mabel u.k

Thank you Denise and you are very welcome. There are lots of experiences to be had within the NHS some good some bad, you can learn from both. Don't allow yourself to become a victim of the system and enjoy the difference you CAN make to the patient. I still love being a nurse, I love where I work and the job I do. Good luck with your training

Instead of responding to the most recent posts I thought I would tell you about my shift today to demonstrate what I love about the NHS, I have had a fantastic day it has been really busy and I have been on duty on my own as we don't have many nurse practitioners and can only cover for 1 on weekends and bank holidays. It has been one of those days where you come home feeling like you have achieved loads. Now that does not imply that I don't understand that it has problems or have a rosy view of it because I have been is some jobs where there has been no support and because of this I have left these jobs. However now I have a great job which I am passionate about I have this job because of the time I have spent as a nurse in the NHS, both the good and bad experiences has shapped the nurse that I am now. I started at 7am and didn't finish until 5pm I have been constantly busy. THe first thing I did was to make a cup of tea which was the first and last all day. I then checked the on call book on the ward that my office is based on to make sure there were no urgent jobs that needed to be dealt with. Fortunately the Hospital at night team had sorted out all of the problems. I then walked the floor. I cover 6 surgical wards and any surgical patient that is outlying on other wards on the weekends which is different to my week work. On the first ward I attended they had a patient they were concerned with, he was post op 3 days (colorectal) and had began vomiting. I reviewed his history and examined him, he had been allowed to drink the previous day and I couldn't hear bowel sounds so I reduced him back to sips and prescribed some IV fluids after checking his bloods. THese are all skills that I have learnt within the NHS fully supported by my managment. I bleeped the SHO to asked him to review him later. I then went to the next ward where they were short staffed because they had one nurse escorting to CT she wasn't going to be too long and I didn't have any jobs that needed to be done, so I took her bay of patients to help alleviate the workload a little until she returned. I made a a few beds with the HCA and assisted a confused lady to have a wash and dress. One of the HCA's was only on her 3rd shift and was unsure how to take a manual blood pressure so I talked her through it and she took my BP then the patients. The emergency bleep went and I attended another post op, peri arrest the staff had notice a deterioration and the pateint had become even more drowsy within the past hour. When I arrived there was very little for me to do as because of the training they had recieved from our resuscitation department put up high flow oxy and they had speeded up fluids. He was a shocked post op so with some fluid he improved and HDU came to assess him further. Now there were lots of other little jobs that needed to be done, resiting IV's taking bloods arranging discharges and the usual sort of stuff that makes up my weekend work. Because it is August the new house officers need lots of reassurance the docs that we have within my unit are a little green but ask for help when they need it and to be honest they are very competent. Today I have also spent time with one of our new ward managers who was feeling overwhelmed by her role and we spent a bit of time talking about how she could feel more in control of her new job. THe highlight of my day was reveiwing one of my patients for discharge. During the week I work with one consultant so I a patient caseload. This lady had been very unwell and there have been times in her admission when I was convinced she would die. During this time as her nurse practitioner I have got to know her very well. The first time I met her was just after her admission, I was called to see her as she had a huge PR bleed and had collapsed. During my assessment of her she grabbed my hand and asked me if she was going to die, she called me dr. I knelt by her side and explained that I wasn't a doctor I was a nurse practitioner. I explained that this was a nurse who worked on all of the wards and I worked for her consultant which made me her special nurse. Now she had been very unwell on a few occasions but every time I attended her she said here is my special nurse. After many weeks of investigations and interventions, then dealing with her home situation and making sure she was safe to go home today she is finally ready for discharge - both physically and more importantly mentally as she had lost much of her confidence during her admission. I cannot explain the relationship that I had with this lady but to see her go home well is reward enough. But it does not end with her discharge as she is booked into clinic in 4 weeks so I will see how she is progressing there. This continuity is priceless. If she had been an elective patient I would have seen her pre admission, pre operatively assessment I would have been there for her admission and discharge and then in follow up clinic. Now this experience is not unique to the NHS I know that, but the skills that I have built up and experience I have has been within the NHS so I have to give credit for that. I have a fantastic job, I work with fantastic nurses, doctors and managers. I love being with my patients and I love working in a role where I can still be a nurse but learn and practice new skills as well. and have continuity with my patients from the start of the care to when they are discharged from clinic. ALthough early on in my carreer I funded all my education and did this in my own time within my current job all of my education and development has been supported by my directorate and the NHS. I realise that I am fortunate in getting this but I cannot believe that I am unique, in fact all of my team of nurse practitioners will also recieve their MSc funded and supported by our managment. I know I am fortunate to have such a job and that there are areas and staff that are not so lucky but I have to speak about my experiences. As far as reflection goes I was always taught that it is just as important to reflect upon the good experiences as well as the bad that was we can acknowledge what we do well as well as what we need to improve upon. Personally I don't like Johns as a model of reflection I find it far too prescriptive and Gibbs is very simplistic. I use Bev Taylor's technical, practical and emancipatory reflection as I find that I can reflect more deeply on what happened, the impact on others and the impact within the bigger picture (Emancipation) As I have said before there is lots about the NHS which is not good, but there are elements, staff and practices within the NHS that are good and this is what I wanted to highlight within this thread not the policital issues but the good practical and clinical issues.

My intention with this thread was to highlight that although the NHS is stuggling there is good practice going on despite this and to demonstrate that not all aspects of the service is poor. I do understand that there is great discontent within the health service and I have never disputed that - I have worked in the NHS for long enough to see both good and bad. Unfortunatley it would seem that there are few that share the belief that there is good work going on. It is possible to make a big difference as one nurse and the small changes that we make contribute to make a better place for our patients to be cared for. Yes I understand why some would want to leave the health service and hope that the grass is really greener on the other side, reading some of the threads on the american section they seem to have their fair share of problmes. I will not apologise for want to stay and try to improve things in the small way that I can, and I certainly won't apologise for being proud of staying within the NHS. Monique you ask how much experience do you need wel my comment was not meant as an insult merely to state that you have obviously had some bad experiences you need to find good experiences as well - they are there.

As with madwife when I qualified in the early 90's there were no jobs, all of my group were unemployed for a while. But the NHS is constantly changing so don't lose hope something will come up, I just hope you don't have to wait too long.

Hi Liam, I love being a nurse and I love working in the NHS, when I qualified in 1990 as with Madwife there were no jobs my whole group were unemployed for 3 months then slowely the jobs were becoming available again. The NHS is an ever changing beast and what happens now is no reflection of what will be happening when you finish your training. Nursing is a worthwhile and wonderful carreer and it opens a world of opportunities to you. As far as independence, yes the is a great deal of autonomy in nursing but within healthcare it is about a collaborative approach. As a nurse practitioner I have a great deal of autonomy but need to know what my limitations are and when to refer to a medic. I am a nurse prescriber so can manage a variety of situations before needing to refer. As one of the posters have already mentioned this type of job takes a great deal of experience and you will need to work through the stages within you career to get to do a role such as this. If nursing is what you really want to do then you should do it. Good Luck

I think you have completely misinterperated my thread, I have been nursing for a long time and contrary to your belief I do realise that nursing in the NHS is not all rosy. However with the constant battering the NHS and it staff get from bad publicity and poor morale I do believe that it is important to recognise and highlight good practice. It is very easy to get into a vicious circle, you complain about your workload your colleague does the same morale declines and very soon all that is left is poor morale and complaining staff. It is vital that we recognise and praise good practice, and support each other only then can we try to make things better. I have already mentioned this in one of the posts, I do not like everything that goes on in the NHS but from the very start of my nursing carreer if I didn't like what was happening I got evidence and presented it to my managers to help promote change. I doesn't always work but there are times like my recent project that it does and it is these times that we need to recognise and shout about. As far as one qualified to 18 patients if this happened in my area I would be filling incident forms, putting together evidence and information to support an increase in staff numbers - clinical risk will get you alot you just need to know how to collect and present evidence to those with the purse strings. If I get staff asking me for authorisation for bank and agency I ask them to prove that they need it, I don't think this is an unreasonable request I need to justify the additional spend. As far as calling you a realist - you are a student nurse, I think you need far more experience of good practice in the NHS before you have a more comprehensive reality of the NHS. My philosophy in nursing is if you don't like what is going on then make moves to change it, if you are not in a position to do that wait and plan to be in a position to influence change. If we all sit and complain but make no active effort to change our work environment then the NHS truly is doomed. however I do believe and have sufficient experience of excellent and motivated nurses who do want to change practice for the better and this allows me to maintain my passion for nursing in the NHS. Don't become dispondent and miserable become a change agent and make things better. M xx

Madwife I also love my team, I manage very experienced and clinically excellent nurses, I love working alongside them. I also admire the level of commitment and determination of the ward staff who despite funding restraints still deliver an excellent standard of nursing care. Our junior doctors are fantastic and never afraid to ask for help even though they usually know the answer. I get really cross when people run the NHS down, it is a credit to the staff working within the wards and department and YES that includes the managers that we provide the service we do. I include managers in that because although many may not realise it they are in strategic meetings fighting the corners of the ward staff, they may not always succeed and usually have to deliver the bad news which makes them unpopular, but I know from the directorate that I work in they do fight for us. I wouldn't want to work anywhere else

There has been quite a bit of negativity about the NHS and working in the UK on this forum recently so instead of another thread saying how bad things are and how much we hate our co-workers I thought it would be nice to have a more positive thread. I'll start I loved my job because: I am a nurse practitioner in general surgery and recently I put a bid together to support a more formalised pre-assessment service, I took it to my senior managers who supported it and took it to the trust board. I have recieved confirmation today that it is a project that will be supported and funded by my trust. There is money there you just have to try to put together a good case to access it.

Hannah it sounds like you have had a really bad week. I do try to remember that at this time of year all of the doctors have changed, you house officers are brand new out of med school and are trying to come to terms with the changes in their responsibility the SHO may well be on his first senior job and feeling a little insecure. I don't know what level doc your experience was with and I would not try to justify bad manners or poor practice but there may be an explanation for his behaviour. Firstly I work as part of a surgical team, consisting of a consultant, SPr, me SHO and HO I wonder if your doctor knew where to find the aprons and inco sheets, also he may not have considered using an inco he probably has never had to change a soiled sheet so may not have even thought of it. If my patient was undergoing a procedure on the ward I would have no problme in explaining the procedure to them, in fact I think that sometimes nurses can explain better in a way that the patient understands and feels reassured by. I always worry that as healthcare profesionals we are very quick to critisie other professions without trying to understand the pressures that other jobs entail, and this is not exclusive to nursing, I hear docs critisise nurses, nurses critisise physios, physios critisise doctors etc etc. and it concerns me that there is little tolerance left in the NHS when we are all trying to achieve the same thing - best care for the patient I hope your week gets better

Hi Guys, I am a UK nurse and wondered if anyone could give me any information about how to go about making enquiries about relocating to NZ and what additional things I would need to to to and practice in NZ, and what it is like to nurse in NZ. I am a nurse practitioner in the UK. Thanks

All nurses within the NHS are paid the same amount depending on which band you get a job at. You say you are just qualifying which means the jobs you would be more likely to get would be as a band 5, no extra for Masters unless you are applying for CNS or NP jobs, but these would expect quite a bit of post qualification experience, as a Nurse Practitioner manager I earn £30,000 oer year so in comparrison to the US not so good. As I said in my other post I expect 5 years post qualification for the NP's that I employ. Have you looked at the NMC to see you would need to do to practice in this country. Have you got your heart set on London the standard of living is not so expensive elsewhere in the UK. Hope this helps M x

Advanced practice over here is very different, the NMC does not yet register nurse practitioners seperately and therefore there are many variations of the role. Usually to get a job as an NP you would need to meet the specific requirements of that particular job, for example I ask for at least 5 years post qualification with experience in critical care and surgery. I also expect first degree level with the expectation to study at masters level. This would vary from post to post. Hope this helps M x

Don't give up hope on nursing yet, keep applying for jobs you fancy and you will get one. It would be a shame for you to leave nursing before you have really had much of a chance to find your niche

I do think it depends where you work and speciality. Yes there are job loses within the NHS in some areas with trusts trying to save money but there are also developments in other areas where cash is available to meet government targets. I did a jobs search within wales this morning at it came up with 70+ jobs this week. http://www.wales.nhs.uk/jobs I do remember when I qualified in 1990 there was a similar situation but it lasted for about 6 months where all of my group (unlike the training today there were only 10 - 15 in each group) worked agency and bank before jobs became available. It may mean that you have to travel to get a job but there are some jobs out there.

I have a terrible memory so from when I first qualified I kept a little pocket sized note book in which I wrote down things that I found importants like normal values, calculations, (drug doses - when I worked in paediatrics), I have details about A and P specific to the specialities I have worked, ALS (I think you call it ACLS) guidlines, peri arrest guidence and anything else I felt important at the time. I have been qualified 18 years now and have 3 of these little books, I rarely use them but the most up to date one is always in my pocket just in case. I find by writing it down I remember it more and then if I forget I don't have to worry because it is in my little book. Every now and then I get a little confidence crisis and feel as if I know nothing, but this is normal as you progress within your carreer, it is also safe because the minute you believe you no everything is when you become an unsafe practitioner.

The NMC's primary mandate is to protect the public by registering, regulating and monitoring nurses and nursing practice. I don't think it insinuates that nurses are dangerous but that we do care for the most vunerable members of the community and therefore there must be some regulation and monitoring of this practice. Without the regulation of the NMC there is the potential for less than adequate nurses to practice. THe NMC does not Enhance practice, the individual practitioners do that, but it does provide professional standards which we must adhere to and therefore attempts to protect the public from practitioners who may not be fit for practice. If you look at the code of conduct it is all about the safety and digity of our patients / clients. I am not saying it is an ideal organisation - what organisation is? - but it's mandate is to protect the public by registration and monitoring practitioners. I don't think that the term Protecting the public through professional standards is derogatory I think it merely states what the NMC is about.

I have a couple of points and questions, there are enquiries so please don't take them personally: How well did you all look at your job descriptions before you signed it off, did you compare it to national profiles to make sure you had all of the aspects that you needed on there to get the band you expected, similarly with the effort factors questionaires. Just a little point, I don't know what other places are doing but banding all E grades as 6's sounds very expensive. What did your F's and G's come out as, did the other areas have things such as managment, nurse led initiatives within thier job descriptions to account for the descrepancy. What speciality within surgery do you work in, could this account for the difference between the bandings. Do you know what plans the management would have for replacing these band 6 posts, would they be down graded to save money, potentially in 5 years the trust could be paying the majority of the ward the equivelant of a junior sister pay. I work as a Nurse Practitioner and we have been banded along with the specialist nurses as 6's, we run nurse led clinics, admit and discharge patients independently, have prescribing powers through masters level study, although our jobs are very different the experience that is required as a start point for the NP's and CNS's is degree level with an expectation for masters with supplementary prescribing and when it comes in independent prescribing. I would be dissapointed to find out that nurses with 18 months experience and no requirement for degree level could potentially be banded at the same level. Please don't misunderstand me, this is not devaluing the ward level nurses but the requirement for an E grade is much less that NP/CNS or even F grade senior staff nurse / sister for that matter and yet they are to be banded at the same level. My other question would be that if your appeal is successful, are you and your fellow E grades prepared to be working at junior sister level as your F grades are now because the KSF expectations for a band 6 nurse will be the same so it will mean more work and responsibility for you. When you appeal try to use wording from the band 6 nurse profile to justify your appeal, there are national profiles that you will have been matched against find the band 6 and use similar wording to establish that you are working at that level. It would seem that to have so many equivelent level nurses banded differently there could be differences in the job descriptions, it would be worth having a look at those that had 6's to see what was in there. Good luck with your appeal, I hope you have supportive managment to help you through this period.

In my role I am attached to a surgical team and work side by side with the junior docs, I am not condoning what this doc has done if you told him the results then he should have acted on them. Yes it is the doctors responsibility to make sure patients are fit for theatre ( and in our case the nurse practitioners) but sometimes the workload these young docs can have is horrendous. I love working alongside my docs and one of the comments was why are nurses always chasing docs, sometimes despite the best intentions if you have really unwell patients the routine stuff gets put on the back burner until you have time, not an excuse but it is reality. At times like these I rely on collaborative working with the ward nurses to keep me informed of the patients who are not unwell - I don't see that as them chasing me or m tema but working collaboratively in the patients best interest. For example, 0ne of our surgical teams yesterday had 45 patients on thier list and things like that may well have been on the list to deal with but didn't get around to it. there was no SHO for the team as she was on nights and the reg was in theatre. We do pre-operative assessments 1 - 2 weeks before to make sure that this sort of thing doesn't happen. You need to document communications with docs in the notes especially if it is something as important as that, it covers yourself. Do you have an on call SHO that you could contact if the patients own team don't act on informations that is a system that I have used in the past. Cancellation of surgery on the day of the operation is extremely distressing for the patient which is why pre-op assessments are so vital in elective surgery. It is realy unfortunate your house officer didn't have the balls to stand up and say I am really sorry I was too busy to chase this up and accept responsibility. Despite that he/she is responsible for check results of tests that he ordered so even though he / she has denied you informing him of the results it was his responsibility anyway so you cannot be held responsible. There are some really good junior docs out there but unfortunatey as with everything there are some really poor ones too. SOrry yours couldn't have been a little more honest

I recently joined the nurse bank at my local hospital to keep my hand in working at ward level as I don't get much chance nowa days. I had a letter from Occi health to ask me to see the Dr. It turned out that it was because I had shown up as a Latex sensitivity and he wanted to check out that I knew. It may be something really simple and nothing to worry about. They probably just want to clarify something on your health questionaire

If by code you mean cardiac arrest (we call them different things in the UK) I spent 3 years as a resuscitation training officer and as such attended all cardiac arrests and peri arrests within my hospital. you don't ever really get used to them but it does become easier with experience and knowledge of the protcols for arrest management. When I teach resuscitation skills I always tell my students that once the cardiac arrest has happened it doesn't matter what you do you cannot make things any worse, the patient is not going to survive without intervention so anything that you do will improve the chance of survival. I worry more about living breathing patients they are the ones that will cause you more trouble. If your patient survived then you did a really good job - well done

Been re-reading through this thread, it is sad that so many nurses within the NHS feel the need to leave because of the system. If you are following a dream and have always wanted to work somewhere else then that's fantastic. I still love working in the NHS, I feel very fortunate because within my role I do get time to spend with my patients and assess them, talk to them, reassure them. The nurses on the ward work very hard but certainly within my unit I would say the standard of nursing care is excellent. We strive to provide the essential basics of care and maintain standards, I think that the majority of the time we achieve this too. Thats not to ay that I have rose coloured glasses, yes there are huge problems within the NHS but there are outstanding nurses who do a brilliant job. I have always been very determined within my carreer, if I didn't like the way things were running then I have got myself into a postition that I am able to influence change. I know that there are some things that I will not be able to influence but within my area I have a fair amount of autonomy and independent practice which means that I am able to work with my staff to use the resources we have in the best ways possible. Plato353 you say that over here (UK) nurses are "go getters", there may be some element of that but that is not everything that UK nursing is about. I look around at the efforts and progress that UK nurses make to survive in a struggling system and feel proud to work alongside them. Yes we have all heard nurse get me this, nurse get me that, but we also hear I couldn't have got through this without your care, thankyou for everything, I can really talk to you nurse, I never feel rushed when your on duty. If there are things that we don't like then we write papers, present evidence, discuss with senior managers and change - yes sometimes comprimise, sometimes fail but we try. I still love working in the NHS

I would try to find out reasons for sickness, and what has been done to control the level of sickness. You could ofer a fixed term contract for 6 months with a review after this time if you are really concerned.

Hi Sarah, I would assume that you are doing some sort of course, if you are looking for extra words / padding it may be useful for you to look at the question from a particular ethical perpective such as utilatarianism or deontology these could give you differing theoretical views for presenting a moral argument. I did an ethical module for my masters and looked at how appropraite emergency surgery is for an elderly patient with dementia who was otherwise mobile and well. I looked from the utilitarian perspective and it created some very contraversial arguments for and against which helped me to pad out my argument. I did a google search for moral theories and read Beaucham and Childress "principles of biomedical ethics." If you want any references PM me.

thankyou for your constructive comments, it looks as if you have dealt with this in a very proffessional way that has been beneficial for everyone involved (except your senior staff) it is unfortunate you have line managers that take advantage like this and do not value thier team. i am very fortunate the ward managers within my team are all excellent which is why i defend nurse managers - there are some very good nurse managers around who do value thier staff. you say that you know that nurse managers have strict guidlines however in your situation this system seems to have failed. without nurses such as yourself raising concerns and addressing issues with senior managment in ways that achieve results and not just resorting to the "it's not fair" attitude that is destructive and demorilising to all, then stricter guidlines such as the one you have managed to get in place may not be implemented which leads to an unhappy workforce. well done

Nope dont believe I mentioned being upset to be quite frank I am very secure in my professionalism, practice and managerial skills and do not need approval (or disapproval) from a complete stranger. You have obviously had a very bad experience with managment which I am sorry for, but this appears to affect your ability to view any one who defends managment constructively and therefore resort to inappropriate and uprofessional personal attacks. I hope you find what you are looking for in the USA but I am sure that there are nurse managers there too and if you cannot resolve conflicts in a constructive manner you will proberly not get on much better there either. good luck on your travels