May 1st sees the launch of a new code of conduct for nurses. Often ridiculed and undermined, some people who frequent the blogsphere seem to imagine that nurses are just people who do their best to undermine doctors, act as if they couldn’t care less and who generally are too grand to get their latex gloves dirty (supposing they aren’t allergic to them), In my experience nothing could be further from the truth. Nurses in 2008 are stuck between the devil and the deep blue sea. On one hand they are meant to be caring individuals who understand the social and psychological needs of their patients and who know one end of the body from the other (mainly so that they can provide appropriate care). On the other hand they need to be able to develop more specialised skills so that they can take on specific roles that some doctors (but not all) have become tired with or who quite rightly see that nurses might actually be pretty good at taking on.

Nurses can’t just complete their pre-registration training, take their RN qualification and go off into the sunset (thank goodness), they can’t just go about their lives forgetting they are nurses when it suits them. Nurses are required to conduct themselves in a particular way that is becoming to their nursing qualification and what is more, the new code of conduct, produced by our regulator the Nursing and Midwifery Council and released officially this week is quite specific.

Some of the areas of note are that:

The people in your care must be able to trust you with their health and well being. To justify that trust you must make the care of people your first concern, treating them with as individuals and respecting their dignity. Work with others to promote the health and wellbeing of those in your care, their families and carers and the wider community. Provide a high standard of practice and care at all times. Be open and honest, act with integrity and uphold the reputation of your profession.

Some of the areas of the code include:

• Treat people as individuals
• Respect people’s confidentiality
• Collaborate with those in your care
• Ensure you gain consent
• Maintain clear professional boundaries
• Share information with colleagues
• work effectively as part of a team
• Delegate effectively
• Manage risk
• Use the best available evidence
• Keep your skills and knowledge up to date
• Keep clear and accurate records
• Act with integrity
• Deal with problems
• Be impartial
• Uphold the reputation of the profession

We have all been issued with a small, but comprehensive, pocket sized document. You can read the full contents of what it says here.

As a nurse I am obliged to uphold the code of conduct, it is not something I or my colleagues should take lightly.

It should be part of human nature to treat people in the way you would like to be treated yourself. For those of us who put ourselves forward for some kind of public service, this is an important quality. Respecting the views of others, listening, giving people privacy, helping those unable provide for their own basic needs are all things that those of us working in the caring professions should consider. These things should go without saying. Why then did I spend my morning at a dignity workshop?

It doesn’t hurt to be reminded that everyone deserves to be treated with dignity. This includes friends, colleagues, and those we encounter in our working lives. How often have you done something for someone else only to be greeted by someone who is not a bit grateful? On the other hand how often have you thought of your own needs over those of others? Nurses, doctors, paramedics, therapists, all professionals providing healthcare (there are many others), but do we all consider the needs of our patients before we speak or act? Do we always do everything we can for others and do they actually respect us in return? In the main I believe that most of us do think about the needs of others, we treat people with the respect and dignity of others and that respect and dignity is reciprocated. Sometimes though this doesn’t happen. Today I heard anecdotes of a nurse taking the blood pressure of a patient, wearing gloves and without speaking to the patient, of doctors not imagining people need to have their condition and treatment explained to them, of people having their bodies exposed to whole wards and this was just examples given by health care professionals in their private lives.

It is sad that the government is having to launch yet another initiative, this time about dignity, it is annoying that this might yet turn into another tick box audit type issue. It would be easy to say that the nurses / doctors / etc are just less caring, that they are in some way falling short. But actually is this more of an incitement of our society. After all we don’t necessarily generally treat teenagers, old people, or single mothers with any kind of respect, so why should we be surprised that dignity and respect might be something needing to be taught.

I have had a few queries about where to send submissions for next week’s Change of Shift.

Email them to me at: lifeinthenhs@btinternet.com

The next edition will be published here on Thursday 1 May

Today is the day of St George, the patron saint of England. Declared a feast day in 1222, St Georges day and the flag of St George (from the Crusades) has in recent times been little promoted and celebrated. We have no special day off, we have no feast as such and people displaying the flag are often thought to either be

supporting  the England football team or being far to nationalistic. Living as we do in a group of islands made up of 4 countries, it is the Scots, Welsh and Irish who are allowed to celebrate their own identity, to fly their flags and to be nationalistic, we as English are meant to wish to be British and make the most of that. After all we have the BBC news which thinks London is the main (if not only) place in our islands and be happy with that. For many years we were told we should not display patriotism of this kind for fear people would think we were racist, or nationalistic in the extreme.

Today I was in London and for the first time noticed more than a few buildings flying the flag. Apparently one is flying from Downing Street (though Gordon Brown is no more English than I am Scottish). Taxi drivers not only had flags on their cars but had music blaring from their cabs (luckily I walked and used the tube so had no need to hear this at close quarters). Good for them I think. Rather than moan all the time about all things English (weather, London olympics, congestion charge, teenagers, NHS) why can’t we sometimes celebrate what makes us what we are? If scottish people can wear a kilt and dance around eating haggis then why can’t I celebrate with a lovely glass of champagne and the nation’s favorite meal (what do you mean they aren’t English?)

By the way did you know that St George is shared as patron saint with Aragon, Catalonia, Ethiopia, Georgia, Greece, Palestine and Russia amongst others and they can’t all be wrong!

Well actually I have been to somewhere on the outskirts of the city, so cannot report seeing any historic buildings, the river Cam or students on bikes. I have been helping to create the NHS Directors of the future.

For the second time this year, I have been a development consultant (note the grand title) on a Leadership / management course for NHS managers who are stupid enough to think they want to run our organisations. This involved spending two long days in a hotel, spend a night in a single bed (why do uk hotels do twin rooms with 2 such narrow beds? Who actually likes these) and observed the behaviour, written up and given feedback to 3 candidates. Whenever I do this kind of thing I wonder if A) I might actually be good enough to aspire for directorship and B) would I ever want to do it?

The great thing about preparation for senior management in the NHS in 2008 is that it no longer seems to be left to chance. There is this 2 day simulation / feedback exercise, coaching, 360 feedback, action learning and study days which of course are called master classes. Observations are carried out by people like me (trained in such stuff) and actual proper directors and the rest is properly planned, resourced and run. There is some hope maybe then that in the future our Trusts have some chance of being run in a half decent manner by people who have had actual on the job training and support as well as completing the obligatory MBA!

The thing for me though is that actually while I love working on this kind of course (while mainly doing my day job) I actually don’t desire to be one of these people. I am not driven for power or even for money (though I could always do with more), I actually don’t want the stress or to work the kind of hours these people often already work. But could I do it? Well, for me thats the actual thing, these people are normal human beings, and no doubt if I or perhaps you wanted to you could, but do you want to?

On Wednesday while my heart was racing and I was willing it to return to normal and hoping to stop being dizzy I sent an email to about 6 key GPs in my PCT area. There is to be a review of maternity services and they, along with midwives, obstetricians, actual people who recently had babies and others have been invited to contribute. I have received 3 replies to date, the first from a GP I know who says - yes, love to be involved, the second from a GP worried his population are poorly served by services right now and a third from one who thinks it is no business of a GP.

This is the fascinating, interesting and often amazing world that is primary care. No two GPs in no two surgeries seem to actually agree with each other. For each sensible, measured response, someone decides to fly off the handle. If you try to involve them, then you can be accused of bothering someone who is busy with too much else to do but woe betide you if you don’t actually send that email or make that call.

This means that every time Dr Crippen flies off the handle, every time Dr Rant is apoplectic with rage, then somewhere a GP is thinking that this is rather a good idea and another is wondering why anyone has actually bothered! This is why I love health management so much!

What more can you ask for when you are taking a day’s rest from work? Nurse Sean, who hosting Change of Shift this week, is the answer to a girl’s prayers as not only does he have some great posts this week, but he does it through the medium of travel. I am happy to say I have visited a few of the places he features, but certainly not all. Lets hope on his part he gets the chance to do that travelling he would love. My advice Sean is 30 is a great age to take in the sights of Europe!

I am the next host of this wonderful blog carnival, what a hard act to follow!

Today I decided to become a patient. Well I say decided, actually just as I was walking from my car to the office my heart somehow decided to beat in a kind of rapid Supraventicular Tacycardic way. This has happened to me before, a couple of times when pregnant and once or twice since, but on each of those occasions it has lasted a few minutes and being a nursey type I have never sought medical treatment or advice. Today was different. After an hour at  my desk it was getting increasingly difficult to get on with any work. 20 minutes later I had consulted with a colleague (well my director) and got myself driven to the local hospital by her PA.

So followed my first experience of resus as a patient and a two hour engagement with a trolley, ECG machine and associated other monitoring equipment and a very good but unpleasant drug which needed to be administered twice for effect. I had a great nurse and a wonderful doctor, who got on with the job efficiently, cheerfully and who made me feel like I was no trouble at all (of course all in a days work).

Now I feel fine, if weary. Have some tablets to take if it happens again and I am to await a cardiology appointment. I am toying with a day off tomorrow to recuperate, but we’ll see.

So there you have it, Julie experiencing life in the NHS from the other end of things!

The best times I have had as a nurse is when I have been part of a team. By this I mean a real team where there are lots of different people, all responsible for different parts of what goes on, all with an equal role in making sure that the end product is as it should be. When I was practicing as a nurse, then the end product was the patient, when I was working in education then the end product was the member of staff needing education and or training and now in commissioning, well the patient is that end product again.

There are some great sites out there telling us the good, bad and ugly of life in the world of healthcare. It is not about identifying who is more important or better than the other. It is about looking at the whole picture, about identifying our own strengths and weakness and recognising our own dirty laundry not just that of other people. as I have mentioned before, I am weary of the sweeping statement and of the culture of blame. We get enough trouble from the media and written press without doctors writing blogs laying into us too. While we cannot all stand shoulder to shoulder at all times, I suggest that we should at least find out as much as possible about a topic before attacking a whole profession. Dr Crippen may have returned to the blogsphere, but I am not sure he has benefited from his long absence. I will not link to him as I don’t wish to add to his already over inflated stats. Instead you can join the debate over at Mental nurse, where you get a more measured, all round debate.

My lack of blog posts over the last few days is really more about a lack of time and energy than a lack of will or ideas. My dad is in hospital post surgery and with my mum not able to drive, then my brother and I have been taking it in turns to take her over there and to go and see him. All seems to be going well in terms of recovery and I am pleased to say that so far I can complain about nothing in terms of nursing care, medical input or anything else. We face a period of uncertainty in knowing whether there is anything further to worry about with his health, but so far so good. As a woman in her 40’s I know that I am lucky that both my parent have until now enjoyed good health, and you just hope and even expect that will continue. People in my family, and particularly the male members have not to date enjoyed longevity. Therefore with this illness came an added issue of my mum being convinced that my dad would die on the operating table at the very least. I had a frustrating 10 minutes on the phone on Thursday when I was trying to explain to her that this was not the same as the emergency surgery my 80 year old granny with a history of heart disease and general poor health had 10 years ago. Thankfully that anxiety has passed for now.

Last night we had a family meal without Dad which was odd. My brother turned 40 on Thursday, the day of the surgery and so last night we went for an Indian meal. I feel slightly strange that my baby brother is 40. I was 5 years and 8 months when he was born and we have always been close. Jealousy at not getting enough attention when he was born led me to cut my hair with some nail scissors a few days after his birth, but other than that I have always had a better relationship with him than the brother who is closer in age. But to find that he is 40 must mean that I will be 46 later in the summer; how did that happen?

A few weeks ago I wrote about the disappearance and subsequent discovery of 9 Year old Shannon Matthews. The little girl had vanished after a swimming lesson, but 3 weeks later was discovered in the home of her step father’s uncle. Since then, Shannon has remained in the care of a foster family and has had little direct contact with her mother, while most days a further piece of the jigsaw of the complicated life of this family has been revealed. There is little hard information other than a number of the family have been arrested and some of those people including Shannon’s mother and step father are now being held in prison having been charged with various offenses.

When I wrote about this topic on my blog, it was with sadness that family life for some people was so complicated, and that those people appeared to live very different lives from what I would call normal. I wondered if poverty and lack of opportunity had anything to do with the way in which some families live their lives. The main thing that struck me last week when Shannon’s mother’s partner was arrested on child pornography charges was that here was a young man of just 22 who had moved in with a woman of 25 when he was only 16. I wondered about the kind of world he had come from. Today Karen Matthews appeared in court charged with child neglect and attempting to pervert the cause of justice. Perhaps Karen knew where Shannon was, perhaps she organised the whole thing, I don’t know. There are rumours that the family tried to obtain money from the Madeleine McCann campaign and others that they based the whole thing on a recent episode of a TV programme in order to try to extort money.

We live in a world of celebrity a world where people think that they can get money for doing little. Only too often people are looking for an easy way, when for most people it takes hard work to earn the money to live comfortably. There is no doubt that some of us have advantages over others in terms of who our parents are, where we go to school, how long we stay in education and the kind of work we do. However, there are plenty of people out there who have lots of disadvantages in life, yet still manage to succeed.

What is most sad is that there is a little girl living with foster carers, what is more, she has brothers and sisters who must also be in care now. What family life there ever was has now disappeared, perhaps for ever. What is even more sad, is that perhaps those children have a better chance now they are apart from their mother and as one myself that is the worst bit.

For the first 10 years of my nursing career an office was something other people worked in, it was a place where secretaries and general pen pushers worked. We had ward offices, places where sister took you to tear you off a strip (if it wasn’t done in full view on the ward) or where you took patients and their families to tell them bad news or to give them a place to escape. When I was a district nurse, we had an office, but it wasn’t anywhere near where we were actually based. We used it to keep notes and equipment and to hold our weekly work allocation meetings on a Friday.

Now I am a person who works in an office, I am a pen pusher, though to be honest none of us actually write that much these days; Even my lovely filofax is likely to become redundant soon since I have now been given a blackberry (more of that later). I sit in a largish office with about 30 other people (give or take 2 or 3 as I don’t sit counting people) and I find the whole thing quite fascinating. I have spoken before about the clique that sit behind me. The procurement people who are extremely entertaining if insular (coffee club, friday breakfast club, in jokes), it is not that they exclude people, it is just really that they don’t notice you (unless you are stealing their coffee or milk that is).

The ethos of this office, unlike some I have been in over the last few years, is that people are there to work. I like that and to be honest there are a few people I’d like to introduce to this kind of philosophy, since we are actually paid to do a job of work rather than to talk all day. However, with my colleague (she sits opposite) off sick for the second time in just a few weeks, my working day is going towards the other extreme. I am naturally a social person, I like to communicate with people (I am a nurse and have already spoken this week of our unique selling point as nurses) and if the only engagement I have is two people saying good morning when I arrive in the office and another telling me about his model train hobby in the kitchen then to be honest I am going to struggle.

On Thursday, I spent the entire day in the office. I had a short meeting at 10am, and came back with plenty to do. I sat for an hour or so in silence getting on with the work and then in the absence of any stimulation from other people began to lapse into a kind of trance. Not only that but I began to become fascinated with the activities of others. Other than the procurement folks busy buying new defibrillator’s, cannulas and other important goods which keep any hospital running smoothly I also have people from Practice Based Commissioning. The person next to me seems to deal exclusively with the appraisals of GPs and the person next to her with QOF, between them they spend nearly all day on the phone to GPs and practice managers. This week has been a big one for these folks since QOF data was to be submitted by 31 March so that practices can be paid by the PCT. Not surprisingly it brought a flurry of panic driven managers onto the phone with last minute problems and by Friday drove the PCT person dealing with it all off to her sickbed.

In front of me sits the specialised commissioning team, which is really fascinating. These are the people who decide if the PCT will fund treatment that is out of the ordinary, or out of the area. They receive calls from patients wanting IVF, new drugs and weird and wonderful treatment. On Thursday, in my slightly stupefied state this got me thinking how much things have changed in the 28 years of my nursing career. Who would have imagined that most people would know what treatment was out there for them much less that they would know exactly who they needed to ring to try and get it. These people are persistent (and quite rightly so) but I do wish people would remember to turn down their answer phones when they are out of the office.

I went home on Thursday feeling that I had been entertained in some small way, but actually annoyed with myself that I had done much less work than I should (surfing the internet for holidays is probably not the best use of my time) so I gave myself a talking to. Yesterday I did things in hour long bursts: work, coffee, work, banana and coffee, work, get up and walk around and engage one or two people in light conversation, work, out for a walk then lunch, work, surf internet aimlessly, work, coffee etc. How people cope all day in an office on their own I will never know because sitting at my desk in a room of 30 without any social engagement is for me detrimental to me getting my work actually done.

Recently I wrote about my boss and her Blackberry. Well now I have one and actually they are addictive if useful little toys. I have found that not allowing yourself you check your emails during the evening / your day off is quite a challenge. I suspect it might be her telling me to turn the thing off in the future!

The picture above demonstrates life in the public sector in 2008 and came from Royalty Free Cartoons

I am not generally gullible but on Tuesday 1 April I saw penguins fly on the BBC breakfast news. I usually consider myself to be quite a morning person; it doesn’t take all day for me to come round, rather I usually feel pretty chirpy by the time I am dressed. But on Tuesday it took me until I arrived at work to realise that the whole thing was an April fool; perhaps I am losing the plot? Sadly what I just saw on BBC breakfast was not an April fool. A man appeared on Oprah in the US to tell the world that he is 6 months pregnant! It turns out this ‘gentleman’ is a transexual who has be gender reassigned from female to male but who kept her internal reproductive organs. At 6 months pregnant, the person sitting on the sofa facing Oprah with what looked like the kind of facial hair my 17 year old son can manage and what also appeared to be something of a beer belly, though of course it is not beer that got him or her in this position.I am struggling right now to know quite what I think of all this. I understand and sympathise that some people grow up realising they have been born into the wrong gender, I support the idea that people will put themselves though hormone therapy and painful surgery to put right what they consider a wrong. But there is something very odd in my mind if you put yourself through all of that, keep the organs you apparently never thought should have been yours and then go on to use them. Thomas Beatie and his wife apparently carried the insemination out themselves using sperm they had bought. This raises a number of questions: Where do you go to buy sperm? If it was possible to inseminate Thomas in this way then surely Thomas has not had the full surgery and is not really a man? What gender will Thomas feel that he is when he has given birth to this baby? What on earth are they going to tell the baby?

Given a choice I think I’d rather the story of penguins flying were true and that this one was an April fool!

I wouldn’t call myself a trekkie as such, but no child of the 60’s and 70’s can have failed to have noticed Star Trek. So lets do a time check - Star date, April 3 2008 and with Captain James T Kirk at the ready, Scottie ready to beam us up, nurse Chapel in the sick bay with Mr spock and his fellow vulcans it is time to get over to Nurse Ratched’s  Place for the latest Edition of change of Shift. The bad news for me is that I am hosting on 1 May (well that of course is good news) because I am now wondering how on earth I am going to come close to this one?

In these days of a health care system that is increasingly orientated to the world of business, then perhaps we all need to be indentifying our unique selling point. Services, including those which deliver care to patients are increasingly subject to competition, they need to be cost effective, evidence based and all of that important stuff. We might not like the way this is heading, but actually there are some positives, it means that services are starting to run according to what patients need rather than what health care staff think they would like to provide. There will in the future be less possibility that a service could be offered on the basis of a whim of one or two individuals. So as a nurse what skills might I have that no one else does. If doctors can apparently be replaced by nurse practitioners / nurse specialists / nurse consultants then we as nurses can also be replaced by a cheaper or as some would say dumbed down version.

A post by The Shrink over at Lake Cocytus about communication skills got me thinking. As is often in the world of the blog, he got the idea for his post from a medical student, this is one of the great things about this kind of media in my view. As a student nurse my very first experience with people on a hospital ward was not to take a temperature or blood pressure, it was not to do a dressing, no we were instructed to sit at people’s bedsides and talk to them. This was really hard. We were the most novice of nursing students, we had a uniform but we had no actual task to perform. But that day stays with me, and now that I reflect on it, I would be as bold as to say that it has helped to make me into the  nurse I became and the person I have become. Communication isn’t just about speaking, it is about being able to give time, to meet a person’s eyes, to wait while they take in and digest a difficult piece of news. It is about being able to pick up those non verbal cues, it is about being able to sign post the patient to the right person and about being able to point the doctor for example to the problem as experienced by a patient.

A patient was admitted with anaemia, can’t remember the underlying problem (it was a few years ago). I admitted the patient, filled out his paperwork, did his obs. He reported that he was a Jehovah’s Witness. I knew some of what this meant, but said little at this point. The doctor saw the patient and came back to the nurses station and wrote up a blood transfusion. I asked the doctor if he had discussed this with the patient? He said yes he had mentioned it. I suspected that he had told the patient what was to happen and the patient might not have understood what was was meant by it. I approached the patient and sat and had a conversation with him about the treatment proposed by the doctor. Not surprisingly he was not prepared to entertain the blood transfusion, but did want to be treated and didn’t want to seem difficult. Nothing I did was better than the doctor on that day, it was just different. I had the benefit of having admitted the patient, but also that our admission process asked questions that encouraged the patient to tell things from their point of view.

When as nurses we think we would like to more exciting things, to diagnose and to prescribe we need to remember the essence of what a nurse is. By all means learn new knowledge, develop new skills. But will the patient benefit and in what way? Will you be applying your new skills plus using the ones you developed in nursing school? Will you still have the time for those high level communication skills? Will you be able to pick up the non verbals? I have been a specialist nurse, I have taken on skills that average nurses do not perform but at the heart of what I have always done has been that special thing that a nurse is best at - communicating with the patient, identifying what the patient thinks and what the patient feels rather than what we think they should think and feel.

I might not work at the bedside in my current job, but actually I use those skills every day. They are what makes me able to say even to this day; I am a nurse and proud to be one.