4.7 +1, Cochlear Implants, and that NEW NMC Poster

Whilst I am not a great advocate of self diagnosis (albeit I can see the value and drawbacks of pathologising everyday life), this week I finally admitted that I had possibly joined the ranks of the 4.7 million people in the UK who have tinnitus. Tinnitus is a condition where an individual experiences ringing, whistling, buzzing and humming noises in the ear. These noises can be incessant and constant.

Interestingly, tinnitus is not a disease or an illness, it is a symptom generated within a person's own auditory pathways. Although it is often assumed that tinnitus occurs as a result of disease of the ears, the precise cause of tinnitus is still not fully understood but is usually associated with some hearing deficits. There is a widely held misconception that tinnitus is confined to the elderly, but as I am only 55, I am not convinced this is the case.

However, in comparison tinnitus is a nothing more than an inconvenience to those people who have to live with some form of hearing loss, or who are completely deaf. Nearly two out of three Britons with hearing loss feel socially isolated because of their condition, according to a new survey carried out (bizarrely) by the high street options Specsavers (is there such a thing as a seeing ear?).

One in ten of the 700 people surveyed by Specsavers said they would not wear a hearing aid due to the stigma attached to it. As such trying to cope with the effects of beginning or becoming deaf can leave individuals feeling lonely, isolated and even depressed.

So it was good this week to hear [sic] OK SORRY! about the UK’s first operation to fit a single cochlear implant to radically improve the hearing of a women. She is aged 44 years old and  has been deaf from birth. The operation took place on the 27th August. A cochlear implant is an electronic device that can help both adults and children who have a severe to profound hearing loss. The device uses small electrical currents to directly stimulate the hearing nerve, which then sends signals to the brain where they are interpreted as sound. The device will make it possible for the woman, from the Isle of Wight, to hear sound – in BOTH ears.

That the UK’s first single cochlear operation took place is thanks to the hard work of the South of England Cochlear Implant Centre at the University of Southampton (yes that’s right Mr Willetts, this ground breaking, life enhancing development came from a University).

In terms of ground breaking, this week has also seen me working with one of my colleagues on a poster for this year’s NMC Conference. For those who don’t know, our School was awarded earned autonomy in this year’s NMC Review of the Quality of our pre-registration programmes. The Mental Health programme was awarded 4 goods and 1 outstanding. The outstanding citation was given in part, for the work the School has achieved, under the leadership of my colleague Naomi Sharples.

Naomi is our irrepressibly enthusiastic Director of Mental Health and Learning Disability Nursing. For over a decade she has worked at making nurse education and training accessible for people who are deaf. We remain the only School of Nursing and Midwifery in the UK that provides such access to nursing programmes. Naomi is currently studying for her Professional Doctorate focusing on Empowerment through Education. The poster we have been working on is brilliant (Naomi’s experience captured in words and pictures – under my award winning artistic direction). However, the poster is not to be unveiled until late September – but watch this space.

Breakfast, Misunderstandings, Men and the Origins of Nursing

Over the last three years I have had some interesting meal time conversations with some of the most remarkable and influential nurses in the UK and beyond. The Council of Deans of Health meetings have provided many of these opportunities. I was reminded this week of a breakfast I had at such a CoD meeting with one Anne Marie Rafferty. Anne Marie is the current Dean of the Florence Nightingale School of Nursing and Midwifery, King’s College, London.

She gained her qualifications at some of the most prestigious educational institutions in the world. Her research interests combine history, health policy and health services research. Not only has she written much in this area, but she has and continues to make an influential contribution to the development of policy across a wide range of areas affecting nurses and nurse education. By any measure she is an extraordinary person. I remember being impressed that over breakfast our conversation was entirely normal. We talked about shared issues we faced in managing our respective Schools, the state of nurse education as well as some personal conversation around families, what it was like to live where we did and so on.

Anne Marie was in the news last week. As part of the 100th anniversary marking the death of Florence Nightingale, Anne Marie reported upon why nursing is not a career choice that many of today’s young people would consider. In a study of 1000 18 year old students it was revealed that the modern-day nurse is misunderstood by the majority of youngsters. Many did not know nurses are authorised to give patients medicines and can also prescribe them. Other areas the students had misconceptions about were pay and career progression - just 6% knew nurses could earn up to £100,000, while only 25% were aware they could rise to consultant level.

However, some 20% of the students in the study (and they were studying different academic subjects), said they were more likely to opt for a career in nursing after hearing of the skills and opportunities involved. This was in a week that has seen many Universities experience problems in dealing with many more applicants for places than there are places available. In our School we have seen applications for nursing programmes rise year on year by 10% over the past four years. Next year we are predicting some 6000 applications for 680 places. However, some 70% of the students that study with us are 25+ years old and often have a family, and have chosen nursing following experience in other areas of work. Predominantly these students are female.

This last point is also interesting as this week the Nursing Times reported upon a survey undertaken with 84 acute trusts, half of which had foundation status. The survey revealed that male nurses are twice as likely to hold a top job in England’s leading hospitals. Men make up just fewer than 8% of acute nursing workforce, yet hold just over 11% of the Director of Nursing posts. This situation is blamed upon the ‘business ethos’ these roles involve which is said to deter women from applying or being picked for these top jobs.

I am not so sure. Partly I think the gender imbalance is due to women still being largely responsible for other roles in society such as bringing up children, and the realities of child care can make juggling the demands of such senior roles very difficult. I do agree however, with the view that has been expressed by Caroline Waterfield of NHS Employers Service who suggested that it wasn’t that there was a 'glass ceiling' for women, but rather that 'there isn’t a glass ceiling for men'. Interestingly, the study revealed that the gender imbalance was less pronounced among primary care trusts. But as PCTs will be abolished from 2013, this could lead to many senior female nursing leaders being made redundant.

Finally, given the Florence Nightingale anniversary celebrations, and the continued debate about nursing careers and gender imbalance at a senior level that in the first nursing school in the world only men were considered 'pure' enough to become nurses. This School of Nursing was started in India in about 250 BC. The Charaka states these men should be, 'of good behaviour, distinguished for purity, possessed of cleverness and skill, imbued with kindness, skilled in every service a patient may require, competent to cook food, skilled in bathing and washing the patient, rubbing and massaging the limbs, lifting and assisting him to walk about, well skilled in making and cleansing of beds, readying the patient and skilful in waiting upon one that is ailing and never unwilling to do anything that may be ordered.' An interesting thought as we prepare our new curriculum.

A Level of Qualifying Ones Position, and the Monkey Puzzle Dinosaurs

It is the time of the year when thousands of young people will be excitedly, hesitantly, or fearfully be awaiting their A Level results. University places, future careers will all depend on these results. It is also the time of the year when the Media will loudly consider the value of A Levels, and whether they really are as tough as they were last year, 5 or even 10 years ago. With the economic situation impacting upon employment opportunities and increasing competition for a diminishing number of jobs, getting the best qualifications would seem to be life critical.

For a variety of reasons this week I have been looking at a number of job descriptions and job specifications. I have been surprised at the range of qualifications that are deemed either essential or those seen to be merely desirable. Academic related roles (lecturers, researchers and so on) seem to demand higher levels of qualifications than say managerially related roles (administrators, professional support staff and so on). Many Universities’s now demand that all teaching staff have a PhD and a teaching qualification before they will be even considered for a position. Yet, this week, I have also seen senior University managerial positions where the only essential qualification is a first degree.

At a time when the nursing profession is preparing for an all graduate profession at the point of initial registration, I find this inconsistency in the value given to qualifications for different but equally important roles frustrating and somewhat depressing. It is a bit like the inconsistency that still exists between the exhortations to strive towards only evidence based practice and the often non-existent evidence based approaches to management and policy making that is characteristic of much of the public sector.

In complete contrast to this depressing situation, it was refreshing to see how the work of Kath Eccles and Gill Lomax has helped make the town of Blackburn and the surrounding area with the lowest level of diabetes-related limb amputation in the UK. These two ‘Foot Nurses’ developed the Blackburn Boot, a pressure relieving cast used to protect ulcerated feet, reduce inpatient stays and prevent further damage. In a brilliant TV interview these two highly engaging nurses employed by East Lancashire NHS Trust, talked about their work with passion, insight and intelligence.

Unfortunately this is not always a universal phenomena. Who can forget that dreadful soap opera originating from the US (where else?) called ‘Passions’. Screened in 2005, this programme featured an orang-utan named Precious in the role of the private duty nurse of one of the programmes characters. The show produced by NBC only lasted 18 months, but every episode reinforced the often media induced poor public image of the work of nurses.

This Saturdays Telegraph reported on our own BBC’s wonderful programme on Dinosaurs. The article discussed not the NBC type dinosaur, the poorly qualified University manager or even those such as Tyrannosaurus Rex or a Plesiosaur, but a much older form that goes by the mellifluous name of Araucaria araucana, better known to gardeners as the monkey puzzle tree. Having survived millennia in many parts of South America, it is now officially one of the world’s most threatened species, and in need of conservation.

I have a wonderful specimen of a monkey puzzle tree in my back garden, which I really like…

Scotland, Saving £21billion, Spending a Penny, and Chicken Sandwiches?

Scotland was a good place to be these last two weeks. Sun, Shiraz and Sandy Beaches were the order of the day, and it felt so good not opening up emails, or doing anything more cerebral than reading the latest Dan Brown. Despite the photo, Cello was in his element. Often the beaches were completely deserted and he could run for hours, unlike me!

Unsurprisingly, my re-engagement with a different reality has proved difficult. Even without email and phones, it did not escape my notice that the economic problems are beginning to become manifest as requirements, targets and objectives that will have to be addressed very quickly, and which, in doing so, are going to hurt. It is clear the £21billion NHS saving requirement will have far reaching consequences for us all. As a School of Nursing and Midwifery, we will need not only to keep focused on our vision for the future, but need to become innovative, creative in way that we haven’t perhaps even contemplated to date. We know that our commission numbers for pre-registration nurse education and training have been reduced over the next three years, and these cuts are likely to be revised, with further cuts likely going forward. Whilst this will save large sums of money for the NHS and severally challenge our five year business plans, the real cost will be three or four years down the road where there will simply not be enough nurses in the system to ensure the quality of future health care.

My fear is that in pursuing the need to achieve these unprecedented cuts in public sector spending, we will increasingly find ourselves in a Michael O’Leary paradigm. O’Leary is the current CEO of Ryanair. His claim is that Ryanair is the most successfully airline in the world. Once calling his aeroplanes ‘buses with wings’ he is perhaps best known for his fanatical cost-cutting approach to running his airline. It has even been alleged that Ryanair staff have to pay for most of their training and equipment, and of course they are still contemplating fitting coin operated toilets on their flights. Spending a penny would really bring in the pounds.

I was interested to read this week of the plight of Norwegian Henrik Ulveren, who was arrested after Ryanair called the police when he refused to pay for an ‘inedible’ chicken sandwich. The incredibly priced sandwich (£3.80) was said to be like rubber and didn’t look like the picture in the promotion literature. On arrival at Oslo, Henrik was arrested by police who he says simply laughed at the incident after he explained what happened, and he was soon allowed to go on his way.

Chickens sandwiches have for some time been big business. It was the American Truett Cathy, who opened his first 24 hour six day a week fast food business, and introduced the chicken sandwich. His business has been phenomenally successful. His business has grown to some 700 outlets called Chick-fil-A. Whilst being a huge success in the US many of us would not recognize the name, although we might be familiar with the advertising campaign ‘eat mor chikin’. Chick-fil-A's menu still includes the classic chicken sandwich although the breakfast menu does include several variations of chicken biscuits including a bacon, egg and cheese biscuit and mini chicken bite biscuits. On June 7, this year, Chick-fil-A released the spicy chicken sandwich and spicy chicken deluxe sandwich. The sandwich has received mixed reviews. What makes Truett’s approach different from the O’Leary business model is that the root of his operating success, resides in his care and respect -- his love -- for others. To this day none of his restaurants open on a Sunday. He claims that all his employees benefit and that no matter how they might chose to use a day of rest; it’s a chance for them to find themselves. ‘Profits should be the score, not the name of the game’ Truett advised in his 1989 book "It's Easier to Succeed Than to Fail." It is to be hoped that here is a place for such thinking as we move forward into the uncharted waters of a new and much less resourced NHS.