1. In The Beginning….

 There is a photograph of me, aged about two, distinctly chubby, frowning straight out of the picture, maybe on the verge of a serious tantrum.  I am sitting on the swing in the back yard of our prefab and I am dressed in one of those toy nurse’s uniforms – I have an apron, a shoulder cape, and a cap with a red cross on it on my head.  My mother always said that in spite of bribes, cajolery and eventual threats I flatly refused to smile for the photographer, who had been specifically engaged to take sweetly charming pictures of me.  I look decidedly unimpressed and quite cross.  Being a nurse was clearly not a childhood dream.

      I don’t remember what my childhood dreams were – or even if I had any.  I’m not sure I ever thought about work, let alone a ‘career’.  On a rail track of constrained horizons, unambitious parents, and no family role models, I drifted through school – bright, but not stretched or stimulated.  Like many working-class girls of the early 1970s, my future was not significant enough to plan.  When I failed ‘A’ levels at 17, those failed exams could have been the nudge into the repeat experience of every woman in my family – a bit of a job, then marriage and children.  But it wasn’t.  Sitting on a wall in the school courtyard, miserably wondering to a classmate how I would ever get away from what felt like a ready-mapped future, she said something that would change things forever: 

 ‘I’ve got a place to be a student nurse. I think they’re still taking applications. Why don’t you apply? Give it a go? The course starts in September, you can live in the Nurses Home, still get away.  Go on, why don’t you just do it?’ 

      So, I just did it.  I applied and I was offered a place. The freedom I had longed for beckoned seductively.  I wasn’t absolutely sure what I was freeing myself from – and I certainly wasn’t sure what I was moving towards – but movement it was.   

      Three months later, I was sitting in the back of the family car about to start a whole new life, looking eagerly through the rain-spotted window. Autumn sunshine lit the wet road and caught the golden leaves on a short avenue of beech trees – a left-over from when this land belonged to a Cadbury, of chocolate fame.  We drove through a campus of large buildings, past glass-windowed blocks, and turned in at a barriered gateway.  My father wound down the window (no electric windows in those days) and spoke to a uniformed man:

      “I’ve brought a new student nurse! Where do we go?” 

      There was pride in his voice, I noticed it. I suspect more pride than if I had opted to go to university.  The value of a university education was not something that would have made much sense to my parents.  Neither of them had had, or wanted, education beyond sixteen. They were, as we all are, the product of their time, their families, their environment.  My father was a steelworker for all of his working life until the decimation of manufacturing industries in the nineteen eighties. When the steelworks closed, a major part of his life, and of him, was gone.  It made him angry and sad, and from time to time both helpless and hopeless.  My mother was a housewife. She never gave any indication of thinking about anything else.  She was impressed by ’a lovely line of washing’ and a clean house and being respectable.  Careers were for others – we were solid, working people and we knew our place.  Go to University? What for? They had no conception of the benefits of higher education, and so it seemed to them a waste of time and, more importantly, a waste of earning potential.  But being a nurse was useful and respectable, something for them to be proud of.

      Through the barrier we drove between more brick buildings; on the right, the main hospital, five stories high, a clock tower rising from the middle; on the left, the School of Physiotherapy, the School of Nursing (‘Look! Look! That’s where I’m going to be!’) and then a large, double -fronted building, with ranks of small-paned windows facing the road and a wide, stepped entrance. The double wooden doors stood open, and above the entrance the carved lintel proclaimed ‘Nurses Home’.  We pulled up outside.

      It was two days before my eighteenth birthday, and I was on the brink of a career that would last more than 44 years.  Obviously, I had no idea at that point how it would turn out.  I didn’t have much idea about anything, to be honest.  A few months earlier I had been wondering what I was going to do with my life and now this seemed to be it. 

      My teen-age self was taking a chance on nursing, and fervently hoping that nursing would take a chance on me.  

It’s all about me…

Well, this post is, sort of. I am 26,000 and a few words into writing a memoir. That’s all about me, too. About being a nurse. About having anxiety and depression. About learning how to make a career with sometimes crippling insecurity. About achievement. About self-doubt. About the fun and the sadness and the anger and the frustration and the success and the laughter and the friends and the life and the growing and the nursing – of others and of me.

I have written for myself for a long time, not necessarily for publication. I have written for others more recently – this blog, my other blog, a bit of academic writing, plus I have notebooks and electronic folders full of writing ‘starts’. I’m a great starter, a finisher not so much. But last autumn I committed myself to writing the memoir that I have wanted to write for a long time. I have a story to tell, but it’s quite hard knowing how to tell it. Not how to start it – I have a file full of starts just waiting to be used – but how to keep it going. How to make it run, jump and fly and keep it on the page. It’s hard.

In that 26,000-odd words I’ve got a few good bits, one or two really good bits, some messy don’t-know-where-they-fit bits, and some crappy stuff. I have no idea (yet) how they’re going to hang together, or even if they will hang together. I hope the crappy stuff will become a few more good or really good bits. Like I said, it’s hard. Even this, which I am telling myself is pre-marketing, is really procrastination because the real writing isn’t going anywhere today.

If I ever get it done, you will have read about it here first. If I ever get it published – you’ll be able to read it for yourselves. I hope. 🙂

Times have changed…not.

The tragic unfolding of the abduction and murder of Sarah Everard this week has brought women (and men) out on to social media to share their experiences, offer themselves as allies, and to protest against a seeming acceptance that it is women’s lot to find their own solutions to the increasing casualisation of threatening and intimidation of women by men. My own social media feeds and timelines have been full of women describing their own fear-filled experiences, their anger at not having those fears taken seriously, and the soul-sapping planning, organising and vigilance they have to engage in every day of their lives. At first, I was thankful that this didn’t seem to have been my own experience, but then I remembered that I’m older (65) and that I rarely – even never – go out alone in the evening, and that it’s very unusual for me to be out alone at any time. Lucky me. Or poor me, for having become so used to not going out alone that it feels normal – when of course, it’s not.

I began to reflect on my younger days and whether things were different forty or so years ago. I was hit almost immediately with many, many memories of unwanted behaviour that I’d tucked away and forgotten, or that I’d accepted as normal and only later been outraged by them, or that I’d been embarrassed to recall. Most of them happened for one simple reason. I was a Nurse, and Nurses were fair game for every jack-the-lad, sleaze bag and ageing lecher that came within a five mile radius.

As a Student Nurse in the early 1970s and throughout my clinical career into the 1990s, I (and many of my contemporaries) were subject to sexual harassment and innuendo in the most casual and accepted way. After mentioning it on Twitter I had no end of replies from nurses offering similar experiences. From not revealing your job when out socially because the responses would be the ‘nudge, nudge, wink, wink’ kind; or being told that there are three certainties in life – death, taxes and nurses; or the frequent but very boring ‘Are you? Would you look at this swelling for me?’ to the innuendo and groping from doctors (Theatres seemed to be a common area); and the unconcealed/unembarrassed erections from patients who considered any nursing intervention to be the wrong sort of ‘intimate’ care. Oh, I’m not saying this happened everyday, or that it was every man that we ever met, but it was frequent and there was an acceptance of it that it just ‘came with the territory’. I don’t remember anyone taking it seriously, or calling it out. I guess things are different now. Feminism; professional recognition, changing social mores – it’s a different world.

Reader, it’s not. There were also responses from current nursing students and Registered Nurses saying that nothing much has changed in terms of saying what you do in a social situation or in the ‘bantering’ and groping by some patients. And it’s not just Nurses, but AHP colleagues and female Drs talk about it too, if asked. The biggest difference is that it gets called out a little more often. Hurrah. I wish I didn’t feel moved to write this blog, but I did. Nursing’s story is woman’s story.

When the angel/hero narrative comes home to roost…

The Govt’s offer to the Pay Review Body of a 1% pay rise for nurses has rightly caused anger and disappointment. But it really shouldn’t be a surprise to anyone. The underlying narrative for Nursing has been one of self-sacrifice, vocation-driven selflessness, and heroic martyrdom for as long as I can remember, and history tells us, for considerably longer. The pandemic, a once in a lifetime moment to educate the world about what Nursing really is and does, has led only to reinforced views of the age-old tropes.

Media talk of ‘NHS heroes’, or ‘angels of mercy’, the weekly clapping and rainbows in windows are not about acclaiming professional skill and knowledge, but re-emphasising sentimental and misplaced views of what is appropriate recognition for nurses. I’ve posted on here previously about the hero narrative and how unsuitable and unhelpful it is. Yet some within and close to the profession are happy to collude in this – openly criticising higher education for nurses; accepting the hero/angel tag with simpering pride; encouraging a ‘nursing family’ notion; talking about ‘not doing the job for the money’ etc. etc. A patronising 1% pat-on-the-head pay rise is where this nonsense leads. Those who vociferously oppose said narrative are too often accused of being strident, dismissive of others contribution, ungrateful or that over-riding insult – ‘too academic’.

This paltry offer should galvanise the profession into a strategic and wide-ranging campaign to inform and educate the government and the public about the criticality of Registered Nurses to all aspects of public health and welfare, to the outcomes of hospital admission and treatments, to life and death. The scientific evidence of the difference an appropriately educated Registered Nurse makes to patient outcomes is clear as day. But largely ignored. Instead the profession is diluted at the patient interface with no regard for the impact this will have, the misplaced notion of a ‘nursing family’ is embraced without stopping to think of the effect on patient safety. It’s easier to recruit. It’s cheaper to maintain. It’s all nursing anyway, isn’t it? No, it isn’t. But as long as the profession doesn’t push back against this, the 1% will continue to be offered as something to be gratefully received.

It’s not enough for the RCN to start an industrial action fund. That may be necessary, but it’s not enough. If it brings about a bigger settlement now, it won’t have changed those deeply embedded views on nursing as being the privileged work that is a reward in itself. And industrial action (necessary though it may be) may even harm the progress of the changed narrative that is so badly needed.

Nursing shouldn’t have to base its arguments on being hard done by, of working its heart out in a pandemic for precious little, and things not being fair. That’s exactly what keeps it in the position it constantly finds itself. I long to see a campaign that focuses on the primacy of the Registered Nurse in care delivery, that pushes for increasing education qualifications throughout a career, that educates the public about the implications of a diluted workforce, and that fights for the rational acceptance of the Registered Nurse as the safety-critical professional at the centre of health care, warranting a specific salary scale that reflects this and is unburdened by ‘knowing its place’ in an outdated employers hierarchy. Without it, expect many more years of a rainbow as a reward.

Troubled times (revisited)…

I stopped writing on this blog in March this year. Here we are, less than 6 months later and I’m moved to write again. Sadly, it’s about a problem with the Royal College of Nursing.

Presidential elections all set up and ready to start voting, and over the weekend a Tweet is sent out from the College saying that the elections are suspended. A little later and a message on the website states that two candidates have been disqualified and the electoral rules have been (allegedly) breached. No further information. Over the next hour or so tweets appear on my Twitter timeline from various people wondering what is happening. What rules were broken? Who decided they were broken? Who decided it warranted disqualification? Who decided to ‘pause’ the election? None of this was forthcoming. These are serious allegations with serious consequences, serious decisions made, also with serious consequences. The issue of the governance of the College raised its head for the second time in two years. Last time resulted in an EGM and the resignation of senior people – the RCN promised it had learned lessons and things would be different. I blogged about it here and I’ve recently reposted it.

I’m no longer a member of the College, but it’s the biggest organisation for nurses in the UK, it is both trades union and professional organisation (see that blog again for my views on that issue), it’s the go-to for the media on all things nursing. And as such it needs to be trusted not only by its membership but by employers, and it needs to be transparent with its membership and with all of its stakeholders. Integrity, trust and transparency should be its hallmarks. They MUST be its hallmarks.

I understand that there have been many welcome changes since 2018, many changes of personnel and a real effort to strategise in a way that includes and celebrates membership. New committees are working hard on communication, on professional strategy, on being seriously member-led, and I applaud and support these efforts. I also recognise the difficulty of doing this. Bringing about significant change in a big (and traditional) organisation like the College is not a 1,2,or even 3 year plan. It will take time, commitment and heartache. There will be setbacks and anger and undermining. Anyone who knows about culture change in organisations knows that it is hard won and the road towards it is full of potholes and rocks. So while I understand and share the outrage and disappointment about this latest issue, I hope there won’t be knee-jerk reactions as a result of righteous anger.

When things like this happen in the middle of a major change process, it’s a sign that there is more to do. That the promises around governance and transparency have held out until a crisis happened – and then old ways of working kicked in. It’s not an unusual thing to happen. Governance of large organisation has to be clear, transparent and the details lived by everyone – when this doesn’t happen, there must be a means to address it and make sure the sticky bits are sorted out – good governance rescues and straightens up. The College, it seems to me, is on a good governance journey and this is an opportunity to strengthen that by being open about what happened here, and fearless about the remedies – no matter who is impacted by them.

So, with no right at all, I appeal to members, activists, and others – be patient. Insist on a full and independent investigation into what happened and why, and then take the necessary action. It won’t be quick, but it will be more thoughtful and probably more likely to get the long term results the College needs without causing collateral damage. Especially at a time when nursing needs thoughtful, credible national representation more than ever before.

One for the road

So much harm, hurt, distress, grief. So much death, so much dying.  It’s hard to know what to write or whether to write at all.  I’ve been thinking about things, and wondering, and sometimes it helps me to get these thoughts out of my head and on paper (screen).  I said I’d put this blog to bed just a few short weeks ago. But sometimes, I have to write.

Over the weekend a few things have been running around in my head and they make me sorrowful but they also provide me with an opportunity to reflect and try to understand.

The old trope of  nurse and doctor as superhero/heroine and angelic special being is alive and well.  It is the overriding narrative of politicians and in all media, together with war metaphors and notions of fighting, of winning and losing.  I’ve been wondering about the pressure this puts on health care workers.  Being constantly heralded as superheroic and/or angelic with all the connotations of extraordinary capability that this carries is a substantial conscious, and subconscious, burden to bear.

In other emergency circumstances, in times of short-term exceptional response – the act of terrorism, the unusually large road traffic accident, the major incident of whatever type – the heroic/angelic descriptor sits more lightly.  A few hours, a few days, most people are treated, set on a pathway to recovery, and the sudden pressures are lifted and life goes back to normal.  Angel or hero for a few days may even feel appropriate and rewarding.

But now? When it ceases to be an ‘incident’ and becomes a new way of living, of working, of being at work?  The only predictability is that more will come.  Hard to see an end in sight. No intervention followed by prompt improvement. No ‘heavy’ days and ‘light’ days, just the relentless file of patient after patient, many who cannot be helped, the isolation, the deaths, the gentle handling of distraught and remote relatives.  The overwhelming numbers and the overwhelming shock.  No-one who ever entered medical or nurse training ever conceived that they would be required to handle this.  Coping mechanisms become fragile, incomprehensible levels of stress become internalised and nailed down in order to carry on. To be the hero/heroine, the angel of expectations.  The pressure must be unbearable.

On top of these come the avoidable things – confusing information, rapid preparation with little time to think through, false promises, inadequate protection for many, inconsistent leadership, frustration with what is meant to be the support system.  And as the days go by, increasing fear.  Fear for themselves, their families and loved ones, their colleagues.  Frustration with a lagging support system becomes anger.  Fear and anger – it’s a losing combination in terms of mental health and wellbeing.

So, it’s small wonder that we see people occasionally kick out.  Under these circumstances being heroic and angelic is time-limited, it’s impossible to sustain every moment of every day.  So, sometimes what might be seen as a ‘safe’ target for that fear and anger might be attacked.  Politicians are a pretty safe target, and often deserving of the opprobrium and scathing comments.  Sometimes those who don’t deserve it feel the heat of people’s anger.  Maybe a boss, or a leader of some sort hits a bad moment and the response is unforgiving.  On the basis of a perceived slight, a real or imagined sense of unfairness, bad timing, whatever it is  – the responses are fast and fierce.

There is small comfort for anyone involved in this crisis.  Everyday on my social media feed I see the ravaged faces, I hear the frustration, I see the anger.  But I also see the compassion, the endless patience, the strength of commitment to doing the best job possible whatever the odds.  No heroes.  No angels.  No heroines.  No Superhuman beings.  Ordinary people in extraordinary circumstances doing extraordinary things.  Whatever their role, whatever their level.  And sometimes being fallible and sometimes being less than kind in their comments.  In other words – being human after all.

Time’s up!

Dear all,

I’ve made a decision to stop posting on the Blogs on Nursing site.  I wrote a little while agothat I was struggling to write about nursing and I think it’s a good time to stop. I haven’t wrapped up my identity with the profession for more than 30 years and so I don’t  do this with any sense of loss or sadness.  I no longer have the motivation or the interest to produce a regular commentary and I surely don’t need any more chores!

Thank you to everyone who has read and engaged.  If you want to continue to engage with me on a more personal level then do try my other blog ‘The Optimistic Gardener’ where I write about all things garden and growing, wildlife and, of course, the knitting.

I shall delete the blog at the weekend.  I may leave the content available, I’ll make that decision later.

Hope to see some of you via‘The Optimistic Gardener’.  With every good wish,

June

One year later…

Writing on my other blog recently, I toggled through to this one and noticed that I haven’t posted on here for just over a year.  This surprised me, as I seem to be always muttering or chatting about nursing somewhere in my social media life.  I’ve been wondering why I haven’t blogged here.  Some of it is because I moved house last year and have been pretty busy doing all the things you have to do when you move house.  But that’s not all of it.  I haven’t been able to motivate myself to write about nursing.  More accurately, I haven’t been motivated to think enough about nursing to write anything.  I couldn’t raise the interest or the enthusiasm.

Reflecting on this ambivalence, I think it’s because nursing feels kind of ‘alien’ to me at the moment.  The rise of the ‘nursing family’ – a term I dislike and disagree with vehemently; the continuing overvaluing and subsequent hierarchical ordering of tasks – something I have never understood; the persistence of old systems and patterns of organisation – the same ways of working that I remember from 40 years ago, just renamed or shaped a little and hailed as innovation; a lack of voice – by which I mean wide-ranging and meaningful debate that is energising and challenging, new and unsettling, iconoclastic even.

I know some will say it’s all alive and well, but I can’t see it.  If it’s alive and well, it’s alive and well internally – facing in on itself, talking to itself, congratulating itself.  It feels diminished somehow, static, suspended.  Maybe it’s me that’s moving – moving on and no longer able to engage with what’s happening.  Perhaps.  Does anyone else recognise this?

#100outstandingnurses

In the last blog (scroll down to see) I talked about lists that crop up at this time of the year and shared some thoughts on some of those lists and the inclusion (or not) of nurses.   I also talked about a new list that was being developed – a simple list of nurses nominated by their colleagues and deemed to be outstanding in their nursing practice.  Nominations via Twitter closed on Christmas Eve and the list was publicised on Thursday 3rd January 2019.  And what a great pleasure it was to see people so happy to find themselves mentioned!  Having the respect and goodwill of one’s colleagues is a very fine thing indeed.

The complete collection is shown below.  These are not people with status -laden job titles, nor have they been previously recognised through other systems.  They are not (generally speaking) leading large organisations or national departments.  They are not well-known, some will be unknown to anyone except their closest colleagues and their patients.   We wanted to get beyond hierarchy and ask people to nominate nurses that they know well, maybe work alongside,  and who, for them, are outstanding.

The list is not hierarchical – it’s in alphabetical order by first name – and the person whose name begins with X, Y or Z is just as outstanding as the person whose name begins with A, B or C.  As I said in the last blog, it’s not in order of ‘outstanding-ness’ because that would be stupid.  It is not a list of ‘top’ nurses, or ‘the best nurses’ or any other kind of competitive adjective that might be applied.  Maybe ‘list’ is the wrong collective noun – people do love a hierarchy, even when one isn’t intended!  The nurses on the list were nominated by friends and colleagues who respect them and want them to be recognised.  Of course these aren’t the only outstanding nurses out there – but they are the ones we got told about and we’re happy to let them know that other people think they’re great.  Maybe this can be an annual extra Christmas present for 100 people!

 

You can see also see the full list here and the twitter wall of nominations.

Congratulations to this particular group of outstanding nurses and Happy New Year!

Calling prospective RCN Council candidates…

My last blog (scroll down) was in the immediate aftermath of the RCN ‘no confidence’ vote.  Council had retired to consider its next actions and I reflected on what had led me to agree with the vote.  Last week Council announced that they would be standing down (with some caveats), and a new Council would be elected as soon as practically possible.  There was a little flurry of media activity and then, in the wider world at least, life continued.

Most of the media I’ve seen has concentrated on the nurses’ pay deal as the reason for the vote of ‘no confidence’ in the leadership of the RCN.  Whilst the pay deal was doubtless the trigger for the vote, many people (myself included) came down on the ‘no confidence’ side because of a much broader dissatisfaction with the leadership of nursing’s professional organisation.  As candidates begin to put themselves forward for the ‘new’ Council, I’d like them to pay attention to the reasons why I (and others) voted for change.  I have summarised those reasons below, and I would like to see Council candidates, whichever ‘constituency’ puts them forward, at least recognise these and commit to addressing them in their election statements. They include:

• a perceived diminishing of the RCN’s function as a professional body e.g. it doesn’t do enough informing/debating the wider issues facing the profession, protecting and championing the role of the Registered Nurse, engaging with the mainstream media on issues other than union representation and terms and conditions
• failure to engage its wider membership – some 400,000 members – illustrated by the very low turnout for elections and other important votes over a long period of time. Less than 4% for the no confidence vote and often less than that for elections to governance groups
• an organisational structure that is modelled on an out-dated trade union model of ‘branches’ and ‘reps’ that many members find off-putting, not reflecting modern multiple channels of engagement and not adequately content-driven
• perceived conflicts of interest, e.g. unable to champion the primacy of the Registered Nurse because it also counts health care assistants/nursing support staff among its members; difficulty in promoting the development of the profession as a whole because it has a major function to protect the interests of individuals – and what may be good for the profession in the long-term may not seem good for individuals in the short-term.

These issues are important to members who see nursing in an increasingly challenging position – inadequate articulation of the unique value of the Registered Nurse, dilution of the workforce, antipathy towards higher education for nurses, an image that is stubbornly resistant to the recognition of the changes and developments in the modern profession, a disaffected workforce creating retention problems for employers and safety issues for patients – and our professional body failing to effectively challenge and articulate these.  

A successful ‘no confidence’ vote was an historic moment in the life of the College, and now that the dust has settled a little, meaningful dialogue with members is needed to move forward.  The feelings that led to the vote won’t be satisfied by a new Council – elected through the same mechanisms as the old, and subject to the same modus operandi – smiling out of headshots and making aspirational statements.   As more and more nurses have graduate education and post-graduate thinking skills, they will not be satisfied with old thinking and old ways.  They’ve been taught to challenge, to push beyond the status quo, to learn & act on evidence.  They’re used to multi-channel, content-driven communications.  They want to pick & choose, not take what they’re given.  Traditional thinking, traditional expectations and traditional organisations are not going to cut it for them – inside or outside the profession.  They are looking for a ‘voice’, and not finding it where they should.

So, prospective candidates – I’d like to hear some thoughts on how you might tackle the bullet points above.  And if it sounds feasible, and creative, and responsive, then maybe, just maybe, someone will be elected on a turnout bigger than 3.47%.