Far too much to do. Things going wrong left right and centre and I’m desperately trying to keep a calm level head in the middle of it all. A couple of people at work are trying to make a drama out of relatively minor things whilst being critical of those who are getting on with life despite difficult challenges being thrown at them. One person in particular loves to take someone else’s crisis and turn it into their own melodrama and she has been on top form this week. I’ve had a very strong desire to just shut myself in my office and hide.

I’m away next week on a fellowship module then on annual leave for the next two weeks. The following week brings another fellowship module. I’m going to be away from work for 4 weeks at a time when several fairly major things are kicking off and need sorting. I’m petrified of what I will return to and I’m risking it over shadowing my holiday. I’m missing team meeting and today wrote out everything that needs to be passed onto the team. The general theme was ‘I asked you to do x, I emailed you about x, I made a crib sheet showing how to do x, we frequently discuss the need to do x at team meeting. X is not being done. What do I have to do to make you do it?’

The desire to scream and then slap people can be quite overpowering at times.

I know I am again being a miserable tired moany person who probably needs a slap herself more than anyone.

So, a sad straw clutching exercise about the positives -

• Finally replaced the rear bulb in my car after half an hour of swearing. I can now drive at night without the fear of being stopped by the police (Its been out for 3 weeks – I know I’m bad)
• Took the cat to the vets yesterday for his boosters. This had also been on my list of jobs I didn’t have the energy to sort. He’s going into the cattery in two weeks and my conscience told me I had to get them done now. He had one manky tooth but our vet is very honest and said it wasn’t worth the money to get one tooth done. He’s got to go back in 6 months in the hope that the rest of his teeth are bad enough to justify cleaning them.
• Got my new phone. I love it. Also feel very sad that I like to read the Guardian in bed at night.
• Samuel no longer cries when I drop him off at nursery. Since changing nurseries in November he had been hysterical whenever I left him. I found this hard as he’d never cried when I left him at his previous nursery. Even though they told me he was fine within a few minutes of leaving him, it still always unnerved me.  I’m now going to work feeling happier about leaving him.
• Someone from IT managed to get my VPN log in for my laptop fixed today after two weeks of dithering with service desk and BT.
• I bought a new handbag from ebay for such a bargain price I feel guilty that I paid too little for it. I felt I was taking a risk but the bag was immaculate.

• And most importantly…….13 sleeps until we go on holiday

Someone I work with was diagnosed with breast cancer last week. We are a very small team so we’ve all been upset about it. She is not that much older than me and we have daughters the same age. It’s one of those things that is very close to home and a little scary to contemplate. I am in awe of her strength and attitude in facing this. After the initial shock on Thursday, the atmosphere in the office has turned back to our usual dark and bizarre sense of humour. Definitely a moment of laughing so that we don’t cry.

In terms of work this has thrown up some issues for me. I’m scared my team will implode under the stress of a lack of staff whilst she is on sick leave. Its happened in the past and I am adamant it will not happen again. A major contributing factor is out of my hand though. There is another ongoing issue relating to long term sickness and human resources. It means that I am paying for a member of staff who is not currently at work and I cannot replace them. Months of attempting to get it resolved have amounted to nothing. On Friday I debated sending an email to someone in HR but didn’t as my frame of mind was likely to get me into trouble.  I am deeply concerned that another person on long term sick leave will mean we cannot function. We have run at capacity with no give for a year. Any sickness has a serious impact on the service we provide. I’m scared that we have now reached a tipping point and the fact that bureaucracy is at the heart of it makes me want to scream.

Steven’s grandad is very ill and we’re just waiting for a phone call. Things have been bad since yesterday and we’re feeling in limbo.  His grandad had made his wishes clear a couple of weeks ago and as a family we’re all at peace with the whole situation. I still worried about what the next few weeks will hold.

I’m still exhausted. Have got the sleepbot app to see how much sleep I actually get and whether the lack of sleep is all in my head. The theme of this months happiness project is vitality. I confess I’m not feeling more energetic but my tiredness is not stressing me so I’m taking that as an improvement.

I’m now halfway through the first month of the Happiness Project. Up until yesterday things had been going well. I’d had two really good weeks where I felt on top of things.  I’ve stuck to three of my resolutions really well but haven’t bothered with the healthy eating. I’ve eaten less rubbish but still not enough of the good stuff. I also haven’t gone to bed early.

Yesterday Steven came home from work early and at 6.30am announced that he hadn’t organised days off for my next fellowship module. When I knew I was going to be away I gave him all the dates I needed him to be off work and at home. This was in November. I’ve asked him more than once if it was all sorted and he told me yes. The next module is in 2 weeks and he hasn’t got any annual leave left. We’d talked about this possibility and we’d decided that Steven would work an extra night one week and take the extra day off another. He’d sorted this arrangement on Friday and told me that I need to take this Thursday off work. I can’t – I have an all day clinic that cannot be rearranged with 4 days notice. I was so angry.

My options were to cancel clinic (not an option) or put Samuel into nursery and Eloise into breakfast club (total cost = £61). When I was offered the fellowship place and saw the amount that I would have to be away from home I nearly turned it down. Steven told me I had to take the place and that we would sort out the childcare issues. Yesterday I felt that it was being left to me to sort out those issues.

Childcare is an issue that constantly rears its head and I get so frustrated that I cannot sort it easily. We do not have a vast amount of family support locally and with Steven working nights I feel I get little sleep.  I resent people who tell me how tough or tiring their lives are when they work far fewer hours than me, have a partner to share the nights with and have a grandparent on tap to take the children for a night just for the hell of it. For Steven and I to get a few hours one evening to just leave the house alone requires such planning or begging for babysitting we generally don’t bother. In the last year we probably went out 4 times alone. A night without the children forget it.

So yesterday I was very miserable and spent most of it shouting. This morning Samuel woke up at 4.30am as he fell out of bed. I spent an hour dealing with a tantrum then just as he had gone back to sleep Eloise and the cat woke up, started making a noise and woke him up again. I accepted defeat at 5.45am and we all came downstairs. I’m miserable, tired and thinking why do I bloody bother. I would just like a break. One night, no children and without the logistical nightmare of organising it or begging for favours here there and everywhere.

So I’m not happy but its only been a two day blip. I’m hoping I can improve things by this afternoon.

It makes me sad that frequently nursing seems to be at the heart of what is wrong with the NHS. Widespread media reports worry me that nurses, as a profession are portrayed as uncaring and cannot be bothered to actually care for people. As someone who takes pride in their work and tries hard to ensure myself and my team deliver high quality of care, it worries me that these reports imply that we are all this bad. I’m not trying to deny that poor standards exist or say that improvements are not needed.

My trust has a mission statement based on the NHS Constitution.  At a recent trust event we were asked in groups to discuss this mission statement and if it had the correct focus for our organisation. The feeling amongst my group was that it is a tokenistic gesture that doesn’t actually have any relevance for us as practitioners. I was very taken aback by this. The pledges made in the mission statement relate directly to the poor standards of care that are reflected in the frequent reports of public outcry. The discussion group comprised of all professional groups, not just nurses. It left me wondering whose agenda are we working to? As health professionals are we not bothering to take notice of the basics that are fundamentally important to out patients? Have we lost sight of what is important in healthcare?

Combining this attitude with the concern over standards of nursing it made me wonder who is responsible for this? Is it due to a minority of individual nurses who are in the profession for the wrong reasons? I suspect that the problem is far greater than a few people and that the overall problem is partly due to culture than personal attitude. Is nurse education that bad that it does not cover the basics of caring? As someone who was a followed a degree programme for initial registration, I was frequently told by others that I wasn’t interested in nursing, I wanted to be a manager. Their presumptions could not be further from the truth. I’ve watched the diploma v degree debate with interest and am saddened that many nurses view degrees as a bad thing purely on the basis that they believe degree courses are only capable of creating managers. Is there a lack of nurse leadership or representations on trust boards? Staffing issues are nearly always the main excuse for poor care – why are these not addressed more fully? Realistically I feel that all of these factors contribute towards the situations that we regularly find are occurring with the NHS.

As part of my next fellowship module I’ve been reading the report into the Mid Staffordshire enquiry. The report was more interesting than I had expected. It also made me realise the point behind many of the activities we regularly have to carry out at work.  Audit is an example of this. I confess I find regular audits at work a bind and a pain to complete. The  report made me consider what potentially could happen in the absence of an audit structure. At Mid Staffordshire audits were not carried out. The trust relied entirely on external inspections and did not monitor standards in between these visits.

This week at work I started regular group clinical supervision sessions for the team. Prior to this we had not formally completed clinical supervision but it is required by our trust in a new policy. Yesterday we mentioned to a visiting rep about our session that day and she sighed and said ‘Oh, another tick you have to put in a box for the sake of it.’ This made me wonder – is this reducing nursing to a tick-box exercise? Again, viewing this in the context of Mid Staffordshire, what would the alternative be in the absence of clinical supervision?

Whilst audit and supervision may seem like a pain at the time, their purpose is ultimately important. I’m lucky to work in a good team where we are open, able to raise issues and safely challenge or seek help when a problem arises. If a work culture is not that supportive though, the importance and value such activities would increase. Staff, and more importantly patients, need a mechanism that regularly ensures standards are acceptable and improved upon. Professionals need a forum where they can raise concerns rather than accepting them and becoming caught up in a culture of poor care.

David Cameron’s answer to poor nursing care this week was an hourly ward round carried out my nurses to ensure standards. I’m not convinced that this is the answer. I feel nurses will view it as yet another box to tick without considering its purpose. I feel it would be more beneficial to explain the reasons behind completing audits rather than adding more forms to the pile.

I do feel nursing has lost sight of what is important to our patients. The basic rights discussed in the NHS Constitution may seem trivial to professionals but are fundamental to those we care for. Until that difference in perspective is acknowledged the complaints will continue.

I’ve taken it out so many times in the last year I keep debating if I should just buy it. The reason I like is it that it helps you to see that reflection can be a simple process. It gives quick helpful pointers and ideas for activities that all help with the reflective process. I spent 4 years at university feeling like I was being forced to sit and reflect to a set cycle that I didn’t find helpful. It just became a tedious chore that I didn’t actually understand the point of.

Anyway, it suggests quick lists that you can return to at a later date. I love my lists so this has probably swayed my opinion on this book. Here are a few quick positive things from the week so far -

My phone docking station arrived this morning.  We have gone from charger hell -

to charger heaven

My only gripe is that it doesn’t have an adaptor for my camera but that’s the only downside. I can live with that.

At work we had our first group clinical supervision. Initially we all felt the pressure of sitting there with expectation that we will all have something to discuss. Interestingly the conversation turned to a member of staff who felt she would have nothing to discuss as she feels she doesn’t contribute clinically. It was a good opportunity to try out some coaching skills and I’m pleased with the outcome (I hope the other person is as well!) Its left me with a positive feeling for our future sessions.

Things are still not good with Steven’s grandparents and the situation came to a head on Saturday. I had to ring his mum and have a really difficult conversation with her about my professional and personal concerns about her dad’s health and prognosis. In October and November we had really struggled as any attempt to discuss either of her parents was ignored as she was in denial. Surprisingly the conversation at the weekend went well. She is now fully aware of his health and accepting of the direction in which things are heading. I’ve had to gently tell her of the difficult but necessary things that need to be done as soon as possible regarding decisions around his care. The big positive in this situation is that as a family we are all of the same opinion, we’re all helping each other with the difficult things that are going on and my mother in law is taking control and being the grown up in the middle of it rather than leaving us to cope as she had tended to do in the past.

I got shouted at yesterday morning in a particularly horrible way. Most upsettingly it was by another healthcare professional (wonder if I should use inverted commas on the word professional in this context). I won’t go into detail but essentially she had created a bad situation and when it all went wrong it was my teams fault. It wasn’t, it was hers. She wasn’t happy when I attempted to explain my perspective and she resorted to just shouting at me that my service was unacceptable. It was upsetting but I put my point back where possible. I didn’t let it upset me for the rest of the day. I usually let things fester but I didn’t. When I put the phone down to her I decided to send an email to her to clarify my side of the conversation and explain the things that she wouldn’t give me the opportunity to do.  Perhaps this was the reason that it didn’t fester. I got my feelings and opinion out and  at the same time created a record of the event that can be used if the incident is raised again in the future.

I needed the strength of the Dalai Lama straight after that call!

The girls create…

I’ve tried really hard to keep positive and not get caught up and dragged down in others doom and gloom. I’m lucky that my secretary is on the same positivity drive and we have adopted the new office mantra of ‘What would the Dalai Lama do?’ to refocus ourselves on positive, calming thoughts (success of this varies!)

So the good things from the week -

Samuel is going to sleep much quicker. No protests or screaming tonight. He played in his room for a bit then put himself into bed after 20 minutes. He’s also sleeping until 7am most mornings. The sleep is making us both feel more human and better natured.

Today we received the clinic letter from Samuel’s last hospital appointment. We had been concerned about his breathing and he hasn’t been himself since October. His consultant feels that the breathing problems are not related to his heart and he probably is just suffering from repeated colds and chest infections. The letter explained that a chest xray shows resolving infection that doesn’t need further treatment. Cardiac wise he remains stable with no real change in his overall condition since his last review a year ago. He still has mild stenosis and regurgitation and some hypertrophy but this is as they had previously reported. He has another appointment in two months time but this is mainly to review his breathing and we were told that he would probably not have an echo then.

Had a really good day out of the office yesterday to concentrate on fellowship things. Have kept up with my journalling. I came to the conclusion that I have a real interest in coaching. I’d like coaching for myself to aid my development and to keep my motivation up. I also think it is a good way to help me deal with my team and help them to develop. I usually take on everyone else’s problems or queries at work and by adopting a coaching mentality I can reduce some of that workload for myself, delegate and aid staff development in the process – win win!

I spent yesterday searching for a coach and trying to find someone suitable. I have received money as part of the fellowship so had intended using this to pay for coaching. Today I had a conference call with the programme leader who has suggested she will contact our regional health authority as they will have coaches that they use and ask someone to contact me to arrange this. I will not have to pay for this meaning I can put more money into my service and team development.

Yesterday I also met with someone I had approached to be my mentor and clinical supervisor. I had sent a cheeky email asking for her to suggest potential mentors to me in the hope that she would offer to do it herself. The plan worked The meeting went well and I have really good feelings about it. We discussed many things and our opinions are the same on a number of key issues. She has given me things to work on and suggested further sources of help. I also discussed with her about a proposed restructure of our trust and that I feel this is a threat to our service. She explained it in a different way to how I had viewed it initially. With a different perspective I am now confident that we can use this proposal to our advantage and strengthen our role.

Operation Declutter continues at home. My shredder is still keeping pace. I’ve ordered the phone docking station and I’m longingly looking at the Ikea website for storage for my kitchen command centre. Today I introduced the 15 minute rule on my work desk (yes, I am just as bad at work). One drawer cleared. My filing cabinet will take a long long time to organise.

So a good week. I’m concentrating on my little goals and using small steps to work towards the bigger objectives. I need to keep focus on this as its working well. Any other suggestions on keeping a positive momentum will be gratefully received!

The first challenge for the Nest Effect has started and its timing is very apt.

The overall theme for the month is prioritising and scheduling. This week involves making a note of what you’re doing throughout the week. I constantly feel I do not have enough time but deep down know I waste vast amounts of time (generally on games on facebook).

In September I reduced my hours at work with the hope of making work more manageable and things at home easier as well. Sadly I’m not feeling that good about my decision. I still don’t feel I have enough time at home and work consists of the same quantity of work with one less day to do it in.  I had dreams of my day off being a relaxed day but instead its a manic dash to do the shopping and washing and then fly around on the school run and then ballet lessons. At the end of my day off I look forward to escaping back to work!

I’ve read before about noting times and identifying where time ‘goes’ but have never actually done the exercise. This time I’m going for it! I struggle in the same way at work as I do at home. I have messages and emails that I think I will sort the next day and often I pass them on and on for a week or two. Not good.  I’ve read various ideas in the past about dedicated times to work on messages or emails but again never tried it. I know as well that I’m easily distracted and can end up doing something totally irrelevant to the job I was meant to be doing in the first place.

I’m planning on noting the time at home and at work for the next few days to try and make things easier for both. I also have to start thinking about what I actually want to do with any freed-up time. I’d said in an earlier post that this year I had conceded that my sewing has to take a lesser priority this year as I simply do not have time. I like to think somewhere I can still keep doing something. Its a difficult balance. I like to keep busy as I’m happier when I’ve got lots to do. On the other hand, I take on too many commitments and eventually become overwhelmed. In that situation its my personal choices (eg. my evening class) that get dropped. Others needs end up taking priority over the things that I would like to do.

I think at the heart of it is that I’m just as important as everyone else and putting myself a bit higher up the priority list isn’t such a bad thing.