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Nursing at Christmas

Christmas is a poignant time of year for me in many different ways.

This will be the 15th year that I have spent Christmas with my work family. Even though I’m in no way religious or affiliate myself with any religion Christmas to me means family time. I now realise how precious this is.

My first Christmas working I remember it started as a rather festive affair, people dressed with tinsel, played festive tunes and everyone was in jovial spirits. This changed shortly after our morning break, there was a pre alert for a person from an RTC, she was about 25 years old and had an accident on her way to spend Christmas with her family. She was also around 36 weeks pregnant. She had been trapped in a vehicle and by the time she had been released her heart stopped beating. She came to us in cardiac arrest, we worked hard but were unable to get her back, we continued to resuscitate while the Obstetric team performed surgery in the ED to deliver her a beautiful baby girl who also sadly died. I didn’t know her name or age or what had actually happened. The nurse in charge delivered the news to her family. The team were destroyed.

That year because I was working, my family decided to go away for Christmas without me, so I went home to an empty home and cried myself to sleep. It had a profound effect on all the team but I think when I look back now the greatest lessons I learned was about love and family.

Christmas since then has never been the same for me, It’s not important in terms of the religious connotations but it is the one time of the year where family spend time together. Often being a nurse automatically rules me out of spending time with family, over time I have missed weddings and christenings and parties because of being committed to my work, but I always try to make more of an effort to spend some time with my family at Christmas.

Nowadays Christmas in the ED is absolutely no different to any other day at work for me. I’ll work 12.5 hours and in that time I’m guaranteed to see at least one case that makes me cry as well as one that makes me smile! I’ll spend time with the elderly man who has no family and diagnose him with loneliness, I’ll fix a stupid injury ….. last year that award went to the 78 year old man that hurt his shoulder doing a roly poly to impress his grandkids! They’ll be someone drunk, several people with stomach pain after over indulging but there’ll still be lots of love no matter what!

This year has been incredibly difficult for the healthcare system, targets aren’t being met throughout the UK, NHS in debt causing real terms funding cuts, resources scare. It is an incredibly difficult place to work. I wouldn’t like to be the new nurse nowadays. I am constantly questioning whether staying in nursing is the right thing for me. I’ve given the best years of my life to the profession I loved 20 years ago but it is now so highly critical and increasingly more difficult to work in. Governed by people who have never set foot in the department I work. I know that I don’t have the support I had when I first started and I’m also not able to offer the same support to my juniors. One day I’ll decide what is best for me. What I can say though is that despite the politics every single person I work with just wants to do their best for the patients that need us but I do realise how hard it is!

Tragedy happens all year round but it always seems to have an impact around Christmas. This year think of the doctors and nurses who have to deliver bad news, the ones that are trying to save lives and the bureaucracy that they are having to work with which is making it more and more difficult to do their jobs effectively!

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Public Sector Stress

Let’s talk about stress!

This week it has been reported that stress related leave is 30% higher this year for fire staff, one in four ambulance staff have taken time off for stress in the past year and 9 out of 10 emergency care staff experience damaging levels of stress.

I am seeing this every day with the staff I work with and within myself.

I recently read Trauma by Gordon Turnbull. Who looks at the treatment methods for PTSD. Interestingly he wrote that experiences of stress were the bodies normal reaction to abnormal events or levels of stress. I think stress is fascinating to look at, simply because it has such a profound effect. As a manager I can look at sickness rates and find that the majority are stress related. Stress can be exhibited in so many different ways, through physical symptoms such as IBS, headaches, migraines, body pains, nausea, fatigue and sleep problems. It can also be seen through emotional symptoms such as anxiety, anger, depression and feeling generally overwhelmed. Finally it can be seen with changes to the persons normal behaviour, alcohol, drug use and withdrawal.

Why is this happening within emergency care? So I can confidently say stress affects me most days…. don’t get me wrong a certain amount of stress can be empowering and liberating but when it becomes a constant something has to give.

Let’s take last Thursday’s shift as a typical day, this involves a 12.5 hour shift. I arrive to start clinical work at 09:00 and find that I have around 100 emails all of which are highlighted as incredibly important by whoever sent them, there are complaints that need resolving, incidents that need to be investigated, staff with concerns and still there are patients that need to be looked after. I also have a queue of staff at the door before I get my coat off with all sorts of problems. For me patients come first every time so I look after them to the best of my ability. I get a sandwich and a drink around 4pm and decide to look at the emails while I have a quick bite to eat. Now there are another 30 emails that need sorting. After 20 minutes the consultant comes to me to say that I have a queue and need to get back to work. I’m due to finish my shift at 9:30pm, always invariably there is a challenging patient which needs my attention today was a young girl who had been stabbed by her boyfriend and leasing with social services and completing the domestic violence and safeguarding paperwork took forever so I don’t finish till 10:15 and go to look at my emails and the ever expanding to do list! I concentrate on trying to finish a presentation that I am teaching at 09:00 in the morning to junior staff I get home 11:30 at night, cook myself something to eat, realise I haven’t had time for a pee all day, I cry because although i try to sort everyone else problems out I actually do not know how I can keep going on with this level of stress….I’m exhausted. Not once in my day did anyone say to be “are you ok?” “do you need a break?” or “do you need any help?” I know I’m just exhausted and this is a symptom of a broken system. Pressure is being put on emergency care currently, the NHS is a failing system in incredible amounts of debt, therefore recruitment of staff is not easy. Justifying the need of another nurse and having it authorised by management is hard work. Therefore we are all working in systems that are short staffed and at the same time having to keep up with high levels of cleanliness and patient care. The quality indicators that we have are achievable if staffing levels are appropriate. The current climate of financial difficulties within public sector means there are less people trying to keep up with overwhelming demand! It is physically not possible. What happens when concerns are escalated…. Jack ****. It’s like managers are putting on the pressure but are not able to see how unrealistic the demands are, along with constant degrading remarks, put downs and constant tellings off. We know we’re not perfect but we are trying our best because that is what the patients require.

Why do I do it? I know the answer to this…. if I don’t do it and put in the effort who will for my patients and my staff?.

When I think of members of emergency care staff experiences of stress I always used to think of those that worked with the military and for overseas aid agencies… What I’ve learnt is that it is actually right under our noses with emergency care staff and we’re actually not very good at addressing it. As a manager if someone has time off for any reason I make sure to keep in touch … I have found when it was the other way round and I needed to have time off I was made to feel ashamed and guilty for having time off .

Stress is an absolute epidemic within emergency care staff… and I can’t see anything being done about it.

Look after each other!

Terrorism effects

Another week and another terrorist incident in my beloved London. To me it almost feels like disruption due to terrorist incidents is sadly just becoming the norm. But I think it is very different to previous times. There now seems to be a cycle in the UK, it goes like this…

Terrorist incident – grieving process & outpouring of love – British defiance & get back to normal ASAP.

I am left thinking about what the effects are overall though. The British are quite well renown for their stiff upper lip mentality… Keep calm and carry on! They’re not very open when discussing feelings and stuff that hurts them. What is the real effect?

There are many victims of a terrorist incident. Those with a physical injury are usually easy to identify and the first to have assistance, those that were nearby and not physically injured have the potential to have a mental health injury, the helpers like emergency services and hospital staff can have a secondary traumatic injury, whereas they were not directly there at the point of impact but they witnessed some of the horrific scenes afterwards, and finally those that see some of the horrific scenes on the TV and through the media.

I’ve seen terrorist incidents from a few different viewpoints now. As a nurse I’ve looked after patients involved in incidents in London. I have personally been close to both a grenade attack and shooting incident when working in Africa, where people close to me have died and been injured and have felt the fear that I’m going to die any second. Now living away from central London I have watched events unfold through the media. If I’m honest this is what I worry about the most.

I remember the first time thinking about the media effect on terrorism was in December 2014 when the Lindt Cafe in Sydney was held under siege. I was at home doing the ironing and this came on the news channel. Now I’ve never been to Australia, and have never been to a Lindt cafe so had no connection to the scene but I have to say this really effected me. I didn’t know if it was because of my past encounters with trauma and terrorism or if this was a new thing I was witnessing. The events played out over the news channels, the hostages names were found out and family members spoke, it was on TV like it was a movie, but the realisation of this being a real event with real people and lots of explosions and shooting. I remember seeing one person receiving CPR and then wondering if this was a hostage or a terrorist. I was also thinking this is the worst time a week or so before Christmas these people all had a family and a story behind them. I think out of the 16 hour siege I must have watched about 8 hours that day, up to the end. Most of that in tears while considering the stories of those involved!

The one thing that intrigues me is the unknown effect of the media on these events. Natural curiosity makes people watch these things as they are happening, but this year I have seen unconsolable people being interviewed as witnesses, I’ve seen CPR performed on terrorists in the middle of the day, I’ve seen hysterical families looking for their relatives on the media, while knowing the likelihood 2 days after a terrorist attack is that their loved one is a victim they just don’t know it yet. I’ve also seen the media make incredible mistakes in reporting names of people involved before the police have found all contacts and future threats.

Is there anyway that the media could be more responsible in the reporting of these attacks. Reducing the overwhelming effect of the media on the general population. Report facts as opposed to speculation, consider what images are being sent to the media. Let the police and emergency services do their jobs and when they have something to report that is ready to be public information they will let everyone know. In a world of social media the responsible thing to do is give any footage or pictures to the police. It concerns me because not only I might be watching but so might our children, even worse the terrorist or other potential terrorists might be watching to see how much “terror’ was created.

The main aim of terrorism is to create mass terror of everyday situations. In the UK we have become used to this over the years. I’ve learnt that these have no place in any religion and are indiscriminate to all people. In my mind the only way to conquer it is to approach it with love, empathy and respect to those involved, and although difficult at times, to not let it affect the way in which you go about your normal everyday life.

Keep Calm and Carry On!

ED Patient Safety

How do we improve patient safety in the Emergency Department?

The A&E clinical indicators are what Emergency Departments are measured against looking at how long a patient waited, how many waited over 4 hours, how many left without being seen, how many patients returned, percentage seen by triage within 15 minutes, percentage seen by clinician in 1 hour and the feedback comments received from patients. These are useful in terms of departmental performance but in the last few years they have become almost impossible to achieve.

7 years ago most EDs were able to achieve seeing 95% of all patients within 4 hours. Now almost no EDs are able to achieve this. In those 7 years ED attendances have gone up by over 10%, staffing numbers have been stagnant despite constant asking, staff training has been almost non existent, and funding has reduced. So how is it going to be possible to maintain safe effective patient care without commitment to change.

I’ve worked in the ED for around 15 years and I’ve never before known morale to be so low. If you ask any of the nurses I work with the one thing that they say to be a factor is that they haven’t been able to look after their patients properly during their shift. This is happening every single shift. They are also being blamed for not achieving the quality indicators every day. I have shifts where I am spending time consoling upset staff, trying to raise morale, give constructive advice, debrief for bad shifts and everyday I go home exhausted! Then I get a day off and have several phone calls, texts emails and social media posts asking for advice or help to cover shifts …. no wonder the staff are exhausted and morale is low.

So what can be done to help improve the situation?

The firefighting needs to stop and start planning for the future, look at staffing levels and training, review incidents to see where mistakes have happened. Allow staff to have a work – life balance and start to look after them, provide pastoral care and forums to bring up suggestions.

There are tools to help assist patient safety, the BEST staffing audit from the RCN Emergency Nurse Forum can help to identify nurse staffing needs. To be fair this is a great tool but should be done independently, and is significantly time consuming to do.

RCN competencies for Emergency nurses can identify training needs. It is so important to train nurses to work in the ED. Don’t just shove any old nurse into a vacancy but give them the appropriate skills to work in the ED to make them more effective, and ultimately making patient care safer.

Create a safety culture instead of a blame culture. When the department is not performing look at what would make it safe instead of blaming the people working in that situation for the performance.

Policies for overcrowding. I’ve not seen any of these but I think it’d be useful so that the nurse in charge has the ability to understand how to manage safety with overcrowding.

Has anyone else got any ideas we can try?

 

 

Hawking v Hunt

There’s some interesting debate this weekend with Stephen Hawking being critical of the Conservative government and Jeremy Hunt in particular. So who is trustworthy enough to believe?

As an Emergency Nurse I have to be appropriately qualified for my job. Lets face it you wouldn’t want to come into the ED with me on duty not knowing what to do! So let’s take Hunt, he studied Philosophy, Politics and Economics at University. Prior to working within government he worked as a management consultant, taught English as a foreign language and numerous entrepreneurial adventures including a failed attempt at selling marmalade to the Japanese. Not exactly a glittering career. Professor Hawking on the other hand has a significant amount of qualifications, awards, medals, he is most well known for providing understanding of the world using science, he is arguably one of the greatest scientific theorists of all time!

What science teaches us is to question! As a nursing student we learned to appraise data in a critical way, to check the reliability and validity. As time changes more data is available to appraise and use to validate practice. So one piece of research mentions a weekend effect and 16 other pieces of research say that it isn’t relative. Someone who is a scientist is able to look at the data in it’s entirety and make a balanced judgement. Someone who wants to create issues, or to make up propaganda will be able to find data out but it won’t ever provide a balanced view. This is a bit like if a company is trying to sell something like a drugs company … this is the best drug ever because the one piece of research… that as a company we have paid for … shows us we are right. This isn’t accurate or valid science.

The other thing that intrigues me is the motivation behind stories like this. Professor Hawking’s motivation is what i would consider to be a concerned service user, someone who knows exactly what it is like to be a patient within the NHS. Whereas Mr Hunt has reportedly taken his children to A&E because he ‘didn’t want to wait’ for a GP appointment! This is encouraging the inappropriate use of already stretched services.

As an ED nurse on the floor, I can guarantee that there is no weekend effect. There are doctors and nurses working every single day of the week and if a patient requires emergency treatment they will get it, if they need a scan they will get it, it they need a consultants opinion they will have it. The weekend effect is some fictitious made up theory that is not supported by science. If the health secretary and government had an understanding of what it is actually like to either work within the NHS or be a service user of the NHS they would have an understanding of this! So I’m with Hawking, I’m also very concerned about the NHS!

So my message is before you believe the propaganda, have a look at the supporting scientific data and assess if you think it to be real or not.

 

 

End of the NHS as we know it!

The NHS is a British institution we’re proud of right? We even played tribute to it in the opening ceremony of the 2012 Olympic Games.

In 1948 the NHS was set up to provide free healthcare at a point of requirement for everyone no matter who or how wealthy the person was, removing the previous inequalities in health that existed. This is something that as a nurse I am incredibly proud of. I have worked in systems where this is not the case and where many people die instead of getting help. I worked at one hospital in Africa which asked for a contribution of the equivalent of 20 pence to be seen in the hospital. The hospital didn’t turn anyone away if they were really poorly but by that time it was usually too late.

The NHS has many issues at the moment, and to be honest it is making me question whether I want to be working in the system.

NHS funding comes from the taxpayer. It is recognised within research that the total amount of GDP used for funding the NHS has gone down in recent years from 6.3% in 2000 to a projected 5.2% by 2020. This is significantly below the EU average of 10.1% and despite there being a privatised system in the USA their funding in GDP terms is around 17.8%. That sounds incredible doesn’t it.

A well funded system is able to support the future of healthcare, money can then be put into education and research as well as front line services.

The real terms effect of this reduction in funding is services being squeezed, beds being closed across hospitals, staff put under more pressure to deliver services, with fewer resources. There would appear to have always been some difficulties in delivering services within the budget, when three years after the start of the NHS it was decided to start to charge fees for prescriptions, dental treatments and eye care.

Now there is increasing demand for all services and less funding, some treatments don’t get the same amount of attention. For example some places in the UK will have guidelines for non urgent care like IVF, or even guidelines for specific expensive drug treatments like oncology treatments or mental health treatments. Both of which have a significant impact on the patients overall wellbeing.

So as funding has decreased, the cost of new treatments, new drugs and innovations has increased. As has patient life expectancy, among with the reduction of childhood mortality. Have we got to a point that the NHS can’t actually do everything? Are we expecting too much.

This can be seen with the recent NHS Cyber attacks, the computer system was vulnerable because the cost of upgrading it and looking after it just wasn’t as important as other funding priorities. Only on becoming a national crisis was something done about it, and sadly I know that some patients had negative outcomes as a result.

It would be interesting to know where money is going. For example when I trained we were told each nurse cost the NHS £45000 to train. Now students are having to fund themselves to train …. where is that money going?

Sometimes i do think that the NHS have significant money wastage. I never can understand why I can buy a decent chair at Ikea for £50 but almost the same one through NHS procurement is £400. Why does each trust need to go on recruitment trips overseas each year to plug the latest staffing crisis, when they could grow their own and look after the ones that they have. A lot of recruitment trips prior to Brexit brought workers to the UK and polls after Brexit suggest that 60% of European workers were considering going back due to the uncertainty around employment. We need to look after these workers, they are the ones propping up our creaking system.

So at the minute we are in a position with less financial resources even though on the front line there is a constant pressure to maintain good patient care and deliver performance targets.

On a personal level more and more I realise that I pay for services that I would have previously expected the NHS to provide. For example I was injured in an accident 4 years ago in the course of my treatment I needed an MRI, Physiotherapy and Psychotherapy input, when I realised this would be difficult to fit around my full time job without requiring sick time and that the waits were a long time along with the anxieties of not knowing what the problem required. I paid for everything privately at my own convenience. I’m really lucky in that I could afford that at the time, but it has made me appreciate that other people have significant challenges in obtaining the care that would improve their overall health and wellbeing. We are so focussed on individual problems, instead of overall well being. To be honest I write a prescription every single day that I know will not be picked up due to the cost of it. So much so if someone gives me a really good story about why they won’t get their prescription I’m also quite liable to give them a tenner with it.

Staffing issues are increasingly prevalent within the system, use of agency has been under scrutiny, mainly because of the cost and IR35. I work with the most amazing agency workers who come from all over the world, there is some resentment from the staff on the shop floor, how an agency member of staff is paid significantly more than the sister in charge of the department with very little responsibility. But these workers are absolutely required until establishments are recruited to and retention of staff is improved.

My opinion is that although the NHS was set up to address inequalities in healthcare, more and more it is creating inequalities every day. We can help it by using services appropriately, buying medications over the counter, consider financial wastage, improve funding but that can first be done by looking at where the funding goes and the effectiveness of it. Most of all we need to encourage staff to stay, it’s all too tempting for young nurses to go to Australia or New Zealand, where they can have better wages and an improved work / life balance. Why can’t we adopt some of those strategies here.

 

Suicide in Healthcare

This week there was sad news that another junior doctor took his own life while working at a hospital.

It made me remember three years ago when I was called into the consultants office to be told  that a friend and colleague had committed suicide. I was devastated, we all were. Jim had been a larger than life character in the Emergency Department, he was a brilliant nurse so caring and gentle towards his patients and colleagues. He was the first to give a round of hugs on a bad day and did anything he could to make us all laugh. But he also had his problems, and we all knew that, he’d recently been through a marital separation and was struggling to find his way alone in life. I have to say at the time I was incredibly angry with him, for not getting help at the time. Nurses are helpers in the world, I guess that I think if he just contacted one of us at work and told us what was going on he might still be here now. I’m not angry at him now, I’m sad he’s not here and I still miss him all the time.

I remember in university, many years ago, learning about Durkheim and the social theories around suicide, but do you know what, no one in my career has ever said that this is an epidemic within the healthcare professions. Looking at literature from US, UK and Australia, this is a problem worldwide. No one has ever said to me to watch out for signs of myself not coping or how to approach colleagues who are not coping.

I don’t understand why healthcare professionals are actually not much good at looking after themselves or are the last people to get any help. Myself included in that! Is it because of the shame of not being able to cope when everyone around you looks like they are coping well. I can guarantee that if you feel that you are not coping there will be at least one colleague that feels exactly the same as you. As a manager I learned that whatever crisis one person was going through publicly in the department, another was going through something much worse and usually in private. I felt in a privileged position if one of the team trusted me enough with their personal issues and insecurities, as a manager I could then provide them with some support.

I personally think that acknowledging the human factors affecting yourself in healthcare is important. For example when someone is tired, overworked, stressed, it’s not possible to look after the patients with the same ability. It is important to be able to switch off from personal problems when at work, but also acknowledge that when that is not possible, it’s time to reevaluate what is going on and what extra support is required.

There is absolutely no shame in getting some help, it doesn’t have to be through work but it can be. From my experience it would depend on my relationship with my manager as to whether I approached them for help, but there are usually opportunities to have clinical supervision, occupational health services, a family doctor could also point in the right direction.

So what have I learned

  • Importance of talking to people … a problem shared is a problem halved!
  • Build a social network outside of work.
  • Have some interests away from work
  • As a manager be approachable, learn about your team.
  • Learn what your work and occupational health team can do to support you.
  • Keep work and home separate as much as possible.
  • Learn to look after yourself, understand yourself and how you can manage stress.
  • Get help if needed and don’t be ashamed of it.
  • If a colleague appears stressed or not right, ask them what’s going on … it might just say their life.
  • Remember suicidal thoughts are usually temporary and they will pass, get some support till they pass!

Helpful resources

Disparity between physical and mental healthcare

Two patients attend the ED, one with a broken arm and one with a self harm wound. They get treated the same right? Although I like to think that I would treat them the same, the answer from my patients would say there are significant differences between staff members.

I like to get to know my patients and I like to find out about some of their experiences with accessing healthcare. Patients attending the ED with mental health problems have told me all sorts of experiences over time. A patient with a self harm wound was told by a doctor she didn’t need local anaesthetic because she deserved to have pain when he was stitching her up, a patient having parvolex after an overdose was left on their own while in distress and vomiting, she felt ignored by the nursing staff. A distressed patient had security and the police called while she was distressed instead of someone talking to her.

I find it incredibly sad that a patient can attend the ED with a broken arm, they get some pain relief, something to support their arm, an x-ray to find out what was wrong and some prompt treatment, and a patient with a mental health problem can be put in a cubicle, ignored, have the police called. I’ve always known there is stigma around mental health conditions but I didn’t expect to find the stigma in the ED. It is like ED staff don’t always know what to do with a patient in mental health crisis. Maybe the ED isn’t the right place for someone in a mental health crisis? Although it is the one place where you can go with absolutely anything wrong and they can point you in the right direction. I think that initial contact with someone has the ability to be able to calm a crisis or exacerbate it.

One in four people will have a mental health crisis at some time in their life. Many of those will attend the ED, whether right or wrong, usually patients I meet are reluctantly in the ED, either because a friend relative or police have made them. Or because there just aren’t enough availability of services in the community.

I think we need to change how we approach mental health conditions all round. So how could that be done? Offer training to ED staff in emotional first aid? Or address the stigma related to mental health? https://www.time-to-change.org.uk Put mental health nurses in the ED, to help support the ED staff.

So a patient comes to the ED with a soft tissue injury are told to RICE the injury, so Rest, Ice, Compression, Elevation for the injury to improve. Could we use a similar principle with mental health, so could we help patients to RICE their injury:

  • Risk assess, Refer if required
  • Investigate causes, Could there be a medical reason?
  • Chat
  • Explore ways of coping

Maybe it is time to think of the patients differently instead of treating their specific  conditions and treat them from a holistic viewpoint.

Would you train to be a nurse in 2017?

Don’t get me wrong I absolutely love my job, but if I had my time again, would I train to be a nurse in 2017, knowing what I’ve learned along the way?

I initially went into nursing at age 18 training at a teaching hospital in London. I was given a training bursary which was around £240 per month and it covered my rent in the nurses home and was just about enough to live on as a student. I worked a little in bars and as a HCSW to supplement my income. It is really difficult to get work as a student nurse because the training demands are significant in comparison to other university courses. Some university courses have 8-12 teaching contact hours a week and then the student can fit reading around other commitments such as working part time. A student nurse balances study with working on placements to an average 40 hours per week and then has independent learning and reading and writing assignments on top of that, making it really difficult to fit in extra work.

September 2017 will be the first intake of student nurses to not receive a bursary. The average student debt right now is £50 800 coming out of university. This is the fees and living costs. I have to say based on this alone I would not even consider going to university never mind a nursing course, where you are not able to work alongside study. In London not many students were straight out of school like myself, many nursing students were mature students who had already had other careers or families, I think these costs are going to put many people off from following a nursing profession. Since the end of the bursary scheme applications for nursing courses have gone down by 23%, there’s an average nursing vacancy rate of 9% and around 1/3 of the nursing workforce due to retire in the next 10 years.

The current vacancy rate is affecting all nurses, with shortfalls in all departments and wards impacting on other team members. This means that nurses are frequently working paid and unpaid overtime to cover staffing vacancies and sickness. Where I work there is an asking of covering shifts every single day and the staff try their hardest for their team but quite frankly they are exhausted. In 2013 the RCN did a survey that revealed that 2/3 of all nurses had considered leaving the profession because of the stress of the role. I have to say that I have considered leaving on many an occasion and still question why I work in a stressful job when others have left nursing altogether to go onto other successful careers, or lead successful nursing careers overseas where they feel appreciated.

A newly qualified graduate nurse earns £22128 per year after 3 years of university, because of government funding caps on pay this is regarded as a 14% real-terms pay cut in the past 7 years. A firefighter earns £29345 after 3-4 months training. A police officer earns £27015 after 2 years training. A paramedic can earn the same band 5 wage of £22128 after 10 weeks training. There seems to be inequity throughout the services and nurses do feel hard done by as it was a government mandate that required all nurses to complete degree level education. A Sunday Time Journalist this week suggested that nurses were people who could give a bedpan and fiddle with your drip. This is so disrespectful in terms of what a nurse can do. I completed a diploma in nursing, as it was most convenient to me at the time, degree education back then was much more difficult to get into although back then it was seen as the way forward. When I qualified i quickly went on to complete my degree by distance learning whilst working, this was a great balance in that I could afford to pay for it whilst working. I’ve also now completed several post graduate specialist courses.

Nursing can be such a varied career choice. Basic nurse training is just the start, the amount of different specialities, Medicine, Surgery, Paediatrics, Mental Health, ED, ICU, Speciality Wards are varied, specialist nursing roles are more frequently used, as well as opportunities in Education and Management … it’s not all about bedpans.

Is anything being done to address a staffing crisis? Overseas recruitment is one way many trusts are trying to attract nurses. It is very difficult to get nurses from overseas with language barriers, English tests and extensive NMC regulations. This has been made worse with uncertainty about Brexit. Not as many European nurses are willing to make the effort with uncertainty hanging over them. It is easier for big city hospitals to fill vacancies this way, a small country district general hospital has little hope of making itself attractive enough to be worth the risk. Nursing associates have been introduced as a 2 year process to fill some vacancy gaps as a band 4 as opposed to band 5 nurse, this has similar university education and the people carrying out this training have the opportunity to go on to do further training to gain registered nurse status. It’s a bit like going way back to having a two tiered system of enrolled nurses and registered nurses. It worked back then so will probably work again and we look forward to working alongside them.

I feel incredibly privileged to do my job. I love working with a team to find out what is wrong with my patients, to treat them so that they can go ahead with their busy lives. It is made worthwhile when just one person says thank you. With all the political efforts causing difficulties and uncertainty in nursing, I don’t think I would want to train again in 2017. All credit to those that go on to pursue nursing as a career, it’s not an easy career choice to make, and full of everyday challenges. When you work within a team that appreciates you it can be very rewarding.

What can be done to help nursing currently?

  • Appreciate your nurses, say thank you often.
  • Respect how hard everyone is working
  • For managers, understand what you expect your team to do and what resources they have and need
  • Make your team feel worthwhile.
  • Ensure that your staff are able to balance home and work life.
  • Help nurses to work to their full potential, offer training opportunities.
  • Engage your team with department or ward changes
  • Offer support particularly for departments under stress
  • Support union efforts with pay and lobby MPs