Because it all went really well. Mind you, worrying about something new whether it be a job, task, project or whatever is not a bad thing because it keeps you pretty much on your toes. I am also a good way to finishing tomorrow’s programme; just need to put a bit of a powerpoint together. I am not a great lover of lots of powerpoint, but it helps me as much as them to keep on track it I have a few slides.

This course is something we have put together in-house, to help with the leadership development of a particular team within our organisation. Health Visiting is a traditional service which predominantly provides a service to the child from birth to 5 years old, as well as targeting at risk groups and providing health promotion and working on public health type stuff (for example smoking cessation and obesity). This service has been run by highly skilled professionals who have an additional qualification on top of general nursing and sometimes midwifery. There has been little skill mix and to be honest many health visitors have sat themselves in an ivory tower where only they can do much of the work.

All of this has to change. For one thing, it is an expensive service which doesn’t necessarily any more meet the needs of it’s client group; that is if the client group are clear about who they are and what they want. More and more we need to target services to those most at risk, and maybe health visiting itself needs to split into two services: one for the under 5’s and one to address public health needs of the population as a whole. Mind you these days you can have a public health qualification and work in that area without being a health visitor. Much of the work of the health visitor can be done, under supervision by other health workers, both qualified and un qualified.

So in essence that is why we have put this course together. We need to provide health visitor leaders with the necessary tools, skills and support mechanisms to meet the challenges they surely face. What’s more they are a great group of people and I have had an enjoyable day; more tomorrow.

As an appendix, I mentioned that yesterday was the start of ‘daylight saving’, with the clocks reverting back to greenwich mean time. I use the alarm on the TV to wake me: did I remember to put the clock on the TV back an hour? Of course not and was woken at 5.40am instead of 6.40; I can inform you that at 5.40 it is dark!

Health Visiting
NHS

Summer time officially ended at 2am and we put the clocks back an hour last night (or this morning if you are me and want to remember the hour you are gaining). So at 5pm it is now completely dark. This pretty much means getting up while it is dark, going to work in the half light and coming home in then dark; quite depressing. My grandmother who died 6 years ago was one of those people who seemed to suffer from seasonally affective disorder (SAD) and became quite depressed during the winter, particularly after Christmas. I can’t claim to feel like that but I do find the whole thing quite unpleasant, I mean who wants to live life in the dark? This year though it has been un naturally warm in the lead up to the end of BST, on Thursday for example it was more than 70f; global warming perhaps.

Anyway, I feel I am rambling here and no one wants to read a ramble, least of all me. I am now going to come clean; I am rather fed up with myself because this time the deadline is a little close for comfort. I have sorted day one of the two day course, but not even worked out how to approach Tuesday and I am short of inspiration, not to mention feeling a bit weary having spent so much of my own time doing the thing. The theme is to be groups and teams and leadership there in. I have the theory but what about making it interesting for the people coming along? I am hoping that while winging it tomorrow, I will suddenly come up with ideas; lets hope I do as I am not keen on making myself look stupid if I can help it.

The picture above is quite suitable for the day before halloween, by the way the diet has been broken slightly by the purchase of those large bags of chocolate mini bars (buy one get one free) which have been opened and partly consumed within the house. Lets hope we get lots of kids knocking tomorrow, or else the scales will be telling me something!

If you run out of your usual dishwasher machine tablets / liquid DO NOT use fairy liquid or some other liquid designed for use when hand washing dishes. Otherwise your kitchen is likely to flood and be full of bubbles; still at least the kitchen floor is now cleaner than it has been since it was put down last year.

Sometimes I do wonder if either I am lacking in common sense or perhaps things just happen to me. Like the time my brother was staying and he left the shower head leaning over the edge of the bath and the taps not completely turned off. I returned home in the dark (not late, but it was winter) to find my lights had fused. He was not the most popular person that day, which leads me to an event which happened during the same period involving not dogs but cats.
My brother and sister in law had 3 cats, all sisters. When they asked to stay until their new house was ready, I was only too pleased to help (well I am a nice sister), but on no account did I want the cats. The day before the move he phoned and insisted they had no where to take the cats, so being the nice sister I am (and the mug I also am) I agreed. Within weeks I was regretting this, when not 1 but 2 of the cats went on to go out and get friendly with the locals and were suddenly pregnant.

In hindsight I think I should have taken them to the vet myself on day 1 (they claimed not to be able to afford the surgery for 3 cats, then why have 3 cats you may wonder), because by the time they left for their new home, they had 13 cats!

My son was at a highly impressionable age, and found it highly romantic that 10 kittens had been born in our house so claimed one as his own, which we have to this day. She I am pleased to say has had NO kittens, but then I am not quite as stupid as I look; sometimes!

Are you the kind of person who, as soon as they are given a task must begin planning how it will be completed and then make sure that it is finished in good time for the deadline? Do you come out in a cold sweat at the very thought of completing an assignment just minutes or hours before it is required? Well, my habit of just meeting my deadlines is completely freaking my boss out. Great, I hear you say, anyone who can scare the day lights out of their boss can’t be all bad.

I am very good at starting things, I am hot on planning, thinking about how something should be done and I am good at starting. But if you don’t need that report from me tomorrow then don’t expect to see it being finished. I can make myself finish things in advance, but I really don’t like it, I just don’t have that adrenalin rush which makes me get on with the job in hand.

Next Monday and Tuesday we are beginning a new course for some of our senior health visiting staff. I have been planning the thing since the summer. I got as far as planning in detail the first two days about 3 weeks ago and earlier in the week I began putting the meat on the bones as it were. But yesterday I kind of ran out of working time and it isn’t finished so now I am going to have to finish this piece of work today (a day off) and over the weekend. This is really not good enough and I have decided to take myself firmly in hand and stop procrastinating quite so much; yipee says my boss! Watch this space to see if it happens.

Yesterday I had my appraisal, and it went very well. My boss had some really rather nice things to say about me, extremely nice in fact. I am very hard working, I manage my staff well and I have a depth of knowledge about my subject people can only aspire to. There was more but I don’t want to bore you by blowing my trumpet. I do find it really difficult taking praise and am more ready to take criticism, which actually I don’t get masses of. I am not sure why this is, but perhaps it goes with the whole working in the NHS thing, of having been a nurse where people are often more ready to criticise than complement. Anyway I have decided that if people want to say nice things, I must learn to accept those comments more readily, so if you want to say something nice, then that’s fine by me.

NHS
Management
Appraisal

On my journey home tonight I completely missed my turning and had to go all the way around a roundabout to turn back. Then later I forgot to turn the grill off (husband was late in) and burnt the dinner. What on earth was wrong with me? Well actually I was reflecting on the day far too much. I hope I wasn’t as dangerous as it feels I was.

How often do those we work or live with give us feedback about how we come across to others? Well the prospect can be quite scary, and as for me, what someone told me today was a bit of a shock. Apparently I am too self deprecating, particularly when stressed, I tend to run myself down and apologise unnecessarily. The informant was keen to tell me that I have no need to do this as I am pretty efficient when it comes to my job (well that’s a relief).

Now if I do this, then it is news to me and if I do it then why? If I don’t know I am doing it how can I stop it? Also does it really matter?

Well actually I care very much about how I am viewed, and maybe that is my problem; over eager to do well and to please. I hate to think I am not liked and I hate to have to say things to people that they might not like. Being self aware is a scary thing though.

I came home and asked the husband and son about this. Hubby claims not to have noticed anything, though has spent the evening winding me up by apologising. I returned the favour by burning his dinner and making him go and buy fish and chips (damn that’s the diet blown). My son on the other hand, astute child that he is says that sometimes I apologise for things which aren’t actually my fault.

One thing is for sure, I am not apologising for this posting. So there!

Reflection

Not very much apparently, though actually I am not for sale.

My blog is worth $2,258.16.
How much is your blog worth?

Just under a week away from work and 127 emails awaited; what fun. I know I have said it before, but what on earth did we do in the old days? Still my journey had been more pleasurable due to it being half term, it seems a lot of people are away from work this week.

I had cause to spend some time today with one of our district nurses, and during the course of our conversation we talked about the way in which people in affluent areas are sometimes reluctant to mix with council estate rif raf. You would imagine that if services could be set up in your area to ensure that you could receive the best available care for say your leg ulcer treatment, then you would think it a great idea. But apparently this is not necessarily the case and it is a sad inditment of 21st centrury Britain that the haves would like to access free health care but not in full view of the have nots.

My district nursing practice took place within a new town where there is little in the way of affluent housing (or there wasn’t in the early 90’s), and much of the clientele were first and second generation Londoners who had moved into the area to escape the poor housing left by the second world war. Many of these people would have jumped at the opportunity to get out and about particularly when offered a free bus service, since these people often appeared to think that health services were their right not any kind of privilege. I remember once visiting a patient with diabetes to administer insulin, and being told that no the patient did not wish to learn how to give their own injections, since they had paid ‘their stamp’ (national insurance contributions) all their working life and was therefore entitled to have me there giving their injection to them. Luckily I was just covering that patch for the weekend and it wasn’t my problem to sort out, but it left me wondering!

I wonder though if people realise that the money being paid into the national insurance pot today is paying for today’s education, health and social security and that none of us has a little bank account sitting there waiting for us to be ill or to retire on a state pension. I also wonder how much longer we can have our cake and eat it too.

The picture above is from a tv show some years ago called the District Nurse, played by Nerys Hughes. I don’t think many district nurses travel on a bike these days, and certainly I never did. I carried all kinds of things in my car (some of which people have more sense than to transport these days, for example commodes), but that is another story for another day!

NHS
District Nursing

One of the best things about the new Agenda for Change pay system is that if you have given 10 years service to the NHS you now get 33 days annual leave a year (well sadly the best bit isn’t going to be a massive pay rise). So today and Friday I am using up a couple of days, of course I need a break from the grindstone and I had nothing in my diary for these two days. It also happens to coincide with half term, and these days I am not required at home for the whole week, infact that would be positively frowned on by the resident teenager.

Anyway, last Friday he took delivery of a new playstation game which had just been released and which apparently he is unable to wait till Christmas for. Today he has decided he must connect said playstation to his computer (don’t ask me why he didn’t just get a PC game), so we have walked round PC World and another electronics shop looking for the correct parts then have ordered them off eBay and Play.com (apparently 3 parts are required). What a useful mother I have turned out to be in taking today off, and he has now had an advance of £57 on his pocket money.

All this has got me thinking about how different ateenagerss bedroom is today than the mid 70’s when I was the same age. My room was, as it is for Matt, a place of my own and for me a place to escape my irritating brothers, but it contained little in the way of high tech equipment unless you count my little portable cassette player from which the Osmonds, David Cassidy and David Essex blared. There was no TV, video, computer, stereo system, but there were books and plenty of them as well as board games which I played with my friends. Having said that, Matt also has lots of books and seems to still read from time to time (school work permitting) and board games like Risk which he plays with his own friends. The music which I can hear all over the house is a little less tame than my own was, not sure how he came to like hiphop, or why most of the music he buys is by people who are now dead, but perhaps it is a phase; after all I have moved on from the Osmonds myself! Check out those suits, what on earth were they thinking?!

One slight complaint about my weather pixie, she is wrong, it is not sunny as she has suggested all day. If I went out showing my tummy like that I would be sure to be laid up with a cold (ok I am a nurse and I know that you don’t get a cold from going out in wet weather, but I am also a mother and it is the thing a mother would say)

I have just been reading a posting by a student nurse in the US which describes the day he has just had in an ITU as part of his clinical experience, and it has got me thinking about language again. Not the UK English, US English thing, but the language of our lives and work. During my career I have had to learn a variety of different lingos, firstly during my nurse training which was as much about being able to understand what people around me were on about as the desire to seem knowledgeable to others. I then found out that you had to know how to translate medical speak back into English so that you could discuss diagnosis, treatment and care with your patients and their relatives. There are also your own family who like to hear you speak in medical / nursing lingo, but also want to know what the hell you are on about!

Different areas of medicine and nursing, not surprisingly provide the health care professional with a variety of different languages to learn, for example acute care is different to district nursing and then nurisng academics often seem in a world of their own. Mind you that is another story entirely!

Now of course I am a manager and can speak manager speak, I am still a nurse and often have to work with other nurses so we need to be able to understand each other. On top of that I have my meetings with university lecturer types who blast me with the science of their world; Oh the circles I move in!

One little anecdote which could be an urban myth as I didn’t witness it first hand. A patient was recovering from a Coronary Artery Bypass Graft (CABG to those in the know, pronounced CABBAGE), and was ventilated so couldn’t speak to the staff around him. After some time he became distressed and following extubation spoke to his nurse and told her how relieved he was that he wasn’t after all a cabbage (what a patient might be if they were brain damaged / dead rather than a vegetable). Makes you think doesn’t it.

This posting is in no way meant to suggest anything about disappearing John’s post which was an excellent reflection on his day, though full of medical speak.

None, I hear you cry, every second meaningfully used in the pursuit of a full and successful life. Well personally I have quite a bit of time within mine which isn’t put to good effect, and to be honest I am not sure there is anything I can do about it. Right now I am willfully wasting valuable time when I could be cleaning my house or shopping for food and other consumables, but it is my progative to sit here lounging around blogging away. This time isn’t really wasted as it is Saturday morning and if I want to chill out I will do, after all it is my time to waste; the same can’t be said of the time I spend journeying to work each day.

I have to admit I am getting a bit fed up with spending quite so long in my car. Now of course if you are an eco-friendly type you will be wondering why I don’t ‘get on my bike’, get a train, walk or heaven forbid jog. Well actually the journey is 25 miles each way and my home town is not on the same train line as my work town, meaning I have no choice but to use my car to get to work. Don’t get me wrong, I absolutely love my little car (a similar version is pictured above), but I didn’t buy it to live in it!

James Richards reports on his work-related blog and news site, that British workers are keen to be freed up from the wasted “dead time” they suffer each day while commuting. I have seen people on trains doing just this, laptop perched on their lap or the little table infront of them while they simultaneously play with their blackberry gadgets and bellow into a mobile phone. I have also heard people running their businesses from a poolside in Cyprus and to be honest none of that stuff appeals to me.

While I am definitely wasting my life sitting in traffic on my journey to work, I do not desire, even if it were safe and possible to continue my working day into my car. I just want to feel less bored during it and less tired after it. I listen to the radio or a CD, and love a good sing along, but to be honest there is a limit; particularly if the radio station I am listening to is a talk radio. I can also reflect (see previous post) on the days events and often do, reflecting on my breakfast contents is less useful to me in terms of my emotional well being.

Well enough of this innate drivel, I am off to do some meaningful housework!

I love this picture that I found; there is something about sunset which is seriously amazing and don’t you just love the way that the trees reflect into the water? One of these days I must get out and about and take some pictures of my own to put up here, one of these days I will have time to call my own. Infact today I saw a man of at least 70 years of age out jogging in the rain wearing cycle shorts; now what makes you do that?

A major part of my course is a module on reflective practice which will last for the duration (2 years) and that fact, plus the 2.5 hours I have spent in my car today (much of it stationary) has caused me to decide to post about the whole reflection thing.

In the NHS we all reflect on our experiences so that we can turn those experiences into some kind of deeper learning. Well that is what we are led to believe, sadly this can’t be the truth as it appears to me we make the same mistakes time after time. Whether that is about the care people receive and the way that is perceived or the way we are reorganised time after time, it amounts to the same thing. It has been my experience that nurses are far to busy to spent time reflecting with their peers and managers can’t see the point of ensuring that they do it.

It is my humble opinion though, that actually sitting down and thinking about something you have done, then discussing that issue with some colleagues is actually a really good way of learning from each other. That and remembering exactly what we have done before and what that felt like. It is just a shame that the department of health appear to have no mechanism for reflection; what message does that send to us at the front line?

while I have no control over the whims of central government, one of the things I am in the process of helping to implement at work is more in the way of reflective supervision for our employees, this means a place and time to be allowed to think about what they do and to plan how things should be in the future. Learning more about reflective practice myself and being involved in action learning with my cohort can only help this.

One thing I have been meaning to mention since my first trip to Harrow in Wednesday is that the high street already has Christmas decorations up! Perhaps they keep them up all year, but if they do then I wonder about the point of 4 strips of tinsel hanging from the top of every lamp post? I don’t agree with decorations before at least the middle of November, but if you must have them adorning the streets then at least make them tasteful and bright!

What does the word mean to you? The idea of the students themselves mapping out what they need to learn from a course feels quite scary. I have previously written mind maps to help with planning out projects and assignments, and I have to say that didn’t feel all together confident with that. But a whole course, now that is quite grown up stuff. Of course we are not completely in control of what we learn. There are specific modules to complete, but within the confines of the university rules and regulations we are actually able to drive what we need to learn.

Bearing in mind this is a course about leadership and strategic leadership at that, the kinds of headings we arrived at were:

• Strategy and Policy (defining, implementing, tools, influences, outcomes)
• Change (resistance, cycles, service redesign, timescales for change, resources, and capability)
• Thinking and language (fads, influences, communication)
• Politics and Power (who has power, how is it exercised, who are the politicians, contradictions, targets, globalization)
• Leadership (definition, behaviour, risk taking, decision making, influencing, power and status)
• organizational culture (values and diversity, what is an organisation, influences, learning, knowledge transfer)

there’s more, but you get the gist. Tonight as I sit here (no wine as it is midweek; I’ve lost 6lb so far by the way), it all feels quite overwhelming. Tomorrow I will be hitting the library, just in time for the weekend and the beginning of my housework avoidance tactic which hopefully might end up with the employment of a cleaner (well a girl can dream).

I managed not to ring work today, as I really don’t want to get involved in what is going on there. Two of the group had been to the office first, now that is not something I am going to do on my study days. Mind you it didn’t stop my boss ringing me this evening, but she was very careful just to ask me the one thing she was ringing for. The important lesson for today is a good leader is not indispensable!

Now I have actually enrolled on my course it feels both exciting but also scary. How on earth am I going to fit all the study and reading into my already busy life? I must say though it feels thrilling to be back in a university as a student.

Today was quite a student like day too, well apart from the fact that I dropped my son as usual to ‘walk to school’ with his friends (this involves in taking him round to another teen’s house so they can walk together, the poor lad might get worn out if he had to walk the whole way). After that though I had a couple of hours to sit around the house and surf the internet etc. Mind you I did spend about half an hour with my manager hat on sorting out work things, but that didn’t cause me much in the way of problems. Then I went off to do a few bill paying chores and to order a new contact lens (another one split). Then it was off to Harrow, a place I have never been to but which I found pretty easily. This was no thanks to the directions one of my work colleagues found me on google (I am able to do this kind of thing, but he was being helpful), which were completely wrong.

There are currently 6 people on the course but another 4 who work in the university itself are joining for the next block or ‘learning burst’ in November. Half of the people so far are from within the NHS and the others from outside, one guy has come over from St Lucia for the course! Part of our work this afternoon has been to walk round in a group of 3 and take photos which demonstrate what is going on around the university. The place itself feels spacious and modern and on the face of it there is plenty of parking which is a novelty in itself.

From our classroom today I could see the new Wembley Stadium which is currently being rebuilt and should be ready for the FA cup final next May. In the distance you could see into central London. So I am enrolled on the course, I have my university ID card and tomorrow we get some induction into the library so there will be no excuse but to load myself up with reading material for the coming month; I can hardly wait.

This feels like something of a special week for me, 25 years ago on Thursday I began my nursing career here at the Middlesex Hospital in London. Despite being an 18 year old, who had rarely stayed away from home without her parents, I was undaunted by the prospect of living in the City and eager to begin my career. Nurse training in the UK in 1980 took place in what was known as a school of nursing and on the wards, learning how to be a nurse. We learnt bed making, how to wash people in the proper fashion (oh yes there is one and it involves washing the furthest limb from you before the nearest), and how to take basic observations. In those days both the sphygmomanometer (Blood Pressure machine) and thermometer contained mercury and didn’t need a battery or to be plugged into the wall, and to take someone’s pulse you needed a new shiny fob watch and the ability to count.

This training was not university based, it was pretty much learn while you work. That is not to say that there wasn’t plenty of theory to learn, essays to write and an exam at the end because of course there was. But it wasn’t academic in the way nursing is today. So little did I imagine that 20 years on I would have a degree and be about to embark on a degree in Strategic Leadership. Come to think of it I didn’t really know what leadership was, in those days management was what you learnt and then not till the final year.

I am not one to live in the past, but 25 years is a long time and the health service I started working for then no longer seems to exist. But then if it did I couldn’t be quite so nostalgic.

I didn’t go to manager college any more than I had training on parenthood, but at least when my son was born I had 9 months to get used to the idea (well 8 actually because he was a tad early). But both are certainly a learning curve; I’ve already described the challenges of parenting a teenager, and now it is time for me to concentrate this posting on my work as a manager.

I try really hard to be the type of manager I would like for myself, but sometimes that is difficult to achieve. After all people have different expectations of what a manager should be and the clues are not always evident until it is too late. There is a lot to be said for the informal nature of being an onsite, hands on manager, but what if several members of your team are based elsewhere. Ok so I meet with everyone on a one to one basis every month or so, but otherwise we have to rely on emails, phone calls and meetings where various of us can get together.

So I guess it shouldn’t come as a shock to find that occasionally things are not going as well as they might, and also that for every short coming you might be able to identify about the way they work that there are two criticisms of you. The ability to take this kind of thing on the chin from one of your own team and discuss this in an adult manner has to be one of the most important things a manager can learn. I am not suggesting that I am to blame for everything another person finds difficult in their working life but to be honest there are bound to be some truths there somewhere. And being prepared to accept that you are not perfect may help the other person to accept that they need to make changes too.

So that was part one of my day, and part two was interesting in a different way. I went off our local higher education emporium for a programme committee meeting. This is where academia and practice get together to talk about how a particular academic programme is going. In this case the programme as the BSc and MSc in Interprofessional health and social care studies. Quite a mouthful, though in essence a potentially good way of getting nurses, therapists, social workers etc to look at how they work together. The meeting itself though felt a little surreal. The practice representatives where myself and a general practitioner who doubles as a lecturer and there were 3 University type academics. The programme is quite new, so there wasn’t much to discuss in relation to how it is running, though we did discuss assessment techniques. I kind of sat there though wondering how I was chosen for this, and what my actual role there might be. While the individuals value my contribution as a nurse and health care manager, there is definitely the feeling that I am someone who can be relied upon to pitch up and say sensible things so I often get asked to sit on this kind of committee. Mind you after the morning I had it was light relief and they gave me lunch too!