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. ūüôā

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.



If you are interested in the continuing story story of my mum’s dementia care, I’m still blogging about it, but on a separate site here¬†. It was helpful to get those words down on the page, but not appropriate for my ‘professional’ blog pages.¬† And that started me thinking…

So why isn’t it suitable for my professional blog pages? After all, I don’t keep separate Twitter accounts for personal and professional. I mix the two, and I think it works well, and I’m very comfortable with it. On that particular social media platform it seems okay to show something of myself, to mix professional and personal conversations, to tweet to everyone who might be interested, not just a particular group. But the blog? The personal stuff just didn’t feel right. Too exposing? Too emotional? I’m not sure. I don’t even think it’s the content, I think it might be the context.

The paradox – and the beauty – of Twitter, is that for a platform that is totally open and accessible it feels comfortingly intimate. Once you’ve built up a cadre of regular co-respondents there is a sense of chatting just with them, and a satisfying predictability that whatever you put ‘out there’, someone you’ve come to know will pop up in response. All those random unknowns who may come across your tweets just don’t seem to exist.

The blog, though, that’s very different. More….crafted. Created. Deliberative. The blogs about my mum didn’t fit that – they were too unconscious, too instinctive. Too raw.

I suppose I’m reflecting on where and when to be spontaneous and where to be more restrained, without losing any sense of authenticity. It’s an interesting dialogue with myself as I refine my relationship with social media. I’d be interested in your thoughts, too.


Alternative Reality part 3

After yesterday’s decision, we start the day shell-shocked. Tearful, anxious, worried. I get up late, but from 9.30am the phone rings constantly so getting myself ready to face the day is continually interrupted. A cousin who’s been through all this with my uncle and was brilliantly supportive, my Dad’s cousin who just wanted to say we were doing the right thing and not to feel bad, my brother to say he was feeling unwell but would see us at lunchtime, the OT from the ward to ask about my mum’s most recent level of mobility, the Dr from the ward to ask what exactly happened on Saturday/Sunday. I give up trying to dry my hair and leave it to frizz naturally. I put make-up on though. Armour.

I meet my sister at my Dad’s before we go to the hospital. Dad doesn’t want to visit and we don’t push it. He says he has slept better than he has for two years. He says he is going to walk round the street delivering Christmas cards. Leaving the house is something he hasn’t done for many months. He looks ‘lighter’. We are pleased for him. We feel bad.

At the hospital Mum has been moved to a ward for the elderly. All the staff are trained to care for people with dementia. It feels so different. I talk to the OT I spoke to on the phone. She was lovely. My sister and I speak to the Dr. He has the same surname as us and we smile about it. We go to Mum’s bedside. She is sitting in a chair chattering nonsense to my niece, who is ok but visibly upset at seeing her Nan. We talk to Mum about cake, visitors, drinks and food. The Chief Nurse puts her head round the door and my sister and I go to the visitors room with her. She reminds us what we said yesterday and asks us to remember how we felt and why we made the decision. She says there will be times when we will think that perhaps we could manage after all, but that we should remember how we felt yesterday and that the decision was the right one. We cry. The Lead Nurse for the ward joins us. She reassures us about care, about processes, that Mum will be on her ward for a while before any assessment can be done and we should know that she will be safe and cared for. We cry some more.

We compose ourselves and go back to Mum’s room. She is in bed, the foot of the bed is raised and she looks dazed and sleepy. Her blood pressure has dropped. The Dr with our name is there, he prescribes fluids (she never would drink anything) and we try to get her to drink. My niece is upset but OK. Mum is drowsy, slurred speech, to weak to suck at the straw. Her blood pressure drops further. Her nurse puts in a cannula and sets up an IV. She pushes the fluid in fast. Mum is unresponsive but asleep rather than anything else. Quiet. Peaceful. We stand at the end of the bed and look at her. We are thinking the same thing. We say it. That we would rather she was like this, asleep, fading but peaceful and not angry and agitated and confused. I think we don’t want her to go back to that. We feel bad. We go for a cup of tea.

Alternative reality part 2

Yesterday we made the decision (my Dad, my sister, brother and I) that we can no longer support my Mum to continue to live at home. It was/is a terrible thing to deal with, and I suspect it will be for a long time to come. We know the decision is right for her (and for us) but…

My Mum’s dementia, a major part of my Dad and sister’s lives for the past two years, just got the better of us. She’s in hospital after a marked change in her physical condition (my sister thought she’d had a stroke) but now the round of assessments will start. There’s a long way to go. Periods of almost lucidity mean that there are flashes of the woman she used to be, and we can have a conversation, albeit briefly.Then the constantly repeated questions start, the confusion about her parents, her siblings, where she lives, where she wants to go. Wherever she is, at some point in the day – or night – she will want go ‘home’ and get angrier, and more upset and agitated. Sometimes I’m June, sometimes Anne or Mary (my sister and aunt respectively). My brother John has become Steve (her brother – dead for many years). When we left the hospital yesterday she begged us to take her home, crying and childlike. Before her admission when she was at home, she begged my sister and Dad on a daily basis to take her home too. In her agitation she becomes abusive, strident and accusatory. Fortunately (how terrible to think of it as good fortune) her mobility is very poor or she would be off and wandering. We know the decision is right for her (and for us) but…

Alternative reality

My mum has dementia. She’s 90. She’s had it for a few years now, but the past year has seen marked deterioration. She no longer walks but can manage some fairly unsafe shuffling on a frame, just a few steps. She only eats if food is put in front of her, and wouldn’t drink at all if she could get away with it. ¬†She veers between the present day and anytime between about 1950 and 1990. She thinks her parents are still alive or have recently died and no-one has told her. She wonders who is ‘that old man who’s always in the house?’ – it’s her husband of 65 years. She is argumentative and objectionable with every member of the immediate family. Verbally aggressive and cruel.

My dad is 92. He is my mum’s carer. He has a leaking (repaired) aortic aneurysm, hypertension and suffers from chronic anxiety and depression. He can no longer deal with my mum. She shouts at him, she gets very agitated and he can’t manage her. He says he is going to kill her.

My sister has been doing as much as she can – more and more – over the past year. She spends most the day there and my dad now calls her at night too when mum goes awry – almost every night. She is constantly verbally abused by my mum. They are both exhausted.

My mum has been assessed a few times. She knows the date when asked. She can answer questions very reasonably. She is polite and accommodating. When asked – yes she can walk. No, she doesn’t need help, she has everything she needs from my dad.Yes, she can get around the house. No, there is nothing wrong with her. Yes, she looks after her 92 year old husband. On the strength of this she is deemed to be fine to be at home. She refuses to have a care package – she doesn’t need one. Last time one was arranged she contacted the GP and cancelled it. ¬†My dad’s views, my sister’s descriptions of her behaviour seem to count for nothing. I live 100 miles away, work full-time and offer moral support as much as I can. I have the easy part.

My mum’s in hospital today. For twenty four hours previously she was agitated, confused and abusive. Constantly arguing and questioning. She couldn’t walk at all this morning, had slurred speech and increased confusion. My sister, at the end of her tether and sleepless for 24 hours called an ambulance and mum was taken to hospital. This evening mum was improved. My dad refused to go to hospital with her. He’s at home, watching tv and relaxing for the first time in two years. He say’s he won’t have her home, he can’t cope. He’s right. My sister is guilt-laden and exhausted. She cannot manage them both anymore. The fragile care from the family has broken down irretrievably. We know my mum will play holy hell if anyone so much as mentions ‘care’. I suspect that tomorrow someone will decide that she doesn’t need to be in hospital. What happens next?

A list – inspired by Anne Cooper


I was reading Anne Cooper’s blog yesterday (here) about the adjectives she would like to have applied to her. She gives a list of those descriptive words and some insights into what feedback she gets from others. That feedback seemed to major on ‘kind’, and I detected a little frisson of disappointment that although it was lovely to be recognised for one’s kindness, there were a whole load of other attributes that Annie was putting out there. It made me smile at her honesty and authenticity (a word I am growing to dislike and distrust – but not in Annie’s case, I hasten to add) and at her pondering on the effect she has on others. At the end of her blog she asks which adjectives her readers might like to have applied to them. It got me thinking. Not least about how we see ourselves and how others see us.

The list of adjectives that I’d like applied to me are:

  • Fair
  • Funny
  • Clever
  • Loyal
  • Committed
  • Open
  • Generous
  • Attractive (sorry, but there it is)
  • Wise

I’m sure there might be others, but those are the ones I would really like. At first glance they look like pretty good attributes to have, and I do know from feedback that most of these adjectives have been applied to me by colleagues, managers, people I work with. But I also know that some of these attributes are not unfailingly positive and they don’t make me some sort of paragon of the workplace. Far from it.

I am well aware, for example, that being fair and being loyal can often mean conflict. That putting fairness before loyalty can feel like unfairness to the person who expected me to be loyal, above all else. So, in others’ eyes I might appear unfair and disloyal when in fact I’m being scrupulously fair and loyal to my values.

I love making people laugh – the smart remark, the quick response, the over-the-top anecdote when everyone is looking at me and listening and shrieking with laughter – there’s no better feeling than entertaining one’s friends and colleagues and knowing that it’s you who have made them rock with laughter. So I know I’m funny. I also know that sometimes, in order to be funny I can be cruel. Not with an intention to hurt, but with an intention to amuse. Humour stands on many platforms – I have to try hard not to stray from one to another inappropriately. Especially when I’m on a roll and all attention is on me.

Committed, open and generous – what’s not to like? Who wouldn’t want these things said about them? Commitment is one of my most closely held values – I work hard, I expect others to do the same, I expect people to do the ‘right thing’ and to stand up for what they believe in. When I sense a lack of that commitment I can sometimes react too quickly – impatient, irritated, quick to judge and to dismiss. After all, everyone should feel as strongly as I do, shouldn’t they? Not so good. I had some feedback recently that made me really think about this – it wasn’t hard to take and I recognised the meaning exactly. Someone said “Ah, that’s June. She runs a bit hot sometimes.” It’s a brilliant description of my occasional lapses into astonishment that not everyone shares my strength of feeling all of the time or about the same things. That phrase was a useful mirror reflecting back to me that commitment to something requires nuance and finesse, flexibility even – even though that might feel like a contradiction in terms.

Openness – now that is something that I hear in feedback, ‘completely open and transparent’ and I really couldn’t be any other way. I am often heard saying “…so, now you know as much as I do. When I know more, you will too.” I can bide my time, I can hold on to information until an appropriate time to transmit it, but there has to be a very good reason for me to hold back information. I trust people and more often than not that trust is rewarded. There is a but though – I am open in other ways too. I struggle to dissemble, I am an appallingly bad liar, my body language is a body-language-reader’s dream. I am, as they say, an open book. When new people join my team, it’s one of the first things I say to them: ” I am very open and transparent, and that means that you will know how I’m feeling – you’ll know when I’m happy or pleased, you’ll know when I’m cross, you’ll know when I’m anxious and you will always know exactly where you stand’. Or something like that. So far, it’s worked well. I don’t play games and I don’t expect game-playing from others. It’s an approach that’s served me very well – and I think it’s one of the reasons I attract good people into my team – and keep them.

The organisation I work in has a set of core organisational values that I helped to define. One of those core values is ‘generosity of spirit’. They appear in our documentation, on the website, and underpin how we work. Generosity of spirit is the one value that most people think best reflects our organisational ethos. I think this is why I love working where I do – because it reflects my own sense of what is important. I try to be generous with my time, with my knowledge and experience, with advice, with encouragement, with lessons I’ve learned. The people who were generous with me are the people I remember. Sometimes being generous means that you get asked to do a lot. Or that you’re near the top of the list when someone needs a favour. That’s not a downside.

And wisdom? Who would claim that for themselves? Well, if it’s not too immodest, I’d like to. If wisdom comes from working through and learning from success and failure, then yes. If wisdom comes from finding out about myself and understanding why I am who I am, then yes. And if wisdom comes from recognising the positive attributes but not beating myself up when the flipside puts in the occasional appearance, then absolutely yes. I would happily accept and recognise all of the above neat and tidy list of labels. And I also happily accept that they’re not always neat and tidy. That makes me….me.

Has the moment passed…?


Safe staffing hits the headlines. Or rather the decision to scrap NICE’s work on safe staffing hits the headlines. If you’re a nurse and you don’t know about this – where have you BEEN??!! Catch up on it here as Shaun Lintern, reporter extraordinaire of Health Service Journal, first broke the news over Twitter. There’s more here¬†and if you want to check out the whole ten days worth just search the Twitter #safestaffing and see the announcements, counter announcements and horrified responses from a very wide range of interested parties. So much shock and disbelief that England’s CNO felt moved to defend NHSEs actions, and you can read that here. I’m not going to rehearse the whole story – suffice to say I am sad, angry, even bewildered that a Francis recommendation and a post-Francis commitment ¬†to formally and rigorously examine nurse staffing levels and to arrive at an evidence-based, expert opinion-informed suite of credible guidelines was pushed aside in such an ill-thought through way. My networks (throughout nursing – NHS, PVI sector, academia, UK and overseas) have been incandescent about it and a lot of nurses have been asking me why it happened, how it could have happened and why doesn’t that good old ‘someone’ do something about it… I have been, as ever, musing on this and trying to be relatively objective.

There were immediate strong reactions, calmly and cogently articulated – a¬†letter to The Times from a collective of high level organisations associated with nursing and this¬†one from Council of Deans UK, as well as concerns raised by NICE itself, Sir Robert Francis, MHNAUK, the President of the Royal College of Emergency Medicine and a number of patient’s organisations. On Twitter and in comments in response to Health Service Journal and Nursing Times articles nurses from a wide range of specialties were angry and disappointed. The sense of appreciation and valuing of their crucial contribution to safe, high quality care that the investment in the NICE staffing work had engendered seemed to have been pulled out from under their feet by an announcement that was difficult to understand. So far, so much well warranted indignation.

So what now, some ten days later? Well…nothing much – publicly at least. I’m hoping that there is work going on behind the scenes because the blogs and the Twitter conversations are dwindling. Arguably the biggest boost to patient safety and high quality care in the UK has been dismantled and there seems to be (what I hope is) a hiatus. Nurses have asked me why the nursing organisations are ‘peeling away’ from the rough and tumble, quietly but noticeably. I try to reassure them that these things are best not played out in the full glare of social media, or other kinds of media, but they are sceptical. Some reflect cynically that open criticism may lead to organisations being zipped out of the nursing ‘great and good’ tent and that’s not what people want. They suggest that the need to have ‘influence’ may trump integrity, even over something as important as this. I don’t think I believe this, though it’s tempting, and it would be a sad day if it is the case. I prefer to think that there is some careful regrouping going on, some consideration of what might be done, what approaches to take once the dust settles.

Those same angry nurses also ask about the absence of any public ‘for’ or ‘against’ comment from the most senior nurses in provider organisations. They either have an expectation that their most senior nurse should be shouting loudly and volubly that ‘the safety of our patients is at stake!’ (Who remembers Nursing Times’ cartoon Nurse Nightingale?) or they are cynically seeing conspiracy and/or helplessness. ¬†I am more optimistic though – I think these nurses will be looking for positive and constructive ways of moving forward with the safe staffing agenda – again as the dust settles.These are tricky times and knee-jerk reactions are rarely the right way forward. The best will lead through this.

Post-Francis we hear a lot about the power of whistleblowing, speaking out safely, the rhetoric of ‘we’re all leaders now’ and how professionals on the ‘front line’ (I hate that phrase) must advocate for patient safety and show leadership. The expectation that the rest of the hierarchy should do the same is strong. But it seems to me that it is just as hard to speak up from the top of an organisation as it is from the bottom, maybe even harder. There is more visibility, fewer numbers to feel safe in, much greater peer pressure, a lot to lose if you’re in the middle of the most successful part of your career. And before being too critical, remember that senior leadership is more about playing a long game, gathering information and evidence, working carefully, cleverly, and with integrity. It’s not always visible, not always obvious. Have a little faith.

The commissioning of NICE to generate safe staffing guidelines was a ‘moment’ for nursing, and as such it was also a ‘moment’ for securing high quality, safe patient care. Has that moment passed? I don’t think so, maybe postponed a little, but the time, not just the moment, will come.