Former NHS Nurse and manager now contemplating the NHS from outside

Archive for the ‘Reflective practice’ Category

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!

That age old rivalry

People often say that there are two groups of people, those that do it and those that write about it (and often teach it too). Sometimes in any given subject those two worlds meet, neigh collide. My dissertation last year was about evaluating an action learning programme, so as someone who does it, facilitates is and also has written about it (though hasn’t been published as yet) I guess that causes me to slightly straddle these two worlds. It would be true to say that I am slightly sad, given that I was more than a little bit excited about the prospect of meeting some of the people I have quoted in my dissertation and in other academic papers but I was and I did. Yesterday I returned from an intensive 3 days at the Henley Management college where the first ever International Action Learning Conference was held. Henley is a great place for a conference, it is right by the river Thames in a beautiful part of Oxfordshire and the College itself provides a range of older and newish buildings within some great grounds. From my bedroom window I could see the ducks being dragged up the thames by a strong current and young men in boats getting in some rowing practice in the opposite direction.

The conference itself was a mixture of slightly confusing academia, not always fully understood by the other academics in the room or indeed themselves at times and people’s accounts of the practice of action learning within various areas of the world including Bosnia, Wales and the USA to name but 3. As always, I left with a few more questions than answers and not all of those were about what I heard. Where did that man get the jacket that looked like it had been converted from a rug, why do some men where sandals without socks in March, and why do some people act like they have never seen wine just because they are not paying to drink it at the time? I also wonder why rather than create this them and us attitude they don’t work out how practitioners could help academics make themselves better understood and how practitioners could add a bit of theory into their practical ideas, or is that too simple?

So what about the men of my essays? Mike Pedler, John Burgoyne and Joe Raelin? Well it was great to know that they were pretty ordinary men who were able to speak in a way I could actually understand. It was great that they are prepared to challenge the assertions made by others and to give the impression that they don’t know it all yet. It was also interesting to note that some published academics still fall down at the same places as other less esteemed people. 45 powerpoint slides should never be shown to any audience in one showing, much less in a short lecture meant to be about 20 minutes and then followed by discussion and questions.

More telling on my return was that my family don’t know how to unload the dishwasher much less fill it again. They just washed up their dinner plates but nothing else. The kitchen (and teen son’s bedroom) was cluttered with plates, dishes and cups. They were apologetic but I get the impression not sorry. They obviously don’t want me to try leaving them for longer than 2 nights since they would never cope. I think they need some training on this matter but I fear I might have left it too late to start!

Keeping the status quo?

It is a year, pretty much to the day since I started my current job and to be honest I have found it a challenge to learn a whole new area of knowledge, get to know new people and to earn myself some credibility in the field of women and children. Many times I have wondered what I am doing spending my time learning about how maternity and children’s services should be commissioned. I have questioned the need for me to act as some kind of administrative support to the local maternity services liaison committees, or as the target of the wrath of paediatricians or GPs who want to apparently blame me for the perceived ills of the PCT. I have wondered why it is that our maternity services couldn’t have been held up as some kind of perfection by the healthcare commission rather than ‘most weak’, and why everyone can’t just get on nicely with each other rather than trying to score points off of each other.A few weeks ago what I have always considered pretty much my dream job was advertised, one which would allow me to return to the arena of the district nurse, my first love and one that would get me back into managing people, something I also enjoy. So when the postman brought me news of an interview at the weekend why wasn’t I jumping for joy. Why instead was I filled with foreboding at the idea of actually performing well at the interview and being offered the job. I can’t quite put my finger on it, but something just feels wrong. I have spent much of the last 4 days considering things and I have realised that I have unfinished business here. I still have lots to learn, I still have work to do with the two new heads of midwifery locally, and with our other providers. I still have work to do in learning how to be a commissioner, in performance managing the services, in getting paediatricians to work together, in getting GPs to recognise the importance of our local maternity and children’s services.

Tomorrow I am going to tell HR that I am withdrawing my application. I hope I have made the right decision, and that the very fact that I have spent 4 days thinking like this means that I have. Only time will tell.

The picture above is the real Status Quo, i.e. Rick Parfitt and Francis Rossi, kings of 2 chords or whatever it is. I have seen them live when they were on with Queen in 1984 at Knebworth. So there you have it!

What goes around comes around

 

The person who decided I wasn’t good enough for my own job is leaving. apparently she has lost confidence in those around her (you can make of that what you will) and the person who got the job has taken to slagging me off while looking like she has stopped sleeping. Meanwhile I am getting feedback about the quality of my work from the CEO.

It is about 11 months since I started this job in the alien world of children, maternity and whats more commissioning rather than providing. It hasn’t been easy. I am an adult nurse by trade, I know much more about leg ulcers and ladults with long term conditions than antenatal and neonatal blood spot screening or children’s urgent care. I have constantly questioned what I am doing and whether I shouldn’t be doing it elsewhere. I have wondered if I shouldn’t just have hung around in education waiting for my time to ‘come again’.

It has not been until the last couple of weeks that I have actually begun to feel that I belong. That I understand this stuff, that I can speak without thinking quite so hard. Even though all along I knew deep inside that it was the right thing, that this is great experience and I have great people to work with I have questioned my right to be here, and whether I should want to be here. Finally I can say; yes I do. So long as my resubmitted job description gets me off of protected pay. Other wise no matter how much I love my job it won’t be worth what the PCT want to pay me. Take note Mrs CEO!

Intellectual property

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.

Don’t leave it to the last minute

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

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

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

For some strange reason

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

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

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

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