The summer starts here

I finished and submitted my final fellowship essay yesterday. It was a huge relief to hand it in and be done with the academic side of it. I have a strange guilt over it – I feel sorry for the poor person that has to spend August reading my riveting 8,000 words.

I now feel I can relax a bit and enjoy the next few weeks. I’d been thrown into a panic every time I saw an Olympic countdown clock as it just reminded me that the essay was due in before then.

Eloise finishes school on Friday and then I have two weeks annual leave. We have lots planned for the summer – no major holidays just lots of things here and there. Next week we’re all off to the caravan for a week, we’re also going to Lincoln for a couple of days and we also have Olympic and Paralympic tickets.  August is going to be very busy but I’m hoping it’ll keep the kids occupied and the sun will eventually shine (highly unlikely I know).

Work continues to be manic but I can see progress happening. I’m also receiving good support from my manager who is reassuring me over the things that I am doing and also helping me to prioritise. I have a few fairly major projects ongoing  and all feel important and urgent and it’s been difficult to decide what needs my attention first.  Getting my essay finished early has helped – I still have a study day booked for this week so will be trying to catch up on everything and get through the pile of work.

My plans to increase my resilience feel like they are working. I wrote a section in my essay about how I felt I had benefited from but it is impossible to quantify or prove. It’s working for me. I remain under pressure but feel I am coping well. The fellowship has meant that I have spent 9 months with a huge workload – both from the programme itself and from changes with my job.  I’ve emerged the other side feeling more confident and able to handle an uncertain and ever-changing workplace.

I’m still going to the gym twice a week. Sadly I do not (yet) have the body of Jessica Ennis but I have lost 7lb and I’m feeling focused and positive about losing weight. I would love to keep this momentum going over the holidays and eventually get my weight back down to where it was 2 years ago.

Focusing on the important things

The week before last was my final fellowship module. As always it was an excellent and inspiring few days away. The overall theme was personal resilience – something that I feel is an issue for me as I tend to get a bit defeatist when things aren’t going smoothly. That said, my outward appearance is probably one of calm and in control whereas in reality in my head I’m sick with worry, know that I am unlikely to sleep that night and visualising the worst case scenario. So yes, I was looking forward to this module.

Jeremy Snape from Sporting Edge came to speak to us and gave a really simple but powerful message on focusing on what is important. A number of things really struck me – focusing on goals and differentiating that from a dream. Making a target practical and tangible on a daily basis is important to increase the chances of success at a later date. All the small daily actions add up and remembering each day will contribute to that end goal. He talked about a ‘to don’t’ list to help avoid distractions and to ensure the things booked in your diary are ones that actively contribute to your long term plan.

I’ve been thinking quite a bit about my work life balance and the feeling that I’m struggling to manage things well and keep my sanity in the middle of it all. I’ve had a minor work epiphany and made a few changes to put myself (and my happiness) first.  I’ve stopped answering my phone on my day off, I no longer look at work emails in the evening and I am doing my utmost to keep work at work.  I’ve started saying no and been surprised that no-one has been horrified by my reaction. Its encouraged me to say it more often. I had a coaching session yesterday and we discussed this. I’m currently working at setting boundaries for my service and I’m now in the process of setting my own personal boundaries and making it clear to people that I am not an endless resource that can be used constantly.

I’ve joined a gym as part of the plan to look after myself. I’m making sure that I get time on my own and  can use my stress in a constructive way. The steam room is also a bonus. My weight is still an issue and I’m getting disheartened by the lack of progress. I’m hoping that the regular exercise will have an impact soon (if not I will be seeing my GP and demanding my thyroid is checked!)

We’ve also been busy tidying up part of our garden – the plan is for this area to be a child free relaxation zone. I’d like an arbour so I have somewhere to sit out in the evenings. I also have a mild irrational desire for a japanese maple.

So at the moment life isn’t too bad. The only sad thing is that our cat died at the weekend. I had the difficulty of explaining it to the children. I still have to work out how I’m going to explain burying his ashes in the garden. Samuel keeps asking after him, Eloise wants to know why I took him to the vets after he died and I keep thinking I’m seeing him waiting at the back door as usual. Still a little strange and foreign without him.

Stopping and thinking

I’ve had a difficult week. I’m under a lot of pressure at work with far too much to do. Things at home haven’t been good and came to a head on Tuesday. Its left me thinking about lots of things, perhaps too much. I spent most of the week not sure what to do. I felt stuck in a bit of a hole without seeing a way out of it all. I’m now calmer, feeling more focused and level headed and planning to work through my worries in my own time. There’s no rush to make any decisions so will not add pressure to myself even further.

So, some positives for the week –

We are a nappy free household

Samuel has suddenly become dry overnight so I’ve ditched all nappies – yay! I’m really surprised as Eloise was still in nappies overnight until she was 4 and a half so for Samuel to be confidently sorted day and night before two and a half I think is a big achievement. It’s rare for him to have an accident so I’ve also thrown out my faithful nappy changing bag. For a boots freebie, its lasted the 5+ years well. I wasn’t sad to see it go though.

I am a little bit sad though that there will not be anymore days of lovely cloth nappies hanging on my washing line

Competition winnings

I am slightly addicted to entering competitions. I can waste many an hour on loquax looking for competitions to enter. In the past I’ve had a few successful runs and recently have had another. It started with a DVD, nothing major but still a DVD I want to watch and will happily be passed to my mum and sister so a bonus. Next came a stash of make-up from Tescos after I retweeted a message. I’m plucking up the courage to paint my nails the interesting shade of blue they’ve sent me. I think I will try it this afternoon. I’d wondered if good luck comes in threes and yes it did! I had an email to say that after completing a questionnaire online for work, I had won an ipad 😀 I’m still waiting for it to arrive so currently spending time mentally kitting it out and making lists of apps that will completely revolutionise my life.

Eloise has unfortunately been introduced to my Mum’s ipad so I can see future fights to get near it!

Successes at Work

Things have been moving since our meeting with the chief executive last week .  No concrete developments or changes but questions are being asked and people who have previously been difficult to talk to are suddenly asking for more information. Staffing remains my highest priority and whilst there has been no mention of this, I remain confident that something will be done.  We are taking part in the trusts annual nursing conference in three weeks time (the source of most of my workload at present). I’m giving an hour long presentation and I am hoping this will be an excellent opportunity to promote my fellowship project to a wide audience and get more people supporting the changes I want to make. The conference also incorporates the trusts annual awards and I heard yesterday that my team has been nominated for the Innovative Practice Award for the work we did on Productive Community Services. My team has been so positive and willing to try and make changes that  I think I had taken for granted the amount of work that we had done. My work looking at and comparing our staffing and activity levels showed me that we are working far more effectively than in the past – our low staffing forced us to do this and as a result we are now working really well.  On Wednesday I went to speak to another team who had not made any changes in the light of low staffing levels. As a result their work is quite sporadic and my questioning or requests for action from them met a very defensive reaction.  The challenge of meeting patient needs under pressure was simply met with ‘we won’t do it’ rather than ‘is there a better or easier way of doing this?‘ which is the attitude my team takes. The teams who are shunning adaptation are key partners in my fellowship project. I realise this will make my project harder but at the moment I am very grateful for the rich material they are providing me for my current assignment.


The week ended with two days of fellowship which ended on a really good session on emotional intelligence. I found a book in the library this morning which is packed with self assessment tests (nice lists with boxes to tick 🙂 ) so that will keep me occupied this weekend. It will give me something to work on in coaching.

We also did some work around Belbin’s team roles. I was completely not shocked to learn that I am a completer-finisher

Nursing cuts: honesty is the best policy

Our chief executive came to our team meeting yesterday.

I had a number of things I wanted to speak to him about and top of my list was staffing. I heard a couple of weeks ago that someone had left my team after a long period of long term sickness. I was told that their hours had been removed from my budget as part of our cost improvement programme and that I would not be allowed to replace her.

My main gripe is that there was no negotiation in the matter. No-one asked me what the consequences of that loss would be and the impact that it would have on patient care. It’s not the first time that this has happened. I realised that over the last 6 years our overall staffing has just consistently been cut every time someone has left, retired or requested a reduction in working hours. I worked out the spend on nursing time six years ago and compared it to today – both in financial terms and whole time equivalent. I was shocked by how much it has reduced when you consider that our county’s population has increased by 5% in this time.

Frequently the message given by the government is that spending cuts will not affect patient care and that front line services will be unaffected. This is absolute rubbish. By doing it slowly through natural wastage nurse posts are being cut without any consultation on what impact that will have on patients. Comparing our workload with 6 years ago we are still  seeing similar numbers of patients. We have made many changes that have made our working processes more efficient, saving time and money and the huge difference is our waiting times. Currently people may wait up to 17 weeks for an appointment to see us.  I do not think this is acceptable and compares to 8-12 weeks when our staffing levels were higher.

Looking specifically at continence, a clear link has been shown between cuts in specialist nursing numbers and increases in spending on disposable products. It saddens me that pressure on our workload means people are not receiving high standard of care and I feel more people are simply being given disposable products because we do not have the capacity and time to offer a good treatment programme. A recent publication made the recommendation that there is one continence advisor per 100,000 of the population. My service operates at less than half of this suggested figure.

So, warts and all, as a team we explained this situation to our chief executive. He said that as a trust we have a waiting time limit of 12 weeks – he would prefer it was lower. Our waiting list has never been highlighted as an issue to the board and he felt that our current waiting time is a concern. I feel we were able to demonstrate that whilst we are ‘coping’ on lower staff numbers, the implication is that people will wait longer for an appointment.  He was also unaware of the practice of staffing hours being cut without consultation. He felt it should not be happening without some sort of conversation about impact on care. I explained that I would not necessarily be looking for like for like replacement but I could offer suggestions that would still deliver cost savings without compromising patient care.

It shows that cost savings need to be considered with input from clinicians in order to keep the interests of patients at the heart of it. I feel I am in a good position to offer this – I have the interests of the people our service treats at the forefront of my mind but I am also capable of making a sensible business judgement on the financial implications for the wider NHS. My recent experience is that this conversation is not happening and it also seems that the board are unaware of this practice.

In the past I think there might have been a temptation to hide perceived flaws in services such as waiting times for fear of being seen as doing a bad job. I feel why hide the truth? Unless the full picture is given then nothing will change. I was keen to point out that we are doing a great job despite working under huge pressure and that potentially we are capable of so much more.

I’m crossing my fingers for a positive outcome from the meeting.

Busy writing (honestly not panicking……..much)

I’ve had a busy few weeks hence my lack of posting.

I’ve got my first essay for my fellowship due in next Monday and it’s reaching a crucial stage. I’m past the halfway mark and not entirely happy but oh well, it’ll be handed in in some form or other next week. My brain is already trying to preserve itself for the next one which follows just a few weeks after.

I’m fed up with work. There’s lots of bickering and stressing between various team members and my attempts to sort it last week went disastrously wrong. I felt totally useless and like I had totally read the whole situation wrong. I’m struggling under the sheer quantity of work and adding the essays and fellowship study days into the mix hasn’t helped.  I’ve had a headache for 8 days (today is the first headache free day 🙂 ) and now have a cough and feel generally rubbish. I had yesterday off sick to try and clear the headache – I had two phonecalls from work even though I had rung in sick. Both related to things that they could have sorted themselves. Today (my normal day off) was slightly better – just 3 text messages. I find it hard to leave work behind and I think this shows that they follow me home as well.  I know this isn’t a good situation and it isn’t doing me any favours.



Today was my first headache free day for over a week. It had been bothering me. It was a bit like a migraine but I felt I was functioning too well to class it as that bad. However you define it, it was annoying me. In a very rash moment on Thursday night I decided I’d had enough and I went caffeine free.  My caffeine intake goes up when I’m stressed, as does my alcohol intake. It’s known affectionately as the ‘caffeine and alcohol diet’ in my office eg. “Things must be bad, Karen is back on her caffeine and alcohol diet”.  Five days later I’m pleased to report I am still alive and functioning on a good level. I manage to wake in the morning and I am sleeping so much better.  My only complaint about it all is try going into a shop and buy a sugar free caffeine free drink – your choice is either coke or full fat lemonade. Not a good choice. I refuse to drink water!


I had a trip to outpatients with Samuel last week and all was well. He needs another cardiac review in September but other than that things are still fine. He’d previously been on an annual cardiac review so the 6 month interval has worried me a bit – the rational part of me is telling myself at least he’s seen and checked before the winter which we know is always a period of time he struggles with. The irrational part of me is still reading into every minute detail that is given to us and thinking they are concerned about a deterioration. At the hospital I told them that he has been really well, apart from chicken pox in February and hadn’t even had a cold since we last went in December. Typically he woke up the next day with a stinking cold and cough. Last night it went into high temperature and then a weird rash this morning – hand foot and mouth. We’re now confined to the house for the next five days so I’m hoping this is the last of the sickness for the winter season.


As Samuel can’t go to nursery I’m off work tomorrow as well. The enforced break has done me (and my essay) good. I need to keep the good feelings lasting once I go back. I’ve got chemistry meetings with potential coaches arranged for the end of the week so I’m taking that as a big positive step in the right direction to sort out my stress and worry.


The mixed bag that is my week

Lots has happened this week – a real mixture. I’m left at the end exhausted and feeling like I’ve not moved forward.

The week started with another fellowship module. Monday morning Eloise had woken up with a very high temperature and couldn’t go to school. Again Steven had worked a night shift so then stayed up all day with her so I could go. He happily volunteered to do this but I still (as always) felt guilty about going and leaving him without any sleep.  She is still unwell and on Thursday couldn’t go to school so I had to work from home. I mentioned in conversation how busy I was at work and this was then interpreted into a snappy response telling me he felt he did far too much and that by asking him to take a day off work I was taking liberties. I hadn’t asked him to take the day off. It had not even entered my head but he made the assumption that I was. Cue an argument.

Eloise has chicken pox and an ear infection and is generally feeling sorry for herself.


Work wise things are busy, stressy and it feels like people are sniping at each other. Human dynamics are causing more problems than workload and the fact that I’ve not really been at work for 4 weeks hasn’t helped. Our office is also having major work done that will take four weeks creating more upheaval.  I’m feeling overhelmed and needing to split myself into several pieces to have any hope of achieving anything. A looming essay is also not helping.   My main feeling is that I am trying my absolute hardest and that isn’t good enough for many people. On the fellowship module we had a discussion around white water leadership. This felt a really good explanation for me and the way I feel about work. I plan to look and reflect on this a bit more over the weekend. I’m making sure my life jacket is securely fastened.

I had a letter to say my child tax credits are stopping. My main feeling about this is relief. The whole management of my tax credits has been bad for the last two years with a number of mistakes, lots of stress and letters demanding lots of money from me. Hopefully I will now have a summer without an HMRC appeal looming over me.

I’ve jumped back on the weight loss bandwagon. Will post more on Sunday after my first weigh in.

I’m throwing myself into my 40 bags challenge and my scary cupboards are looking a little less scary.

On a lighter note I’ve decided I hate my hair and I’m sick to death of it. We were watching ‘Tangled’ yesterday and again I admired Rapunzel’s hair when it was short (is it wrong to want the hair of a Disney character?)

How do I find a haircut like this so I don’t have to take a picture of Rapunzel to the hairdressers with me? Haircut will be booked!

Our holiday now feels a distant memory

And back to reality: the fellowship hangover

I’ve been in Coventry for the last four days on my latest fellowship module.  Again, I’ve returned really fired up and inspired to make changes at work. I’m also getting ideas for my future direction and generally a sense of where I would like to head.

The main message I took away was that the NHS reforms are coming in and no amount of protesting is going to make the government drop them. Andrew Lansley came to speak to us and said that once he makes a decision he sticks to it. He will ensure that these reforms go through.  With this in mind there was much discussion about taking advantage of change and using it to make a big impact. Part of me thinks if this change is inevitable, why are we wasting time complaining about it rather than getting plans into action to make sure that it does succeed. I also think that we can influence and utilise the reforms to the advantage of patients.

Whilst I was away we had a family bereavement. I’ve returned to some tension as one family member has started to help herself to the deceased’s possessions (well, strictly speaking he was still alive when she started).  She is very publicly telling people to help themselves as ‘they will only be binned’ and even offering items to people outside of the family. To say the rest of the family is horrified is an understatement. She is not an executor and is not part of the will so legally speaking she has absolutely no right to do this. It also left me questioning her morals as well. We were talking about it this morning and someone told me about this phrase –

My principles are very important to me and I rarely compromise on them, even if it makes me unpopular. Again, discussion today made me realise that this conviction of what is right was one of the main reasons I was bullied at university.

I left Coventry yesterday with the understanding that ultimately the NHS is looking at ‘doing the right thing’ and the importance that is currently being placed on clinical leadership increases my faith in this principle. There was discussion around morals and addressing poor standards in care. Whilst the Department of Health and NHS Confederation are communicating this message clearly, I remain uncertain if my trust is listening. I now understand that this is where I come in. Whenever I return from a fellowship meeting I’m excited and have more courage than usual. I have plans that tend to be reconsidered after a few days when I’ve lost my bottle. Even though I’m meant to be on a day off today I started to put some of those plans into action before the courage starts to evaporate. I’ve emailed my chief executive and asked if I can meet him to discuss the fellowship and my strategic plans for my service.

Another insight for me was being told that leadership involves ‘pissing people off along the way’. As someone who avoids conflict and is currently reflecting on my aversion to tension I interpreted this in a different way to usual. My thought is if you upset someone because you are pushing an idea or an agenda that ultimately and morally is right for the care for your patients why on earth should you comprise on your standards and expectations. Along the way people may not like my viewpoint but if I am doing the right thing then it is their problem, not mine.