Two conversations caught my eye on Twitter last night, both seemed to get a lot of air time.  The first conversation was sparked by this tweet from @DebsCooper131:

The tweet got many responses and a good deal of interaction with lots of people tweeting about finding and loosing pens.  It was a good fun sort of thread.

The second tweet and ensuing conversation that captured my interest was sparked by this Tweet from @captaintau:

There were lots of answers to this tweet and subsequent conversation, and I have to admit that some of the comments surprised me a little.

The two tweets got me thinking as both mention tools that we can use in nursing, the humble pen – been around for eons, everybody has one in their pocket (or even three if you are super organised) its a pretty useful communication device and no one questions its use in nursing; then we have the smartphone – its been around for a bit, it fits in your pocket, its a really useful communication device and yet we seem to question it’s use ! The two devices, pen and smartphone both seem quite useful to me however the two Twitter conversations could not have been more diverse.

The conversation around the pen was light hearted and fun but the conversation about the smartphone could not have been more intense.  I mentioned above that I was surprised by some of the tweets … and I was.  Some people were adamant that it is unprofessional to use a smartphone as a nurse, that it was too “tempting” for nurses to have smartphones in their pockets and why would they need a smartphone anyway ?!!

Can I just say this here and now …. GOOD GRIEF !!!

Firstly a device or a tool no matter how technological can never be unprofessional, ( I am currently rolling my eyes) it’s the inappropriate use of such things that is unprofessional.  A smartphone is a pocket sized communication tool that gives us a world of knowledge and expertise in the palm of our hand ….. why on earth would we not use that?  I would actually argue that not to have one is unprofessional. As for nurses being “tempted” if they have access to a smartphone whilst on duty (again I roll my eyes) I challenge any nurse to find the time to be tempted !! I know that when I do clinical work I really don’t have time to think about anything but the people I am caring for.

What worries me more about both of these conversations is that our willingness to accept that a nurse needs a pen and that it is a valid nursing tool for 2017 (I rarely use a pen in my personal life, yet at work could not get through a second of clinical practice without one) yet our complete inability to accept that a smartphone is not a valid nursing tool (rolls eyes for third time)

There is so much that the smartphone has to offer nursing – access to information, access to expertise, bedside recording, access to records when and where we need it, access to apps, access to the internet, portable communication and all in your pocket.  The pen … well that just writes, and maybe stirs your coffee from time to time.  I was in a restaurant the other day and the waitress got out a smartphone to take my order, I didnt think it was unprofessional of her … I thought “wow, how fab is that?” Go into any Apple store and the sales assistants all use smartphones to help you make a purchase .. are they unprofessional? Does anyone question them? No ! So lets get over this …. smartphones are a smart way to work not an unprofessional way to work.

I was glad to see that Ann-Marie Riley (@AnnMarieRiley10) from Nottingham University Hospitals tweeted and shared her experience, as I know that they are really embracing the use of smartphones for nurses at Nottingham:

I think Ann-Marie has hit the nail firmly on the head – why wouldn’t we use technology? It’s definitely the smart thing to do – we don’t need to work harder as nurses, we need to work smarter, we need to embrace the technology, we need to stop being fearful.  We are are the people who make ourselves look professional, technology is merely a tool and it cant take away our professionalism.

Finally Matt Ballantine (@ballentine70) brought my thinking full circle when he tweeted:

It’s not the tools, it’s how we use them …… so lets get smart !

I have had a few conversations lately both on and offline around continuing professional development (CPD)  in nursing, I guess its only natural as more and more of us are revalidating CPD is very much on our minds.  However with austerity still very much the order of the day it worries me that many nurses still remain very fixed in their idea of CPD. I had a conversation with a nurse a little while back who was absolutely adamant that CPD only counted if it took place in a classroom, he was utterly convinced that this was the case until I showed him what the NMC (2017) say about CPD:

Why was he so fixed in his idea of CPD? I guess historically CPD is something that has always “happened” to us as nurses.  I recall as a newly qualified nurse we had training sessions on the ward I worked, where people came in to teach us about different areas or skills, we were also sent on training courses regularly and CPD was something that came to us from our employer.  Most of the CPD I did was passively sat in a classroom like environment, being talked at – CPD wasn’t something I had to actively do.  So perhaps this has something to do with the reason why so many of us are so fixed in our view of what counts as CPD in nursing?

I have three problems with this idea of CPD:

Firstly – I am not so sure that sitting passively and being talked at in a classroom is really the best way to learn and develop.  I know that it’s certainly not the case with me – I need to actively discuss things, have the scope to read or find out more, explore ideas, try things out and actually “do” instead of just sit and take notes.  A few years ago I came across this on Twitter:

(Source: http://www.une.edu/studentlife/biddeford/las-1 )

I’m not sure if it’s steeped in any good quality evidence or research but it makes sense to me. I certainly know that passive learning is not for me, conversation, discussion, doing and showing seem to work much better. 

Secondly – There is no money… austerity reigns and classroom based CPD is expensive. Theres the cost of the venue, the speaker(s), the cost of lost work hours and also the cost of travel and expenses.  There has to be a smarter way that gathering people together at a venue … in fact we know there is, we just need to start using them.

Thirdly – We should take control of what we learn.  As a practicing nurse I have interests in social media, elderly care and dementia … learning IVI’s, TPA , BAL, HFEA or some other acronym is not really where i want to take my learning.  I was my CPD to be based around my needs.  I want to dictate when i do it, how I do it and what its on … its my learning after all.

How do we move with the times? How do we change our mindset regarding CPD – perhaps the answer is in developing . social mindset.  I really like this sketchnote by @tnvora that explores social mindset, in particular the social learning element:

Social learning is about taking our traditional idea of learning and giving it a good shake.  I love the term “working out loud” and I think that the potential to apply this is nursing is huge.  learning together, developing communities of practice and creating an ecosystem of learning when and where we want it is, in my opinion, a very attractive proposition.

Isn’t it time that we took hold of CPD and turned it on its head? Isn’t it time we took responsibility for it? Isn’t it time we took control of it?  Isn’t it time to stop being passive about our learning as nurses? I think that social learning is the way forward – it’s time to step out of the classroom and into individualised lifelong social learning.

I quite often listen to Radio 2 as I go about my day to day life, it’s on in the car, the kitchen and even the office, I like the mix of music and chat … this week Chris Evans was discussing some rather interesting stuff that really resonated with me.  The section was all about worry and stress and whilst I mostly don’t get too stressed I am a worrier so the conversation was one that I stopped and listened to. Chris and the person he was chatting to (apologies I didn’t catch his name) were talking about how we can cope with stress and worry and the phrase “put your own oxygen mask on before helping others” This was something that I had not heard in this context before and it certainly made me wonder … do we do this in nursing?

Entirely by coincidence last week I ran a series of Twitter Polls through WeNurses asking nurses if they had taken their break that day.  I ran it for 3 days … and here are the results:

Whilst the polls themselves reveal some concerning results the comments made in reply to the polls were perhaps the most interesting part:

I’ve never missed a break as a student but I’ve seen lots of nurses miss theirs. Not sure how they can think straight after 12 solid hours!

— katie (@katiel0uise) July 11, 2017

I’m newly qualified. I’ve often gone without a break .. I only do short shifts so not as bad ..

— Sarah Kylie Manning (@RivieraJamming) July 11, 2017

I took 1 half hour break but didn’t get my 2nd break. Made sure my water bottle was at the desk though to stay hydrated

— ✨Debs Cooper✨ (@debscooper131) July 11, 2017

Yes, but staff room was full so ended up eating at my desk…and doing emails!

— Joanne Swidenbank (@jo_swidenbank) July 11, 2017

Not taking a break means that we don’t get to rest, eat or drink.   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” This doesn’t even take into account hunger or tiredness … and what about the long term effects on mental health and wellbeing and morale? Not taking a break is a serious problem in nursing and you might argue one that affects the care we deliver, yet from the comments not having a break seems so … well … normal … and .. acceptable!

I wonder if we were to view our breaks as oxygen masks would we think differently about the importance of them? I am not being flippant here, I honestly think that we need to take this approach.  We have to take care of ourselves before we can take care of others – how can we make important care decisions if we are have not rested, eaten or drunk throughout the course of our shift?

At this point I feel I must confess that I have often been on a clinical shift where I have not taken a break and recently I have been reflecting of why this has happened.  Sometimes the shift has been very busy and there just doesn’t seem to have been time for me to step off the floor .. so given the now established fact that breaks are akin to oxygen masks would I do this differently? Yes I think I will – no matter how busy the shift working tired, hungry and thirsty is counter productive and we need to recognise this.  If I were on a plane and attended to someone else’s oxygen mask before my own I would soon be on the floor gasping for air and we would both be in trouble ! By taking a break this means I can return to my work refreshed and able to care more effectively.

Although taking breaks whilst on duty takes a change in individual mindset I also think that we have to support colleagues to take breaks to … ask them if they have had a break, do that urgent thing for them whilst they go off the floor, reassure them that you will care for that really unwell person and tell them that in order to care effectively they must take care of themselves.  We also need to address organisational culture – is it normal in your work environment that people take breaks? How can we make this a good thing to do? How can we check that people have had a break? How can we support people to take breaks?

The choice is simple – we can either care until we drop, leading to unwell nurses and poor care … or we can take a break and breathe in the oxygen that enables us to provide the very best of care.

It’s not long now until I have to revalidate for the first time and I am trying to be super organised.  As my revalidation date is at the start of September I thought it best to get everything sorted this side of the summer.  I have always been an overly organised person – when we go on a long dog walk I’m the person who takes bite cream and plasters just in case! My revalidation is no exception – I have lost count of the amount of times I have logged on to the NMCs revalidation website - to the extent that I apologise to the NMC as its me who is bumping up your visitor figures, which are sure to drop post September!

I now have my portfolio ready.  I opted for a paper version in the end – I can hear you all saying “what?” – however I tried digital but felt that I needed to really see, touch and visualise my portfolio.  I think that this has something to do with the way I learn, I need to use as many senses as possible and my revalidation is no exception.

I have divided the portfolio into colour-coded sections that correspond to each revalidation requirement. I have my feedback and have completed my reflections.  And this week I had my reflective discussion.

I have an unusual role being a self-employed nurse working in social media so I was a little worried about my reflective discussion.  I approached a fellow nurse, Wendy,  who tweets who I respect and who’s opinion I value and she kindly agreed to help.  We live quite far apart from each other so we decided to use Skype.  I emailed her my reflections so that she could read them before hand and we both sat down with a cup of tea and Skyped.

Having never experienced a reflective discussion before I’m not sure that I knew what to expect.  I was worried about being put “on the spot” or having to answer tricky questions but it wasn’t like that at all.  Wendy made me feel at ease, she used phrases like “I was really interested to read……” and she related my reflections to her own work and experiences.  We found that there were similarities in situations we had come across, particularly one challenging situation that I had reflected on,  but we had dealt with them differently.  We were able to look at why that was and how we would perhaps deal with similar experiences in the future.  We chatted for almost an hour – and stayed on topic ! I can’t thank Wendy enough for making the reflective discussion a positive and worthwhile experience.

The whole discussion has left me reflecting …. Did the reflective discussion help me to become a better nurse? I think perhaps it has …. It gave me time to stop, articulate thoughts, share experiences and understand the reasons for my actions.  It helped me to reason why I felt the way I did about some things and in turn I feel that this will help me in the future in applying learning and learning from experiences and feedback. I think that it has also given me a bit more confidence, people often say that a problem shared is a problem halved perhaps this is true for reflecting on challenging situations. There is a part of you, when faced with a challenging situation, that thinks “is it me?” By reflecting and discussing it can help with that feeling of being the only person to have experienced this and give confidence to act as needed in the future when faced with similar situations.

I hope that if ever I am asked to have a reflective discussion with someone I can do it to the same excellent standard as Wendy did for me, I certainly have a great role model to follow.

At the end of the discussion Wendy asked if I had someone to act as confirmer – I sheepishly said that I hoped that she would consider doing it and again she kindly agreed.  However my hefty, well organised portfolio is somewhat of a challenge in itself – so we decided this was a great excuse to meet up and catch up in person …… I will be hiring a trailer for my portfolio ;D