A friend and work colleague today dragged me off for a talking to. 2 days back into the same grind and I had begun to lose the positive outlook I had spent all last week cultivating. There are jobs available that need to be applied for by Friday and I have been thinking though not seriously about them. My friend though challenged me about my apparent willingness to be walked over and asked me what I was actually scared of. I spent an hour this afternoon with a senior manager discussing the job possibilities and actually what do I have to lose? Details will follow, but involves the new buzz area of commissioning and involves service redesign. Trouble is it is in Children’s services, now what do I know about children? I am sure I can learn, after all I didn’t always know much about education either.
Four days away from work and the daily grind, mixing with different people has given me some time to be able to reflect on events and begin to think properly about what I need to do. The time has not exactly been packed with lectures, firstly that isn’t the nature of this course, and secondly this was our dissertation workshop, we needed and time to think and discuss how we will tackle this large piece of work. Most people I know who have studied for an MSc have taken about a year or so just to do the dissertation and we have to identify our research paradigm, conduct the study and write it up by June 1st!
I have decided that I need a new job of some kind, I just can’t decide whether to wait until the course finishes. Part of me thinks I should just go for any jobs that come up which I feel I would really want to do and part of me thinks no wait. One of the things that makes me want to hesitate is the planning I am doing to go it alone and whether I wouldn’t be best placed to get going with that and then just gradually cut my hours down in the job I am about to be given. A new job would give me back my motivation and would probably make me more like my normal positive enthusiastic self, but it will also be tiring to try and juggle everything at once. There is no way of knowing if I would be jumping from one negative environment to another until you got there and at least I know the people in my current PCT. The material for my dissertation, which I am almost certain will be about Action Learning and its relationship to supporting and developing leaders will come from my current organisation or more precisely the people within it, but then again that data can be obtained while I work my notice. I wonder why a question always leads to more questions than it does answers!
Thirteen Things For 2007
Ths is not so much about new years resolutions (I am not sure I really believe in those and anyway it is 25th Jan!) but about my plans for this year
- I have just 5 months to complete my MSc, and boy do I have a lot of work to do before then. I am going to have to get on with things and devote lots of time and energy to it. There is a research methods piece of work, a reflective portfolio and the dreaded dissertation.
- I need to sort out my job situation. I am thinking more and more that I need to be really brave and start applying for jobs outside of my current situation. I think I want to get closer to the patient again. Not sure that will mean actual patient care but never say never.
- I need to work with my colleague to get our consultancy work off the ground, so that the job I have in #2 can be part time, and I can still pay the mortgage!
- Studying will be a big part of home life this year as teen son approaches his GCSEs. He seems focused on them, but again he has till June to prepare.
- Starting to think about holidays, once the dissertation is done and teen son has finished his exams we are going to need to get away. I am thinking the Greek Islands.
- I need to stop dieting and start to just get active and eat better. I am beginning to see that dieting is just a way to get fatter, as I yoyo up and down. I am also going to need to get out of the house and exercise to clear my head (see #1-3).
- I want to try and do a few more things that are for myself, and this kind of relates to #6, if I want to go off and walk, maybe I should see about finding other like minded people to walk with (or head off on my own) rather than be put off by a husband who would far rather sit home watching football!
- I am going to catch up with a few friends I haven’t seen in ages and who I know I should ring and go and see (I know these things work both ways, but someone has to make a move).
- I am going to blog more (dissertation, work and visiting friends permitting). Some weeks I am very lax, and it doesn’t exactly take much time out of your day.
- I am going to read more of other blogs, and not get wound up by some of the comments our medic friends make about the place of the nurse!
- I might be needing some early nights at this rate!
- I must try not to leave things to the last minute!
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A saga has been going on since last week when I missed the year 11 parents evening. It has involved my trying to contact the head of maths at my son’s school and him trying to contact me in return. Despite it being 2007 where we have a wealth of technology it has taken a week for us to speak to each other. Something very strange has happened with Matt’s coursework, something he himself cannot explain and it has resulted in him being scored zero for it. In essence he has lost 20% of his total marks and will need to score a B in his final exam to receive a C. It is suggested he handed in what had been a practice paper done in class as his course work. Matt said he was confused, and other people also confused had attended a maths after-school group to make sure they got things right. Matt is essentially lazy when it comes to extra curricular activities, he is happy to work at home but after school clubs have never been his thing. I don’t blame the school and really if he doesn’t understand he has to learn to ask. But I wonder why it has taken a year for this whole thing to come to light. Tonight we are going to a meeting about some kind of after school maths thing he now has to attend so that he can make the best of a bad job.
Arsenal play Tottenham in a local derby, cup extravaganza this evening. My brothers and dad (though luckily he is currently in Dubai) are Spurs fans, and I will have to accept a certain amount of ‘flack’ if Spurs win. If the opposite happens of course I will maintain a dignified silence. Anyway the second leg is next week.
Meantime, it is academia and not work I am interested in this week, so nothing here about the NHS. I am also happy to report that I managed to leave university today without my car being clamped and it costing me £75!
Off to the University for the first of 4 days of a ‘learning burst’, I was quite looking forward to seeing everyone although as usual slightly nervous of the assessment day. This course has the fairly odd and in my experience unique process of self and peer marking. It entails reading an appraising 5 other 5000 word essays and then being prepared to sit and discuss what people have offered up. It has got easier over the last year, but still it is slightly anxiety provoking as we try to offer critical evaluation of not only our own work but also that of each other.
It is plain to see that we have all improved in our ability to challenge the literature and to apply the context of our own situations. This is the first time however we have conducted any kind of research of our own, but this process offers an insight into our own working practices, even if some of us struggle with action research as a methodology and some just struggle!
Harrow-on-the Hill looks lovely in the winter sunshine from the classroom and we can even see some of the boys of the great and the good playing Rugby. I have enjoyed the discussion’s we had today, even if at times it seems that the process has been unnecessarily protracted. Off I go then to my car.
I am clamped!!! This morning, I had gone to reception to ask for a blue sticker. It is such a long time since I was last in this car park that my sticker is still yellow (2005/6 colour), I had also paid and displayed. Some time during the day the sticker removed itself from the windscreen and dropped, unseen even by the digital camera of the parking police onto the floor of the car. Much arguing and £75 lighter (he would not believe my story and said there was no evidence I hadn’t just got my blue sticker) I leave the University for home. How am I ever to give up midweek snacks and wine if my life is to be one long episode of stress? I can hardly believe the injustice of it all, but then isn’t that just the story of my life these days?
In the good old days, when I was first a district nurse, I had colleagues who took their patient’s washing home, did bits of shopping for them and even walked their dogs (the last one might only have happened once). The traditional view of district nursing was of a homely middle-aged person who was like a friend to the families they visited and who could also dress a wound or give an injection. Now I have never taken any ones washing home, after all doing my own washing and ironing is enough of a chore for me but I did perform a type of nursing where I had free reign to decide what care I thought I should provide, when and where. Once a patient had been referred by the GP or hospital, I was responsible for assessing them, and planning their care. If I thought the patient needed a particular dressing to be applied daily, then it was applied daily. If I thought I should visit each time then I did. There was little opportunity to challenge practice, and I especially didn’t tell my colleagues who had been district nurses for years that they were visiting patients unnecessarily in my opinion.
Things have changed, though I have a hunch that some people are still practicing in a hybrid way – evidence based family friend perhaps – I am not sure how long they will be able to do that though. Referrals to the service increasingly need to be made in a professional way, using such technology as a proper form, fax machine and certainly with a clear plan in mind. The days of a few words scribbled in a message book – Mrs Smith, 88, off her legs – are thankfully over. There are not enough qualified district nurses around to perform every assessment and reassessment, and so there is skill mix and whats more the junior nurses and health care assistants need to be competent to perform the duties they are asked to do. Evidence tells us how long it should take to complete a particular episode of care and a district nurse needs to be able to justify why things are not going to plan. Patients are often sicker, they come out of hospital more quickly, they are prevented from going in at all (our district nurses all know how much their employer is charged for a patient going into hospital and staying there). They need to be skilled up at giving IVs, cannulating, inserting suprapubic catheters, managing complex wounds, and prescribing care and medication for patients with long term conditions.
The relationship with GPs has also needed to change. The doctors who I worked with as a district nurse were sometimes heard to describe me as ‘their nurse’, proposed changes to the district nursing team structures locally led to cries from GPs that they would lose their personal service. But we are not their nurses, we are competent, experienced, knowledgeable, skillful individuals who are able to provide a range of care to sick people in their own homes. What is more, GPs are about to take on a new role, they are to become the commissioners of the District Nursing Service and when you are buying something you begin to look at exactly what is being bought. You need to know you are getting value for money, you need to know it going to be effective and you need to know exactly what you are getting for your money – after all any service provided by real people is very expensive.
I personally think it is a very exciting time for district nursing, it gives the opportunity to move out of the shadows of characters like Gladys Emmanuel and the like, and it gives an opportunity for working relationships with GP colleagues to develop in a much more professional, team like way. Trouble is, this is being done at a time of extreme PCT chaos, financial problems mean that when a district nurse leaves he or she isn’t replaced and any good will that existed to maintain the smooth running of the service is quickly evaporating. I just wonder exactly what the future holds!
The PCT newsletter told me yesterday that a small number of individuals were unsuccessful in obtaining a tier 4 job, and that assistance is being given to those people in applying for positions. On one level I am glad that I am seen as an individual person, but on another it feels like a dismissive term to describe something quite irritating. I had a meeting with someone from the HR department this week who told me that on one hand I am displaced and can therefore apply for any post that comes up in the region which I think I am suitable for. On the other hand she warned me that I shouldn’t take too long about it, as a new job was about to be created in education and training, on a pay band lower than my present one. Whats more it is very likely this will be deemed suitable alternative employment for me. Over my dead body, was my immediate thought as I shot off to go and find any suitable job anywhere!
Agenda for change has been a very expensive experiment in giving those working in the NHS (who are not doctors) an amount of pay which adequately reflects the job that they do. This is because they have discovered many of us were underpaid in terms of the rules created, therefore there seems to be a slight mission going on. The organisation is seriously in debt, pay costs represent a huge proportion of outgoings, redundancy costs too much so lets just try and reduce the pay we give to some of the higher earners. This isn’t just about the ‘individuals’ who were unsuccessful in their first choice of job and who will now need to accept a job at a ‘lower level’ but it is actually about the successful ones too. These people are now beginning jobs that are twice the size of their previous ones, and most are doing those jobs for the same pay as they were already on.
I am a nurse, I didn’t become a nurse to get rich. I am now over 26 years into my career and have worked hard to get to this place. I don’t deserve to find myself devaluated any more than I would if I worked on a ward as the most junior nurse. Don’t forget that these things have a habit of finding their way down to the bottom level!
On a positive note, I might just catch them out at their own game. I am going to be helping to write the new job description, and already it is unlikely this new job will carry any less (and perhaps more) responsibilities than my original job. Lets just see what happens! Meantime, I am meeting my RCN rep to discuss all of this in the very near future!
Yesterday just as I was preparing to leave work early to go to teen son’s school parents evening we are delivered some bizarre news. The gate at the entrance to the underground car park is stuck in the down position, no one can go in or out. There is a definate disadvantage to working 27 miles from home and at a place pretty inaccessible by public transport (train travel involves going into London to come back out). Locals were able to arrange lifts or get the train but a group of us were stuck there for the next 3 hours. Now don’t get me wrong, I value having the time to get stuck in to work for longer, but actually it is currently not my favorite place to be. Especially when I am meant to be discussing maths and english with some teachers!
This morning saw me doing some team building with a group of dietitians, interesting, fun and worthwhile. Back at the office, I decided the underground car park wasn’t for me so parked outside and stepped out into a big puddle half way up my boots. Great fun! Plus slightly wet trousers, still at least I could leave the place by 5pm today and whats more I did!
Just days after writing a positive post about the work I have been given to get on with while I wait to be offered something meaningful to apply for, so it starts to become apparent that things might not be quite so easy. For anyone who works in an office environment, or even comes into contact with one, it will be no surprise if I say that administrative staff need to be treated with extreme care. They can be the difference between a smooth running efficient department, and one where you can’t get so much as a letter sent out without a major battle. If you are planning on bringing together a group of admin staff currently based around the county, perhaps you would be best placed not to upset several of them before you actually do it. What is more, perhaps if you ask someone else to identify how best to create a new structure in the admin team, you don’t start telling people how it will look before the work has been started by that person.
So there I was on thursday afternoon, calming down two very good administrators, and receiveing apologies from the new manager of the service. I know that I can resolve the problems, I know that we can probably avert the potential for a slight crisis, but once bad feeling has been created it becomes more difficult to do the job in hand. It also provides a valuable lesson in management (I hope).
Trouble is we haven’t even got started with this yet and this small but significant problem fills me with a slight sense of doom. I will reserve judgement for the moment, but I am beginning to wonder if when I do have a job or two to apply for, whether that job shouldn’t be doing something outside this education and training department and maybe even this organisation?
The latest edition of Change of Shift is up at Emergiblog, go over there and take a look!
The job I have been doing up until now will soon cease to exist as the next stage of the process of locally implementing Commissioning a Patient Led NHS (affectionately known as CaPLNHS) takes place. At times, even the people who wrote the policies and consultation documents seem confused about what they are doing, but then this is the NHS so I am not sure I can expect more! I am officially displaced, and in the fullness of time (before the end of June) I must be given the opportunity to apply for other jobs, and if they can’t find a suitable alternative job for me, make me redundant. Let us be clear, they are not about to do the latter, I have too much service, and will cost too much, and anyway hopefully they value me too much for that (well I am being positive and hopeful here so humour me).
The work I do now is meant to be of a project like nature, I am happy to do any kind of useful, nay important work the PCT would like me to do. I prefer to be busy and having little to do recently has been a challenge leading to some laziness. But no more, hopefully I have some work to do till they decide what they want with me, and I decide what I want from them. I will be doing what I know best, working within the new education and training department, trying to sort out the administrative processes and bringing the team of admin assistants etc together. Plus I will be developing a leadership and management training strategy and working with one of my existing team to work out how we bring together information, and to put together a case for a database across the training function. More than likely it will end up with me taking a job as a kind of deputy to the person who has the job I wanted, but we will see. I don’t think it will lead to any kind of complacency or assumptions in that area, because if it doesn’t work out on either side I will look for something else. But essentially I have work to do, pleasant people to work with and soon the opportunity to move my office to within 20 minutes by car of my home. Now that will be the best bit!
The action research project assignment is in. I can’t decide if it is good or indifferent, but reviewing the evaluation process was interesting. One of the things I will be able to do in this new and perhaps temporary role is to look at evaluation and how we do it so hopefully I might get to implement some of my findings. My studies are about to pick up momentum as we head into the dissertation and end of the course in the summer. I haven’t really decided on my subject yet, but there is no doubt something that I will be doing that will be worthy of some study. Suddenly this new year feels more positive anyway!
My first post of the new year and I must be slacking, after all it is 5th January and so if my new years resolution was to blog daily, then I would already have failed. Luckily I am avoiding resolutions as such, and it feels better to blog when you actually have something to say or as in my case today are trying to avoid doing something more important. What can be more important than blogging I hear you cry? Well the long awaited and discussed assignment for my MSc is due in on Monday. I am 2000 words or so into the write up and actually feel increasingly confident that I will actually be able to write another 3000 by Sunday but at this very moment communicating here on my blog seems more attractive.
It hardly seems possible that only 2 weeks away I had finished work for Christmas and was getting prepared for the big day (plus boxing day when I had more guests here). Tomorrow, twelth night, I will take down the decorations, and send the tree for recycling (see I am trying to be green) and Christmas will officially be over.
I returned to work on Tuesday, I feel strangely serene about the place. Not excited to face the year as I might have in other years, but then you can’t get very excited when you don’t know what job you are meant to be doing. But some of the old enthusiasm is back and what work I have will be done well (I think). I still await further instructions and also a job I can apply for, I am reticent about the idea of another job in training and education in the NHS but we will see what is on offer before I make my decision. Yesterday, funnily enough I did some one to one coaching with someone who is in a similar position to me but whose replacement job is now in the offing and who was nervous about interview etc. Every now and then I have to ask myself if I am qualified to help people like this, after all, I can’t have performed that well in my own interview. My confidence has definitely taken a knocking, but people around me keep telling me not to be so silly and that I am as competent as ever (whatever that means!)
Apparently the UK is soon to be short of nurses (and indeed junior doctors), so I can always go back to nursing if things get really bad, or failing that get a job as a nurse practitioner and take a junior doctors job (ah yes time to keep Dr Crippen happy for another year!) The NHS ship feels like it is heading towards the iceberg but I am not sure it is actually the titanic or that it will sink and it is up to people like me to help keep it that way, even if someone in my own trust seems to be trying to throw me off the deck without a life jacket!
