Well get yourself over to change of Shift. When I started blogging just over 2 years ago there weren’t that many nurse bloggers. Kim from Emergiblog and myself started around the same time and of course hers is now one of the top nursing blogs in the blogsphere. One of the best ways to get a view of the range of what is being written by nurses and about nurses can be found in the fortnightly blog carnival hosted by Kim. One of the great things for me is to find out about nursing in different specialties but also in different parts of the world. As in pretty much all areas of life, the English spoken in different places has different meanings and interpretations and that is true within nursing. I often need a dictionary of both words and acronyms to read some of the US nursing blogs, but one thing is for sure, a patient is a patient wherever they are and nurses across the world are there doing their best for their patients. For me that is what comes through loud and clear and that is what is important. Thanks to Dr Anonymous who is hosting this week’s Change of Shift and has done a great job, not least because I actually managed to write something about nursing and health care this week and have had it included. I am off there now for a good read!

Three days off for me this week, mainly so that I can use up some annual leave. You would think I would be more organised than that; every year I am going to plan my whole years’ leave so that it is evenly spread and every year months go by and I suddenly wonder why I am so weary. That can’t be said now as I have only been back at work for 5 weeks since the cruise (not that racing around the Mediterranean gave me much of a rest), but a girl has to use up her entitlement. So this morning hubby and I got the train into the ‘west end’ to start the dreaded Christmas shopping.

Last year I was flush from my Agenda for Change back pain and I have to admit that I was a bit on the over generous side. This year things are very different and I really need to cut back and not spend too much, but if anything that made choices of presents easier rather than harder. I quite like Oxford Street for shopping, it has several good department stores, where you can pick up some good quality gifts without necessarily breaking the bank, especially as on such store had a one day sale meaning I was able to get between 10 and 25% off quite a few things.

I actually love Christmas, but tend to dread the start of things, but now I have begun the shopping, and the inevitable will happen then I might as well look forward to it and embrace the thing.

As someone who has worked in the UK health service for close to 30 years (much as it pains me to be old enough for that to be even close to the truth) I can honestly say that things have changed beyond recognition. In 1980 I doubt anyone but those in the top positions had any idea of the costs of health care, and even then I do not know if anyone took any notice of how much was being spent. I expect there were always budgets, but as a lowly nurse they were of no concern of mine. If we needed equipment we ordered it. If a surgeon wanted to try a new procedure he was the boss and got on with it. The wards were clean (as far as I remember) and that cleaning was done by the cleaners who belonged to those wards. We also had a house keeper whose job it was to make sure we had all the equipment we needed and that the cleaners did what they were meant to do. At the same time though, as a student nurse cleaning beds after patients had vacated them was our job and weekends were often spent clearing out and cleaning cupboards. Hospital food left something to be desired, and in the hospital I trained at I would have given it a wide birth anyway given the probable state of the cockroach ridden kitchens (at that time hospitals were immune from health inspections due to crown immunity). Hand washing is a major thing these days, and rightly so. I remember learning how bugs are transmitted and remember washing my hands a lot. I also remember not doing dressings for an hour after ward cleaning had taken place and I remember learning how to perform a dressing using an aseptic technique. But I also remember the surgeon who took his gloves off to take a photo of the inside of someone’s body for his book and then put on new ones without so much as going near a sink. No one challenged this behaviour, he was a top surgeon and practically god.

In those days I doubt many people complained about anything. It was considered that everyone was working very hard, doing their best at all times and that all nurses were angels and doctors were special beings to be revered. If a patient was unfortunate enough to develop an infection no one considered that any of the staff were to blame, it was just one of those things. People often knew little of their condition and indeed asked few questions, particularly of the doctors who might have known the most. If they wanted to know anything they generally tackled the nurses for answers and were happy to be reassured that we knew best. That is not to say that everyone was happy with this, but of course we hardly ever asked what people thought of what we did and lived in the knowledge that if we had asked they would have been completely satisfied.

Now everyone is who works in health care is meant to know the cost of everything, is meant to know if what they are doing is effective both in terms of clinical and cost effectiveness. Patients expect us to keep them informed of everything about their diagnosis and treatment and if anything untoward happens it is pretty much going to be someone’s fault. The buzz words now are outcomes, key performance indicators and cost benefit. Those who provide patient care must ensure that they meet the outcomes, and that those outcomes can be measured. We are always asking patients what they think of our services and if we don’t ask they tell us through the means of local and national media, online forums and through letters to their MPs.

The way in which people perceive health care is important, and is something those of us working in the health service need to take account of. Because while I might be delivering all the outcomes my managers ask of me, and while I might be making sure I contribute to the reduction of infection rates by washing my hands and following universal precautions how do I know that patients perceive that I and others are doing all that they can? A report by the Healthcare Commission into the experiences of maternity services gives some insight into the gaps between policy and experience and between the perception of care at one hospital from another. For example:

26% reported being left alone during labour or shortly after giving birth at a time that worried them. This suggests midwives may not be adequately reassuring women when they have to leave the room - NICE guidelines say women should not be left alone except for short periods. Looking at labour alone, 9% of women at one trust said they were left alone at a time that worried them, while 33% said this at another. In 18 out of the 148 trusts, more than 20% of women said they were left alone during labour at a time that worried them.

8% of women said their hospital room or ward was “not very clean” or “not at all clean” while 18% said this of the toilets or bathrooms. At one trust 63% of women said the toilets and bathrooms were “not very clean” or “not at all clean”, while at other trusts only 4% of women said this.

This and other parts of the report demonstrate potential differences in the care women can expect in different hospitals but may also reflect expectations versus reality. If your midwife explains what is happening, and you feel reassured that you are safe with them then you are less likely to be concerned if you are left for a short period of time. If on the other hand she seems busy and rushed, doesn’t explain things to you and disappears without explanation then of course you are going to be anxious about being left. If your over all experience is good then the fact that the food could have been better might be less of a problem to you while if it was poor then this will add to your perception that the experience was poor.

The Health Service is a better place for wanting to control costs and wanting to improve the effectiveness of the care that is delivered within it. But we need to be mindful of the perceptions of our patients and as nurses and managers we can’t just assume that just because we are within budget and meeting the outcomes set by our boards and by government policy that our patients see it that way.

I have been a poor blogger lately and that really won’t do. So the deal is this; I am going to try and post every day up to Christmas Eve just to prove I can. I have a few days off coming up from tomorrow so what better time to start getting back into the swing of things? Some days there will be meaningful words that may be profound and just too cool and other days there will be the usual level of trivia and dross. But I will post and I will get this blog back on the road. After all, as I said in my last post, I have staying power. Now is the time to prove it!

Picture from Joho the Blog

I am getting a bit worried about the staying power of the medical blogger. Ok so they are popular, they have well researched, educated, politically aware though often scary stuff to tell us mere mortals but where is their ability to last for longer than, well me? Some days only about 30 people read the drivel I write (and some of those are probably people who read it twice by mistake), often I have nothing of any importance to write ( which accounts for the lack of visitors no doubt). I keep going because I believe I am delivering a public service to some poor person somewhere and because I am slightly gratified that many of those medical bloggers have less staying power than me and of course because any day now something very exciting will happen (I promise it will).

So let us look at this issue in more detail. While my nursing colleagues like mental (of course not a person but a collective), emergiblog, nursesean, disappearing john and the wonderful mouse thinks continue to post despite hard work, study, family stuff and general apathy our medical colleagues seem to be dropping like files. It is quite amazing to see that despite posting about 3 times since June Dr Crippen still manages to get thousands of hits to his sites a day. Mean time, Hospital Pheonix has again disappeared,  The Angry medic has taken flight, and a number of other British medics have disappeared off the scene. Have they all been frightened away? Are they all too busy saving the NHS or are they just bored with the world of the blog? Only time will tell!

If you are English the months of June and July every 2 years are pretty much taken up with football mania. The TV programmes are taken over with almost daily (and sometimes twice daily) matches, and when no actual football is being played then with other programmes just talking about it. The newspapers produce magazines and wall charts so you can examine the chances of the england team against their opponents and the supermarkets have special offers on beer and various fast food and bbq options. General hysteria takes over the country and suddenly everyone is an expert at football. Generally the excitement for England lasts between 2 and 3 weeks depending on how well or (usually) badly the team perform. It all ends in tears eventually, because we never actually get past the semi finals and it would be true to say that less and less people actually remember the great day when England won the world cup in 1966.

This time though there is to be no summer football fest. Well there is one taking place, but the England team will not be part of it. Those who want to watch football can do so, but England fans will need to choose another European country to cheer. The economy will apparently suffer, there will be no feel good factor, no one rushing out and filling their fridge with beer and bbq goodies. Instead people will wander around aimlessly not knowing what to do.

Last night the England team failed to qualify. They were rubbish, and if they were planning to play like they did last night then I for one am glad that I will be able to do other things next summer. We can still drink beer and wine and eat our bbq or  pizza but at least the England team won’t be making us feel ill afterwards. We won’t have to be hyped up by TV and other media only to be let down and instead we can take pleasant walks, visit the sea side and generally have a football free summer. Sadly my husband will no doubt wish to still get his daily fix of the nations favorite sport but at least I can opt myself out of it. This may not be a popular viewpoint, but this is my blog and it is my view! Link to the story here

Two posts in one day? Well lets just say I am fast going from someone without any ideas of what to write to someone who is full of them (at long last). Sometimes you happen to read something that so incenses you that you just have to write about it and this is just one such occasion.

We are told to take care of our personal data. Anything with our names, addresses, dates of birth and the like could be valuable to someone wanting to steal your identity; many of us now shred our bills and other documents likely to fall into this category. shredding gives me immense pleasure, but I am very sad.

Now I discover it is not necessary for me to bother since her majesty’s revenue and customs department have sent my full details including national insurance number, date of birth, address and maybe even bank details by unregistered post on a CD and lost it along with 25 million other records. We are also told that while this is an unfortunate matter we have no need to worry about identity fraud.

I am glad to see that someone has taken responsibility and resigned, but in what world does any government employee think it is ok to send my personal data on a CD by post when it is well known that the mail service in this country is at best just about reasonable and on a bad day is rubbish.

The BBC version of events can be found here 

What did the swan say to the other swan as it crossed the road? No this isn’t a joke and actually I don’t know the answer, but this afternoon I did witness the bizarre sight of 2 swans and 4 geese crossing a road to get to the other side of a river separated by a small road bridge. They couldn’t cross underneath the road as water levels were quite high, so the road was the most convenient means of travel and it was great to see a couple of cars being made to wait for the crossing to happen. Boy my days are becoming exciting!

I had just left a meeting of the maternity services liaison committee for which I am the PCT rep and general dogsbody for the group (or so it seems). I have no problem with writing the notes, or with organising the venues, sending out agendas etc. But I do get the distinct impression that I am being viewed as something provided for their use because we are obliged to provide it and some of those people are jolly well going to speak to me as if I am just the hired help! Of course it might be me and my sense of inadequacy coming out, but I don’t really have problems with confidence in the normal run of things so I think my instincts may well be correct. The problem to me lies in the definition of user representative. To me a user rep for a group which is about maternity services is someone who has used or might in the future use the services of a maternity unit. So the fact that many of the so called users are actually teachers and people who run groups for the National childbirth Trust, but whose childrearing days are confined to ancient history rather grates on me. The problem is that national guidelines say that actually these people can and should be classed as users and it is my own issues that make it not feel right to me. They work with pregnant women and new mums and they do know about the issues but still it seems kind of odd.

The involvement of the public in the planning and reorganisation of health services is important and necessary. But it is important that we use the right people to help us with that work. Luckily in this case we have a number of just the kind of people who have recently used the services and can truly represent those who will use it in the future but I wonder how we manage the fine line between working (all be it on a voluntary basis) for a charity organisation and truly being able to call yourself a user representative.

Which I guess is why none of the diaries of my childhood, started on around the first of January, rarely lasted until the end of the first week back at school. I have definitely done much better with this blog, after all I have droned on for more than 2 years. During that time I have been through something of a traumatic organisational change process (I don’t use the T word lightly) and I have completed an MSc (the contents of which I am using in my work, but as yet it hasn’t helped my actual earning potential much). The NHS Exposed blog has noticed my writers block and suggests that I sex things up a bit! Now there is an idea, because I have to admit that working in Children’s commissioning might be interesting but actually it isn’t especially sexy. The challenge is to know quite how to make it so.

Thursday saw me at an awayday with our counterparts in social services. In our area that department is called children, schools and families which was around far before the Government decided to name their own department the same way. It is pretty obvious that there must be more commissioning to be done in social services because we were outnumbered by around 4 or 5 to 1 (there are only 5 in our team). I also noticed that most of their team are extremely skinny and while I have lost 17lb in weight (which I am extremely happy about) I have a long way to go before I could fit in with them on that score. They were extremely welcoming to our team and we all seemed to get on pretty well. I am kind of struck that all of the people that I deal with in Children’s services are very nice people. I have come across a paediatrician or two with a bit of a side to them, but they were only tough on me because I represent the evil PCT who might not give them the money and the freedom that they covert. Niceness is not something you always come across in adult services, indeed it is often obvious that members of the same team think very little of each other.

What I would like to do, but am struggling with, is to describe in this blog my observations of the large numbers of people in our PCT who seem to be in the wrong jobs,  who appear to be struggling badly to actually achieve what they are being asked to do. I would like to tell you about the large numbers of colleagues who have lasted a year post change and are now remembering that they are old enough to retire and are therefore calling it a day. This is about to release a few positions that I wouldn’t mind having a go at,  but I do hesitate in the knowledge that the people in children’s services are slimmer and nicer than those in adult services and therefore of course I belong in the latter!

Not many posts from me lately, and in reality this is down to a slight lack of ideas swimming around in my head right now. It is hard to know why some days and weeks I could think of 3 or 4 topics and then suddenly a week goes by and not a new or sensible idea. I know that some of my fellow bloggers write down topics and associated notes so that they have a stream of fabulous posts at all times. Sadly I am not that well organised, though maybe it would be another new leaf I could turn over, perhaps a resolution for the soon to be with us new year. Scarily someone told me today that it is 6 weeks to Christmas and no I am not ready for the festive season though many shops seem to be offering the full range of goods already. Is it me (and my advancing age) or does it get earlier each year?

Some of my more in depth thoughts this week have been about teenagers and the continuing trend for some of them to damage and even kill each other.  This was brought home to me at the weekend when my son told me of an acquaintance of 19 who had so badly beaten up another boy of the same age that the latter had died. You cannot ignore these things, even if you would like to when those involved have come from your own community when your son has played football with someone who (years later granted) has apparently killed another. What happens to young people that they go off the rails to such an extent? What makes the difference between the thoughtful and caring young man I have living in my house and others living close by one of whom is now dead and the other in prison? Is it something that I have done as his mother that has made a difference? Or are the issues more subtle that that? I don’t really have the answers, but I don’t believe people are born bad. I am just extremely grateful to be the mother of my own son right now and not either of the two mothers who will be wondering how and why such a nightmare has happened to them.

No I haven’t suddenly become some kind of eco warrier type who thinks all cars should be banned and that if we can’t get somewhere by bike or our own two feet we should jump on a but. Actually it has become apparent to me today that I am missing too much of life sitting in my car all on my own when I could be experiencing so much more by using public transport. Sadly the bus and train service available to me will not get me to work in a timely fashion and so this is all in the realms of fantasy but of course one day it might be possible.

I have been to the great metropolis of London town today and boy you see some sights and you hear some things. I saw the houses of parliament and heard big ben strike 10 and I don’t even mean those! No on my way into town on the train I sat myself next to a lady in white tights. That was the first thing I noticed, having glanced at her was that she was wearing a white hat and white fingerless gloves while playing on a pink Nintendo DS or some other similar games consul. I tried not to show my shock when I realised that this woman had been a teenager at least 10 years before me (unless she is just aging badly) and I haven’t seen 19 since 1982!  White tights in November (even wool ones) is just not right. All this occured after the encounter I had at the station within my home town where a woman emerged wearing what can only be described as a pink short set and pink tights. Luckily she had a coat on to protect her from the elements, after all it is November and we are in the UK. Shortly after this encounter I was some what reassured to see two teenage girls in their pyjamas and dressing gowns - it is obvious that the local college was hosting an event where people turn up dressed for bed (well we can hope).

Luckily the tube was not over crowded at around 9.30 so I managed to grab a seat. For a change my fellow travelers seemed reasonably clean (i.e. there were no bad smells) but some of these people looked as if they had got dressed in the dark (probably they had after all it is not light these days until nearly 7.30am).

The greatest fun  however was to be had on the journey home when the woman opposite me barely contained her irritation that the young people around her should utilise that modern contraption the mobile phone and what is more speak into it during a train journey. She was probably around 60 ( perhaps younger) and was trying to read the Telegraph magazine (I think from either Saturday or Sunday). Perhaps she has been doing this since Monday morning and would like to get to the end by Friday, or perhaps she just likes to huff and puff. A man behind us spent most of the journey getting someone else to complete a multiple choice exam paper on matters financial. This process took place via phone, with numerous recalls due to tunnel problems. Others around us either rang people or received calls and were able to tell others that they were ‘on the train’. I sat half hoping my own phone would ring while at the same time fearing ‘the look’ she would give me and the huffs she would make if such an event happened. Sadly or probably luckily it did not. Tomorrow I return to my car, I will be safe to listen to music and even sing along without fear of people thinking I am mad and I will have my own personal space. But I will look forward to the next time I join the commuters and am able to observe their dress sense and enjoy just a bit of their world.

In the two years before the NHS reorganisations that caused me to change my job I wrote, alongside a few colleagues, a number of policies, guidelines and other papers which at the time appeared as if they would end up on a dusty shelf, or worse in the shredding bin. But no, yesterday I read a new policy which has its roots in something I wrote before and what is more contains references to other papers including my dissertation. The latter belongs to me, it was essentially written in my own name, it was written by me and most of the time spent writing it was my own time rather than my employers (the same cannot be said for my reflective practice journal which was completely compiled during an afternoon in May this year at my desk and the one next door!) But all of the documents I poured over for hours and which are now being taken by the new organisation do not actually belong to me. As employers they retain intellectual copyright and can do with them what they might wish. One of the things I find most interesting is that at the dawn of the formation of the new PCTs my work and my ideas were not deemed valuable, instead they decided that a person better equipped to ticking boxes would be preferable to run the show. Now though a new softer edge is needed so out come the ideas a group of us had about providing better support for our clinical staff, for implementing programmes of induction and performance management. They say that what goes around comes around, but it has barely been a year and boy that is even faster than I had imagined.

My teenage son has just begun his literary career. He has moved from the fact driven basis of education as it is taught up to the age of 16 and entered the world of A levels where analysis, opinion and fantasy appears rife.  He proudly told me as I drove him to school this morning, that he had created an A4 page from just one quote from the Tempest. The ability to be creative in this way is a skill that needs to be nurtured both for his future educational career but also for the world of work. It might not be right and proper, but it is a hard and sad fact of life that the ability to write pages and pages from nothing will often get you far in the world of work. Whether you have the right to reproduce such stuff elsewhere or not, it means that even after the person has been discarded their words live on.

Reading some of my favorite blogs and now actually getting around to writing a post. It would be true to say that I am getting very lax at writing anything meaningful in my blog. Nothing right now seems to be getting me going enough to rant, and in my post holiday euphoria even the latest BBC scare stories (I should never eat red meat or bacon again for fear of cancer, and only yesterday, I am sure to get heart disease on account that I suffered pre-eclampsia when pregnant). I have come to the conclusion that there is someone who sits at the BBC trying to find one reason why we are going to die which can then be fed to us on a daily basis.

Work is scarily stable at present. No reorganisations have happened for at least 2 weeks, however there is a general trend towards the exit. Some of the people who have been around the local health service for as long as I have (and longer) are beginning to retire early or to move on to new things. This time last year everyone was hanging on to whatever job they could get, and now those people are deciding they no longer want the kind of pressure those jobs bring and are off. This is going to bring with it some opportunities, particularly in management of what are now known as the ‘provider services’ and this is going to present me with a dilemma. Don’t get me wrong, I am really enjoying my work in the world of children and their health services. I have learned loads in a very short period of time and some of the things I have done already have been pretty interesting, profound and will probably have an effect on the real health care given to children. But I am an adult nurse and I miss being involved in things to do with the nursing of adults. I have no desire to find myself 4 layer bandaging a leg, or sitting an old lady on a commode, nor do I wish to personally have to calculate drug doses. But maybe I would like to get myself back into that world at some point. The question though is this, is it too soon? Should I think of giving up my relatively stress free life to get back into the management of a service or some other role within provider services? Or as I suspect should I take more time to get to know the job I have had for only 8 months and wait until the call is greater?

The feelings of being out of control, of not being wanted or valued are still raw and actually I don’t think I am strong enough emotionally yet. Having said that, my brain is now clear and I am starting to make my mark again. I think actually I have enough to be going on with.

With that thought I am off to get on with my weekend chores!