Every picture tells a story…



I am never stuck for a blog subject – in fact, sometimes it can be difficult to choose between competing possibilities.  And today is no exception.  Do I write about the shambles surrounding the miscommunication of the recent pay award?  Do I write about Gosport and the way that an awful lot of nurses thought it was OK to say (and do) nothing whilst inappropriate medication regimes were prescribed?  Do I write about the issues facing the nursing regulator?  So many blogs, so little time.  Last time I wrote about nostalgia and the dangers of thinking that the past is a better place.  And I am minded to continue that theme today because this morning something happened that compellingly illustrated the meaning behind my last blog – that ‘nostalgia is a seductive liar’. 

Whenever I, and others, talk about what we call ‘modern nursing’ i.e. evidence-based interventions, Bachelors degree entry-level, autonomous practice, acceptance of accountability, being patient-centric, professionalism with a big P etc. there is an instant response from far too many people (including nurses), denying the need for all this unnecessary over-thinking and calling for a return to the days when ‘nurses did the real work at the bedside and patients were properly cared for’.   It has become depressingly familiar.  The rose-tinted specs go on, the self-preservation and lack of insight appears, and those who defend their own level of training/education as the best there has ever been promote their vision of the past as a credible way to handle the future.  Sadly, some of this even finds its way into policy making.  As I said, it’s depressing.

So, this morning when the video below appeared on my Twitter feed, shared by Liz Anderson who tweets @nutritionlizA, I thought it might illustrate some points, although I wonder how many of those who need to read this blog, will actually see it.  I suspect I am preaching to the converted.

I have first hand experience of this sort of nursing.  I spent many hours as a student nurse in the early seventies working with Staff Nurses and doing exactly this.  In elderly care environments and also in more acute environments, the principles were often the same – get the jobs done.  And when you watch you can see that there is care here – these patients are bathed, and dressed and undressed.  They are positioned in bed and turned.  Their hair is combed, their bed linen is fresh.  Their environment is clean and tidy.  I can hear some people saying ‘Yes, and that’s how we need to be now. Those patients were really cared for’.

And look at the nurses.  Busy and purposeful.  Tidy and their rank obvious.  Brisk.  Getting the job done.  All patients washed, clean, tidy and neatly in bed.  All boxes ticked.  ‘All care given’ – remember that? Written in the Kardex?  ‘All care given’.

But, oh, those women.  Naked in a public place.  Covered as an afterthought by a towel.  In bed though it is broad daylight.  Tucked up and tidy with covers right up to their chin.  No conversation.  No information.  No choices.  No distraction.  No entertainment.  No interaction.  No interest.  And look at their empty faces, the weary eyes, the resignation, the waiting, the sadness.

I know that this is not how we expect things to be now.  We have moved far away from the rote completion of tasks and those in our care are treated as individuals with all the involvement and interaction and choices that means.  Getting the jobs done is not at the heart of our care any more, is it?  Seeing the individual, understanding what those facial expressions or that body language and those clinical signs mean, and responding to them appropriately and thoughtfully, drawing on our education and experience to make changes, to tailor interventions, to improve lives – these are the actions we would expect now.   How differently those women could expect to be treated, nursed, today.

The difference, the biggest, most obvious difference in my opinion, between the nurses in that video and today’s nurses – is in the education of Registered Nurses.  Rigorous academic teaching of the developments in nursing and in medicine, a greater  understanding of the elements that help to keep people in our care happy, healthy and safe and comfortable, and the clever translation of that into appropriate intervention.  A complete change of approach from ‘getting the tasks done’ – the baths, the rounds, the teeth, the hospital corners and the turned under counterpane (a signal action of the 1970s nurse) – to seeing the whole person and understanding what is going on in their bodies, and their minds,  and how we can help them.  Having the intellectual capacity and intellectual training to be able to access a huge knowledge base, sift what is best in any given situation based on the evidence, and apply it confidently and with exquisite individual finesse.  It has been a transformation.  Mostly.

It makes me very nervous when I see shifts in the way that care is led and organised that seem to promote the task above the knowledge; the ‘basket of skills’ rather than a depth of education that enables the intervention to be chosen and tailored, modified and improved upon.  It reminds me of these times.  In this video the tasks were done.  The jobs completed.  I’m sure any checklists were filled in.  But it looked pretty grim to me.  Valuing the rote performance of task is backward and dangerous.  And it is still around us.  There are places where the thinking (or lack thereof) of some can be frighteningly similar to that video.  I blogged about my experience of the same sort of thing in a different context during my mother’s last weeks in a hospital, just two years ago.

I cried when I watched that video.  I cried for those women, and for the ignorance of the past.  What makes the difference between that video and today? Education and the application of knowledge in every moment of practice.  The valuing of education as the route to excellence and safety in care.  Let’s not start forgetting it now, for pity’s sake.




As health care seems to be enjoying something of a nostalgia fest at the moment, I thought I might reflect a little on part of my own past.  Not in general, but specifically on my time as a student nurse in that rosy-tinted, glowing period that was pre-degree nursing, pre Project 2000 nursing, and probably pre-history for many nurses.  The early 1970s. The time when some people think nurses were nurses, Matrons were fierce but wonderful, you only needed to read the six books on your reading list and they would fit you for practice for the remainder of your career, and caps and aprons came starched with ready-made authority.  I remember it well.

I also remember being very frightened a lot of the time.  I remember feeling ill-prepared for most placements and trying desperately to look as though I was supremely confident.  I remember being taught neat little recipes for how to nurse specific conditions – not people.  This is what you do for an MI.  This is what you do for ‘congestive cardiac failure’ (that must date me, surely?).  This is what you do for ‘a diabetic’, an appendicectomy, a lobectomy.  I’m trying to remember a patient from those three years where I knew anything about their home life, their social circumstances or their family.  I’m struggling.   Sociology and psychology were introduced into the course during the second year but with no relationship to practice.  Nobody talked about research. The term ‘evidence-based practice’ was not something we heard, or did.

Everything seemed to come with somebody’s name attached to it – not just those awkward little bits of anatomy – Oddi’s sphincter, Langerhans’ islets and Willis’ circle – but equipment – Pearson knee support, Roberts’ motor, Paul’s tubing, Thomas’ splint, Nelson’s inhaler, the Charnley tent, and the show-off pocket piece for every nurse who was a real nurse – the Spencer Wells – the 1970s equivalent of the stethoscope around the neck.  And even surgery came courtesy of someone – Bilroth 1 and Bilroth 2 (partial gastrectomies), Gritti-Stokes (amputation), a Ling-Lee hip replacement, a Girdlestones op.  This really was the naming of parts.

I remember being one of three staff on night duty on 32-bedded wards.  One RN, me and a Nursing Auxiliary.  I remember being left on my own for an hour during supper breaks and being so scared that something would happen I could scarcely breathe.  As a third year, I would be on nights with no RN.  Eight nights of unbearable responsibility.  But it was normal.  A perfectly reasonable expectation of a third year student nurse at that time.  It was do or die, one of many baptisms of fire.  I thought I was the only person who was scared witless, everyone else seemed so confident, and we never discussed these things.  Mostly, I think we didn’t know what we didn’t know.  As long as nothing happened, it was all ok.  It terrifies me to think of it now – the risks, the casual attitude to patient safety  and the arrogance.  The expectations,  the inadequate theoretical preparation, the unimportance of knowledge beyond the task.  As long as you could carry out a list of procedures at certain points in the three years, you were doing well.  It didn’t matter why you did them, or when it might be better not to do them, or how to tell if it wasn’t appropriate; no, doing the task well was everything.  We would tick them off in a little book, confident that being able to do the procedure meant we were good nurses.  Thank goodness things are different now.  (There is a hint of sarcasm there, but just a hint).

Support on placements was a hit and miss affair.  You might be with staff who enjoyed working with students, you might not.  There was no formal student supervision or regular assessment.  People talk about how marvellous it was to have Clinical Teachers.  The only time we saw a clinical teacher was if they came to do a formal assessment – watch and sign off one’s aseptic technique, or a drug round, or some other isolated task.  There was no equivalent of Link Lecturers or Practice Educators, no Mentors.  No student services, no counselling, or help with study difficulties.

In spite of this,  I (mostly) enjoyed my time as a student nurse, and I learned many lessons that have stayed with me always.  Being in a large University Teaching Hospital (hospitals with ‘University’ in their title were pretty few and far between then and usually located with a medical school) meant that I was getting some of the best experiences possible and learning with and from exceptional professionals.  But being a student nurse then was a million miles away from being a student nurse now and I know that I would be loving it more if I was a student today.  Formal, academic award-bearing education, the deliberate linking of well-taught theory with practice,  fabulous university libraries,  the support of Link Lecturers and Practice Educators, practice supervision and supernumerary status.  Curiosity and questioning encouraged, an incredible variety of placement opportunities, good academic support, academic rigour and real scholarship.

I could have chosen today to blog about how wonderful it all was – telling you amusing anecdotes and how those fiery baptisms made fantastic nurses of us.  But I know that The Good Old Days were really not the good old days at all. We should beware of misplaced nostalgia.  As George Ball said, and we would do well to remember, ‘Nostalgia is a seductive liar’.  I wouldn’t go back there for anything.

Who’s who continued…


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Just a couple of blogs back I was thinking about the lack of 20th century figures who are well-known to the profession for having an impact on its development.  It seems to be quite a serious gap in our history.   The blog, and a subsequent editorial in the Journal of Advanced Nursing, has piqued the interest of a few people and I think we have the makings of a serious project to try to address this vacuum in some way.  We have conducted one short survey aimed at Nursing departments in the UK; we are going through the results of that and will write about it soon.  As things progress, you will be able to keep up to date with it here.

As a result of the early conversations we have already had a number of suggestions to consider, and as always, social media has been an interesting source of names.  Social media conversations were also useful in helping us to think about the questions we wanted to ask those who lead nursing programmes.  Will our suspicions – that large numbers of student nurses are not being taught the history of their profession or about the many influences on its development – be confirmed?

The names we are hearing informally come mostly from the latter quarter of the 20th century and are predominantly female.  Historical male figures seem to be an equally closed book.  It is sad to think that some of today’s young men thinking of joining the profession may only be able to relate to fictional characters – Charlie Fairhead or the other bloke that used to be in The Bill – when it comes to significant male figures in nursing.  At least Nightingale and Seacole were real.  All good reasons to be getting on with what seems to be a very necessary project.

So dig around in your memories, oral histories, local archives.  It’s a fascinating process and between us we will uncover or rediscover nursing luminaries for at least one more generation.  And, by the way, in terms of men here are a few starters to consider.  Try looking up Bob Tiffany, Trevor Clay, Phil Barker or Alan Pearson.

International Nurses’ Day…

It’s 12th May and that means two things for nurses.  1. It’s the anniversary of the birth of Florence Nightingale and 2. It’s International Nurses’ Day.   Not something that was a big thing for the most part of my career but I think for the past ten years or so it has been a growing phenomenon in the UK.  Originally started informally by the International Council of Nurses in 1965, it was formalised in the USA in 1975.   Now it is truly an international day as nurses all over the world take the opportunity to celebrate their profession and the contribution they make to society.

I began my nursing life as a student in 1973 (I’m up there in that header picture), qualifying in 1976 and I have been continuously on the register ever since.  That’s 42 years as a Registered Nurse.  There’s sure to be someone out there who has put more time in!  Over those years I have seen, and done, many things I never thought I would, and met many people who in the course of a non-nursing life I wouldn’t.  At this point, I guess I should wax lyrical about the rewards, the compassion, the wonderful opportunities to give to others; but I’m not going to.  It’s not my style or my nature to sentimentalize.  What I will say is this:

Those 42 years have made me strong.  And fearless.  They have exercised my intellect, my ethics and my patience.  They have given me knowledge and wisdom and good judgement.  I hope that all those people I met were able to take those same things from me, whether they were patients, students or colleagues.  That would make me proud.

Have a good International Nurses’ Day.

Disagreeing well…


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Like many of you who read this, I often take part in nursing related discussion/debate on Twitter.   I join conversations about nursing on Twitter almost every day, and have been doing so for some years now, and have been interested to see how things change and develop.  It’s still a great place to mix with nurses from many different work contexts and interests, but recently I have noticed something that gives me pause for thought.    Nothing dramatic, just an increasing awareness of some reactions to nursing debates on there.  Any regular user of Twitter will be familiar with the wide range of comments that appear on timelines: from the kind and supportive, to the vitriolically opposed and everything in between.  If the subject is controversial or popular, then often feelings run high.  Most contributors are polite, some people are often amusing and sharp-witted, sometimes there’s sarcasm or irony, occasionally people are a bit rude, or personal.  But generally speaking conversations are interesting, enlightening, amusing, informative and annoying in varying degrees.  A bit like a conversation anywhere, really.

What does concern me a little is when the ‘professional’ word raises its head.  As in ‘that’s not a professional way to react’ or ‘that’s unprofessional’, sometimes stated directly, more often an implication  – usually when there is disagreement or dislike of someone’s point of view, or turn of phrase, or vehemence.  It’s said as a rebuke, and is a serious allegation to make if we understand what being a professional is.  Disagreeing with someone isn’t unprofessional.  Disagreeing strongly with someone isn’t unprofessional.  In fact, one of the characteristics of being a professional is the ability to question and challenge and disagree.  A former boss of mine used to say that one of the benefits of higher education is that it teaches us ‘to disagree well’.

Having spent part of my nursing career in academia, I’m used to having my views challenged.  Not just my views, but my thinking, my writing, my proposals, my ideas, sometimes my right to be contributing at all!  Robust discussion is a part of academic life.  Mostly it’s good-natured, frequently blunt and to the point, occasionally it’s a bit hurtful, and it’s challenging.  And rightly so.  It’s how thinking is refined, arguments developed and theses defended.  It can be very critical, but it’s rarely meant to be personal.  On the occasions when it feels personal it’s usually a prompt to step back and examine whether there is any truth in the remark.  An academic’s life is an argumentative one.

As nursing becomes a predominantly graduate profession, nurses will operate more and more within an academic framework – critical appraisal applies to clinical signs as well as evidence, marshalling a rational argument applies to advocacy as much as debate,  challenging practice as important as challenging ideas.  Dissent and questioning accepted as healthy and welcomed as tools of reflection and improvement, even if they occasionally (slightly) hurt our finer feelings.  Professionals give and take criticism and challenge as much as giving and taking praise and reward.

So, I get a bit concerned when I see ‘unprofessional’ used as a veiled insult, when what someone means is ‘that’s a bit sharp’, or ‘that’s unacceptable to me’ or just ‘I really don’t agree with you’.  Twitter is a great place to exchange views, to contact other nurses  and to share etc. but it isn’t a formal group.  It doesn’t have invited members, everyone isn’t like-minded.  Even if they have joined the same conversation.  That’s the point.

Twitter is an open space and sometimes we forget that.  It’s not a professional space with boundaries and rules and expectations of behaviour.  Participants are not in any sort of hierarchy.  That’s the joy of it, and also the problem with it.  It can’t be manipulated and moulded into some sort of reflection of a workplace, it can’t be ‘professionalised’.  It is uncontrolled.  I like it for those very characteristics.  It is more often a breath of fresh air than cause for a sharp intake of breath.



Who’s really who in nursing?


I’ve written before in this blog about images of nursing, elsewhere I’ve touched on nursing heroes and icons, and a bit of nursing history.  I’ve been considering for a while the ‘famous names’ of nursing from an historical perspective, and wondering why there aren’t rather more.  I’ve had a few conversations with colleagues about it – this lack of a UK roll-call of nurses who have contributed significantly to nursing practice, research and education and also to nursing’s image and status in a positive way.

When I Google ‘famous nurses’ I get a list of mostly American women (nurses in the USA do seem to do celebration rather better than here at home).  The UK representatives on the lists are the expected ones – Florence Nightingale, Mary Seacole, and occasionally Edith Cavell.   Nineteenth century women, two of whom were – arguably in my view – not really nurses as we recognise the term today although the contribution of both is undoubted,  and one who is recognised for her heroism and war-time subterfuge rather than her nursing skill.  Ethel Bedford-Fenwick is beginning to be recognised for her work on registration and she crops up occasionally in searches, but beyond the 19th and very early 20th century there is no-one clearly identified – and widely recognised – as having a significant impact on the development of the profession.   Yes, individual nurses can maybe suggest one or two who, to their mind, made a difference, but there is no formal recognition.  In fact, there is no list even of potential contenders.

This made me wonder how nursing students are taught about the history of the profession, and if that history teaching falters in terms of the contribution of individuals beyond 1918 (Nursing faculty – there’s a survey coming your way…).  I suspect that when we formally research nursing history we probably do quite well at 19th century women, and nursing in time of war.  Neither of which help to move us on more generally from the stereotypes/archetypes that give us only 19th century women as our icons.

So, I’m thinking of embarking on a piece of work to correct this a little.   I want to find out who were the nurses who made a significant impact on UK nursing practice, education or research, or the improved status or development of the profession between, say, 1920 and 1980 (or thereabouts).   A quick literature review reveals very little serious work on this subject in this period.   I’m not interested in later than that – there has to have been enough time passed for their achievements to have been consolidated and accepted.   For example who were the nursing ‘firsts’?  The first PhD in Nursing?  The first Professor of Nursing?  Who’s innovations in practice led to their name becoming a byword for a particular intervention or group of interventions?  Who was influential in nursing becoming an academic subject?  Who influenced professionalisation?  Who wrote the first undergraduate degree programme?  Wouldn’t it be fascinating to know?  Wouldn’t it be brilliant to hear the stories of these nurses?  Wouldn’t it be great if we could hold up half a dozen or so 20th century nurses as significant contributors?  Promote them nationally and internationally?  Get them widely recognised?  Taught in schools?  Move the iconography and therefore the image of nursing away from the 19th Century?

I could sit here and find all this out for myself – it’s a PhD waiting to happen really, but I’m old and don’t have the time or the inclination to sign up to a million years of part-time study.   I want to crowd-source possibilities.   Then the research would need to start on whether the suggestions are worthy of making the cut or not.  It’s exciting isn’t it?   Do you want to help?  Let’s add a bit to nursing’s history.

Update a few hours later: Give me time to get organised and now I know there’s interest, I’ll be on it!

Another blog on blogging…


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Last time on the blog (see below) I talked about getting started with blogging.  Hopefully by now some of you will have set up your page and given it a go.  In my last blog I also said that the whole point of a blog was to put yourself out there and have others read your words.  Publicising your blog is part of blogging – you can just publish and leave it to chance that the people you want to reach will find you, but far better to deliberately target the people you want to reach and the ones you think might be interested in what you have to say.  Once you’ve found your ‘Voice’ then you need people to hear it.  You need to try to do what’s called ‘driving traffic’ to your blog.

First I have to say that I am no expert at this.  I really only use two mechanisms for publicising my blog – Twitter and LinkedIn.  Before I started blogging I had already built up a following on Twitter, so I knew that if I tweeted a link to my blog it would reach quite a few people and some of them might actually read it.  I also found that if I blogged regularly then some people signed up to follow the blog and so received any new blog automatically.  There is a setting on a WordPress blog where you can put a ‘Follow’ button (see my sidebar), there is also a setting (Post Settings) where you can automatically share your blog to Twitter and to LinkedIn, so it’s worth doing that.  I also might send the blog via Twitter to a few specific people.  If they like it, or think it may resonate with their own followers, they will often retweet it to all their followers.  This builds up a fairly substantial reach.  But there is no point just tweeting it out once.  For the first couple of days after I’ve published a blog I will tweet a link to it every few hours – especially at the times when I know my followers will be likely to look at their Twitter accounts – lunchtimes and evenings.  I then retweet the link a couple of times a day for the next few days and at the end of a week I will do a couple of Tweets with ICYMI (In Case You Missed It) and the link.  This way you will catch more of your own followers and they will in turn catch more of theirs in a retweet.  Some people I know feel slightly uncomfortable about ‘pushing’ their blogs in this way – I did at first – but if you don’t keep resending, then you simply won’t reach as many people.  Just think how much stuff rolls through your timeline that you don’t ever see – that’s your blog tweet rolling through there, unseen.

I also allow comments on my blog – again you set this up when you start.  I allow comments but I always see and approve them before I let them appear on the blog.  I respond to comments if they need a response, and even if they don’t, I always respond to say thank you, or to ‘like’ a comment.  I think that not enough people comment on blogs – I love it when my blogs attract a comment!

My blogging process goes something like this:

  1.  Write the blog. Publish. Tweet a link to the blog saying something like “Here’s the latest on the nursing blog…(link)”
  2. Tweet a link to the blog to individuals who I think might be interested in it, so it    appears in their Notifications rather than just in their Timeline
  3. Retweet a link to the blog every time I use my Twitter account over the next day or two and retweet a link to the blog every day for a week
  4. Retweet a final ICYMI link just a few hours before I post my next blog.  I do this to keep me fresh in their timelines as a blogger.

And that’s about it really.  You just have to start doing it, and see what works for you.  It takes a while to build a followership, but if you’re interesting, then you will get readers and if they like what you say, they will become regulars.  In summary then, here are my points for blogging about nursing:

  • Read blogs by other nurses to get a feel for how they approach subjects, style, format etc.
  • Think about your subject matter – topical, controversial, educational, illuminating, musing – be focussed, then go for it.
  • Be careful about unintentionally identifying people or patients. Be mindful of your professionalism and don’t blog anything you wouldn’t say out loud in a public place.  Because you are saying it out loud and in a public place.  Follow the NMC Code of Conduct and their social media guidance.
  • Check your blog before you publish it and edit and format it properly.
  • Be part of a social media community/ and build some followership BEFORE you start blogging if you can.  That way you have a ready-made audience.
  • Respond to comments positively.
  • Remember that what goes out there, stays out there.


Go on – give it a go! And tag me into your first blog link!!




A blog on blogging…



Coming late to a WeNurses Twitterchat last week, I caught the last bit of a conversation on nurses and blogging.  I think it was called ‘Why don’t nurses blog?’ or something similar – you can find it here .  I made a few comments but I was really too late to join in the main conversation and I was cross with myself because I wanted to contribute.  I’ve been blogging for nearly four years and I’ve learned quite a lot about the process in that time.  If you’re thinking about starting a blog and you’re a nurse or a student nurse – then just do it.  Try it.  Don’t betray any confidences,  don’t abuse people,  be sensible in terms of the NMC Code and their guidance on using social media.  Find a platform (of which more later) and get what you want to say out there.  If you enjoy it,  and you’re not frozen by fear of what people might think, then start to work at it a bit more seriously.  Looking at some of the questions and concerns from the Twitterchat, the following might be useful.

What would I blog about? Blog about anything that moves you enough to want to share a view.  You might give your blog a theme.  This blog is about nursing, but sometimes I write about other things on here.  This question really should be Why would I blog? Here are some reasons why I blog:

To give my opinion on something I feel strongly about.  To provide information, or to add information to something if I think it might be useful.  To agree with something and to be  persuasive to encourage others to agree, or at least, to think again about something.  To disagree with something or to challenge something.  To tease, needle, irritate or provoke.  To be controversial and start a discussion.  To berate or to rant if I’m cross enough about something.  To educate or explain or debate.  To sympathise, empathise or otherwise show solidarity.  To describe and share an experience or my feelings.  To encourage people to think and think again.  To help myself think a bit harder.  To rethink.  To amuse.  To make contact.  To entertain.  Lots of reasons.  Often I am prompted by a snippet of conversation, a news item, a Tweet, something I’ve read or heard.  Sometimes people ask me to blog about something in partiular.  There are no end of motives for me.  You will find your own motives, and when you do, you will want to write.

Don’t blog if you haven’t got anything to say, or if you really don’t want anyone to hear/see what you say.  The whole point of a blog is to have your words read by other people.  Some people say that a blog might be helpful as a reflective tool just for them personally, and not shared with anyone.  It might.  It probably will.  But that’s not a blog.  It’s a diary, or a personal journal.  A blog is meant for an audience.  It is public.

Why would anyone want to read what I have to say?  This is the question on every start-up blogger’s lips.  And there are quite a lot of answers to this; it’s a much more sophisticated question than it seems.  First – You are part of a very large professional group.  So even if you don’t have very much to say, quite a lot of people will just swing by and read it anyway, just because you are a nurse, and so are they.  They aren’t reading YOUR blog, they’re reading a blog by another nurse.  Sorry to prick your ego straight away, but there you are.  The trick is to get them coming back to read YOUR second, third and fourth blogs etc.  And that’s about content, which is Second – Your blog is interesting/informative/topical/thought-provoking/amusing.  These are the things that bring people back.  If people get to know that your blog is interesting/informative/ topical/thought-provoking/amusing – they will come.  Your blog may not quite be their ‘Field of Dreams’ but it will engage them sufficiently so that they want to hear what you have to say.  Note that list doesn’t include ‘exquisitely written’, ‘grammatically awesome’, ‘spelling perfect’.  Not yet.  If you are interesting etc. then your readers will forgive quite a lot in terms of indifferent writing skill at the beginning.  That’s at the beginning – so don’t ignore the Third – Your style is easy to read.  Craft your blog a little more.  A Joyceian stream of consciousness is fine occasionally, but not all the time.  It’s difficult to read.  As is text with very poor punctuation, very bad grammar, a lot of spelling mistakes.  Very long sentences.  Very long blogs.  Eventually, it will put people off.  So work on your writing.  Be concise.  Go easy on the adjectives.  Use paragraphs shorter than this one.  Edit, edit, edit.

So, when you start, it’s less about what you have to say and more about what you are saying and how you are saying it.  Lots of blogs are written by people who aren’t ‘famous’, don’t hold positions of power or authority; their names are not well-known within the profession – and their blogs are very successful.  Sometimes they’re anonymous.  Nobody knows who is the writer and it doesn’t matter because the content brings the readers in.  Using your name or being anonymous is a matter of choice.  If you’re employed and you want to be controversial and you are scared it may have repercussions at work, then anonymity may be the way to go.  But what happens if you also want to write stuff that you would be proud to put your name to?  That you actually want people to know who has written it?  Just think this through and I’ll address it a bit more in part two of this blog.

How do I blog? Google how to blog.  Find a platform – there are free ones – WordPress and Blogger are two of the most widely used.  This blog is written on WordPress.  It’s reasonably simple to use, fairly intuitive to set up as long as you are patient, and there are good choices of template to use.  Generally speaking, you will need an email address, a name for your blog, and a name for your account.  A photo or two may be useful.  A bit of customizing, which can all be done through menus, and off you go.  Ask someone who already has a blog to help you.  At the top of your blog menu there will be a page called ‘About’, or something similar.  This is where you tell people what to expect from your blog.  Whether it’s focused or eclectic.  Whether it’s weekly or infrequent.  Whether it’s truth or fantasy.  You might also want to give a little information about yourself.  Maybe a photograph.  Take a look at my ‘About’ page above.  Read other blogs to see a variety of format and layout.  Keep it simple to start with unless you are a whizz at these things.  Once your template is set up, write your blog, tidy it up, be sure you are happy with the way it looks (you should be able to preview it) and press the ‘publish’ button.  Your words will be out there – available for however many zillions of people may choose to take a look.  That feels a bit scary at first.  Less so when you check your stats and see that only 6 people have viewed your post…and 3 of them are probably bots.

Next post – how do I get people (other than my friends and family) to read my really interesting blog?  To be continued…


Nursing Associates – a few facts

The information in this blog was correct at the point of publication.

From time to time people ask me questions about the role of the Nursing Associate.  They forward tweets to me, or screenshots of Facebook pages, generally demonstrating confusion, or inaccuracies, or ambiguity about the role and they ask if I can comment.  I usually engage and try to be accurate, but I am also aware that there is confusing information out there, sometimes contradictory information even from authoritative sources, and it is not easy to get at the most up-to-date and accurate position.  I thought there was scope for a blog that sets out the current position – as far as I can ascertain it – so I’ve been in conversation with the Chief Executive of the Nursing and Midwifery Council (NMC) and this blog is a result of that conversation.

1 Nursing Associate education

Most current trainees preparing to be Nursing Associates are undertaking a two-year Foundation Degree (or equivalent).  These are pilot test programmes at academic level 5.  Whilst on these programmes trainees could accurately be described as Trainee Nursing Associates (TNAs).

The pilot programmes were developed using Health Education England’s (HEE) curriculum framework.  HEE established a two-year Nursing Associate training programme in January 2017 and these have not been approved by the NMC as they started before the regulation of the role.  The NMC has shared an early draft of Nursing Associate standards of proficiency, and it will consult on a further version later in the Spring of 2018, but the regulatory standards cannot be formally agreed until the new legislation is in place (see below).  Therefore the pilot programmes cannot be assessed for approval until after the legislation is in place.  The new legislation is expected to be in place around July 2018.

HEE is engaging with the NMC to support its pilot cohorts to meet the NMC’s required standards.  However, according to the Department of Health’s Nursing Associate consultation, the NMC will, where necessary, still have the power to insist on further education and training and a test of competence, if required, in order to protect the public.  Ensuring qualifications meet the required standards will provide assurance that all registered Nursing Associates are appropriately qualified and capable of safe and effective practice.

2  Nursing Associate Registration

There are two  main part to the NMC Register – Registered Nurse and Midwife.  In terms of Nursing, the existing Register is for Registered Nurses who have completed an NMC (or its predecessor bodies) approved three-year preparation programme (I know there are shortened programmes/pre-registration Masters etc, but for simplicity’s sake I am citing the usual route here).  Since 2013 entry onto the nursing part of the Register requires a Bachelor’s Degree from a University which has been approved by the NMC.  A Bachelor’s degree is at academic level 6 and normally takes 3 years of full-time study combined with a standard number of practice hours.  Entry on to the Register allows the use of the title ‘Registered Nurse’.  This title is protected in law.  It is an ‘offence’ to use the title Registered Nurse if an appropriate programme leading to registration has not been undertaken successfully, and it is an ‘offence’ to use the title Registered Nurse if one is  not on the appropriate part of the NMC Register.  More detailed information on the Register for Nurses can be found on the NMC’s website.

A part of the Register for Nursing Associates does not currently exist.  The NMC has to be the regulator in law before that new part of the Register can be created.  As stated previously, that legislation is not expected until July 2018.  Nursing Associates will apply to join the new Nursing Associate part of the Register when they qualify and can demonstrate that they have met the NMC’s standards and wider registration requirements.  They will not enter the Registered Nurse part of the Register.

The date of the required legislation is crucial.  I understand from the NMC that if the legislation is delayed, the Nursing Associate part of the Register may not open in January 2019 when the first 1,000 Nursing Associates qualify.  If the legislation is not in place, there will be no requirement for Nursing Associates to be registered in order to practise and they will be practising unregulated.  The title ‘Nursing Associate’ will only be protected when the new Nursing Associate part of the register opens.  I understand that there is constant dialogue with the Department of Health relating to this crucial timing.  Some information on potential transition arrangements can be found in the Department of Health’s Consultation document on the Regulation of Nursing Associates. Pages 18 and 19  specifically.

There is also some confusion over the title to be protected for the new role.  The title ‘Registered Nursing Associate’ with the post nominal ‘RNA’ is felt to be too close to the already protected title of ‘Registered Nurse Adult’ with the same post nominal of ‘RNA’.  The Department of Health has consulted on protecting the title ‘Nursing Associate (NA)’.  This will help to avoid confusion with Registered Nurse Adult.  However, this will not be known for certain until the Department of Health publishes the responses to its consultation in February 2018.

In the same way as for Registered Nurses, the Department of Health will create an ‘offence’ – anyone calling themselves a ‘Nursing Associate’ who is not registered on the appropriate part of the register with the NMC will be committing an offence. This is an important point for individuals, and equally important for employers to recognise that they cannot use the job title ‘Nursing Associate’ for workers who are not on the appropriate part of the NMC register.  Further information on this can be found in the Department of Health’s consultation document on the Regulation of Nursing Associates. Pages 25 and 26 respectively.

The purpose of regulation is to protect the public.  It does this by approving standards of education and only allowing those who successfully undertake such education to be entered on to a register and to be able to use the appropriate title. Where titles are protected in law e.g. Registered Nurse, they cannot legally be used by someone who has not undergone such education, or someone who is not on the register – neither by an individual nor as a job title by an employer.  As a result, the public can feel confident that anyone caring for them who uses a protected title has undergone a specified period of education and continue to meet certain standards.

3 Additional information

A Batchelor’s Degree leading to registration as a Registered Nurse and a Foundation Degree (or equivalent) leading to registration as a Nursing Associate are different programmes, at different academic levels, leading to different roles.  A qualified and Registered Nursing Associate is not a qualified and Registered Nurse.  The Nursing Associate is a support role and the key areas of delegation and supervision are still being actively considered.  These areas will need to be clear by the time the NMC’s Council agrees the standards for Nursing Associates.  See the NMC’s draft standards of proficiency for Nursing Associates for some description of the major differences between the functions of the Nursing Associate and the role of the Registered Nurse. Page 5 specifically.

It may be possible for Registered Nursing Associates to progress to undertake a shortened Bachelor’s degree leading to registration as a Registered Nurse, but until the Nursing Associate standards of proficiency are published it isn’t possible to say how much of the Bachelor’s degree they would need to complete.  Entry onto a shortened Bachelor’s programme is normally at the discretion of an awarding higher education institution (University), following the assessment and mapping of the content of the completed FD (or equivalent) against the content of the Bachelor’s degree, bearing in mind that the two programmes are at different academic levels  i.e. they will differ in terms of breadth and depth of study as well as content.  Given that the Nursing Associate role is meant to be a ‘bridge’ between the Health Care Assistant and the Registered Nurse, it seems likely that there  will be some firm guidance on this in due course.

So, there you have it.  Some facts from an authoritative source that I hope will be helpful.  Please note that this blog is not my personal view, my opinion or a reflection of my own thoughts.  It is an attempt to set down some factual information.

I would like to thank Jackie Smith, Chief Executive of the Nursing and Midwifery Council for a frank conversation and for checking the information in this text prior to publishing.

Looking forward…



We are just into the new year and it’s high time I returned to the blog.  A very happy and peaceful new year to all of you.  I hope 2018 brings you all you might need to be happy.

Although I love the good wishes and the sense of new starts, I dislike the new year period.  I find it hard to feel hearty and celebratory as another year slips by, and as I get older, I realise more and more how sweet life is.  I’m not miserable about it, it’s just that the noise, the false bonhomie and raucous entertainment simply don’t appeal.  I haven’t stayed up to see the new year in for many years.  I ring around family and friends during the evening and then take myself off to bed as usual, looking forward to a new year in the morning.

When I was a child new year was a very traditional affair. The whole family (including one and a half sets of grandparents) would gather at home during the evening.  At a few minutes to midnight my father would discreetly exit the house by the back door and make his way to the front door, which would be ajar.  He would sing the chorus of a mawkish old music hall song, I think called ‘The Miner’s Dream of Home’ (see below*) and then walk though the house, in through the front door and out through the back, carrying coal, bread and salt. There would be much sentimental weeping, hugging and kissing and shouts of ‘Happy New Year’ and we would all gather on the doorstep to listen to the local church bells ringing  “…the old year out and the new year in…”.  It was like something out of bloody Dickens.  Dad would then go off to do the same at any neighbour’s house that didn’t possess their own tall, dark male.  My parents had been brought up in working-class families with Edwardian, if not Victorian, values and this was just one manifestation of them.  This was the nineteen sixties – it could have been the nineteen hundreds.  It’s maudlin influence has seeped down the decades leaving me with a melancholy apprehension and a life-long dislike of New Year.

There is one part of those remembered evenings that I miss, however.  Do the church bells still ring in towns and villages on New Year’s Eve?  I haven’t heard any locally for many years, and I think the occasion is the worse for it.  I’ve always loved a proper ringing of church bells – two of my uncles rang at our local church and I would sometimes get taken along to practice evenings.  The rich, falling cadences of the quarter peals, the called changes like some arcane ritual.  It was enthralling.  Sadly, it seems to have been lost to shrieking and fireworks.  I’d rather sleep through it all and have the year fresh and new, ready when I wake.  And then the plans begin – there are seed catalogues to read, the latest Nigel Slater to cook my way through, theatre tickets to book for the whole season, the greenhouse to prepare, a book to properly start, garden shows…

Life is sweet, indeed.

*’I saw the old homestead and faces I love; I saw England’s valleys and dells.  I listened with joy, as I did when a boy, to the sound of the old village bells.  The fire was burning brightly – ’twas a night that should banish all sin.  For the bells were ringing the old year out, and the new year in.’