Posted in achievement, Art, Change, Commitment, Debate, Development, Environment, goals, Health, Health Promotion. Diet, Ideas, Liberation, Modern society, Personal Growth, Psychology, Skills, Thoughts, Writing

Mindfulness: the Way to Declutter your Head.

I was in a newsagents last week when I spotted a new magazine called Breathe:it was the first issue.

  This magazine is written for a growing sector of readership, just like myself,whose desire is to enhance their physical,social and mental well-being. Designed to include four aspects of living: wellbeing, mindfulness, creativeness and escapism, the magazine is beautifully presented and covers a wide range of related topics, all of which are highly interesting and fresh in presentation. I am already eager to see the next issue on sale, September 22nd and have it marked on my calender. 

But what does it say about the reading habits, especially of women, and of a movement ( gathering an ever greater momentum ) where there are now courses and qualifications for a different type of practitioner? I am talking about the subject of mindfulness, and the interest clearly is growing enough for a publisher to create a new magazine, to include this subject, to live calmer, less stressed and more meaningful lives- lived in the present moment.

For someone who has experienced anxiety and stress, sufficient to have produced depression in the past, mindfulness is helping me now in a number of ways; the main benefit being in the unclutering of the mind. This mental dejunking has had several spin offs and I would like to share those here:

It keeps my anxiety into perspective and I will only focus on a concern in the present moment. A worry about a potential, confrontational meeting, regarding a thorny issue next week, can wait until then.

It has empowered me in my relationships. I am finally shaking off the need to be liked. Believe me, this has taken me years! I can be proud of who I am and have no need to seek others approval. I recognise my own power and this power has yielded results, so that gives me more courage to be assertive. This spiral is on a trajectory of only one way which is up. This excites me.

It has helped me to think more creatively. As a result, I am now starting to doodle mindfulness scribbles and pictures. I intend to share some.

It has helped me develop new hobbies. I have taken up drawing and really enjoy it. It does not matter about the level of skill. When I draw I forget everything. The concentration of the drawing keeps me totally in the present.

As a result of drawing, I have taken up postcard colouring. This is a nice spin off. This has brought joy to my family – so much so that one has been framed. This has brought me happiness, knowing that such a simple thing can bring other people joy.

I listen more, but realise I still don’t really listen at all well. There are gaps in people’s conversations that I don’t always pick up. This has been a shock. I am tuining in more to people and can respond better to them. Challenge yourself on this next time you listen to someone. Is your mind mentally on to the next task of what to cook for dinner?

I have started meditations and have returned to a much simpler form of Christian faith which includes prayer. I am beyond astonished that how these prayers have been recently answered. I search out quiet space, churches, under skies, on my walks for these types of moments. I am grateful so much for this.

I have found time to take up blogging again and to really think about what I want to write. Words jump out of my head randomly for future blog post. In the space of my mind, a book idea and even its title is already taking shape. I just need the belief to write it now and to say I am good enough to do it.

I have uncluttered the house. This has been going on for two years now since moving and embraces the minimalist movement. I like simplicity and space. Even my clothes tastes have changed. I like minimalism and follow Joshua Becker and his minimalist blog site.

Over thinking for me has been a real problem. I think too much most of the time. This is a hard habit to break. Recycling your thoughts have a shelf-life. Sometimes, you just have to bin the trash once and for all.

So these are the main changes and observations to date and these won’t be by far the end, of that I am certain . In the meantime, I am looking forward to reading Breathe and wish the magazine every success. My close friend tells me that when you are in tune with your heartfelt desires, things like books find you. I wish I had found mindfulness years ago but am glad to have discovered it now.

Go out and find out for yourself. You might be in for a few surprises! I would like to hear what you find.

 

Posted in achievement, Change, Commitment, Debate, Development, Liberation, Modern society, Politics, Thoughts, Uncategorized

So We Left

I have decided to write a post concerning the UK’s decision to leave the EU and why, against the astonishment of my own husband and some friends, I decided to vote Leave.

The Brexit camp have been accused of right-wing prejudice, racism and divisiveness, and indeed there will be some who have these motives; a kind of selfishness against humanity of which there is no dignity. However, I wish to defend myself and others here who have been branded by this one brush of darkness.

I am a humanitarian and centre – left in politics. I volunteer for an NGO, am an environmentalist and against neo-liberalist policies. I have never voted for UKIP, nor even the Tories in the last three elections.It has been breathtaking to read the strength of feeling in this debate, some of which has been nasty and potentially patronising, because we dare to ask for controlled and responsible immigration and to take back control of our own destiny.

Decent people with passionate feelings and concerns, as to why we should have stayed have vented this anger;that by denying the Brussels State Machine of Federalism we should be denying the very heart of compassion, love and care for which the majority of people are aligned to. But let’s get to the heart of this debate and why people decided to vote Brexit with three words: beaucocracy , globalisation and immigration.

1) I think we can all agree, that the then Common Market back in the seventies was about free-trade. It wasn’t about stopping another World War, ( NATO was largely formed for that purpose.) Neither was it about creating a single currency, with ever greater political integration. Along with the trade agreements came rules and regulations, and as the years wore on the rules became longer, with more red tape and countless counter clauses and more strangulation with it.

Recently, I drove past some old orchards in Suffolk. My Dad told me that when we joined the EU, the orchards along with the apples were dug up and destroyed. Why? Because we had to accept the French Golden Delicious imports instead. We weren’t allowed these apples grown for years on our own soil anymore.

The same can be said with the decimation of our fishing industry with the Agricultural and Fishing policies, enforced quotas and a sharing of maritime waters.  Lowestoft, my home town, was a thriving fishing community, now this is all but dead. No wonder then, that as early as 1975, people were uneasy and we had a re-think to stay. However, we were in the grip of a recession ( The Three Day Week loomed large in people’s minds),so we decided It was best to hang -on -in- there and stay and hope for the best.

2) You have to ask the question. Why when one country decides to leave a club of traders should there be so much fury, economic blackmail, worry and anxiety? This is of course tied into globalisation. This leads to one pivotal question. Has the EU become so powerful that to dare leave it creates such a horrific reaction of market forces of doom and despair? Of stock market collapses, shoring up of the pound against the Euro and economic fall-out. Should one institution ( comprised of now 28 nations) hold that much dominance, that much power in the world? To want to trade more freely with the rest of the world comes a robust no, like you have no right to ask. How dare you! That the cost is so high no one dares to do it because of your pension fund. Market forces and capitalism at its worst is what springs to mind here.

When Greece was at the mercy of the EU, after it elected a government to address its virtual bankruptcy and collapsing Euro, what happened next?  The newly elected Prime Minster wad told by Merkel this is what you will comply with, or you won’t get your bailout and you will go bankrupt. How many days did they have to shut their banks for, nearly a week? Where was their democracy in all of this? The Greek government wanted a different way, whether that way was right or wrong is not the issue here, but to not have any control was, and still is. Thank God, we did not join the Euro in 1992. That situation could well have been us.

Therefore, You can not wonder why comments were raised about Germany winning the war, by the back door. This is not working together for the common good of man. This felt like a dictatorial superstate. I didn’t like it one bit.

3) Now, let’s talk about immigration and let’s start with Gt Yarmouth. 71.5% of the town voted to leave. Yarmouth has a large immigrant population, run down, depressed and poor. Like Thetford and Boston of which the later had the highest vote to leave of 75.6%, It has a high non-British- born population. Ok, nothing wrong with people’s from other countries coming to live and work here in principle ,but I do have a problem with Gt Yarmouth and Boston for two good reasons which is repeated, especially in inner cities.

Firstly, the creation of ethnic ghettos where you walk the street after nine at your peril. The English man just does not do this there. This is repeated in Luton, Northampton and Bedford, ( that I know of ) because my brother and parents have either worked or lived close to these areas. They have been exposed to it. This is not a racist statement, this is a simply a fact.

An example of this being that my Mother was told by my Dad to keep her eyes down and walk quickly past a gang of East European men raiding cars in broad daylight in Gt Yarmouth. No one did anything for fear they would get a knife in their back. Ok, we can’t say this one action reflects the majority’s behaviour by  these ethnic group. I work with some of these people and they are great but you can see why society is sick and tired of unremitting, unrelenting immigration, given this situation and why right- wing factions seize upon this example.

These passions continue to run high when welfare benefits are sent back home to renovate a house in Romania ( in a documentary last week) or child benefit.  This is against a backdrop of our own homelessness – a national disgrace of which over 300,000 are left on the street or in hostels and savage disability benefit cuts. Mr Cameron wanted to stop much of this welfare going abroad but most of you will know the outcome of his renegotiations on this issue. Mr Brussels said once again,no.

Secondly,  today I learned of an individual having no district nursing cover at their surgery. An A/E department recently asking for only life-threatening injuries to come in because services were at breaking point. Are you seriously suggesting those of you in the Remain camp that we continue to have unlimited free-movements of labour, across 28 member states, not even addressing the huge refugee crisis ( another topic entirely) given the resources we have in schools, hospitals, surgery and housing? Ok, this is a government funding issue, yes it is, but we still don’t have the infrastructure whose ever fault it is. I want to see controlled immigration and I resent being called a racist for it.

To conclude: no, I am not a brain-dead, bigot, nit-wit having a fit of madness to vote leave. I have read widely on this subject. I have given consent based on informed information to the best of my knowledge. I have listened to both sides, even read a whole book about it.

Ultimately, I don’t wish to be part a United States of Europe, at Brussels’ mercy, of seeing TTIP ( sanctioned by the EU ) to erode our already precarious NHS. I don’t want to pay my hard earned taxes to shore up Brussels, their sub committees, beaucocracy, for MEP expenses, etc,etc. I don’t want to see exploitation of migrant workers on low wages, living in container blocks like battery farm hens, such as those in our Eastern ports. I don’t want to see depressed wages for the rest of us as a result.

Yesterday, contrary to feeling ashamed, I was proud to be British. To stand up, be counted and have courage against the hysteria and the scare-mongering. I am European, want to trade with Europe, be friends with Europe, work together with Europe against war, climate change, famine and disaster. I just don’t want to be a part of a federalist super state. For that I am maligned and chastised today by those in the Remain camp.

If we in the Leave side are so wrong and the EU is such a sound institution, then why have we got a domino effect rippling across the continent after 24hrs. France, Denmark and Holland are asking for the vote too. We dared to question. We stood up for the true meaning of liberty, equality, fraternity. Yes, there will be extreme right-wing factions seizing the chance to promote their dangerous ideology but in reality it is going to be the Common Man, the Working Man, without an extreme political agenda that will seize the day and have the deciding vote.
Make no mistake, the EU will change as a result of this vote, it has to. PIty Brussels never gave us a chance to change it from the inside. It will change and secure its future because we Brexits were brave enough, against the tidal flood of criticism, to vote for a new path. The British vote was the catalyst. Perhaps then, for once in a very long time we can say, that this may not be defined as our finest hour ( I am not comparing myself to Churchill) but it certainly wasn’t the darkest one by a long shot.

Go on Britain, let’s come together and make this work!

Posted in Modern society, Psychology, Relationships, Thoughts, Time

Christmas

Angel 2

The tug and pull of Christmas.
Like tinsel on a tree swaying with responsibility.
Over who is chosen and who should wait.
Until the next day, or do we cramp all our loved-ones in a box, tied with ribbon.
And open it all at once;
them springing up like a Jack-In-The-Box saying:
“Merry Christmas.”
How I wish I could get it right and have something left for us as well.

Christmas is a time of giving but what if you have been spent up all year.
Not just meaning money but in time and energy.
But being dutiful, your carve yourself up, like the turkey.
Seeing everybody but seeing nobody.
I don’t know what to make of Christmas.
Who benefits, or even if we are suppose to benefit from it at all?

I would like to get away from all this really.
Just for one year but duty calls and expectations beckon.
Roll on New Year!

Posted in Change, Children, Commitment, Debate, families, goals, Health, Home, Modern society, Thoughts, Uncategorized

I Am Seriously Worried

Yesterday, I started to really look and notice something for the first time. Walking along the seafront, my eyes wandered around the people and their outlines. Many were overweight, and the striking thing of all was that many young and middle-aged women were not just overweight but clinically obese. Yes, the word most Women I am using here, from what I saw yesterday. And overall women appeared to be fatter than men. I wondered why.

That word fat is an awful word isn’t it. We don’t like saying it, as it potentially portrays a negative comment about an individual. It conveys that we have no self-control. That it is our fault we are just big. Fat is bad both in word, shape, image and representation. It is an ugly word and you just don’t say it. We avoid it and look beyond it to another conversation. TV programmes have aided this invisibility of weight. Being in love with your curves, dressing to enhance the natural shape are the things to do. Yet, I know several women who have tried to “diet” another bad word. Like me, they can fluctuate from weight loss to weight gain and then stop and start.

Against this, we have a tide of programmes showing us every aspect of cooking. People like to watch Masterchef, Nigella Lawson and Jamie Olivier showing us to how to cook. We have no shortage of inspiration tips and advice. Cooking on a budget, cooking something different. Cooking healthy nutritious meals, it’s all there. Sadly, most of us appear to be using it for entertainment against the reality of true cooking or not, as the case may be.

We have had a lot of media coverage about the ailing health service struggling to cope, the time bomb of heart disease, the labelling of food and a food industry that is committed to serving us fat, sugar and salt. The simple truth is we are losing the battle on eating a diet to give us health. A newspaper report this week showed stark figures that our children will die before we do, as their weight and lack of exercise spirals out of control. The not so hidden rise of Type 2 diabetes, heart disease, liver disease (yes, as we consume ever dangerous amounts of alcohol) is causing greater alarm bells than ever before. We simply won’t have a health service able to cope. Societies health is going to collapse and the infrastructure to support it unless we take some radical action now. This is what is going to happen and that is why I am seriously worried.

I can’t begin to answer all the questions that could be posed here as to what could be done about it. What I do know is, how hard it is to lose a few pounds. How when you go out to eat, in the vast majority of typical restaurants, you find it almost impossible to eat low-calorie, low-fat, tasty food. I know full well how easy it is to throw food in the supermarket trolley just because your are tired after a day’s work and just want to get home. And once you are at home, you just throw something quick and easy into the oven because it’s just too much bother. How you need time to shop wisely, how you need positive energy to make the changes. Healthy eating and weight reduction is hard and it can be costly. Many people on ever tighter budgets can’t do it and the apathy is, I just don’t care. I do my best, I eat what I can.

We eat for comfort, we treat ourselves to chocolate as a reward to ourselves for a hard day. I am not judging overweight people at all. Everything is stacked against us. I am not overweight but I am in the same boat as most of us. I will be sharing on my next blog what changes we have managed to make here as a family. It’s not been easy and by no means has the battle being won yet but we are trying. This is being done because quite simply we can’t rely on our health service to patch us up. It isn’t going to there for much longer. We have to look after ourselves now the best way we know how.

Posted in achievement, Change, Commitment, Debate, Development, goals, Government, Health, Human Rights, Learning, Modern society, Politics, Psychology, Skills, Thoughts

The End Of My Nursing Days.

In my twilight days of nursing there saw an introduction of a laptop computer. We all had one provided and training on how to use it. Those days had seen our area of work extend and staffing cut. The laptop had one very important function: to record data. This is what we all had to do. My area of work was then in the community, so I travelled a lot, covering many miles sometimes between two surgeries caseloads and in all weathers.

Every detail and work entry had to be recorded on a system called System One. So that meant that every phone call, procedure, paper work, (EG, if it involved an referral or assessment), was logged. This had to be done for every patient visited. The time we took to do each thing and how long it took to get from one patient to the next. This was logged in our work dairies and then onto System One. You still had all the patients personal records of care to do in the home as well, I might add. This was asked for to help see where the workload was, for accurate records of patients, and to prioritise resources.

You can imagine that this was a lot of work and when we could not get it done in the days schedule, it had to be taken home to do it. We were all given the appropriate connections to the data base to get this done. At the same time, my e-mail box was forever getting fuller. New policies, training, forms, referrals and memos. I personally was finding it harder to keep up. Sometimes, my brain was a fog and the effort to juggle the balls was becoming harder. My own personal stress levels went up and I felt vulnerable. Vulnerable that I would miss something, forget something. I had a note book and wrote everything I needed to do down so everyone got seen, every task and communication done. My tick list was ticked off at the end of the day and shredded. I worked incredibly hard but the passion and the enjoyment went to a very low point.

It was like being a hamster on a wheel. The harder you ran, the harder the wheel turned and it just went round and round, always to the same place, never to finish. Because the hamster was always running and the wheel just ended up at the same point for you to run all over again. It felt like you were getting no-where.

Sometimes, a ray of energy would emerge. A really excellent job was done, you had made a difference to someone’s life and job satisfaction prevailed. You were happy and pleased and felt it was all worthwhile. But, like the hamster, the next day you were back to just running, eventually you burn out and that is what happened to me.

In the end, I had had enough. I had done all that I could do. I knew that there was no end in site to any of it, if anything it was going to get worse, and I have been told that since then it has got worse and I am well out of it.

But I took 28 years of care with me and it was brave decision but I just said no-more. I thought, as it had been my identity all my working life, it would be hard to let go. But it hasn’t been. Now, my new life working in a school as a teaching assistant has made me so happy, opened up so many new doors. I have never looked back. I go to work each day never having the dread or the worry. There is no stress and if there is it is very minimal.

I had some wonderful times, happy memories, really dark days, sadness and some regrets. But I did something worthwhile and I did it well and for that I am proud. I have written these blogs to defend my former profession. I could not just sit back and let the recent press hound us in such a way, without trying to defend those still brave enough to work in nursing.

I would say to the general public one thing. Come and do a shift. Put a uniform on for a day and live it with us. See what it is like. I am not defending shabby care, hostility and I am not minimising the pain that bad care has caused to families. I feel ashamed that such cases have existed. But the general public just has to know how hard and almost inhuman it is to be asked to just keep going, like we are now asked to do in such work conditions. This is the vital message I want to convey to any reader out there.

Later this week: a summary of what has gone wrong, given what I have discussed here and what can be done now if at all?

Posted in Change, Debate, goals, Government, Health, History, Human Rights, Ideas, Modern society, Politics, Skills, Thoughts

Government Policy And The NHS.

When something is going wrong in a system of work,fingers naturally will often point to the management structure. Senior staff can be questioned, managers decisions criticized.in this case with the NHS, the biggest manager and where the buck totally stops, is with the Government of the day. They have the overall say in how our NHS is run.

I am no expert here on figures and am not a statistician . What I can say can only be based on what I have seen for myself and read in the media. So let’s take the Mid Staffordshire case. The horrific situation of systematic failings in care was largely created by a catalyst of cost cutting and the relentless drive towards becoming a Foundation Hospital. In order to become that,(foundation status means more self-governing) the hospital had to slash debt, have improved performance targets and be seen to be keeping on track, not only in budget but what it could show on paper to be improvements, efficiency and throughput.

In-fact, this objective is part of every hospital up and down this country. Along with this, the Private Finance Initative called PFI’s was introduced by the last labour government and its impact have made the present situation even worse. PFI’s are loans to hospitals to rebuild, improve and to makeover old hospitals into shiny, spanking new ones. However, many of us will know the outcomes of hospitals struggling to pay off these loans. They have been left with huge debts and deficits.

Then, on top of that, we have fines if certain targets are not met. If a patient goes over a four hour waiting time to be discharged from the Accident Emergency Department to a ward, transferred to another unit or sent home, the hospital is fined. If an ambulance does not deliver and dispatch a patient in a certain time span, it is fined. This is all supposed to be about improvements in performance, get the stick of financial punishment out, and somehow magically results will be produced forthwith. But what has happened? As wards shrink in size, as hospitals slash inpatients beds and staff to save money, there results in a chaotic rush of bed juggling, and the frantic efforts to free up beds against fewer manpower resources. If a patient is discharged and then that patient is what we would term a “bouncer”, that is to say they are re-admitted within a certain time frame,the hospital gets… you guessed it, a fine!

How are hospitals suppose to stay on track budget wise if all they are threatened with is fines? This is government policy now and it is doing nothing to help patients with their care.Infact, this only creates more pressure to treat a patient as a price tag, a unit, a juggling ball on a bed; and leads to what we have heard about bed moving in the middle of the night, against the tide of complaints of sleep deprived patients on wards. It’s like musical beds. Patients become little more than another stat to be got through the system as quick as possible. Now we have jobs purely for bed managers and early discharge assessors and the term, the “bed- blocker” comes to my mind. This is when someone is stuck in the system with no outlying community bed to go to ( because they have been either cut or closed) but they can’t go home either.

Never has the pressure for beds and timed targets been so great as it is now; with increased population, sicker older people, increased expectations of the population to be seen and treated and the changes in GP’s out of hours care. Literally hospitals are fit to bust…..

I leave you with a question. How can these government-led poliices be conducive to quality total patient care? And the nurses, as well as other NHS staff, are caught right in the middle of it. I tell you something: it makes for a hell of a lot of stress. It does nothing to help health-care professionals, with their own mental health, who are suppose to be angels or compassion, care and tranquillity, when really they are tearing their hair out, to give this essence of care that is talked about….

Tomorrow: An example of the crazy burden of data collection and why ultimately I left NHS Nursing.

Posted in Change, Debate, Development, Government, Health, History, Modern society, Politics, Psychology, Religion, Skills, Thoughts, Uncategorized

Good Leadership Skills Within the NHS: Are They There Or Not?

During my nursing career of 28 years within the NHS, I worked with only three exceptional leaders of people. Two of those leaders worked together in the same unit. One was senior to the other and both worked in harmony together. It was some of the golden days of my NHS life.

When you have a good boss, it shows through and through. You feel valued, invested in and your opinions matter. There is a fairness and compassion within that person. They are interested in people, usually are highly skilled and experienced in their field and have a humane and caring character. They have disciple within themselves and enhance and encourage that in the workplace. The atmosphere in the place of work is happy, standards are high and efficiency prevails. When you are asked to perhaps stay late, or to help in a crisis of staffing, you will come forward because you invest in your workplace, in return for how you are treated. Well, that was how it was for me anyway. 

Sadly, overall leadership within the NHS is poor in my opinion. There are good leaders in the NHS of course and these ones stand out. However, a good leader is often challenged by higher management, if they are not a “yes man” and not always popular with that seniority. In the end these people leave and go on to other positions, leaving the vacuum and the loss behind. Poorer management often comes in as a result and then staff leaves and recruitment/retention gets harder. Moral goes down: stress goes up.

I think one of the problems for nursing is a lack of experience in leadership. Historically, to become a ward sister, at one time, you needed to be qualified for five years.

This is now a dreadful statement to make but I have heard someone say once, that nurses are like “painters and decorators”, you climb the ladder so fast that you scarcely come into contact with any patients. This is a simplistic and rather brash view, but the point here is that, I personally feel that the quality of those in charge, in terms of interpersonal skills with people, CAN be lacking. There just isn’t that core backbone of personal standards, discipline and integrity that there once was.

Then at the heart of the matter, combine these factors with nurses who do not feel listened to by higher management. They feel dis-empowered, that no-one really cares and that they are just a number, easily dispensed with and easy to replace. Challenge anything with anyone who is in a higher position than you and you will often come out worse. Employees can easily feel start to feel vulnerable. Conflicts and bullying are present in the NHS, just as they can be in any large employing organisation. Staff feel threatened and gagged if they dare to speak out. Confidentiality clauses are cited as a means of fear to shut people up for fear of losing their jobs or being frog-marched up to the NMC ( Nursing, Midwifery Council) professional conduct committe. Nurses are in a terrible dilemma if they feel standards are being compromised, yet have no confidence in any leader to talk to or simply feel too afraid. They trust no one. Both the Royal College of Nursing and the NMC have issued guidelines on how to whistle-blow professionally but too few are still prepared to blow that whistle at a local level with a mortgage to pay.  

Finally, it is in my view that the NHS also operate within a very rigid and hierarchical structure. Everyone knows their place in the pecking order from cleaner, to porter, from nurses to doctor and consultants. There is less snobbery now between those at the top of the management tree to those at the bottom; and nurses are no longer seen merely as doctor’s hand-maidens due to their increased technical and skilled roles. Thankfully, there has been this shift ( enhanced by our increasing number of graduate nurses) but both leadership qualities and this persistent hierarchy remains an issue……

On Monday: Management decisions at the very top- Government policy. How PFI’s and the obsession for targets and figures are critically wounding our NHS.

 

 

 

Posted in Change, Debate, Government, Health, History, Ideas, Modern society, Politics, Skills, Thoughts

The Role of the Qualified Nurse. Past and present

When I qualified I remember what was then called ” task-orientation.” We started in bay one and went, in two teams, up and down the ward with our care and our trolleys. With aprons on, we washed and turned, fed and hydrated our patients. Every chart was filled in, everyone seen, mobilised, toileted. Dressings were done,medication was given and when that was finished we went off to separate breaks ( one team at a time) and then came back and started it all over again.The ward sisters -there were two of them had an eye on everything. Nothing was missed and woe betide you if it was missed. The ward sister was the heart and the nucleus of everything. Doctors went to her, everyone went to her. She often took the phone calls. She managed everything. I was lucky as I was on a strict but excellent ward in terms of care. There was no shortages of nurses wanting to work on this ward.

However, task orientation was criticised. It was not giving personalised, individual care. People were not a set of tasks but with unique and differing needs. The regular “Kardex”, as it was called then, of writing up the care was changed. Up to this point it had been short and concise. An idea from America came to our NHS,it was shaped on the Roper’s Model of Care:it was called the Nursing Process. This was the first of the mountain of paper that emerged.It meant that all patients had to have an individual care plans for every activity of living. These were first hand written and then when I left nursing they were typed photocopies and had become little more than tick-boxes, another task in my opinion.

Then something else happened which changed our role. Doctors were working sometimes 80 hrs a week, being on call etc and this was rightly considered too much, something had to be done. With this concern came an increase in technological advances in care. Patients who might have died now lived with advancing medicines, diagnosis and procedures. Slowly, the nurse practitioner would be born out of all of this. However, in the mean time sisters were becoming bleep holders, budget holders and bed managers. Staff nurses became clinical shift leaders and I was told to take my apron off and start running the ward instead. There were still qualified nurses and nursing auxilaries doing the care, but what was once undertaken in a higher dependency unit was now becoming mainstream on the wards. This was very marked for me when I returned to acute nursing after working for four years in elderly care rehabilitation. The work load even by then was becoming more stressful.

So registered nurses paper-work increased, more advanced skill became the norm, including venepuncture, cannulation, IVI drug administration to name a few. Hotel workers replaced nurses both qualified and unqualified in giving out meals and drinks. The nurse mentor was born and he/she was now responsible not only for patients but for students as well. This was all happening when I left acute hospital nursing in 1993. I left and went into community after a particular night when one visitor came up to me and said:

” Hello again, there are two things I observe about you. One is that you are always here and two you are always writing out bits of paper.”
It is now 2013 -20 years has passed since then.

Now multiply what I have said a few times more, as demand for services, changing clinical roles, paper, stats, sicker older people, European Economic Community patients needing care, cuts in resources, cuts in staff and you can begin to see why we are in the current crisis situation. Also, crucially from the very top of the decision-making tree, our government and senior NHS management, who increasingly see patients as a entity of profit-making and not focusing on them first as someone needing care. No wonder the Government is stating that it is costing just all too much and auctioning the whole care parcel out to who ever can give the best price…..

Tomorrow: Let’s start to look at leadership within the NHS.

Posted in achievement, Change, Debate, Development, Government, Health, Learning, Modern society, Skills, Thoughts

So What Improvements do We Need to Student Nurse Education?

Today, I want to discuss two points in relation to student nurse education. (Please bear with me as this has to be a longer blog post today to get the points across.)

It has been suggested by the Government that before an individual embarks upon nurse training that they should spend one year as health-care assistants so that they can learn compassion, care and have a better grasp of the basics of nursing. I would pose a question to you, as one who now work in education. Would you say that in order to train to be a teacher you have to become a teaching assistant first to understand children, their needs and how they might learn more effectively? No-one is suggesting this, so why nurses.

Yes, it can be strongly argued that having some ” grounding” in a care setting is helpful in giving you an edge, a valuable insight and knowing if nursing is for you. I can’t argue against that. I, for one, was a nursing auxiliary for ten months prior to student nurse training. However, many potential student nurses attending interview have done just that.It’s seen as having a possible advantage in being offered a place, if you have worked in, say a care home or as a nursing auxiliary. Yet, certainly when I was nursing ( up to 2010) there was an emphasis on basic-care needs that had to be met in order to pass one’s placement. Teachers learn to be teachers with one years post-graduate qualification after a first degree. Student nurses take three years. I would argue that student nurses have enough time to learn to be registered nurses if the quality of the theoretical and clinical teaching they receive is safe and effective. Any prior experience before this is very desirable but not essential.

This brings me to the second point and a potential flaw in the current system. The clinical teaching and assessment of student nurses is now in the hands of registered nurses themselves, mostly by staff-nurses working in an unit or ward. Many nurses are inspirational and dedicated teachers but many are not. Historically nurses have not been taught to be teachers in the same way that teachers have not been taught to be nurses in school. Teaching is a skill. I must add here though, that in order to be a mentor, nurses have to be qualified for at least one year and then go on to pass a three month teaching and assessing course at level three( degree level). In practice even with this, teaching quality can still be very varied. Personally, I loved being a mentor and felt that I gave the support and teaching that student nurses needed. I was passionate about it and did my very best. Every student nurse knows that a mentor, their attitude towards them and what they can provide in knowledge and experience, can make or break a placement. Every student nurse told me that, and I learned that first-hand again when I was a student midwife. 

Also, we now have what is called sign off mentors. So at the end of the students training their last placement has to be signed as passed and fit to practice by a sign- off mentor. This is not a clinical tutor but again a registered nurse. For me this was a half-days training on the paper work and the seriousness of what was being asked of, for those who were doing the signing off. That’s a lot of responsibility and means that the quality and safety of all the placements assessments have to be there, right from the word go!

Mentors know how hard it is to give the time, care and attention to student nurses in a busy and packed ward with stretching workloads and demands on time. Students stick to them like glue as they pursue their work, teaching on the spot and on the job. Most do their best. Lengthy student assessments have to be completed. Standards of assessments are much more rigouress in today’s nurse education. For me, back in the 1980’s, it was four small pieces of paper and tick boxes of accomplishments graded from outstanding to poor, now there are pages and pages of it. I am not saying the tick box was best practice either but I am making the point that, in theory, the standards of education are there but in practice it can vary widely from placement to placement and from one nurse mentor to the next.

Therefore,I would like to see the return of qualified clinical tutors in the work area working alongside mentors, supporting and helping them teach and these tutors easing the workload by taking charge more of the students and directing them in clinical area activities. Then I believe we can see the clinical quality of student nurse education improve…..

 

Tomorrow: moving on to being a staff nurse on a ward. What it was like for me. What I did back then and what staff nurses have to do now.

 

Posted in Change, Debate, Government, Health, Human Rights, Modern society, Skills

The Student Nurse.

Let’s begin with my training back in the early 1980’s. When I was training to be a nurse, most of my experience was gained in the clinical area. We were part of the numbers, were employed by a hospital and was paid a modest wage. The ward sister was responsible for our end of placement reports and oversaw our educational,supervision whilst on their ward or department.There were clinical tutors who visited us regularly. They were on-site at the hospital, as there was a School of Nursing attached to that hospital. They came on to the wards and helped us learn to do a bed-bath properly. We were reminded to change the water, the first bowl for the hands and face, the second for the body. Mouth care, eye care, hand care and even hair washing was taught both in the classroom and on the wards. Even now, I remember that to wash the hair the bedhead would need to be taken off first. Who has had their hair washed by a nurse whilst on bed rest recently?

There were four assessments that had to be passed. One of them was called total-patient care. This is where you were assessed solely on the care of one patient or a small group of patients. This meant that all elements of care had to be considered. Clinical observations including blood pressure,fluids, charts, dressings, medicines-everything. A tutor from the School of Nursing or senior nursing team on the ward would be responsible for that assessment. We were all nervous of course and I remember mine to this day. For me, I was in ITU at the time and looked after the cardiac patients.

Then education for nurses changed. Project 2000 came into force and this was the start of the nurse being seen, not as a pair of hands but a student and supposedly supernumerary- not counted as one of the shift numbers. Nursing was becoming a profession that first saw the Diploma of Higher Education qualification and then onto the graduate status. Why? Well, this was to reflect the growing complexity of the role and to give the profession more status as a profession.Schools of Nursing were moved to Universities and the clinical tutors became redundant. There was to be more theory taught. The terms evidence-based practice was part of the new terminology for care and this was led by current research.

Let me stop there and say this, which may surprise some of you. I am all for a graduate profession. The reasons why will be discussed in another post. While, I accept you do not need a degree to wash patients,I am totally behind seeing a workforce who questions the care they give and why they do it based on the best quality research available. Learning a skill is not enough in 21 st Century nursing. It needs to go a lot further than that if we are to deliver safe and effective care. The increasing advanced skills we are asked to do and the complex conditions we now treat, where sometimes several pathologies have to be considered is another reason……

Tomorrow: So what needs to be addressed with student nurse training? And why sometimes student nurses do not feel supported as they move towards registration as a qualified nurse.