A Word on Bravery Certificates ...

I had another lightbulb moment today - a truly privilidged experience of "walking in my patient and their families shoes" and understanding the very importance of the impact healthcare professionals can have upon those under their care.  For a while now one of my guiding principles has been an inspiring quote by the great writer Maya Angelou.  She said:

With that context in mind, for those who do not mix in paediatric healthcare circles - let me explain the principle of a "bravery certificate".  A Travel Health Nurse specialist describes bravery certificates as "one of the most popular items nurses like to use when seeing children".  It's very true.  In my 13 years qualified as a nurse, I have seen again and again how important they are to the young people and their families.  But largely within the NHS - they are often seen as a "luxury" that a nurse can only personalise for their patients if they have time.  Sadly the comment I often receive if I am taking time to colour in a bravery certificate for my patient is - "well you obviously aren't busy if you have time to do that".  I understand that comment - in an NHS often consummed with bed numbers, targets, waiting times and so on - a "little" thing like a bravery certificate is seen as unnecessary.

But here's what made me re-energised in the important part they play in the overall experience for especially children and young people and their families - twice this week, and from two different families, I have been able to find the time (usually during my break) to colour in bravery certificates for my patients and have given them on discharge.  And both times I got the same comment from the families;

"Oh wow - look at that "Billy" - we will frame that and put it on your wall!".

Let me make it clear - I am no artist.  My colouring is poor and I sometimes step outside the line.  It is no masterpiece worthy of the National Gallery!  So why this response I wondered?

My reflection leads me to believe that it is quite simply that this certificate reinforces to your patient and their family the fact that you - their nurse - have thought of them as a PERSON - not as a bed number.  The very little bit of colouring demonstrates that you have taken a little bit of extra time in your busy day (and your patients know you are busy - they are mostly watching you!) to express your admiration for the bravery they have demonstrated.  And I think that by giving them this little gift along with their discharge paperwork - you are showing that you recognise they and their families have been through a great deal in coming into hospital and going through the procedure they have or the treatment they have.

My call to nurses is - it doesn't have to be bravery certificates.  It's not about "what".  It's about "how you make them feel".  It is the little action of showing your patient and their family that you are recognising they are people, they have their own individual stories and hopes and fears and aspirations.  It shows that you recognise them coming into hospital is a big deal for them (and possibly scares them rigid) and you care about that and their feelings.

So don't think "it's nothing - it's not important" as yes - bravery certificates can't be quantified, and don't meet CQUIN standards for NHS Trusts.  They are important I feel, because they make a difference to the patients and their families at that moment in time, and improves their patient experience ten-fold.  And that is the one opportunity we have.  Chief Nurse of NHS England - the wonderful Jane Cummings - always says "we only have one opportunity".  And back to my opening quote from Maya Angelou;

"They may forget what we said, they may forget what we did - but they will never, ever forget how we made them feel".

And as nurses - our NMC Code of Conduct binds us - we MUST put patients first!

To Strike - Or Not to Strike? That is the Question ...

There was a fascinating discussion on the Nursing Times twitter feed today which I eagerly took part in.  It was centered around the debate as to whether nurses in the United Kingdom should consider strike action over the on-going pay dispute.

For those non-nurses among us - simply put, nursing and midwifery pay in the UK has effectively been frozen for the last 5 years or so, and the small increases when they have come have been so below inflation that they effectively equal a pay cut.  To add to the anger among my colleagues - it doesn't help reading about MP's voting and awarding themselves pay rises of considerably more.  Or (closer to home) perhaps some senior NHS managers receiving also larger pay rises.  A further note of discomfort for many colleagues is that our regulator - the NMC - is consulting to raise our yearly registration fee from £100 to £120 which is mainly use to hold Fitness to Practice panels often resulting in nurses being struck off over doubts over their capability.

Nurses are angry.  That is common knowledge.  But is striking the best way?  I responded a strong "NO"!  I've suffered too.  I had to take out a loan to renew my NMC registration this year.  My hero - Nursing Times Editor Chief Jenni Middleton commented this to me;

It made me take a step back and think.  Am I disgracing my profession and colleagues by such a standpoint?  Should I be marching with placards out in the street?  Are the government really cackling in glee at such a "naive" view as mine?  But here's my issue.

The Code of Professional Conduct - which defines myself and all colleagues as a nurse or midwife says this;

"The people in your care must be able to trust you with their health and well being. To justify that trust, you must make the care of people your first concern".

In it's closing statement to the "Mid-Staffordshire Public Inquiry" chaired by Sir Robert Francis, the Department of Health submitted this key statement:

"The patient should be at the center of all that the NHS does".

So before I personally consider strike action - no matter how angry I or colleagues may be - the patient must be considered!  Now a couple of unions have proposed variations on a complete strike.  What about emergency cover only (such as firemen often do)?  But here's the rub.  What constitutes "emergency" cover for the patients under my care?  Let me walk a few moments in my patient's shoes.

• What about the young person admitted to Surgical Daycare for the insertion of a Hickman line?  He has just been diagnosed with leukemia and needs to commence chemotherapy.  I guess the insertion could be cancelled - but the longer his chemotherapy is delayed, the longer the potential for spread.  I would argue that procedure constitutes an emergency for that family.
• What about the young person who has an outpatient appointment with a cardiologist - she's been having "funny palpitations" but as yet undiagnosed.  Without an OPD nurse, that appointment could be cancelled.  But the fears and worries for that family that their beloved daughter has a heart problem needing heart surgery would constitute an emergency in their case.
• What about the disabled child with learning disabilities who has been waiting months for an appointment to be fitted for a wheelchair?  They have been getting sore and uncomfortable and have outgrown their current chair.  Without that nurse-led appointment they may have to wait months more.  To that child and family - it's an emergency.

I am aware this very personal view may be seen as a "betrayal" in my colleagues eyes.  I will understand if some unions vote - and indeed go on strike to protest the unacceptable pay decisions imposed upon us as a profession.  But at present - I just cannot see myself personally and professionally accepting going out on strike.  The trust of the patients and their families just mean too much to me.  I have read the complete "Francis Report" and I think the actions of a few have brought the nursing profession into disrepute.

This doesn't concern me - it challenges me!  It is up to us - and me - to re-gain that trust and that respect from the public.  Patient by patient.  Family by family.  And I fear that strike action would further damage the profession I so love.

A Review of "Little Stories of Life and Death" by Dr David Drew

I don't often review books on this blog - but this book was and is an exception.  It is very important to me personally for a number of reasons:

• It is about child patient safety - something both Dr David Drew and myself have dedicated our lives to.
• It is about injustice - something that I cannot tolerate personally or professionally.
• It is about endurance - the story doesn't always end with a happy ending.  But has the story ended?

A few words about how I came across Dr David Drew.  I am an unashamed social media advocate.  Yes I do believe it can be used for harm, and can (like any medium) be misused.  I am grateful as a nurse - to my regulator the Nursing and Midwifery Council - for not blanket banning use of it but promoting professional use.  Any nurse, midwife, doctor or Allied Health Professional must bear in mind at all times we can be called to give account for what we say, write or do.  But the massive benefits of social media mean a far wider social and professional network beyond your immediate workplace.  So it was due to Twitter that I became familiar with the account of Dr Drew and his whistleblowing account, and difficult personal and professional experience at the hands of Walsall NHS Trust.

Haven't heard of Dr Drew?  This page is the best summary with links to appropriate news articles.  The most heart breaking link is this news report concerning baby Kyle Keen.  "Little Stories" - Dr Drew's autobiography - is dedicated to the memory of baby Kyle.  It can be objectively argued that his professional difficulties began when he argued that the manner in which baby Kyle died was unacceptable and should not have happened.  But for more detail on that - you will have to read the book.

Here's what struck me about the book:

1.  Dr David (and all HCP's) is first and foremost HUMAN and have stories.

This book is published at a time when our beloved NHS is coming under a lot of criticism (much of it deserved) because NHS professionals are sometimes not giving their human patients the respect, dignity and care that they deserve.  Much of this inexcusable care is often delivered because a basic human fundamental truth is being forgotten - PATIENTS are HUMAN BEINGS (Mid Staffs and Winterborne show an appalling demonstration of this).  But we must not forget that NHS professionals are human beings too - there's a reason why we ended up wanting to care.  And when that duty of care fails - is anyone asking why?

So I urge and encourage and recommend the first few chapters of "Little Stories" because Dr David writes candidly and honestly as to how he "ended up" in medicine.  I very much found an affinity with him because like him, my parents did not actively encourage me into nursing.  I ended up in nursing quite by accident.

Throughout the account of "Little Stories" - I found myself being drawn time and again to the pain and agony that Mrs Janet Drew must have gone through - living Dr David's pain as an observer.  Again it is something I am hugely familiar with.  In a way healthcare professionals families can suffer uniquely because they have to watch (and not understand) the pain their loved one experiences being mistreated at the hands of their employer.  All they can do is watch.  Their healthcare professional loved one must walk it alone!  And for that (as has been said before) Mrs Drew is very much the heroine of "Little Stories" for standing and walking by his side - what a wife!  What a hero!

2.  Dr David cares passionately about his patients.

Any reader of "Little Stories" - whether they be critic or supporter - cannot deny (I feel) that Dr David cares passionately about the patients under his care.  The quite incredible case of extremely low temperatures on the paediatric ward due to facilities failures demonstrates his concern greatest.  I was gripped by his account of getting up during the night and coming in to direct equally concerned night nurses to ensure electric heaters were distributed appropriately and babies were clothed with woolly hats.  

His heartbreaking account of Baby Kyle - and the healthcare failures that led to his premature death - again demonstrate this beyond doubt.  The reader can easily get into Dr David's head and ask; "Could I have done more?".  To any healthcare professional reader - who has gone through the agony of losing one of their patients, this will be familiar territory.  While death is an accepted part of life, something within our very souls rejects it as abnormal and wrong - particularly in the paediatric world.

I noted particularly - in scouring the Employment Tribunal hearing of Dr David, that the Trust did not once claim he did not care about his patients.  Their claims were directed elsewhere.  The Nursing and Midwifery Council is making this statement key in it's review of the Code; "Make the care and safety of those in your care, your primary concern".  Dr David did this - but confusingly he paid an awful price for it.  The reader must ask - is this right?  Is this just?

3.  Dr David won't give up if patient safety is at stake.

This is the issue for all whistle-blowers I feel - and it is an issue that the Department of Health, NHS England and perhaps the Government have yet to grasp.  They are not trouble-makers.  They are not makers of "toxic culture" - ridiculous phrase.  They - we - are simply people who care desperately about the best for the patients and families under our care.  If they - we - see politics or bureaucracy interfering or hindering that care, then they - we - get mad.  And the whistleblowers - Julie Bailey, Deb Hazledine, Dr David Drew, Sharmilla Chowdhury and so many more - are mad people.  They are not mad because of loss of income, indignity, reputation - no, they are mad because of loss of due right to the patients under their care.

I am ashamed to say there was a part of me that was inwardly begging Dr David to accept the gag bribe that Sue James - the CEO of Walsall Manor - was offering him.  It would have provided temporary safety and security to his family and would have ensured a "happy ending" - that he and Walsall Manor parted company.  But THE hero moment of the account of "Little Stories" comes when Dr David comes home and reports the gag offer to Mrs Janet Drew and his sons.  Her response?

"If you accept that money - I will divorce you".

His sons response?

"If you accept that money - we will never speak to you again".

THAT is family!  THAT is support!  I leapt and whooped in my chair while reading it.  I am ashamed to admit that if I were in Dr David's position, I suspect some of my family may urge me to take the gag offer for the simple results of immediate financial security and peace.  But as healthcare professionals we have a duty to constantly ask ourselves - yes, but is our patients at risk because of our actions?  Dr David rightly noted that his patients WERE at risk if he compromised to the offers from Walsall Manor.  So he didn't.  At his personal detriment.  I hope that Walsall Manor have learned from that experience, and I hope desperately that patients are far safer today than ever before.  I don't know.  But I hope.

But I closed the chapters of "Little Stories" absolutely without question - a true NHS Whistle-blower who really cares for their patients will NEVER accept a gag offer - if the safety and security of their patients is left at stake.  And whistleblowers and their supporters hope and pray the day is coming when the government, the Secretary of State for Health and the Department of Health are wakening to the fact that the safety of our patients will ALWAYS be of higher concern than the "reputation" of any NHS organisation.  Let's face it.  Any "reputation" of ANY NHS organisation based on spin and lies and not on true fact of patient safety - really isn't worth the paper it is written on.

So in conclusion:

I cannot commend "Little Stories" highly enough to you.  If you are the Chief Executive of an NHS Organisation then you need read this.  It may save your career.  You may save your organisation and "political face" in the short term.  But you are managing people.  And truth will out.  Stand for truth - and you will be respected.  Hide - and spin - and you will never escape.  If you are a healthcare professional - nurse or doctor - then you need read this.  It will make you ask the question: how much am I willing to sacrifice for my patient's well being?  Am I willing to remain silent to their cost?  Why am I in nursing or medicine?  And if you are a parent, family member or patient - you need read this.  We who are looking after you are human.  We are fallible.  But the most of us really do care.  So let us connect with you.  Tell us your fears, your hopes, your dreams.  We want to help.  We want to care.

Phil Johnson speaks against Celebrity Christianity

I am not normally a staunch proponent of John Macarthur or the Shepherds Conference (see previous posts on "Strange Fire") but I am so grateful to Todd from Dubai for this.  He is right - it's excellent, and something I am becoming increasingly convinced of as a great error and problem in evangelical Christianity at the moment.  I say that as one who spent years almost worshipping "heroes" in the faith.  The whole sermon is well worth a listen to!


May add some key quotes shortly.

Life after "Strange Fire"

I've made no secret of my struggle to maintain interest or passion in theological/spiritual matters this past year or two.  I still believe in God (not so sure about the church thanks to past experience).  But this is a work in progress - certainly not an unfinished story.  A few issues sparked my interest - for example, John Macarthur's "Strange Fire" conference of a few months ago.

A brief history with Macarthur:  As I was growing up in Dunstable and discovering an experiential relationship with God, my church and senior pastor were going in polar opposite directions.  And Macarthur's "Charismatic Chaos" was the instruction manual flogged around Dunstable for that.  I have always fervently believed my pastor Stanley Jebb's motto that; "the unexamined opinion is hardly worth holding".  So I read "Charismatic Chaos" and found it thoroughly interesting.  It didn't persuade me in the slightest of anything - apart from human beings are human beings and make mistakes.  Oh - it also persuaded me that John Macarthur was a throughly negative, unpleasant individual who was having a nasty effect on the pastor and my church - and it was something and someone I didn't want to be like in the slightest!

So the mention of "John Macarthur" usually makes me roll my eyes.  That's why when C J Mahaney started preaching for Macarthur - some reformed/charismatics were thrilled and thought it meant Macarthur was "softening" in his anti-charismatic views and maybe the bald-headed one was impressing him with his sense.  Rubbish.  All "Strange Fire" proved was that in fact Mahaney is taking the same path my pastor in Dunstable took, and is taking all possible steps to reject charismatic life in his church (apart from apostolic authority - in all but name).  A quick glance at Mahaney's "church programme" proves that - no room for the Holy Spirit there!

So I was interested today to find a You-Tube video of Macarthur speaking about the follow-up from the "Strange Fire" conference.  He has taken a lot of stick (quite rightly) for his harsh and intolerant suggestions that charismatics are not Christians.  This is his answer - and essentially he sticks by his views.  Another book is promised to answer his critics (around 26 minutes).  But what particularly interested me was Macarthur's taking on of Dr Martyn Lloyd-Jones and John Piper in particular (38:12) - namely that pastors and preachers have NO business seeking an anointing or unction from on high to preach!

Astounding.

Here it is;

Sing It Louder!

I was thinking a lot about mental health issues today thanks to the great "Time to Talk" focus day this week.  One account particularly moved me - that of "Time to Talk" campaigner Johnny Benjamin - sharing his experience of how he almost threw himself off a bridge in London but was saved by a passerby.  It struck, worried and moved me how awful the reality of suicide is - and how surely it is OUR responsibility as a race to try and protect our own?  NO-ONE should feel so lost and alone that they end their lives!

So what keeps us going?  What keeps us living?

I have considered suicide myself personally this past year - I confess it.  Things just got "so" bad that it occurred to me as a distinct possibility.  I know that psychiatrists consider the risk of suicide greater if "there is a plan".  I had a plan.  I kept on living for a largely negative reason - I did not consider the cause of committing this final act "worthy" enough to do so.  It's not perfect but it worked for me!  The fact is that life serves good times and bad times.  And I have learned over the past year or two that rather than just "keep hoping that life picks up" - it is wiser to enjoy the good and use it as a foundation to work through the bad.

I got a little revelation today as to one of the reasons why I "keep going".  It was listening to one of my favourite song tributes to my adored and revered Her Majesty the Queen; "Sing".



The lyrics in question that moved me immensely were;

"There’s a place, there’s a time in this life when you sing what you are feeling, find your feet, stand your ground, don’t you see right now the world is listening to what we say? ... You brought hope, you brought life, conquer fear, no it wasn’t always easy, stood your ground, kept your faith, don’t you see right now the world is listening to what we say?"

What occured to me is this (and bearing strongly in mind; "Time to Talk" campaign) - one POWERFUL reason to "keep going" - is that there may be others out there who are encouraged, find strength, find hope from the story that we tell.  I shared a tweet the other day about the reality of living with an anxiety-related disorder.  It's horrid.  But if by speaking out - I can encourage or remind or tell another person that they are not alone and are not alien or weird - then surely I must do it!

There is a reason for keeping on living - and keeping on going.  We do not live alone in isolation.  If we live or die - this does have an impact on our fellow human beings!  And we have the opportunity to affect the world we touch by the words we speak!  So my hope and my aim right now in life is to try and take courage and speak out honestly about problems and solutions.

If it were one day to save a life, or to even just encourage someone that they aren't alone - that would make the ups and downs of my life ALL worthwhile!

Keep singing!

How Her Majesty the Queen helped me survive these past 1.5 years.

Dedicated to every brave soul who daily choses to continue living - even if it means facing demons, hardship and heartache.  Dedicated also to the fabulous Rev Dave and CEO Lisa who together gave me the bravery to speak out and put pen to paper.

It is amazing that even in the 21st century, it still isn't very easy to speak openly about mental health issues - particularly on a personal leveMORE empathetic and compassionate rather than building walls and de-personalising our patients!  Somehow anyone within the NHS, there is a ridiculous notion that "we are professionals and shouldn't struggle on this level".  But the unspoken reality is that the NHS is wonderful because it is staffed by human beings who do go through similar problems to the patients and families we see on a daily basis.  That reality should make us

My own personal background was somewhat more complicated by the fact that I came from an extremely fundemental religious background where mental health issues were particularly disapproved of, and usually put down to "sin" on some level.  When I first went on antidepressants some 10 years ago for a time, I didn't dare tell my parents for some years - as it was seen as an admission of "failure".  I have seen my General Practioner and various Occupational Health services through work pretty regularly - and the clinical feeling is that I am not "depressed" per se - I apparently tend to struggle with "chronic anxiety".  In short - I daily seem to imagine up (I have a very vivid imagination) all sorts of fears, worries and panics about what life may bring.

The last year and a half has been particularly rock-bottom in terms of experience, health and work.  Two or three times I did in fact consider suicide and whether it really "was all worth carrying on".  Those low points were often prompted by events I read, such as the tragic account of the nurse involved with the Australian DJ scandal while Prince William and Kate were in hospital expecting Prince George.  Reading that account made me feel an affinity with the nurse - but in a ludicrous way, a rather morbid wondering if I also committed suicide whether the Chairman/Chief Executive of my workplace would make a statement to the press.  I decided they wouldn't bother - and somehow found that enabled me to "keep living" that particular low day.

But the benefit of this year has meant that I have been forced to confront some of my worst fears headon - with no support, help or alternative.  That's a story for another time - but what I found was that actually - my imagined fears were WORSE than the reality!  But what I wanted to focus on in this post was what enabled me day by day to "keep going" this year.  And that was the person and example of Her Majesty the Queen.  Before you snigger - let me explain why.

I am sure there may be psychological reasons why the Queen means so much to me personally.  I lost both my beloved Grandparents at significantly low times in my life to cancer, and both losses affected me deeply.  I guess there may be a degree to which I long for a "Grandmother" figure.  But Her Majesty's example has meant more than that this year.  It is well known and commonly cited that her life motto is;

"Duty first - self second".

When Her Majesty was 21 she made a monumental speech in South Africa where she committed her life to;

"I declare before you all that my whole life whether it be long or short shall be devoted to your service and the service of our great imperial family to which we all belong".

Her committment to duty has ruled her life and service - even if at times it has meant that her family life and personal life has been affected as a result.  Many commentators (and we never know what Her Majesty herself thinks - as she does not give interviews) suggest that call to duty is something that has remained with her, and has driven her throughout her life and reign - to the present date, her amazing 86 years of age and her now-over 60 years of reign.

Let me make it clear - I do not equate myself in ANY way to Her Majesty the Queen in ANY sense (other than to count myself fortunate to be one of Her subjects).  But what remained with me throughout this blackest of years, was initially a thought - does Her Majesty the Queen ever get down or low?  And this wondering grew into an interest that lead me to reading many of the biographies written about the Queen, and the difficulties that have beset her (especially her famous "annus horribilis" year and the year where HM lost both her beloved mother and her sister) - yet continued to perform her duty.

Her Majesty's personal difficulties are made worse by far because they are so often in the sight, criticism and debate of the press and therefore the public of both the United Kingdom and Commonwealth.  At the very least any personal problems I have, were able to be limited by myself to the people I trust and were able to depend on (and to them - a few in number - I owe them a debt of gratitude I will never be able to repay!).

While working through - day by day - the blackness, the lowness and utter desolation of the past year - at times, it was quite simply the fact of seeing Her Majesty the Queen at an official function (I follow several blogs that track and report the Court Circular) that gave me courage and conviction to try and "live the day".  At times, this was as pathetic as leaving the safety of my flat and walking to the corner shop to buy a pint of milk.  It sounds ridiculous to write this - but my mentality was;

"If Her Majesty can go to yet another engagement despite the wealth of possible aches and pains she may have as an over-80 year old, smile constantly even though she may not feel it, and shake umpteen hands even though she has done nothing but for the last over 60 years of her reign ... then surely I can put clothes on, leave the flat and do a simple task?".

That simple role-model and mentality enabled me to gradually build and grow in confidence, activities - and as a result I found my mood and outlook on life improving, my determination to work through my difficulties strengthen, and focus my goals beyond just "surviving the day".

It is for this reason I will never fail to be grateful to the unfailing example of Her Majesty the Queen.  The couple of visits I have been SO fortunate to make to Buckingham Palace only served to enhance that.  It is why I am a Royalist through and through!  I know this example will not work for everyone who suffers with anxiety, depression or any other mental health disorders.  But I do think it underlines the importance when you are struggling so hard to "keep living" - sometimes it can be the most simple or obvious of things that help keep you "living"!  It could be a family pet that needs feeding.  It could be a planned outing in a few weeks time.

The majority of the victims of suicide almost invariably state; "they ran out of hope".  So for us - as NHS professionals - one of the key responsibilities upon us is to help find that hope (and it will be individual to each person).  But we can only do our job well and effectively - if WE are honest about our struggles and experiences.  Small things such as a "thank-you" from a Chief Executive or a line manager can change the complete "mood" of a working week!  More importantly - cared-for staff give better care (it is widely acknowledged - I cite an excellent PICU Intensive Care Consultant as an example) so it is vital that if NHS staff do share mental health struggles and issues, they are supported and not vilified or patronised (as has sometimes been my experience).

Positive thinking (in my opinion and experience) is absolutely vital to "keeping on going".  For many of my 36 years of living - I thought that positivity and happiness was a reaction to the experiences that life forces upon us.  If life was going well - then I was happy!  If it was going very ill - then I was not.  But I have come to realise and understand (thanks to Twitter friends - in particular Kath Evans, Head of Patient Experience for NHS England and her friend 'Engaging Emma') - that in fact positivity and happiness come from "within" and are a state of mind that can be increasingly immune to life's changes and events!

My conclusions?

1.  Life isn't fair or just.
2.  We all have a choice - to continue and fight or opt out.
3.  We can all chose to benefit from our experiences and use them for good.
4.  There is always hope - even if it is the smallest glimmer (such as the Monarch carrying on her duties!).
5.  The night cannot last forever - the dawn does comes, even if it seems forever!