I can hardly believe I am writing about this topic, but what kind of nurse would I be if I couldn’t discuss one of life’s most basic functions? I have to report that as of today, my employer is apparently too poor to purchase toilet rolls for use in its clinics, offices and other buildings. If you are lucky, the person who orders such things, has a good supply stashed away, if not, you may well be forced to take your own into work in the next few days. For 18 months we have had a vacancy freeze, we have been banned from ordering things considered frivolous, where possible there has been no use of bank and agency staff, there has been little staff training other than mandatory and statutory but at least there is still water (see a couple of posts below). But they know how to make us feel valued, they know how to treat patients who happen into their buildings, just so long as they don’t get caught short!

This is my last week in my current job, so time to remove five years worth of mess from the office. Well its not quite that bad, I have after all moved office twice in the last year or so, and 3 times in the last two. Each time I have had a good session of paper throwing. Today though it all took on a new meaning, I no longer have need for even one years worth of old meeting minutes let alone 5. There were also brochures for courses that are not even worth passing on today anyone else, given that there is no money!

A good clear out is something I find immensely therapeutic; it is almost worth hanging onto a pile of papers just so they can be sorted through and put into the recycling / bin / shredder. I have to admit though that I am beginning to be something of a paper hoarder. Any sensible person would get rid of rubbish as it arrives, both at work and at home, but I seem to get some kind of perverse thrill from ending up in a mess so that I can have a clear out. Maybe I’ll try to turn over a new leaf in the new job; I won’t hold my breath though!

I have been tagged by Kim from Emergiblog, with a Meme about the 5 things I couldn’t live without as a nurse. Kim, who of course works everyday as a proper clinical nurse, decided to let us into a few secrets about the things she does in her off duty. I have decided to tell you about the things that I most liked about being a nurse, during the 20 years or more that I worked in clinical practice.

First and foremost, I have always found working as part of a team to be something to hang onto at all costs. I have worked in large ward teams, small community teams and have been something of a lone person as a specialist nurse so I have seen things from all perspectives. As work colleagues you support each other through those difficult times, makes each others working lives worth while, and whats more you have fun doing it. Nursing doesn’t have to be serious all of the time, or even most of the time, people do and say funny things, plus there is that morbid sense of humour nurses are famous for. Yesterday I had lunch with the team I am about to leave behind as I go onto my new job, it is that group of people who have kept me going during some very challenging and confusing times.

Second of my choice of things I would never have been without was my uniform, including hat (at certain times). I wanted to be a nurse for as long as I could remember, and putting on that uniform for the first time was very special. We wore a lilac stripy affair as students, and at the end of the first year were ‘awarded’ our hospital hats. These were completely impractical, fell off when moving patients and caused you to get a head ache. But they denoted our belonging to the hospital and to years of tradition. When I moved hospital about a year after I qualified I was forced for the first time to wear what has been described by many as a jay cloth dress. It was more like a sack and was singularly unflattering to all sizes. The only good thing was that I could proudly display my hospital belt.

Third on my list would be my patients; it would be true to say a nurse cannot really be a nurse without them, but I have had some interesting and varied patients in my career. I still to this day remember nursing my first AIDS patient, and the bewildering fear of his visitors who gowned up to go into his room and talk to him.

Of course none of us knew what was in store then! I remember an old lady abandoned by her family on Christmas Eve, I remember a lady being reverse barrier nursed on whose behalf I went mothers day shopping. As a district nurse I had a patient who followed me to a new area, joining a new GP surgery in the process. I thought I would never be rid of him (he was one of those challenging young people who know lots about their condition and engage in some kind of love hate relationship with you), but I moved on to Rheumatology and thankfully he didn’t have arthritis!

Fourth on my list would be some of the skills I learned along the way.

From that first scary injection into a real patient (nothing like an orange at all), to my first dressing, IV, teaching a junior doctor that it was best not to resuscitate patients who were sitting up, and towards the end of my clinical practice being able to inject joints. It was amazing to be able to remove large quantities of fluid from a patient’s knee and have them walk out in much less pain. Then have them ring me a day or 2 later and tell me how much better things were. Something I find amazing is that some of the knowledge and indeed I am sure the skills I learned then, still hold firm with me today. I haven’t yet reached the point when I don’t think, with a bit of refreshing and reskilling that I couldn’t go back to any of the areas of practice I have worked in if I wanted.

So finally I would say the fifth thing I wouldn’t want to be without is my registration. The fact that I can call myself a nurse. My actions, even today in a job not directly linked to patients are informed by my code of conduct and the fact that I am a nurse. I am extremely proud of that, and it saddens me when other nurses don’t conduct themselves in a way that demonstrates that they are proud of being a nurse too.

So I guess next I will be required to tag 2 more nurses. I would like therefore to ask one of the nurses who contribute to Mental Nurse, and Nurse Sean so we can again get perspectives from both sides of the Atlantic.

Working in the NHS at the start of the 21st century seems to have brought with it some perks which people have started to see as a right rather than a priviledge. Last summer, during a period of very hot weather, the water supplies bought in to keep staff in the PCT hydrated couldn’t keep up with demand. People were quite shocked to be told that the water in the taps could actually be drunk, and whats more it came out of the tap icy cold. But when exactly did we all start to expect our water to be brought in? Why as a nation do we suddenly find the water from the tap so unpalatable?

Chatting to some colleagues last week, they seemed quite surprised that firstly I tend to buy my own stationery (well I have a bit of a passion for pens, pencils and notebooks, I can’t help it). They were even more surprised (they were admin staff) to hear that as junior nurses in the 1980s we always bought our pens and notebooks. These were not obtained from a stationery cupboard or even in those days from drug reps. I guess that habit has stuck with me, and anyway why should the NHS buy my pen, it is not the most expensive purchase you will ever make!

Some other things have already begun to disappear, like biscuits at meetings and sandwiches at study days and people recognise these as being luxuries that perhaps are a step too far. Something that is yet to completely bite though is being prevented from taking study leave for something that is not going to benefit the organisation or going to be of value to the individual in their particular job. For a while people seemed to be able to go on study days, courses and conferences that bore only a passing relevence to their work, service or indeed the organisation itself. Very few people had leave turned down because it didn’t meet the areas identifyed in their PDP, but that has begun to change drastically. Money was one cause, but also the KSF which identifies areas of development within a particular role. If you can’t demonstrate competence in the core areas like communication, then what are you doing going to an obscure conference for the purposes of ‘networking’ and generally having a great time. In my time as education manager, I have even had people try to pass bottles of wine in their expenses, and they didn’t like it when I pointed out that this is public money!

I think that perhaps this is the crux of the problem, many people working in the NHS today, fail to grasp a few fundamental things. The NHS is funded through our taxes, we need to be accountable for the money that is spent and that includes the money spent on sending us places. Nothing is free, if you nip off for half a day on a free study afternoon it is not going to be free to the organisation if you go in their time and the sooner people start to recognise some of these hidden costs the better!

My teen son is like a bean pole, over 6 foot tall and so skinny you can see his pelvic bones (he uses them to stop his Jeans falling down), he is active though not sporty in a participating in team sport type way. When he was about 8, and could swim a few lengths of the local pool on front and back, I was informed that there was no more need for lessons. While he liked swimming he really didn’t like to be told what to do. Most of his football playing then, save informal mates games and school sports has taken place via the terraces, the TV or the PlayStation consul. He is also frequently to be found posting on football related web forums and appears to know what team is lining up, who is playing for whom etc before even the newspapers do.

He is not clear about where his future career lies, and as someone who felt the draw to nursing at a young age (this involved bandaging and splints on dolls and teddys) I don’t necessarily think this is a bad thing. Many people criticise the kids of today for the way that they apparently spend too much time at a computer / games consul screen but for most the interaction that takes place is less of an obesity forming problem and more of an advantage. The first time I properly realised this could be true was when Matt used his Age of Empires strategic play and knowledge to pass the end of year history exam with top marks! I am further encouraged today by a post on Loopy Librarian’s Health Media roundup which orignated in the Guardian:

“It is the ultimate excuse for every video-gamer accused of spending too long hunched over a console: “I’m not addicted. I’m just honing my surgical skills.” A study has found a direct link between skill at video gaming and skill at keyhole, or laparoscopic, surgery. Young surgeons who spent at least three hours a week playing video games in the past made 37% fewer errors, were 27% faster, and scored 42% better overall than surgeons who had never played a video game at all.”

Now my squeamish son is not about to become a surgeon, I doubt he possesses the single minded determinationand required to become a doctor and with the current state of the NHS that is not such a bad thing. But it is heartening to see that my suspicion that computer games, and their use are not such a terrible thing.

The application form for a part time job he asked me to obtain today from the local Sainsbury’s is also a start in the right direction to developing a bit more of a work ethic, after all no one wants a complete lay about for a son! One day he might be someone’s husband and I already have something of a couch potato of my own!

Apparently, if we are to believe the BBC news children must not be allowed to watch TV before the age of 3 or else they will suffer untold (well autism, shortsightedness to mention but 2) harm. Not that I can find reference to this report on the web! I use the TV in my bedroom as an alarm clock, hubby uses the real clock and gets up at some kind of unearthly middle of the night hour, and to be frank the BBC news I hear subliminally as I reach levels of consciousness is damaging my psychologically. Being the kind of person who likes to hear news as it is, I have always been a BBC type person, but just recently the Breakfast Programme has turned into a tabloid of the Sun or perhaps Daily Mail proportions. Each item is given a maximum of 2 minutes and many quite important sounding type stories are given all of about 30 seconds, but in that time you could be forgiven for worrying that you cannot eat anything, do anything, go anywhere or let your children do anything without something awful happening.

Mind you I was amused to hear that the government is now suggesting round the clock surgery to clear waiting times. The very idea of getting your routine hernia repair, or hip replacement at midnight sounds bizarre beyond belief. We have PCTs who are bankrupt telling NHS Trusts not to operate on their patients before April and suddenly it is a good idea to operate in the dead of night. How much would it cost your average cash strapped hospital to run services in this way, and how many doctors would be left to cover the day time hours? Puts a new perspective on ‘day’ cases which would be come ‘night’ ones and if the hospital was in London would save money for all by avoiding congestion charges! Maybe the idea has mileage after-all?

Mid February and spring seems to be very close. Only a week ago, we had our annual dose of snow and today I have seen my first daffodil, plus Sainsbury’s has a special area for spring cleaning. I am happy to see daffodils but I am not going to be told when to give that extra special clean my house so I steer clear of that one! Is this global warming, consumer pressure or do we always get this happening in February? I can’t remember.

I am taking a welcome break from work and have 7 working days holiday, during which I need to concentrate on work of another kind; the dreaded dissertation. So far this is involving me reading books to help me assertain my philosopical position, and I am struggling with understanding exactly what people like Weber and Habermas are about. This is not necessarily going to help me do my research into action learning, but I have to write stuff that demonstrates some understanding of what I know and where my world view fits into the big world of research. When I work this one out you will be the first to know!

Thirteen Things about The Joy of being the parent of a 16 year old So today is teen son’s 16th birthday and what a joy it is to be the mother of a child/adult hybrid! As he told me today, he is bigger than me, and reminding him that I knew him when he was a tiny babe in arms (and before that actually if you count when I was pregnant) does nothing to change that. I no longer appear to have the right to know exactly where he is and what he is doing at all times. After all I have no need to worry ‘he will be alright’! I am unable to keep the fridge well stocked enough for his needs, where does all that food go to? Money is the most sought after birthday gift of a 16 year old, the more the better! Apparently Eric Clapton is ok at the guitar, but not that good! Mind you teen son has only had his guitar for 2 weeks and therefore is nowhere near Eric Clapton class yet! Cannabis is a less dangerous drug than alcohol so I am told. Maybe or maybe not, but please don’t take either you are 16. 16 is not too old to re-read Harry Potter or to eagerly await the publication of the latest / final book I am so senile that apparently I have bought him the same birthday card 2 year running, but it is ok to do that apparently! He might consider a part time job now he is 16. I have put him forward (with his cousin) for 2 weeks manual labour renovating a friends house in France this summer. It will be hard letting him go though. 16 year old boys don’t like to cuddle their mums. In fact he tells me he doesn’t do cuddles, just hugs and I haven’t had one of those in a while. Today he told me that after university he may live abroad! Whatever he may think, he is still my baby boy, born 16 years ago today! Links to other Thursday Thirteens! - please leave a comment below

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It was 2001, the government was still being referred to as new labour, the NHS plan was in its infancy and money floated around the new PCTs like it was going out of fashion. We were new organisations, we needed infrastructure, we needed to set up our systems and to be honest no one really appeared to know what they were doing. Money for education was allocated in pots - one for setting things up, one for our clinical staff, one for our non qualified staff, the list went on. If you could dream up a project and show a few outcomes the money was yours. It was wasteful, but a lot of people went off and learned lots of stuff that would give them a theoretical grounding in something and we did plenty of training on-site too. Some of the pots of money could be used to employ staff, and in some PCTs whole departments were set up on the back of such funding. GPs too benefited, there was funding to introduce appraisal for GPs, there was money for primary care medical tutors and money to pay GPs to employ locums so they could attend educational meetings and events (I kid you not).

The trouble was this pack of cards was built on a kind of never never type approach to healthcare investment. The more money the trusts were given the more they spent. We always kept within our budgets but along the way we paid for all number of conferences, away days and general jolliness. The good times had to end, and when they did the house of cards came with them. The departments built on project money allocated for education began to collapse as cash strapped organisations were unwilling or unable to pick up the costs. Course costs could no longer be met, and as the belt was tightened there was money for little more than mandatory training. Then one day the good times ended, there was a realisation that there would be no more central funding for education for NHS staff, employers would (shock horror) have to pay to educate their own staff like everyone else does. But there was no money and suddenly even fire training seemed to be a luxury.

This seems to be a good point to dip out, but is also a time for reflection. What could have been done differently? Were we corrupt? Well perhaps in some ways, this is public money and rich tea biscuits are as good as chocolate digestives, though less tasty. Training taking place in a hotel is more pleasant than the local post graduate centre, and the parking is better. But money is only ever allocated for a year at a time, and perhaps if there was more long term planning then there would have been less waste. The trouble is the way in which decisions are made, the long winded nature of the process of deciding whether to do this or to do that and then the time it takes to actually get things done. Before you know where you are it is January and you need to off load the money by march.

So the bottom line is that much money was spent wisely, some was wasted but that would have much less of a problem if the NHS didn’t function on an annual budget setting process. The good times are gone and now you can’t get a biscuit at your training session unless the person running it buys some out of her own money and she is off to be a commissioner!

That is my great news this morning, yesterday I had an interview and now I have a job. How great is that? The last 2 months have been hard for me and those around me, I have been forced to take a good long hard look at myself and think about what is important to me. This has resulted in what will be a complete change of direction as I enter the strange world now of commissioning and the even darker and more mysterious world of acute children’s services and maternity services. I am going to be busy, I am going to be learning lots of new stuff, it is going to be challenging but hopefully it is going to be a good move for me.

The last couple of months have been tough, I have been forced to examine my values, I have had to manage the often bizarre thought processes going through my mind as I struggled with the feeling that I was no longer wanted within my own service. I also had to fight against being pigeon holed into a job that people wanted to make up for me. Who knows how this new move will pan out, but once again I feel in control of my own destiny, and for me that is the most important thing!

Each week at work, we are sent a newsletter via email, it tends to tell us how much all of our work is valued, but that the financial picture remains very serious nay dire and that it is our responsibility to keep on saving. At the same time, we are told that some very important and more than likely expensive company has been called (or more likely sent) in to help identify if more money could be saved and if the processes already applied for money saving have been the right ones. At this rate, there could be a succession of different auditors and other financial experts all charging some great amount to tell the chief executive and her board that they either are (or are not) doing a great job there.

One of the results of all of this is that we can no longer order anything without it being approved by a director. Last week I heard about an admin person being refused a new cartridge for her printer, perhaps she is meant to write everything in long hand now or perhaps she just has to send everything by email (who knows). Our mileage claims will now be scrutinised by an assistant director and all invoices that come in have to be countersigned. The bottom line is obviously getting very serious, no one has yet suggested we work for free but you get the impression some bright spark will be suggesting it in the good ideas box very soon.

Very little education and training is going on right now. This is partly because we are in such a state of flux that we just haven’t organised much, but also because clinical services are under pressure, with the vacancy freeze now making teams extremely stretched. There is however once type of training that is meant to continue, and that is what is considered statutory and mandatory. These sessions include fire, health and safety and patient moving and handling sessions some of which should be updated annually. I have my own ideas about whether there is much point attending a session every year to tell you the same old stuff, but the organisation needs to do these things for reasons of insurance and governance and we must do as we are told. Suddenly though it is not so important, saving money is more important than a nurse updating her moving and handling training. Yes you have got it, we have been asked to look at the possibility of cancelling all training including that determined mandatory and indeed statutory if you count fire training. Firstly this will just move the problem to the next financial year, but what if something happens in the next few weeks and someone is injured, what liability will the trust be at by this kind of action. Finally though what kind of message does this kind of thing send out to the people working for this particular organisation - you can’t have a new ink cartridge, you can’t attend the training we consider at any other time as mandatory and any time now we might ask you to work for free. Who would want to work in a place like this?

Well a few inches, and the whole place comes to a complete standstill. It is difficult to understand how, even when snow is fully and accurately predicted by the weather forecasters that traffic should come to a standstill, schools close and people’s interviews get postponed to another day. I wouldn’t mind, but on the day that people just turn over in bed rather than struggle to work, I have already taken a day’s annual leave to help me remain calm and prepare for interview. Now though I have a whole day to myself, not that there isn’t plenty to keep me occupied, what with a lecture to 250 students to prepare for and college work to do.

My topic for monday’s session at the local university is Leadership in the NHS. The event is a 3 day student conference, and I have 25 minutes to cover this massive topic. I think I am going to be looking at the kind of leadership behaviours seen in the NHS, how a newly qualified professional (these are nurses, therapists and paramedics) can demonstrate leadership and the barriers he or she might face. This topic makes me think of the difficulties many of us face early in our careers, trying to be heard, trying to do what seems to be right, while facing opposition from those who consider themselves older, wiser and perhaps better than us.

In the 1980’s it certainly wasn’t the done thing to challenge our more senior colleagues. The word of the ward sister was gospel, and doctors were there to be bowed and scraped to. Generally we were expected to do as we were told, this included making sure the pillow cases faced away from the door and the bed wheels were straight. If a doctor said we should put egg white and oxygen or eusol onto a wound, then we did it. Even if we had known the evidence base for these treatments was beginning to suggest neither were particularly useful and might even have been detrimental to our patients, we would never have had the nerve to challenge the word of either sister or the doctor.

Somewhere though things changed, more research applicable not only to medical practice, but also that of nurses was carried out and increasingly nurses have been able to challenge their own practice and that of others. It is ok to ask why we do things the way we do them, even if it is uncomfortable to do so. We are accountable for our actions and ignorance is no defence to challenge we must. We must acknowledge and embrace change, we must try and imagine (or vision) how we can change and mostly we must think about the needs of patients before the needs of ourselves. Of course, not everyone wants us to think like this, and at times we find ourselves doing things because that is the way we do them, and sometimes changes seem to being introduced for their own sake or merely to save money.

We must however stand up and be counted, if we are willing to challenge practice we must know why we are doing it and we must be accountable. As nurses and other health professionals we must actually be able to see that what we are doing is for the benefit of patients and not because the government says they think it is the best and cheapest option.

Staying in my current job will mean monthly team meetings that are 4 hours long. Well if today’s experience is anything to go by. OK so it was the first time most of them had got together and for the most part it was good humoured. But 4 hours? Don’t these people have better things to do with their lives? The whole thing took me back about 4 years to a time when I belonged to a newly formed smallish PCT with a Director of Nursing who liked to spend the first hour of the fortnightly nursing directorate meeting discussing the plans for any forthcoming social events. I didn’t like it then and I don’t like it now.

It is interesting when you don’t actually feel you belong somewhere to watch people’s body language. The leader of the team who doesn’t quite know how she got into this position and is clearly quite uncomfortable with it. The people who have done a job of work a particular way for a good number of years and are clear that nothing will make  them change. The idea that there can be a team within a team where everyone is equal, and democracy will reign.

Meanwhile I sit there wondering what I am doing in this place with this bunch of people. All are individually very nice people, all probably very good at their own jobs but the more I sit there the more I wonder what will ever make them into a team. I never thought I would say this, but I am glad I am not in charge of this lot, I pity the person who is and I want the job I am going for tomorrow than the one I was interviewed for in December. It sure is a funny place; the NHS.

I wonder when people in the health service started to speak as if they had swallowed some kind of management jargon dictionary and I also wonder how necessary it is for people to use those kinds of words? When I look at the current job adverts on the NHS jobs website or look at job descriptions for the positions there I am told that the person needed should be able to develop ‘matix working’ or have a ‘can do attitude’. I am meant to be able to promote partnership working, use joined up thinking and possibly walk on the moon for all I understand some of it. Nurses and other medical types of course have other types of words they can use to help create their semi secret world, and I have been privy to much of that for a long time. At least these are often proper medical or nursing terms, though in my opinion there is too  much use of abbreviations and acronyms. There is a time and a place to use these terms and there is a time to speak in plain English and that is where some of this manager speak seems just plain wrong.

I would hope that I have an attitude that says, I can do that, and whats more I am going to try to help you do it too. Surely that is what leadership and change management is about. But it is a behaviour, a way of doing things. Matrix working though is just a word someone seems to have thought up and chucked into a meeting one day to see who would ‘pick it up and run with it’! I think matrix and partnership working might be quite similar things, they might be about trying to work across organisational, professional and team boundaries to get to the same end result. But putting the terms in a job description makes them look like they are some kind of special skill that only a manager might understand. Having said that of course, I am going to have to keep brushing up on my vocabulary to that I have a chance of understanding what the  hell is going on around me!

I caught up with the head of year 11 yesterday to discuss teen son’s progress towards his GCSEs. All she could really tell me, and I am not sure I didn’t know this, was that he needs to work harder. My two recent interactions with teachers at this particular school just highlight to me that some people find it difficult to listen to what others say and are highly inclined to talk over them. I am left wondering how the voice of the students gets heard, because I am a mature, professional woman and I couldn’t get my points across.

This was my second visit to the school in just a couple of hours, as I had been summoned to collect Matt at lunchtime, the poor boy has a bad dose of man flu and has now retreated to his bed where he will stay till this afternoon and it is the weekend. I am happy to report that his appetite is reasonably in tact, so at least he won’t waste away. Often these days I am glad I don’t have more teenagers, I am not sure I could afford the food bill!

Today I am meeting with my RCN representative to discuss the messy job process I have been thrown into. It got better yesterday, when I discovered that the lead interviewer and my current assistant director told the successful candidate before she told me that I interviewed really poorly! I haven’t yet had feedback from that fateful day, but actually am sure my interview was pretty poor but that is not the point. Treat people as you would like to be treated has always been my motto and in this case treatment has been shoddy. I had to reassure my colleague that I actually am able to go to interview and be successful, it was just that particular situation with that person with whom I already have some history. Though I am nervous about my interview next week, I am actually also very positive about what I need to do in order to set about getting the job, in fact I am oddly clearer than I was in December for the job I should have been better at getting. I am beginning to wonder if all this hasn’t happened for a reason and whether I really wanted that job at all? I need something new to reignite my enthusiasm for work lets hope that something is just around the corner!