I have worked as a consultant for nearly four years and it has huge benefits but also drawbacks. I love working with someone and not for someone but it can be a lonely and stressful path. In order to win business we often need to work alone and that doesnt suit me at all and never has. Winning business equates to paying essential bills and in the months when clients are scarce or organisations are cutting back and paying late it can be incredibly stressful. There are high prices to be paid for leaving a service which cushions you from some of the pitfalls and stress of managing money which is never certain.  I acknowledge that managing budgets and financial pressures are stressful but they cannot be compared to knowing that you are a step away from bankruptcy or from problems putting food in front of your kids and the joy of knowing my salary for the next four months is safe and secure is unbelievable.

 On the plus side being a consultant and running a business has taught me a self suficiency which the NHS never could and has enabled me to say and do things which were certainly impossible within the precious fold of the department of health. I have been more honest about the reality facing a service I love and a profession of which I am proud to be a member.  I have sat in front of senior people who have listened to me properly because they have paid for my advice and have taken that advice and made improvements to their organisations and to the nurses working in them.

Going back may mean that I am not listened to in the same way and may shed some light on why organisations cannot solve their problems themselves by listening to the clinical voice telling them things which are clear, practical and often simple common sense.

I am looking forward to really getting my teeth into something. A consultant has a severely limited timescale for making judgements and improvements and is under delivery schedules which often are based on money rather than on what would be best. I am excited at the prospect of a full four months in one place and a feeling of belonging somewhere and being part of a team and an organisation.

And my fears? Ahhhh, already the slimey hand of bureaucracy is crying for attention and the noose of conformity is shrieking but the policy says in my ear. Of course those who know me well are looking forward to my expliots and are eagerly awaiting my downfall in the face of these foes but it hasnt happened yet and I have worked in the NHS since 1984 so I am certain four months wont do it now.

 Good and perhaps we will see the end of large scale expansion into ideas such as social enterprise and the current vogue for encouraging nurses not to care or do their job but to become “entrepreneurs”. This whole idea smacks to me of desperation. First we had leadership initiatives which were supposed to transform nurses and encourage best practice everywhere and now we have the emergence of a market for creating entreprenuership.

 What exactly is meant by this term? I dont think many  people have the faintest clue. Do we really need or want people within the healthcare system who do everything differently? Whatever happened to getting the basics right? OK so it isnt sexy, it doesn’t sound like Richard Branson and people from the Apprentice are going to save us and reform and modernise services but frankly it is what the service is crying out for.

Nurses across the country cant get things such as stopping people wearing their uniform too and from work right. Patients and visitors wander around hospitals looking for direction whilst staff busliy ignore them. Patients want a district nurse or widwife who sorts out their care efficiently and effectively and doesnt shape services or create a new vision.

Is this a role for an entreprenuer? Not really it is boring to most people but can mean the difference between a person getting a five star health service and something no one really understands or perhaps even matters. There is always room for improving services but the patient should be at the centre of such changes and the crucial relationship between patient and nurse should be where improvements to services should be focusing their efforts.

“An internal memo has been sent to wards at East Lancashire Hospitals NHS Trust asking nurses to regulate the milk that they put into drinks for patients. Nurses have said that this has already resulted in them having to deny teas and coffees for patients in Blackburn and Burnley hospitals. Officials state that the amount of milk is not being reduced to save money but that they were trying to ensure that consumption was reasonable. Nurses are being asked to discourage patients from enjoying milky treats such as Horlicks or Ovaltine until bedtime. One nurse (who did not want to be named) said “they now only provide one hot meal a day and now one hot drink is what they’re saying. It disgusts me when food and drink is the basic essential needed for getting better.”
Incidents have occurred where diabetic patients have been unable to have a milky drink to keep their blood sugar in check.””

It seems crazy to me that managers can make stupid decisions like this. Not only is it a really bad decision, it demonstrates a complete lack of understanding of economics as well as healthcare. Every day that someone is in a hospital bed unnecessarily costs the Trust hundreds of pounds. This policy only has to delay the recovery of a handful of patients to cost the Trust far more than it will save buying milk. It also shows a staggering ignorance of healthcare and nutrition. Milk is a fantastic source of calories, vitamins and minerals and should never be restricted to people who are ill, who often need all the calories, vitamins and minerals.

Many nurses complain to us that they have to deal with managers who do not understand healthcare and make decisions which harm patient care, reduce staff morale and often end up costing much more money in the long run. Perhaps more managers should have a clinical background or at least try to understand more of the core business of their organisation, which is providing healthcare not saving money.

Why is this ok I ask myself? How awful to have to beg for money in this way if true and if not how awful to do such things.  I loathe these emails and am aghast at healthcare being demanded in such a way.

Yet could this happen elsewhere and if we got rid of our treasure of the NHS would it ever happen here? We sometimes forget how precious the NHS is and how much we rely on not having to stump up huge amounts of money for basic life saving care. We have no need to send an email because we have a service on which we depend and which is at heart dependable. There are many people out there who are not so lucky and as I gaze at this babies face I am reminded of all that we have.

1) podcasts are entertainment. If they are informative as well as entertaining then that is all the better, but they have to be entertaining. There is a good reason that they don’t put very dull corporate output on the radio or TV.

2) podcasts are generally listened to in people’s leisure time. Who wants to listen to their boss talking at them in their own home or car?

3) podcasts need to be regular. There needs to be a regular output which eventually grows a user base and a cohort of regular subscribers. Look at the really popular podcasts on iTunes. They are entertaining, informative (sometimes), generally ahve a number of presenters and are prodiuced weekly (or monthly).

4) video podcasts are IMHO self-indulgent. Even with good bandwith, these take an age to download and there has to be good engaging visiual content for that to be worthwhile (not just the chance to look at someone’s head)

We currently produce the most popular nursing podcast on iTunes (Busynurse podcast) because we have multiple presenters, try to keep the content interesting and engaging, produce a regualr show (we are now on our 20th podcast) and have hundreds of regular subscribers. If all you are going to do is put out some dull corporate blurb then put it in a plain text format and use email or a webpage or even (heaven forbid) post it. Trying to use technology like podcasting inappropriately is not only a waste of money but it can make the oragnisation look foolish.

 I am awaiting the Chinese New Year now and this year it is the year of the pig. I wondered what the year of the nurse would look like? Well I think something like the year of the pig.

“Its better to give than to receive” would probably be the Pig’s motto. Pigs are more comfortable giving of their own time or attention than they are to ask others for it. They do not find asking for help an easy task and would rather carry the burden themselves. Pigs will do anything they can to maintain a sense of peace amongst family or friends. This can lead to a tendency to be taken advantage of, but Pigs basically forgive and forget everything. They are compassionate souls who simply want to keep the peace.”

So, Yes I am going to rename this the year of the nurse. I was going to campaign for us to become more like my old namesake the tiger (the year I was born in) but having looked at all the chinese horoscopes there is not one which accurately describes the sort of nurse I would like to see.

What sort of a nurse is that? Someone who does ask for help when needed and does not struggle on regardless. A nurse who will fight for what is right rather than maintain a sense of peace and who will fight not only on behalf of their patients but also for their own rights as nurses. A sense of compassion which enables the nurse to make sure there is fairness, equity and justice both for them and for their clients.

We need to become fiercer in order to change things we do not like about the current trends in health care and in order to ensure that we are at the front of any change taking the lead on the shape of services and patient led care.

 We have been really busy with our podcast and getting some support for busy nurse which can only exist and grow if nurses register and join the growing number using our free resources and development tools.

I have made a number of resolutions which I mean to keep for once and many of them are in terms of my job and career. So my first, which is blog once a week, is starting today and you can always support me in this by adding a comment or three!

After ordering the HSJ online in September I have started receiving it on a regular basis - I guess late is better than never but it does explain their falling reader numbers. There are a number of interesting stories but what has struck me is the lack of jobs in both the HSJ and the Nursing Times. Where once the job sections were huge and scoured by anyone with a pulse now they are scimpy sections with almost nothing in middle management. Admittedly online recruitment and NHS jobs has taken off so why would cash strapped organisations spend huge amounts on print adverts, but still it seems to me to represent the current problems in the NHS and perhaps also the private sector.

In the meantime the Keep our NHS Public campaign launched a report in London on Saturday (which we will try and link to) regarding the patchwork privatisation of the NHS. The report makes the point that whilst the government says that the NHS will have a plurality of providers and will continue to be funded through taxation access to a service is not the only determinant of whether a service is public. I think this point is crucial and a good example provided in the report is that ITV is different from the BBC although both provide television which is free to the viewer.

Much of this modernisation is yet again untested and being rolled out too fast and  what has happened has neither represented value for money nor better services as a whole. For example, privatising services such as the provision of oxygen has resulted in chaos and one woman, Alice Broderick, has died while waiting for an emergency delivery of oxygen that took nine hours to arrive.

I am surprised by the lack of public debate and worried that the government is simply slipping in one change after another without proper scrutiny. Whilst I welcome new and creative thinking in health I remain deeply scetpical that the current agenda is going to improve the health of those in society who need the NHS the most.

 Prior to my first student nurse Christmas I was working at Tooting Bec as it shut down and threw an advent party for the residents. I remember decorating the main room and a tall patient walking around touching all the decorations and talking animatedly to them in his own language which made perfect sense to him.  We cooked Chicken and black eyed peas and the staff gave us £50 and helped me set up a disco for everyone!

My first Christmas day was spent on a care of the elderly ward where my family came in and visited people who had no visitors, not in a lady bountiful manner but because they genuinely wanted to support me in what I was doing. My brother was in his late teens and the ladies thought he was gorgeous. My mum remembers one man telling her that he knew when someone had died because he always peeped through the closed curtains! We all had a christmas lunch together with sister at the head of the table and then I went home to open my presents.

We always had a drinks trolley at big events like Christmas and New Year on every ward (and usually  before Sunday lunch as well). I used to sing carols on the wards and in the main entrance to the hospital with a group of other students.

Nights over Christmas also involved me bringing in my stocking and opening it all night long whilst trying to keep going with the chocolate in it. One year I did this whilst sitting with a man who was dying very noisily of lung cancer, drowning in his own secretions. The next year I spent new years with a man who was Islamic and was having the Koran read in Arabic whilst he died.

My first new year as a student I was holding a vomit bowl listening to Big Ben and cars hooting on Westminster Bridge whilst a woman retched coffee grounds. I always felt a sense of closeness with others in hospital at these times but what always impressed me was that no matter what life goes on, the woman retching was trying to gasp Happy New Year in between spasms.

Merry Christmas to all our readers and a very Happy New Year.

 My personal favourite as a patient is to be looked after in a single room, maybe its a nursing thing but I cannot rest on an open ward and being in hospital means I am ill and need rest. I am not sure this is my favourite as a nurse however but mixed sex wards have never made sense to me in any context.

Other nurses have told me that actually there is evidence that in mental health mixed sex wards are better as patients socailise more but the evidence that over 300 assaults on women patients have taken place in mixed wards in mental health over the last 3 years would lead me to say they are dangerous and bad.

Christmas is nearly upon us – or has been since July in some places - and as shopping days dwindle I am reminded of how good Christmas was in hospital. I wonder if it is as good now as it was when I last worked on the wards which is some time ago, but people used to dress up and many years ago we had a proper turkey carved by the consultant and dished out by sister. We also used to have a drinks trolley for patients and sherry before nearly every meal. My best memory is of a patient who had a cardiac arrest on Christmas day and came round to find the sister dressed as a christmas fairy and a consultant dressed as father christmas working on him. He must have thought he really was dead .

 Before I go into complete “good old days” mode though it would be good to collect peoples best working stories of christmas and if anyone wants to write in with them feel free to send them to stories@busynurse.com. 

Why couldn’t these nurses think of any modern nurse heroes? Is it that there haven’t been any great nurses in recent times? That seems unlikely. Figures like Trevor Clay, John Goodlad, Christine Hancock, etc have had a major impact on nursing but their names do not seem to trip off the tongue of today’s generation of nurses.

When the exercise is repeated at a personal level (i.e. people are asked to name a nurse who inspired or supported them), nurses can often recall a particular ward sister or tutor or care assistant who touched their lives. Sometimes through their words and sometimes through example, nurses carry the inspiration of these personal heroes into their everyday practice. They recall them with smiles and affectionate memories and produce wonderful anecdotes and clinical stories.

So why does this inspiration happen at the personal level but not at the level of the whole profession. Why aren’t there the equivalents of Nelson Mandela, Mother Theresa, Bob Geldof, etc who are celebrated in nursing? In an age of satellite television, the internet, mobile technology, etc it is easier than it has ever been to pass stories around and yet we don’t tell stories of great modern nurses.

Maybe we should have a Nurse Heroes Day where we all have to find a modern nurse hero and simply tell other people about it. There could be small celebrations in clinical settings across the country where we tell great stories about modern heroes that can inspire as well as Florence, Edith, Margaret and Mary did to their generations. In colleges across the country, student nurses could hear stories about modern nurses who have changed practice, influenced institutions and governments and moved the profession forward. And perhaps, just perhaps, this may inspire the nurse heroes and heroines of the future.