Is expensive. That is my not surprising discovery. Having discovered I cannot afford a new car, and deciding I do not want to borrow money in someone else’s name to get one, I now have to spend money on the existing almost 3 year old car to bring it up to scratch. In the past I had cars which were leased by whichever NHS trust I was employed by and for which I paid dearly in both rental and taxation. However if for example the brakes needed fixing then they got fixed at no extra cost to me. Now though, the burden will fall to me and now that I have an ‘older’ car things like this need attending to. I have therefore parted company with £250 just in time for payday! What joy!

Today I went back to my former working environment and taught on a management programme study day. The topic was providing leadership for your team. I was surprisingly nervous, didn’t sleep well and found it quite hard to ad lib in the parts when I would usually just speak. However the day did go well, and people seemed to enjoy it and whats more actually learn stuff (now there is a bonus)! I was surprised to find that out of a room of 16 pretty experienced people, very few if any had actually read any leadership theory or indeed new any of the key leadership authors. I guess they are all busy doing their day jobs looking after patients, running teams and services and being manager types. I am doing the session again in a couple of weeks for a different group and think that I might be a bit more confident about that one. Might make a few changes to part of the day though, even I began to find some of the theory a bit dry!

I received a report today which has made me think of the difference between the way nurses are treated in the UK for making a mistake as against that made by a doctor. I won’t go into specifics for very obvious reasons but let me introduce a hypothetical incident for you here.

A patient presents in the emergency department and is assessed by a relatively junior doctor as requiring a particular drug. The doctor tells the nurse to administer the drug to the patient and that nurse does so. Error number one is that there is no written order and as a nurse you should not take a verbal instruction for a drug. However perhaps as a doctor you should not actually try to give one. Error number two is that the dose is inappropriate (perhaps the drug is inappropriate too but that is another story). The nurse gives that wrong dose, with serious results (thankfully not fatal). The  nurse ends up being suspended from duty, and the doctor is ’spoken to’.

It has been my experience that many doctors do not know that a nurse is responsible for their own actions and omissions. But should they also be responsible for the actions and omissions of the doctor? If a mistake is made by two professionals, should one be dealt with more severely than the other?

I’d be interested in people’s views on this issue!

I wrote last week about my financial difficulties and how it would potentially affect my ability to buy a new car on finance. Well yesterday, I received the news I had feared, the finance company have turned me down. The idea of a new car to replace my existing one was a nice one, but I am forced to wonder if I actually need such a thing. If the current deal resulted in me actually owning my current little car then all would be well, but it doesn’t. I need over £3000 to make this happen. My job is county wide and I am expected firstly to have a car and secondly to use it as part of my job. I do try to plan my diary so that I am not crossing the county too much, but sometimes meetings are set by others and I have little control over where they happen. The choices we faced yesterday evening were that either my husband stands as guarantor for the planned purchase, or that we ask my inlaws for a loan and that I pay them the current car payments until that is paid off (about 15 months) or that I send the car back and buy an old runaround type car. After a pretty sleepless night on my part I have decided on the second option and hubby has phoned his mum to ask. Thankfully she has agreed and so she now knows the shameful truth.

As I have said before, I take full responsibility for the situation I am in. However there are some factors that contributed. I took all the debt myself personally, so that hubby didn’t share it, I was persuaded by banks to borrow more, but then continued to spend in a stupid way. Now I am paying the price. The good thing is that I have paid off a fifth of the debt in just over a year, and will be debt free in just over 4 years. The inability to obtain more credit is I believe a blessing, because who am I kidding, I am still the same person and I can still happily live beyond my means and hubby is great at doing that too if it involves my name on the dotted line. I am not an alcoholic, or a drug addict, but I believe this is a problem along the same lines. I have a problem, but I am trying to take control of it, I just sometimes lose sight of the reality of what needs to be done.

The above is the reason I am struggling to think straight when it comes to normal blog posts. Hopefully normal service will be resumed very soon as I have some quite interesting things going on at work and in the NHS in general right now!

I cannot imagine what it must be like to lose a child, and my definition of child is pretty wide. If you gave birth, then that person, even as they grow up is still your child. The worries you have as they begin to have to leave your side, go to school, cross the road without you, ride their bike, and go off to town on their own do not go away you just have to learn to manage them and to be realistic about the risks.

I am the mother of an only child. I did not set out to have just one child, but at the age of 45 it is likely (well pretty definite) that he will remain as such. One child can never replace another, however I suspect that the fears I have for his safety at times might have something to do with that.

A few weeks ago a young girl of 17 disappeared. There were fears of abduction and of murder, but eventually her body was found and it seemed that she had died crossing a railway line. Today I read that her mother has been found dead near the same railway line. It is impossible to imagine the torment that women went through on losing her only child, but also impossible for me to imagine wanting to end it all in that way!

Are you the sort of person who, knowing that a deadline approaches, gets whatever it is done in good time. Or like me do you need the very fact that you have little time to spur you on to actually get the thing done? I hardly seem to be able to help myself in all areas of my life to just put things off and leave them for tomorrow, or next week or the next. At work recently I have had more time, my new job is less busy than the old one (though it is picking up) and I have improved. Well I tend to start a project and then complete is just before deadline. Then there are home things; my car needs new brake pads and a service before it goes back and I hopefully get my new car. Today is likely the last day I can ring about this in time for getting everything done in time, and this morning I woke with that realisation. But why am I like that? Why can’t I be the kind of person who gets things done when they first need doing, why can’t I write a plan and stick to it? Why do I have to reprioritise instead of going with the first priorities that I decided on?

On various courses I have done Myers Briggs and other personality test type things and they do point to my need for being a last  minute person but sometimes I find the stress of the last minute greater than the adrenalin rush of the deadline. I mean if I can change my eating habits and lose weight, if I can begin to sort out my finances, then why can’t I make myself tackle this?

Are you a nurse? Would you like the opportunity to win an iPhone? Well over at Nursing Voices you might just be able to do that! Because Nursing Jobs.org are sponsoring a competition where 2 iPhones will be given away. This is how you can win:

The first iPhone will go to the one who scores the highest point total from Sep. 15 through Oct. 15, according to this point system:

• Every post here on Nursing Voices earns you 1 point. The posts must be worthwhile, too, not just one-liners like “I agree!” or “Cool!” Posts like that will not be counted.
• Every blog post you make about the contest with a link back to Nursing Voices earns you 10 points.
• Linking to the contest sponsor (Nursing Jobs.org) in the blog post earns you an additional 10 points.

Also, because it’s most important for you to actually be a part of Nursing Voices and not just blog about it, you must be within the top 25 posters during the contest period for your blog points to count.

So what about the second iPhone? That one will go to the one who refers the winner. On the forum registration form, there’s a field for the member name who referred you Nursing Voices, so make sure you tell people to include your member name in the Referral field when they sign up!

So why not get over to Nursing Voices now. Registration is simple and once you have done so, you can join in all of the discussion topics and who knows, you could be a winner.

Sadly, as a forum guide / moderator type person I am unable to enter the competition, but that doesn’t mean I won’t be over there posting or indeed encouraging those who might win!

The BBC have a feature called 10 Things where they give snippets of information that help to round up what has been in the news this week. I am going to do something similar here to round up the life according to Julie, in and outside of the NHS.

1. The weight loss is progressing well and I have now lost 10 ½lb. I am feeling positive about the whole losing weight thing and I am in the right mindset to carry on. I have (as mentioned earlier in the week) been feeling a bit down for various reasons and this has not caused any trips to the shops where chocolate is sold in large quantities.
2. I have been given the go ahead to review my job description and to look at getting my pay back up to the level I am protected on. This will then mean I can receive the wonderful pay awards from the government. This year’s 2.5% in 2 parts is still eagerly awaited by all those entitled to it. The unions are still arguing, we are still being asked for our opinions and it looks like the pay rise might happen sometime in the next millenium!!
3. Today I am off to attend a consultation event organised by the National Childbirth Trust on the future of women’s and children’s services (including maternity). This whole meet the public and discuss stuff and listen to them kind of thing is new to me and is extremely interesting though slightly nerve wracking at times.
4. My teenage son is now what we in the UK call in the 6th form. He has finished his compulsory education and is now concentrating on relatively few subjects in more depth. Part of his time is spent in school and the rest at the local further education college. I have noticed that he has developed a more mature attitude to the whole thing and is already working quite hard. He has also submitted application forms for part time jobs around town, something I am keen for him to do now. He is a major drain on resources, though of course I love him dearly!!!
5. Led Zeppelin are reforming for a concert and teen son has registered on the site. I guess the chance of his being successful is quite slim, but tickets for this event are going to be £125. That is a lot of money for a couple of hours of entertainment.

Thats the first 5, the next 5 will appear later!

It is now later, about 13 hours later and here are the next 5:

1. I am going to have to get back in to the swing (or step) of the Lateral Thigh Trainer. Having used it every day for about 3 weeks I have now barely been on the thing for a week. I don’t want to be like all those people who start something and then don’t carry it on (but I might be!)
2. I have written a summarised form of my dissertation for my director at work as part of a new piece of work I am going to be doing and am now considering trying to get it published and perhaps accepted to speak at a conference. It would be a shame if all the work stayed as something on a shelf.
3. We have been notified about our graduation. Well actually we found out by accident because the university forgot to tell us! It is on November 12 at the Barbican in London.
4. My parents are keen to attend as is hubby of course. I guess you never stop being proud of your kids!
5. It is hard to think of 10 interesting things about yourself and what you are up to when generally you feel you lead a dull life!

Last week I wrote some thoughts about the parents of the missing girl Madeleine McCann, who I suspected was being framed for her supposed murder. In the 7 days since that particular post a few things have happened than we know for a fact; her parents have been interviewed by police in Portugal, they have been named as suspects and they have brought their 2 year old twins home. As far as I can see that is the extent of most of what we know for certain. Since Madeleine’s disappearance at the beginning of May, we have been told numerous times by the media that in Portugal it is illegal for the police to discuss the case with anyone or to give information out to the public. How then one wonders do the newspapers and others apparently know that:

1. Blood / other bodily fluids belonging to Madeleine have been found in the hire care that the family did not have at the time
2. Hair, and handfuls of it have been found in the same car
3. The child was drugged with sleeping tablets
4. The child was accidentally killed by having been given some kind of sedative
5. The child has been buried under cobbles outside a church, or even hidden inside a church
6. Some kind of sniffer dog, trained to detect dead bodies has smelled such a thing on Kate McCann, her bible, her clothes, the child’s toy.

There are probably other things that apparently various quarters of the British, French and Portugese press know for a fact, but which actually no one really knows to be true.

My appeal at this point would perhaps be that the media could just calm down a little, print was is actually a fact rather than a supposition and not condemn people as guilty of murder when the evidence seems at best flawed and at worst fabricated. I am no expert on DNA but I wonder how they can be quite so sure of their facts without a body and with a family who all share certain parts of the DNA of Madeleine. I would imagine and have read that the siblings share a considerable amount of that DNA. I know it is alien for many newspapers to actually print facts but I for one am getting a little weary of this whole circus.

I am having a busy week at work, and it is involving me doing lots of things with people from other organisations and with people who are what can only be described as the public. Yesterday I described an experience I had just had, and today there were more. A lady, who appeared not to know I was in the room spoke of having spent half an hour on the phone to ‘the PCT’ last week, and recounted some of what had been discussed. I knew that she was describing the conversation she had with me, but it was interesting to me that I was just an invisible thing to her and apparently represented an organisation that both commissions and delivers health care. We also had the opportunity to hear the real experiences of people who have had babies in the last few months. It is useful for us as commissioners and useful to the people who manage the midwives to hear both the positive and the negative. It was also interesting to note that the thing that interests the official patient and public user group (comprising mainly older people including the person described above) which is the place a baby is delivered was not the thing most vital to the new mums (the ante and post natal experience). I still have more of this stuff to come with a public meeting to go to on Saturday.

I am preoccupied by something this week. It is affecting my ability to concentrate at work, it is not affecting my ability to do my work but I am having to work hard to make myself appear to be my normal self. I feel kind of miserable, scared, nervous and many other things inside. It has affected my ability to sleep properly, it is affecting my appetite (not a bad thing) and it is making me snappy. I have spoken before about the financial problems that came to a head about 15 months or so ago and which I have been managing pretty well. However I am in danger of losing the plot because I have to do something about my car. I have a car on one of these ‘options’ deals. You pay for it monthly and the end of 3 years you give it back, or you keep it and pay up another £3000 or you part exchange it. I can’t just hand it back, because there would be a mileage penalty, I don’t have the money to buy it and I don’t know if I am credit worthy enough to part exchange it. However I am going to try the third option, and now I am just waiting to see what happens. To see if I can get the new car, and if I do how I will manage for a month having stumped up a deposit. I had forgotten how much money problems can cause you to feel stressed and constantly worried. I hate this feeling of being out of control and it brings home the fact that my financial situation is precariously balanced. Having said that I have paid a large amount off of my over all debt in the last 15 months and am still on track. So that is me, muddling through at work, feeling a little persecuted and yes kind of scared. However, on a positive note, at least I am thinking before I act, something I didn’t always do before and something that helped me get into that whole financial mess before.

I work for a small team, and our work takes me into situations where I am the sole representative from the organisation for which I work, and of course I am still a relative novice in the world of paediatrics, though I hope I am learning quickly and am coping well. It is still quite scary when an individual decides that all of the problems they perceive to exist in their working life are down to the organisation for which you work and that on this occasion as you are the sole representative, you are going to sit and listen to them. It is a fact of life that you will never please all of the people you come into contact with at any one time, however it is dangerous to believe that your way is the only way. It is however double scary when all of this takes place in a large workshop type situation, and the person who is holding you responsible for their ills is a hospital consultant, and when others in the room are kind of leaving you to it.

This is however, not the first time such as thing as happened, though on that occasion I worked for the hospital trust and it as GPs who were blaming me for all of the ills of the hospital and their perception that the hospital were passing all of their work to primary care. Today, whatever might be written and spoken in the media, it is currently the GPs in their practice based commissioning groups who have the upper hand in the health care politics of 2007. This is essentially because they are the budget holders of health care. Trouble is though that specialist services like paediatrics are not easy to plan for, to prescribe for and of course they are heavily legislated for (i.e. it is easy to make a mistake and to be blamed for it).

A month ago I was wondering if there was enough to keep me interested in this job, and today I am wondering if I have the time to keep up; lets just say this is not boring stuff  - watch this space!!!!

I have just been having a bit of a play with some new themes for the blog and have come across this one, which is actually new to try out. Let me know what you think of it for style (might not improve the content but you never know!

Quality time with the man in my life
My lovely hubby has spend much of the 6 weeks working nights. Well actually he has been working overtime and nights so that he has been leaving in the afternoon before I get in from work and not getting home until 7am, which has meant seeing about an hour of him per day. This at least prevents any arguments or generally getting fed up with each other, but then again it doesn’t allow for much in the way of interaction at all, and a tired man is generally not the happiest of men!

Yesterday we had a day out on our own to kind of catch up with each other. We considered the idea of a trip to the coast, but then settled on getting the train into central London and acting in a kind of touristy way. Hyde park was particularly crowded and indeed was looking pleasantly green. The good weather (oh how we have waited for more than 2 consecutive sunny and warm days) brought out families, people walking for Crohns disease, people roller blading, skateboarding and even just strolling. Hubby had the bright idea that we should walk from there to the banks of the Thames and that is one long walk. We had lunch in a pizza / pasta restaurant that for some unknown reason had no pasta yesterday!! Strangely typical of London that one! It was a nice pizza, but I just hope it doesn’t affect my weightloss that has been going well (9lb so far). Mind you the walking must have helped, and it meant we had time together when we were both awake to actually speak to each other in a grown up manner; maybe we’ll do it again soon!!

I was out with a group of work friends last night. A group of about 8 of us who started off as colleagues, all managing services around 2 years ago try to get out for dinner and a good chat every couple of months or so. The changes we have seen in our PCT(s) over recent times, that many of us are now doing different jobs, most of us have been through some kind of unpleasant experience work wise so it is great to have a group of people who can relate to each other like this.

One of our number has just got back to work following surgery and was sad to report that her experiences in a local NHS establishment had not been the best. This had started with having to plead not to be sent home while the list was canceled; there was no recognition that you might have gone on sick leave from work, arranged child care and generally psyched yourself up to get this surgery out of the way when you are told suddenly that they are short of an anesthetist today so will be canceling the whole list! Then waking in terrible pain, because the anesthetist they managed to find didn’t usually do this list and didn’t think you would need more than voltarol! But the worst experiences seemed to concern the knowledge, attitudes and general availability of nurses to actually provide care that patients needed and deserved in a timely manner. As a nurse, my friend found the experience she had both shocking (you never believe it will be that bad), frightening (at least she knew what should happen and could ask for it) and also depressing (is this really what the NHS is like now?)

The trouble is that much of the poor care that we are seeing in our wards now is due to the pressure that nurses find themselves under. There are often just not enough nurses for the number of patients and what nurses there are, may not have as  much experience and knowledge in that field as they should. If you are struggling with poor ratios of nurses to patients then what time is there for giving the patient anything more than the minimum and what time is there for people to be adequately trained and supported to become better nurses?

Over at Mental Nurse they have begun a petition to improve nurse patient ratios (by having a minimum safe level declared). They have not only blogged about this subject but they have now started a petition on the Downing Street Website. If you are a British citizen then please go over there now and sign up. If you are not, but have something to say about this subject please leave a message below (obviously you can do this if you are British too!).

It is really hard to know what to think about the idea that Kate McCann is now being treated as a suspect in the disappearance of her daughter Madeleine. I know there are people out there who have always suspected the parents; I have spoken to a few of them and have read various blogs where people have stated as much. I though cannot believe that you would willingly put yourself through the media spotlight, travel around Europe meeting various dignitaries including the Pope if all along you knew you had killed your child. Their’s has been a personal crusade, they have remained in Portugal, apparently to remain close to Madeleine when to me it seemed more likely the child was dead and little could be gained from remaining.

They certainly seem to have made some major errors. They did not act in the best way as parents on the night in May when Madeleine disappeared. After all, if you go on holiday as a family, even with friends then you should spend the time together as a family. If you want an adults night out then use some kind of baby sitting service. Leaving 1 child is bad enough, but leaving 3 children as young as these appears to be negligent. But what is done is done. They have been stung by people’s harsh words; they have been both praised and vilified in the press, using it as a medium for their own ends but then appearing surprised when people accuse them. They have courted publicity, but then they have been on a mission, a mission to find their daughter and you can’t really blame them for that. Why though would you put yourself through that whole circus if you had killed the child yourself?

One thing is certain, there is much more about this case to emerge. One would hope that would involve finding Madeleine, whether that is alive or perhaps more likely dead. I’ll bet that right now TV and newspaper companies have journalists travelling to Portugal, after all many had scaled back coverage. If the McCann’s thought the worst that could happen already had, I suspect they were very much mistaken. Whatever happens they are in for a very rough ride.

I am left wondering though if the Portuguese police, who have been criticised along the way are now looking to hang this on someone so that they can wrap up the case and get out of the spot light of the British and world media. What better way to do that than to blame the crime on one or both of the parents who after all are English?

Apparently the government is beginning a consultation on the services that are provided for children. This is going to involve asking children, young people, parents and those who work with children how things could be improved. There will apparently then be a 10 year plan so that next time there is a UNICEF report on childhood the UK won’t be at the bottom of the list for the experience of childhood. But I wonder how many people know that there is already a children’s plan, in fact there are many. There is a Children’s Act, there is a National Service Framework (Every Child Matters) and there is lots of work going on in all areas of the country where statutory and voluntary services are apparently working together to provide a better deal for children. If the government has just decided to ask children and parents what they want then perhaps this is being done the wrong way round (and no doubt money is being wasted somewhere).

Yesterday I attended a workshop which was about improving the way in which services are accessed by those with Autistic spectrum Disorders. As someone with limited experience and knowledge of these kinds of issues, I found the whole thing quite an eye opener. The most amazing thing seems to be that different children, with a similar set of presenting symptoms and behaviours can end up experiencing different processes and outcomes not because of the differences in their conditions but because of the customs and practices of different parts of the health, education and social services. There seems to be an over reliance on the individual qualities of specific practitioners, there seem to be paediatricians and psychiatrists doing things that might be better done by other members of the team (if such a team existed). It is definitely time to listen more to the needs of children and families. I hope though that this doesn’t lead to expectations that can’t be afforded or that the work already underway isn’t undone so that something new can be started.

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