That is pretty much the name of the game out there in our part of the NHS at the moment. There are a few things that we know for sure, our PCTs have managed to save about £10 million through the vacancy freeze, changing and cutting services and who knows what else, but still we are about £3 million over budget as we approach year end. No one knows when the vacancy freeze will end, and if it does, which posts will be ‘unfrozen’. No one yet knows who will be employing us all in the next few months, no one knows what any of our services will look like. That goes for front line services and those like mine which support those services to deliver. It is a massive shame because over the last few years, I believe we have made a big difference and really to commission and run the kinds of training and education which is needed by those who are out there delivering the care to patients.

Now I am faced with the prospect of perhaps not having a job in the future, well perhaps not this one, I am forced to think about my future. Am I still a nurse in the true? Do I want to go back to clinical practice and if I do what would I need to do to ensure I am clinically safe? Do I want to apply for one of the management jobs which will surely come about once the changes really kick in and vacancies become available? What could I do outside the NHS? Because actually do I really want to do this kind of thing anymore?

The facts as I seem them are ta lotalot of experienced practitioners and clinical managers will be lost to the NHS. We are used to coping with change, it is part of our lives, we are used to looking at how we can make savings, and how we can persuade others to change too. But these changes feel like the whole dismantling of a system, and they feel like we are working towards a vision which is so far over the rainbow that we can’t see it. We can’t see if there is a pot of gold or if actually the rainbow leads into the abyss. Uncertainty is scary, but right now I am going with it, what I am not sure about is where I actually want my future to be.

We have had a CD player since about 1989, and when we bought our current stereo system about 3 or 4 years ago there was no turntable. Not surprising as everything now is small, in fact things have got smaller not to mention digital since ipods appeared on the scene. So our record collection has remained hidden at the back of a cupboard on the upstairs landing, discs like wings at the speed of sound and out of the blue by ELO often mentioned never heard. All that is about to change, because at the weekend, via the wonder that is e-bay we have bought ourselves a turntable, and if I can work out how to do it, soon we might even have those old sounds of the 70’s and 80’s turned into digital sound (watch this space I’d say!)

Yesterday we retrieved about 50 LPs, EPs and a few singles from two cardboard boxes and found the music which catalogues our single then joint lives, quite a range of music but I guess reasonably middle of the road if I am entirely honest. No punk or heavy metal but plenty of Paul McCartney, Queen, and DISCO! Now I don’t want you to get the wrong idea here, Hubby will not be wearing a white flared suit, and strutting his stuff across the living room. At his age moving too quickly could be fatal!

Tomorrow I will return to the happy topic of the soon to be bankrupt NHS!

How is it that my Thursday 13 seems to have resulted in adverts for giving up alcohol at the top of my blog? Does someone know that I have been sitting here reading postings to my favourites with a glass of New Zealand Sauvignion blanc by my side? How can that make me an alcoholic? sometimes, the internet is quite a scary place!

More later!

Thirteen Things about Julie’s Week Last Friday I got myself involved in the on off marriage of my brother and sister in law, who I am sorry to say deserve each other. My son saw his cousin for the day and that is the only good thing you can say about it! Having started off as a very cold office on Monday our new abode turns out to be warm and bright and very nice. It is also quite quiet and a place you can actually get work done! I have started my agenda for change appeal, though I am still none the wiser about the difference between complex and highly complex. Who thinks up this NHS jargon? My new manager told me she is a control freak, that makes 2 of us, so not sure what that will do to our working relationship! Actually I think we are going to get on very well indeed. Strangely people think I am psychic. They think that I will somehow magically know what courses they want to do at the local university. They ignore my requests for them to tell me about their training needs and then complain when they can’t get on the course they want because there are no places! Whets more they expect me to pay for the course if they can get on it. On Wednesday we launched our support framework document, I am hoping it is going to lead to a greater uptake of clinical supervision and action learning. At the moment people are huddling in corridor’s moaning, I want their discussions to be better structured. Yesterday I saw some of my dad’s long lost cousins. People who have re-discovered each other through the power of the internet and are now catching up on years of lost family life. In my pay slip I received information on the consultation process and likely timetable for the merger of the PCTs and the implications of the split between provider services and the commissioners. In black and white it stated that all of our jobs are safe to June 2007. The nursing times this week asks: Is nursing a job for life? I think it is true to say that no job is for life. We had some snow this morning, sadly for my son it didn’t settle. I on the other hand I was very pleased; I once spent 10 hours in my car trying to get home from work and don’t like snow in England! Arsenal won their champions league match this week, and Chelsea lost theirs. Who would have thought that? My hubby was so upset that it stopped him sleeping - bless! We have today received a settlement for the mis selling of our endowment mortgage in 1991. I don’t know if it is enough money, but I am hopeful. Hubby would like to spend the money on a trip to Las Vegas. I am more sensible! More bad news NHS stories this week, what’s new? Links to other Thursday Thirteens! 1. (leave your link in comments, and I will post your link here) Daddy roses Collect My thoughts

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The uniform was probably both the best and worst part of being a nurse for me. On the plus side it showed everyone who you were and offered you the opportunity to use if to your advantage or if necessary hide behind it. Also it saved having to worry about what to wear each day. On the negative side some of the uniforms I have worn during my career have been less than comfortable to wear and less than flattering to be seen in. I had already been thinking about blogging about this very issue when I read about just that on both Kim’s Emergiblog and Tom’s Random Acts of Reality, which got me thinking about the whole thing even more.

I was 18 when I started my nurse training and was issued with a very nice lilac striped uniform and an ordinary nurses type hat. A year later I was ‘awarded’ the Middlesex hat which had to be folded from a semi circle, and was neither hygenic, comfortable or useful but I was seriously proud to wear it. I have trawled the internet and found what may have been a for runner, though we didn’t have the bit under the chin thankfully. Maybe I need to scan a more personal picture?

Uniforms have changed a lot since 1980, few nurses wear a uniform dress any more, for reasons of practicality (infection control and moving and handling mainly), but as far as I can tell people seem to be less proud to wear their uniforms now. I remember not so long ago, that the cleaning staff at a hospital I was working at were issued with uniforms that looked almost identical to those of the nursing staff. If you look similar to a cleaner when you are at work, then why would you be proud to wear your nursing uniform. The hats have also gone; a pain to wear and again an infection risk (apparently), there is now little opportunity to show yourself as a different rank or type of nurse from anyone else.

The first time I had a job where I wore no uniform felt really strange. Seeing patients and providing care and treatments wearing my own clothes was more of an issue than I thought it would be. Being mistaken for a doctor was one problem, but as I have never wished to be one of those, was not difficult to sort out. But it showed that patient’s had difficulty in working out who you were and where you fitted in the big picture was an issue especially as I was learning to be a specialist nurse at the time and would have loved to have been given the opportunity to hide behind my blue district nurses dress at times. To tell people, without opening my mouth that yes, I am a nurse.

My message to nurses out there are: Look smart (if you can), be proud and wear your uniform with pride. Let people know that nursing is a worthwhile profession and it is ok to be a nurse.

And my first full day in my new, pretty quiet and not entirely warm office. We still have no phones, but it seems that BT are working on it(not sure how hard it is to put the lines in seeing as there were phone lines in our office before the previous occupants moved out, but what do I know? The fact that the building is not occupied by too many people will probably turn out to be a good thing as it means I will be able to get more done (I hope) and have made a good start today by getting about 100 emails answered / dealt with / deleted. I have also finished off a paper on the supervision framework which we will be launching on Wednesday and put together a flyer for some change management session we are holding at the end of next month. The latter wouldn’t usually be my job but the person who usually does such things is now in Australia!

The building seems to be a very cold one, certainly it is from where I sit; more clothes needed tomorrow I think! Still it makes you get up and move around a bit more than you might otherwise do.

I found out today that 2 more of my team have received their agenda for change banding, and this means that they are just 3 incremental points below my salary! I think though that it may give me more ammunition for my appeal as it cannot be right for us all to be paid the same when it is I who manages the budget, manages the team and carries the can. But hey what is new in the NHS?

I am sure my parents had little idea when we were growing up, that the lives of their off spring would become quite so complex 30 years or so down the line. But a trip to my brother yesterday put me mind of an episode of Eastenders rather than something like the Waltons, which I am sure was the kind of bland and happy lives our parents had in mind for us. Personally I think it all went wrong when I didn’t marry a doctor, my elder brother married a girl he had known less than a year, and when my younger brother moved out with his girl friend when only 18 and before brother number one had even met his future wife. It is clear to all of us that they are still disappointed with our choices of spouse and that their actions and words sometimes reflect this. It is also clear that they think we are still in our 20’s not 40’s (as 2 of us are) or 30’s.

Still when it comes to behaviour I am not sure that my brother and his wife can blame my parents and the fact they still haven’t come to terms with their 1989 marriage. Infidelity is not conducive to a long and happy married life in my opinion, but I am not sure what makes one party think their own actions in that direction are less damaging than that of the other and sadly this is what is being played out by both parties. Meanwhile they are both clear that their problems stem from my parents and their attitude to their children and their wives and husband!

Ok, slight rant over. Yesterday I spent the afternoon and evening in the company of my brother and his wife, who may or may not have split up. He has got himself a flat about 3 miles up the road and he has stopped paying the mortgage on the marital home so that they are now 2 months behind. What is not clear though is why he did this, because he has eaten and slept at home every night (or day as he works nights) since he announced his intention to leave. It transpires also that both have had various relationships with other people which may or may not have been sexual and / or serious. They have apparently decided to try to ‘make a go of it’, but in my humble opinion neither is willing to be completely honest with the other and probably haven’t been so for a very long time, and I am not sure what future there is in a relationship like that.

Still on a good note, Matt got to see his cousin of the same age who seems to be in Matt’s words ‘absolutely fine’, we met my nephew’s new girlfriend who seems very nice and her mum who described her and my sister in law as the only ‘normal’ mothers with children at the school where the love birds go. Not sure what to say about that idea which wouldn’t put me straight in a league with my own mother and her acid tongue and what girl wants to be too like her own mum in that context?

Thirteen Things about Me and My Team I am currently having 3 days annual leave, and still have 3 more to take before the end of the financial year. I could have done with spending more time in the office this week as all of a suddenly there is a lot to get finished, but with J at work off to Australia tomorrow, I needed to have a few days off before she goes. J has been the person who has provided our department’s administrative support since, well even before there was just two of us as she was there first! We have been through a lot of changes together and no doubt have lots more to come. She keeps me on the straight and narrow, manages my diary when I don’t interfere by putting things in myself, manages the education database and the finance allocation for non professional staff. I have to admit she is making a better job at it than I ever did and this week she asked me if she could go on a course so she can teach admin skills to other administrators. I have a new manager who I think is going to be really great; not that I didn’t like the last one, but I think it is going to be good to have an HR person as manager during this time. This is the first time in my career that I haven’t been line managed by a nurse (just realised that), but actually it doesn’t seem the issue it might once have been. One of my team has decided to leave us after she finishes the 3 months post maternity leave you have to work so as not to have to pay back your work related maternity pay. This was her second child and she has decided to get a part time practice nurse job instead. It is a real shame but she doesn’t feel she can give her best to the job which involves giving professional support to the practice nurses in our area. I fully respect her decision, but don’t know if I will be allowed to replace her as we have a vacancy freeze at the moment. Three of us are currently studying for masters degrees. D is just finishing her post graduate diploma in Education (not sure if she will go on to do the dissertation to finish her masters), R is doing her dissertation for her MSc in Advancing Practice and I have just started my MSc in Strategic Leadership. The PCT we work for has always shown commitment to the education and development of staff, hope this continues! R and D have a job which involves supporting students and mentors in practice which takes them into various areas of practice in different ways. It is the type of job I would have loved to have done myself a few years ago. It is also the kind of role that I wish had been around when I went through the stress of my district nursing course (one of my friends had a nervous breakdown as a direct result of the course!) We have one male in our team, M, who was employed to help us implement the knowledge and skills framework. He has been a massive asset in many ways though not least because he is very easy on the eye and has a great personality but is really good at his job and has not yet become cynical about life in the nhs. One of my team is quite a challenge to manage because I don’t think she particularly thinks she should be in our team and this is compounded by the fact she sits in another office. Hopefully she will be coming over to our new base soon and I will get some management assistance from my new manager. There are 2 other teams based in our new office, these are the palliative care team and the child protection teams (sounds like a bundle of fun I know!) Hopefully it will give us a chance to know some of the people in those teams better now that we are all together and in quite close proximity to each other. We have 6 desks in our new office and at present only 3 of us using them (J, M and me). Soon 2 others will join us and we will keep the other as a hot desk. We have a back door in the office which we can have open in the summer. It is slightly drab at present but I am intending to get some pictures to put on the walls to Brighten things up. I try to meet with all of my team members individually at least every 6-8 weeks. This takes up a lot of time, but I think helps you save the time you would be spending crisis managing. I also have a one to one with my own manager every month (have only had one so far) and we have monthly meetings as a team. We have secured 2 desks in the other office (in another town) so that we can have somewhere to work when we are over there for meetings etc. I haven’t been to look at where in the building they are yet, but will do so next week. Most of the office based staff from our PCT alliance are based there so we need to be seen there from time to time too. That office is far too close to some very nice shops and for the sake of my credit card balance it is best I am not there every day! I think it is the people who I work with that make my job worth going to every day. Without the support of some of them I think I would have walked away long ago. I just hope we can show what a good job we are doing and be allowed to keep doing it as the changes begin to take effect. Links to other Thursday Thirteens! 1. (leave your link in comments, I’ll add you here!)

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So time I got my finger(s) out and got on with writing something! Today is teen son’s birthday; I am now the mother of a 15 year old! This seems scary stuff to me, I couldn’t feel much older if he was about to get married (well maybe I could). This post will therefore be quite self and Matt (this is how he wishes to be known on this blog) indulgant and unashamedly so.

Yesterday was St Valentines day, which, for the last 15 years has been less of a thrilling time for me than perhaps the previous 10 years, because there is nothing like going into labour to channel the mind and nothing like a bit of pain to help you remember the whole day in graphic detail! I also have a clear idea that hubby bought me some lovely flowers and then said there would be no more for having given birth 6 hours later; he was lucky that my blood pressure was high and I needed to remain calm!

Over the years we have had some fun birthdays, we have done the games and entertainer thing, the bowling party, the whole class in the school hall riot (and it nearly was), the cinema thing. We haven’t had a bouncy castle as it is February and also I am not keen on them (blame the lady I looked after with a broken neck after going on one). Now though we are in a calm and tame lull of an evening out with parents and grand parents and an afternoon at the cinema and burger king with the friends before wild partys are discovered (and hopefully not held in my house). My nephew whose mum who has been involved in a ‘my party is bigger than your party thing’ has had wall climbing and ice skating, Matt though has always been happy to do less dangerous persuits and to be honest that is him all over.

As I am not an only child I am not sure of the effect this has on your social skills per say and whether this affects the type of enjoyment you might crave. I have a hunch it is more about people’s personality than the number of siblings you have but I have no proof and it is too late to experiment with more children. Before you say, but 43 is not too old, actually biologically no it is not but for me and the emotional health of my teenager it is much too old - imagine the embarrassment of having a pregnant mother when you are 15, mind you I guess there might be babysitting money to be made.

The office move is done, this didn’t go all together smoothly, though I managed to keep away from the place till yesterday. Our new office is quite nice, but will be a bit quiet. This will be great for getting work done, but for me who likes a bit of a chat it might be a bit too quiet. I have unpacked my belongings and claimed my desk and now have a few days off for the rest of half term which should give me plenty of time for some blogging. Hopefully that means it won’t be five days to my next post!

The way the media portrays medical stories is beginning to annoy me (I say beginning, well maybe it is just annoying me more than before). Every week there is at least one tale a of medical or nursing accident / mistake / willfull lack of care; call it what you will, played out in the full view of the TV or written media and often both. Most week’s those of us working in the NHS are told we are fully responsible for people dying from MRSA in our hospitals because a) we don’t wash our hands and b) we don’t clean our hospitals well enough. Both of these may be true, but actually there are other contributing factors like the consumption of antibiotics which has led to increased resistance to bacterial infection and to the fact that many of us are walking around with Staph Aureus up our noses and don’t know it.

This week I was upset to see a teenager who is suffering from cancer being paraded on TV with her parents because she has suffered from a medical mistake. Firstly I am extremely upset that health care professional colleagues have miscalculated her radiotherapy treatment and over dosed her causing her visible side effects and untold damage. However I am also concerned about the way the health professionals are being held up to the pillory of the media in this way. It seems that we are less likely to sue our doctors than desire to parade them on TV and make them publicly apologise for what they have done. I am not wishing to belittle what has happened to this poor girl but merely point out that the way we are reporting such events is nothing short of obscene.

One of the things which has been happening in the health service since 1997 has been that we have been much more ready to examine our mistakes and look at how these can be prevented in the future. We are encouraged to report incidents and near misses, which occur within our areas of clinical practice so that we and others can learn from them. The trouble is that we have enough of a blame culture internally to prevent real learning from taking place, without having a BBC news team camping outside our doors whenever an incident occurs. It is no longer enough to say sorry and no longer enough to receive financial compensation, people want someone’s head. Next they will be sticking them up on poles infront of the hospital entrance, or will that just add to the MRSA problem?

Thirteen Things about my week On monday we had a party at work, the start of our moving week. We all brought in some food much of which had been prepared at home. We had a great time. I fell off my diet that day and haven’t been able to get back on it properly, I am going to start again next week because I am off out with some work colleagues tonight. As the week has gone on it has become more and more difficult to get around the office because of all of the boxes, it has also been quite sad as we are not all moving to the same place. I have had some very odd things to deal with, particularly in relation to parish nursing (more about that tomorrow). Yesterday (as previously mentioned) we held a very successful conference for admin support staff. I have been quite concerned by the way in which medical mistakes are now played out in the media (more about that tomorrow as well) Today I finished packing up my desk area and unplugged my PC at 3pm. I have been to buy some new trousers and a top to wear tonight on my way home! Tomorrow I am going to begin to plan the next essay for my MSc, I am working from home as I am not part of the moving party; yipee! I am constantly amazed by some peoples inability to communicate by email without being quite rude. One person I deal with never writes Dear Julie (or whatever) and then gets immediately to the point. This may be quick but it is rather curt in my opinion. People seem to think that if they are rude to people on the phone they will get what they want - amazingly that is often not the case. What’s more it gets our backs up! It is still light at 5pm, which must mean spring is on the way! Teen son has been ill this week with flu and therefore has eaten less than usual, this means that there is still food in the fridge! I am running out of things to say, which is ok as this is number 13. I am off shortly to get ready for my night out - at an italian restaurant in Tring Links to other Thursday Thirteens! 1. (leave your link in comments, I’ll add you here!)

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Who would you say are the most important people working in the NHS today? I think most people would think of doctors, nurses, therapists. Definitely people who work in those acute clinical areas; the sharp end. Certainly no one, least of all me would suggest managers are in any way important. In my mind though, the group of staff without whom the NHS could function as it does, and who are pretty much the least valued are the administration support staff. The receptionists, secretaries, personal assistants, data input clerks, and administration assistants who are the first line of contact for patients and staff alike and who often bear the brunt of people’s disgruntlement. These are the people who are lowest paid, but are least likely to be released from work to receive training.

Today we have attempted to address this, by holding a conference / training day for our administration staff. This saw over 120 people from across the county to come together to learn and to network with each other and hopefully to see that we do actually value this group of staff.
These events are always labour intensive in terms of organisation, today was no exception, and it was our training departments’ administrators who did all of this work, all I had to do was chair meetings, make the odd decision and then turn up and introduce the day. In the main the delegates recognised the hard work carried out by their peers and enjoyed the sessions we had on offer (there are always the odd few people who are never happy, but we expect that). A brilliant session on stress management got us off to a great start, before we broke into groups for sessions on appraisal, minute taking, managing your manager and customer care, then back together for the final session on the knowledge and skills framework.

In these times of financial constraint and wholesale service redesign, we can lose sight of the important things in life but hopefully today we went some way to address the balance.

We are moving offices on Friday, so the de-cluttering has moved to the office. I have packed the stuff that I sadly couldn’t dump in the bin into some plastic packing cases. My office life will soon be in half a dozen of these large boxes. This move is prompted because the office is old, cannot be made to comply with any kind of disability discrimination act and what is more doesn’t currently have a fire certificate. The situation is that should there be a fire, the people based up stairs would need (if the stairway were blocked) to climb over the mezzanine floor railing and down a rope ladder! The new building is also old, but at least is on one level.

The pressure of under capacity services being run on a shoe string began to bite today. The health visiting service is saying that it needs to cut back on the number of student nurses who are allocated into their practice area. Each student spends 6 weeks, near the start of their training with a Health visitor to begin to understand about health and health promotion in relation to families within a primary care environment. If students can’t get placements, then ultimately they cannot become nurses, given that the training is 50% theory and 50% practice, and that that practice must be closely supervised particularly at such an early stage. The trouble is, I quite understand their dilemma; trying to run a service when they are understaffed and under resourced. This is of course an area of nursing practice you hear little about until something terrible happens. It is only a matter of time before this difficulty spreads across to District Nursing as they are also a service under review, in the middle of a vacancy freeze and of course under pressure. At this rate my team members whose job it is to support students and mentors in practice will be out of work (well unless of course I can find them something else to do, and of course I can!)

The photo is of our new office building.

Your Five Factor Personality Profile

Extroversion:You have medium extroversion. You’re not the life of the party, but you do show up for the party. Sometimes you are full of energy and open to new social experiences. But you also need to hibernate and enjoy your “down time.” Conscientiousness: You have high conscientiousness. Intelligent and reliable, you tend to succeed in life. Most things in your life are organized and planned well. But you borderline on being a total perfectionist. Agreeableness: You have medium agreeableness. You’re generally a friendly and trusting person. But you also have a healthy dose of cynicism. You get along well with others, as long as they play fair. Neuroticism: You have low neuroticism. You are very emotionally stable and mentally together. Only the greatest setbacks upset you, and you bounce back quickly. Overall, you are typically calm and relaxed - making others feel secure. Openness to experience: Your openness to new experiences is high. In life, you tend to be an early adopter of all new things and ideas. You’ll try almost anything interesting, and you’re constantly pushing your own limits. A great connoisseir of art and beauty, you can find the positive side of almost anything.

The Five Factor Personality Test