Former NHS Nurse and manager now contemplating the NHS from outside

Archive for the ‘Nursing’ Category

Using Twitter to discuss nursing issues and share information

wenursesbadgeBefore my redundancy I had little time to explore how social media is being used by healthcare professionals. I knew that our PCTs and Trusts were using it to report what was going on, but I had no idea about how many individuals were doing the same. Since I finished work though, I have joined Twitter myself and started to follow some of the people out there who are tweeting about nursing and healthcare. Of course, I have other interests too and am also following a few celebrities.

Unlike Facebook, people on Twitter tend not to lay bare their entire lives. This is helped by the fact you can only post 140 characters or less at a time. It seems an ideal way to share news and information with others. Some individuals are quite prolific in their posts, you wonder how they find time to get anything done. Maybe, they are the irritating people you see at meetings who spend the whole time studying their mobile phones. I used to think those people were answering emails, but perhaps they are on Twitter?

I have been interested to see read the tweets of nurses and doctors who work at the bedside, quite rightly of course they will be offering general information and personal opinion. Just as with blogging there are massive pitfalls to writing online about work. But it is great to see that people are overcoming the potential minefields of confidentiality and employer resistance to social media. Many NHS organisations don’t allow staff to access social media from their work computers, but since everyone now has a smart phone, this doesn’t stop people.

A couple of weekends ago, as a celebration of International Nursing Day, @WeNurses held a ‘tweetathon’ for people to post stories of nursing and to send pictures of badges and buckles. They also hold regular discussions about pertinent issues for nursing and healthcare; today there was one about the Liverpool Care Pathway. Because this discussion takes place in an open forum, as members of the public and media get to know about them, there is a greater chance that people will see nurses in the positive way we need. They will see professional discussion from caring and intelligent people. They will see the sharing of best practice, they will see compassion in action and they will see that some of the recent rhetoric is plainly untrue.

Social media seems to be here to stay and for me it seems to be a great way of finding out what is happening out there and for getting to know the lives of other people.

You can follow me here Though of course, I don’t have loads to say just yet. Hopefully that might soon change!

Celebrating Nursing

Over the past 6 weeks or so I can honestly admit that I have been taking things rather easy. I am now over the experience of organisational change and redundancy and from my encounters with colleagues employed in the new worlds of NHS England and the local Commissioning Support Unit, I am well shot of it all. My pension has now paid up (suggestions by NHS Pensions that it would all take 3 months were unfounded) and I am about to become an investor in ‘funds’. Soon, I will swop the Nursing Times for the Financial Times, well, maybe not.

I have begun to consider what work I would rather do in the future and on balance, while I am unlikely to find my way back to a bedside any day soon (my back has been playing up something chronic), I would like to work closer to the patient and hopefully with some nurses. A week ago I helped out at a training session for community staff, something that I have contributed to a number of times. It didn’t take longer than coffee time to dust off my brain, and I know that I could and would like to do more of that. I also stepped up and sorted out a presentation for an ex boss last week, banking a few hours of self employed work (there is more to come). Plus there is a job in the pipeline which I intend to apply for, but which I am waiting for the advert to appear.

Yesterday though, I went of my own free will, unpaid to a nurses day celebration and I am glad I did. It filled me with an enthusiasm for nursing and the NHS that I have not felt for a while. So much has been written and said about the state of the health service, about whether nurses have forgotten the purpose of providing care, forgotten perhaps how to care.

It is easy to buy into the idea that nurses who are out there now are in some way inferior to the way they once were. The concept that they have in some way lost their vocation and that they lack the compassion to deliver the best that they can. It is easy to believe that nursing leaders are lacking in some way, that they are not committed to ensuring that they set the vision, to inspire and support their workforce.

The conference took place at a local university, run jointly between acute, community and mental health Trusts. Present were all of the nurse leaders from those Trusts as well as in excess of 100 nurses from across the area. The purpose was to celebrate nursing locally and nationally, to inspire and to inform. It did just that. The keynote speakers, one from the chief nurse and the other from someone who has achieved so much despite and because of his disability were great to hear. But equally the quality of presentations from local nurses was of equal quality. It made me proud that I am still a nurse and it inspired me to get back to work soon. I want to work with these people, to be able to support their ability to overcome the negativity and continue the great work they do. To recognise the complexities of modern healthcare and to show people that compassion still exists in nursing. To celebrate nursing.

Near the end of the day, we were shown this youtube clip. I think it tells us what we need to know about the future.


Too little too late

So the RCN and RCM have withdrawn their support for the NHS Health and Social Care Bill. About time too in my opinion, but you have to wonder exactly why it has taken so long. It is 18 months or so since the Government first published their ideas for abolishing PCTs and putting GPs in charge of commissioning as well as a whole range of changes which will apparently increase competition and fix the mess that apparently is our healthcare system. Since then we have paused, given our views, seen some cosmetic changes and started the long weary process to change. The Bill still isn’t law but I suspect that will come soon. At the same time we are to save £20 billion, because after all the NHS is wasteful.

I respect the RCN both as a professional organisation (I studied for my BSc through them) and as a Union. But I wonder why they have chosen now to declare outright opposition. Is it as Andrew Lansley says that they are doing this because of the changes to public sector pensions? Because nursing is getting a bad press right now? Or is it because at long last people are realising that the current pressures on nurses which appear to be resulting in a deterioration in the level of care nurses are able to provide will only get worse? Nurses have been telling whoever will listen to them that this reorganisation is being done for its own sake and that services are being affected and people are losing their jobs. It is good to know we are being listened to by someone – at last!

This weekend I am meeting up with some of the people I trained with 30 years ago. Over lunch we will no doubt reminisce about the good old days and will talk about nursing today. We may well talk about the mess that political meddling has done and will do in the future to the NHS and to our profession. We will also wonder how on earth patient care will improve as a result. We might wonder if actually it is too late and we are lucky that we are approaching 50 rather than just starting on our careers.

Caring for people with learning disabilities when they are sick

I am an adult nurse who started their training in 1980. We received education and training across many spheres of nursing practice, but nothing specifically about the specific needs of people with learning disabilities. I worked in a long stay mental health facility for 8 weeks during my training, people with severe mental illness were mixed together with people who had learning disabilities and some people who probably started off with little in the way of an illness of any kind. As general nursing students we were able to offer some more general nursing care, after all everyone develops physical illness. The first time I encountered patients who were learning disabled was when I was a District Nurse. I had little knowledge of their specific needs and learned most about their conditions from their carers (family members and care home staff). What I did know was that I needed to offer care, compassion and time. I needed to give time and to listen and to use my instincts. I didn’t assume someone with a learning disability had no feelings, could not experience pain or that I knew best. My knowledge looking back was woeful, but to the best of my knowledge no one came to serious harm or died because of me.

Over the last decade or more, nurse training in the UK has been split into different areas of care – adult, children, mental health and learning disabilities. In the main nurses remain within their sphere of practice, despite the obvious cross over between disciplines. My own training failed to prepare me to care for many people I have encountered along the way, but there are ample opportunities to learn along the way. There can be compassion and there can be kindness. Yet again today I am ashamed and embarrassed by a report that suggests that nursing care in this country isn’t all it is cracked up to be. But I refuse to believe it has to be like this!

Happy New Year!

So 2012 has arrived. It is good at this point in the year, i.e. at the start to reflect back on the good, bad and ugly of the previous 12 months and to look ahead to the coming months. 2011 was pretty eventful. In June I was interviewed for a job which finally in October I was able to start. In December I was at last allowed to stop doing two jobs at once, just as well as the new one has just got pretty busy. There are lots to do to help support the improvement in services for people with cancer. I just hope that this job can last past the end of my secondment (March 2013); as the year goes on that should become clearer as we await a report on the future of clinical networks which is due in the next few weeks. The great thing about a new job is that it means you have new things to learn, and things have moved on massively in the world of cancer care since I was working clinically so my learning curve has been pretty steep. I actually look forward to going to work each day and that is a pretty good thing.

I am also pleased to report that my dad, who was coincidentally diagnosed with cancer around the time of my interview, has completed chemotherapy and at present seems to be doing well. This is a huge relief as the cancer is secondary and probably cannot be cured. It was great to see him eating and drinking well and buzzing around us all as usual. Fingers crossed that the scan he had a few days ago confirms this.

My son, who is studying in California for a year is home for Christmas. It has been great having him home even if it seems to have doubled the amount of washing and ironing I have to do and has increased the food bills considerably. He goes back on January 15th, but this time we can look forward to seeing him just a month later when hubby and I visit for his 21st birthday.

So I start 2012 hopeful that this might be a reasonable one for me personally. At work we continue to live through the protracted process of the new NHS Bill which is not yet law, but which is causing a fair amount of change for the sake of change. The GP commissioners are flexing their muscles but at the same time discovering that commissioning is not about telling people what to do and expecting it to just be done. From my new position within a clinical network which will be part of the Commissioning Board I am finding all of the PCT related stuff interesting. People are not surprisingly positioning themselves and that is always fun to observe!

New years resolutions? Well probably best not to promise anything but I will try to blog more (but then I have tried that before).

I wish everyone who takes the time to read this blog post a happy and healthy new year. I hope 2012 is full of promise for you too!

At last

After being interviewed for a new job, a secondment, at the end of June, I have finally got started in the role. For the last two weeks, and for probably another two weeks I am in effect doing two jobs. This is an approach I would not recommend but sometimes we have to make sacrifices in order to get what we want from life.

I moved desks, within the same building, on 3rd Oct and since then have combined induction into the world of cancer and palliative care with managing what I can physically do in the world of maternity and acute children’s commissioning. I am really pleased to say that the new team have been really welcoming, my old team gave me a good send off and all of the people within the network that I have met so far have been friendly.

My new job started with a 2 day meeting in London which was great for giving me a grounding on current issues in cancer services and also in working through some issues about how we can best approach the issue of needing to make sure the voice of the patient / user / carer heard in the way services are planned and provided. I think that hopefully there will be lots for me to write about on this topic once I get my brain properly into gear.

As for the old job, there is plenty that I would like to write about how you should not manage people, and about the emotional mechanisms a person may use to cover up their own short comings and make you feel guilty for them. However that may be difficult and what is more I think moving on rather than going on about it might be more healthy!

The Health and Social Care Bill has this week progressed further on its slow and painful journey to some brave new world that is only clear to people like Andrew Lansley. But it is now inevitable that it will soon be law; it pains me to say but the sooner the better now. We cannot continue with all of this uncertainty and what is more the PCTs are busy making the necessary changes to make it happen and it would be a crime to put the brakes on and go into reverse now. My hope is that the review of clinical networks comes out clearly saying that they need to be developed and strengthened and that what is more that my job needs to be made permanent. There is no way on earth that once I say a final goodbye to commissioning that I intend to go back. But I guess they say never say never!!

Time to reflect

I am on holiday from work this week. During March each year you will always find that there are lots of people away, generally using up their annual leave before the end of the financial year. Probably as many people absent from their desks as in August, but at this time the weather is generally rubbish and depending on when Easter falls there may or may not be lots of kids around. This year the weather is dry and mild and the kids are still in school since Easter isn’t for another month. A week at home with no one else around is great for both recharging those batteries and as an aid to general reflection.

Two events have sought to aid my thoughtful mood this week. The first was Friday when I received a pension statement as part of the process of consulting with staff to move people between NHS pension schemes. In black and white (with lovely coloured charts) it tells me exactly when I joined the scheme and for how long (  up to 14th Feb) I have been paying in. This is scary for someone who has been making contributions for so long. It tells me how much I could walk away with at 55 (if I was still in a nursing job which I am not) at 60 and at 65, both in terms of a lump sum and as an annual pension. This serves to tell me that if nothing changes to the scheme (which of course it will) then by 60 I will have sufficient in the pot to be able to take a pleasant holiday, pay off any remaining debts and perhaps help out my son, plus I could live frugally for the next how many years (given that hubby has no useful pension of his own to speak of) but if I wait till 65 I will receive only marginally more. I guess seeing the facts laid out in this way serves both to reassure and to cause anxiety. In one way the money is there, but is it enough, and what will future changes mean?

The second event was yesterday when I went into work during my leave to collect my long service award from the chief executive and board. For 30 years of NHS service I received a certificate which someone in the HR office had obviously made. The fact that this part of proceedings had been done so cheaply was in a way reassuring (no money wasted). any lack of professionalism in the certificate was made up for the fact that the executive team turned up for the lunchtime ceremony. They laid on a light lunch and small talk wasn’t too painful since there weren’t too many people present. The £150 in vouchers I received (this comes from the endowment fund incase you worry that I am preventing someone receiving a trip to A&E or something) will probably be put towards a new TV; soon we are going to move into the era of the LED TV though it won’t have any 3 D features I can assure you!

Today I am off to lunch with some of the ‘girls’ I managed in a previous life and then, joy of joys the rest of the week will be all about painting the living room ceiling and walls!

Dr vs Nurse

I am now 48 years old and as such am subject to both speaking and acting in a way as I would never have believed; i.e. I am now a middle aged parent type. Therefore, when reading a book by a nurse who trained in the 1950’s I am able to see that many of the great things about nursing generate from that era. Of course if I had read such a thing in 1982 I would have declared this the work of some old timer, stuck in the middle ages. This is of course the way of the world!!!

In the 1950’s the sister was the queen, and the consultant, however he believed himself to be was only some kind of lowly prince, perhaps akin to prince Harry. Close to the throne, but without the deaths of his Granny, dad and brother never likely to be the king!

I can’t deny that I remember medical students being told to heed the word of sister and her qualified nurse colleagues. I can’t even deny that I have been party to the idea that we were equal beings; and even to the idear that they complied.

I haven’t ever been a ward sister, since I escaped to the world of district nursing and the super being of the GP Of course District nurses are superior to any hospital nurse!.

But even I was shocked recently by the behaviour of a Consultant  at a meeting. The way he spoke to the matron; the very person who he should be respecting; the very person who will understand his patients and the nurse who care for them. He was beyond rude and try as she did to appear in control she sounded like a 19th centurary servant. This is not good and may be contributing to the way in which the people who work in the NHS are showing themselves to the world?

What do you want?

What do you actually need?

I want to have a holiday in the sun this year; what I need is time off from work during the year to recharge my batteries. What I might get is a couple of weekends away as a midway kind of compromise! This summer my lovely son will head off for a year in California. This is a study year abroad as part of his degree. I am willing to make this sacrifice and hopefully early next year I’ll get to visit him, maybe we may take him to Vegas for his 21st. I am blessed that generally he doesn’t expect these things but is pretty pleased when they come his way. He does however believe that anything is possible. He is young and when you are young you can probably expect anything.

I wonder though if we don’t want too much these days? If we don’t assume someone owes us something? Certainly in healthcare there seem to be many people who fit into this world.

Suppose you feel that after 3 children your boobs are just a little droopy and your life will be just perfect if the NHS were to buy you just a little surgery? This is a want, it is not a need. This is the friend of a work colleague; I doubt it will happen.

Suppose you developed a small swelling in your groin lately, you have some pain and discomfort and you see a surgeon. Surgery is recommended, perhaps it is needed. When through an administrative error this is denied (all be it briefly) you shoot off a few nasty letters to the people you consider responsible. You kind of jump up and down. You get what you want, though you would have got that by being less nasty. Real issue I dealt with last week.

Out there though there are real people in real need. People who seem to be being denied the care and consideration they deserve. These people are often elderly, they often don’t complain much less shout, demand or write rude letters. Why don’t we do better by these people? Maybe we are too distracted by the ones who want something they don’t need?

The link to the dispatches programme on the secret shame of the NHS can be found here! Not sure how long it will be there for.

You know you are getting old when…

You truly believe that things were better in the old days.

I have always thought that my nurse training prepared me well not only for a nursing career but for life in general. I was lucky enough to train in London where, not only was the clinical care excellent but actually we were well taught by nurses and also doctors who were already understanding the concept of evidence based practice (even if it wasn’t articulated then). We were also lucky that we had amazing staffing ratios even if most of that staffing came from students rather than properly qualified nurses. I accept that we were given a lot of responsibility (perhaps too much) early on in our training and that sometimes our patients may have been at risk in a way we couldn’t have understood because of it. However we learned quickly and effectively how to provide an excellent level of nursing care to our patients. We were encouraged to care about people, to be compassionate.

The higher than average ratios of nurses to patients  meant that we were often able to talk to our patients (of course at that time we could even perch on their bed), we had time to give people a drink, to feed those unable to do so for themselves. We turned people unable to do so for themselves and we changed unpleasantly messy beds. It wasn’t usually glamorous but we were there to care weren’t we?

In the last couple of weeks I have been reading a great book “Yes Sister No Sister” by Jennifer Craig a nurse who trained in Leeds in the 1950’s. My nurse training was in one way nothing like she describes – life was really hard for those girls. Long hours, long days, hard work, cleaning and preparing meals as well as providing nursing care. Just testing urine involved bunsen burners and could have done with a chemistry degree. However my training was heavily based on the principles of those days. The over lay of the vocation of nursing remained and we were actually better for it.

I have for many years welcomed the professionalisation of nursing. I welcome the fact many of us have degrees. I welcome that we challenge the status quo. But do nurses out there starting on their careers actually care? Do they believe in what they are doing or is it just a job? A means to earn a living, a way to get to a higher level?

Yesterday the health ombudsman reported on 10 cases of poor care of elderly people in the NHS. This isn’t just about nursing but is about a whole system failing in how we care for the most vulnerable people in society.

More on this later!

Celebrating 30 years

Last Saturday I enjoyed a great lunch with some of the ‘girls’ I trained with. Just over 30 years ago in October 1980 28 of us arrived at John Astor House to start our careers in Nursing and in the NHS. Some of us never made it past the first year, but 24 qualified in 1983. This was only the 3rd time we have managed to get together in all of these years, though of course various of us have met up with each other at various times and some remain firm friends. What is more at this event there were just 9 of us, what with family commitments and the distance of oceans. What was gratifying was that of that 9, 8 are still working for the NHS and 8 are working clinically. I was the only one of the group not in daily contact with patients.

30 years is a long time, but strangely as we chatted over our wonderful lunch a stones throw from where the hospital we trained in used to lie, the years slipped away and we remembered days and nights on the various wards, nights out together and the amazing responsibility we were given at such a young age. We agreed that our training had been a good one, and it had prepared us well both for our careers and for life in general. We also agreed that some of the changes within our profession had not been for the best. We also wondered about the impending change; apparently for changes sake.

Ben Goldacre today in the Guardian (and on his Bad Science blog) says that there have been 15 NHS reorganisations in the last 30 years, this means that we have lived through each one. Some of those will have passed us by, after all, when you are busy working clinically, caring for patients you can often continue to provide that care as the world seems to move around you. This was the case for me until about 10 years ago just as I prepared to move into a managerial position. My employer merged with another and a number of managerial changes took place. This was around the same time as the PCTs were formed and that was where I headed for.

I left clinical practice at that time because I was weary. My job was a struggle as my patients needed access to new medications but these were expensive and they and we seemed to be fighting unendingly for them. The work was hard and I seemed to be allowed to expand my practice to take on an unending number of tasks. Fearing burn out I thought a job in education within the new PCTs would allow some relief and what is more it would mean I could make a greater difference to more people.

Clinical work, and for me, nursing remains amazingly important work. In some ways I would like to return to it, but in what capacity. Generally my student colleagues work part time and have husbands earning far greater wages than I do. If I return to practice I will have to take a pay cut, and essentially I am not sure I can afford to do this. I also don’t really know what nursing job I would want to do, or if my body would stand up to the pressure required of it.

I also happen to think that it is important to have people who have worked as nurses and to whom nursing and the care of the patient is important, working within management. When politicians belittle those of us working in PCTs they appear not to know or care about this and apparently think that we were born in a pen pushing role and have little or nothing to contribute. What is more, they don’t seem to value nurses in the same way as doctors and GPs at that. I wonder if they will yet receive the awakening they need before it is too late!

I become a union activist!

The Joint Negotiating Committee met this week. The meeting was mighty odd for an RCN member not currently actually practising as a nurse. Still I am a nurse and to prove it my annual re-registration fees will be due in November.  I also pay my RCN fees monthly and my job is going to be at risk, therefore it is time to become something of an atavist!

This occurred because the PCT is a commissioner (all be it one with a short shelf life).  The requirement that the provider arm of the PCT must become separate from its provider  arm necessitated that a PCT staff side was created. I as a person who cares about their own career and that of others in a world where the current government has decided to create a new health service felt the need to join the new Staff side.

So back to the JNC. It was me and 3 men; 2 from Unison and one from Unite though he thought his union was one of its previous incarnations. My RCN colleague was busy on business in Antigua (something involving a pool or beach and a pina colada I believe).  This did not help me to fulfil her request that Mr number 1 Unison person was not allowed to be the Chair of Staff Side. However I am now a member of the risk committee (this sounds like something both important and necessary; oh the irony!)

The meeting was dull and do you know, there was nothing exciting or special that I learned that I didn’t already know. What is more I sent apologies to something actually more important – I gave up my afternoon for a half hour meeting which followed something of a fisaco of a real union actavist trying to make people think that the whole thing might turn out to have some importance.

I am not convinced, but I am on the other half sad. This is a real issue, we are real people faced with either the loss of our career and livelihoods or else the loss of something greater our dignity! Hopefully by the time of the next meeting in November we will actually know what is likely to happen to the health service and also my RCN friend will be back from Antigua!

Here we go again

So it is 10 days post NHS White Paper: Equity and Excellence: Liberating the NHS. The question is who will be liberated by Andrew Lansley’s document?

It is 3 1/2 years since the last whole sale NHS reconfiguration kicked me out of the job I had then and lured me into the dark world of commissioning. I have spent the last 3 years or so learning about the world of the commissioner, I have learned about the pathways of maternity and child health and illness and I have applied myself whole heartedly to making healthcare a safer and more effective place for the people of the county within which I reside. As a nurse I have been well placed to challenge practitioners about the work they do, to listen to the needs and views of the patient (including the professional service user activist). I have often wondered at the target driven world created by the last government, but actually I saw real improvement in services so went with it (mind you as an employee you do have to play the game to a great extent),

The NHS was not a big election issue. Choice about the type of healthcare you can access has improved along with waiting times, infection rates, cleanliness and the general feeling within the NHS. A particular group was unhappy of course but even though they had been given a greater role in health care it was quite possible to ignore some of the views of the GP.

No longer. Our CEO told us just days after the coalition was formed that GP was now king. And so it seems. The new white paper appears to allow GP consortia to be formed in place of the soon to be defunct PCTs and Strategic Health Authorities. So what of us the humble nurse turned commissioner types inhabiting the offices of the PCT?

Over recent weeks politicians have lined up to describe us, the hard working people working in the offices behind healthcare as faceless bureaucrats. We earn more money than anyone can believe, we have pensions which will make us rich and of course we do nothing for patient care.

Well Mr Cameron and Mr Lansley. I am still a registered nurse. My work is about improving patient care and the outcomes of that care. I have worked for the NHS for 30 years this year and each month I have contributed 6% of  my income to a pension scheme. I have been on protected pay for over 3 years which means I have had no pay rise. That pay is reasonable, but as the main breadwinner in my household it is important and necessary. I have a face and I would like you to pop round for tea one day soon and tell me why it is you continue to maintain that I am not worthy of my job!

More to come….. much more!

Transitioning into nursing from different careers – A Guest Post by Richard Hemby

As a UK nurse who has moved into a managerial career in the NHS, I was intrigued to receive a request for a guest post by Richard Hemby. Ok so he is keen to advertise the work he does for an online resourse for US college qualifications. The sentiments and much of the information given here by Richard are also true in the UK and for that reason I am publishing a guest post written by him here:

The demand for many types of professional skills is diminishing.  Companies all across the country are being forced to downsize, due to economic constraints.  Many of those faced with unemployment are considering a career change.  Nursing is a good field to transition into, as there is presently a shortage of between 100,000 and 150,000 nurses nationwide.  In as few as 15 years, that number could climb to 800,000 if current trends continue.

While there are thousands of opportunities available, it is important for individuals to carefully consider the wide variety of options when it comes to nursing jobs.  It is important to know the type of nursing job you would like to eventually work into and begin to chart a course to that job. Perhaps that job will be taken at the specific hospital you would like to work in.  You could take a similar job at another hospital and wait until your job is available, or take an alternative job at the same hospital and maneuver your way to the job you want.

Aside from the large number of available opportunities, there are many other reasons many people may choose to transition to a job in nursing.  Nursing is one of the most respected occupations in America.  Patients spend far more time interacting with nurses than they do doctors.  Nurses are the face of the healthcare industry, to most Americans.  While it can be a stressful and demanding job, it can also be one of immense personal satisfaction.  Nurses make a real difference in the lives of their patients every day.

Nursing is also becoming one of the best-paying occupations in America.  LPNs can earn between $35,000 and $40,000 a year, not including overtime (and many LPNs tend to work a lot of overtime).  Registered nurses will make even more.  The median income for registered nurses, in 2004, was over $52,000.  In some areas, where demand is greatest, registered nurses have been known to make between $40,000 and $60,000, fresh out of nursing school.  As demand increases, hospitals and nursing homes will be forced to offer ever more money and benefits to nurses in order to attract and retain quality employees.

To become a nurse, one will need to attend some type of nursing school.  Nursing schools vary and it is important to know the type of job you want when considering a nursing school.  To become an LPN, only a year or two of study at a community college or technical school is required.  To become a registered nurse, you will need to attend two or three years of community college or technical school in order to receive an Associates Degree in Nursing.  A four-year, Bachelor of Science degree in Nursing is also available at most traditional four-year colleges and some community colleges.

This is a guest post from Richard Hemby, a writer for Online College Guru, an online resouce for online degrees, colleges, and careers. For more information on online nursing degrees and nursing careers visit OCG’s comprehensive nursing section.

Living in the past

middlesexToday we have been informed by the Patient Association that a small but significant minority of nurses are cruel and uncaring. We have been told that some nurses in the NHS hold (often elderly) patients in contempt, that they fail to deliver even basic nursing care to them. Sadly, I am not surprised by this.

Today also we are told that school students have achieved the best ever levels of GCSE results and that rather than being better educated and better prepared for modern life they are in some way lacking from the necessary skills for life.

On the basis of my knowledge of these two issues, I wonder if we are living in a dreamworld originating somewhere around 30 years ago.

31 years ago in 1978 I took my ‘o’ levels. I say that but actually in a few subjects I did something called 16+, declared to be a new exam of the future. Something where the whole of your school career would no longer rely on 1 or 2 exams, but instead would include some coursework. Also there wouldn’t be separate exams for the clever and less bright, but instead one exam, where we would all be judged along a single scale. These were the forerunners for the GCSE of today. Today, I heard a phone in show on the radio was asking if we should return to the O level. I didn’t actually hear the debate, but wonder exactly what would be proved by returning to something phased out 30 years ago?

29 years ago in 1980 I began my nursing career. We learned how to perform basic nursing care. We were taught ‘total nursing care’, we existed in a world where average length of stay in hospital was about 2-3 times what it is now, a world where evidence based practice, NICE guidelines and Health Care commission (now superceded by the Care Quality Commission) had never even been conceived.

In 1980 nothing had a cost or a price. We lived in the world of crown immunity, no one judged us and patients came to hospital half expecting that anything more serious than a hernia or similar operation could end in death.

Care in the world I inhabited during the 3 years of my training was excellent. We had fantastic staffing levels, mostly admitedly provided by students, though well educated and trained students at that. It was 1984 before I ventured into the world of the district general hospital where I realised that not all nursing care was the same as I’d experienced in a London teaching hospital. This is not to say that I was in any way superior (though some people suggested that I might like to dump my London ways at the door) but that not all healthcare was well resourced, that not all nurses were trained in the same way and that not all staffing levels were what I was used to.

Those people who want to return to those olden days of old time matrons, where all care was excellent and where all patients wore pink bed jackets are living in a world of fantasy. Lets face facts – Money and targets now rule the world. Everything must be cost effective. Throughput, bed managers, bed days, 18 week targets, NICE are the buzz words and acronyms. Qualified nurses are in short supply, and those that exist are often of a different culture to their patients. What is more people survive illnesses that previously killed them immediately and what is more life expectancy grows by the year. Doctors who worked day and night for most of the week in my day are now restricted to a normal working week. Who you might wonder picks up the work? Nurses no longer provide the basic and total nursing care of 30 years ago. Nurses now provide much of the work doctors provided in those days, they manage wards, budgets, staff and patients but often the actual care is provided to others. Nurses should supervise the care delegated to others, but how easy might that be?

I doubt that any  nurse gets up in the morning and decides to provide substandard care, but too many nurses are expected to provide the care expected in 1980 in a system that has moved on and that inhabits 2009. Maybe it is time for nurses to reclaim nursing? Or maybe we had better inform people what nursing means in 2009 and if they don’t like that, what it might mean to return to the world of 1980. The choice is yours!

The photo above is also from the past, since the Middlesex Hospital is no more!


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