Nurses uniforms are stupid

Sometimes I will write a blog and put a deliberately provocative title at the top to hook people in … however this time my sentiments are exactly what the title says … nurses uniforms are stupid !!

I hate to state the obvious but it’s been hot … very hot … and when it’s hot I starts to see a plethora of tweets about 2 things from nurses uniforms and getting enough drinking water. Whilst I would love to tackle both topics that would make this blog too long (& I have already blogged about hydration HERE) morning so I am going to focus solely on the uniform issue.

I have been nursing over 20 years now and the uniform has not changed. In fact I have a picture of me as a newly qualified nurse at the Bristol Royal Infirmary and the uniform I am wearing is still the uniform at the beloved BRI.

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I literally can hear some of you saying but they look smart, we love buckles and belts … and what about the hats and capes … those uniforms made us look like proper nurses! Well I am not so sure ….In the words of Professor June Girvin “We should beware of misplaced nostalgia.  As George Ball said, and we would do well to remember, ‘Nostalgia is a seductive liar’.  I wouldn’t go back there for anything.” (Nostalgia 2018)

So lets look at this through a different lens instead of rose tinted spectacles:

Hospitals, care homes, clinics and even peoples homes are hot places .. even in the winter! A uniform that is made out of tent canvass (the type of uniform you have to wash a million times before it relaxes enough not to chaffe and that can stand up on it’s own) is going to make us sweat, which is not only unpleasant for the people we care for, who we are often in close quarters with,  but also excessive sweating can contribute to dehydration … which lets face it (I am pulling no punches here) is a patient safety issue. Then there’s the whole dress issue – I have to say I have lost count of the about of times a patients hand has gone under my dress, leading to embarrassment for me and (if unintentional) embarrassment for the person I am caring for.  Not to mention the whole belt and buckle thing … have you tried moving about when restricted by one of those belts? Surely that is not conducive to our own health and safety? My belt and buckle are safely tucked away in a drawer and that is where they are staying !

Why do uniform traditions and legacies still persist in nursing? Lets look at policing and the uniform change over the last 50 years:

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Or the fire service:

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Or girl guiding:

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Or Sainsburys’s:

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I have a small confession to make now …. I confess to having started a small uniform revolution where I do some bank shifts from time to time.  The uniform is made from the aforementioned tent canvass and has a high collar and a popper down front (don’t even get me started on poppers and nursing uniforms!) … it’s hot, even in winter, it’s impractical, I can’t breathe or move in it … so I hopped onto the internet and bought a uniform of the same colour … a smart, light weight scrub top. The top allows me to move freely, not sweat and is comfy and up to the tough job of nursing … I love it.  At first I thought no one had noticed that I was technically was in the incorrect uniform and then a few weeks ago (when the hot weather started) people started asking me where I got it from … so I told them.  I have to admit to smiling a little when I last went into work and heard that the uniform was being changed to the exact top I have been wearing.  Of course I do not recommend this approach for everyone, there is a time and a place to the “seek forgiveness not ask permission” approach – I am very fortunate to have a understanding and flexible employer … however if you feel your uniform isn’t up to the job then I urge you to say something and start your own revolution.

Although the title of this blog could be construed as provocative I have to say with confidence that I stand by it … nurses uniforms are stupid.  So lets stop the nostalgia and get to grips with uniforms that are fit for modern nursing and allow us to do our jobs.

Inches and miles

I have sat down several times over the past week to write a blog post and each time written a paragraph and then given up … it’s not that I don’t have anything to say, but rather that I have too much to say ! Last week was a incredibly busy week for me, with the opportunity to talk about #70nursebloggers and #70midwifebloggers at an #NHS70 event, being on the Victoria Derbyshire show (brief appearance but there’s something about TV that is always exciting) ongoing work with the fab team at Plymouth University, plans for the We Active Challenge (go #nursesactive!) and a brilliant morning spent at Barts Health NHS Trust talking about nursing and social media and being nominated as one of the 70 most influential nurses between 1948 & 2018. Then there’s the news – Jane Cummings is stepping down as CNO, Jackie Smith is stepping down as Chief Exec of the NMC and Matt Hancock is the Secretary of State for health.  Then on a more personal note my son has broken his wrist, my daughter is just about to leave primary school and my dog has a sore paw and is on antibiotics and analgesia ….. my brain feels a little overwhelmed !!

And breathe !!

Breathe

Here’s whats on my mind currently (each point a blog in it’s own right!)

  • Times are changing – for the better or for the worse I do not know, but whats probably most important is that we all keep striving to move forward
  • Being on TV in a bit scary – not sure how people do it all the time
  • How do we get more nurses blogging and sharing their wonderful work?
  • I’m not sure I am influential and feel like a bit of an interloper – what I do is connect and bring people together rather than influence.
  • The team at Southmead Hospital in Bristol are fab, my son is getting excellent care
  • 3 trips to London and 6 train journeys in the hot weather is not pleasant – kudos to those who have long journeys to work every day
  • Can’t wait for August and We Active Challenge – how can I inspire more nurse to join this year and how can we beat the AHP’s
  • Who is Matt Hancock? Does he have any healthcare background? Does he really not need any healthcare experience?
  • I love being with a group of nurses and getting them excited about the potential of social media
  • How do I get my dog to eat the rather large antibiotic tablets? Cheese??
  • I am going to have to be super organised to make it to all of the end of term things: Leavers School Production, Leavers Assembly, Leavers Disco ….the list goes on!
  • How will Jane Cummings and Jackie Smith’s departures affect nursing?
  • How will Matt Hancock affect healthcare?

With all of that down on paper, out in the open, shared with the world I am left wondering why? Why share this blog post? What is my key point? Well perhaps my first point hits the nail on the head … times are changing, in fact they are always changing, and we have to keep momentum going forward …. I am reminded of this picture about success:

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Things … life even … may be complex and convoluted and seem like a large scribble on a piece of paper but lets not loose sight of the general direction in which we are all moving.  Celebrate the success of moving just one inch towards a common goal … which leaves me still concerned about the plethora of things invading my thoughts but recognising and celebrating how the past week has also seen some inches for miles.

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Hot, hot, hot !!

Wow it’s been hot lately ! Temperatures have reached 30c quite a few times in the last 10 days or so and I have found myself worrying:

My first thoughts were for our children – Did they have sunscreen? A hat? Water bottles for school? Were they cool enough (in the cold sense not the “hey dude” sense!)? Were they drinking enough?

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My thoughts then turned to our dog – Was it ok to take him out? Should I just do very early and very late walks?  Is his water bowl full?  Is the kitchen too hot if I pop out for an hour? Is the tarmac to hot for his paws?

And then this morning I was on an early shift and I thought about the people I care for – Are they getting enough fluids? What about that lady on the high dose of furosemide?  What about the gentleman who is susceptible to UTI’s?  Is that lady confused because she’s dehydrated? Does that lady have a wide brimmed hat to go outside in? How can we cool bedrooms down? Do we have enough ice lollies for people today? How can we encourage everyone to drink more?

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Eventually, this evening, whilst walking the dog (in the shady woodland) my thoughts turned to me – Was that headache I took paracetamol for at break time a dehydration headache?

I am pretty sure that I am not unusual in the sense that I worry about others, put the people I care for, the children and even the dog before my own needs …. it seems to be something we do in nursing… however perhaps we need to think again:

The National Hydration Council (yes there is such a thing!) state the facts in simple terms:

  • The recommended daily intake of fluids for men should be 2.5 litres and for women 2 litres
  • When performing physical work,sweat output often exceeds water intake, producing a body water deficit or dehydration
  • Dehydration can adversely affect worker productivity, safety, and morale.

There is also evidence that is specific to healthcare workers: Hydration amongst doctors and nurses on call (El-Shakawry 2016) is a study that looked at the scale and impact of dehydration on doctors and nurses.  The study found  ”Thirty-six percent of participants were dehydrated at the start of the shift and 45% were dehydrated at the end of their shift” and “Single number and five-letter Sternberg short-term memory tests were significantly impaired in dehydrated participants”

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So what does all this mean in practical terms for us as nurses …. it means we should look after ourselves better! A melting nurse, who is hot, sweaty and dehydrated is of no use to the people we care for, their children or even the dog !

The moral of this tale (yes I will put this in shouty capitals!) ….. NURSES LOOK AFTER YOURSELVES IN THIS HOT WEATHER !!

Running towards danger

I have always been a cautious person, I like to think about things, look before I leap and often not leap at all! In fact at a recent family trip to one of those tree top adventure courses I was the one who opted out of the Tarzan swing and went the long, but safer, way around.  I also recall when my children were young we took a trip to The Needles which involved a rather steep ski lift descent during which my son said to me “mummy can you stop squeezing me now” … it seemed I was being overly cautious about the risk of him falling out of the seat! My caution has often been the source of amusement in our family, I don’t mind as I quite like being the cautious one (it’s a mum thing) but last night I was watching TV and I came across “Ambulance” and it caused me to reflect on caution.

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For those of you who have not seen it “Ambulance” is one of those fly on the wall documentaries where a camera crew follow a day (or night as the case was last night) in the life of interesting people.  “Ambulance” follows the working lives of some of the crew of West Midlands Ambulance Service.  In this particular episode multiple crews got a call to say there had been a major incident and 3 people were already dead … there was some initial speculation over the incident at first and the word “bomb” was used.  Nevertheless the ambulance crews put on their blue lights and drove to the scene.  I was so in awe of the courage shown by the crews – they had no idea what they were heading into, they were literally running towards danger to help those in need.  As it turned out it was a devastating traffic collision with multiple fatalities – but regardless the crews earned my utmost respect.

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This got me thinking about my own actions, particularly within my nursing career … do I ever run towards danger? Would I? The closest I have ever come to “danger” was when I was student nurse back in the 1990’s and I was out with some friends, it was 2am and we had just left a night club when a young chap was stabbed and I immediately ran to assist him.  I administered first aid and waited with him until the ambulance and police arrived.  I can only describe it as an automatic response – someone needed help and I knew how to help, so it stood to reason that I should step forward.

But perhaps it’s not just danger that we run towards as nurses? Perhaps we also run towards adversity? I think that maybe this is more common – when the emergency buzzer goes off at work don’t we all run? We never know what we are running towards but we are aware of the simple fact that it’s an adverse situation … and yet here we all are, throwing caution to the wind and running hell for leather towards it … so that we can use our expertise to help someone in need.

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I remain in awe at the courage of the crews in “Ambulance” and I also remain cautious. I will always be the person who takes the photo of my family upside down on an amusement park ride but at the same time I know that I too will run towards danger and adversity if someone is in need – it’s who I am…. I am a nurse!

Inspire and be inspired

The last few weeks have flown by in a flurry of tweets and blogs it seems – ever since we first launched #70nursebloggers and #70midwifebloggers I have found myself attached to my computer … in a good way!

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The idea behind #70nursebloggers and #70midwiifebloggers is simple … inspire 70 nurses and 70 midwives to get blogging (you can read more about it HERE) I don’t know what I expected when we (by we I mean me and Sam Sherrington with help and support form the fab people at NHS England) thought about bringing what was essentially an idea from a tweetchat into reality … I guess it was the hope that we would get somewhere close to 70 nurses and 70 midwives blogging .. and yes we are getting there as we now have 39 nurse bloggers and 18 midwife bloggers ! Which is amazing in such a short space of time.  What iI didn’t expect, and what hit me right between the eyes, was how overwhelmingly inspired I have been by the blogs.

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As the person who is collating the Twitter lists, responding to the tweets and collating the Twitter moments I have felt honour bound to read each and every blog post …. but this has not been arduous … far from it in fact! What has astounded me is the breath of the nurses and midwives who have put pen to paper, we have had people from the UK, the USA and Nigeria take part, and they have come from all walks of nursing and midwifery.  There have been blogs that have informed me, blogs that have shared projects, blogs that have shared a single day or a single thought, blogs that have made me laugh and blogs that have made me cry.  The one thing that all of the blogs have had in common is the ability to energise and encourage me in a way that only nurses and midwives can.

The single most important reason as why I find so much value in blogging and tweeting is the people you meet – it’s such a fantastic way in which to surround yourself with the very best of nursing and midwifery!

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Please don’t just take my word for it … have a read of the blogs .. i promise you won’t regret it .. you will be inspired! Here they are:

#70nursebloggers…. blogs so far 

#70midwifebloggers…blogs so far

And if you are yet to write your blog post then why not take the first step and be inspired to inspire others.

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Blogging, nursing and lots of bicycle analogies!

Whilst helping a nurse friend to get blogging this week I noticed that my first blog post on this website was 5 years ago … although I had an anonymous blog before this one .. this blog marked my decision to be me in social media.  Back then I both tweeted and blogged under “Agency Nurse” I didn’t use my name, not because I was doing anything wrong but because I wasn’t very confident in social media and being a nurse in this space …perhaps not revealing my real name was akin to having stabilisers on your first bicycle, it gave me confidence and helped me to practice getting my voice just right.

bicycle-14863_640Back then things were very different, there were next to no blogging nurses, hardly any tweeting nurses and no NMC Social Media Guidance.  Blogging as a nurse was not really a “thing.” I recall, when i first set up my blog, reading through my copy of the NMC Code and checking off each point to make sure that I wasn’t compromising myself as a nurse by blogging … I was nervous as there was no one for me to copy or emulate, no one to show me the way, but, nevertheless I took a deep breath and published my first post.

I was really not sure what to expect – perhaps I hoped, (

to carry on with the cycling theme that I seem to have started,) to be an instant “Tour de France” type hit, find lots of other bloggers, for blogging to be taken up by every nurse that ever nursed and for blogging to be the best thing since sliced bread (or a red bicycle) for nursing.

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Of course the reality was more like this:

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It felt like I was on a journey all by myself … and it felt like that for a long time!

At this point you may be wondering why I kept going …. well mostly for me.  Quite early on i found that I liked blogging.  It helped me to reflect, to organise thoughts, to develop ideas and to challenge thinking.  But mostly it has been about moving forward and pushing the boundaries and by being determined, by working to raise the profile of how social media can help nurses and nursing I hope that this ultimately helps nursing to keep it’s balance … cue next bicycle analogy:

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Slowly I found more nurse bloggers, slowly I found that more people read my blogs (maybe it was because I got a little better) slowly I found that people began to comment and quote my blogs and slowly I felt that we started to move forward.

Blogging can do so much for nurses and nursing….. but in the main it can give us a voice, and we can use that voice to share ideas, experiences, research, thoughts, reflections, resources and so much more.  This in turn, due to the global nature of social media, makes who we are and what we do more visible …. and thats got to be a good thing.

So my stabilisers are definitely off, I’ve been blogging as me (and not anonymously) for quite sometime now and have clearly found myself helping other nurses to find the value in blogging.  Today see’s the launch of #70nursebloggers and #70midwifebloggers, backed by CNO Jane Cummings, this initiative blossomed from a tweet by Sam Sherrington where she suggested that we could encourage more nurses and midwives to get blogging by challenging 70 nurses and midwives to blog for the NHS’s 70th Birthday celebrations.  Read more about it HERE …. but this is my blog …. encouraging you …. yes YOU to get blogging.  You may need some stabilisers, it may not be quite the Tour de France to start with … but keep moving forward and you will find value in blogging.

As for me I am thinking it may be time for one of these:

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(Mostly because I kinda gotta keep going with the whole bike thing now, right up to the bitter end of this blog post … for which, dear reader, I humbly apologise!)

And as for the friend I was helping (way back at the start of this blog and before the bicycle stuff got in the way) you can read her first blog HERE

 

 

The positive side of leaving digital footprints

Being a nurse who advocates social media I often come across doubters – those people who say that nurses shouldn’t use social media on a professional basis as it will damage their reputation and that of their organisation, those who doubt that social media can do good and those who firmly believe that as nurses we should NEVER set foot in social media spaces (usually what these people say is accompanied with undertones of consequences of biblical proportions!) These social media doubters used to be many in number but over the years I have seen a decrease in their numbers … however they do seem to becoming more adamant! I listen politely and then point out the converse view, that perhaps by NOT engaging in social media we are damaging our reputations and the reputations of their organisations…. What would happen if you Googled an organisation and found nothing??? A bit weird huh? And I think that we are fast approaching a time when if we Google an individual and find nothing this will also ring some alarm bells.

It’s 2018 not 1918 … our lives are becoming increasingly integrated with our digital spaces, and everywhere we go on the old world wide web we leave a digital footprint … and this is quite often seen as a bad thing, something we should be cautious of, something we need be mindful of and perhaps even strive to eradicate. I have often shared the video below about Digital Footprints … it’s a bit dramatic and really does make you think … but it’s a bit one sided in that it explains the doom and gloom and not the bright side.

Whilst I agree to a certain extent that we should be mindful of the footprints we leave in digital spaces I wonder if perhaps we are missing a trick.  I think that we often forget that our digital footprints are in our control – they are not something that happens to us … we can craft and nurture our footprints and make them look how we want them too.  By engaging professionally in social media spaces we can use it to help us build networks, professionally develop and advance our careers as nurses.

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The first step is to see yourself how the world sees you … Google yourself! Do you like what you see? Is there anything to see? If you want to change what you see … you can ! It’s up to you.  Simple things like:

  • Use your real name in social media accounts – yes, this is contrary to what we teach our children but this is about people seeing you and creating a positive digital footprint
  • Including professional looking photos as your avatars – again contrary to what we tell our children to do but remember that this is a professional space
  • Using multiple social media – for example using Twitter and writing a blog or setting up a Facebook group and a YouTube Channel
  • Use evidence and research in your social media spaces – don’t leave evidence at the door just because it’s social media
  • Be an active participant in your online networks – jump in, join in, ask questions, talk to your peers
  • Create content – write blogs, make videos, create inforgraphics etc
  • Share the part of you that you want the world to see – remember you are in control of this
  • Feel free to question, disagree and challenge in a constructive and respectful way – it is possible to disagree and still remain professional
  • Know the NMC social media guidance and adhere to it and advocate professionalism online – be an active role model

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As nurses we do need to be cautious but we also need to be courageous, taking positive steps and crafting our digital footprints can be both empowering and advantageous for individuals, organisations and nursing.

 

 

Evidence based tea

This blog has been rattling around in my head for a few weeks now, mainly because I wanted to find the right words to share my thinking.  Sometimes I feel that we have to be careful with our words so that we don’t get misinterpreted .. I hope that I have chosen the right words and I am sure that my caution will become clear as your read on.

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A little while ago whilst working a clinical shift I seemed to be inundated with tea.  Yes, you heard me right … tea! I made cup, after cup, after cup of tea.  I got many comments from the people I care for along the lines of “oh i don’t want to bother you” and “you are too busy to make tea” After my shift had ended I reflected on my tea making and these are some of the conclusions I came to:

To the lady with dementia who swore she hadn’t had a cup of tea all day – I saw that you were more confused than usual and I was concerned that you may be in the early stages of a urinary infection, so wanted to increase your fluid intake (The British Association of Urological Surgeons 2017)

To the man who was married to the lady with dementia – I made you a cup of tea because I felt that as eating and drinking are very social things your wife would be more likely to drink her tea if you joined her for a cup (Alzheimers Society 2017)

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To the lady who really hates the taste of the medicine she has to take – I made you a cup of tea because it’s your favourite drink and I know that the taste of the medicine is easier to bear with a cup of tea ready and waiting. (no reference here, just the evidence of knowing the people i care for)

To the lady who was upset that day because it was just a bad day – I made you a cup of tea as that’s what you needed at that time. (The Telegraph 2019 – apologies I can’t find the original study here)

To the lady with dementia who was starting to get agitated because she often does in the evening – I made you a cup of tea and found you an interesting book to look through so you could focus on something positive. (Alzheimers Society 2017)

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To all the staff who I made a cup of tea for – I know that you were all on a long day and it had been a busy morning before I arrived and I wanted to make sure that you were hydrated as if you were dehydrated this can affect the safety of the people you are caring for. (Natural Hydration Council 2017) I also know that happy staff make for happy patients (Kings Fund 2012)

To all of these people – I know the importance of a cup of tea and the impact that it can have (Care Opinion Search)

So why did it take me so long to write this blog and why was I worried about finding the right words … well I didn’t spend my shift making tea because it was the nice thing to do, or because I am kind, or because I am an “Angel”  I made tea because I spent 3 years training to be a nurse and 20 years nursing and I know that in each and every one of these interventions tea mattered.  Some days I when nursing I spend my time figuring out why wounds aren’t healing, caring for people who are at the end of their lives who need complex care and support, managing peoples pain, liaising with other health care professionals, training and supervising staff, supporting people who suddenly become very unwell and much, much, much more …. and on each and every one of those days I apply the same thinking as I did to my “tea day”

Whilst I wanted to stress the importance of a simple cup of tea I also did not want to trivialise the profession that I belong to … nursing is complex and we need people to understand that behind each and every intervention there is an evidence base … even tea!

I made tea that day because it was important, on multiple levels, at that time, and for those people. I don’t make tea because of some perceived hand maiden role in nursing  or because I am not highly skilled and highly trained.  I’m not ever too busy to make a cup of tea for someone who needs it and it’s never a bother to be asked. Some days tea is important, some days it’s not.  I apply thinking and reasoning to my actions and deduce that sometimes tea is needed and is important … it’s evidence based tea and it can mean the world to someone.

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Strategy AND Policy

I have been thinking a bit lately about social media and what we need to move social media forward in nursing.  Even after 7 years of being a Tweeting and Blogging nurse I still hear stories of social media being shot down, of employers and universities emphatically urging nurses and student nurses to steer clear of any social media; I still hear people poo-hooing social media and saying “it’s a fad”; and I still get incredulous looks when I put the idea on the table that social media has a role to play in our professional lives.  So lets clear this up here and now … social media is here to stay.  Take a look at the timeline below …

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… and just take a moment to reflect on the fact that social media has been around for quite sometime now …..

….. yep !

Social media is not going away! Isn’t it about time we realised that ? Social media is no longer new! Isn’t it about time we realised that? Social media plays a huge part in modern life and can be of huge benefit to nursing! It’s definitely time we realised that!

It’s time to think about social media and how we can use it moving forward in nursing and although many healthcare settings have a social media policy (which don’t get me wrong is a fab thing) how many healthcare settings have a social media strategy? How many of us are looking forward and strategically thinking about how we want to shape nursing and how social media can help, support and drive that ?

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I think that we need not only social media policies but also social media strategies and the two, even though at first glance seen to work in opposition, will help to create a balance that can drive forward the brilliant professional tool that social media can be.

Social media is not new, it’s firmly established .. so lets start setting guidelines and setting goals … and then I believe that nursing can really start to unlock the potential that social media has to be a productive item in our professional toolkits.

Not Mrs Smith!

When I was a student nurse someone told me a story that went something like this:

One day Mrs Jones went into hospital for a minor operation. Before the operation the consultant came to the ward to see Mrs Jones and said “Hello Mrs Smith I am your consultant Mr Brown” Mrs Jones, quite rightly corrected Mr Brown and replied “My name is Mrs Jones not Mrs Smith” to which Mr Brown responded “Hold on let me just check my notes …. ahh yes, you are correct!” 

I am sure that you have all heard similar versions of this story throughout your careers – the point of the tale being that the health care professional is not always correct and when we are incorrect we really need to own up to it and apologise. After all, did the consultant really need to check his notes to see that Mrs Jones was correct about her own name!  I was told this story some 20 years ago now, yet to this day I still come across versions of this story in my practice.

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I was recently nursing a lady who challenged a nurse who was misinformed – it took great courage for the lady to do so, yet she was dismissed by the nurse.  It then took an enormous amount of faith and bravery for her then to raise the issue with me.  I sat and I listened and I checked she was ok.  I took her seriously and reassured her that it was right for her to be concerned.  I then explained what I needed to do next and why and I kept checking back with her to update her on where I was.  Before I went home that day the lady took me to one side and thanked me for taking the time to care.  I was a little overwhelmed by her thanks as I really felt that it was just what should have happened to start with and I in fact felt sorry that this hadn’t been the case.

Over the last week I have been reflecting on this event and how we as health care professionals are in a position of power.  We hold a great deal of knowledge but even with all the knowledge we possess we do not know the people we care for as well as they themselves do.  It’s important to understand this, to listen and respect the people we care for … and when we get it wrong, as Mr Brown did with Mrs Jones, and are corrected we need to admit that we are wrong.

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I am sure that when we all first heard the story of Mr Brown and Mrs Jones we laughed at the absurdity of it.  Yet not giving the people we care for credit for knowing how they need to be cared for and knowing information about themselves, their care and what matters to them still continues.

I have often heard that nursing is an art and science and i think this is true. Nursing is a science because throughout our careers we gain lots of knowledge, information. and experience and this helps us to be the very best nurses we can be … but nursing is also an art and the art of nursing is listening to and gleaning knowledge from each individual person and encouraging them to lead their care.  The art is also in believing that the people we care for know what is best for them …..and they know better than what we think may be best.

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