for Nurses she gives us a wonderful sample of the ways in which you can sound as if you are complimenting people when just the opposite is true.

What nurses probably need in preparation for both their work and for dancing around that may pole are stretching exercises. Revitals.com has some information for us on how you can attend to those personal fitness needs, how we can prevent injury and prevent stress too. It would take more than a bit of stretching to allow me to get into the position shown on the post in question!

Heather Johnson at Student Nurses’ Notes gives us 5 very useful ways to reduce stress. Of course you might be given a May posy, or you may be crowned King or Queen of the May (I’m not holding my breath either) but failing that you will find Heather’s post helpful in managing this problem of our times.

My research into the origins of May Day (don’t worry I didn’t get much further than Wikipedia!) puts me in mind of some of the Urban Legends that are part of any healthcare organisation. Max from It Shouldn’t Happen in Healthcare offers up some examples of the types of things that new staff has allegedly shown their naivety by doing. We have all heard of the student nurse collecting the false teeth of an entire ward for cleaning and then not knowing from which mouth they came, but would any of us ever own up to actually do such a thing?

Nursing Blogs on Nurse Connect offers a post about how nurses can be more environmentally friendly. An important issue for everyone, particularly when it comes to saving energy along with the environment!

Have you ever longed for just one internet site where you can find just about all the information you need about nursing? Well that site is out there, at RN Central.com and what is more it offers 100 really useful websites for nurses. Its one drawback is that Lifeinthenhs is not deemed worthy of inclusion, but I am not bitter, honest.

Kim from Emergiblog tells us why RN to BSN is the way to go. As someone who last year completed a Masters and has a Bachelors in Nursing after many years as a bog standard ordinary (but of course excellent) nurse I completely agree with her sentiments. The knowledge that you gain about the professional and theoretical aspects of nursing are invaluable in making those links which might just make you a better nurse.

It is Kim’s post that I am using here as my link into the other reason why May 1 is considered an important landmark date across the world. This is because May Day is a celebration day for workers, it commemorates the fights that have gone on in the past for rights like the 8 hour working day. I know that not all of us work an 8 hour day, but actually in days gone by it was the norm not the exception to spend most of our waking lives at work. It is true that the communist countries tended to high jack the day for parades of national strength, but with the end of the Cold War, that is hopefully behind us. The USA and Canada no longer celebrate this day on May 1, but many countries particularly around Europe still do. The best bit for me (call me a mercenary) is that we get a day off on the Monday closest to May Day.

May 1 is a day for international celebration of the social and economic achievements of the labor (or labour since I am English) movement. The struggles that our predecessors have had in ensuring that workers are well trained and educated, that we have those holiday / vacation times and that our working conditions are safe and pleasant are remembered. This is not to say that there aren’t challenges out there for us as workers and for us as people who need to advocate for our patients (Julie jumps off her soap box at this point and returns to the point).

I am not sure that the level of violence some nurses come across in their workplace was really part of the deal. Mother Jones, in her second offering for this edition of Change of Shift tells of a harrowing tale of just such violence by a patient against several nurses. Often linked to the issue of violence is that of consumption of alcohol by those who use health services. Braden from 20 out of 10 tells just why he hates alcohol

In a further story depicting our violent society, Jen from RN Again?! tells us about her last EMT clinical which saw the admission of a patient with a self inflicted gunshot wound.

Congestion in and around the ER is a major cause of frustration for patients and professionals alike. Waiting times are something that have challenged hospitals in the UK and trying to ensure that people don’t wait during times of high volume that cause problems around the world. Ian Furst of Wait Time and Delayed Care, examines how EMS crews in Edmonton Canada are being used to treat patients who cannot actually get into the ER. Not surprisingly this leads to delays for patients who subsequently call 911.

Nurses have made great progress in developing their careers and in being recognised as people who with the correct development opportunities can examine patients, diagnose and prescribe. After completing her Nurse Practitioner course and getting herself that dream job, Nurse Practitioner Saves Lives is understandably frustrated by the pharmaceutical companies who imply in their adverts that the only person who can give advice to the public is a doctor. NP Saves lives would like you to sign up to a petition to get that kind of advice changed.

Nursing is not the kind of thing you can just learn in a classroom, clinical practice is an important part of nurse education. The trouble is that as part of that process you have to learn about bodily fluids and gases! Our student at Nursing School Insanity: Whats a perineum (you can find out the story behind the title on the site) tells us about Flatus (which is something you wouldn’t think to call it if you hadn’t started that nurse training). ‘Floating’ seems an increasingly common way of redeploying people around different departments. But if you are a ‘float nurse’ then you are continually needing to update your skills, continually feeling like a student. This post called A fish out of water, on Nurse Connect looks this topic which has also been discussed on Nursing Voices, and will I think increasingly be something that worries nurses now that managers seem to seek the most mobile and flexible workforce possible.

The way in which we as nurses communicate with our patients is vital, and with our aging society it is highly likely that many of those patients will be elderly. This Nurse Connect post offers advice on the things we need to consider in communicating with this group of patients. Those elderly patients are just the group of people who have fought hard to achieve the kinds of rights we take for granted today. Dignity and respect are something we all expect, yet only too often some of us don’t seem prepared to offer. My own post about this subject asks whether this is a reflection on society, and wonders why we need to teach this topic, and Nursing Blogs on Nurse connects looks at how we address our patients - would you call any patient ‘honey bunny’? No nor would I!

It is about 18 months since I last hosted Change of Shift. I am heartened to find that the nursing blogsphere remains a healthy place, even if some of the work our colleagues are doing out there is difficult and challenging. We still have our sense of humour, we can still laugh at ourselves and what is more we are true to our origins both in terms of dancing around that may pole and in respecting those who campaigned for the rights we take for granted now.

The next edition of Change of Shift will be on Thursday 15 May at Parallel Universe, when Dr Emer will be our 3rd MD host. You can submit your posts via the blog carnival icon on Kim’s blog at Emergiblog, or by sending directly to Dr Emer: doc(dot)emer(at)gmail.com

May 1st sees the launch of a new code of conduct for nurses. Often ridiculed and undermined, some people who frequent the blogsphere seem to imagine that nurses are just people who do their best to undermine doctors, act as if they couldn’t care less and who generally are too grand to get their latex gloves dirty (supposing they aren’t allergic to them), In my experience nothing could be further from the truth. Nurses in 2008 are stuck between the devil and the deep blue sea. On one hand they are meant to be caring individuals who understand the social and psychological needs of their patients and who know one end of the body from the other (mainly so that they can provide appropriate care). On the other hand they need to be able to develop more specialised skills so that they can take on specific roles that some doctors (but not all) have become tired with or who quite rightly see that nurses might actually be pretty good at taking on.

Nurses can’t just complete their pre-registration training, take their RN qualification and go off into the sunset (thank goodness), they can’t just go about their lives forgetting they are nurses when it suits them. Nurses are required to conduct themselves in a particular way that is becoming to their nursing qualification and what is more, the new code of conduct, produced by our regulator the Nursing and Midwifery Council and released officially this week is quite specific.

Some of the areas of note are that:

The people in your care must be able to trust you with their health and well being. To justify that trust you must make the care of people your first concern, treating them with as individuals and respecting their dignity. Work with others to promote the health and wellbeing of those in your care, their families and carers and the wider community. Provide a high standard of practice and care at all times. Be open and honest, act with integrity and uphold the reputation of your profession.

Some of the areas of the code include:

• Treat people as individuals
• Respect people’s confidentiality
• Collaborate with those in your care
• Ensure you gain consent
• Maintain clear professional boundaries
• Share information with colleagues
• work effectively as part of a team
• Delegate effectively
• Manage risk
• Use the best available evidence
• Keep your skills and knowledge up to date
• Keep clear and accurate records
• Act with integrity
• Deal with problems
• Be impartial
• Uphold the reputation of the profession

We have all been issued with a small, but comprehensive, pocket sized document. You can read the full contents of what it says here.

As a nurse I am obliged to uphold the code of conduct, it is not something I or my colleagues should take lightly.

It should be part of human nature to treat people in the way you would like to be treated yourself. For those of us who put ourselves forward for some kind of public service, this is an important quality. Respecting the views of others, listening, giving people privacy, helping those unable provide for their own basic needs are all things that those of us working in the caring professions should consider. These things should go without saying. Why then did I spend my morning at a dignity workshop?

It doesn’t hurt to be reminded that everyone deserves to be treated with dignity. This includes friends, colleagues, and those we encounter in our working lives. How often have you done something for someone else only to be greeted by someone who is not a bit grateful? On the other hand how often have you thought of your own needs over those of others? Nurses, doctors, paramedics, therapists, all professionals providing healthcare (there are many others), but do we all consider the needs of our patients before we speak or act? Do we always do everything we can for others and do they actually respect us in return? In the main I believe that most of us do think about the needs of others, we treat people with the respect and dignity of others and that respect and dignity is reciprocated. Sometimes though this doesn’t happen. Today I heard anecdotes of a nurse taking the blood pressure of a patient, wearing gloves and without speaking to the patient, of doctors not imagining people need to have their condition and treatment explained to them, of people having their bodies exposed to whole wards and this was just examples given by health care professionals in their private lives.

It is sad that the government is having to launch yet another initiative, this time about dignity, it is annoying that this might yet turn into another tick box audit type issue. It would be easy to say that the nurses / doctors / etc are just less caring, that they are in some way falling short. But actually is this more of an incitement of our society. After all we don’t necessarily generally treat teenagers, old people, or single mothers with any kind of respect, so why should we be surprised that dignity and respect might be something needing to be taught.

I have had a few queries about where to send submissions for next week’s Change of Shift.

Email them to me at: lifeinthenhs@btinternet.com

The next edition will be published here on Thursday 1 May

Today is the day of St George, the patron saint of England. Declared a feast day in 1222, St Georges day and the flag of St George (from the Crusades) has in recent times been little promoted and celebrated. We have no special day off, we have no feast as such and people displaying the flag are often thought to either be

supporting  the England football team or being far to nationalistic. Living as we do in a group of islands made up of 4 countries, it is the Scots, Welsh and Irish who are allowed to celebrate their own identity, to fly their flags and to be nationalistic, we as English are meant to wish to be British and make the most of that. After all we have the BBC news which thinks London is the main (if not only) place in our islands and be happy with that. For many years we were told we should not display patriotism of this kind for fear people would think we were racist, or nationalistic in the extreme.

Today I was in London and for the first time noticed more than a few buildings flying the flag. Apparently one is flying from Downing Street (though Gordon Brown is no more English than I am Scottish). Taxi drivers not only had flags on their cars but had music blaring from their cabs (luckily I walked and used the tube so had no need to hear this at close quarters). Good for them I think. Rather than moan all the time about all things English (weather, London olympics, congestion charge, teenagers, NHS) why can’t we sometimes celebrate what makes us what we are? If scottish people can wear a kilt and dance around eating haggis then why can’t I celebrate with a lovely glass of champagne and the nation’s favorite meal (what do you mean they aren’t English?)

By the way did you know that St George is shared as patron saint with Aragon, Catalonia, Ethiopia, Georgia, Greece, Palestine and Russia amongst others and they can’t all be wrong!

Well actually I have been to somewhere on the outskirts of the city, so cannot report seeing any historic buildings, the river Cam or students on bikes. I have been helping to create the NHS Directors of the future.

For the second time this year, I have been a development consultant (note the grand title) on a Leadership / management course for NHS managers who are stupid enough to think they want to run our organisations. This involved spending two long days in a hotel, spend a night in a single bed (why do uk hotels do twin rooms with 2 such narrow beds? Who actually likes these) and observed the behaviour, written up and given feedback to 3 candidates. Whenever I do this kind of thing I wonder if A) I might actually be good enough to aspire for directorship and B) would I ever want to do it?

The great thing about preparation for senior management in the NHS in 2008 is that it no longer seems to be left to chance. There is this 2 day simulation / feedback exercise, coaching, 360 feedback, action learning and study days which of course are called master classes. Observations are carried out by people like me (trained in such stuff) and actual proper directors and the rest is properly planned, resourced and run. There is some hope maybe then that in the future our Trusts have some chance of being run in a half decent manner by people who have had actual on the job training and support as well as completing the obligatory MBA!

The thing for me though is that actually while I love working on this kind of course (while mainly doing my day job) I actually don’t desire to be one of these people. I am not driven for power or even for money (though I could always do with more), I actually don’t want the stress or to work the kind of hours these people often already work. But could I do it? Well, for me thats the actual thing, these people are normal human beings, and no doubt if I or perhaps you wanted to you could, but do you want to?

On Wednesday while my heart was racing and I was willing it to return to normal and hoping to stop being dizzy I sent an email to about 6 key GPs in my PCT area. There is to be a review of maternity services and they, along with midwives, obstetricians, actual people who recently had babies and others have been invited to contribute. I have received 3 replies to date, the first from a GP I know who says - yes, love to be involved, the second from a GP worried his population are poorly served by services right now and a third from one who thinks it is no business of a GP.

This is the fascinating, interesting and often amazing world that is primary care. No two GPs in no two surgeries seem to actually agree with each other. For each sensible, measured response, someone decides to fly off the handle. If you try to involve them, then you can be accused of bothering someone who is busy with too much else to do but woe betide you if you don’t actually send that email or make that call.

This means that every time Dr Crippen flies off the handle, every time Dr Rant is apoplectic with rage, then somewhere a GP is thinking that this is rather a good idea and another is wondering why anyone has actually bothered! This is why I love health management so much!

What more can you ask for when you are taking a day’s rest from work? Nurse Sean, who hosting Change of Shift this week, is the answer to a girl’s prayers as not only does he have some great posts this week, but he does it through the medium of travel. I am happy to say I have visited a few of the places he features, but certainly not all. Lets hope on his part he gets the chance to do that travelling he would love. My advice Sean is 30 is a great age to take in the sights of Europe!

I am the next host of this wonderful blog carnival, what a hard act to follow!

Today I decided to become a patient. Well I say decided, actually just as I was walking from my car to the office my heart somehow decided to beat in a kind of rapid Supraventicular Tacycardic way. This has happened to me before, a couple of times when pregnant and once or twice since, but on each of those occasions it has lasted a few minutes and being a nursey type I have never sought medical treatment or advice. Today was different. After an hour at  my desk it was getting increasingly difficult to get on with any work. 20 minutes later I had consulted with a colleague (well my director) and got myself driven to the local hospital by her PA.

So followed my first experience of resus as a patient and a two hour engagement with a trolley, ECG machine and associated other monitoring equipment and a very good but unpleasant drug which needed to be administered twice for effect. I had a great nurse and a wonderful doctor, who got on with the job efficiently, cheerfully and who made me feel like I was no trouble at all (of course all in a days work).

Now I feel fine, if weary. Have some tablets to take if it happens again and I am to await a cardiology appointment. I am toying with a day off tomorrow to recuperate, but we’ll see.

So there you have it, Julie experiencing life in the NHS from the other end of things!

The best times I have had as a nurse is when I have been part of a team. By this I mean a real team where there are lots of different people, all responsible for different parts of what goes on, all with an equal role in making sure that the end product is as it should be. When I was practicing as a nurse, then the end product was the patient, when I was working in education then the end product was the member of staff needing education and or training and now in commissioning, well the patient is that end product again.

There are some great sites out there telling us the good, bad and ugly of life in the world of healthcare. It is not about identifying who is more important or better than the other. It is about looking at the whole picture, about identifying our own strengths and weakness and recognising our own dirty laundry not just that of other people. as I have mentioned before, I am weary of the sweeping statement and of the culture of blame. We get enough trouble from the media and written press without doctors writing blogs laying into us too. While we cannot all stand shoulder to shoulder at all times, I suggest that we should at least find out as much as possible about a topic before attacking a whole profession. Dr Crippen may have returned to the blogsphere, but I am not sure he has benefited from his long absence. I will not link to him as I don’t wish to add to his already over inflated stats. Instead you can join the debate over at Mental nurse, where you get a more measured, all round debate.

My lack of blog posts over the last few days is really more about a lack of time and energy than a lack of will or ideas. My dad is in hospital post surgery and with my mum not able to drive, then my brother and I have been taking it in turns to take her over there and to go and see him. All seems to be going well in terms of recovery and I am pleased to say that so far I can complain about nothing in terms of nursing care, medical input or anything else. We face a period of uncertainty in knowing whether there is anything further to worry about with his health, but so far so good. As a woman in her 40’s I know that I am lucky that both my parent have until now enjoyed good health, and you just hope and even expect that will continue. People in my family, and particularly the male members have not to date enjoyed longevity. Therefore with this illness came an added issue of my mum being convinced that my dad would die on the operating table at the very least. I had a frustrating 10 minutes on the phone on Thursday when I was trying to explain to her that this was not the same as the emergency surgery my 80 year old granny with a history of heart disease and general poor health had 10 years ago. Thankfully that anxiety has passed for now.

Last night we had a family meal without Dad which was odd. My brother turned 40 on Thursday, the day of the surgery and so last night we went for an Indian meal. I feel slightly strange that my baby brother is 40. I was 5 years and 8 months when he was born and we have always been close. Jealousy at not getting enough attention when he was born led me to cut my hair with some nail scissors a few days after his birth, but other than that I have always had a better relationship with him than the brother who is closer in age. But to find that he is 40 must mean that I will be 46 later in the summer; how did that happen?

A few weeks ago I wrote about the disappearance and subsequent discovery of 9 Year old Shannon Matthews. The little girl had vanished after a swimming lesson, but 3 weeks later was discovered in the home of her step father’s uncle. Since then, Shannon has remained in the care of a foster family and has had little direct contact with her mother, while most days a further piece of the jigsaw of the complicated life of this family has been revealed. There is little hard information other than a number of the family have been arrested and some of those people including Shannon’s mother and step father are now being held in prison having been charged with various offenses.

When I wrote about this topic on my blog, it was with sadness that family life for some people was so complicated, and that those people appeared to live very different lives from what I would call normal. I wondered if poverty and lack of opportunity had anything to do with the way in which some families live their lives. The main thing that struck me last week when Shannon’s mother’s partner was arrested on child pornography charges was that here was a young man of just 22 who had moved in with a woman of 25 when he was only 16. I wondered about the kind of world he had come from. Today Karen Matthews appeared in court charged with child neglect and attempting to pervert the cause of justice. Perhaps Karen knew where Shannon was, perhaps she organised the whole thing, I don’t know. There are rumours that the family tried to obtain money from the Madeleine McCann campaign and others that they based the whole thing on a recent episode of a TV programme in order to try to extort money.

We live in a world of celebrity a world where people think that they can get money for doing little. Only too often people are looking for an easy way, when for most people it takes hard work to earn the money to live comfortably. There is no doubt that some of us have advantages over others in terms of who our parents are, where we go to school, how long we stay in education and the kind of work we do. However, there are plenty of people out there who have lots of disadvantages in life, yet still manage to succeed.

What is most sad is that there is a little girl living with foster carers, what is more, she has brothers and sisters who must also be in care now. What family life there ever was has now disappeared, perhaps for ever. What is even more sad, is that perhaps those children have a better chance now they are apart from their mother and as one myself that is the worst bit.

For the first 10 years of my nursing career an office was something other people worked in, it was a place where secretaries and general pen pushers worked. We had ward offices, places where sister took you to tear you off a strip (if it wasn’t done in full view on the ward) or where you took patients and their families to tell them bad news or to give them a place to escape. When I was a district nurse, we had an office, but it wasn’t anywhere near where we were actually based. We used it to keep notes and equipment and to hold our weekly work allocation meetings on a Friday.

Now I am a person who works in an office, I am a pen pusher, though to be honest none of us actually write that much these days; Even my lovely filofax is likely to become redundant soon since I have now been given a blackberry (more of that later). I sit in a largish office with about 30 other people (give or take 2 or 3 as I don’t sit counting people) and I find the whole thing quite fascinating. I have spoken before about the clique that sit behind me. The procurement people who are extremely entertaining if insular (coffee club, friday breakfast club, in jokes), it is not that they exclude people, it is just really that they don’t notice you (unless you are stealing their coffee or milk that is).

The ethos of this office, unlike some I have been in over the last few years, is that people are there to work. I like that and to be honest there are a few people I’d like to introduce to this kind of philosophy, since we are actually paid to do a job of work rather than to talk all day. However, with my colleague (she sits opposite) off sick for the second time in just a few weeks, my working day is going towards the other extreme. I am naturally a social person, I like to communicate with people (I am a nurse and have already spoken this week of our unique selling point as nurses) and if the only engagement I have is two people saying good morning when I arrive in the office and another telling me about his model train hobby in the kitchen then to be honest I am going to struggle.

On Thursday, I spent the entire day in the office. I had a short meeting at 10am, and came back with plenty to do. I sat for an hour or so in silence getting on with the work and then in the absence of any stimulation from other people began to lapse into a kind of trance. Not only that but I began to become fascinated with the activities of others. Other than the procurement folks busy buying new defibrillator’s, cannulas and other important goods which keep any hospital running smoothly I also have people from Practice Based Commissioning. The person next to me seems to deal exclusively with the appraisals of GPs and the person next to her with QOF, between them they spend nearly all day on the phone to GPs and practice managers. This week has been a big one for these folks since QOF data was to be submitted by 31 March so that practices can be paid by the PCT. Not surprisingly it brought a flurry of panic driven managers onto the phone with last minute problems and by Friday drove the PCT person dealing with it all off to her sickbed.

In front of me sits the specialised commissioning team, which is really fascinating. These are the people who decide if the PCT will fund treatment that is out of the ordinary, or out of the area. They receive calls from patients wanting IVF, new drugs and weird and wonderful treatment. On Thursday, in my slightly stupefied state this got me thinking how much things have changed in the 28 years of my nursing career. Who would have imagined that most people would know what treatment was out there for them much less that they would know exactly who they needed to ring to try and get it. These people are persistent (and quite rightly so) but I do wish people would remember to turn down their answer phones when they are out of the office.

I went home on Thursday feeling that I had been entertained in some small way, but actually annoyed with myself that I had done much less work than I should (surfing the internet for holidays is probably not the best use of my time) so I gave myself a talking to. Yesterday I did things in hour long bursts: work, coffee, work, banana and coffee, work, get up and walk around and engage one or two people in light conversation, work, out for a walk then lunch, work, surf internet aimlessly, work, coffee etc. How people cope all day in an office on their own I will never know because sitting at my desk in a room of 30 without any social engagement is for me detrimental to me getting my work actually done.

Recently I wrote about my boss and her Blackberry. Well now I have one and actually they are addictive if useful little toys. I have found that not allowing yourself you check your emails during the evening / your day off is quite a challenge. I suspect it might be her telling me to turn the thing off in the future!

The picture above demonstrates life in the public sector in 2008 and came from Royalty Free Cartoons