In short

While I am aware of the many failures of the national systems, I have also been fortunate to have experienced a golden time. Maybe we all experience a great first couple of years but as we become more aware of the system & more skilled, we become more used & “living the dream” becomes more of a sarcastic comment than a comedic response. It’s easy to forget the great times & miss noticing the great in lots of different kinds of days. Today I will focus on reflecting on the positives & in doing so enable them to expand & reverberate.

Training, we made it!

As a student I remember the kindness many staff had for me, they would say how they remembered their student days being scary, so they would be supportive & welcoming. Of course, there were times when I was treated like dirt, but today is about the positives. The staff who stood out to me were relaxed, firm but kind. I remember the pride I felt when a patient described me as such because it felt like this was the right balance we needed to emanate in our service.

When I started nursing, I began observing the staff around me. I was impressed by the axillary nurses without whom I would never have survived the first six months. There was so much to do but they knew what to do to move forward promptly, politely & with a laugh; if the patient was in the right mood for it. It wasn’t long till I had to make increasing amounts of decisions, a challenge for anyone & at the time I often took on too much myself. The axillary nurses supported me with helpful advice & got much done without me needing to request it, I’ll forever be grateful.

The first year or two were still golden, the workload was heavy but the staff who had been around longer kept tending to group morale. On Sundays, we’d sort breakfast for the patients, dish out their meds, & then stop for tea & toast ourselves. I wasn’t much of a tea or toast fan but our time together reminded me of the heart of our care. We were there to support others as a team & I’ve valued this my whole career. Like any work culture, some people would have better suited a role in politics but we were fortunate to be mostly a great bunch.

Patients are a virtue

I’ve often welcomed a new patient for their first chemotherapy, specifically encouraging them to sit next to another patient that I knew had been many times; they knew the staff & the routine etc. I would then get on with my job but witness the new person getting comfortable as they made a friend, they’d become distracted by light conversation, maybe even laugh. It’s so beautiful to be part of introducing & witnessing a caring relationship blossoming. Regardless of where their cancer was, age or gender, these patients would often support each other. They’d also develop a heightened awareness & skill in listening, hearing & contributing to others with what they needed at the moment.

I’m so grateful for countless opportunities where patients shared their hopes, fears & dreams. Sometimes, they would share when they couldn’t sleep in a night shift, they could have been pre-op with concern for any possible negative outcomes. Others shared when at their last options for life-saving chemo or immunotherapies. Or in their likely last days alive. They’d share regrets, in-depth stories sometimes saying I never told anyone that. On  occasion I couldn’t hold back tears as they said I just wish I did more, it always seems to be I wish I did do rather than regret something they did. Although I’m sure these exist, at the end of their journey faced with “mortality… they focus on what they’d still like to do, if they were given just a little more time & strength.

Many patients suggest they know very little although once we get talking, I find they know many things about health. Some know plenty about their condition & are great to learn from. I also enjoy asking their preferences so, if possible, I could meet their needs as they felt happiest. It’s such a small detail for me to wrap a central line a particular way but makes a big difference to that individual’s week when done the way that feels comfortable to them. Last year, I met a couple in their 70s, they’d been listening to a podcast on Integrative medicine, & asked me have I heard of it & what I thought! I was so happy & encouraged to hear someone safely, exploring, continuing to learn & grow.

The cast is not set

After three & a half years working in Oncology, I decided to have a break, & then returned to a bank/ locum role. I decided to make myself go to a new hospital, out of my comfort zone & hopefully prove to myself I could gain confidence, learn new things & visit new places. I started with 6 months in one hospital, then another for a month & then another. I realised I could potentially work in every region of the country, I made a plan that had to change a bit, delayed by that covid thing; but I completed it. Working in different areas of course varied in Devon compared to North Tees. Or Salford & Ipswich. However, everywhere I worked was the same but different. I was noticed as a newbie, but I focused on serving the patients. I worked with hundreds of staff & only a handful were rude, who knows what they were going through. The majority of staff were kind, it was extremely rare that anyone spoke out of turn; mostly it was all about how else can we be more for patients. 

Night shifts were often great for getting into a few minutes of conversation with staff. While many patients sleep, many do not, requiring support & treatment throughout the night; so time to converse among colleagues was precious time. Preparing paperwork, reviewing & auditing; the party continues all night. Sat with another nurse, clinging to a radiator to warm up & learning more about their life outside of work. It was so important to know each other as individuals & support each other through work or home concerns. Hearing others tell me their woes helped me feel less alone & I felt honoured to listen to or guide them if I had something supportive to contribute.

Well, what can I say thinking about the positives has led me to think of the people. No matter the building, the weather or the equipment or lack thereof; the people make up our healthcare system. Although I recall thanking both staff & patients, I remember them shying away & saying oh it’s nothing. No amount of thanks could repay or express how much I mean it. As someone who used to think every part of life was bleak, I’ve been overwhelmed by the love that keeps the system afloat. In meditation I think of you often; equally cleaners, nurses, doctors, patients, porters, pharmacists & all other professionals. We’re not professional by title but by our work ethic, contributing often at the expense of our health. Thank you.

3 Proactive steps forward

1.          Self-reflecting, learning from stressors & noting the positives isn’t just useful for revalidation but also to recognise the positives that happened. It’s an opportunity to hold the thanks someone gave you as you rushed by, hold it for a moment in your heart & receive it again when you read it once more. Focusing on some things you did well, it’s so easy to continue with the list of things to do or that were left undone at the end of a shift but focusing on what you did well usually means taking time to actively recall them. There’s an unwritten rule that certain jobs should be done on a day or night shift, however many things happen that may get in the way. So give yourself grace that you did your part & if someone hands over that something wasn’t done, give them the benefit of the doubt that they tried to get it done.

2.          Having worked in fifteen different trusts I’ve witnessed how the expected similarities & learn of differences. Many differences are transferable like multi Acute medical units! I don’t know if many other hospitals have this but it makes sense to extend those areas to get people moved out of Emergency to short-stay wards. Of course, not everywhere has the physical capacity or staff to extend in this way but it is a shift I’d like to see as we encourage shorter hospital stays & enable home recovery. Some places have fingerprint access to electronic med cupboards. Clever & could be utilised for maintaining inventory but we’re currently having to go around to different units cos it wasn’t stocked correctly. The machine encourages poor practice as the meds are dispensed far away from the patient; enhancing the chance of errors but enhancing blame culture. In a positive thought, some places are very good at dispensing meds into bedside lockers, saving lots of time queuing for a machine & supportive of prompt discharge. One of my favourite things was a simple mini walkie-talkie. If we were working in a pair, one going to collect dressings or linen, you could call them from the other end of the ward asking if could they also bring… so you didn’t have to leave a patient unsafe or just waste time walking the whole ward. I often wonder what a hospital would be like with many little …

3.          While we all extend our kindness to others, there are times when we don’t make an extra effort to thank patients for their patience & their families for not interrupting us. For their understanding of our restrictions by the system; it’s limited resources, overwhelm & lack of resourcefulness. I often stay late after my shifts to make sure my paperwork is complete, but I’ve also often made sure to expand on my conversations with patients, so they feel the sincerity & understand it’s the poor culture & system not the intent of each individual. Without this sharing, they are having to guess from an outside perspective. There is a fine line between making excuses & sharing the facts of the matter. Eg. We’re short of staff or have an unexpectedly high number of patients.

FREE 3-minute practical’s

• Spend 10 mins listing all the positive, funny, amazing, beautiful moments in your career so far. What were the top 3? Why were they so magical? Was it because of years of studying, working long hours or something else?
  •            Share with a colleague & ask them what their most magical moment has been.
  •            What is something positive you’ve noticed in a colleague but haven’t got round to telling them? Without expectation of a response, aim to share at a time they will be able to hear you, sharing fully & openly. I tend to say, you don’t need to say anything back I just thought you should know & I hope you’ll consider it in your own time.

Interpractive nurture consultant Ltd