How much do we value our Nurses?

Last week, I valued every spare moment I had. Among many other things I was decorating our bedroom, a process that through the lack of time, was becoming rather drawn out. I had promised J we would have a new bedroom by Christmas. We had bought a new bed, wardrobes, dressing table and so on, all stored in another bedroom waiting for our bedroom to be decorated! So there was no escape. Over the last few weeks, I have stripped wallpaper, filled cracks, painted walls, wallpapered and had the floorboards sanded and renovated, and I’ve now been able to varnish them. All in all it has been a successful transformation. However, if you had been in our house last Wednesday, you might not have thought so. I had jumped out of bed, seen J off to work, and had spent a couple of hours sanding down the walls. I was covered in dust, and my hair was like straw.

No worries I thought, a quick shower and I would be ready for my mid-morning Teams meeting. I hadn’t bargained on United Utilities turning the water off so they could mend a leak. They did send me a text to say they were working on fixing the leak and they were going as fast as possible. No water, no shower so there I was thinking I might have to pretend my camera wasn’t working at my meeting. I needn’t have worried as Telenet, fixing new cables outside on the street, also then managed to cut off my internet supply. Yes, it was turning into one of those days.

Most of us take for granted those things we always think will be there day in and day out. We turn on the tap and expect water to flow, every time. Increasingly we take for granted that our technology will work each and every time. There are many things we fail to realise the true value of until they are missing from our lives. That is when we realise how important something is. But it is not just tangible things like water and technology that we might value. Other less tangible things can be valued too.

It takes noise to value silence, sadness to value happiness, and absence to value presence. We might never actually know the value of a moment until that moment becomes a memory. Likewise, we might not know the value of someone until we see the gap they leave behind when they are no longer part of our lives. I think this will have been something many folk will have experienced during the last 20 months of the pandemic.  

If I had valued my time a little more, I might have got in a decorator, paid the bill and moved back into our bedroom a lot sooner. However, as well as time, there was something else I valued, the satisfaction of doing all the work myself, even when, as in the wallpapering, it was something I had never done before. Values, themselves, can shape the way we live our lives. Many healthcare organisations will publish a set of values on their website, but I do sometimes wonder how many people, both collectively and individually, actually live those by those values.

Last week, I was very pleased to see someone, who believed in the value of something, actually taking some action. Dawn Butler, a Labour MP, spoke to her amendment to the Health and Social Care Bill currently going through parliament. It was aimed at protecting the nurse title in UK law. She wanted the law changed so that no one is able to ‘practice’ or ‘carry out business’ under the nurse title unless registered with the Nurse and Midwifery Council (NMC). Sadly, the amendment was not passed, MPs voted 304 to 240 against the motion. With so much professional and public support, it is hard to understand why.

Edward Argar, a Conservative Minister for Health, claimed that the amendment was flawed and didn’t address some fundamental challenges, such as the title ‘nurse’ being used by other professionals working in other areas, such as dental nurse, or veterinary nurse. To my mind this a rather spurious argument to make. Readers of this blog will, I’m sure, remember the case of Ian Levey, one of the new Conservative MPs of 2019, claiming to be a nurse during his election campaign, when in fact he was a healthcare assistant. There have been many others who have traded on the title ‘nurse’ for their own gain. In so doing, they undermine the trust the wider public has of what ‘being a nurse’ implies in terms of safety, qualifications and knowledge.

Although I’m no longer practising as a registered nurse, I am proud to be a nurse still. It is a part of my life that I value highly. I still retain the knowledge I gained as a nurse, and might still know what to do in certain healthcare-related situations. What I wouldn’t do is use such knowledge and skills while claiming to be a nurse. Likewise, when I take my dog to the vets and the receptionist says, ‘the nurse will see you now’, I don’t think I’m in the presence of someone who might be qualified to meet my health needs.    

I hope that Edward Argar’s public promise to keep the intent of the amendment under review holds true. Valuing our nurses goes beyond rainbows and clapping. The title should be protected in law, and I’m sure that those campaigning to make sure it is will continue to fight until it is. 

These are the hands that care

I have written in previous blogs, and in many papers and conference presentations, of the importance of touch in therapeutic relationships. It can be a difficult subject to talk about against the Me Too context. However, last week I saw some brilliant examples of how touch was being used effectively and appropriately in therapeutic relationships. These relationships were very brief, and could be measured in minutes, not sessions, days or weeks. I was with our School Nurses, who were running Covid-19 vaccination clinics in schools for 12 -15 year olds.

The programme was highly ambitious, a potential logistical nightmare to organise, but a great example of how to do collaborative partnership working well. Thanks go to Jen Connolly (Director of Public Health, Stockport), Ben Fryer (Consultant in Public Health) and Anita Rolfe (Stockport CCG) who worked with Fran Jackson, our Service Lead for School Nursing at Stockport NHS Foundation Trust, to help make the programme a success. There were 17,000 eligible 12-15 year old's across the area and over the 7 weeks of the programme, some 6,612 children have received their Covid jab.  There was a ‘day on day’ increase of children and young people taking the opportunity to get vaccinated, and all those who did so, were informed and eager to get protected. Of course, when I spoke with the children after they had been jabbed, any anxiety had melted away and they were mainly nonchalant, said it was no big deal, and they were just glad they were now protected.

These important vaccinations contributed to over 500,000 Covid jabs being given in Stockport over the past 12 months – a tremendous achievement.

The vaccination hub I visited was in the school hall of Marple Hall School; a school whose ambition is to become ‘the most successful School in the country’. I think they are likely to succeed too. Joe Barker, the Head Teacher seemed to be remarkably buoyant and enthusiastic, which given the school has some 5,500 pupils, is probably testament to his professionalism and approach. He also writes a weekly blog, which is something in others I greatly admire.

The school is situated behind a high fence, and like many others, had a locked electronic gate to get through. A kind receptionist rescued me, and after signing in, I was able to join the session. Given there were 30 or so children in the room, there wasn’t as much noise as I thought there might be. Everything was ordered and well thought through. I was able to first meet some of the team, and it was quite a large and assorted one too. There were a group of very cheerful folk from the local authority Covid Advice and Testing Team, who were busy inputting all the immunisations onto the national system; there was a lady from Everest Pharmacy, who drew up the vaccines used during each session; two lead nurses, (Fran being one of these); two colleagues who supported the programme logistics, planning each session and then managing each session’s administration, and then there were the immunisers themselves.

What a team! I was able to speak with them all, both about what they did in their day job and how they had experienced the vaccination programme. I have to say I was amazed at the scope of their professional practice. They all ran community clinics and school-based clinics for the HPV vaccination programme, undertook health assessments, were part of safeguarding committees and ran health clinics offering support and advice to young people regarding lifestyle choices, self-harm, depression, relationships, weight issues, sexual health, and a couple which I thought were a sign of the times, smoking cessation and gender identity. Each School Nurse had a case load of about 2,500 children and young people, and the scope of their clinical practice was enormous.

I did like the description they gave of the sessions they ran on relationships and sex education, which again covered very contemporary issues around consent, sexual abuse, sexting, contraception, all of which the children preferred hearing from the School Nurses rather than their teachers! In the vaccination session, it was clear that the children and young people were very relaxed and accepting of the School Nurses. I watched a number of the children getting their vaccinations. I was struck by the gentleness and kindness of the nurses. Each child was treated like they were only one that mattered in that moment. Some children were obviously anxious and I saw hands been held, a hug being given, a pause for a word or two of encouragement. It was compassionate care at its finest.

As I have reflected upon this experience, I was reminded of the fabulous book, published last year, called ‘These are the Hands’ – if you have not had a chance to read it, please take a look. It contains the poem Michael Rosen wrote to celebrate the 60th birthday of the NHS. I sure all those readers who have children, grandchildren, or younger siblings will have read his work. Most of my grandchildren still love his book, ‘We’re going on a bear hunt’. Thinking about the School Nurses, I thought it appropriate to reproduce his poem here (albeit it takes me over my self-imposed word limit) as for me it captures more eloquently than I could ever aspire to, the work of so many who continue to make our NHS a place of great care.

These are the Hands

These are the hands
That touch us first
Feel your head
Find the pulse
And make your bed
 
These are the hands
That tap your back
Test the skin
Hold your arm
Wheel the bin
Change the bulb
Fix the drip
Pour the jug
Replace your hip
 
These are the hands
That fill the bath
Mop the floor
Flick the switch
Soothe the sore
Burn the swabs
Give us a jab
Throw out sharps
Design the lab
 
And these are the hands
That stop the leaks
Empty the pan
Wipe the pipes
Carry the can
Clamp the veins
Make the cast
Log the dose
And touch us last

Lest we forget.

Where were you at 11am last Thursday, 11th November 2021? I was in our hospital chapel. It’s a simple place, stripped down to the bare essentials for worship. One wall has some coloured glass panels, a nod in the direction perhaps of the more traditional stained glass windows of older churches. The altar and pulpit were made of oak, with the minimum of decoration. There are no pews, just stackable chairs, which on Thursday were arranged to ensure social distancing was possible. All in all, it is an unpretentious space. But in the maelstrom of a busy acute hospital, it is also an oasis of calm, peacefulness and hope.  

I was there to take part in our Remembrance Service. I had been asked to read the now famous poem ‘The Fields of Flanders’. It was a real privilege to be able to do so. It was in the Spring of 1915, that a Canadian doctor called John McCrae wrote the poem after seeing poppies growing in the battle-scarred landscape of Ypres, in Belgium. This small town saw the first time chemical warfare used in conflict, so also maintains a close relationship with Hiroshima, a place where nuclear warfare was first used. It was one of the places where the British and German forces unofficially stopped fighting to celebrate Christmas - the so called ‘Christmas Truce’.

Today the poppy is a symbol of remembrance and hope, including hope for a positive future and a peaceful world. The poppy is a symbol of support for the Armed Forces community, both those who have served and who may no longer be with us, as well as those folk who continue to protect us and keep us safe.

Reading the short poem was a humbling experience for me. It made me feel connected to a place, a time, a conflict that I have no knowledge of. My parents, although affected by the last World War, were too young to have fought in it. I have never experienced the horrors of war. The nearest I have got to knowing anyone in the Armed Forces is our young sea cadet animal sitter who wants to train as a doctor in the Navy when she is able. Yet, last Thursday, standing in that small stark chapel, I felt a huge sense of connection.

I’m sure many of us will today too. It is Remembrance Sunday. It is different from Remembrance Day. November 11th is Remembrance Day or Armistice Day to give it its proper name - the day in 1918 that Germany and the Allies agreed to stop fighting on land, sea and air in the first World War. Remembrance Sunday, which is always held on the second Sunday of November, is a time to pay tribute to all those who fought in both the World Wars and other conflicts around the world. The last time that Remembrance Day and Remembrance Sunday fell on the same day was 2018, and it won’t occur again until 2029. This year maybe the last year that our Queen can actively participate in the Remembrance service. I hope not.

Last Thursday, I was joined by patients and colleagues in that small chapel and by many more folk who participated online, as the service was livestreamed. Then, after this brief pause and act of remembrance, it was back to meeting the needs of our patients, their relatives and the communities they came from. Thankfully we are not in a world war any longer, but we are joined in the fight to deal with Covid19. Last Thursday, 151 people died from Covid in the UK. Since the start of the pandemic, some 143,000 people in the UK have died from the virus. Of course, whilst this number of deaths cannot compare to the estimated 22 million deaths of the first Word War, every life is precious and every person who has died from Covid was someone’s daughter, son, husband, wife, mother, father, brother or sister.  

Of those 22 million people who died during the first World War, several millions of soldiers died from the flu pandemic that was also raging at the time. The earliest case of what became known as the ‘Spanish Flu’ was in March 1918, in the US. By April of that year, it had spread to Europe and the UK. It was one of the deadliest pandemics in human history. It is estimated that during the two years of the pandemic 17 to 50 million people died from the flu. As of this morning, 5,110,862 people worldwide have died of Covid. Strangely, Spanish Flu disproportionately killed more young people than older adults. Hypercytokinemia was thought to be largely the cause, but why this was is not fully understood, although poor infection prevention and control measures were often the norm at this time, and that may have been a major contributor to the high numbers of deaths.

Back in the present, our hospital has suspended patient visiting once again. This is due to a couple of Covid outbreaks occurring. While folk coming onto the site won’t be the only cause of these outbreaks, we do know that at least 1 in 5 people have Covid, but are completely free of any symptoms. Without strict adherence to frequent hand washing, social distancing, good ventilation and mask wearing, these unknown Covid carriers will continue to unwittingly spread infection. While vaccination remains the best defence against Covid, as we have seen in recent media reports, many people still refuse to get vaccinated. Sadly, this also includes many colleagues working in health and social care services.

I say sadly, because as today we remember all those who gave so much for the rest of us, and all those still serving in the Armed Forces today, we should also remember the more than 1,500 NHS staff who have so far died as a direct consequence of catching Covid. To me that is an immensely sad fact. I make no apologies for this blog being a bit of a history lesson. Sometimes it’s important to actively remember through the retelling of stories. So, like all those who lost their lives through conflict, let us not forget those who lost their lives trying to help those many people who, in their time of most need, turned to the NHS for help.  

Kindness Matters, It Really Does!

You know things are going seriously wrong in the world when the newspapers start reporting on their front pages that we are facing a shortage of fake tan lotion. I have scrubbed the bath too many times after the children have used it, and fake tan is now banned from the house. With all that has been going on last week in Glasgow and Westminster, why anyone should be worried about getting a bottle of fake tan is beyond me. However, having attended a ‘kindness matters’ workshop last Monday, I shall use the lessons learnt and simply say that each to their own when it comes to fake tanning. It was a great workshop, more of which later. First of all, what would you choose to do if you knew you only had 10 minutes to live?

It's not such a strange question as it might sound. Back in my younger days, and I am talking many years before Extinction Rebellion, Insulate UK and Cop26, I was a fully paid up supporter of Greenpeace, and an advocate of banning the bomb. As a schoolboy I sat in class and endlessly drew the CND symbol and the ‘make love not war’ slogan instead of paying attention to whatever the teacher was saying. My great act of protest was not standing naked outside 10 Downing Street, no it was much worse. I wore my enamel rainbow warrior Greenpeace badge to Buckingham Palace the day my Dad got his MBE. We were a generation that feared the Soviet Union sending over a nuclear missile and annihilating us all. We were told we would have just 10 minutes warning* of the incoming missile. So, what would you do?

There was the old joke of course, you could have sex, but what would you do for the remaining 7 minutes? Me. I would probably enjoy a large glass of whisky. Then again there is always the advice from Raymond Briggs in his 1982 book ‘When the wind blows’ which explored the impact of a nuclear strike on the retired couple, Hilda and Jim. It’s actually based upon the UK Government’s own official advice ‘Protect and Survive’, published in 1980, although Briggs story is a great deal more humorous (albeit in a slightly more macabre way).

Well, I had my own 10 minute warning last Monday. It was from those good folk at the Care Quality Commission (CQC). They let us all know that, in 10 minutes, they were coming on site to do an inspection of our urgent and emergency services. The last time they were in our Trust, they found these services ‘inadequate’. A great deal of work had been done since that time and the service has been completely transformed. We will have to wait for the official report of the inspection, but no significant concerns were raised and pleasingly, they noted that our emergency care colleagues were treating all the patients with great compassion and care. Given that it was a Monday and the department was running flat out, I thought it was a wonderful acknowledgement of the great work of our colleagues.

Being compassionate and caring are tangible examples of kindness shared, and kindness always matters. I didn’t need to spend my Monday afternoon exploring this notion. I have known for some time that kindness matters. I haven’t always been good at embracing this idea though, but over the past few years I have tried much harder to embrace a kindness first approach. So, I was interested in seeing what else I could learn from the session. The session was facilitated by the ‘A Kind Life’ organisation. If you haven’t heard of them before, have a look at their website here. The session was part of a national programme supported by the NHS England Improvement Civility and Respect Programme. There will be a session coming to a virtual venue near you soon, and I would highly recommend trying to getting a place at one of them.

The afternoon started by reminding ourselves of the NHS People Promise – you can remind yourself here – and then it was into imagining and/or remembering a good day, and what made it a good day. An interesting exercise, made more so by sharing with others. I have to say I love the way you can be effortlessly whizzed into a virtual breakout room and then whizzed back into the main session. Something difficult to do in real life without using up lots of time traipsing around a conference centre! The enthusiastic facilitator (and I’m being kind here), who could be said to be somewhat of a cross between Gordon Brittas and Bill Oddie, also used the Menti smart phone system to poll participants whose responses were immediately turned into a word cloud – very slick and impressive and great fun too!

Of course, it wasn’t just about having fun. There was a serious side to the afternoon. We explored empathy, what listening to others might really mean, how to give appreciative feedback, the impact of bullying and how to create a safer culture, ways to promote curiosity (a favourite idea of mine, I have to say), and the importance of wellbeing conversations. All in all, it was an afternoon well spent. Whilst kindness might be difficult to define, it was a privilege to spend a few hours exploring what it could mean. For me, the session reinforced my desire to be more generous in the way I am with others, more generous in my thinking, actions and words. Kindness matters.

As does conditioner. Apparently, conditioners contain cationic surfactants, which can bind radioactive particles and trap them in your hair – not a great thing after a nuclear attack. However, I don’t expect any of us will be experiencing a nuclear attack any time soon (that said, none of us expected the Covid 19 pandemic). I do know though that as we enter the Winter season, things will get even tougher in health and social care, both for our colleagues and for our patients and the folk that make up their families and communities. Let’s remember, it costs nothing to be kind, we can all spread kindness every day, and kindness really does matter.

  

* 10 minutes was the time the ‘Protect and Survive’ advice reckoned you had to get home – back in 1970 we were told that following a nuclear attack we would have 10 minutes between the warning and certain death – although though there was a common belief there was only a four minute warning to be given – in the 1990’s all the UK ‘four minute warning’ air-raid signals operated during the Cold War were dismantled. Today, it is estimated that in the event of nuclear explosion, all the radioactive material caused by the blast would take 15 minutes to return back to ground.