If you’re stressed at work do you grumble about it or start doing something to change it? It’s much easier said than done but Dave Dawes, recently elected RCN council member, tells how it is possible as he discusses how he went from a general nurse to chief exec before going it alone in the public sector.
What made you become a nurse and what made you want to take a step away from patients and move into management?
“I did a degree in maths first and someone from the NMC did once tell me that I am the only maths graduate that they have on the NMC register! 95% of maths graduates become maths teachers or accountants. I didn’t want to do either so I did a career aptitude test at university and it suggested nursing and social work. My mum was a nurse and I had been a first-aid instructor in the Territorial Army so I thought I’d give it a stab and see how I like it. I started my training and loved it.
“Very early on in my training I was becoming frustrated with the way the system seemed to be working, how I was seeing wards run. There seemed to be a lot of really rubbish decisions being made. You deal with that kind of frustration in a number of ways. I thought I could do this a lot better so when I qualified I managed to get on the NHS management training programme.
“It was interesting as I went from being a staff nurse on a general medical ward, to immediately being the manager of the A&E department, surgical outpatients, four operating theatres, two surgical wards and an orthopaedic ward!”
How much experience did you have of being a nurse on the wards?
“I did nine months of clinical practice and when I started the management programme I did voluntary work on my old shift for about a year until that stopped working out. I’ve been out of clinical practice for the past 15 years and do miss it from time to time.”
You managed to be become one of the youngest chief executives in the NHS at the time, how old were you?
“I was 31 and someone said here’s £92 million and 100,000 people to look after, off you go! It was a real learning experience and I did enjoy a lot of it but it is very different to what a lot of people imagine. If you work in a hospital or a PCT you see the Chief Exec as the top dog, someone with full control of the money. When you get to that level you realise that there are lots of layers above that, such as the Strategic Health Authority and the Department of Health. You imagine you are at the top of the tree but you soon realise that you are just one branch with lots of other branches above you.”
Having been a nurse and a manager can you see areas where both parties criticise each other, but with some co-ordination could work together very well?
“Massively so. If we take the RCN as an example, I am Chair of the Nurses in Management and Leadership Roles forum and I can remember open hostility between nurses in clinical practice and their managers in the early 1990s at RCN Congress. I think that has got better over the last decade and when both sides understand each other it can work very well.
“If I am coaching nurses I try to get them to understand the world as their manager does and to try to understand what board members or senior managers do. Conversely when I train people with no clinical background I tell them that they have to understand the care they are commissioning and managing. Without fundamentally understanding this they are going to make some really dreadful mistakes. It takes real effort on both sides.
You encourage nurses to be entrepreneurial, but when do they get the time?
“Time is always an excuse, there is never a genuine shortage of time – the issue is what people choose to do with it. I’ve done time management coaching with people from student nurse level right up to chief exec level and everyone has the same hours in a day. The issue is how you see your work and whether you tend to feel in control of it.
“When nurses complain they do not have enough time, it is usually because they don’t prioritise very well and that they don’t have a sense of control over their own jobs. Actually I have yet to meet anyone that I could not free up seven or eight hours a week. People often say that they are too busy for something, but that just means that task is not as important something else they want to do. No-one is ever too busy to leave a burning building!”
Can you summarise the process you went through when you broke away from the NHS and set up your own business?
“I had been working for the Department of Health for two years and we had just won a national award for our e-learning work on nurse leadership. The project that we were part of was coming to an end so myself and Ali Handscomb decided to set up our first social enterprise in 2003. This was the European Nursing Leadership Foundation which focused on nursing leadership as well as a consultancy for healthcare organisations in and around Europe.”
How smoothly did the process go?
“It went atrociously! In fact quite often when I am helping people set up their own business I talk about lots of mistake that I made. Lots of entrepreneurs make lots of mistakes, but the trick is to make those mistakes, learn from them and change and adapt very quickly. One of our biggest mistakes was trying to replicate what we did in the NHS. We had more staff and bigger offices than we needed so we had to re-think very rapidly and change what we were doing.”
How do the stress levels compare between nursing and being an entrepreneur?
“That’s a really interesting question. Most of the stress in nursing is not being in control of the care that you are delivering or feeling that you’re delivering really poor care. If you look at people in A&E departments or in the military, if you feel you are doing a good job and you are well supported you can cope with most things.
“Being an entrepreneur is a lot more about how much risk you can cope with. There are times when it will get very, very hairy financially and sometimes you have to take huge amounts of personal risk, but it depends on how scary you find that. Sometimes I talk to people and I find that they are very risk-averse so I tell them that being an entrepreneur is probably not the right route for them. There are different stresses and a lot of it depends on your personality.”
Can you name one nurse and one entrepreneur who has most inspired you?
“Margaret Sanger as a nurse. She pioneered family planning in America and a lot of the world-wide initiatives around the development of the pill and access to the family planning. She was an amazing woman, incredibly inspirational and sadly many nurses in the UK have never heard of her.
“For social entrepreneurs, probably the biggest inspiration has been Mohammed Younis who won the Nobel Peace Prize a couple of years ago. He set up the Grameen Bank that lent money to the poor of Bangladesh and helped bring in massive social change.”
Originally published by ProNurse.co.uk the career-based social networking site for nurses.