A group called diversity

Diversity is something that is an issue that has always existed in nursing, perhaps in more recent years has it become an important subject in delivering modern nursing care. But are we as diverse as we like to think? How diverse are we in reality?

I have no doubt that at junior level, nursing is very diverse. I have worked with nurses from many different corners of the world, of different ages, backgrounds and ideas and personal values. That is true of people in general and is nothing unique to nursing. I find it sad that some members of the public and other professions do not find as much value in diversity as the profession claims to be proud of. I recall some time ago, the NMC sent out a questionnaire to every nurse and midwife asking them about their background. The NMC stating that they we interested in learning about the diversity of the registrants.

Would I be correct in thinking that nurses believe diversity is a good thing in the profession and this reflects the diverse needs of the people we care for? sadly I've noticed that in reality we really don't have to look very far to see the lack of diversity in the profession, the last time I looked at actual numbers regarding people in the profession, the number of men registered as nurses was only 11%. Would it be true that there are more nurses from abroad recently due to chronically low staffing levels forcing employers to look elsewhere? Are we only as diverse as we are due to practical need as opposed what we should be to claim to be truly diverse?

The Nursing times recently wrote that nurses BME background were more likely to be involved in fitness to practice cases compared to nurses of white ethnicity, would this be a true reflection of nursings opinion of diversity or simply a coincidence in cases of poor practice? http://nursingstandard.rcnpublishing.co.uk/news-and-opinion/news/bme-nurses-more-likely-than-white-staff-to-face-nmc In reality, I learned from  one ward sister I worked with when I was newly qualified (who was filipino as it happens) that no-one  would ever intend to practice badly, but all of us have a chance that things could go wrong, that even as an experienced nurse, it could happen to her and I should therefore not worry about it as much as I did.
I would be interested to find out exactly why BME nurses are more likely to be referred to fitness to practice proceedings.

The nursing times and nursing standard also went further to look at the number of BME nurses employed in senior positions in the profession, or lack thereof I should say. I would be interested to find out the diversity of council members at the NMC and whether the council also reflects diversity of the profession it regulates and the public it serves. http://www.nursingtimes.net/why-are-there-so-few-bme-nurses-in-senior-nhs-posts/5000204.article

I don't doubt however that the diversity of nursing has really evolved and developed over time, according to the history of nursing, Florence Nightingale herself was discouraged from taking up nursing as it was not seen by her family as work befitting a woman of her class. Some years later, Florence refused the assistance offered to her group by Mary Seacole, again I would be interested to find out why.

I often think that the publics perceptions of what a nurse is can influence the professions diversity. Sometimes I have connotations of a young woman, wearing a crisp apron and a cap with a fresh face. I wonder who else has that idea of what a nurse is? Oddly enough, it doesn't seem to leave much room for all the different nurses in reality.

Ultimately though, the point is diversity is a good thing, provided we as nurses and the public open up our minds to what a nurse is, was and will be in all their different forms. we may not be able to fully meet the diverse needs of the people we care for. If we can be completely open and diverse, how good is the care we provide? At least for now, I think the solution could just be as simple as an old saying I once heard..."Free your mind, and your body will follow".

A new adventure awaits?

I think if you were to ask many people, whether they are nurses or not, if they could do with a nice holiday, you may get an overwhelming response saying yes! But, what nurses can do is take work in a far away country and take a very long holiday all at once and one additional bonus is you can put it all on a CV.

I met with a friend the other day who told me that she is off to australia for a few months. She has handed her notice in on the ward where she works and is jetting off to a new job down under with two other nurses. I would be lying if I said I wasn't jealous, but then I have thought that perhaps I should look into working abroad...what a tempting thought.

Sounds incredible and too good to be true. Better pay, better living and working conditions and a whole host of new adventures, but is it a case of the grass is always greener on the other side or is it same situation, different country? If it was that simple, wouldn't every nurse be doing it?

I guess it isn't that simple. There are countless adverts for nurses to leave the UK for sunny shores such as the middle east and Australia. My friend spoke particularly about the difficulty of obtaining registration in Australia. this alone seems to be no easy task. I also wonder how some nurses feel about uprooting their entire lives and taking themselves away from family and friendships on the promise of a quick buck and a sunny beach.

I wonder if it is easier for young nurses with no children, partners or mortgages to pack up and head off to another country, I have to confess that I am often very keen to take advantage of what appears to be on offer, but what is actually waiting when I get there? Or put another way, what is stopping me?

When I think about going to work abroad, I also think about the cultural change, for example in the middle east...I am however assured by one international agency that I am not required to learn arabic and that most of the staff and patients understand and speak english. I guess the shortage of nurses worldwide is such that countries are prepared to overlook some things to better the situation.

I have also tried to look at it from another angle, more specifically all the nurses who have come from Africa and the Philippines to work here in the UK. I have no doubt, that without their being here, the situation in healthcare would be dire, but I often wonder how hard it has been for some of them to leave people behind, in a country where actually obtaining work in the Philippines as a nurse is difficult and in some cases, leaving their children behind to support a foreign healthcare system...all to make a bit more money.

Are nurses also leaving one set of politics and problems, to go to another country and find another? If one country is terribly short of nurses, surely that would set a nurse to think why, as they say...there is no smoke without fire? this piece of writing may sound depressingly negative, but I do wonder what awaits nurses in the land far far away.

I guess thats half of the adventure though...the not knowing what you will find, I did contact one of the agencies to find out more. I'm keen to see what opportunities are out there. who knows, you will never know unless you get out there and try it. I wish my friend the very best of luck in Australia and selfishly, I hope she doesn't enjoy it so much she decides to stay. Can't wait to see it for myself someday. regardless of if you are a nurse, I am a firm believer that travelling makes for well-rounded people in society with a lot of stories to tell

A partnership of Equals?

Looking back, I have been tempted to write about the current situation in nursing, specifically the rise in registration fees for nurses. Having attended the meeting at the NMC offices and thought at length about the situation and voiced my own opinion in the nursing standard, I have decided that its is an issue that goes far beyond my own reflections. I will leave every nurse to voice their own opinion...enough said. Instead I opted for another issue close to me, inter-professional equality.

Outside of attending NMC meetings, writing this blog and having my fingers in other proverbial pies, I still have time to work full time as registered nurse in an acute hospital. My day to day practice  consists of two parts, I have a permanent role as a scrub practitioner at the trust, but I also enjoy maintaining my skills in ward and specialist based practice through a staff bank (given most nurses current situation, I dare say not many don't!). Nonetheless, it is important to me to widen my professional horizons as well as pick up a few extra pounds.

This particular issue arose out of my practice in the operating theatre. The trust I work for have recently reviewed the swab, sharps and instruments policy. Any nurse practicing in the peri-operative environment will be fully aware of such a policy and every hospital trust that carries out invasive surgical and/or diagnostic procedures will have such a policy in place. For those of you who don't work in such an area, it is essentially the policy that stipulates responsibility for swab, sharps and instruments checks and counts during a procedure and responsibilities (among other more specific duties) of each profession in order to facilitate safe surgery.

Due to some issues with clarity in areas of responsibility the trust took the liberty of reviewing the policy and thankfully decided to be highly specific about who takes responsibility for what and when. This is where the issue of multidisciplinary equality began. As part of our checks that are undertaken as a "team", we religiously perform the stages in a WHO surgical safety checklist...without fail I might add. All of the above is necessary to ensure we get everything right the first time, when getting it right is of high importance.

As a team we share the responsibility of performing the necessary checks and supporting each other to fulfil our duties. One benefit of working in such an environment is based upon trust and spending a large quantity of time in one room together. However, the revised version of said policy states that it is the responsibility of a surgeon and anaesthetist to ensure that the WHO surgical safety checklist is completed and documented appropriately. One anaesthetist pointed out two interesting points, one; ensuring this new responsibility is communicated to them and secondly and just as importantly, that does this newly delegated responsibility undermine the "team" approach in carrying out this work and reinforce the concept of a hierarchy in the health care professions?

I remember in my first year of nursing school, undertaking a module in multi-professional team working, whereby students of each discipline worked together to solve a problem in patient care and role play solving this problem as a team. The aim of the module is partly to ensure each profession contributes equally and is left feeling empowered in patient care. I was in some respects, in for a rude awakening when I qualified however. In many situations on the ward, nurses can be made to feel insignificant, that doctors/surgeons make the final decision and there is no room for debate. Sadly on more than one occasion I have felt belittled by the fact my reasons for doing something were not considered as important. I have worked bank shifts on wards where the communication between the professions is poor and in some cases some professions do not believe it necessary to communicate with other professions despite it causing friction. Not to mention the lack of understanding of role or knowledge base. I believe this has a huge impact on respect for each other. This is not when multi-professional comes into its own, and why operating theatre work does encompasses everything that multi-professional work is supposed to.

Lets face it, we don't work as hard as we do for our health? I'm sure we would all love an environment where we all communicate properly and that patients are then right back where they should be. In the centre of the care! I would encourage anyone to challenge the hierarchy in multi-disciplinary working otherwise we will always be left with professions feeling demoralised, undervalued and disrespected much to the contrary of what we should be working towards. I can certainly tell you that I resent having  other professions talk to me or treat me without respect as a person let alone as a nurse.

I hope to be senior nurse one day and multi-professional team working is a passion that I will promote enthusiastically, I cannot tolerate the hierarchy when it goes against everything I have learnt from tutors, professional colleagues and other nurses. I have a great deal more respect for professions that don't work on a culture of fear but instead makes other people feel respected and valued and that their contributions are equally important. one fantastic example of this is the comments from Dan Poulter in this week's Nursing Standard. I commend his thought into the role of nurses, not necessarily his full opinion. There is a doctor who understands professional empowerment.

If nothing else, it is nice to see changes. Comparing stories that colleagues describe, we have made changes in the right direction in equal working. There is still work to be done but, it is a step in the right direction. It is just disheartening when you read new policies that don't reflect the hard work of all professions. Perhaps, it is the hospital trusts that need a lesson in multi-professional team working and not the health care professionals?  

The Good Nurse

Dedicated to all the new nurses, starting out with a whole career ahead of them. The fresh new faces that remind us why we do what we do every day. My best wishes to each and every one of you! My thoughts are with one in particular, for whom I am sure the future holds bright things! 

We all have a reason for becoming a nurse, everyone has a different reason. I am asking myself what this is at intervals in my work...usually when the day isn't going my way. But self doubt has been a part of my routine since qualifying as a nurse 3 years ago.

I am thinking about this more at the moment as it is the time of year the all newly qualified nurse have waited for; the day they take the title staff nurse and begin work as a fully qualified practitioner. It always reminds me of the day I began my first day of work in late september 2009 on an elective orthopaedic ward in a new hospital and new town. I also think about the new students at university embarking on the first few days of their nursing course, ready to take on the challenge that studying nursing is. I hope the course lives up to everything they hope it to be. I wish everyone the best of luck with their studies!

When I think about new nurses and how new people come into the profession, I think about how the profession has evolved, the values it hold and have our attitudes evolved too? I truly believe that every nurse in the profession has something special and unique that only they can offer, their hallmark. During my time working on a surgical ward at my current hospital, I co-mentored a third year nursing student, who I believe showed endless promise as a great nurse. I feel one of the most valuable things I tried to teach her, was that nursing is like a baking a cake, you need to follow a correct recipe for the best outcome, but best thing about it is, you can decorate it your own way. Making the most of that special gift that only you can give to those in your care and those colleagues around you. Its what I feel makes us as diverse as we are.

I suspect there are a few nurses who have cared for nurses of older generations or perhaps (such as myself) are related to nurse of an older generation. I am all too familiar with the statements "Too posh to wash" or "nurses don't care like they used to" or of course find the fact that nurses must now attend university distasteful and hold that as the justification for the above quotes. I however, would beg to differ. I guarantee that myself and many of my colleagues despite being university educated nurses still hold care and compassion as the highest priority of our work. I cant speak for everyone, but I would much rather be performing the tasks we might describe as "nursey nursey" but nursing today is such that I am not afforded with the opportunity every time...much to my disappointment. Does this make me a bad nurse?

I personally find it difficult to believe that nurses are driven by financial motive, I also find it far more palatable to believe that nurses really do care and would love to return to more traditional nursing. but sadly time has moved us on and we can at best hope to achieve the highest quality we can with resources we have. Of all the nurses I have worked with, I am confident that an individuals own underlying reasons for becoming nurses (and indeed keeping them in the profession) is the desire to care for people. I can tell you hand on heart that it certainly is the reason I became a nurse.

Does the individual personality make a good nurse? Obviously the desire to care for a person and the good level of education is need to undertake the course, but what about a personality? How does this fit with the profession? we pride ourselves on being a diverse profession, but are personal interests taken into account when choosing the right applicant for nursing. I might be thought of as cynical if I said that   nurses were chosen on the basis of having the right attitude to be moulded into what the profession would like...someone reflective and calm and kind and certainly an individual with a heart. In my opinion, much the same as profession has always desired. Perhaps I am wrong, perhaps all the profession would like is someone who is self-aware enough to make the right choice in the right scenario, to an extent a robot?

Sadly, there will always be those who do let us down in the profession...I will leave those matters to the NMC, and I'm sure said matters are dealt with appropriately. To a lesser extend, I'm sure every nurse understands, the day that leaves you feeling like an awful human being and nothing seems to have gone the way you would have liked, or just feeling generally deflated no matter how good your intentions are. But I ask, does this make you a good or a bad nurse? Are you only having these feelings because everyone has a bad day, or are we just reflecting on our practice?

I frequently come across the CARE campaign in the Nursing standard journal (and my words are by no means aimed at belittling the work of the good people at nursing standard) but I feel worried why we need to promote a campaign of CARE. Promoting communication, and caring for peoples basic needs such as nutrition, using the toilet if need be and of course feeling warm and cared about with their feelings and wants taken into account...for as long as I can remember, I believe, if you aim to get the basics right, you achieve a good relationship with your patients. I would be surprised if nurses did not relate to this. All I ask nursing standard and the wider profession...aren't these the basics?

The Florence Nightingale School of Nursing in London, some time ago launched the Culture and care programme promoting nurses to reflect and celebrate diversity through study and development of individual interests and talents. the theory is that it encourages students and staff to explore culture and artistic values to improve non scientific skills in the profession there by improving patients experiences, they boast a collaborative module entitled "nursing and the arts"meant to enhance these skills through exploration of arts in relation to nursing. It certainly appears that the profession is expanding its imagination when it comes to the development of good quality nursing. It would seem it encourages a nurses interest in the arts as a way of developing practice. Call me naive, but maybe it is worth applying this idea to the wider profession? Making this compulsory in nurse education?

Before I reach I point of infinite confusion and being a major source of chronic boredom. I would ask anyone interested, that if they do lose faith in nursing to try and talk to their nurse, get to know them and if you have a good relationship with nurses so far, then I hope you empathise with this piece of writing  and really do appreciate the kind of nurse I believe them all to be...I have a lot of faith in them. I also believe that despite negative attention. People really do believe that the work that nurses do is truly invaluable and genuinely think that a nurse can be nothing other than a good nurse.