Ten years on

Reflections on a learning experience 

I know I tend to hoard what I'd call resources to do with work, be it books, papers, certificates and bits of card. "It'll all be useful one day" is my internal mantra. I've been cutting down on books by allowing them to be more widely available at work; that in itself has been liberating as in recent times I've gone back to more 'hands on' hard copy reading.

Whilst preparing this week for a session on resilience I went to my cupboard and found amongst other things the workbook from the excellent St Christopher's multi professional week I attended in May 2006. I recall thinking the whole experience had been exciting and stimulating. Do they still do it? Yes, see http://www.stchristophers.org.uk/education/diary and one is coming up soon.

The attendees came from across the world and we were truly multi professional, adding further texture to the week.

The opportunity to learn from David Oliviere, Malcolm Payne, Nigel Sykes, Barbara Monroe, Nigel Hartley, Avril Jackson, amongst other talented colleagues was so invigorating.

I still remember much of what was said and done; from giving instructions on making tea, digital pebbles, spirituality, teamwork and with role play thrown in the international participants were challenged to think, act and learn.

So what's brought this all about? I'm still teaching on occasion so a dive into the resources led to me think about the workbook. I was sure there were pearls of wisdom to find and was right (on managing stress and teamwork). So ten years later I can hold the pages and how that itself has changed. Hospice UK can put entire conference abstracts, posters and videos on line - an example of the revolution in the way we communicate and produce materials. I wonder what those who will attend my session will recall of the session next week, and in 10 years time. How will they access our presentation, will a virtual channel have the same physical and intellectual resonance as my purple covered booklet? 

Maybe the physical presence of thoughts, ideas and reflections last longer in the memory? I need an educationalist to confirm that; may be though that the way that week was organised and led has left this influential mark. It's a  been a powerful experience revisiting these materials; reflection and development distilling an enervating week in one afternoon.

A man of letters, all about E's and the 7th C

Enthusiasm - our younger cat has a way of launching herself at the world each day as the dawn chorus starts without hesitation and a tangible sense of purpose. How many days do we start like that?
Engagement - on the 12th May #IND2014 I was able to join my Twitter friend Pam Nelmes and the lovely team at Plymouth University School of Nursing and Midwifery to witness the finals of the 4th annual Nursing and Midwifery Challenge. This was a great day seeing how nurses and midwives of the future can engage through their learning and experiences on placements to create innovations. It was motivating to see; a positive sign for the future, and I strongly advise you to to keep a look out for the winning idea. 
Enterprising - All this is of course very enterprising; I know our hospice team enjoy the challenge of finding person-centred ways to deliver care to those in our hospice. The team thrive on discovering ways to raise and save money to support our work. Their enterprising nature is taking our service forward.
Employment - this is more personal; as I write the organisational  announcement is expected regarding the outcome of the reorganisation process going on at my level that began in late March 2014. I and my peers have had our current posts 'deleted' (technological language providing cover for harsher words - a whole other subject?) and an interview process for the new posts has taken place.
I have been unsuccessful. 
I know now, for the first time in my experience,  that redundancy is a realistic proposition. 
I readily acknowledge that I am not unique in this; I am not complaining, merely letting you know. I would like to make plain my thanks to all those who have offered words of support and commiseration. My peers in the same situation as me and the hospice leaders I met at the end of last week have been very kind; my family have stepped up too with their messages.
The Challenge is to keep going; there's no immediate threat to my income as there is plenty to get done. I suggest though that for me Challenge is the 7th C (see the 6Cs here). It is almost unnecessary to say its a time of opportunity too.
As so often happens though timing is all. I have joined the discussion on compassion and resilience stimulated through the blog by Maxine Craig. Then along came a blog by Laura Green, about the nature of resilience, and in particular its dynamic state, within the setting of end of life and palliative care. All in all very helpful and enabling me to keep my head. 
So now I face new opportunities; I'll need my enthusiasm; I must find ways of sustaining my engagement and use enterprise to identify what next in terms of employment.  I think that's enough challenges for this Monday morning.

Reflections and Echoes

I have been considering writing again for a while; I suppose this is a kind of 'slow-blog' or 'Slog'.  As ever though, strands of life have combined to make sitting down to this task inevitable. I have a notebook that since given it last Christmas I have used to jot down thoughts and ideas. I can see that in mid-MArch 2013 I was thinking about creativity in nursing.

In response to comments by Prof Don Berwick reported on the BBC on 12/3/13 regarding Mid Staffs I was asking do we stifle creativity in healthcare and particularly in Nursing?
Whilst pondering that on 14/3/13 Roy Lilley said this in the first of his blog pieces that day,

"Nursing has been at the forefront of innovation and nurses use some of the most sophisticated kit the NHS has to offer.... Nurses are the mothers and daughters of invention."
So I am not missing a theme here; once we consider nursing history we find the examples of Florence Nightingale, Mary Seacole and many others who have developed kit and service models since then that have led to improvements in care. In my specialist field of palliative care Dame Cicely Saunders qualified as a nurse, as well as in medicine and social work. Her influence remains profound though I wonder if we have lost some of the energy that went with such creative spirits. Is working under the pressures many nurses describe sapping their energy and ability to see problems as they occur?

The other requisite for creativity is risk taking; when dealing with the lives of others we obviously have to minimise the risks, 'do no harm'. Yet whilst discussing service improvements via a Twitter nurse chat last week, care of WeNurses it was evident there were plenty of ideas yet little evidence that things were easy to change. So if creativity is there, what seems to holding things back? Is the appetite for change difficult to identify amongst the bad taste in nursing's mouth delivered by the hands of the detractors of the NHS? 

In all of this I had decided I ought to try something different in terms of learning. I took advantage of an offer from Martin Shovel to join a cartooning for communicators workshop in Brighton. Martin and Martha his partner led four of us through a journey of discovery through drawing and use of language to communicate in simple direct terms. I hadn't drawn for many years; art was something I have always loved yet lacked the confidence to pursue. The workshop enabled me to connect with the idea of simplicity in drawing; finding the key message and developing from there. I found it quite an emotional day, as echoes of past 'you're useless' school days passed by.

On reflection I now know I can use a simple drawing to convey a message; my style is under development and I try to practice in spare moments. Another side to creativity, yet I am sure it has value in terms of increasing my range of communication styles, as well as my confidence in my messages. It has also reshaped my thinking, making me consider the core messages I want to convey.
All this has come about through social media 'SoMe'; using Twitter I have found a new arena for creativity. The aforementioned chats, blogs and vlogs, all make increased links with greater immediacy. This was brought home to me when a nurse contact made via Twitter looked like they could do with some support. I was happy to offer advice and to listen; and now nearly a year has gone by, the echoes of that time are coming around again. On reflection I have to acknowledge that I know there were some days I thought I could have done differently and been a better support. Even so it appears what I did sufficed for that person, at that time.

Reflections and echoes swirl around; often catching us unawares. For me this 'slow-blog' or 'Slog', has enabled to me look at how I have learnt to innovate with modest personal reputational risk taking, using the opportunities social media have offered to be creative.In my work the benefits are that I can see how important it is to allow all the team to reflect and sense the echoes of learning and opportunities that will allow us to grow and develop; from there we can take innovation forward, personally and professionally.

The funeral of a friend who was a nurse

Working in palliative care, the end of life is a daily event, but today it touched me personally. I, and many others, attended a gathering and well attended reunion at the local Crematorium. We were there to remember our friend, boss, peer and co-worker. Of course there many family there too. Her husband had also worked with us. Jenni took the development of Willen Hospice, and its clinical services to a point where a 20 bed inpatient unit was complimented by all the community services with back up from incredible fund raising and retail support.
I know too that Jenni would play down her part, understandably pointing to the team effort involved.

Jenni had trained as a nurse, and went on later to manage a variety of services after leaving the hospice. Whilst care of the patients was at the forefront of her mind Jenni also had the care and development of her staff alongside this too. I think this is why so many turned up today, from all sections of the hospice, current staff and those who have moved on or been wise enough to retire. Many of the people there today came from Willen. I was lucky enough to have two bites of the cherry working there, both times Jenni took me on under her wing. In many ways these two appointments were critical to me in the development of my career, particularly in palliative and end of life care, and in taking me forward as a service manager. 

Whatever the role, Jenni had touched all these lives as well as all the lives of all those whom the Hospice has cared for. As such then the turnout today was a reflection of the esteem and affection we had for her. That a malignant disease should be the cause of her death at so young an age is another part of the story. 

Alongside that is her reputation for enjoying a night out. In the company of friends and co-workers the loudest laugh was hers. A love of gin, as well as other drinks if required, fueled many an evening. Of course Jenni loved her job and her family; she will be much missed.
Jenni leaves a significant legacy; people who continue to clean, cook and care for those who are frail and nearing the ends of their lives; those who have been encouraged to take chances, develop as people and as servants of those who need the care.
At a time when healthcare and nursing particularly are being frowned upon, and the NHS seems to be falling apart, I am proud to say Jenni was someone who taught us all how to do it right; how to enjoy work; and how to make a difference.  I am very happy to have known Jenni, though very sad now that she has left our presence. She was a light in our lives, and I look forward to carrying her legacy into the future.

Rethinking Implementation

This morning I had the opportunity to hear Dr Brian Smith http://www.pragmedic.com/ speak about the difficulties we face when implementing strategies, the big ideas organisations go for to take the business forward. The research Brian has been doing is leading to new thinking about why  implementation of strategies can fail.
The view is that a number of influences pay there part, not least the individual, group, organisational allegiances and alliances that exist.
It has made me rethink my approach to implementing our business ideas, as we strive to move forward in the challenging UK healthcare market.
I will be seeking to increase our skills at decision making and exercising discretion in planning.
We  be clear about who/what it is we are going after and what we are going to do to/for them.
There are some antecedents to over come, and individual commitment to test.
So long as our strategy is clear we are more likely to get there using a different approach than the usual one organisations use.
Time for implementing the re-think. Time for effective strategic achievement.

Failing nurse leadership puts jobs at risk, or how nursing needs to do better

Three Nursing Times headlines today led to me creating the title for this blog; see https://mail.google.com/mail/?shva=1#inbox/12e7ad7e48c73a94

The United Lincolnshire Trust is taken to task for its poor record keeping, associated with poor standards of care. Where were the managers? What kind of compaints does this Trust get? It would be easy to pick on the front line staff - and they must be responsible for either actions or inaction that led to this situation. However someone should have been checking the quality of the care on offer, and looking for the evidence it was being deliverred. Nurse leadership would help with this; providing a framework for staff to learn and develop. It'll be the spring before the CQC reports - I'd put money on this saying nurse leadership is lacking, and the United Lincolnshire Trust have been tasked with making immediate improvements. I hope the managers are up to it. The staff will need support and opportunities to develop - I don't hold out much hope for that in the current financial situation.
Meanwhile NHS Trusts are still in a state of flux over nurse leadership and its importance - a survey has found areas where development of leaders takes place - but plenty of evidence leadership and management are being held back by financial pressures. The survey was following up after the Francis inquiry into Mid Staffs last year. 
My esteemed colleague Dave Dawes head of the Foundation of Nursing Leadership was quoted a saying: "It’s sad that nursing leadership has been identified as an issue in almost every [NHS] inquiry in the last 20 years.

“The same issues seem to come up again and again, and don’t seem to get any better.”

The Foundation is at http://www.nursingleadership.org.uk/index.php

With financial pressures building to squeeze education and development spending we are surely storing up trouble that will result in further failure at some future point. United Lincs Trust may have been spotted before it's too late and so avoid becoming a disaster - but can we be sure the CQC will always be there to catch the next oranisation in time?

And on the financial pressure theme - at the Pennine Acute Trust they are warning about 1,000 posts being under threat. Amongst other ideas they want to stop using temporary staff and redeploy permanent staff into new roles. I feel pressure coming on for those who may manage or have specialist skills; perhaps really good leaders who help mainitain good standards of care and maintain the delivery of a safe effective and appropriate environment in which the people of the Pennines can have their care.

At risk are not just jobs but standards of care and the reputation of nursing - all because we keep doing the same thing; not investing sufficiently in leaders and managers.