Relax, refresh and renew…

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When I gave up full-time employment in March of this year, I was looking forward to a change in lifestyle.  Six months later I am reflecting on that change and how it feels. It feels good.  I expected it to be a positive change – I had planned for it for a while – but I have been surprised at how comfortable it has been to slip the traces of routine, commitment, power and influence.  I still engage informally with my discipline and with the higher education sector and that’s enjoyable and interesting.  At first, I still got irritated about things and picked up old frustrations, but I find, over time, that the old issues are less significant to me and I am finding I let things pass by in a way I would not have done twelve months ago.  I am consciously choosing what to spend my intellect on, rather than reacting on auto-pilot to what I see.

In the first few months I was keen to keep up with former colleagues and accepted invitations to meet.  More recently I find that I am looking for personal value in relationships, rather than ‘keeping in touch’ for reasons that are often unclear if I stop to examine why something is in the diary.  This has surprised me.  I am a gregarious person and enjoy the company of others, but new people are cropping up in my life and although they do not replace old friends, they are gently easing aside former acquaintances.  And I find it is increasingly easy to distinguish between friend and acquaintance in a way that I hadn’t previously.

I knew when I gave up employment that I would want to continue to make a contribution somehow.  I have been surprised by not really knowing what that means.  For example, I put myself forward for a couple of things that I thought would be interesting – they were the kind of things that you would probably expect me to be interested in – but as time went on I found that actually, I couldn’t raise that much enthusiasm. That puzzled me for a while and I thought that perhaps my energy was low, but slowly I realised that they felt like ‘ought to’ rather than ‘want to’ and I recognised that actually, I just didn’t want to.  This is one of the benefits of not working that takes a little getting used to.  You don’t have to do what you don’t want to (except for necessary chores, of course, and going to the dentist etc).  I still don’t always say no soon enough, but that’s coming too.  I still work and I’m still available, but in a much more focussed way.

I am spending time and brainpower on the things that I promised myself I would – the garden, writing, cooking, my remaining family, reading – and I’m about to enroll on a Masters in Research in History.  The MRes is not something I was planning but it presented itself to me through a conversation with a friend and I thought, ‘why not?’.  And throughout the excitement of finding a course that suited me, the tedium of the application process, the novelty of being interviewed before acceptance, I have maintained an enthusiasm and curiosity about studying again that has delighted me.  I am really looking forward to it.  And to being a student for a while.  The thought makes me smile.

I’m sure the next six months will bring more changes – and more choices.  I love the intellectual freedom, the physical freedom and the lack of obligation.  Who knew it would be so good?

 

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Think about nursing’s image, then think harder…

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In the last year or so I’ve written a bit about inappropriate images of nurses in the media and elsewhere.  Inappropriate in my view because they depict nurses unprofessionally, or as objectified or over sexualized, or grotesquely parodied.  Each time, I’ve been congratulated and berated in equal measure.  I’ve been called ‘brave’ and a ’stupid, stupid woman’ (and worse).  I’ve been thanked and also accused of having a ‘sense of humour failure’.  No matter.  What does matter to me is the profession of nursing and its future.  I’m a nurse, and I care very much about how my profession is presented to and viewed by the public.  Not least because that public image underpins society’s trust in nursing, it’s view and value of nursing, and because society’s view influences the view of decision makers and Government.  And there are some important points that need to be made to counter some of the negative views put forward.

*Firstly, there’s nothing wrong with being seen as attractive and sexy – as long as it doesn’t become one of the most common public images associated with your profession. ‘Sexy nurses’ are a persistent fantasy – a well-know high street and online lingerie shop sells a ‘Naughty Nurse’ outfit that is very popular.  It’s right next to the Naughty Maid outfit.  And the Naughty Air Hostess.  I couldn’t find a Naughty Doctor, Naughty Lawyer or Naughty Engineer outfit.  In fact, it seems that the Naughty costumes are largely associated with jobs that are traditionally female, as nursing is.  Does it matter?  Well, it matters to me to see the profession used as shorthand for unintelligent, submissive, or sexually dominating, available females, or pantomime-dame-parodied as if there was something intrinsically amusing about a profession that concerns itself with the health and well-being of the population.  And I know it bothers other nurses, many of whom won’t speak up because they don’t want to be seen as strident, or shrill or prudish, or any other of the tedious adjectives applied to women who say they don’t like their profession being seen in this way.

*Secondly, objecting to these portrayals isn’t about nurses ‘losing their sense of humour’ or their ability to have fun.  It’s about pointing out the danger of ‘disparagement humour’ – when prejudice/sexism/racism is delivered in a joke.  When disparaging remarks, or a demeaning image, is presented ‘in fun’ it discourages criticism of the discriminatory message, because it encourages the receiver to accept that message as the norm.  There is research from the USA that has found that repeated exposure to disparaging jokes creates a greater tolerance of future discriminatory events in those who are already prejudiced.  It’s called ‘prejudiced norm theory’.  So, if the jokes aren’t called out for what they are, they’re repeated, and they become more and more acceptable, and it becomes more and more difficult to challenge them.  Does this seem familiar?  There is a big difference between nurses knowing how to have fun, and nurses being made fun of.  I think many nursing leaders need to understand this.

Thirdly, the pressure on nurses to ‘just get over it’ has been around forever.  I don’t want to get over it, I want to change it.  If there is anyone reading this, who is not aware of nursing’s history, then please, go and find out about it.  Its route to professionalism has been nearly two hundred years of struggling for improvement and change.  For example; gaining acceptance as a job for women other than gin-soaked semi-criminals or religious orders (a nineteenth century cliché, but it will do for starters); for the most basic training in the care of the sick; for regulation and registration in order to protect the public from the untrained and incompetent; for recognition as something more than a doctor’s helper; for recognition as a profession in its own right; for formal education in line with other similar professions; for a career structure that rewards skill and knowledge; for better pay – all of these are linked to a battle for respect.  Every step hard-fought and hard-won in the face of political prejudice, societal norms about what women – and men, come to that – should and shouldn’t do, can and can’t do, and sexism and gender constraints.  And  in the twenty-first century there are still those who think nurses don’t need to be educated to the same level as other health care professionals, that a warm heart and a cool hand are all it takes, and that as long as they hand over a few quid they can patronise and make fun of nurses.  And if that sounds angry, then yes, I’m angry.

*If a profession is subject to decades of  low recognition, innuendo, and lack of respect, then should we be surprised if sections of society and government are dismissive about its worth or importance?  Or if that societal disrespect turns into an impact on its terms and conditions and how well it does when the government resources are divvied out?  Should we also be surprised that a profession so closely associated with females and constantly associated with female sexuality does not attract and retain many men? Or that the many bright, intelligent men and women who do go into nursing can become disillusioned to find themselves not worthy of more respect – in terms of recognition for the job, in terms of career, and, of course, in terms of pay – and so they leave?  To use the cliché, it isn’t rocket science to see that a century or more of this kind of broad societal disrespect will have an impact, and will be a factor in people avoiding nursing as a career – the number of men in nursing hasn’t increased above 10-12% for years – or discouraging their kids from going into nursing or leaving the profession itself.  It’s naïve to say that the public’s understanding of nursing fed by media stereotypes has nothing to do with the nursing crisis – that the shortages are only about poor pay and poor resourcing.  That may be the end point, but the low pay and poor resourcing have their roots way back in that insidious lack of respect for ‘women’s work’ and a continuing lack of understanding of what modern nursing is.

At the moment there is a big national campaign by the Royal College of Nursing – ‘Scrap the Cap’ – to lobby the Government to remove the 1% pay cap nurses (and others) are subject to and pay them what they are worth to society.  And there’s the rub.  When some elements of society see nurses as cheerful, hard-working young females happy to give their all for the love of it; others see them as something to make fun of, mock or denigrate; our own professional organisations and leaders don’t make a strong, consistent stand against disrespectful representations; and some nurses collude because they think it’s ‘affectionate’ or funny – don’t expect any Government to be falling over itself to treat nurses as the serious, highly educated, knowledge-based professionals that they are.

 

Bibliography

American nursing campaign website  ‘The Truth About Nursing.’ This is a fantastic website, full of resources and I’ve used their stuff in this blog, marked * because they make great arguments.   If you don’t know it, take a look.

Thomas E. Ford and Mark A. Ferguson (2004) Social Consequences of Disparagement Humor: A Prejudiced Norm Theory Personality and Social Psychology Review 8 (1) 79-94, http://tinyurl.com/9gwl48f.

Girvin J (2015a) Editorial: the public understanding of nursing – time for a step-change? Journal of Clinical Nursing 24 (23-24) 3341-3342

Girvin J (2015b) Guardian Health Network blog site. 14th September 2015

Girvin J, Jackson D, Hutchinson M (2016) Contemporary public perceptions of nursing – a systematic review and narrative. Journal of Nursing Management 24 (8) 994-1006

Twitter thread on low value of women’s work and caring.

‘Aut delectare aut prodesse…’*

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As a regular follower of Anne Cooper’s blogs, I enjoyed her recent ‘fantasy party guest’ post.  Not necessarily a list of people with whom to paint the town red, but a list of colleagues and others that she enjoys learning from and with, and who inspire and motivate her in her professional life.  At the end of the blog Annie exhorted readers to draw up their own list and to share it.   So, here are the people I would like to attend my own ‘salon’ to talk nursing, past and present.  Unlike Annie – I haven’t restricted my list to people I know personally and not all of them are, ahem, alive.  They are, of course, in no particular order.

Professors Debra Jackson, Trish Davidson and Nicky Cullum – all fierce nurse believers, strong in thought, word and deed.  Always a joy to listen to and talk with, full of energy and optimism.

Debra, a single-minded, action-oriented powerhouse of a Prof, it was my great pleasure to appoint her to lead the Institute of Nursing, Midwifery and AHP Research at Oxford Brookes University.  One year in, when I retired as Dean, the Institute was well established and she was consolidating connections locally and globally.  She had already achieved more than I expected.  Relentlessly energetic, I have never met a more single-minded person.  An amazing woman.  She’s also a great mentor, a good laugh, and a brilliant storyteller.  I love her.

Trish, arguably one of the most powerful women in nursing today,  presiding over the Johns Hopkins School of Nursing in Baltimore, has had the kind of career one dreams about.  A globally recognised researcher, leader, manager, teacher she is the stuff of nursing legend.  I have met Trish just once, but have read her work, listened to her speak and followed her achievements with awe.  To see someone who is a significant influence on nursing right here, right now – just look to Trish Davidson.  Respect.

Nicky, I got to know through the Council of Deans UK.  Down to earth, no nonsense, straight-talking Head of the Division of Nursing, Midwifery and Social Work at the University of Manchester.  Frighteningly intelligent, not easily impressed, and reassuringly irreverent, I count myself lucky to be an acquaintance.

These three would lead a conversation about nursing scholarship that would set intellectual sparks flying.

To challenge and question, I would invite Elaine Maxwell @maxwele2 and Alison Leary @alisonleary1 .  Always interested, engaged and incisive, they would remind us of our need to be politically aware and our obligation to always seek for evidence – robust and valid evidence.  Smart, funny and clever, unafraid to prick the pompous and deflate the self-important they would keep our feet on the ground whilst our heads were in the air.  Invaluable contributions.

Dr Ann Ewens @AnnEwens would be round the table.  Ann has just taken up post as Dean of the School of Health and Social Care at Staffordshire University and prior to this worked with me for a while as Head of Department at Oxford Brookes University.  Ann is one of the few people I know who really does turn absolutely every experience into a learning experience.  Many times when working together I have been aware of Ann quietly listening and processing, asking questions and clarifying, challenging and provoking and then utilising what she has gathered and synthesised into her academic practice.  A voracious learner, a pragmatist with a huge capacity for resolving the complex and awkward, and a delight to spend time with, I can see Ann just ‘hoovering up’ everything she was hearing and filing it away for future reflection and use.

My invitation list would also include Virginia Avenal Henderson (1897 – 1996).  A legendary figure in 20th century nursing, how could any nurse of my generation not want Henderson round their fantasy dining table?  The woman who gave us the most enduring definition of nursing…‘the unique function of the nurse is to…’ etc.  and stressed the importance of patient self-determination at a time when being a passive recipient of care was the norm.  A profound influence on nursing world wide, Henderson is, in my view, the 20th century’s Nightingale.  I would sit at her feet.

Given the discussions we have today about the title ‘Nurse’, the importance of regulation and rights of the public to expect those Nursing them to actually be Nurses, I would welcome a conversation with Ethel Bedford Fenwick 1857 –  1947.  Mrs Bedford Fenwick campaigned successfully for a longer education preparation for nurses (three years), for a nationally recognised qualification (State Registration) and the regulation of nurses through a professional register, the latter in direct opposition to Florence Nightingale who was against what she saw as the ‘professionalisation’ of nursing through registration.  It was Bedford Fenwick’s view that the biggest issue facing nurses and the general public who might need their attention was that anyone, with any or no training, could call themselves a nurse.  Oh, how we would talk into the night about this!  What Bedford Fenwick experienced in opposition to her plans, is so very similar to the arguments we see today around Registered Nurses and supporting nursing roles.  Bedford Fenwick thought she had achieved safeguarding and protection of the title “Nurse’ when the register came into being in 1919.  Sadly, despite campaigning for thirty years, we now know that she didn’t do enough.  There is some fabulous reporting on Mrs Bedford Fenwick’s battles and the chaotic debates around nursing summarised here.  It’s rather depressing to see how history repeats itself.  I would lift Ethel from her grave to spin around my table, which she would surely be doing at the current professional issues in nursing.

I think the above eight women would make for a fascinating dinner table conversation.  Who wants an invite?

June

 

‘A salon is a gathering of people under the roof of an inspiring host, held partly to amuse one another and partly to refine the taste and increase the knowledge of the participants through conversation. These gatherings often consciously followed Horace’s definition of the aims of poetry, *”either to please or to educate” (“aut delectare aut prodesse”). Salons, commonly associated with French literary and philosophical movements of the 17th and 18th centuries, were carried on until as recently as the 1940s in urban settings.’ Wikipedia.

 

 

 

#50shadesofHey (acknowledgment of the # to P Darbyshire!)

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I have written on these pages and elsewhere about the public understanding of Nursing and the issues that this may lead to for the profession and for those who need access to it.  Some of that has been polemic in the general media (here), editorial aimed at the profession (here), and research into contemporary perceptions of nursing (here) in order to try to find out if views are changing.  The research revealed that there are indications that the perception and image of nurses and nursing in the USA is a positive one, whilst in the UK there is still a struggle to move beyond traditional and often denigratory images.  Although there is some evidence of strong public trust, this does not generally appear to be born out of an understanding of nursing work and impact; rather it appears to stem from the respect held for the traditional, more sentimental stereotypes of selfless young women, cheerful, hardworking and overworked.  Nursing in the UK knows that it has an image issue and recently the Chief Nurse for England announced work on addressing this.

It is one thing when the popular media portray Nurses in an unhelpful way, but in the last few months there have been at least 2 inappropriate portrayals of  Nurses by employers, which is both disappointing and troubling.  The first, an advert recruiting Nurses that showed a group of young women in uniform, presumably Nurses, grinning at the camera, whilst another lay across a trolley, kicking her legs in the air.  It was, I think, meant to show ‘the fun side’ of Nursing.  It resulted in a Twitter surge of anger and, to the Trust in question’s credit, was quickly taken down and an apology made by the Chief Executive for any disrespect shown to the profession.  The second incident was more worrying.  This was an advertisement produced by a professional marketing company, that portrayed Nurses in arguably both sexist and disrespectful terms – again, under the excuse of being ‘a bit of fun’.  You can judge how amusing they are here .

There was disapproval voiced on social media, with many Nurses (and others) expressing their distaste for an advert that was seen, variously, as ‘crass’, ‘ill-judged’, ‘sexist’ and ‘disrespectful’.  The Trust in question had little to say, other than an approximation of the ends justified the means (yes, really, see below) and the Trust’s Head of Education and Training was quoted as saying: ‘This is without doubt is (sic) the most intelligent, inventive and creative campaign I have seen anywhere within the NHS and it has worked a treat’.

I looked up the Trust Board because I was interested in the gender split.  It’s here, if you’re interested too.  It seems that no-one recognised that the adverts could be seen as sexist and demeaning to a highly educated and knowledge-based profession.  The entertainment value of demeaning Nursing is clearly identifiable from the research  literature mentioned above, and hostile or sexist interpretations of Nursing are frequently seen and used as amusing entertainment.  ‘Just a bit of fun’ and ‘it’s a bit of banter’ are worn-out and discredited excuses for what has become known as everyday sexism, and these adverts, for me, fall well into that category.  It is all too easy (and lazy) to use images and references to Nurses and Nursing that demonstrate a clear lack of respect, often arising from denigratory stereotyping.

Gender prejudices are alive and well in public images of Nursing, and these prejudices are evidenced in portrayals of Nurses characterised as sexual playthings, beautiful young and sexy, defying danger to find romance – all resonant in these adverts.  The statement that ‘it has worked’ and that the end justifies the means serves only to demonstrate how deeply seated these damaging stereotypes are, how normalised in some thinking, how unrecognised as offensive, even when tongue-in-cheek.  It’s one of Nursing’s biggest issues professionally and it is deeply troubling that employers should exploit this as a recruitment tactic.

Post script – 24 hours after the offending ads hit Twitter and three hours after I posted this blog the Trust put out this statement on Twitter.

A letter to a friend…

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16th May – I heard a couple of days ago that a friend was recognising that his low mood was something rather more than a bit of feeling fed-up and exhausted. The letter below is my message to him – and to anyone else who is hitting a bout of depression. I feel duty bound to add this introductory paragraph, as so many of my lovely webfriends have interpreted my letter as a veiled reference to myself. Be assured – my emotional well-being is fine, but thank you all for the kind thoughts! June

Posted on 14th May:

Dear friend,

I’ve heard you’re not well.  That the black thoughts are crowding in, that the tears are falling unbidden and unexpected.  That your body is heavy and your brain fogged.  That the great pleasures in your life have lost their power to uplift and the future has become a hidden place.

The person that you trust the most – your self – that self that has guided you through so many years of life, through pleasure and pain, through success and failure, that self that has recognised beauty and love and optimism and strength – has started to lie to you.  It has forgotten all these wonderful things and now whispers darkness in your ear.  That self is imprisoned in a drawstring bag of sadness and weight and powerlessness.

It will pass.  It WILL pass.  The strings will loosen and the light will seep in.  When you can’t loosen those strings yourself, others can help you to unpick the knots.  And as they loosen, your self will see more light than dark, more hope than despair, the power of your amazing life will reveal itself again.

It will pass.  It WILL pass.  Your tears will become tears of knowing and relief.  They will be welcome because they will refresh and refill you with understanding of your self.  You will recognise the things that are truly worthwhile and meaningful to you and you will put away the things that have pretended to be meaningful in your life and that have overwhelmed the real.

It will pass.  It WILL pass.  That drawstring bag of blackness will collapse in on itself and you will be able to tuck it away, out of sight, but not out of mind because you will want to know where it is, and to recognise it again.  And when it does collapse and shrink away (and it may take a while) your self will be clearer, lighter, wiser and kinder to you.  The power of life and love and beauty will lift your heart and your head.  And you will come back to the world with a smile and the world will come back to you. Your friends will be waiting.

It will pass. I promise.

June

A cuckoo in the nest?

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I’ve been wanting to write something like this for a little while. It’s something I feel very strongly about and I think many others do too. You can agree or disagree, that is your prerogative, but hopefully, the views expressed here will encourage thinking and discussion. Feel free to use this as a basis for discussion in your workplaces and classrooms if you wish.

In their workplaces Registered Nurses are supported by a range of assisting roles – nursing assistants, health care support workers, assistant practitioners. These roles and functions vary across employers but they all work under the supervision of a Registered Nurse, who remains accountable for nursing interventions and treatments. These support roles are reasonably well established and in most cases have appropriate education and preparation. In 2016 the introduction of an additional support worker role – the nursing associate –  was announced by Govt.  The rationale  was to create a role that ‘bridged’ the functions of the existing support roles and the Registered Nurse. A bridge that might easily have been constructed by ‘skilling up’ existing roles, providing a coherent career pathway and saving time, money and effort. I have seen no convincing arguments for a completely new role, and I know that I am not alone in finding this an odd way forward.

The introduction of the nursing associate role coincided with the transfer of the funding for nursing (and other health professional) students away from the control of Health Education England (HEE) to the standard student loan system, bringing these students into line with all other graduate-entry professions.  A move that should remove the ‘different’ label that these students have carried in education institutions, finally pushing off the deep-rooted perceptions of an apprenticeship type training to be seen as fully engaged students of an established and rapidly developing academic subject. It has taken student nurses out of the volatile and short-term HEE workforce planning system, which has perpetuated the ‘boom and bust’ simplistic mechanisms of the past, and into an employment market driven system, where demand and supply should find its own balance over time.

There are pros and cons, of course, but the old system failed spectacularly to plan sufficient workforce to meet the needs of the NHS – let alone other health care providers – and was driven by availability of funding, buffeted by vested and competing interests, and inadequate workforce planning skills. To be honest, pretty much anything that removed student number planning from the vagaries of NHS funding was likely to be cautiously welcomed by those trying to provide high quality education in an ever-declining and increasingly antagonistic pricing and budgeting environment.

It has been interesting to watch how HEE has responded to this shift, moving quickly to pick up the baton of the nursing associate as it was forced to drop the baton of student nurses and other health care professions, perhaps seeking for a function to replace what has been removed. Pushing a narrative of the nursing associate ‘freeing up’ Registered Nurses, whatever that might mean – most Registered Nurses clamour to spend MORE time with their patients, not less – and ignoring safety concerns as ‘not their territory’ (£), even though there is a growing body of evidence that patients are significantly safer when in the hands of graduate, i.e. Bachelors degree level, nurses. I choose very carefully that phrase ‘in the hands of’ because that is the fundamental crux of any comment on this new role. For patients to benefit directly from graduate nurses’ expertise, those graduate nurses must be nursing them.

It is clear from national and international research that patients are safer when nursing is carried out by Registered Nurses with at least a Bachelor’s level education. And the more Bachelor’s level nurses that are nursing them, the safer they get. So, if safety is the primary concern in healthcare then the skill mix needs to be weighted fairly heavily at the graduate end – to coin a phrase, that’s not exactly rocket science. So, why another role at sub-Bachelor level? And is it going to replace those other assistants in the team – the health care support worker and the assistant practitioner – thus increasing the skill mix? Or, as many suspect, will it be seen as a way of filling Registered Nurse vacancies because, after all, this role is going to be regulated by the Nursing and Midwifery Council (NMC). Sadly, regulation itself doesn’t make a Nurse, neither does it make an individual a safe practitioner – it can set a minimum standard proficiency bar, and it can sanction poor practitioners, but sanction usually comes after the event,  the damage having been done. No, it is education that makes for safe practitioners. In the case of nursing, education at a minimum of Bachelor level, delivered in a rigorous teaching and learning environment which synergises theory, practice and research, and encourages a critical and challenging mindset – the better to advocate for best practice, to constantly seek it out and to deliver it directly.

The NMC refers to the nursing associate as an ‘addition to the nursing family‘. I don’t agree. At best it is an addition to the growing and confusing assortment of formal carers. There is no ‘nursing family’. There is a collective of nursing specialisms, all requiring Bachelor’s level preparation and often post-graduate education. Nursing is a profession, not a ‘family’. A profession that has long outgrown such emotional, domestic and patronising descriptions.

No, the nursing associate is not part of some mythical ‘family’. Perhaps it’s time for nursing and nurses to protect the profession from the expansion of support roles and make it abundantly clear that the title ‘Nurse’ refers to something very specific and cannot be applied in the cavalier way that we see so often – the use of the terms ‘Nurse Associate’ and ‘Associate Nurse’ are not uncommon, and one hears anecdotally of trainee nursing associates who see themselves and mistakenly describe themselves as nurses or student nurses, often without correction.

So, not part of a family, but maybe something of a cuckoo in the nest. And we all know what cuckoos do when they hatch. Perhaps the time is right for ‘Nurse’ to become a protected title. For the benefit of Nurses and the protection of patients.

 

A tale of frustration…

Here is a little story about patient-centred care. It’s also about fitness for purpose, organisational management, and attitudes. It’s about ‘training’ people to do tasks and then being thrown when the requirement is to go beyond the task. And it’s about putting yourself in the patient’s place, and listening to what is coming out of your mouth. It’s a learning experience – as they say.

Today someone had a bit of a meltdown at the GPs. Don’t get this wrong – the GP is very good. They have a fab appointment system which means you get seen the same day, you can have a telephone conversation if necessary, they always call back within an hour, it works  very well. Their system works very well – until you have to go beyond the GP to other services. So, let me tell you what happened – to a Friend, of course.

Friend goes to the GP with breathlessness on exertion, and in the cold. She gets wheezy, it goes away if she rests for a few minutes. There’s no pain, just wheezing and trouble breathing out. GP and friend decide lung function tests and an ECG would be a good idea. Friend goes to the receptionist and books an appointment for lung function tests and an ECG for the following Monday morning at 9am with Sister Somebody. So far so good. Over the weekend Friend receives two reminders of the appointment and asking her to remember to cancel if she can’t go for any reason. All very sensible.

Friend arrives punctually.  Checks in on the computerised system. She is called in promptly. A woman in a striped tunic checks that she is there for an ECG. Yes, says Friend, and for lung function tests. Ah, says Striped Tunic (friend doesn’t know who or what she is because her name badge is a)small and b)covered up by her cardigan) I won’t be doing your lung function tests because I don’t do them and you’re in the wrong room for lung function tests and your appointment isn’t long enough anyway.

Oh, says Friend. Then who will do my lung function test which was booked for today?

No-one says ST. We will have to rebook it.

Hang on, says Friend. I have booked it. For today. Now. With Sr Somebody. I assume you’re not Sr Somebody?

No, and I don’t do them, says ST. The person who does them (Sr Somebody) is next door and she’s down to do bloods today. So the room is busy and the person is busy. So you can have your ECG because I can do that, but we will have to rearrange your lung function tests.

Friend is calm-ish.

Friend: OK, maybe you can do the ECG and then the person who does lung function tests can come and do those.

ST: She can’t because she’s booked up with bloods and you’re in the wrong room.

Friend: OK. Can you do bloods?

ST: Yes

Friend: How about you go and do her bloods and she does my lung function test?

ST: We can’t because you are booked into the wrong room.

Friend (less calm now): Her bloods patients come in here to you for their bloods, and I go in there for my LFT? Seems pretty straightforward…

ST: I’ll go and talk to her.

5 minutes go by.

A different woman in a striped tunic comes in – Friend can’t see her name badge because it is too small so she don’t know if she is Sr Somebody or not. Friend can see the smiley face on the badge though so she knows it says ‘Hello, my name is…’ but can’t see the name. She sits down and Friend catches a better glimpse of the name badge, she can see it says ‘Sister’.

Sr Somebody apologises. There has been a mistake. Friend can’t have the lung function tests because Sr is fully booked with other patients.

Friend: But I am booked with you for lung function tests. I don’t understand. I have an appointment, which I have received  two reminders about, and now I’m here I’m being told that my appointment is with the wrong person, in the wrong room and not for long enough. This really doesn’t feel very efficient, or very patient-centred.

Sr Somebody visibly bristles: I must disagree with you there. Our care is very patient-centred, there has just been a mistake. We have a new receptionist and she didn’t realise how lung function tests have to be booked.

Aha – something’s gone wrong, let’s blame the lowest person in the hierarchy.

Friend: So the new receptionist has got this badly wrong? She was new and working unsupervised?

Sr: She had supervision.

Friend: So the person supervising her doesn’t know how to book lung function tests either?

Friend is given A Look. Friend is rising towards the ceiling.

Friend: how will you make sure this doesn’t happen to someone else?

Sr Somebody: well I’m not in charge of the receptionists but I can go and speak to her.

Off she goes. Back she comes.

Sr S: The receptionist says she tried to get hold of you but couldn’t.

Friend: Well, I was home sick on Wed, Thur and Fri of last week and no-one rang the house phone or my mobile. I was in all of those days and, also, there are no missed calls or messages on either of those phones.

Sr S: Well, she says she rang you. Of course, I can’t prove that she rang you.

Friend bites her lip. In her head she is saying: No, but it looks as though I can prove that she didn’t. Friend gives Sr A Look.  Sr  apologises again. It’s a mistake, there is nothing she can do but apologise. Friend suggests that perhaps she can rearrange the lung function appointment as quickly as possible. Sr S sits at computer, then comes the straw that breaks the camel’s back. She says, OK, let’s see. Do you work?

Inside Friend is exploding. Do I work? If I do, then presumably I can wait for a convenient time. If I don’t, then my life is so empty that I have nothing at all to do except fit myself around the surgery staff possibilities. Do I work?

Calmly, and quietly, but with feeling Friend asks: What has whether I work or not got to do with anything?

Sr S is silent. She clicks a few times. Then she says: Can you come this afternoon at 2pm? She apologises again for the inconvenience. She apologises for the mistake. The appointment is agreed. She leaves.

The first Striped Tunic says: Do you want your ECG or do you want to rearrange that now?

Friend has the ECG. Friend goes home and lies down in a dark room.

Talking nursing…

Tags

This blog doesn’t have a theme as such. It’s more of a stream of consciousness – rambling, discursive, offering no objectives or rights and wrongs, it doesn’t really go anywhere. I share it on that take-it or leave-it basis. You might find it interesting, you might not. It may rings bells with you, it may be a complete turn-off. If you want to comment, please do, if you can’t be bothered, then that’s fine too.

This week I met with a nursefriend who I don’t see very often. We did what people who don’t see each other very often do – catch up on work news, update on families, share bits of gossip. And then we did what nursefriends do – talk about all things nursing. Not the detail of everyday working, but the bigger stuff.

We started with ‘what is it that nurses want?’ and moved through ‘why are nurses always looking for leadership?’,  ‘what makes nursing really work?’ and ‘why does it feel like we’ve been here before?’. We covered the appetite for starting campaigns like ‘bursary or bust’ and wondered why we seem so good at starting things but less good at follow through. We mused over the attraction of slogans and ‘joining in’ stuff – The 6Cs, those ‘shiny stars’ used on Twitter, ‘Caremakers’ (whatever happened to them?), and so many more going back over the years. Some good and useful, some little more than look-at-me exercises.  We agreed that there seemed to be something about being part of a defined group that nurses found irresistibly attractive – just look at how we defend our specialisms and constantly seek to stratify and hierarchify (is that a word?) them. We wondered about whether nursing would ever be a cohesive professional group with cohesive professional aims.

We discussed how well or how inadequately we understand the purposes of professionally related organisations – the Royal College, the NMC – and whether those organisations do a good enough job of talking to the public rather than the profession. We talked about whether nurses do a good enough job of talking to the public rather than to each other (I don’t mean talking to our patients or clients, but talking to the wider world), we talked about whether we should be concerned about our ‘voice’ and where, or who it comes from. And even if we have a ‘voice’ at all. We mused upon how many other nursefriends were having identical conversations.

We were struck that in this time of unprecedented public focus on the NHS – all over our TV screens, or device screens, the print media, on the political agenda – that we hadn’t noticed any nurses offering an opinion, or being interviewed, or being a ‘talking head’ as an expert voice. We wondered why – beyond the constraints of employment and being nervous of voicing an opinion. After all, there are lots of nurses (thousands) not working in the NHS who might venture to offer a view.

In amongst all this, we also talked about what great jobs we had been in, how we had made real differences, how much we wanted to find ways to help colleagues who were under pressure. We talked about how we had been helped, what had worked for us, who had made a real impact. It was a really fabulous couple of hours. And, so what? Will we do anything? Did it mean anything? After all, it was just a conversation that any two  nurses would probably find themselves having if they sat down to chew the fat over a coffee.

I told you it was a stream of consciousness. I’m trying to work out if I want to do anything with it. If there is anything I can do with it. Right now, who knows.

*nursefriend – someone who you know only because you are both nurses. My definition.

Embracing the unorganised life…

In my last blog I talked about my impending retirement. Since then, my last day at work has been and gone – the farewell tea, the flowers, the gifts, the kind words and amusing speeches. It was all lovely.

What has struck me though, is the way lots of people have greeted my intention to retire with a question…’So, what are you going to DO?’ There seems to be some sort of unspoken belief that when you say you are going to retire, you don’t actually mean it. What you mean is you’re going to set yourself up as a consultant, or do interim work, or go back to work in a different role. In any event, doing ‘nothing’, where nothing is interpreted as not having paid employment, seems to be totally puzzling.  What a strange attitude this is. I have experienced it from people who would rather die than be thought discriminatory or less than inclusive and yet, the notion of a clever, powerful woman choosing to leave paid employment clearly strains their idea of who is valuable and who is not. Interesting.

I’ve noticed some people unable to hide the look of horror quite fast enough when I say ‘I’m going to spend time in the garden’ or ‘I’m cooking a lot’ or worse still, ‘I’m knitting’. And after years of my child-free status being irrelevant in the workplace, I am back to the embarrassed pity from people who have assumed I have retired in order to help out with ‘the (non-existent) grandchildren’. Sigh. Of course,  these responses are a minority (just about)  but worth noting just the same.

Do you remember last blog when I talked about finding a new story to be in? There’s another quote that’s become a favourite of mine. It came to me via a coach that I worked with a few years ago at the Harvard Women’s Leadership Forum. We were talking about the increasing need to be able to handle uncertainty, not just at work, but in life generally. She sent this to me, a quote from Gilda Radner the American actress and comedian and wife of Gene Wilder:

“Some stories don’t have a clear beginning, middle and end. Life is about not knowing, having to change, taking the moment and making the best of it, without knowing what’s going to happen next. Delicious ambiguity.”

Delicious ambiguity. Isn’t that wonderful? Delicious ambiguity. I’m loving it.

Ch…ch…ch…changes

To paraphrase a title from that doyenne of crime writing, Agatha Christie – A Retirement is Announced. Yes, the woman who always said she couldn’t imagine not being at work, who wanted to work ’til she dropped, is retiring from her current job. Me.

So what changed my mind? Time, thinking, reality, wisdom, self-awareness, life. All good things of which to take proper notice. Interestingly, it wasn’t a difficult decision to make and it was a surprisingly quick one. I began to think about what I wasn’t able to do – like clean the house properly, or cook from scratch, or see my family, or see my husband more than three nights a week. Like going away for a few days spontaneously, like taking a holiday without planning it a year in advance to synchronise diaries, like starting a project at home and having it finished in a week instead of it taking 6 months (or not getting finished at all). Like sitting in the garden for hours. Like reading for a whole day. Like staying in bed ’til 10am. Like going to bed later than 10pm. Small things you might think, but small things that are about having control over my time, over my life. And suddenly, that control became very, very important.

So, I did the sums, examined my lifestyle, and boom! There were better times to be had. Don’t get me wrong. I’ve loved my jobs (well, most of them), I’ve loved the whole of my career and I’m proud of my achievements and the contribution I have made to organisations and to people. Now, it’s time to contribute to me. To do what I want, when I want and with whom I want. To spend my time – precious time when you enter your seventh decade – doing things which stretch me, challenge me, excite me, and above all, things that make me happy.

When I talk about my career, or what I have learned over the years, I talk about knowing when to move on. There’s a slide I use, it say’s ‘If you ever find yourself in the wrong story, find a new one’ and there’s another slide, a quote from the late, great Muhammad Ali, ‘A man who views the world the same at fifty as he did at twenty has wasted thirty years of his life’. 

Well, not one moment of my life has been wasted so far. And as sure as eggs I am not going to start to waste it now. My career isn’t over, I shall continue to contribute and comment, write and rant, encourage and include. I won’t be stopping this blog, for instance – I think it’s one of the ways I reach out, and can continue to make a wider contribution – and I haven’t reached my seventh decade without learning a few things that are worth passing on! But I’m going to be in a different story – and it feels good.