But…
Well the media are having a field day today.
Psychiatric patients causing carnage and incompetent mental health professionals not doing their jobs properly. I’ve no doubt the media have a point and I’ve even less doubt that there is a big debate to be had, but I’d like to briefly turn the spotlight in another direction. I’m very well aware that it is a case of there but for the grace of God go I (I’ve had some very close calls and my heart has been surgically retrieved from my mouth on a number of occasions) but I haven’t lost a patient in my care, nor have any of them ever committed a serious criminal offence. I have, however, experienced the following:
Nurse 1. Entered into a relationship with a former patient. I had not nursed this person but I met them socially and my suspicions were not aroused. Nurse 1 was murdered by their partner. Nurse 1 was a close friend and colleague. I attended the funeral.
Nurse 2. When we talk about core nursing skills this nurse had it all. In spades. Nurse 2 was a close friend and junior colleague doing too many hours to mitigate the problems of student debt. Nurse was killed in a road traffic accident on her way into an early shift on a winter morning. I attended the funeral.
Nurse 3. Nurse 3 did not work on my ward. Nurse 3 was not really a close friend but I worked extensively with Nurse 3`s partner. Nurse 3 took their own life.
Psychiatry can be a dangerous business. The grim reaper is often in close attendance. It is, however, important to remember that the victims are not only patients` families and members of the public. Mental health professionals make the ultimate sacrifice too.
Well, I’m a secondary care CPN, you know, the glamorous world of “severe and enduring.” I know exactly what you mean. I’ve been in a quite a number of situations when it’s brown pants time….
Lucky and then unlucky, were my observations on reading your post OSB. Firstly lucky that you’ve never had a service user commit a serious offence and then and that you’ve never lost one, but perhaps your experience is closer to the truth behind the headline today.
And then Unlucky I thought, that you’ve had such experience of losing three colleagues….until I stopped and thought about the casualty rate amongst my colleagues too, 2 definite suicides and 1 misadventure verdict and at least three leaving the profession with significant depressive illnesses.
Has anyone else considered that these stories are getting a very high profile just after the Queen’s speech and the decision to push ahead with the reforms to the Mental Health Act?
2 things,
1. I realised after reading this, I have not heard or watched any news today so have no idea what you are talking about, nor can I see anything on BBC news just now. Is it specifically today?
and
2. I am saddened to hear of both your experiences. I am also slightly frightened. I haven’t heard things like this mentioned by any of the staff I have worked with so far, perhaps they don’t want to scare students off, or maybe they have all been lucky, I don’t know.
With regard to your experiences Oldschool, i would like to ask if you’ve ever reached a crunch point and thought “that’s it, i’ve had enough, i’m off?”
Nel, just to let you know that OSB may be delayed in responding…he’s still having to beg for cybertime on other people’s PC’s, or posting through me. OSBaby may suprise me….but I think he’s one of the indestructables!
Hello to Shadwell…keep commenting…we like CPN’s here…..honest, and there’s getting to be a small but dominant club of us, made more obvious by the lack of contributions from Ward Staff other than OSB…….I sarcastically can’t imagine why that should be!
And Rosey…….I hope it’s good luck that means none of your colleagues have had similar experiences…..but I had to be reminded too. It could be argued that in Mental Health Nursing the rewards come because of the struggles. I do hope that you aren’t being scared off.
Rosey: If you click on the link at the top of the article (Well the media are having a field day today) it takes you to the newspage.
Thanks Mo, my observation skills are obviously piss poor!
The link came after your post Rosey…sort of in response to it.
My PC has been away for a good sound thrashing, I hope to have it back shortly. Not a moment too soon really. MrMansWife has got away with scurrilous allegations regarding my odiferous socks. Social Workers have been abused without me being able to leap on to the band wagon in very enthusiastic fashion. Malcolm has deluded himself into believing that CPN`s are becomuing “dominant”. Rosey needs a morale boost – with me on a mountainside. Watch this space.
I`m back ! My PC has been scrubbed with a wire brush and Dettol and is currently compliant.
I just want to answer Nel`s question. I don`t ever think “that`s it, I`ve had enough, I`m off”. I ruthlessly apply strategies which I`m sure are as old as the hills but which sadly seem revolutionary to many people I work with. My primary interest is the team. I always look to set the example, in early, out last, work as hard as your best grafter, do more than my share of the dirty jobs and make sure that your junior members get more than their share of the breaks and early finishes. Encourage your team and thank them. I`m always smart and always there. I`m decisive and I`m happier than most to take a risk. They all know aswell that the buck will stop with me. I also place huge emphasis on fun, practical jokes, banter and funnies on the toilet wall. Regular social activity is also important, a few beers, a laugh and abject embarassment on the dance floor.
If you offer people this they will follow you anywhere. The foundation is set for a good quality of patient care. You will get the job done and leave very little shit for others to clean up.
I don`t consult management. I don`t have clinical supervision, management supervision, group supervision, peer supervision or any of that nonsense. I`m anti – psychiatry, very sceptical of psychotherapy and I take the evidence base with a big dose of salt.
Works for me
That said I`m no martyr. If the employment Gods banished me to the Yorkshire Dales to spend the rest of my days repairing dry stone walls, then that would be fine with me.
How can you say that clinical supervision, by peer, group or individual is nonsense!
On that subject, I`m going to enlighten you in a post.
I reserve the right not be “enlightened” – but am as always interested in your view.
Welcome back, and thanks for the reply, am very glad your approach works for you!
If i’ve read it right i think self belief in your own work ethic and regard for your team seems to guard against becoming jaded in your job, combined with some dodgy manoeuvres on the dance floor (Kaiser Chiefs’..”I predict a riot” has a lot to answer for at our works do the other night..am still blushing!)
Have various experiences of supervisions, some good, some bad. Documentation of the training and resources you have asked for and concerns you have isn’t always a bad thing. However a paper exercise in ticking boxes on your personal development plan to please some investors in people award turns out to be just that, and can waste everyones time.
Nel, I think it`s more to do with the ethics of work rather than a work ethic. I always put in a good shift but I`m not some kind of workaholic. I just think the little things are so important. It`s unpleasant driving in to work anticipating one of the team wont have turned in. It`s unpleasant, at the end of a tough shift, looking at the clock and wondering exactly how late the next shift will be. It`s unpleasant when you realise a colleague is secretly looking for an easy option and applying for a job as a CPN. It`s unpleasant getting enthused about a project, which will obviously benefit the patients, and having cold water poured on your head by the health and safety gestapo. Set high standards, be reliable and fight the nonsense. I often feel quite humbled by the response you get from junior members of the team.
On top of that you need some fun. The other morning our daily patient meeting ended with some cossack dancing ( not that anyone present had any idea how to cossack dance ). No evidence base and absolutely no rhyme nor reason. I looked around the room and everyone was beaming from ear to ear. I couldn`t have been happier.
Anyway, I`m sure you`re getting my drift. I find I`m having to withold a lot of points I would like to makes as I want to incorporate them into future posts.
OSB,
The evidednce base for the use of humour in mental health is quite extensive, I’m sorry if that disappoints you.
It’s great that you love ward work so much and I have nothing but admiration for that – why then does it upset you so much when your colleagues want to work as nurses in the community – which is not an easy option, as those who have been there will tell you. Is it some form of secret self doubt that leads you to feel the need to constantly undermine colleagues – don’t you believe you could do it? I’m quite certain you could.
Nothing angers me more than nurses who divide – there are plenty of them out there – who have to set up artificial boundaries and specialities, proclaim superiority and expertise in a given area, and who are naive enough to think that they know best. You come across like this sometimes, and yet at the same time these are things you have spoken against. You know that managers love it when we are divided and fighting amoungst ourselves.
Service users don’t experience mental health services as separate. Hospital and community are two parts of the same service. I’ve met as many crap CPN’s as I have crap ward nurses, and as many good CPN’s as good nurses on the ward. This is the issue for me – how do we improve the quality of care and the quality of nursing practice across both sectors.
Both jobs are as hard or easy as the skills of the individual nurse and how dedicated they choose to be.
Sorry if it upsets your G grade sensibilities but this E grade upstart really does have to enlighten you !. For the record the CPN jibe in my last comment was meant purely to irritate CPN`s, I didn`t really feel that it advanced my argument at all. I`m in minority these days, I need to get my shots in first.
I will keep the specifics of why I so dislike community types until we do our joint post. I will say this though. I have no doubt that being a CPN is an easier option. I don`t want to give the impression that it`s always like this, it certainly isn`t, but during my next shift it is virtually guaranteed that I will deal with faeces and be assaulted. Not everyone can, but I can live with that. Quite comfortably. The difference between my job and yours is that I get no respite, the pressures of mental health nursing are ever present. The plate spinning we have discussed previously. I wholly accept that it`s not everyone`s cup of tea. People want or need to leave the arena. Like it or not, accept it or not, the community is the emergency exit. In actual fact, I`m cool with that. We need CPN`s. That`s indisputable. What we don`t need is CPN`s looking down their noses at those they left behind. Perhaps I`m protesting too much, they don`t treat me with disdain, they daren`t. But it goes on.
That`s old hat though. This is where we will really disagree. The situation is getting worse. Nurse education, clinical supervision and the like ( concepts you support and which I`m sceptical about ) foster the belief that everyone can be educated, guided, supported into doing whatever. They can`t. But recruiting no longer takes account of that.
These days if you haven`t got a skill you`re made to feel inadequate whereas previously you would be valued for the many skills you do possess. The arena is becoming tougher.
As for my proclamations, specialities and expertise. That`s a cheap shot. You know my background, a good number of Mentalists do, I disclosed it during the Blogwar. I bang on about leadership and teamwork. I couldn`t care less what anyone says. It`s hugely important and hugely effective. It works. It used to be evident in nursing. It`s dying out. It is NOT in any way anything that I`ve discovered or developed myself. If anyone wants to learn it for themselves, take the Queen`s Shilling. With regard to nursing practice, the simpler the better as far as I`m concerned. Nothing superior about that.
Finally, Malcolm, please refrain remarks like “the evidence base for the use of humour in mental health is quite extensive”. NHS managers may not be aware but to every bugger else it`s blatantly f****n` obvious. Who funded this “research” ?. Why ?. I`m off for my hypertensive medication.
P.S I`m getting on a bit now and I do have some concerns as to whether I would be able to keep up with a sexually insatiable Kate Humble. Apart from that I have no secret self doubts. I could do a CPN`s job without breaking sweat nor stride. The overwhelming majority of CPN`s would be severely rattled after a day in my shoes.
You really need to provide some evidence to support your remarks!
And I suspect, unfortunately, that the overwhelming majority of Ward nurses would be severely rattled by a day in your shoes too! (that looks like a cheap jibe, but I am referring to the outstanding work you do and not your own personal size 12′s).
No-one, as far as I know, has ever funded research into humour in mental health (- something that you seem to be lacking at the moment), like most nursing research it has been written about by people who have, off their own back, wanted to spread the same message that you do, but instead of just having an opinion have taken the time to ask service users if it’s important and helpful in order to convince those NHS Managers who are miserable gits, full of their own self-importance, and think the only way to get the best out of people is to abuse their power. Is that such a bad thing?
We don’t, by the way, disagree that the situation is getting worse. You are just throwing out the baby with the bathwater. Nurse education is pretty poorly done, and in my opinion the move to universities has something to answer for that, but not all of it, since most of the training occurs in practice; and clinical supervision is not done properly or seen as important….like it used to be….its not new.
I don’t understand what you mean by cheap shot and your background…I’m confused…you say that it’s wrong “that everyone can be educated, guided, supported into doing whatever”, but then suggest taking the Queen’s Shiling to learn how to be Leader and Team Player. So can you learn it or not? I’m all for a bit more of that being brought into nurse education if it improves things for service users.
This is more fun than writing Christmas cards.
Sorry Malcolm but I do think that too much research isn`t helpful. The unfortunate truth is that a lot of service users live solitary, unhappy lives. They will respond well to any intervention, they`re just pleased to have someone take an interest in them. I could offer them bingo and jaffa cake therapy and I`d get a very positive response. That issue has no impact on my shifts, I`m up for anything, egg and spoon racing, corridor football and I`m very much looking forward to this years dancing Santa competition. However, a lot of nurses worry about introducing anything that doesn`t have an “evidence base”. I`m going to post about this too but health and safety crap plays on their minds aswell. “Do nothing, do nothing wrong” culture is never far away. Nurses need emancipating to do what they instinctively feel is beneficial. They don`t need to be constantly referred to research based practice.
Thank you for pointing it out but I was already aware that I was sounding somewhat pompous in my proclamations about leadership. I go on as it is so important. As it compromised my anonymity to a degree I was a little reluctant to acknowledge that I was simply transferring skills I learnt in the military. The fundamentals of leadership can be learnt. That wont make you a natural and it wont make you inspirational but it will give you a headstart over most current NHS management. That`s sad as the NHS used to have plenty of good leaders itself. I`m not sure if teamwork can be learnt, however, the military have very effective techniques for ensuring you contribute fully. I haven`t had to utilise any. NHS staff respond very well to basic leadership. In fact, they revel in it.
Caring instinct, caring drive, compassion, sympathy, empathy can`t be taught. Nurse education will never change that.
What I`m looking for in a team is very simple. Individuals who can make the whole greater than the sum. In a million years I`ll never notice when someone`s SEC 58 needs amending but I`m good at Nursing Reports. Tick box management looks for everyone to be capable at everything. Can we have our skills mix back, please.
oh dear, malcolm and osb must be pre-menstrual at the moment! (imagine if I was a man and you two were a female, how entirely wrong that statement would be!!)
Anyway, after reading the following comment, I want to add my opinion:
“Nurse education is pretty poorly done, and in my opinion the move to universities has something to answer for that, but not all of it, since most of the training occurs in practice; and clinical supervision is not done properly or seen as important….like it used to be….its not new”
My personal experience disagrees with the University comment, but then I am attending a “University” that used to be “just” a school of nursing, but was moved to University status with a lot of the same staff. The staff ensure we are taught what they think is relevant aswell as some other bits and pieces that are on the curriculum, that one could argue is a load of crap.
But, my “clinical supervision” overall, so far has been pretty poor. I have heard lots of times that the staff are too busy, but can still have a 40 minute morning tea break (that is meant to be 10), watched them run around but not really do much and fob me off as they are worried I will point out that they aren’t doing much. Fortunately, not all my placements were like this, and I really hope that my future ones are not.
What worries and annoys me is that when I qualify, if I turn out to be the most inadequate and crap nurse ever in existence (won’t happen, but bear with me!) the nursing staff will blame the University for my failures even though I am taught 50% in school and spend 50% of my time in clinical practice, with a list of cometencies to reach and a feedback sheet with more direct comments. If I was really crap, the staff have the option to contact my Uni.
Sorry, I feel I have gone off a bit on a tangent, but I feel better for sharing.
Maybe I have pmt aswell :S
Think you’re right Rosey, a case of handbags at dawn!
(Incidentally, a male colleague at work reckons that men also have a time of the month, i recommended some sanitary products and offered to insert one into an available orifice but he declined and told me to Feck off. Hmmm…. maybe he did have PMT)
Thoroughly enjoyable though and i would like to add my tuppence (as usual)
The other week i was working with an agency staff in the residential home who was in their final year of training to become a mental nurse.
We chatted about the various placements this had involved and they then said they had been at an elderly residential home working with patients suffering from dementia. Within the first few days the person had witnessed two members of staff running down the hall with two patients tipped back in their wheelchairs. They did not appear to be enjoying the ride.
They then questioned their placement with the appropriate people but were told that it was difficult enough to get placements.
I agree you can,t teach people compassion but why do people without any choose to go into a caring line of work anyway?
Manbags if you please.
Thanks, you two, for joining in and preventing this from becoming even more of the OSB and Malcy Show. The irony of it is that beneath both our crap we agree and most of the time I love dear old Oldschoolbaby.
Rosey, I don’t blame the universities, I blame the move to the universities. It was, and I think there is a lot of evidence to support this, hurried, ill thought out and resulted in Project 2000 (since abandoned). At the moment nurse education is undergoing further and necessary improvements, buit has not lost its roots in a failed training and I think there’s a long way to go. Your experience of staff “not having enough time”, but still having long tea breaks and reading the newspaper meant for service users is evidence of that. I would also suggest that lack of PROPER Clinical Supervision is to blame for the behaviour of some burnt out staff. Compassion Fatigue.
Student Nurses are in my experience still inexperienced and lacking in confidence three years after they started training. Its not the Students’ fault, but they are not allowed to work on their own with service users until after they are qualified! Did you know that Social Work students are expected to hold and manage their own cases from the outset, first working alongside colleagues and then through long-arm supervision. They HAVE to get on with it, but Student Nurses can’t do anything without a qualified nurse overseeing it. This is patently nonsense. Experience and confidence comes from doing the job: facing and overcoming challenges, questioning your own and others’ practice and learning from successes and mistakes. That’s not possible while Student Nurses are forced to hide behind the skirts of their superiors.
Nel and OSB: Mmmmmmm…….I agree about not being able to teach compassion to an extent, but wonder where it comes from then if people don’t learn it. If it’s innate and instinctual then doesn’t every one get it at birth?……I can accept that, but can also accept that some people lose it along the way because it gets knocked out of them (one way or another). If it’s innate then it can be, not taught, but encouraged to emerge and grow and develop, since instincts can’t be completely supressed. Isn’t that part of what you are doing OSB, when you have a laugh with service users? Trying to give them back a bit of humanity? Isn’t that at the core of mental health nursing?
OSB – you said “However, a lot of nurses worry about introducing anything that doesn`t have an “evidence base””.
That’s because they are stupid and don’t understand what evidence base means – which is: can you show that what you do works? Cause if you can’t you shouldn’t do it which seems perfectly reasonable to me – not as some think: has this been proven to work using a Randomised Control Study?
Sorry about the delayed reply, I`ve been coming to terms with the fact that I`ve got PMT. If my mood`s are swinging it must mean Mrs. Oldschool is stable. It`s too much to take in. Roll on the menopause. Where do I get the hormones ?.
Malcolm, nurses aren`t stupid if they`re confused by the “evidence base”. You make a valid point, in the other thread, when stating nurses should ask patients about their experiences, but why the hell should that be mystified and labelled clinical supervision. Any service provider in any field should be curious as to what the “customer” thinks. It isn`t rocket science. However, it`s quickly being turned into a pseudo-science. If you type clinical supervision into a search engine you are immediately exposed to some twat talking in terms of “isomorphic and parallel processes”. Eyes down for buzzword bingo. Nurses struggle to understand, lose their confidence and all of a suuden doing sweet FA looks a more attractive proposition.
You`ll be pleased to hear that there are no student nurses hiding beneath my skirts ( rather fortuitous if I`m menstruating ). It`s full steam ahead for the Oldschool mentees.
Oh yes, and on our ward we all work for 7hrs and 45 mins. No one ever bothers with a break.
Stupid enough to just rely on google. Proper clinical supevision I said.
Malcolm, I`ve long assumed that you wouldn`t be able to raise your game sufficiently to re-enter the acute arena. Perhaps I was wrong. Every effective acute nursing team needs a pedant. I know nothing of search engines. I use the one at the top of the page and I`ve no idea how it got there. I`m not really aware of any alternatives but I`m very sure that they`d all turn up an isomorphicist in double quick time.
I`m not ignoring you Nel. I`m going to write a Christmas / New Year`s Message which I hope will address some of your point. ( I did ask the BBC for a 5 minute slot at 15.05 on Christmas Day but they told me to “feck off” ). People move into all sorts of employment for economic rather than vocational reasons. Fair enough. If it transpires that they have no compassion then you need robust leadership prepared to get rid.
Rosey, Come and do a placement with me. Good fun, loads of learning opportunities and hard graft. Of course we`ll sit down and discuss matters but it won`t be given a fancy clinical supervision tag. As for some respite beneath my skirts ?. Sounds appealing but I`m not sure that it`s professional.
Will you sit down and discuss matters with Rosey (how will you find the time with all those breasts to put away and the impending bankruptcy of the NHS to prevent?) or will you navel gaze? The first is what I do in something I call Clinical Supervision, the second is pointless.
Sitting down with students to explain your rationale, allay their apprehensions and field their questions was the sensible and decent thing to do way before clinical supervision was conceived. It only need take 5 minutes and as you rightly point out, during your brief incursions into reality, it can sometimes be done simultaneously with another task. The modern truth of the matter, however, is that all and sundry ( including the ward clerk ) are now disapperaing for hours, of whatever type of supervision, at the drop of hat. It`s a charter for the idle. Like a lot of modern innovations we were better off without it. By the way, if you do actually talk to patients in the manner that you advocate, they will tell you there aren`t enough nurses on the ward. The truth is the number of nurses on the ward is not, in any way, corresponding to the number of nurses on duty. This problem is not exclusive to mental health.
Don`t be too flippant about NHS finances, I fear there is a lot more axe wielding to come. We can discuss that after my next post.
Right, I`m taking my hormones now and going to work.
How new do you think this is? It’s been part of my practice since 1991. I can’t believe that you work in the land that time forgot. Have a good one.
You are arguing over the same thing here. OSB hates the terminology, not the act itself!
You know I get an elective placement in 3rd year, I might just ask to come and work with one of you (that includes you Mental!) And if my expectation doesn’t meet up to your promises I can tell the whole world via the WWW! Hehe!
Yeah, I was hoping that OSB would realise that but you noticed it first. He does it, it’s part of being in a good team, it happens. I hope that soon he’ll admit to doing it with his qualified colleagues too. It’s like pulling teeth with him sometimes.
Problem is it doesn’t happen in bad teams, so maybe some pressure needs to be used to get those who don’t, to actually think about what they are doing. Having weekly formal supervision is using a sledge-hammer to crack a nut, but hey – that’s how we ended up with CPA.
You`re at the cutting edge of isomorphism Malcolm, congratulations. Oh, I forgot, it`s a parallel process, perhaps that should be double congratulations.
I`m up for that Rosey, you`re more than welcome.
Blogrolling: M…
Smack in the middle of the alphabet! Let me know what’s missing from this list………