More politics than Parliament

When any of us all started out in nursing, did any of us imagine that part of your day to day work would include becoming a politician? It certainly was not the first thing that brought me into nursing. Ever since I stepped out onto a ward as a student nurse, I found that keeping the community on the ward happy and the general opinion of yourself to a high level could be exhausting. I always felt that ensuring the ward staff had a good opinion of me was an integral part of my training, that went hand in hand with achieving all the necessary competencies. I found it incredibly disheartening when I found a certain atmosphere of distain on some units, it could often be difficult to ignore unfair comments and unfounded negative treatment of students. I'm sure most students have a tale or two to tell about uncomfortable situations they find themselves in whilst on a placement. Its seems to me that it is a worldwide culture in the nursing profession.

The situation remained that way when I found myself to be ward staff, as a newly qualified nurse I felt I had a lot to live up to...especially since I had move to that trust purely for my first job, I had trained elsewhere. The backbiting, gossipping and general politics that went on on the ward was an entity of its own. the relationship with other wards and departments could often be challenging to say the least and why...because gossip and opinion of another department had formed the basis of the relationship between the two of them. It was nauseating to be honest...a dizzying range of possibilities that taught me more about "politics" than I could have realised. That on occasions were responsible for the demise of several nurses I have worked with...sadly.

Even sadder, it the fact that nobody is ever left out of it, even if you keep silent and avoid it, someone always has something to say. I sometimes find myself saying to colleagues, that if there was a speciality in nursing where I had to work entirely alone, in isolation from people...with the exception of patients, I would probably choose to work there. Just for a quiet life. I can only believe that this is the case because of the difference in opinion. Nursing is a free, self regulating profession...not a police state and as long as we are free, we are free to speak ill of one another...shame, never more true would the saying be "If you can't say anything nice, don't say anything at all".

I come to disapprove of "politics" particularly when good nurses suffer. For instance, I worked on a general surgical a about 2 years ago, the ward was run by a mixture of kind good hearted senior nurses and some that appeared to take enjoyment in belittling and putting the junior staff down, it became sickening that they were deluded and arrogant enough to believe that they were doing this for the protection and interests of the patients. Believe me, if poor practise occurs, I firmly believe in challenging this however bullying and abuse of seniority is intolerable. I soon became the victim of two senior staff which ultimately lead me to confronting the situation and then after concluding the situation, I chose to move to theatres as I refused to continue on that ward...I was not the only victim. I worked with some junior nurses qualified for a short time and very given opportunities over more experienced staff. Sadly a good friend of mine who worked on the same ward, left to find new opportunities as she was not given the development she felt she deserved...she had not taken her mentorship nor band 5 development meanwhile a nurse who had been working on the ward one year less that her was promoted to band 6. My friend later said to me that she felt her "face didn't fit".

Shame, a profession that is meant to be caring and yet we frequently attempt to tread on people to get what we want. anymore cut-throat and I could swear i was competing to be the apprentice sometimes. As if the NHS today wasn't hard enough, now I have not only to go to work, I sometime have to go into battle. I always promised myself that if i ever mentor a student or become a charge nurse, i won't make my students or staff feel how I felt in the past. I like to think thats is what might make me a good teacher or leader...perhaps.

Changes

As a great singer once said, "a change would do you good". I've always been one nurse who was never   hostile towards change either at work or at home.
As I mentioned in my previous blog, I've had my own experiences receiving nursing. Lets just say it was not the happiest few months. I did however manage to turn these events from life's bricks of coal into the proverbial nuggets of gold.

When I decided to write about my experiences of being a relative, I was in the process of applying and taking up employment in another place. I felt that the only way forward was take a chance on a new experience, go out and find life and new challenges because if you don't...it could be too late and life has escaped you. My mind then started to think specifically about this sentiment and my evolving nursing career. I have worked with some nurses who have trained, worked and would soon be retiring...all in the same hospital and more alarmingly in the same speciality or department for the last 20 to 30 years. to me, this felt as if it would be limiting my options, especially in the area of practise I work in. I knew that if I didn't change what I was doing, I would become resentful and almost territorial over my area and work...I worried this would tempt me into a trap of becoming cynical. I decided that the only thing to do was to keep it fresh, learn something new.

I took a job in the northwest, about 160miles away from my old job, family, friends and more urgently a department that frankly... felt stale. It is still working in the same area of practise but a change in surgical speciality. I've never considered it to be a bad thing to expand your knowledge, skill and experience in nursing, but is it possible to change too frequently? I got to thinking about my student days when I spent time of around 5-13 weeks at a time in a variety of different specialities and got an insight into the specialist care and treatment in these areas. I enjoyed the variety and the change. when I qualified and began working, it dawned on me that I was based in that speciality as a permanent member of staff...that was scary. I knew I could change jobs and learn knew skills if I wanted but it was very different to being a student. Even when I went to one placement which subsequently became the area of practise I work in, it grew stale and I longed to go back to the ward.

I have always had an interest in peri-operative nursing since I was a first year student but it occurred to me that I qualified as a nurse four years ago and I am already in my fourth job! some nurses believe that if you change to often and try to expand your knowledge, it can have the opposite effect and be detrimental to your career leading to burnout for example, it may also lead employers to a false conclusion that you are unable to commit to a job and may led to them feeling that you are not the candidate they are looking for as you won't stick around for long. I do worry about this because often I have taken a job, learnt the basics of the speciality and decided that I don't want to continue with it as I am bored...strangely at the point where I am just beginning to feel more confident in my role and want to learn something new instead of going into the speciality in more depth. I also grow to develop a lack of tolerance for my other colleagues and they frequently irritate me after about 18 months and I decide it is better to move on.

What does it take to keep a nurse in a speciality though? especially someone as fickle as myself? I think you have to reach a point where you still want to learn but are willing to adapt and move as needed, I am a firm believer that it makes for better nurses the more multi-skilled we are, it keeps us grounded and allows us to respect our fellow nurses more, for example, in my last job, I was the only nurse in the department who regularly took shifts out of the theatre and on the wards with the aim of keeping up the skills that I had brought from the wards. Many of my fellow nurses in the theatres were not shy about saying that they would never go to work on the wards again...ever.

maybe I am just fickle but so far, I have managed to stay in this speciality for the longest of all my nursing jobs. I have plans to develop and take on further education but I have felt able to settle within theatres, I may not move jobs but I do plan to try other sub-specialities within theatre...but I just hope I don't get bored again and try to take off just as I get my confidence.

Valued? I think not

Everyone is certainly aware of nursing in the press at the moment (unless you've been on mars for the past 2 months) and I started thinking about the profession losing its way and the pressures on us to change. I hear the profession being scalded for allowing poor standards of care in the midst of the mid staffordshire "scandal". Why did the profession not speak out against poor care? Where did it all go so badly wrong from a nursing point of view? Quite simply...fear, and fear being a very powerful thing. I've familiarised myself with some of the cases involving mid staffordshire at the NMC and I feel so sad that these nurses went so badly wrong and so angry at them for letting us all down so badly. it is one of the occasions where I feel ashamed and embarrassed for them. The only thing I can think about at the moment is the deep origin of the wrong-doing. I often feel the pressure will wear people down over time and they will grow to resent their responsibilities over time. I often feel guilty of this myself sometimes, the pressure to get care and documentation completed within a short timeframe with what appears to be less and less staff and resources...no wonder people feel we don't have time for them!

When we work day in and day out in this fashion, I often stop to think about our values as a profession and not only within our profession but the wider healthcare environment. We are usually encouraged to believe that our employers are working hard to promote a culture of mutual respect and regard to one another's viewpoint, this being one important value in multi-professional working. But on a day to day basis I sometimes find, this simply does not happen. An example being our recent pay rise of 1%, this alone can represent the value the government puts on us as a profession (despite inflation being higher).
Quite often I feel that although there are unions speaking out on our behalf, we often seem to just accept what we are given. We maybe a profession of care, but to what extent do we care enough about ourselves to take action? We do little about it except talk and yet when it comes to speaking out on patient care, we spoke and once again, we're not listen to and accept criticism from government, the public and even our colleagues. Its get extremely demoralising and bluntly put, it hurts (after working 13 hours days and missed breaks).

I quite often feel that other professions need to get their own house in order before they criticise other professions in the NHS, the medical profession is by no means perfect and according to the Francis report, the management certainly is not. The key difference for me is the lack of self defence for the good nurses out there. sometimes a thank you is all it takes to make someone feel valued in there work. Sometimes all a person has to do is hint that they appreciate the effort a colleague has gone to for them. I often find that can be forgotten. I would encourage any nurse who is unhappy and feeling taken for granted to say so, believe me I am extremely vocal when is comes to defending the younger generation if nurses. However, I think we as a profession need to be more vocal about defending ourselves and our actions and don't simply "take it lying down" so to speak and stop attacking each other! I often feel let down by the NHS management and government in not recognising our hard work and effort.

We may be made an example of by the public for poor nursing, but I find that an antidote to all the negativity is to set your own gold standard to aim for, it allows you think about where you can achieve more and stop torturing yourself at the end of the day (we've all done it, and there is only so many hours in the day). I know the vast majority of us aim for excellent care and can fall short of this on occasions, but I know you all do a damn good job 98% of the time. Promote that for yourselves and don't be afraid to say to your seniors if you don't feel valued, others may feel the same. You give up and then...worst case...another mid-staffordshire.

How much value do you put on you? As Peter Carter Once said "Be the kind of nurse you know your patient needs you to be"








 

On the receiving end of nursing

The last few months have been difficult, if I am completely honest. This difficulty has come to ahead recently following the death of two relatives. Its has given me great opportunity to reflect on being a relative of a patient as opposed to delivering care as a nurse. Today, I will write only about the story as
a person involved in receiving nursing care in hospital.

My Aunts Story

Cared for at Churchill Hospital (Oxford University Hospitals NHS trust)

My Aunt was 58 years old and was first diagnosed with breast cancer in 2006, not long after I had left home to attend nursing school in London. Initially she had a breast lump that she had found, but delayed  an appointment with the GP as she was going through a painful break-up with her partner. When my aunt finally did see a doctor she was referred to an oncologist and in a nutshell underwent a bilateral mastectomy. According to the surgeon, it was approximately the size of a tennis ball at that point and they had also found another golf ball sized tumour in her other breast. Following the operation, my aunt went through an aggressive regime of chemo-radiotherapy. She suffered hot flushes, fatigue, lost her hair and her skin went very pale. She slept a lot during the day and the hot flushes were so bad that you could feel the heat radiating from her head, her eating became irregular but she kept her motivation to beat the cancer. She remained positive throughout and to this day, I may not have been especially close to her but I have great respect for the positive attitude, spirit and bravery she had during her treatment. It astounded me that she could still laugh and be positive in a situation that could defeat most people. Eventually sometime after the treatment, my aunt went into remission, the earliest I remember this being the case was after I qualified, sometime in 2009 and sure enough my aunt built up strength to start rebuilding her life, but this had many mishaps along the way. She was monitored closely after she completed chemo-radiotherapy and her consultant at the hospital was sincerely attentive, kind, thoughtful and full of compassion, in short a model of a doctor who took good care of my Aunt through her whole illness not just as a doctor, but whom my aunt came to regard as a trusted friend.

Sometime around summer 2012, my aunt began to suffer neck and back pain, almost to the point where she couldn't get up or walk for long periods of time. As before, she delayed seeing her GP due to work and social commitments. She began to vomit severely, she lost weight and became very weak, to the point my paternal grandmother began to care for her. After becoming so ill, she was admitted to hospital where her condition gradually deteriorated and my Gran had to helplessly watch. The consultant who had cared for my aunt during her whole illness attended her and my aunt underwent MRI and CT scans and had a multitude of other investigations. A long story short, my aunt had metastatic spine and stomach cancer that had spread to her lungs, bone and brain. I had the news told to me directly by the consultant's house officer, who again was a model of compassion, kindness and sympathy. I believe she will surely make a fine consultant physician one day in the future...without a doubt I cannot fault her care. The nurses who cared for my aunt on the ward, also deserve high praise. The were kind to my aunt and held genuine high standards in their care delivery. They communicated with her and my family, did their utmost to manage her pain and endlessly encouraged her to eat and drink, and they didn't hesitate went she needed help. I was especially glad that in particular one nurse was a friend of mine, who I had done my nurse training with in London, the familiar face was a certain comfort.

The ward arranged transfer of my Aunt to a hospice nearby where again, my aunt was cared for exceptionally well. I'm very glad of this and made it a point to thank the matron and all the staff on the oncology ward for their hard work...words cannot express my gratitude adequately. My Aunt was cared for in a wonderful environment, where we could visit anytime, we could bring the family pet dog and my aunt was given all the pain relief and anti-sickness she could need. Alcohol and her favourite foods was also available to her and she was helped to take her first bath in a while, which she described as "Amazing". My aunt wanted for nothing.

She died early in the morning around 8am on January 2nd 2013, she was on her own, but I take comfort in that she was not alone because she was in the best hospice I know. I will always be grateful to the staff at the hospital and the hospice for their first class care. They made a horrid situation a little more bearable, if anyone can say the same about the care I give them, I will be a very happy nurse.


My Grandma's Story

Cared for at James Cooke University Hospital in Middlesborough

My (Maternal) Grandma was 83, and lived with my Grandfather in a small village in the north Yorkshire dales. One day in May 2012, my Grandparents were driving home from the supermarket during a very warm day after some lunch. My Grandfather unfortunately suffered a sudden cardiac dysrythmia and blacked out at the wheel of the car. According to hospital staff, my grandparents car collided with a tree, span out of control across the road and collided with another oncoming car. They were both airlifted to the regional trauma centre at James Cooke University Hospital in Middlesborough.

Sadly, My Grandma suffered the most significant injuries. As soon as I received the message about the accident from my mother I contacted the A&E department directly from home. I spoke to the sister, and she confirmed that my grandparents were there and then kindly explained a little of their injuries before handing my call to the registrar caring for my grandma. She had suffered bilateral fractured femurs, a fractured tibia, a colles fracture on the left wrist, a possible vertebral neck injury and a lacerated kidney and liver. Sufficed to say, the situation did not look good, but all the staff took time out of their very busy day to calmly and kindly explain the situation to me without once making me feel as if I was causing them extra work, they made me feel confident in their care.

Following orthopaedic and renal review my grandma was admitted to ITU and prepared for emergency orthopaedic trauma surgery to repair her legs. She spent 3 weeks on the intensive care unit where the one to one nursing care was superb, they had all her needs under control and the nurses were calming and personable when it came to dealing with me and my family. Nothing was too much trouble. they communicated with us at every opportunity. provision was also easily made for my grandfather (who was on a nearby cardiology ward) to visit whenever he wanted. It may not be directly relevant, but I noticed the staff's hygiene to be of an excellent standard whenever I came to visit my grandma.

After about 3-4 weeks my Grandma was transferred to a trauma ward, where even though the nurses were busy, they always had a smile on their faces and a positive attitude towards their role. My Grandma was well fed, given physiotherapy to help her begin to get up, she was helped to wash and thanks to their wonderful care, left hospital and went to a rehabilitation unit without a mark on her skin!

During her admission, my grandma's doctors discovered a a suspicious lesion on her head CT scan, more specifically a lesion on the frontal lobe of her brain, which after extensive consultation with neurosurgeons turned out to be a meningioma. The decision was made to observe my Grandma's condition but it would be unnecessarily cruel to put her through invasive neurosurgery following her significant injuries, her age and frailty being a major influence.

Sometime after her admission to the rehab unit my Grandma became increasingly disorientated and withdrawn, her memory deteriorated but nevertheless she was at a stage where she was fit enough to be discharged. After a monumental effort on the part of the staff at the rehabilitation unit and my parents, my grandmother was discharged to my parents house on 31st October, where my parents and Grandfather tirelessly cared for her with the help of some carers and one particularly kind district nurse, who I had known when she was a student during a placement on a ward I had worked on, once upon a time.

Sadly my Grandma's memory deteriorated further and my family were unable to cope with her care needs at home and she was again admitted to another hospital in December, where she was cared for during investigation into her decline in general health. When I met with the staff, the ward sister was a kind and gentle woman, with the patient listening skills of a saint, I was made to feel welcomed by all the nurses who never allowed care of patients to suffer despite their difficult working conditions, I was never made to feel a nuisance and was treated with care myself. Eventually, my Grandma's conditioned deteriorated to a point where her treatment had become futile, but the care remained at a high standard. I was kindly visited by an American doctor who had initially assessed my Grandma on admission. She took the time to talk to me and just ensure Grandma was warm and pain free and just generally see how she was. She held my Grandma in high esteem, she also took the time to ensure we were cared for and she was there right until the very end. Grandma died on January 3rd 2013 in hospital of a frontal meningioma with significant intracranial oedema. Even at the end, the nurses searched for me, trying to contact me to come to the ward, and finally they found me and I was sent to the ward by my senior staff nurse on duty. Her efforts to reach me despite not knowing where to begin the search, ought to be commended, for no other reason she will always have a special place in my heart.

I've not simply wrote this because I want to make my fellow nurses look good in light of bad publicity, I have genuinely had an exceptional experience of nursing and medical care of my relatives. I will forever sing their praises and cannot fault them. I will ferociously defend them against bad word simply because they gave us a wonderful experience that gives me faith in being a nurse. Despite all the negative publicity nurses and the NHS receive, I was always be their number one fan...I just happen to be a nurse too

Keep doing what you do my fellow nurses, you've made me proud!

The game of consequences

Considering consequences is something that plays a pivotal part in a nurses decision making on a day to day basis, that is not news to us as a profession. Sadly, I have come to think about the consequences of our actions in light of the tragedy that has befallen us as nurses in losing one of our own in such unfortunate circumstances. My heart goes out to the family of Jacintha Saldanha, I wish them well in recovering from this horrible situation.

The situation did however make me think about considering the consequences of our actions. The fact is, if we as nurses do not stop to think about our course of action and the likely possible outcomes based on passed experiences, it could lead to people suffering and a scenario from which we can't go back. When I think about my past experiences, I think about the things that I would have done differently. Itq doesn't matter how much I try to imagine the things I would do differently, I made a mistake and it isn't the first time and it won't be the last. The differences is, I stopped to consider my actions at the time and after and I learnt from it. It is when people don't stop to think, that the outcome can be disastrous.

I happened to watch an interview with the two radio DJ's, involved in the hoax call to the King Edward VII Hospital on an Australian news channel, and although the two DJ's sounded genuinely sorry for what happened, the words "We didn't think" really hit home and I just couldn't get this phrase out of my head when it comes to the idea of consequences. Seriously, what does this interview have to do with nursing?

Whenever I have heard about serious mistakes or errors in practise that has resulted in harm or severe consequence to our patients the common theme I seem to notice is the lack of thinking prior to taking some action. In the end the two DJ's also said they were sorry and it was not what they planned. I don't doubt they are sorry but all it demonstrated to me was the lack of insight into possible consequences for the people on the receiving end of the joke.

We as nurses learn that making a mistake is an inevitable part of practise and that we are humans, not robots. There does come a point however when our patients would question whether we had really considered something prior to taking action if the outcome is dire or considered preventable. Cases such as those going to professional competence and conduct hearing at the NMC are full of cases where nurses did not stop and think, the exact same thing as these two DJ's .

All that aside, I also noticed that despite the practical job not going to plan, these to DJ's continued with the prank, it was meant to be fun, it was done everyday, they thought they would be hung up on, the outcome wasn't thought about, they were doing their job and when it came to the decision of airing the practical joke on national radio...the decision was out of their hands. I also might add, that these were their own words, uttered from their own mouths at interview.

It was like an epiphany, it was like so many stories in nursing where things had gone unintentionally wrong, the likeness what strikingly similar and I thought, surely there is a lesson nurses can take from this? The most obvious being, even when a situation seems normal, day to day practise, we still need to stop and think and make sure we are absolutely sure of our confidence in what we are doing before we pursue it, otherwise we may end up uttering the words to an NMC investigation panel "I didn't think"

Sadly, these two radio DJ's are finding out the hard way the consequences of not stopping to think. It has had the most tragic of outcomes, that in my opinion could have been avoided. Unfortunately for them, like many nurses who went wrong because they didn't think, they have to live with those consequences for the rest of their lives. Just something to think about.

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