Nursing needs its leaders to respond to FrancisPractice blog
All posts from: December 2012
What are your New Year resolutions at work?
It seems that my resolutions have a five to one hit rate – that is of five resolutions only one will come good. But nevertheless I am thinking now about my list of do more/do less and hoping that some of them will stick.
Some New Year resolutions are easier to decide than others. It’s not hard to make the obvious ones of eat less, exercise more, go to the cinema once a week, read more books, drink more water, drink less tea and of course just drink less. But making them around work can be more tricky.
Policy overload – both national and local – can leave you feeling that there is no space for you to make change as an individual. Perhaps New Year resolutions at work should not be about meeting targets or reaching objectives but should be about wellbeing in the workplace. After all you are your responsibility. And the New Year gives us a chance to judge how we are feeling about the past year and the one coming up.
So New Year resolutions offer a chance to to think about how best you can nurture and protect yourself in the workplace. I am thinking about resolutions that will improve my work life balance. Leaving on time, taking a proper lunch break and eating healthy food at work – no more biscuits! How about you? Will it be about getting enough sleep before an early, how you use time before a late shift that means that you don’t feel as if you spent all day at work, cycling to work, getting the earlier/later train, taking proper breaks or what?.
I hope that your resolutions have a better hit rate than mine. Perhaps one of mine should be – stick to my New Year resolutions. Good luck with yours and have a good 2013. If you have any that you would like to share with us please do.
When making a difference makes it all worth it
One of my oldest and dearest friends reappeared in my life late last year, over 20 years after disappearing. She had spent the intervening years battling severe mental health problems that made her assume her friends and family wanted nothing to do with her. These have not gone away, but she has felt able to get back in contact with people.
Having her back in regular contact has been one of the highlights of my year, and since she tracked me down via this website I have Nursing Times to thank for that.
However, she also brought home to me that the work we do can make a difference, even if it is simply by ensuring the wider profession hears about some of the excellent practice and innovations nurses are responsible for.
We recently published an article on the use of reading groups in mental healthcare, and the same week my friend told me she had gone to such a group for the first time. It had taken her weeks to pluck up the courage as the new situation provoked anxiety for her. However, she had met new people who had a love of literature in common, rather than only mental health problems, and they discussed novels and poems that meant something to them, instead of these problems.
She was so enthusiastic about the group that I sent her the issue of Nursing Times containing the article. Three days later she told me she had read it out to her group and it had touched them all so much that many had cried. She thanked me for publishing it and said the group hoped it would enable more people to benefit from similar initiatives.
Of course I played only a minor role in ensuring the article was published. The authors did all the hard work in setting up and running the group, and writing the article – which highlights the importance of sharing good practice through publication.
However, it did bring home to me that even though we may not directly transform lives ourselves, we at Nursing Times do give you information and tools that can help you to make a difference. That seems like a pretty good reason to get out of bed in the morning.
Why should you buy your manager a Christmas present?
I was idling my time away on twitter a few weeks ago and came across a blog by Dean Royles, the director of the NHS Employers.
It made me smile.
He bemoaned the fact that “Hardly anyone supports and encourages NHS managers, or shows any recognition or appreciation of the context they work in or the difficult, sometimes intractable challenges they face”.
His blog struck a cord with me.
We often describe managers as faceless bureaucrats, men in grey suits doing terrible things to make our jobs more difficult.
But any nurse who has had to juggle a Christmas off duty will know what it is to make difficult decisions. Hours spent deliberating, manoeuvring and negotiating and despite every effort no one is happy.
I don’t believe any of us came into healthcare to deliberately annoy and antagonise our staff.
I was speaking to a manager the other day who has spent 10 years building a team and service and the last 18 months dismantling it. Clearly staff and patients were angry but funding had been withdrawn and difficult decisions had to be made.
I asked why she didn’t leave and she described how committed she was to the last 10 years and the staff who had made it work. Despite the flak she was getting from those around her she felt she had to hang on in there for the good of the team.
So in the season of goodwill think about your managers and the difficult jobs they have. And to quote from Dean’s blog, “We have some – in fact, a lot of –brilliant managers doing a tough, demanding and mostly rewarding job that they love and care about”.
So if you have one of them, go on, buy them a Christmas present!
The care gap that cheats nurses and patients alike
As the news focuses again on the dangers of going into hospital and the pressure I wonder if we are missing something fundamental.
I know from my own experience how quickly things can go wrong when the bed pressures take precedence over safety. Some years ago I worked a night shift on a ward with seven empty beds.
Within 15 minutes of starting work we had four patients arrive, three at the same time. The admissions ward refused to hold off on the next three patients who arrived in short succession. At 2am we were still completing assessments, trying desperately to get through the work.
Then the cardiac arrest buzzer went off. One of the new patients had arrested and by the time we confirmed she was not for resuscitation, CPR was well under way and the team had been called. No-one remembered the transfer nurse handing the DNR over and the admitting nurse had not had a chance to look in the patient’s notes.
The patient didn’t survive, she died alone and she didn’t get the end of life her family had been promised.
We wrote an incident report but like many nurses we finished a shift feeling we had worked really hard but let our patients down.
I seems to me that just as the Beveridge Report could not have anticipated the effect of modern pharmaceuticals and medical advances on longevity, neither have we really got to grips with the demand that an ageing population is putting on our health care system.
There is endless talk about the need to provide more care in the community but while there is a shift in that direction, these developments are not keeping pace with demand.
Without adequate community services is it surprising that pressure on beds and pressure on staff is increasing and mistakes happen?
Currently we have hospitals with too few beds and community services that are not sufficiently developed to provide acute care at home. Between the two is a huge gap that no one wants to take responsibility for.
The people who suffer most are the old and vulnerable who end up in a system that is not designed to meet their needs being cared for by people who care but simply don’t have time. That is not good for anyone.
Six-step dementia care approach must be given a chance
Alzheimer’s disease and other forms of dementia are devastating both for those unlucky enough to develop them, but also their families.
The early stages of dementia must be terrifying, as cognitive abilities disappear, and while we cannot know how it feels to experience advanced dementia when the ability to communicate or to understand what is being said is affected terribly, we can only assume that for most people it can only be worse than that.
For family members, watching their loved ones gradually losing not only their independence, but also the personality traits that made them who they are, is horrific.
Many families continue to care for their loved ones when their dementia has rendered them unrecognisable as the partner or parent they once were, seeing it as their last opportunity to show love or gratitude.
While dementia can reach a stage where 24-hour care in a specialist setting is essential, this is often reached as a result of personality changes resulting in challenging behaviour that compromises the safety of all concerned. If this behaviour could be addressed, it may give families more time together.
News that an American team has developed an approach to managing these symptoms offers some hope to these families.
The six-step approach can help clinicians to identify and manage most behavioural symptoms of dementia without medications.
Instead the focus is on identifying triggers for these behaviours and establishing structured routines, both of which are likely to reduce the distress caused by confusion.
Designed for use in any setting, including primary care, this tool has the potential to give families extra time together, and to reduce some of the fear that dementia causes.
I hope those commissioning care for this patient group will make resources available to test its efficacy, and assuming it has positive effects, will ensure it is rolled out widely and quickly.
