I love to read the various nursing blogs from around the world, and am always struck by the similarities of the challenges faced by nurses but also by the differences in the education systems, working practices and expectations of those nurses. One thing unites them though and that is a desire to provide the best possible nursing care for their patients. What better way to make the world seem a smaller place, and to share ideas and experiences than a forum specially for nurses. Well I have just become part of such a venture and am now a moderator along with some of the other nursing bloggers on Nursing Voices. It is really just getting started, but already I can tell that it is going to be a great place to share ideas and to get to know about the work each other do. If you are a nurse, then take a minute or two to go over there, and if you are interested then why not join up and start contributing?

The following is copied from the Nursing and Midwifery Council Website, and helps us to understand why we still have confusion on the place, status and titles of those nurses who are working at a level above that achieved at registration:

“Advanced Nursing Practice – update 19 June 2007

Previous Work:

For a considerable amount of time, a major concern of the NMC, the public and many NMC registrants is the existence of the plethora of job titles that do not help the public to understand the level of care that they can expect. There are nurses who hold job titles that imply an advanced level of knowledge and competence, but who do not possess such knowledge and competence. In addition, their practice may not be subject to the scrutiny of another professional as they often act as independent practitioners.

The NMC also recognises that there are now significant changes in the way that services are delivered to patients, particularly following the General Medical Services (GMS) contract and European Working Time Directive (EWTD). Nurses, midwives and specialist community public health nurses are undertaking treatment and care that was once the domain of other health care professionals, notably doctors.

Therefore, a national consultation was undertaken during the months of December 2004 - February 2005 following which external analysis was undertaken and reported to June Council 2005. Council agreed that ‘advanced nurse practitioner’ should be a registrable qualification and that the NMC should seek approval from the Privy Council for opening a further sub-part to the nurses’ part of the register.

To implement the Council’s decisions of 9 June 2005 regarding the outcome of the consultation for the framework for the standard for post-registration nursing, a letter was sent to the Privy Council in December, with additional information being sent in January 2006.

The NMC’s mandate is set out within the legislation of the Nursing and Midwifery Order (2001); therefore the Privy Council has been seeking the views of the Department of Health (England), which takes the lead on regulatory matters relating to healthcare professions across the UK. The NMC has been awaiting the response from the Privy Council.

Current Position:

Following an interval of very little movement, the NMC has now been very encouraged to read within the recent White Paper Trust, Assurance and Safety - the Regulation of Health Professionals in the 21st Century (2007), that;

‘The Government agrees that the regulatory body for each non-medical profession should be in charge of approving the standards which registrants will need to meet to maintain their registration on a regular basis. Where appropriate, common standards and systems should be developed across professional groups where this would benefit patient safety. The Department will ask the Council for Healthcare Regulatory Excellence (CHRE) to work with regulators, the professions and those working on European and international standards to support this work. This will encompass the development of standards for higher levels of practice, particularly for advanced practice in nursing, AHPs and healthcare scientists. The Department will discuss with the Nursing and Midwifery Council the outcome of their consultation on advanced nursing practice to agree next steps (2.30)’.

Council has interpreted this very positively and looks forward to working in partnership with all the relevant stakeholders to progress this and we are currently awaiting further detail from the White Paper Implementation Plan (WPIP). Please note that it is impossible to pre-empt any debate on the progression of this work until we have looked at the WPIP in totality, as the work from many aspects of the White Paper will cross over to the work on advanced nursing practice such as revalidation.”

I guess this suggests that this is a bigger issues than just nurses, after all we have physios and other practitioners delivering advanced practice as well. But I think this issue is continuing to fuel the whole ‘quacktitioner’ debate. If we as nurses don’t know what qualifications you should have to be allowed to called yourself advanced, specialist etc. then what hope do the rest of the world have? If I attend a GP practice and see a nurse how will I know, based on what he or she calls themselves what qualifications they have to see me and provide me with the treatment I need. I ask these questions and I am a nurse. Not all patients have the knowledge I have. No wonder our poor doctors are in a state of utter confusion. Come on Department of Health and NMC get on with the work you have been doing for 3 years!

Improve the weather would be my request! Ever since hubby got the base to the garden umbrella out of the shed ‘in case it is hot when you get home from work one day’ it has not stopped raining. But I hear you cry, what can Gordon Brown do about the weather? Well not much I am sure, but I do wonder quite how effective he will be at the kinds of things he can have an affect on. I have always quite liked Tony Blair, and found Gordon a bit awkward and kind of accountant like. Of course now, what with Iraq and the mess that has been made of the NHS and such important things he is pretty much hated around the country. Therefore if I was asked, as I was at an interview 7 years ago, who do I most admire perhaps, if I wanted the job I might not answer Tony Blair on this occasion. Of course in 2000 the millenium was young and we had seen the statesman type stuff in action (death of Diana and 9/11) but we had not seen the rest of it (for example he had not yet inflicted Patricia Hewitt on us!)

Personally I don’t like the idea that a new prime minister can be inflicted upon us, seemingly based on some kind of old boys pact decided in a restaurant 15 years ago (or how ever long ago it was meant to have been) without there actually being an election. Hopefully Gordon will do the decent thing there quite soon. I also worry about his assertion that there is to be change. We have suffered more than enough change in the NHS and I and many of my colleagues are fatigued by it. So while I am happy for Patrica to get the push (as apparently she has) I am not quite ready for a new wholesale, new and changed NHS. After all I haven’t properly worked my way through the last one yet.

Picture from: Englandism.com

I have always had a bit of a problem with the way some of our private hospitals are run. I don’t mean in terms of the hotel type services or even the staffing by those who actually work there, but I have been quite suspicious of the way they employ medical staff. Speaking as someone who on a number of occasions picked up the pieces of poor private medical management, and who as a specialist nurse working in the NHS was called in on a number of occasions to provide care ‘on the side’ as it were for private patients. The consultant I worked with had a thriving private practice, he could do little else when at the time the wait to be seen on the NHS was quite long, ok so mainly these people were outpatients, but that doesn’t detract from the fact that I provided care for people that were essentially private patients and I provided it for free. This didn’t take place in the private hospital but on the phone, and in people’s homes. More fool you I hear you say, well no I did it in my working week (in NHS time) and I was being paid by someone, I also cared about the welfare of the patients and it did not matter to me if they were paying someone or not.

Dr Crippen is right, up until now there has been little use of nurse specialists / practitioners in private healthcare in the UK, that may be because they are getting NHS care for free.

There is also another kind of private, this is where a drug company or private healthcare facility fund a nurse or group of nurses to work in the NHS as specialist nurses. This whole thing, I guess started with charity funding for example Macmillan where nurses who specialised in caring for people who were dying of cancer were employed through their local NHS trust but were funded through macmillan cancer relief. My own experience of this kind of nurse, apart from in palliative care has been a nurse looking after people with multiple sclerosis and one for parkinsons disease. The trouble with these kinds of posts is firstly that they are often related to the use of specific drugs and second that the funding is usually only for a fixed term (say 2-3 years) and this funding may not be sustainable. In the case of the MS nurse it resulted in a nurse who was redundant, patients who lost a service and a neurologist unable to safely prescribe drugs in the way he had. The other problem for me is that while the term ‘nurse’ is protected and you have to be one to practice as one, the term ’specialist nurse’ is not. I could get myself some funding and set up as a specialist nurse in any kind of specialty today and possibly I could blag my way into getting people (though probably not Dr Crippen) to believe that I was more knowledgeable than I am.  It is time then that the nursing profession did something about this and that you could not pretend you were something that you were not. I would be interested in hearing from British nurses who have something to say about this topic because it strikes me as wrong and partly to blame for the accusations of ‘dumbing down’ which we are being accused of at the moment.

Have a look over at Mental Nurse for an excellent debate on specialist nursing too.

Apparently all the ills of the world I now the fault of the middle classes. They binge drink, often having obtained some kind of 2 for 1, 3 for £10 kind deal they then go home and drink the lot in one night. Then still the worse for wear probably they, wait for it, knowingly and willingly break the law. This involves doing things like paying people for work they have done, ‘cash in hand’, or maybe stealing the odd pen and paper clip from work, and even perhaps who knows eating an apple while driving (of course this is not to be done after binge drinking because that is proper law breaking and is extremely dangerous and not to be condoned).

Who are these middle classes? I was born into what could be described as a working class home, old labour (not that you would know it from how my tory brothers have turned out). But is nursing in the 21st century working class, and anyway I work  on the dark side, lets face it not many managers could be described as working class. Also, I now don’t just have the one degree, I have 2. So maybe they mean me and people like me.

I have to agree to being guilty to a) partaking of more than one glass of wine in a sitting and b) paying cash for my trees to be chopped down last year. Does that make me a bad person? Or is the real crime to be kind of middle classed!

Thursday saw me at University for the final time. Having planned to go out after college I took the train in, but madly decided to walk the about 3 miles to the station (I am still aching today from that one). Key features of that part of the day were that we all passed, that apparently (though we don’t remember) at some time during the course we agreed that the course would become a pass or fail one rather than being graded pass, merit and distinction, and that we gave our feedback on the good and not so good aspects of our experience. The lack of help from the tutors particularly at the end were firstly our own fault, after all we should have done more to ask and secondly helped us to form into a cohesive group that worked well and achieved together. Well maybe, but you do wonder what we and our employers were paying for. If it was a DIY course we could have passed and gone off on holiday today on the proceeds!

This in no way detracts from my pleasure and excitement at for the first time in my life (and I mean ever) finishing a course top of my class. I know this sounds immodest but I am nearly 45 and I am going to enjoy that bit for a few days.

So it was on to London’s South Bank and a bit of a bar crawl with food thrown in. I have now experienced wine on a terrace overlooking the Thames, champagne in the Oxo tower, a mango dacari and then been served greek food (which was very nice) but the most miserable and surly waiters I have ever had the misfortune to encounter. This meant that the time spent eating was relatively short and cheap in comparison to the time spent drinking. I am no advocate of binge drinking, but there is no doubt I engaged in it on Thursday.

At Kings Cross, I some how got myself of the slowest train to 3 stops short of my destination (no it has nothing to do with the 3 Bacardi and cokes I had after dinner), then spent 45 minutes on my own on a station platform where I made use of the mens toilet because the ladies was on the other platform. I am glad to report that it was clean and tidy and that no men turned up to embarrass me! Finally I took a taxi from the station home and got to bed not far short of 2am. It is not everyday after all that you find that you are now a Master of Science!

Sound advice, but of course I did. Post dissertation relief was followed by the realisation that I was meant to submit a reflective practice portfolio which represents my learning and reflections over the last almost two years. The trouble was I was all ‘essayed out’, I couldn’t make myself be bothered and at the weekend I even found that housework was a desirable alternative to delivering the work on this one. So on monday I set about writing a short academic piece which is meant to underpin my portfolio and frankly what I have written is complete rubbish. Trouble is I just can’t make myself do any better. As for the reflections, well thank heavens for this blog. I was pleasantly surprised that I have at times ranted, and described in detail the minutiae of my essay writing, university attendances and so on and therefore with some embellishments that bit doesn’t look too bad. Is it good enough to pass? Well if I fail on that it will be a travesty!

So I head off for the last 3 days of  my course, the decision making process will take place today and tomorrow which determines if we are masterly. Of course I am and in a number of things, but whether that includes Strategic Leadership, who knows? The course has been interesting, I have learned a lot, but whether it is truly valuable to my daily life well only time will tell. I am glad I did this over an MBA, I am glad I did it in this kind of free and easy style though a bit more structure and support from the tutors wouldn’t have gone amiss.

Tomorrow I am going to college by train, this is so that I can enjoy a glass or two of something cold and white without worrying about the need to drive home. It is the end of the course and more than anything, when (if) I know I have passed I will just be relieved. No more academia for me, there is no way on earth you will see me heading down PhD alley!

My post yesterday concentrated on the petty attack by one blogger (doctor) against the grammar and punctuation of another (nurse) when the real fight was going on over on the other side of the Atlantic. Reading Kim’s post yesterday I just caught a small part of the argument and since then there has been a full blown nurse v nurse fight. Now even though I’ve read some of the stuff surrounding that whole thing, I neither can nor will enter any part of the disagreement except to say that I don’t think Kim or anyone deserves to be personally attacked for something she writes on her own blog.

It has been my sad experience throughout my career to find that whereas doctors tend to close ranks and look after each other during times of trouble, nurses act in completely the opposite way. Ever since the nursing officer on duty the day my grandad died made me work my days off in return for a day off to go home to be with my grieving relatives and another for the funeral (I was 19 at the time) I have had insight into the way nurses treat each other. People get sick and colleagues just complain about the extra work, people take time off to look after their children and they are accused of being skivers at the expense of those without children. mistakes happen and people queue up to report each other and line up the firing squad.

There is no excuse for poor practice, and people should not cover up for each other but there are times when people could offer more support to each other. When they could perhaps think before they speak (or fire off some of those more unpleasant comments). I am not suggesting that life at work (or in the blogging world) should be like some kind of Walt Disney cartoon (after all even Bambi’s mum died a nasty death) but sometimes I do wonder why we appear to have it in for each other.

Why Bambi? Well the April showers song is currently on an advert for nokia and it is in my head!

Over the weekend, real life got in the way of the blogging one so I have just begun (over coffee and toast) to catch up on some of my favorite sites before work. Interestingly two of my frequent reads cover similar types of subjects, but boy do they take different approaches. Kim is a fantastic advocate for nursing, and she makes no excuse for writing about her own experiences and for giving her opinion, letting us see the world from her point of view. She does this in a positive way and Emergiblog is a great place to visit over a cup of coffee, you are always likely to get a pretty good read. Dr Crippen on the other hand, is increasingly likely to make a nurse reading his blog splutter over her (or his coffee) and need a change of clothes despite the fact that they have only just got dressed!

For some reason Dr C has it in for nurses in a big way and sadly, if he can’t get you on content he will now resort to your spelling and punctuation inadequacies.  No doubt he would have a field day with me, because though I am better educated than most, for some strange reason I am kind of grammar blind! I am not sure that my inadequacies with the comma and semi colon would ever have kept me out of medical school or indeed stopped me from becoming a doctor. Luckily for me my decision to be a nurse went back further than secondary school, and a nurse I became. I am no failed doctor, but I have during my career carried out duties and tasks which at some time would have been carried out by a doctor. Things like venepuncture (taking blood), was when I started my training, something that medical students and doctors did. Now we have people whose actual job it is to expertly take blood, but strangely this is not something you need A levels for, it is more about skills learned through training and practice. There are numerous tasks that were previously the territory of doctors but are done by others now, and for the good of the patient in terms of the time patients can be given while the job is done, level of skill and the frequency the task is done. At the same time there are jobs which are clearly the role of the doctor and in my humble opinion there is plenty of scope for the medical profession to concentrate on improving how they do those rather than continually attacking the words of nurse bloggers and nurses in general!

This week’s edition of Change of shift is up at Nurse Ratched’s Place. This is a very special edition because Change of Shift is a whole year old. I personally would like to thank Kim from emergiblog for starting this wonderful Blog Carnival, and all of those people who have contributed such wonderful examples of nursing practice and health related stories through the year. I myself hosted last November, and found out how complicated it is to do so, but also how popular Change of Shift is. Hopefully now I am finished my Masters I will be able to contribute more, and perhaps host again in the near future!

I have spent more than my fair share of time in traffic today (what is it about the roads around the south east of this country? Yes I know - cars!) and to be honest I am getting fed up with the way some people drive and particularly the lack of consideration people give to each other. I am not perfect, and would never claim to be. After all, before Christmas I picked up my first speeding fine (40 in a 30 type offense, captured by one of those mobile police vans) but tell me why people no longer indicate which way they are going and tell me why a red light now seems to mean go?

There is nothing worse than people who decide to turn (particularly right) but do nothing to let you know that fact. Today that has happened a couple of times at roundabouts and once along a road where someone just suddenly pushes out. Then there are the lights. tonight I stopped as a light went red and someone nearly went into the back of me because he obviously thought I was going to keep going. My other bug bear when you are in heavy traffic and need to move into another road is that no one wants to let you out and into the queue. That extra 2 yards is obviously of vital importance to getting to your destination as quickly as possible.

There are probably other things that irritate me, but for now; rant over!

I a, finding blog topics hard to come by at the moment. Not sure why this is, or if it is related to my general fatigue with writing, or just plain laziness on my part! My new job involves making sure the PCT is buying the most appropriate services for children (also includes maternity services) and this is involving me spending a lot of time reading, meeting with people to discuss stuff and generally absorbing information. That in itself is tiring, and I guess contributes to the lack of blog posts. The other problem I guess, is that I don’t yet have the confidence in what I am saying on such topics to feel that I should put pen to paper (or text to blog) about them. There is plenty of cynicism about the kinds of people who work in the PCT and the experience of going through the CPLNHS process has been scarring to say the least. So much so that I am not in the mood to antagonise those who might find stuff that I say a little shall we say controversial.

I have one last piece of work to do for my Masters course, which is my reflective practice portfolio. I need to go back to the personal development plan I drew up at the beginning (nearly 2 years ago now) and think about what has happened, what I have learned and what has changed. I also need to write something academic about the process of reflection and being refexive. Then next week the course ends and I am free to get on with life, work and think about my holiday which is coming up in a month. Maybe I am just weary.

So for those of you who pop by relatively frequently, I am sorry that this blog has been a little dull lately. Once I find a way to snap myself out of it, I’ll resume normal posting. Until then, well I am erratic to say the least!

I have been neglecting my blog unfortunately and the main reason is that life has been getting in the way. A poor excuse i know but there you have it! This post then is a catch up of what I have been up to since my last post, Friday.

Friday - Went to a local hotel for a workshop run by our local Children’s Trust on improving participation in the planning of services. Of course those working in education and to a lesser extent social services have a captive audience when it comes to asking the opinion of children and young people (what they like to call teenagers) but in health we have done less work in that area. My experiences so far in meetings where there is so called ‘users’ have seen representation from people who are generally old enough to have grandchildren than to be children themselves. This is something we have to do, so the day provided some interesting thoughts for me. Friday night we visited the inlaws, who have decided to pay for us to go on a cruise around the Mediterranean later in the year. What can you do?

Saturday - Housework, housework and more housework. As I have mentioned before, I have seriously neglected the housework during the write up of the dissertation and decided that it was time to get on with it. Later I cooked a lasagne and chilli and took both with us for the visit to my brother. This had come about because they were meant to move house and I had suggested I come along later with food. The move was postponed at the 11th hour, but Mrs Mug offered to still provide the food. We decided on the spur of the moment (I felt like consuming a glass or 2 of wine and hubby had already been to the pub) to stay over. This was fun but entailed a late night and a return home at midday Sunday.

Sunday - Showers all round, then a trip to the shopping centre, to buy teen son’s prom suit. Yes the American Prom idea has arrived in the UK, and interestingly his is to be on 4th July. He looks extremely smart and handsome in it (as you might expect me to say). Watch this space for the photos which will appear after the event. Onwards to a local Italian restaurant for a pizza and then home to chill out.

Monday - Work, which today involved an away morning with the bigger team I am now part of. You know, one of those team building events. Good fun and I thought useful too. Team lunch (paid for by ourselves by the way) and then back to the office for some proper work. Later, had to go food shopping, because unsurprisingly I didn’t have the time at the weekend. So thats me up to date. Weary, but we seem to have done lots!

Thirteen Search Terms used to find Life in the NHS

I haven’t done a TT for ages, so time to join in with the popular Meme again. I am always intrigued by how visitors to my site get here so here are some of the recent search terms people used to find me!

1. Celtic Motherhood heart / sign - had quite a few of these since I posted a picture of one
2. Debate, topics, nurse practitioner - not surprising that I get lots of nursing topics, including nurse practitioners
3. NHS Direct stress levels - don’t know much about how stressful it is to work at NHS Direct
4. Failure in life - Of course I know nothing of this!
5. What is reflective practice - Something I have written about quite a bit, particularly in relation to my reflective practice module of the MSc
6. what does a nurse do - This comes from a post I did last year, and I believe that the numerous visits I get from this search term, are to do with that article being on a reading list for student nurses at a university not far from here!
7. Big picture on Florence nightingale - Yes did one of those!
8. Chihuahua barking - don’t have a dog of any type and I cannot stand the yapping of any little dog!
9. Madeleine McCann - Sadly this little girl is still missing, and her parents are working hard to keep her profile high within the public and media.
10. Your complex meaning
11. See Suzy spin - not sure about that one!
12. Sadness blog (happily I am not so sad thanks)
13. What causes sadness (probably linked)!

Get the Thursday Thirteen code here!The purpose of the meme is to get to know everyone who participates a little bit better every Thursday. Visiting fellow Thirteeners is encouraged! If you participate, leave the link to your Thirteen in others comments. It’s easy, and fun! Be sure to update your Thirteen with links that are left for you, as well! I will link to everyone who participates and leaves a link to their 13 things. Trackbacks, pings, comment links accepted!View More Thursday Thirteen Participants