Battling an invisible baddie.

You may or may not have seen a lot in the news recently about on site drug testing at large events. Specifically for me, a company called The Loop. Many people have felt their work encourages and normalises drug use. As a Clinician with significant experience of leading large events, I want to take this opportunity to explain why it is so vital.

As a massive geek, I shall tell this story in comic book form.

 

You are the hero of this story. You are a warrior. You come from a long line of warriors, descended infact from knights, with the sole purpose of protecting people. You’ve spent years honing your craft, you constantly work to better yourself and learn more, and you surround yourself with the best possible crew for your quests. You and this bunch of likeminded nutters (or family as you choose to view them) even choose to do this in your own time, outside of your usual, commissioned, quests.

You and your team have been tasked to defend a village for a weekend. You relish the challenge. It’s going to be varied but exciting (and that’s just the Cumbrian weather). As the lead monster-slayer on the team you have planned for what you hope is every eventuality.

But then something goes wrong. An unseen monster begins attacking the villagers. It’s brutal, it’s unpredictable, it’s absolutely kicking your arses.

You’re all trying your best, but your team are exhausted. You’re all running entirely on potion (coffee) and magic beans (haribo). The nature of the monster and it’s unknown path, means it’s coming at you from all angles. You can’t predict what it’s going to do because you can’t see it. It’s claiming the lives of the villagers. You can’t see any way to help other than throw everything in your armoury at it and hope it works.

Then suddenly a wizard appears! In his shack next door he has done something amazing with lasers. Suddenly you can see the monster. You can even look it up on a national index of monsters… monsterbase if you will.

Incredibly you now know exactly what the monster will do next. You can predict it’s every move. You know what will hurt it and what won’t. You can save the rest of the villagers!!!

This is why we need them. They’re wizards! And I don’t want to go into battle without them.

This blog post coincides with the airing of this documentary. Being a part of the team involved, watching it brought tears to my eyes, and I urge you to watch it if you’ve read this far.
http://www.bbc.co.uk/iplayer/episode/p05c1fk5/one-night-of-ecstasy-series-1-1-back-then-you-felt-free

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Being a shit manager…

 

I came into this role quite by accident. I started out as a cadet in the organisation but left to do my nurse training.

Shortly after finishing my old unit leader, someone I had been very close to, died. I was asked to come back to help teach the cadets, and I jumped at the opportunity. I hoped I could guide young people in the way I had been guided. To be a role model. A friend. A leader.

I apparently became known as a person who could get stuff done, and stood up for others, so when the reorganisation happened I was asked to be the lead nurse for our region. I said I didn’t want to be a manager. My boss stated that “it would be easier to teach me to be a manager than it would to teach anyone else my leadership ability”.

So what is the difference between being a leader and being a manger? Can you be good at both?

I had a previous matron who was hailed as a good manager. Targets were achieved. Statistics and flow charts looked good. But staff cried at work and on the shop floor. I once went into his office to say you can’t talk to people in that way and was told “you’ll never get anywhere in this career as you don’t play the game”. I left (for a promotion) shortly after.

I have been into the office of a different matron to ask advice about going for a role I was blatantly under qualified for and told “well if you’re going to learn this is the best place for it”. So I went for it and I bloody got it. She regularly checks on staff wellbeing. Can you be a good manager and be everyone’s friend? Perhaps.

I’ve been told by my other half that I’m a shit manager because I’m a great leader. My first reaction was to be insulted. But he’s right.

Rather than discipline or micro manage my staff, I try and do things myself and hope they will follow my example. For three years I’ve been the person that will answer the phone nomatter what the hour. I’ll personally turn up and cover an event as I can’t bear to see my friends struggle when someone has let them down last minute.

I’ve also developed or helped develop policies to support students and newly qualified staff, the reason I agreed to this post in the first place. I’m respected amongst my colleagues in the organisation. Mostly.

However this has had a knock on effect. I was writing clinical ops plans when I should have been revising for OSCEs. I’ve given up weekends with family for running after drunks in a rainy car park. I’ve sat in managers offices crying or shouting saying I need help and can’t do it any more.

Whilst deciding my way forward my hand has been forced. In a new restructure my area of responsibility has doubled. There is now simply no way I can continue with my current management style.

So do I now have to become a great manager? And will this make me a shit leader?

Perhaps more importantly, am I too much of a control freak to walk away and let someone else do it instead?

 

When she was bad…

Today I read a quote that an EM consultant from the US posted on twitter that pretty much sums up how I feel about Emergency Medicine….

EM is like Longfellow's little girl with the curl:

"When she was good
She was very, very good,
And when she was bad she was horrid."

— Goldilocks (@ERGoddessMD) October 27, 2016

Maybe I should elaborate.

It’s been a rough couple of months. I recently made the transition from being an ENP, seeing and treating mostly minor injuries and illnesses, into a trainee Nurse Clinician role (mostly thought of as ANP).

Before I even went for this role I knew I was going to struggle, but it’s my dream job, and after chatting to our consultants and matrons and my fellow advanced nurses I went for it and was very lucky (even more lucky that they know what I’m capable of as I was a blithering idiot in the interview).

So here I am. And so far I seem to be doing ok. It’s extremely bloody hard work. I go home most days with a headache from having to think so hard.

And our department is the same as any other, full to busting, stressed, overstretched and underfunded.

But I’m lucky in that I have an incredible team around me.

The consultants, other ANPs and senior doctors are ridiculously supportive and happy to teach and discuss things. They take on the role of supporting parent when I have a panic that I can’t do this, remind me that I haven’t done five years of medical school and it’s ok to still be learning. They can be a protective mother, (in way that only Emergency Department gang members can) and I’ve had at least four of them so far get into stand up arguments with other departments on my behalf. And they can role their eyes and take the mickey like an older brother when I forget my words and say things like “this looks too wiggly”, or “It sounds a bit fluidy”.

Theres a sense of camaraderie with the junior doctors in that if we can stick together then we can get through this, and we constantly seek advice from each other, or reassurance that “don’t worry I didn’t know that either”. The ED nursing staff constantly save my arse and have my back, in a way that only ED nurses can, somehow finding the time during the ridiculous amount of stuff they have to do to remind me of things I’ve forgotten, tell me not to worry and “did you spot that early warning score double?”.

I also have a very supportive network of friends, family and an amazing other half around me to tell me I’m amazing when I don’t feel it.

So between all that, the stuff I’ve learnt at uni, the stuff I’ve picked up by osmosis over the last decade, and the reading I feel I’m constantly doing  to keep up, I think I’m getting there.

There are certain things, however, that can’t be taught. That you just have to do. Things that aren’t a “nurses job” so they don’t cover it in uni. It’s the art of delivering bad news.

I say art, because it is. As an ED nurse I’ve been in a position many times seeing doctors give various forms of bad news. I’ve seen some do it incredibly well. But at times I’ve sat there thinking “shit that’s not how you tell someone that”. I try my best to draw on all this experience and do it in a way I hope ‘judgmental staff nurse me’ would approve of.

The first “big one” for me was telling a young woman, also a nurse, that it looked like she may be having a stroke. She came in alone to get her headache checked out. And I saw the fear in her eyes as I told her. I knew as a nurse she was thinking of all the worse possible outcomes and she started to cry. So I hugged her. I didn’t know what else to do. And it seemed to help. We sat there on the trolley like that for ten minutes whilst she cried and I hugged her. I tried to reassure her by saying we needed more tests yet, and joked that if it was anything to worry about she knew fine well how many people would be in there flapping about, and she felt much better so I think it went ok. So I sent her to the stroke ward and went on to the next patient.

Then I went home and cried my eyes out. And I think that’s ok too.

We recently had a small person die in our department, and in the debrief one of our incredible consultants cried. The fact that he could do that, I think, is testament to what a wonderful team we have. Him showing his emotions like that showed the rest of us that it’s OK to feel things, so we cried too. Its sad, it’s what you’re supposed to do. As it was a first time for both of us, the senior registrar and I spent the day working together as a tag-team, taking care of each other.

For a long time we’ve been taught that we should keep our emotions in, or “man-up”. ED staff have a reputation for being hard faced and unfeeling. But here it doesn’t feel like that. And I think that’s a very good thing.

When I have a bad day I use my 30 minute drive home to call Poppa Mids, and his words were “if you don’t get upset when something like this happens then you shouldn’t be doing that job” and I think he’s right.

Being able to care and empathise, but still remain professional, is an important aspect of our job. And I think coming from a nursing background into advanced practice makes me better prepared for that, having spent years holding people’s hands and making tea when they receive bad news.

So now I just need to learn all the big words!

Becoming a professional badass.

  
I was recently copied into an email from a patient. A lady attended my place of work with a relatively minor injury, but one which she could not treat herself and, rightly so, she came to the emergency department. I assessed and treated her independently, whilst chatting away, as you do. During the course of this interaction she told me she was a children’s nurse. It appears she grossly downplayed this, as her email revealed her to be a professor at a local university, and she was so impressed with my care that she felt compelled to write to my former course leader and the head of school to tell them how great I had been. She actually used the phrase

 ‘… care was exemplary on every level; and I was really impressed by the way that looked after me. Nursing is safe in the hands of caring, compassionate and knowledgeable nurses like…’. 

Naturally I was proud as punch. As were my mum and dad when they saw it. 

But when I showed it my friends I was met with jokey comments like ‘well she must have got the wrong person’. And I’m not even remotely offended by this. Why, you ask, because I put an awful lot of time and effort into coming across as a heartless bitch. An ice queen. A diva. And telling them ‘oh no actually I’m a lovely person to my patients’ would undo all this hard work. 

I’m not entirely sure where this reputation came from. I’d put money on the fact that more colleagues have seen me cry than lose my temper. 

So why am I like this??

Is it because it comes with the territory? I once heard a colleague tell another nurse ‘you’re too nice to work in A&E’. Do we have to be heartless? I don’t think so. Because I don’t actually think we are. When my hairdresser recently told me about her bad experience in my department I was genuinely devastated that she got the impression the nurses didn’t care.

Is it that we are too worn out? Pushed to the limit? Anyone who has worked a shift in ED would believe it. Not everyone can do this job. One of my consultants recently asked me why I chose to return to emergency medicine when everyone else appears to be trying to get out. Certainly doctors training posts are hugely under filled. 

I prefer to think it’s a coping mechanism. There’s an episode of scrubs that sums it up perfectly. For our patients it’s the worst day of their lives. For us it’s a day at work.  

 

I used to cry every time a patient of mine died. I never knew them or their families. But it still devastated me. And then one day I had the worst day. Anyone who’s been in this job long enough can remember it. There are lots of bad days but the worst sticks with you. I can still here the mother scream when we gave her the bad news. And 3 minutes later I had to go into the next cubicle and say ‘hello there my lovely, tell me about this chest pain…’. At the end of that shift I say with a junior doctor and ate pizza and sobbed. But if I could get through that shift I now knew I could get through anything. 
So since then I’ve worked my arse off to be invincible. To stand up for colleagues, often to my own downfall. To disagree with doctors to protect my patients. I’ve got to the top of a management ladder without being entirely sure quite how I managed it. I’ve got a degree and the job of my dreams. I start an MSc two months after my 30th birthday. I spend my spare time writing documents so that the next generation of nurses have the best possible support and doing my job for free. And sometimes I go home and cry.

Will it ever be enough?? Who knows. I’m too bloody knackered to think about it anymore. Whatever it is though it will be badass 😉

  

  

Junior Doctors

I am not a junior doctor.

I want to make that fact very clear from the outset because I am about to spend rather a lot of effort telling you why the proposed contract for junior doctors is a terrible idea, and I need to make sure you know where I am coming from on this. I am also going to explain why I don’t think the government will win.

My job role is that of a Nurse Practitioner. Despite the amount of hard work going in to developing this as a profession of our own, we are seen by the government as one of the ‘quick fixes’, along with physicians assistants, to fill the gaps of missing doctors. We have the ability to see and treat patients autonomously, can independently prescribe, can directly refer to other specialties and can discharge patients. All without them having to see a doctor.

But here’s the punchline… I cannot do my job without doctors. Those who know me well will know how much it pains me to admit this, but it’s true.

You see we are a team. And the way teams work is you all have your different roles to play to achieve a common goal. As a former cricket player, Geoff Hurst might have been alright in goal, but I doubt Gordon Banks could score a hat-trick in a World Cup final. Do you see where I’m going with this?
You can try and ‘fill the gaps’ all you like but you can’t use one role to replace another.

When I have a patient I am unsure about, I go to a senior doctor for advice. Likewise, doctors will come to me and ask me my opinion. It’s similar to how the government have the pay review body for advice, except that we respect and take on board the advice given to us.

These senior doctors, funnily enough, were once junior doctors. I’m now at a stage in my career where I get the privilege of seeing staff who were once our junior doctors becoming consultants, and it makes me very proud.
These are people who turned up fresh faced and anxious in an A&E department and were taught and nurtured. Junior doctors learn a lot from nurses, and we from them. It’s part of being a team. We have sat together and mourned after traumatic arrests. We have mocked them relentlessly for honest, harmless mistakes. We have comforted them and told them not to worry, it will all be ok, after a consultant has berated them. And we’ve berated them too, in hopes that learning from these mistakes will make them better doctors.
And it has. To get to this stage in their career you have to be hard working, dedicated, and pretty bloody tough. And this is why I don’t think the government will win.

You see, as nurses, and indeed other members of NHS staff, we have taken a pretty big beating in recent years with pay freezes, job cuts, funding being slashed etc etc. We made some noise about going on strike but not all the unions agreed. We say we are going to put our foot down. But the fact remains that most of us carry on regardless. I even moved to a private company and yet am choosing to return to the NHS.

When I was a student we were told we wouldn’t get a job as there had been an influx in nurses recruited from overseas. As is the way of the health service, this happens in circles and nurses can be drafted in again to fill gaps if necessary. As it stands I gather most staffing deficits are due to funding, not lack of nurses willing to work.
The truth of the matter is that many nurses are just too beaten down to fight any more.

The same cannot be said for junior doctors.
They can’t just be replaced. You can’t just bring them in from overseas. Despite claims to the contrary from the daily fail, nobody actually WANTS to come here. And you can’t just train a new doctor overnight. It takes many years and lots of debt to train to be a doctor.

In the simplest terms, the new contract will mean a pay cut of around to 30% for some junior doctors. It means those women who have the audacity to be a doctor AND a mother will be penalised. It means that they will be working for, quite frankly, dangerous lengths of time. It means they will work even longer hours with fewer breaks (which they struggle to get already).

These are some of the cleverest and most highly achieving people in the country. Why are they going to sign up for all this work when you could get the same money working as a manager in McDonalds, and actually get to eat on their break??

So I for one really hope Mr Hunt and his mates don’t win this battle. Because we need them.

And, as someone who has been professionally winding up doctors for a long while now, I think they’re going to regret starting this fight.