Nurse, manager, wife and mum: In short a busy life!
Great news, it is time for Change of shift again, this time hosted by Dr Emer over at Parallel Universe, there are some great posts once again. I for one am looking forward to having a good read over this weekend! More from me later!
My hubby spends time on a Saturday or Sunday evening studying the football league tables after the weekend’s games have taken place. Now at the end of the season Manchester United have beaten Chelsea on goal difference, hubby is sure if that game 3 weeks ago had been won rather than drawn then Chelsea would be top. Football is a game (though many people would hate me to say so) and the league table is based on how many games you win, lose or draw and the number of goals you score or concede. What though are the league table the government has become so obsessed with publishing show?
As a parent I can apparently judge the worth of my son’s school by the league tables of GCSE and A levels plus some kind of value added score (whatever that is). His school is not at the top of the table, his experiences have been generally good, though there have been some moments when I have questioned teacher quality, the way in which particular things are done and the influence of the people around him. The league table shows me little, my son has turned out to be above average in a slightly below average school but probably pretty average within the country as a whole. His education continues, he is working hard and hopefully will turn out with pretty good grades which in turn will raise the average of his school.
What about hospital league tables? What do they tell us? The latest is based on a survey of those using the hospitals, and if you are a really sad person you can look at some kind of rating system, helpfully colour coded red, amber and green to give you an idea of how well they do on things such as infection control, cleanliness, perceived waiting times and dignity measures. All of this of course is relative and based on opinion. This is no exam league table, nor does it tell you how many goals have been scored. I have had a quick look at the scores for my two local hospital trusts, and sadly one of them is significantly worse than the other plus pretty much near the bottom of the pile. This trust is pretty much always near the bottom. It changes its CEO frequently, struggles with staff morale, and often has high staff turnover and vacancies. The local people are always being told how bad the hospitals are in the league tables and the trust is always having to defend itself. I wonder then if you were a patient and asked to fill in a national survey based on your perception of various things such as do the doctors wash their hands sufficiently, were you treated with dignity or was the food up to scratch, whether your perception would be coloured by what you already know. I am not saying the hospitals in this group are perfect (far from it) but I am not convinced they deserve to be classed as bottom of the pile. I also wonder how on earth the staff can improve not only reality but perceptions of it?
In the UK we don’t tend to have a whole week celebrating nurses and nursing, but rather just the day. That day is today the birthday of Florence Nightingale, and let us just say this is pretty low key. Professions go through different patches in terms of popularity and whether those who are part of it are worthy. My assessment would be that nursing is going through a rocky time right now as it attempts to find its place. Traditionally nursing has been seen to be about caring, about providing a particular type of care for patients but increasingly it has been about developing new skills, perhaps specialising in particular areas and that has led people to question whether nurses have forgotten their roots.
The Royal college of Nursing has a set of pages devoted to Nurses Day this year, within which nurses tell the story of the work they do. Entitled ordinary people, extraordinary care nurses from different backgrounds with different roles tell us about their daily life. Take a look they are worth a read and cover areas of practice many wouldn’t even think of as being roles within nursing.
Sadly it would be my guess that few people in the UK know that it is Nurses Day today, for goodness sake many people don’t even celebrate national days like St Georges day but if you come across a nurse today, perhaps rather than criticising them for perceived wrongs with them and their profession, congratulate them, after all nursing isn’t something that just anyone can do, but then of course I would say that, because I am one!
For a short working week (4 days one of which has only just started) I am feeling incredibly weary. Summer seems to have arrived early, which is no bad thing since we have suffered a miserable end to winter and most of spring; rain, hail, wind often all in one day. What is more my week has felt a little odd. From the person who found my blog through searching to purchase the ability to inseminate their chihuahua (you know that kind of small dog) which, while I know a variety of things, that is not one of them. Then there was a very strange dream which involved me flying off somewhere not too far away (it was a short flight) and then finding myself in the kitchen of Kim from Emergiblog where she was holding fort to a number of men eating breakfast (sorry kim, but that is the only bit I remember!)
Work is incredibly busy, as a number of projects I have been working on come to fruition. I have discovered the power of the director - I might email and phone someone till I am blue in the face but I will still get no where, while the director sends one email and gets a response so immediate it makes me want to cry! I know lots of responsibility comes with that kind of job, but oh to have that kind of power! My other observation is that a blackberry is incredibly useful if you are out and about a lot as I have been and will be today, but it causes your inbox to be a complete mess when you actually do get to the office. I definitely need to spend some time sorting it out since I can no longer find anything and I like to pride myself with keeping it spick, span and pretty lean.
So there we are as another weekend approaches, the questions to be posed are: will I be able to get my hubby into the garden to do some work there? Plus, will we go to the Apple shop to buy that new ipod touch I covert? Work is important, but I am happy to leave it at the office when it comes to 5pm ish this evening!
As little as 10 years ago who would ever have considered arranging their holiday / vacation themselves? At the very least we started off with a brochure, usually obtained from a travel agent (or occasionally requested by phone or a little form cut out of a newspaper). Then we visited our travel agent and spent an hour or two there while they checked availability, got us to decide on flights etc. and tried to sell us their own travel insurance. I do remember booking a holiday direct with a holiday company on the phone about 12 years ago, but for many people that was just not something they did. This kind of process is fine for those who want to travel for 2 weeks to the costa del whatever, stay in a hotel and then return, but less suitable for people for whom the holiday they want can’t easily be found on the page of a book.
Since I got my first computer the way in which people plan and book their holiday has changed beyond recognition, what is more, with sites like trip advisor you can find out what real people think of the places / hotels / resorts you have chosen. There is a wealth of advice out there, choice is one thing there is no shortage of. But it sure has turned into a time consuming business.
Hubby and I along with my parents, will be travelling to the west coast of the USA in October for hubby’s 50th birthday (you would think he would want to sit in a dark room but no) and he desires to spend the weekend of his birthday in Las Vegas. With 3 stages to the holiday there is a certain complexity. Even if I wanted them to, the brochures out there wouldn’t quite give us what we want. I have already done hours of reading my book about California (plus the book on Las Vegas I have now mislayed somewhere in the house but thats another story) and more hours looking at fligths to San Francisco, hotels in San Francisco, flights to Vegas and back and finally holiday houses on the coast. I have also spent time looking at the Vineyards of the Napa and Sonoma Valleys, because I would like to do a tour or two with a small amount of tasting thrown in.
Yesterday my parents came over for Sunday lunch, and between cooking roast beef etc. We went through all of my work to date, tracing the steps of the holiday and discussing exactly what would be our preferences. Now all that is left is to retrace all of these steps and actually book the thing. We are not rich people, and this is going to cost more than our average annual break, we will also be travelling pretty far from home so it is important to try at least to get things right.
The internet is a wonderful thing, it gives pleasure and freedom to do things like this, but you sure can lose hours of your day while trying to do something as simple as arranging a holiday. I must say though that now we have got this far, I am pretty excited about the prospect. Now all I need to do is get the 17 year old up to speed on his cooking and housekeeping abilities!
Welcome to the May Day edition of Change of Shift where we will be exploring the different origins of this day across the world and what is more linking (sometimes tenuously) to some great nursing (and medical) blogs along the way. Sean from Nurse Sean (dot) com set the bar extremely high in the last edition with his tour around Europe, so lets see if we can go some way to matching his standards (do you sense a competitive edge here?)
There are two distinct themes or origins for May Day which will become clear in the fullness of time, and it gives me the chance to start off with some of the more light hearted and frivolous stories that I have to share with you and then to move onto the more serious and thought provoking.
Did you know that May Day (1st May) has been celebrated since ancient times to welcome in the end of winter in the northern hemisphere and to rejoice in the first day of summer. May day was traditionally famous for dancing around the maypole and for celebrating the Queen of the May. So let us celebrate this time of year with some great posts from the Blogsphere.
Mother Jones suggests the use of a book she has found called The Joy of Yiddish as a way of managing some of your more difficult patients (and managers for that matter). In her post Yiddish for Nurses she gives us a wonderful sample of the ways in which you can sound as if you are complimenting people when just the opposite is true.
What nurses probably need in preparation for both their work and for dancing around that may pole are stretching exercises. Revitals.com has some information for us on how you can attend to those personal fitness needs, how we can prevent injury and prevent stress too. It would take more than a bit of stretching to allow me to get into the position shown on the post in question!
Heather Johnson at Student Nurses’ Notes gives us 5 very useful ways to reduce stress. Of course you might be given a May posy, or you may be crowned King or Queen of the May (I’m not holding my breath either) but failing that you will find Heather’s post helpful in managing this problem of our times.
My research into the origins of May Day (don’t worry I didn’t get much further than Wikipedia!) puts me in mind of some of the Urban Legends that are part of any healthcare organisation. Max from It Shouldn’t Happen in Healthcare offers up some examples of the types of things that new staff has allegedly shown their naivety by doing. We have all heard of the student nurse collecting the false teeth of an entire ward for cleaning and then not knowing from which mouth they came, but would any of us ever own up to actually do such a thing?
Nursing Blogs on Nurse Connect offers a post about how nurses can be more environmentally friendly. An important issue for everyone, particularly when it comes to saving energy along with the environment!
Have you ever longed for just one internet site where you can find just about all the information you need about nursing? Well that site is out there, at RN Central.com and what is more it offers 100 really useful websites for nurses. Its one drawback is that Lifeinthenhs is not deemed worthy of inclusion, but I am not bitter, honest.
Kim from Emergiblog tells us why RN to BSN is the way to go. As someone who last year completed a Masters and has a Bachelors in Nursing after many years as a bog standard ordinary (but of course excellent) nurse I completely agree with her sentiments. The knowledge that you gain about the professional and theoretical aspects of nursing are invaluable in making those links which might just make you a better nurse.
It is Kim’s post that I am using here as my link into the other reason why May 1 is considered an important landmark date across the world. This is because May Day is a celebration day for workers, it commemorates the fights that have gone on in the past for rights like the 8 hour working day. I know that not all of us work an 8 hour day, but actually in days gone by it was the norm not the exception to spend most of our waking lives at work. It is true that the communist countries tended to high jack the day for parades of national strength, but with the end of the Cold War, that is hopefully behind us. The USA and Canada no longer celebrate this day on May 1, but many countries particularly around Europe still do. The best bit for me (call me a mercenary) is that we get a day off on the Monday closest to May Day.
May 1 is a day for international celebration of the social and economic achievements of the labor (or labour since I am English) movement. The struggles that our predecessors have had in ensuring that workers are well trained and educated, that we have those holiday / vacation times and that our working conditions are safe and pleasant are remembered. This is not to say that there aren’t challenges out there for us as workers and for us as people who need to advocate for our patients (Julie jumps off her soap box at this point and returns to the point).
I am not sure that the level of violence some nurses come across in their workplace was really part of the deal. Mother Jones, in her second offering for this edition of Change of Shift tells of a harrowing tale of just such violence by a patient against several nurses. Often linked to the issue of violence is that of consumption of alcohol by those who use health services. Braden from 20 out of 10 tells just why he hates alcohol
In a further story depicting our violent society, Jen from RN Again?! tells us about her last EMT clinical which saw the admission of a patient with a self inflicted gunshot wound.
Congestion in and around the ER is a major cause of frustration for patients and professionals alike. Waiting times are something that have challenged hospitals in the UK and trying to ensure that people don’t wait during times of high volume that cause problems around the world. Ian Furst of Wait Time and Delayed Care, examines how EMS crews in Edmonton Canada are being used to treat patients who cannot actually get into the ER. Not surprisingly this leads to delays for patients who subsequently call 911.
Nurses have made great progress in developing their careers and in being recognised as people who with the correct development opportunities can examine patients, diagnose and prescribe. After completing her Nurse Practitioner course and getting herself that dream job, Nurse Practitioner Saves Lives is understandably frustrated by the pharmaceutical companies who imply in their adverts that the only person who can give advice to the public is a doctor. NP Saves lives would like you to sign up to a petition to get that kind of advice changed.
Nursing is not the kind of thing you can just learn in a classroom, clinical practice is an important part of nurse education. The trouble is that as part of that process you have to learn about bodily fluids and gases! Our student at Nursing School Insanity: Whats a perineum (you can find out the story behind the title on the site) tells us about Flatus (which is something you wouldn’t think to call it if you hadn’t started that nurse training). ‘Floating’ seems an increasingly common way of redeploying people around different departments. But if you are a ‘float nurse’ then you are continually needing to update your skills, continually feeling like a student. This post called A fish out of water, on Nurse Connect looks this topic which has also been discussed on Nursing Voices, and will I think increasingly be something that worries nurses now that managers seem to seek the most mobile and flexible workforce possible.
The way in which we as nurses communicate with our patients is vital, and with our aging society it is highly likely that many of those patients will be elderly. This Nurse Connect post offers advice on the things we need to consider in communicating with this group of patients. Those elderly patients are just the group of people who have fought hard to achieve the kinds of rights we take for granted today. Dignity and respect are something we all expect, yet only too often some of us don’t seem prepared to offer. My own post about this subject asks whether this is a reflection on society, and wonders why we need to teach this topic, and Nursing Blogs on Nurse connects looks at how we address our patients - would you call any patient ‘honey bunny’? No nor would I!
It is about 18 months since I last hosted Change of Shift. I am heartened to find that the nursing blogsphere remains a healthy place, even if some of the work our colleagues are doing out there is difficult and challenging. We still have our sense of humour, we can still laugh at ourselves and what is more we are true to our origins both in terms of dancing around that may pole and in respecting those who campaigned for the rights we take for granted now.
The next edition of Change of Shift will be on Thursday 15 May at Parallel Universe, when Dr Emer will be our 3rd MD host. You can submit your posts via the blog carnival icon on Kim’s blog at Emergiblog, or by sending directly to Dr Emer: doc(dot)emer(at)gmail.com
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:
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.
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 | tracya on Celebrating Nurses Day |
 | Mint on When was it decided that our l… |
 | Ian Furst on League table obsession |
 | B.Catly on Celebrating Nurses Day |
 | Julie on Celebrating Nurses Day |
