Purplegerberas's Blog

A rambling collection of my thoughts about life, my children and crafty things

Calmly being busy

I’m caught again in a mad crazy time of too much work and too many other commitments. February is shaping up to be a horrendous month that I am mentally willing to pass quickly. I dream of sleeping through it (but still meeting all of those commitments and obligations!) I have some very tight deadlines on a work project as well as two essays to complete for my masters that are due in next week. To add to the fun I found out last week that my job is at risk of redundancy as part of a reorganisation at work.  Whilst I’m confident of having a job at the end of the process I’m finding it all a bit unnerving. The actual change in job isn’t worrying me (I’m looking forward to a challenge), I’m more worried about the prospect of having to return to full time hours and the impact on us as a family.

On Thursday I lost the plot. It all got to me and something finally snapped. Last weekend I’d been criticised by someone and been given a list of everything that she felt I ‘should’ be doing. Its very different from both my ‘should’ list and my ‘must’ list. It came back to the same problem of me being deemed the most responsible person in the family so organising all other family members falls to me.  Eventually I handed all of this over to Steven. He is just as capable as me and whilst he prefers to sit back and let me sort it all I simply cannot any more.

Yesterday I woke up in a surprisingly good mood and decided to make the most of it. Rather than killing myself with stress I’ve decided to take a step back and calm down. I will tackle this mad month in a relaxed calm way and will look after myself in the process. We went to an indoor play area in the morning – the kids got to run around whilst I made the most of the free wifi, caught up on a couple of jobs and enjoyed a cup of coffee. In the afternoon the kids had a choice of what do to and they asked to make a carrot cake. We had a great time but got into trouble as we were singing too loudly and woke Steven up.

Rather than panicking, over multitasking and actually achieving nothing, I’ve got more done in short focused bursts and have now completed everything on my list for the weekend. I’m off to the cinema later (Les Mis – again!) to end the weekend feeling like I have done something worthwhile for myself.

I think I’m getting the hang of this personal resilience business.

 

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A week of contemplation

I’ve had another mad busy week and I’m so glad tomorrow is Saturday. I’m debating a lazy parenting day tomorrow that involves taking the kids to a Wacky Warehouse and sitting drinking indulgent amounts of Costa coffee.

A number of things have happened at work or connected to work. Some are quite major, having a big impact on me, my career path and where I go from here. Others have helped and hindered the internal debate I’m having as I contemplate what to do. Sadly I can speak about them here. I had a great day today but it involved signing a confidentiality agreement so you’ll just have to guess what I’ve been doing (it won’t be as exciting as you think – but I had a good day).

 

This week we also had a visit from one of my oldest and loveliest friends. Sadly she is emigrating to New Zealand next month so the visit was a good bye one. It was the first time we met each others children and the first time we had seen each other in a very long time. We talked about Skype – something that has passed us by – and I wonder if we will now see more of her living in New Zealand than we did living here. We have also decided that any trip to Australia will involve tagging New Zealand on as well (fingers crossed for all those lottery rollovers this weekend). Jo was with me on holiday when I met Steven. Here is a dodgy old photo from then. I can remember being adamant that the person taking it should have ‘Bad Boys’ in the photo???? and I ended up married to ‘Tosser 1’ (what a catch). Please remember this was taken over 12 years ago.

And so I go back to my inner turmoil, contemplation, list making and furiously scribbling notes in my journal. I have a tough few months ahead with some major changes whatever I decide to do. Thankfully I have a coaching session on Wednesday that I pray will shed some light.

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Tipped over the edge by NHS procurement and audit

Time is flying at a ridiculous pace. I cannot believe October is nearly here. Its a little depressing as well…

This week has not been good. I’ve had a really stressful and difficult week at work that started with me falling out with someone who did not provide support when requested, instead criticised me for a decision taken by my employer. Over a number of years our staffing levels have been reduced as cost improvement targets were deemed more important than the delivery of services to patients.  This week things have started to go wrong. Despite our best efforts we are unable to provide a suitable standard of service. This appears to be my fault for failing to create a contingency plan. In December I had highlighted to senior management that there was no capacity for a contingency and nothing was done. There is a consistent expectation that we will do more with less. I do believe that there is wastage in the NHS and areas can be improved but last year our service went through a long period of change implementing a number of measures to improve our productivity. I believe we have achieved as much as we can on our own. We have ensured service continuity on half the amount of staff we had 5 years ago (in fact we see 30% more people) but the service has absolutely no flexibility to cope with sickness.

The middle of the week saw an incredibly frustrating time over ordering a cable for a computer that left me mentally writing emails to the Secretary of State for Health.  After waiting 6 weeks for a cable from IT I contacted them. It appears they did not understand what I was requesting. The cable in question is available on ebay for £1.30. IT told me that postage alone would cost £10 and looking for the cable myself through NHS Supply Chain showed that the cable would cost £12.45. How on earth can a business the size of the NHS accept £22.45 for a cable that is available on ebay for £1.30?  We have no petty cash and I cannot reclaim costs so again, I bought the cable myself online. I wonder how much is the NHS propped up by well-meaning employees who would rather spend their own money than waste an exhausting amount of time and money going through the official ordering channels.

By Friday I had completely had enough and I sat and debated looking for a new job. This is the first time that I have very seriously had this thought.  At present I believe that I am a nurse first and a manager second. This week has felt the furthest from nursing that I have ever been and instead I have had to battle audits, risk assessments, sickness cover, procurement, finance and IT. All elements of my job that need attention but the demands on my time have been particularly hard.  The NHS cull of middle management was meant to protect patient facing services. My time and workload is proof that this isn’t true and I am now expected to do the work of the two managers above me who were made redundant and still carry on with my clinical caseload. When I’m constantly being told that audits and risk assessments are essential (I agree they are important) it is my clinical work that gets left behind. There seems to also be a trend in sending emails demanding a response ‘by close of play today’ – a phrase that I would happily see banned.

My service is about to enter into a difficult period of time as we’re in talks with our commissioners to create a specification for the next financial year. My thoughts at the moment are to see the service through that process and then evaluate and plan my next move. Is it time to look for the next step or further afield?

 

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Technology in healthcare

I found a link on twitter today on useful apps for women’s urinary incontinence but disappointed to see that they are all American. It got me thinking though…

There seems to be a reluctance to embrace technology in healthcare but we expect it everywhere else. I recently renewed my car insurance. I hate sorting out insurance and for the last few years have done it entirely online (I find speaking to people on the phone quite painful). It is possible, simple and normal to arrange insurance without ever having to speak to someone.  At the same time I’m trying to arrange an out patients procedure for myself at my local hospital. It is turning into a small saga with no real sign of being sorted after more than 3 months of waiting, writing and phoning. Working full time doesn’t make it easy to contact a hospital department which is only open 9-5 Monday to Friday. In most other sectors of modern life I can contact someone or make arrangements 24 hours a day via the internet. I’m not expecting my local hospital to discuss an appointment with me at 3am on a Thursday morning but a little more flexibility than the current offering would be nice.

Other businesses can do this and have embraced the use of technology to improve customer interaction. Why has healthcare been so reluctant?  My attempts to introduce more technology at work have often been met with a general feeling that it is not relevant to our patient group – it would not be used. My gut feeling is that this simply not true – recently in clinic I had an 86 year old lady offer me her email address as her preferred method of communication.  Whilst our patient population is predominantly eldery, 10% of our caseload are children. We deal with parents, relatives, carers and professionals who are all busy and highly likely to use electronic methods of communication quite comfortably in other areas of their lives.  For our service I created a generic email account, accessible by all team members a couple of years ago. This has been hugely successful in improving communication with both the general public and other professionals.  As a very small service it is difficult to get through to us on the phone and immediately speak to a nurse. The email account ensures that queries can be dealt with more quickly and efficiently than frequently attempting to return calls.

At a time when we are looking to make savings, both in terms of time and money through QIPP, I believe there are a number of small technological opportunities that we can take advantage of for a minimal cost outlay (if any).  Many of these will improve communication with the public or at least offer an alternative method of communication which can only help us to reach more people.

So, I will go away and put QR codes onto our patient information leaflets even though my team worry I have lost it. I have downloaded lots of continence related apps onto my ipad (bizarrely this does not worry my husband) and will be blogging my thoughts very soon.

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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.

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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.

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Me the introvert

I’m very conscious of my Myers Briggs type (ISFJ) and my preference for introversion. This isn’t shyness or quietness, it relates to how you get your energy. Some people are energised by others, loving a crowd of people (extroverts) whilst some prefer a bit of solitude and find it easier to think and get energy internally.

I’ve always been aware of this from an early age. At school I preferred to work alone. I can happily work with others and consider myself a good team member but ultimately I feel I work best when left to my own devices. Interestingly my five-year-old appears to be heading in the same direction with very familiar feedback from her teacher.

The fellowship has taught me that there is nothing ‘wrong’ about my personality type. I simply have strengths and preferences that are different to others. At times I feel under pressure to ‘be’ something that I’m not. There have been times recently where the fact that I’m not talking is perceived as a lack of involvement. Its not, I just chose not to say things for the sake of saying something. Usually I’m not talking because my brain is going mad trying to make sense of the issue.

There are times when I have to work against this preference for solitude and work with big groups of people. I feel I can flex to this alternative way well but continually being put into a busy atmosphere causes me stress and I feel like I cannot achieve anything. I’m interested in the thought that introverts are overlooked for leadership roles and that they find such a role challenging.  I read this post in the week and it struck a simple chord with me – I don’t have to be something I’m not.

We recently acquired a new office in my building at work. Its a small office, tucked away from the rest of the rooms we have. I’d said that I would take it as my own office with an element of guilt – was it right that  I was separating myself from the rest of the team? This week I’ve come to the conclusion that yes it is.  My time at work is pressured and I feel I do not have enough time in the office to do my job. The time that I am there is often a struggle to deal with other members of the team who feel that they can come and speak to me about anything at any time. I’m all for an open door policy but at times people will come to me to just recount a phonecall they had just had. No input or help is needed for that phonecall. Its not a problem that needs debriefing. Often its just an off the cuff ‘you’ll never guess what she said?’ which then drags me into a conversation that isn’t necessary and I don’t want (I’m far too sensitive and polite to say ‘stop wasting my time’) In the past I’d explained to the team that I needed set times when I was available to talk through any issues – a day and a half a week – but this has fallen by the wayside. I requested this when someone grabbed me in the carpark to tell me all about a urinalysis result from the day before and then attempted to follow me into the toilet to continue telling me about a second patient. I was put out that she hadn’t even said hello to me and I wasn’t given the chance to get in the door and take my coat off.

So, this week I’ve moved my stuff downstairs into the new little office. I am separating myself from the rest of the team but this is to increase my productivity, make the most of the limited time I have in the office and to reduce my stress levels. I am concious of the need to interact with others and will not become a hermit in there but just the thought of a space to escape to is calming me already.

 

 

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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.

Fellowship

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

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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.

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Happiness Online – March round up

Another month has gone and spring is definitely here (although sleet forecast for this week :/ ) – sunshine is very good for the soul.

The theme for March was work – an area of my life that feels like its dominating all my thoughts at the moment.

My resolutions were –

  • Focus on one thing
  • Remember that I am not an endless ‘resource’ for others, I must stock up on ‘reserves’ and not get too drained
  • I must be fair to myself and remember, at all times especially in the face of criticism, anxiety and difficulties, THAT I AM DOING THE BEST THAT I CAN!!
  • Delegate
  • Do a daily priority list

 

Its been a mixture of success and totally forgetting them. Focus on one thing is a miserable failure – I still have far too many tabs open at once and flit around trying to do three things at once. Half my issue is keeping my emails open all the time – I need to be brave and only check them a couple of times a day. The world will not end if I’m not on the internet.

I had a bad first half of the month work wise with a couple of difficult situations cropping up. I found it hard – especially as I felt unwell at the time and it involved conflict. I had a week of getting my head together and after revisiting the situation its better and I feel I’m dealing with it (and the rest of work) with more clarity. Essentially I remembered that I am doing the best I can.

In terms of putting myself first and stocking up on my reserves I’m pushing ahead with finding a coach. I had a really good meeting with one yesterday and I’m feeling excited about this opportunity.  I want to be pushed and stretched to get as much as I possibly can from it. Its not only to challenge me but also a way of building up my own resilience. I’ve now got 12 days off work and I’m looking forward to doing as little as possible.

Delegation is a fail – it was discussed a fair bit yesterday with the coach and will be an area for work in the future!

The daily priority list – in general this is working well. Its helping me sleep at night and is a one of my personal safety nets for feeling in control when life is hectic. Yesterday I was talking to someone about mind mapping. This looks like a useful way of taking the simple list one step further. Mind mapping is my homework for the weekend.

Overall I’m ending the month in a happier place so I’m taking that as an overall success. I’ve been in an interim post for over a year and this week found out that the person I am covering has left the trust. The job will now be advertised and I have to apply for my job. There was a time when this would have thrown me but I’m not feeling too bad about it. I know that I can argue and clearly demonstrate why I am the right person for the job. My only irritation is at having to fill out an application form and sort my portfolio out. I’m debating doing it now whilst I’m in a positive frame of mind and not feeling too busy or stressed.

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