#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…

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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.

World Mental Health Day

Today is World Mental Health Day. If you work in health care you’re probably already well aware of this. If you don’t, this tells you a bit more about it. And there are facts and stats on the website too. Like 1 in 6 adults have had a common mental health problem in the last week. Or that if we don’t act urgently by 2030 depression will be the leading illness globally. Shocking isn’t it? Even more shocking is that it’s such a common problem and yet we still don’t talk about it.

How many people do you know who have a chronic health problem? Asthma? Diabetes? Coeliac disease? Psoriasis? Arthritis? Epilepsy? Heart disease? They may not make a big deal about it, but they let people know for various reasons – because they need to prevent inadvertent triggers, or they need people to know what to do if there’s an emergency, or they want to raise awareness and educate people. Or because it’s a part of who they are and why shouldn’t they talk about it? Or it’s obvious to everyone and people want to be supportive and helpful if required. Chronic disease is a part of their life.

How many people do you know with a mental health problem? How many people have said to you ‘I have chronic anxiety and I need to be careful about these things…’ or ‘I get very low sometimes and when it happens I can’t manage such and such..’? Not too many, I bet. But mental health problems are a part of life too.

Chronic anxiety and low mood have been a part of my life for about 40 years. Less frequently as I’ve learned to recognise early symptoms and to utilise coping strategies, but it’s still there – a part of me. At the moment I’m in a bout of anxiety and low mood. I missed the early signs because I was dealing with family deaths, juggling work, supporting others. It will pass – I have a supportive GP, a patient husband and I understand what’s happening and that it will go away. I talk about it. I’ve been open about it with work colleagues and senior people. I’m writing about it. I’m not ashamed of it, it’s a chronic problem and I deal with it in the same way that others have to deal with ‘flares’ of auto-immune disease, or unstable diabetes or asthma. I sometimes need to take time off, but it’s rare these days. Even during the current bout (which has been bad), 3 to 4 weeks of time out is seeing me pretty much back to ‘normal’.

So, on World Mental Health Day remember that even the most confident, the most lively, the most unlikely person may well be suffering and keeping it to themselves, because they don’t know how YOU might react if they tell you. Maybe you could surprise them. 🙂

Notes on nursing (apols Flo)

Once a bit of time had passed after my mum died in February (a terrible end of life experience for her and the family, some of it blogged here), I asked for her notes. I wanted to see how she had been cared for in a professional sense. I wanted to see the decision making, the prescribing, the carrying out of care. I wanted to know who had cared for her, who had assessed her need for nursing, who had signed off nursing interventions, who had recorded her care.

I filled in the form, paid my £10 and duly received a 3 inch pile of paper. 0.1 inch of the papers were the medical notes. Handwritten but largely legible, dated and signed, succinct, little diagrams where necessary. Referrals noted with date and time, and followed up with results. OT visits and assessments were written in the medical notes.  Physio assessments and instructions were written in the medical notes. Social worker visits were recorded in the medical notes. A clear, chronological narrative of those aspects of Mum’s care.

The other 2.9inches of the papers consisted of charts and forms. TPR/BP charts. Bowel charts. Fluid balance charts. Prescription charts. Fall assessment forms, done on admission and never reviewed. Pressure area assessment forms, filled in on admission and never repeated. Something called an ‘observation form’, only filled in when Mum was deemed to need ‘observing’ (but in 7 weeks of hospitalisation there were pages and pages of them). Some entries readable, many illegible. Some barely literate, appalling spelling, laughable grammar. Scribbled and unidentifiable signatures. Often no indication of the level or grade or even the profession of the person who had filled in or signed them. Not always dated, rarely timed. Finding a nursing narrative of Mum’s care was impossible. I read and cross-referenced and pieced bits of paper together to try to work out what had happened, when. Even then it was fragmented, incomplete and uninformative. There was no sense of the progression of Mum’s nursing care and treatment, no reviews, no judgements or prescribed interventions. I had no idea how anyone new to Mum would know what she needed shift by shift. It was a shocking indictment of what passed for nursing on that ward. Fill in the chart. Tick the box. All that was done. Yet she fell, harmed herself in her confusion, developed a grade three pressure sore, was severely dehydrated and malnourished, cried out in pain. But all the boxes were ticked, the charts completed.

What has nursing come to?

Please use this as a case study for students. To impress upon them that the documentation is important, but it isn’t care. It’s only worthwhile if it’s literate, descriptive and chronological – and even then, it’s not nursing. Mum’s nursing documentation was embarrassing in the poverty of its description, in its illiteracy, in its lack of meaning. I’ve heard nurses chant with pride – ‘If it’s not documented, it’s not done’. Well, let me tell you – when it’s documented sometimes it’s not done either. On that ward someone, everyone, had badly missed the point.

 

 

Educating nursing

Changes to the funding system for nursing and allied health professionals is a major shift for the professions. Probably the biggest change since the move to all graduate entry to the nursing register. As such you would expect there to be major conversations and debate going on in health care provider organisations, in careers services, in professional organisations and associations. And there is some of that. However, most of the debate in nursing seems to be focussed on the change from bursary to standard student loan and the potential impact on individuals. As so often, nursing concentrates on ‘What does it mean for me?” rather than “What does it mean for the profession?” The change is both complex and complicated. Too much so for a blog, so I refer you to the Council of Deans extremely comprehensive and useful microsite of information on the whole picture.

I’m an optimist about the pre-registration funding changes. I think people will still want to study nursing at university and be proud of the education that prepares them for a life-long career. I also believe that the bringing of nursing funding into line with other disciplines studied at university says something about nursing being a serious and recognised academic discipline, and that pre-registration education has not been served well by being kept firmly under the control of those who must respond to NHS funding constraints. It has taken many years for nursing to become all-graduate entry, many years for it become established in universities and this move to the student fee system is, for me, an illustration of its acceptance on equal terms in higher education. I believe this is in the best interests of the profession for the long-term. For its value, its status and its recognition.

Much more worrying – and much less talked about – are the reductions in funding for Continuing Professional Development or Learning Beyond Registration. Conversations with colleagues show that the money available for continuing education has been reduced by anything from 40% to 90%, with more reductions to come. This at a time when Registered Nurses are under immense pressure, Trusts need to find ways of recruiting and retaining them, and research is telling us that the better qualified the nurse (i.e. degree level) then the better the outcomes for patients.

It is hard to understand why the development of the existing nursing workforce is such a low priority, and how Registered Nurses are expected to maintain and develop their critical skills without some funding support and time release for formal, substantial education that can help them to develop and change services. Instead they are exhorted by ‘Commitments’ and alliterative characteristics to work harder and do more with less and less. Sad. And infuriating.