Apologies for my absense. Several times over the last few weeks I have thought of a blog post that I might want to write and post, but something (not entirely sure what) has stopped me. The question is – am I just lazy? Is it just that the obsession to score over 100,000 on bejewled blitz on facebook was too great? Or am I just an ordinary person who from time to times loves blogging then needs an interlude of several weeks for a break from it all?

This month has been a big one for our small family. My teenage son, Matt has gone off to University and I have discovered just what empty nest syndrome feels like. In some ways, and to an outsider it feels much the same as before, after all it is not that he didn’t go out a lot (that boy has a social life to be proud of) but it is very odd that a house where the teenager is just out for the evening and one where he is currently living elsewhere feels different. Hubby and I are enjoying food that is slightly different – teen son isn’t fond of fish and I have cooked more fish than for years. But actually I like him here and I like cooking food that he likes. Ok so his now tidy and clean room has remained so for over a week, but I like to hear myself grumble about the state of it and he say that it is fine!

Yesterday we visited to take the printer that he said he didn’t need, but now does. His room had been hastily tidied and apparently he had shown a hoover to the floor! He has new posters on the wall and his dirty clothes were in the linen basket thing I bought him rather than on the floor. He is managing well, cooking for himself and learning how to budget. He is enjoying living with other teenagers in the flat they share on campus, he continues his good and varied social life and claims not to have been too drunk. His schedule is not all that busy, but he says he has lots to do; indeed he has a to list on the wall – very organised. However on Saturday he popped up on facebook and asked me why I wasn’t at work. It is Saturday I said. “oh Yeah!” says he!!

So my plans for the coming few weeks – On Wednesday we are off on holiday for a week – to France! Yipee. On my return I plan to change the name of this blog – to something more about life in general when you are middle aged (but feel pretty young inside) and need to get yourself into some kind of gear for the coming weeks, months and years. Watch this space, I will return!!

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.

Today 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!

Over the years there have been many miscarriages of justice. I guess that because we don’t execute people then it is always possible to release a person who has been wrongly convicted. Recently the body of a young woman killed in 1979 was exhumed after the convicted killer was released when DNA evidence not available at the time showed he wasn’t the killer. 27 years in prison for something you didn’t do is a long time, and Simon Hodgson is not alone in serving years in prison in this way. The Charles Smith blog gives a whole list of British Miscarriages of justice, and generally in the lack of serious evidence it is when an individual continues to deny guilt and therefore show remorse that they are less likely to be released guilty or innocent.

This is one of the things that on the face of things makes the release of the Lockerbie Plane bomber all the more amazing. He may claim to be innocent, but he is guilty in the eyes of the law. No DNA or other evidence has been presented and he denies guilt. Of course if you are the potential martyr of a whole state, formally known to be at the forefront of terrorism and if major politicians have been involved in your case then you have a better chance than most. Once again our politicians have managed to do the wrong thing and to trip themselves up over their words. I don’t blame the American relatives for being angry and I wouldn’t blame the families of much  more blatant miscarriages of justice for being angry either.

Having no team to manage is often a blessing. I have to admit that I have had very few people reporting to me who have been troublesome, and the stories I hear from colleagues about the workshy, the incompetent, the people discovered working while off sick and so on are just that. I have had a few difficult staff; one who tended to cry during our one to ones without good reason, one who appeared to do little work and hated to be challenged about why this was the case and another when I was a district nurse who couldn’t understand why 4 inch heels might not have been a good idea. Dealing with people in these situations can be tricky, and what is more managing poor performance in the NHS doesn’t seem to be easily resolved – there is a balance of power that appears to lean more towards the rights of the individual than those of management or organisation.

What is really difficult though is managing a manager who is less than brilliant at their job and who while working their notice has stopped turning up to do the things they are meant to do. It is difficult when colleagues from other organisations know what is happenening and pass comment. Even worse, more senior colleagues know what is going on, they talk about it, but they do nothing about it. What kind of message does that send out – it is ok to be workshy and bordering on incompetent so long as you have found yourself another job and are going to be leaving soon.

Personally, as a person (along with others) put in this position, I would rather not be at work either, it would make my life easier. I am no shirker however, I also won’t completely avoid a difficult situation and so I will carry on doing my work, with my head firmly down. All we can hope is the next person to inhabit that job is better at it than the previous encumbant.

On another more positive note, can I draw your attention to the latest installment of the brilliant Blog Carnival Change of Shift, which can be found over at Emergiblog. This week’s edition contains some great nursing posts!

Exponants of leadership development and practice will tell you that one of the most important areas of senior leadership or management is to prepare for the future and plan your own leadership succession. At the moment a great deal of money and effort is being put into doing just this within the NHS. Our regional Learning and Development team have put together a fantastic programme for those who aspire to be Directors in the future. This starts off with a 2 day development centre. I am familiar with this as I work as a development consultant at these centres, observing the behavours of candidates as they go through a team simulation event. This is followed by a series of master class sessions, coaching, mentoring and peer action learning. It is hoped that the people who come out the other end of this process will be much better prepared for senior management that might have been the case in the past. Some people realise, having gone through the process that they are not suited for being directors in the NHS, and insight into this is important if you are not going to be the cause of chaos in the NHS in the future.

Given that a number of our PCT staff are currently going through this process and another few people completed the process earlier this year, I wonder why it is that none of us at the next level down are considered suitable for a similar piece of development. Within the commissioning team one assistant director has gone on secondment internally, another has left to take up a director post and a third is about to go off in a couple of weeks to that lucrative new job. The response internally has been to employ on a consultancy basis 3 individuals from an agency to take on the roles of these people rather than to seek to develop anyone from within. Permanant replacements for these people are unlikely to come from within because we have pretty much been warned off of applying. Even if none of us are ready for that step up, then how is it none of us are currently being prepared for promotion? Is it that our employers want to keep us in our places? Is it that they don’t value us and what is more don’t know what potential they have in their midst? It is not just my own trumpet I blow here either!

It is with great pleasure that I have to tell you that my Son Matt and his cousin Brad are both off to University in just a few weeks. Both have got the grades they need and are off on what might be the biggest adventure you can have at the tender age of 18. I don’t care if I am boasting here, but as far as I can see an A in English, a B in History and a C in Business Studies are good grades and I am a pretty proud mum tonight.

The day started with me unable to sleep after hubby left for work (I hate to admit but this was about 4.30am). Finally I dropped off at about 5.30 and woke to the alarm at 6.30. The news told me that A level results would once again reach record levels (people who already have degrees telling us that things were tougher in their day) and that people not getting the required grades had no hope of a university place due to a shortage. Just what you want to hear!!

At about 7.30 there was movement, and eventually Matt appeared. The UCAS website informed him that he hadn’t been successful at Sheffield but had a place at Essex. Trouble was that while we knew at that point that he didn’t have grades AAB that he needed they were at least BBC. The stupidy of the system therefore was that he knew that he had a university place but couldn’t get his acutal grades till 10am at school. Technology is a double edged tool!

Off I trek to work. In hindsight I might as well have stayed home, gone for a walk or gone swimming, for the good I could be while I waited. Matt kept me waiting till 10.45 before giving me the great news.

So he is off to Colchester, formerly the capital of England. A proper seat of History, for a 4 year course which will include a year abroad – this year can be in Europe or in America. Whatever happens it will cost me, but I think it will be worth every penny.

Brad his cousin is off to Bath Spa University. The two cousins who grew up together, who played together, holidayed together are off to different places, but will have lots to share as they are both studying History!! Good luck to them both!

The pictures below are  them in Rome and most recently at my mums 70th birthday.

Ok, so this is a lazy way of blogging, to write one post about everything that is currently going on in your life. But when you don’t have a great deal to say aboutu specific topics then maybe this is the way forward and at least people know you are still alive!

Firstly the blog. I have carried out a bit of maintainance and removed the inactive links from my side bar. I was sorry to see that Disappearing John had well.. disappeared. Sadly he looked up the medical records on his child while they had been a patient – something I’ll bet he isn’t the first to have done, and got found out. This, unsurprisingly, made him extremely nervous of carrying on with his blog. I hope things have improved work wise and that he will return to the blogesphere one day soon. I am now in the process of adding to my blogroll, so if you read this and want adding let me know.

I am still wondering how I might be able to write more candidly about work related stuff myself without risking the sack, but so far I haven’t quite worked through that one. As I have said before, I am the only maternity commissioner in this county and one of not that many in the region which makes things a little tricky. Having said that I do have a few posts in the pipeline about my work.

Tomorrow is a big day in this household – it is results day. It would be true to say that I am displaying greater nerves than the boy whose destiny depends upon those results, but then it is the job of a mother to fret on his behalf. I am hoping that tomorrow I will be posting something exciting and excitable – watch this space.

This month has been a big one in my family – a number of birthdays including my mum’s 70th and my own less special and rounded birthday. We have also had a weekend away in a swanky hotel celebrating my parents’ Golden Wedding – now that is something these days isn’t it? 50 years of married life. What is more it saw all 3 of us siblings present, along with our partners to celebrate that great milestone.

So that is your round up of events in the life of Julie, now I am off to carry out the best job of the week – putting the rubbish (garbage if you are that way inclined) for the bin man. From next month they want us to put food waste and cardboard into our garden waste bin. Not sure about what I think to that, but as with all recycling I’ll give it a go!

The US Healthcare debate seems to have caused some people across the Atlantic to suggest that the NHS is some kind of evil Socialist ideal and to have fixed on what they consider to be the worst aspects of the system to try to prevent government involvement in healthcare. I guess that when the NHS started in 1948 it could have been accused of being a socialist ideal, a system that would provide free healthcare at the point of contact to all those who live in the UK. I am not sure that the current NHS is quite like that, and what is more I am not sure it is particularly socialist. The UK is a much smaller place than the US but even here we don’t actually have one NHS as such. Ok so policy and top level guidelines are national, but the way they are implemented and the way in which priorities are set is part of local and regional decision making. This in itself casues accusations of rationing and post code lottery, but the money available is finite and the needs of all do need to be addressed.

Some of the arguments against the UK system seem to rest on the perception of long waiting lists, of people being denied drugs and treatment and of the idea of some kind of death panels taking place. So what is the truth of these from my point of view? Waitning times were a major problem in this country, and it was at one time not unusual for people to wait perhaps 2 years for a hip or knee replacement. When I was a specialist nurse in Rheumatology, I tried to intervene a number of times (often successfully) to get people moved up the list. At the same time there were stories of people dying while waiting for heart surgery. Over the last couple of years though, things have changed considerably and now no one can wait longer than 18 weeks between first referral to a hospital specialist and first difinitive treatment, which could be surgery, could be medical intervention and could be physical therapy if it will make a real difference. My dad on booking online for a hospital appointment was shocked at the speed he was seen by the consultant, and then pretty much told the doctor he really couldn’t cope with surgery so quickly (he wanted him in within a couple of weeks).

Advances in medical treatment have meant that people who previously died of their long term conditions or of cancer are now able to not only live longer, but with much improved quality of life. This however must come at a cost. Research into new drug developments are expensive and those costs must be passed on in some way through the cost of the drug itself. For a system where the state is pretty much picking up that bill, then the efficacy and cost effectiveness of them needs to be taken into account. This has led to some difficult debates, and to some emotive topics aired publicly. Children, pregnant women, the elderly and people with specific medical conditions can receive free prescriptions in England. In Scotland and Wales, everyone gets their medicines free. Therefore the drug costs for the NHS are massive and high cost items do need to be condidered carefully before they are introduced freely. Finally there are our locally held Exceptional Treatment panels. If you are referred for a treatment that cannot be provided easily and widely or you need particular equipment or an expensive drug then a panel of clinicians and health administrators meet to consider the request in the light of evidence of cost and effectiveness. This often results in people being given access to very high cost treatment, but sometimes it means that access to something is denied. The point of these panels is to ensure that the system is fair to as many people as possible.

I don’t know if a system like the NHS could be successful in a place like the US, I am not even sure anyone is suggesting it should be tried. I don’t know enough about the current system in the US to criticise it but I wish those who are currently badmouthing our system (including a conservative MEP) would get their facts right.  The NHS in not perfect, heaven knows I have been enough of a critic myself. But it is the system we have, and for us it pretty much works most of the time.

Just under 4 years ago, during a bank holiday weekend I discovered the existence of weblogs or blogs. I can’t exactly remember how I came to be surfing the web that  morning, but what I do remember was that in browsing through I was struck that there were very few blogs written by nurses or others in the health world, but that those that were there were interesting to read. One of the first I came across was Emergiblog, written by a new and novice blogger called Kim. As a nurse in the UK, I have read about healthcare in the US, I had at the time met nurses who had worked in the US and as a teenager I loved the series of books featuring Sue Barton, but I hadn’t really read any first hand experience by a nurse actually working in the US and what is more working in an ED. What struck me most was the enthusiasm and love that Kim had for her work and for her patients. How despite the frustrations of dealing with the public, working with some of lifes more irritating doctors and having to deal with the bureaucracy of healthcare providers Kim really loved and still loves her job.

The last 4 years has seen Kim begin her studies on a pathway that she believes will lead her to a Doctorate, she has questioned and developed in her practice in a way that we all do as we reflect on our work, read around the subject and then write academically. What is different with Kim is that she then puts those thoughts into her blog posts and creates more debate and more blog posts through the great following she has for her site. I wonder if Kim would have believed just 4 short years ago that she would have spoken at conferences, hosted Grand Rounds several times and devised the wonderful blog carnival that is Change of Shift.

Kim is the envy of the blog world. She writes wonderfully, she has great topics to write about which just flow and flow, and what is more she always finds the most wonderful pictures to accompany her blog posts. Kim is an inspiration to nurses across the world and what is more she is  able to write with the authority of a clinical nurse at the sharp end and as a nurse manager type I can only admire that.

Happy Blog birthday Kim!