What would Flo think of Nursing Now?

I have to be honest Florence Nightingale is not a historical figure that I have ever paid that much attention to. It feels almost blasphemous to even type that statement. So I spent a bit of time this afternoon having a read around and educating myself. I guess without Florence nursing would not be an established profession in the way it is today. I would imagine setting up a School of Nursing back in Victorian times was a massive challenge, nursing wasn’t viewed as a very ladylike profession and was certainly not seen as a acceptable work for ladies of a certain social class.

I read some of the quotes attributed to Florence and the one above I thought was very profound. I had a job interview earlier this year (I didn’t get the job!) and I used this quote as part of my presentation. I strongly believe that we must continually be learning and to crave knowledge. I find it hard when I read so many opinions and views that continual learning and education is not needed. That nurses who pursue academia are somehow not interested in caring for people but merely the pursuit of qualifications. I can’t tell you how many times I have heard “you don’t need a degree to be a nurse”. If Florence were here now I am sure that she would be wholeheartedly supporting nurse education, both pre and post registration. Every single day I learn something as a nurse, it may not be earth shattering but I am forever googling, what is that? what does it mean? what are the symptoms? What is the new NICE guidance on something? It doesn’t necessarily have to be formal learning but continually learning and challenging ourselves is something I think Florence would definitely advocate.

An enthusiasm for learning is essential as a nurse, nurses should thirst for more knowledge they should strive to improve the care they offer to patients. I have worked in haematology since 1997, the changes in the diagnosis and treatment or haematological conditions has changed so much over the years. I am sure that all other specialities are the same. We have a duty to our patients to ensure that we are up to date with research and guidelines. We should continually ask questions, just like we did when we were student nurses. We were told back then there is no such thing as a silly question and I believe that is still the same today. I often plonk myself down in a consultants office or in the registrars office and say…Can you explain something to me please? I have never been turned awayor made to feel silly or stupid.

During the Coronavirus pandemic my learning curve has been steep. Learning how to videoconference, mastering Microsoft teams, telephone consultations plus all the updates within my own speciality. There have also been a wealth of free webinars on team building, psychological support, resilience. I have also been enrolled on a course provide by my Local Council on Raising Resilience in young people whilst they try to self motivate at home and struggle trying to master learning at home. Even in something that is aimed at my own child has so many learning points that can be used within my own work environment as we all struggle in these difficult times. I think all nurses have risen to the challenge that coronavirus has presented us with. Nurses have been redeployed, embraced specialities they know little about, learnt new ways of embracing technology and changing the way we work When all this is over it would be a shame to leave behind some of the new ways of working. I suspect if Florence were here she would be wholeheartedly embracing Microsoft teams, virtual ward rounds and a all hands on deck ethos.

Florence Nightingale was a political leader, she challenged the status quo, fought for the patients and was an innovator. Today nursing is a strong profession, full of nurses who strive for social justice, advocate for their patients and is deeply political. Covid 19 has thrust nursing under the spotlight and we must utilise this to show people that it is a highly skilled profession in it’s own right. That we deliver compassionate holistic care based on research and clinical guidelines. That we are proud to be nurses and are deeply committed to our patients/service users/clients.

The Elephant in the Room

 

I really have struggled to think of how to approach this months blog, retention of nurses is not something that I have ever thought of in any great detail. I thought about those conversations I have had with nurses who are moving on to another job, another ward or another hospital. It also made me think about why I have considering moving on myself on so many occasions in the past couple of years.

The chronic underfunding of the NHS and shortage of nurses does little to inspire us. For many staff over recent years the fact that the only training and education they received was their mandatory training is hardly motivating. Health Education England slashed their budget year after year which in turn led to a reduction in funding available locally for CPD. The lack of CPD leads to a decrease in workforce morale and a lack of valuable training, education, skills  and overall professional development.

There are a number of conferences available to the nursing workforce but the cost of these is usually out of reach of many nurses, a one day conference can often be between £200-£300 and that’s without any travel expenses.

The shortage of nurses also leads to restrictions of study days being allocated and many nurses often attend courses and training in their own time. I can’t imagine many private sector employees who pay for their own courses and attend in their own time.

Many nurses are often tempted to other trusts with the promise of courses, promotions and further career development, whether this transpires when they arrive I am not sure. Again having more career development opportunities would help to retain nurses in areas. However the fact that on most wards there are 3 band 6 posts and 1 band 7 doesn’t lend itself to an opportunity to progress. It can sometimes feel a bit like dead mans shoes.

The retention of nurses relies on a solid foundation of CPD, the opportunity to attend courses and conferences. Access to secondments so they can dip their toe in the water without jumping. The implementation of rotational posts to allow nurses to spend time in different areas, to diversify their skills, to experience other areas.

In some ways although the COVID-19 pandemic has been a devastating time for many people and a huge pressure on the NHS many people have moved out of their comfort zones, volunteered in different areas and showcased how diverse the role of a nurse is. The fact that many nurses returned after leaving in response to the pandemic shows that the motivating factor is the fact that you are needed, valued and play a significant part.

Whilst writing this blog a WhatsApp message pinged through, it was a message from a senior colleague saying thank you and expressing their appreciation. Often that is enough, it doesn’t have to be people out clapping, a nursing award or an employee of the month or whatever, it’s a simple thank you.

Who Inspires Me?

I have mulled over this question for quite a few days now and there are many people who inspire me, some I am privileged to actually know and call a friend and others I may not actually know but have heard them speak, read their research/articles/books or simply follow on Twitter. Broadly speaking people generally inspire me because of their behaviours; integrity, professionalism and the ability to push boundaries and make a difference for patients and their families. I admire and am inspired by those who take chances, who probably feel the fear but nevertheless carry on regardless.

•  Those who work and also study for further qualifications. Who crave more knowledge to use improving their own nursing practice and influencing those around them.  You all rock, to do a days work and then head off to university or wherever and also juggle family commitments!  You are an inspiration!

 

• Those who always have time for others, who have time to help, nurture, mentor and support. Those who don’t just talk the talk but who actually walk the walk. Words mean nothing without action and there are many who I see demonstrating kindness both in the workplace and online. You are an inspiration!

 

•  Those who practice integrity, those who are open and honest, are not afraid to have those difficult conversations, to hold themselves up to scrutiny and are not afraid to say sorry when they get it wrong. You are an inspiration!

•  Those who go the extra mile for their patients, who think out of the box and nothing is ever too much of a problem. Those with a real “can do” attitude and are not afraid to bend the rules. Those who have a vision and a real drive to make a difference. You are an inspiration!

 

• Those who lead others, who have an ability to inspire others to catch the vision. Those who empower others, who don’t see others as a threat and are happy to let others shine. You are an inspiration!

I have been fortunate to work with many people who have inspired me, some may not realise their impact and maybe I didn’t at the time. Often it is only by reflecting and looking back that we see the value of an experience. In turn this should also shape how I portray myself. Although I am more likely to suffer from imposter syndrome there is always the small chance that someone may be influenced in a  positive way by my attitude and behaviours. in the same way I try to parent my children by being a positive role model this should also extend to my place of work. To display those behaviours and attitudes that we want to see in those around us.

“You must be the change you want to see in the world” Mahatma Gandhi

The other side of the bed

2019 quite literally was my Annus Horribilis for quite a few reasons. In Feb 2019 my 20 year old son woke up unable to see. I thought initially it may be a migraine as he seemed ok otherwise but had been complaining of a headache a day or so before. He had also had a bit of a bug that week, nothing major just the usual winter germs I thought. I called 111 as I really wasn’t sure what to do do I go to the GP, walk in, A&E. The lady taking the call decided to send an ambulance. I remember feeling embarrassed and thought it wasn’t that serious surely. The paramedics arrived, again really pleasant, temperature was ok, pulse was ok, oxygen saturation ok, obviously being unable to see was a concern and so they decided to take him in to A&E. We got in the ambulance and Josh was connected to the BP machine, the reading was 280/160, I am pretty sure that is the highest BP I have ever seen. The paramedic decided to do it manually just in case it was a dodgy reading, it was correct. At that split moment the mood changed in the back of the ambulance, the paramedic phoned ahead to notify A&E we were coming and the blue lights and siren were activated. I can honestly say that nothing crossed my mind, I was literally clueless, I had no idea what the problem could be. Although Josh has POLR3b he is actually pretty well on the whole, no major issues and from what we have been told of the disease nothing significant to keep an eye out for.  At that moment in time I was not in nurse mode whatsoever. We arrived in A&E resus and it all just escalated. Josh quickly deteriorated, became agitated and combative. A CT scan of his head was needed and this was proving tricky due to his agitation, he was eventually sedated after 2 failed CT scans and on the 3rd attempt with some Propofol managed to stay still long enough for the scan. Bloods were taken and his BP continued to rise. The CT scan showed encephalopathy obviously due to the hypertension. Blood results showed extremely deranged renal function with an eGFR of 15. Josh was then taken to ITU where he stayed for 2 weeks before being transferred to the renal unit in another hospital. He remained in hospital for 2 months, had lots of tests, scans, several episodes of flash pulmonary oedema, had central lines inserted along with femoral lines, started haemodialysis and eventually ended up on home peritoneal dialysis. Both myself and his Dad were a match and we decided that his Dad would donate a kidney and so the preparation began. However on November 11th at 10pm the phone rang, a donor kidney had been matched to Josh. We were shocked and surprised as he had only been placed on the active register a few weeks before and to be honest people wait years for a kidney don’t they? At 6am the following morning we arrived at the hospital and Josh was in theatre by 11.30am. He arrived back on the ward around 9.30pm with his new kidney. This was 12 weeks ago and Josh has a eGFR of 88% (from 8%), a creatinine of around 100 ( from 1600) and is doing fantastic.

There are lots of things that happened  in between but the aim of this blog is not to go over every detail but there are so many things I learnt during this period. Some of the things were practical like peritoneal dialysis  and others were about my own resilience and tenacity. I witnessed and came across some excellent health care professionals, who were brilliant at what they do. I think I had always thought that I knew what made a good health care professional but that came from the position of myself as the nurse. Whilst that is very relevant, that someone is competent and able at what they do I also learnt what makes a good health care professional from a mum’s perspective, a mum of a son with significant learning difficulties. I stayed with Josh 24/7 for the first month, after which time me and his dad took turns. Sitting by your son’s bed for that length of time is challenging. I don’t doubt there were times when I was a nightmare, what could be worse than a patient who is a nurse? It’s a patient who has a mum who is a nurse. There were some I came across who were just wonderful, who I trusted implicitly, who spent time with me too, made me a drink, offered me food, sat with Josh whilst I went for fresh air, reassured me, explained things to me and to Josh, took time to get to know Josh, to understand him and his needs. There have been some amazing people, doctors, surgeons, nurses, domestics, radiographers, porters, ward clerks, receptionists, phlebotomists, student nurses, paramedics, physiotherapists, learning disability nurses. Having worked exclusively in the specialty of haematology for almost 23 years I have quite a small insight into the NHS but this whole experience has opened it up for me.

No one can go through an experience like this and not be changed in some way, it will change perspectives. I can honestly say that I have learnt so much about what matters to patients and their carers/family. Being on the other side of the bed opened up a whole new window. It made me realise what things matter to the family and that often it is the small acts of kindness which mean so much. The fact that Joshua tolerated so much is down to people realising that as parents one or both of us needed to be with Josh at all times. Josh struggles to articulate his feelings and due to his muscle weakness has ataxic speech. I have always been a strong advocate of those with additional needs  and had a keen interest in how patients with additional needs access healthcare in a way that is meaningful and meets their learning needs. This is something I would like to explore further within my role and the past year has given me a desire to make a difference.

It is also important to acknowledge those who have made such a difference and I have tried to always ensure that people are appreciated, yes it is their job but lets face it some people just go above and beyond, it is important to lift them up. In a time of uncertainly and pressure within the NHS we need to build one another up, affirm one another, congratulate each other when something is done well.

My pledge in this #YearoftheNurseandMidwife is to be an encourager, to say thank you to people, to send that email when someone has been helpful and to try to acknowledge all the positives out there. I will begin this by writing to the donor family to thank them for the selfless gift which my son received and although there are no words that will seem enough, nevertheless I will try to convey my gratitude.

Hello 👋

One thing you will soon learn about me is that I am one of life’s procrastinators. I am not a very spontaneous person and am a little fearful of the unknown. I suspect if you met me you would never perceive me in this way. This blog will no doubt be full of my questions, concerns, musings and rants.

I have worked in my current role for 12 years and I love the speciality and the patients. Haematology is such a diverse range of disorders including, leukaemia, myeloma and lymphoma affecting the very young, very old and everything in between. That is possibly why it is so rewarding such a range of diversity.

However the NHS has changed, in some ways for the better but in other ways for the worse. It is now target driven, overworked and underfunded. Everyone is under so much pressure to perform and to prove their worth. As a CNS it is tricky to prove your worth as the interventions are not necessarily coded and therefore don’t income generate. How do you quantify time spent with someone who has just found out they have cancer, who maybe just a few days earlier went to the GP feeling under the weather. In the blink of an eye they can be admitted to hospital and not leave for around 4 weeks. This is certainly the case for a newly diagnosed Acute Myeloid Leukaemia. they have families, jobs, bills, homes and now everything is rocked to the core.

On a personal note I have been married for 20 years and have 2 children, one aged 19 and the other 12 going on 30. My eldest son has POLR3b leukodystrophy a progressive neurological disorder. It was clear from when he started school that he was different. An MRI scan showed a number of abnormalities. The actual disorder was not identified until around 4 years ago when the abnormal gene was identified. He accesses specialist education as he has significant learning difficulties. Having a personal experience such has this has given me a real interest in patients who have a learning disability or additional needs, whatever they call it these days…lol. in addition I know what it is like to live with an uncertain future, not knowing what is round the next corner.

At this moment in time I am contemplating a change of role, after 12 years in my current job I do feel like I am on a bit of a road to nowhere. I feel like I have much to offer in terms of experience and enthusiasm plus I want a challenge. My dilemma is with 21 years of haematology experience do I stay in the speciality or do I move to something different…..palliative care or acute oncology?