Hard times... Reflection

'Its all about

the blood, the sweat, the tears.

Attribute to the strength

built through the years'

Machine Head (1999)

 

 

 

This blog post is a bit of a hard one for me as I need to remember that this is not a platform for venting frustration and ranting.  So I need to reflect on things and see the good as well as the bad.

 

My last few shifts have been difficult and very taxing.  Over the 18 months we have lost a large number of experienced staff, including our Ward manager.  As you can imagine, this has put strain on the staff that remained on the Ward.  This wasn't just happening on our Ward, departments across our Trust were short of staff.  To fill this short fall the Trust look to solve the problem by recruited over 200 international nurses.  This was great numbers wise, but as a lot of these nurses were newly qualified, the skill mix became a problem.  This brings me to my last few shifts.  I am going to go back to my days at Uni and use my favourite form of reflection that I use in at work and also on the tatami when doing Judo - Rolfe et al 'What, So what, What now.' 

'What' - The situation

I walked onto one of my last shifts and looked around the room and didn't recognise half of the staff.  Experience went as follows:

 

Sister - 10+ years

Me - 10 years

RGN (international) - 18 months

2 RGN (international) - 10 months

RGN - 2 months

RGN (international) - 4 days

2 Apprentices - 4 days

2 Cadets - 4 days

2 CSW - 2 months

 

It also turned out that 7 of these were only on till 1.30pm.  I exchanged looks with the Sister and knew that this was going to be a long day (I txt the wifey and told her to put a beer or 2 in the fridge ready for when I got home... I was going to need it).  The lack of experience and language barriers that were present meant that the newly qualified and international nurses were missing simple, but important things.  This is by no means their fault.  I feel that the international nurses are brave and determined individuals.  They have come to a new country with no real family/friends network to support them, new language to learn, new culture and a new social ways of living (I will never forget one of them saying that I was odd for going to a coffee shop on my day off and sitting on my own reading a book with a cracking coffee and awesome slice of cake... she has now seen the light though and goes to the same coffee shop and reads a book. hahaha).  It also turned out that they were the only 2 people on the Ward who could do IV's, and the other 2 international nurses were both need observing still as then were finding their feet, while the newly qualified nurse needed supporting. 

'So what' - Action plan and implementation
Following Handover myself the Sister and the RGN who had the most experience had a conflab in the back to formulate a plan.  The myself and the RGN would each work with one of the 2 international nurses while he Sister would work with the newly qualified nurse.  The aim was not to do the work for them, but to support them.  They would run the bay and we would be there to help and guide them when and where needed.  IV's would be split between the Sister and the RGN.  Come mid afternoon the Sister and RGN were up to their eyeballs in IV's and 1/2 the staff had gone home.  It was at this point that we realised that the newly qualified nurse was on her own in her bay as the people working with her had gone.  The only problem was that she didn't tell us and had spent a few hours struggling to keep the bay in check on her own.  We made sure that the 2 international nurses were coping in their bays and then had a huddle with the newly qualified nurse.  The conversation involved prompting the newly qualified nurse to delegate jobs so that they could get on top of their bay (a conversation very similar to the one in my other blog 'Supporting the future').  A high five and handful of Haribo each (Haribo make everything better) and we got on with the jobs.  These involved medication dispensed, discharging a patient and some wound dressing, this enabled the newly qualified nurse to get on with other jobs and get the care plans finished.

'What now' - Looking to the future
This is where we are now... what do we do to make sure that our new nurses are not left to struggle or feel abandoned.  But on the flip side, what do we do to stop the experienced nurses from feel like they are being stretched to thinly and feeling like they are unable to give the standard of care they want to give.  This is not easy to do and I know I don't have the answer.

Following this reflection of my last few shift I like to think that no matter how bad things seam there will always be a light at the end of the tunnel.  Everyone has felt at some point over the past 18 months like we have hit rock bottom, but it will get better - 'From the ashes will rise the phoenix'

And so we come to the end of what may look like a negative blog, but I look at it as being realistic.  If anyone has the answers then please send them on a postcard to me :)

Back to basics

"Be a simple kind of man.

Oh won't you do this for me son,

If you can."

Shinedown (2003)

 

Well it's the morning after the weekend before... and 26hrs on the Ward as I've been on shift all weekend. 

 

I was working with a good team over the weekend - reliable, hard working and fun to be on shift with.  I got to work with one of our colorectal team, right hand woman to the consultant, and one of my Wards old manager.  She does extra shifts on the weekends (anyone would think that she didn't have enough work to do!) and when we are both on shift at the weekend we normally get put to work together as she works until 15.00 and I take over for the rest of the day with Sister doing my meds.  I enjoy working with her, not only because she is a wealth of knowledge but also because she is fun to work with.  She is great with the patients, laughing and having a joke with them.  A lot of them she has seen in pre-op clinic or in theatre itself so there is a bond before they even hit the Ward.  She always jokes saying 'You have drawn the short straw again.  I will let you do all the work, I don't know why I bother coming in as you end up doing everything. Ha Ha Ha'.  By this she means I normally tell her to go and do other thins that I can't do such as cannulation, prescribing and doing discharge letters as trying to get hold of a Dr at the weekend is like getting blood from a stone.  When it comes to documenting in the afternoon I normally tell her again to go and do something else as I know she has a mountain of work to get ready for Monday and the start of theatre.  'I got this, you go do something more useful.  I'm sure that slave driver of a consultant has left you a mountain of work to do while he is relaxing at home watching the rugby.'  This made her laugh and after 5 minutes of arguing about me not letting her do any of the care plans she went and made me a cuppa and got on with her mountain of work.

 

But as the lyrics say at the top of this blog - "Be a simple kind of man. Oh won't you do this for me son, if you can"  I look after a lot of elderly people in hospital and you find that it's the simple things that can make all the difference.  One of the patients in my bay I had looked after before on a previous admission.  He was a little bit confused on this admission and he was dependent on the staff more.  When he saw me walk in the bay he smiled and called me over.  He remembered my name, always a nice thing as I feel it shows that I must have done something right for him to remember me.  We had a little chat and there was one thing he asked me a question: 

 

'I know it's silly, but is there any chance I can have a shave this morning? It's a simple thing I know, but I'm struggling and I don't have a razor.  Can I borrow your comb as well as I don't have one and could do with combing my hair.' 

 

I looked at him, raised my eyebrow and smiled...

 

'Not a problem, let me go find a razor and we will get you looking good for when your son comes in.  As for borrowing my comb... Do I look like own a comb??? I'm bald... I haven't needed a comb for about 10 years.  I will get you a comb from our store room... unless you want me to shave your head so you can look as good as me?' 

 

He laughed at this, as did the chap in the bed opposite him.  Later that morning after breakfast I got a razor and a comb (not one of mine though) and helped him have a shave and comb his hair.  The smile on his face following this was great, you would think he had won the lottery.  This one action made me feel like I had made a huge difference to his stay in hospital.  I guess this makes me a simple man as well, when something as mundane as giving someone a shave and combing their hair made me feel so good.  It's one thing to be able to give out medication, catheterise and cannulate, but it's the simple things that sometimes have the biggest impact on people, something that me and some of the staff I work with try to emphasize to students and new staff... go back to the basics.

 

Well that's the end of another instalment for 'Trials of a Shaniepoo', hope that this story of how simple things make the biggest impact made those of you who read my blog smile as much as it did me.  Later peeps :)

Supporting the future

'Un pour tous,

tous pou un!'

The three Musketeers (1844)

Well, what a week I've just had at work!  There were 3 main highlights from last week that can be put into 3 categories - Mentoring, RCN and Revalidation.

Mentoring:  As with a lot of Trusts and NHS professional areas we are struggling with staffing levels - Retirement and retention are proving to be a problem.  Due to this we have had a huge intake of international and newly qualified nurses, as well as a large number of agency nurses.  Although this appears to be a bad thing I have found it to be quite a good thing for me on a professional level as it means that as an AP I have been put to good use.  Over the last week I've been working with one of our newly qualified nurses to help her find her feet.  I've found it challenging in some ways as I start to go into auto-mode and just start to work automatously (big word for me!) before realising that I'm there as a support role and have to put the breaks on.  She has found it had over the past 4 weeks as our clinical leaders have been up to their eyeballs in mentoring and supporting the large number of new staff we have and so struggle to get round everyone... step in yours truly :)  I had a long chat with her while on shift and told her, in my opinion, the best way to run her bay.  This involved a number of thing.

1. Use your support worker - As an ex-support worker myself I know how useful these lovely people are and how they form the foundation of the work place.  Use them to the best of their ability, but never... EVER... abuse them.  They are hard workers but if you abuse them they will become disgruntled and not want to help you, thus causing a long and uncomfortable shift.  Always offer to help them and thank them for supporting you... you will be amazed at how nice it is to be thanked and how much more they are likely to want to work with you in the future.

2. Time management - You need to prioritise your workload.  Some jobs are more important than other and you do not have to do EVERY job yourself, if you try to work like this you will never leave the Ward on time.  By prioritising your workload you can ensure an efficient and safe shift.  As above, use your support worker to help by giving them some items from your list of jobs.  This will make them feel valued and show that you have trust in their abilities within the work place.  This then leads to the next item...

3. Delegation - I find this to be one of the hardest things for new staff to do as they don't want to look like they are abusing the staff they are working with.  This takes both items 1 and 2 above into account and will have a huge knock-on effect.  Delegating to your support worker will mean that your time management stays on track.  One thing to remember though, if you delegate a task to someone then you are saying that you feel they are competent in that job - If they make a mistake... you have made that mistake also.  I find the best way to get a newly qualified nurse to delegate is to tell them that I will not do anything unless they tell me.

4. The 'Huddle' - For me this is a vital part of working as a team, and incorporates items 1, 2 and 3 from above.  Every few hours you should have a 'huddle', this can be in the corner of the bay, the back room or by the nurses station.  The 'huddle' is where you and your support worker can get together, pass on things that have been said on Ward rounds, inform each other of situations with patients, and formulate a plan of action.  The action plan involves you deciding how to use your support worker to the best of their ability, managing your time and then delegating jobs.  Here is a conversation from one of my 'huddles' last week and an example of how I try and teach newly qualified nurses how to run a bay. 

'What needs to be done?'
'I need to change 3 wound dressings, I need to do a CHC & STRATA, I have 2 DN referrals to do, I have a dietitian referral to do, and 2 discharges.'
'Ok, While you do all of them I am going to go and have a brew in the back.'
'Err, umm, ok.'
*walk out of the room and then come back in again* 
'Would you like me to do any of these jobs for you?  If you don't tell me, then I wont do them.'
'Err...Yes please...'
'Ok, you know what I can and can't do.  What do you want me to do?'
'Do you want to change that wound dressing...?'
'No, what I actually want to do is go and have a brew in the back.'
*Grins*
'Oh... Ok then.'
'Would, you like me to change that wound dressing?'
'Err... only if you want to.'
'As I said, what I really want to do is go and sit down with a brew.'
'Err... Ok then.'
'I will say it again.  Would, you like me to change that wound dressing?'
'Only if you want to...'
'What did I just say I want to do...?  Delegate.  If you don't tell me... I won't do it.'
'While I discharge one of the patients, can you please change the wound on bed X'
'Yes.  And after that?'
'After that can you do the 2 dietitian referrals.'
'Yes I can.  Now that wasn't to hard was it?'
'No.'
'There you go then.  If you want to get out on time you need to delegate.  If you ask a support worker to do a job and they say 'No', ask them again and ask why they won't do it.  If they still say no and don't have a legitimate reason then tell them to do it - 'I have asked you to do job.  As your senior, I am now telling you to do the job I have delegated to you.'  If they still say no then inform the clinical leader.  You may feel bad about this but that is part of the role for both you and them.'

RCN:  I received an email during the week from my NW RCN Learning & Development Facilitator informing me that she was happy to sign off my 2nd module learning grid.  What does this mean?  It means that I've passed my RCN Learning Representative course... I'm a fully fledged  RCN Learning Rep!!! :D

Revalidation:  During the 2nd module of my RCN Learning Rep course, and following a Ward meeting I've been looking into NMC revalidation.  This doesn't affect me as I'm not a nurse but I feel that as a Learning Rep it is something I can sink my teeth into.  I brought this up a while ago in a Ward meeting asking if people knew what the provisional criteria was at that point in time.  The reaction I got wasn't great as the only people who had the vaguest idea of what I was talking about were the Ward manager and clinical leader in the room.  Following on from this I decided that the large intake of newly qualified and international nurses not knowing anything about the new revalidation criteria would be a great project for me t sink my teeth into.  I decided that the best thing I could do would be to make a simple guide that condensed the NMC's 30ish page document into a bite sized easy reader.  I ended up making a double sided A4 pamphlet that broke down the criteria into individual areas and explained what was needed for each bit.  Before I could start handing this out though I had to get the all clear from my Trust's senior management team to make sure it contained the correct information and that they were happy with i's presentation.  Ward staff I had shown it to thought it was great and quite a few staff from other Wards have come and asked me about revalidation and if they could have a copy.  Well, mid week I got a few emails from our Listening into Action tem, chief of nursing and our Communications team all saying that they supported the pamphlet and that I could distribute it to staff!  One small step for the Trust, one giant leap for Learning Representative Shaniepoo! :D

Right, I've been procrastinating all morning and have jobs that need doing round the house so am going to stop talking and get a shifty on.  Remember guy... Respect your support workers, they are the foundation of your team :)

Evolution - A technical transition to victory

"If you put water into a cup, it becomes the cup.
You put water into a bottle and it becomes the bottle.
You put it in a teapot, it becomes the teapot.
Now, water can flow or it can crash.
Be water, my friend."

Bruce Lee (1973)

I've been back on the tatami now for 4 weeks and I'm loving it.  But one thing has become apparent... My injuries are proving to be a problem.  Between my damaged left AC joint, left hand/wrist and tendonitis in my right elbow I'm finding that some techniques and kumi kata are harder for me to execute.  My 'go to' techniques (right sided Morote-seoi-nage & left sided Tai-otoshi) have now become less effective due to pain or restricted movement upon execution, meaning I am now having to change my entire style of fighting.  As much as this is an inconvenience for me, it is also interesting and challenging... and what Judoka doesn't relish a challenge!

The quote I have used by Bruce Lee sums this up quite aptly.

'Water in a cup' - I was comfortable with the Kumi-kata and Nage-waza I used on a regular basis.  Morote-seoi-nage and Tai-otoshi were becoming the Nage-waza I could trust and rely on... I was complacent.

'Water poured into a bottle' - I had been trying to improve my Kumi-kata for a while and would go on about it's importance when coaching.  I now have to put this into practice and change my Kumi-kata and Nage-waza to work around my injuries.  I have started using more Kumi-kata before trying to execute any Nage-waza in an attempt to baffle Uki and open up opportunities.  My Nage-waza also changed, I have started to using Ryo-hiza-seoi-otoshi (that's a mouthful!) and Tani-otoshi both from a left handed Kumi-kata. The Tani-otoshi Kumi-kata I have developed is very adaptable as it can be used to execute a deep hip throw of any kind depending on how Uki reacts - If they stay close you have Tani-otoshi, while if they step back/push away you have the deep hip.

'Water poured into a teapot' - This is the end stage, to become comfortable with the new Kumi-kata and Nage-waza I am using.  

'Be like water' - Evolution and adaptation, the technical transition to victory...

Until next time, keep on throwing peeps :)

Back on the Tatami!!!

'Practise makes permanent...

not perfect.' 

Neil Adams (MBE)

Well, after 8 weeks of physio my shoulder for a long standing Judo injury ive finally been given the all clear to go back on the tatami! :D  I've had problems with my shoulder for over 10 years after dislocating it on the tatami twice, an unforgiving injury within the sport causing all sorts of recurring problems.  I Ave tried to get back into full training over the years following the second dislocation but all it took was a hard knock, a bad breakfall or someone landing on my shoulder following a throw.  It was the last of these that put me on the shelf just over a year go following a squad randori session.  I no longer complete sadly as my shoulder has become unstable and due to my Mum being the NW competition controler and my Dad being the NW director of examiner's it's hard to fight within the area.  LoL.
 

Over the past 3-4 years my coaching has started to focus more and more on technique and fighting styles.  I've become a little bit obsessed with the importance of Kumi-kata according to my friends (I thought that reading academic papers on Kumi-kata was normal?!?).  One of my favourite things to go on about is to use an average of 3 Kumi-kata before executing a winning Nage-waza.  The other thing that we enforce in our club is that you need to be able to understand the basics before you can master more technical Waza - why do we use that Kumi-kata, why Kuzushi, action reaction... I'm a firm believer that if a Judoka has technical skill they can overcome any opponent no matter how big or strong.
 

Two weeks ago I had my 1st session back on the tatami since starting physio (8 weeks before), and more importantly it was my 1st real randori session in over 1 year!  I was like a kid on Christmas day!  Most of the guys there were bigger than me and we're 1 Kyu's or Dan grades so I knew I was going to get a good scrap (something I have missed so much), but I knew I would need to go easy as I didn't want to damage my shoulder... again.  With this in mind I decided to put my theory into practice.  I actually surprised myself.  By consciously using a mix of Kumi-kata between attacks and a use of 'unorthodox' entry's I found I was able to score a number of Ippon scores with minimum scores against me.  Last week I went back to the same club and again, a mix of 3 Kumi-kata between main the attack meant that I scored more Ippon's and put the other person on the back foot.  One thing that I did notice was that there was a Judoka there that up until a year ago had train with us from novice to 2nd Kyu over 10 years.  We had spent alot of time training them to use technique over strength (he is as strong as an Ox!).  He left us and was training 4 times a week at various clubs within our area... What I wouldn't give to be able to do that again.  2 thing were apparent - 1. He was still as eager, dedicated, enthusiastic and determined as ever. 2. His technique... was none-existent.  He was now training with bigger Judoka at randori sessions and when watching him fight you could see this.  He had become predictable and relied on strength over technique.  When he came to fight me in Randori I knew exactly what he would do - Huge right hook to get a high grip, big pull down, grab low on the sleeve, 3x big pull down... turn in for a failed Uchi-mata.  It was a bit disheartening to see all the work we had done over 10 years fall apart within 1 year :(  I had a chat with him later on and explained to him that pulling Uki down closed them up and grounded them, he needed to pull up and out to open Uki up and initiate kuzushi.  2 minutes later and he went back to what he knew best... strength over technique.
 

All in all it was great to be back on the tatami and I'm itching for the next session.
 

Till next time peep, keep on throwing!