Reflecting on Revalidation…


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Who would have thought that applying for revalidation with the NMC could be such a uniquely rewarding and affecting experience?  I certainly didn’t.  I thought it would be a chore.  In fact, I wasn’t even sure that I wanted to bother.  I’d heard about lots of older nurses choosing to ‘lapse’ rather than revalidate, although of course I don’t know the reasons for their decisions.  Maybe they thought it would be too onerous, too time-consuming, too threatening even.  Or maybe some of them had had enough of the pressurised life that today’s clinical nursing is and the thought of revalidation requirements couldn’t compete with retirement or getting a different job?

I first registered as a Nurse in 1976.  This November will mark 42 years continuously on the Nursing register, and if I want to stay on it I need to revalidate with the NMC, and I must admit – some of the above thoughts passed through my mind too.

Since revalidation started, I’ve been keeping a note of information I would need, but I haven’t been completely convinced that I would do it.  I read the NMC’s guidance (over and over), and in the end I thought I would fill in the documentation and then make a decision whether to revalidate or lapse.  Documenting relevant practice hours, professional development and feedback was straightforward.  I had made notes of several reflections on events over time, and it was just a case of tidying these and transferring them onto the ‘reflective logs’.

Almost immediately I was struck by how much additional reflection I did as I wrote them up onto the formal documentation.  Filling in the paperwork was so much more than that simple transfer of information; it became a major reflective activity in itself.  Even though I had collected the instances and drafted the logs previously, it wasn’t really until I came to write them up more formally that I really reflected deeply on all of the issues collectively as well as seperately.  So much so that I chose the revalidation process itself as one of my reflective events.

It was interesting to see the issues that I had chosen to use.  They were very similar – communication, working with others, education, influencing others – all deeply significant to me as the main areas of my professional practice as a nurse.  Looking back at my previous notes gave me another opportunity to reflect, often bringing other useful points to mind that had arisen much later on in the validation period.  I saw how distance and re-reflection can bring a deeper consideration of issues, often with more perspective than immediately after an event.  In addition to that, the opportunity to reflect again in discussion with someone else meant that my ‘confirmer’ and I had a great conversation about how some of my reflections resonated with her and helped her reflect too, so we were both learning something.

Having been through the process once I shall be much more aware of events that could be part of the next cycle.  That will mean I am more organised about noting significant learning points from my practice and keeping a good contemporaneous record so that when revalidation comes around again I will be less anxious.  One of the reasons I wasn’t sure that I would revalidate this time was because I’m no longer traditionally employed and I thought that would be a disadvantage – it’s absolutely not.  In fact, one of the most satisfying parts of revalidation is the way the process has reminded and reassured me that I am still operating as a professional Registered Nurse in my particular field and context and that my registration is a crucial part of that.

That deep reflection and aggregation of different reflections has been an affecting experience, and one that I hope others will go through.  I’d like to suggest that the NMC finds ways of sharing reflections from revalidation for others to learn from.  For me, this revalidation has been about effective practice, safe practice, prioritising people and promoting professionalism through my own actions and my interactions with others.  It has been so much more than a paper ‘exercise’.  It has been a revalidation, in every sense of the word.



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%.

Times of trouble…


Today the Royal College of Nursing held an Extraordinary General Meeting (EGM).  You can read about it here and you can also read both sides of the argument from a link on the same page.  A recording of the debate will be available shortly on the RCN website.  I couldn’t go to the EGM but I did watch it streamed live.  I’ve also been openly supportive of the resolution that was proposed:

“We have no confidence in the current leadership of the Royal College of Nursing and call on Council to stand down”.

Briefly, the resolution was sparked by the feelings of disappointment and anger when the pay deal that the RCN negotiated for its members wasn’t quite what they had been led to believe. The furore resulted in the Chief Executive/General Secretary standing down from her post and the College instigating an independent review of what had happened to cause such a breakdown in communication and understanding.  You can read that review here too.  Some people thought this should be enough.  Some didn’t and felt that accountability for whatever happened was likely to be more widespread than one individual.  Hence the resolution.

Today the vote on the resolution was held and the results were:

For the resolution: 11,156

Against the resolution: 3,124

So the resolution was carried and the Council should stand down.

I voted in agreement with the resolution.  I’ve been open about my views on the subject on social media.  I’ve also been open about my broader concerns about the College.  For example, it’s my view that the College does less than it could do to develop and support the profession as an entity.  It is a Trade Union and much of what we hear from it is related to that part of the College’s business – representation, terms and conditions, supporting individuals.  The structure of the College follows a Trade Union model.  The language of reps, and branches, and elections and votes turns me off.  I think it turns a lot of people off – see below for what I think is some evidence of that.

The communication to members is through these structures and from what I hear from friends and colleagues, rarely gets beyond those who attend branch meetings, or who are involved ‘reps’ or union activists.  In today’s nursing world sophisticated communication strategies that use multiple channels are needed.  Keeping the noticeboard up to date is really not going to cut it.  And communications should be easily two-way.  I don’t see that.  Finding agendas and minutes is a struggle.  In fact, to date I haven’t found any minutes, just meeting ‘reports’ – sanitized and reduced notes without even the members present being recorded.  I shouldn’t have to search to find information that I have a right to see.  It’s not transparent.  These are symptoms of a management that want to keep knowledge as power.  Or that’s what it says to me.  Others may find it perfectly acceptable.

But back to the vote.  The RCN has more than 400,000 members.  That’s a lot of people.  Do you know how many members voted in this really important vote on the very essence of the RCN’s practices?  Less than 4%.  In fact 3.74%.  This isn’t unusual in RCN elections. In the recent elections for the Professional Nursing Committee – the Committee that is supposed to reassure members that the College is more than a Trade Union – the committee members were elected on about the same turnout, or less in some cases.   It also appeared that getting the right strategic skills and experiences brought to that Committee at a crucial point for the College were secondary to following a Trade Union election model; and that employment, age, and geographical location were more important.  It was disappointing.  And it said to me, that nothing was changing here.  New committee, old thinking.  Less than 4% turnout for important elections and votes.  An organisation that can’t engage, or even interest, more than 4% of its membership in these fundamental activities is an organisation that is failing its members.   What I heard from the EGM today was the RCN promising to reach out to its members.  All well and good, but first, it needs to take a long, hard look into itself.

I’ve been a full member of the RCN for 42 years.  45 years if you count my student days and  I want this organisation to work for me and for others like me.  These days, I work for myself.  It’s very liberating.  But I still want to belong to a professional body that champions my profession.  That gets itself into the mainstream media.  That is a ‘voice’.  For example, I expected at least a blog from the RCN on the implications for the profession and it’s value to national policy-making when the CNO stepped down into a part Regional Nurse role.  I would have liked to see an exploration from the RCN on the background to the CEO of the NMC standing down and a broader discussion on the regulator and how it protects the public and also protects the profession from itself.  I expected outrage that Trainee Nursing Associates won’t need to be supernumerary when they are supposedly learning in practice.  But the issue that exercises me more than any other – is the absence of a strong, authoritative RCN voice drawing attention to the dangers of diluting the workforce.  The danger of undermining the contribution to patient safety of the Registered Nurse.  Why aren’t they quoting chapter and verse of the research on RNs and safety/mortality/recovery, and getting that talked about outside of the profession?  I don’t understand how the College can stand square behind the primacy of the Registered Nurse when it also has an obligation to promote the roles of members who are not Registered Nurses.  I think that’s a serious conflict of interest.  And these things are why I got involved in this vote.  I thought – hoped – it was a catalyst for a whole range of dissatisfactions to be raised; and some of them were raised at the EGM.  And I’m raising them again here – for what it’s worth.

No CNO, no CEO of the NMC, no CEO of the RCN, and RCN Council vilified by (some of) its ordinary members.  Some would say this means that at a really troubling time for the profession – dilution of the workforce, failure to regulate advanced practice, substitution of RNs, antipathy towards higher education for nurses – there is no visible leadership.  I disagree – because for quite a while now I haven’t looked to these roles for leadership.  They are too embedded in Govt, employers and established systems to ever take an independent stand, to speak against the status quo, to be awkward.  I look for other voices, other influencers, other opinion leaders, independent thinkers, independent minds.  A professional body, more than anything needs independence.  Independence from Govt, from party politics, from employers, from factions.

But on the other hand, I really want a renewed RCN to be a voice and to show leadership for the profession as an entity, not just seeming to represent a group of workers with employers, or fighting the government, no matter what political shade it is.   My vision for that renewal is entirely predictable, I want the trade union activity and professional activity to be separate – completely separate.  So that the professional body can champion the profession, without fear or favour.  Because sometimes, what might be in the best interests of the profession in the long-term, may not be in the best interests of individual professionals in the short-term (another significant conflict of interest in my eyes).

So, stream of consciousness over.  As usual, this is meant to encourage you to think a bit harder about this, a bit further than the vote of no confidence, and the pay deal.  I’m not asking you to agree with me, and I’m not saying I’m right or that my take is the only one.  I’m just putting my worries out there.  Catharsis.  And, I hope, stimulation.

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!!