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.

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)

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)

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.

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.

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.

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.

I think that’s it’s time to open up the debate on the term resilience – I have a problem with resilience, I know its en-vogue currently for nurses to be resilient, and in theory I get why, but in reality I am not so sure.

How about we start this with a definition …. The internet says resilience is:

I think this is where my problem with resilience starts – recovering quickly, bouncing back and toughness are concepts I find hard to reconcile as a nurse.  Here’s the rub .. I don’t think that I am resilient.  When things upset me I often take them to heart, I can find it hard to recover quickly and spring back and I am not sure that I need to.  I feel what I need are good support networks and self-care so that I can reflect and grow from experiences.  When something adverse happens, I don’t want to be resilient, I want to be human, but I want someone to ask me if I am OK … in the same way that I would ask them.

I recall a particularly tough day whilst working as a care home manager a good few years ago now.  I felt really ill, I had a really bad head cold, I had been in work since 5 am, I was dealing with a number of incidents and short staffing.  I had a phone conversation with my manager during which I asked if it was ok if I left early as I wasn’t feeling 100% and had been at work since very early … she told me I had to be more resilient.  I got off the phone and sat and cried.  Whilst I was crying at my desk another of my managers walked in – he asked, “are you ok?” Of course, I wasn’t but he sat and listened. We brainstormed a few things to help with the staffing and the incidents and he told me to go home and rest.  The first manager epitomised everything I hate about the term resilience and the second show cased everything that is right about supporting one another.

Having had a few discussions on Twitter about resilience I can understand that it’s not the term itself but perhaps how we apply it.  With this in mind it is only fair to look at resilience in the context of health (and not just an internet, black and white – definition) Murray (2014) states:

“Resilience can be defined as ‘the ability of an individual to cope with and adapt positively to adverse circumstances’. Resilience has been identified as comprising a serious of personality traits such as optimism, self-efficacy and hardiness which enable an individual to cope with increased adversity. Increasingly, resilience is viewed as the combination of internal and external factors, a dynamic process which develops over time and one which can be learned” 

I agree that we need this! I agree that as nurses we need to be able to cope with increased adversity and yes I love that resilience could be a combination of self-care (internal factors) and support (external factors) I do take exception to the word “hardiness” here but let’s set that aside as the definition within the context of health sounds pretty utopian to me and perhaps what we should all be aiming for. To me though this description is not resilience as I have seen it.

This leads me to think that resilience is the wrong word, I think that it does what we are trying to achieve in nursing a huge disservice.  This isn’t about toughness or bounce-back-ability this is about support and self-care. It’s about what we do to take care of ourselves and what our colleagues and organisations do to take care of us.

So what is the way forward? How do we equip the nursing profession with the skills to cope with adversity? I don’t think that anyone has or ever will become more resilient by a colleague telling them that they need to be resilient! The term resilience, when used like this, seems rather like telling the profession to “man up”! This is not healthy or productive.

I rather like what the police are doing…. Have you heard of Oscar Kilo? There is a great link here that explains all > https://oscarkilo.org.uk/about/ The Oscar Kilo website states

 “We need to get the message to our staff that “it’s ok not to be ok””

Oscar Kilo doesn’t talk about resilience it talks about health and wellbeing.  It acknowledges that policing is tough and that people are affected by the things they see and the role they have but it focusses on support, health and wellbeing.

I guess at the heart of this is that I feel that the term “resilience” is a spoiled fruit.  I can see that there are good intentions by encouraging nursing and nurses to be resilient but I don’t think that this term can be used as its synonymous with hardiness, bouncing back, being tough and manning up … and do you know what … it is ok not to be ok!  I think that we should acknowledge that nursing is tough and learn and grow form this, support ourselves and each other … ask that question to yourself and to colleagues … are you ok today?

I was looking down my Twitter stream this week when I came across a really though provoking question:

Pondering upon why the caring professionals often find it hard to ask for help when they need it themselves? #CarersNeedCaringForToo

— Ruth Sanders (@ruthalexsanders) June 22, 2015

I found it thought provoking for a good reason, and that’s because I have found it hard at times in my career to ask for help when it’s needed.  I am sure that I am not the only one and I strongly suspect that every nurse who reads this blog will have a story to tell of a time when they should have asked for help and support and did not.

 My own story starts over 10 years ago, when I was working as a care home manager.  It was a really stressful job and as a mum of two young boys back then I was also juggling work and family life too, again as many nurses. I really didn’t realise how stressed I was.  Looking back, with the clarity that hindsight affords us, I can see the signs that I was finding it hard.  There were times when I really didn’t stop all day and didn’t take a break.  There never seemed to be enough hours in the day and I would always take work home.  I started to feel very run down and often had colds – I remember having a really awful head cold one day and ringing my manager to ask if it was ok to leave early as I felt very unwell and she just said to me “well that’s not setting a very good example is it?” It wasn’t very caring, or compassionate of her and I just sat in my office and cried – luckily the owner of the care home came in and then sent me home, I must have looked awful, I certainly felt it … but nevertheless returned to work the next day.

In amongst all of this my husband and I were trying for another baby and much to our delight I became pregnant.  We were both over the moon and as the mum of two very boisterous boys I was secretly (well perhaps not so secretly!) wishing and hoping for a girl.  It was still early days and as with all my pregnancies I felt quite sick and extremely exhausted.  Nevertheless I kept working.  The home I was managing was one the company I worked for had recently taken over and it had an awful reputation, and rightly so! I had been appointed as manager as I had had some success in turning other care homes around but this home was a real challenge.  There were many issues to deal with regarding staff, inspections and most importantly ensuring the people we cared for got the quality of care they needed and deserved… all through the early stages of my pregnancy I did not stop !!

At about 18 weeks I started to feel that something wasn’t right.  I had a little bit of bleeding, nothing too much but made an appointment with my GP straight away.  My GP sent me off to have a scan …. I knew something wasn’t right, but had experienced this before with my boys so talked myself out of the worry that something was wrong, to the extent that I told my husband not to come to the scan as I was sure everything was ok.

 Everything was not ok.

Our baby had died.

 I will never forget the wonderful nurse who was scanning me, who broke the news with such compassion.  To this day I cant recall what she said to me, or what words she used, but I do remember that she said it in a phenomenally caring way. She took me to a room where I could call my husband – I can still see the white push button phone that I merely stared at for ages before I found the strength to pick it up and call him.  I really struggled to find the right words but my husband just said “I am coming” When he arrived I just cried.

Everything after that was a bit of a blur but somehow we agreed to come back in two days time to have surgery.  This seemed like the best option for me and I was glad that I had a little time left to hold onto our baby and say goodbye.  We went home just feeling numb.

The next day was the most beautiful spring day, the sky was wonderfully blue and my husband and I went out for a drive.  We drove to a local castle and didn’t even get out of the car, but just enjoyed the brightness of the day; I sat and cuddled my bump for most of the journey.

The day of the surgery came and I felt ready to say goodbye, my husband took me to the hospital and I really don’t remember much about it all until I woke up.  I woke up in lots of pain, the nurses couldn’t understand why everything was so painful but looking back I think that I felt the pain in my very soul.  The first thing I said to my husband after the surgery was “I’m not going back to work” and he simply said “I know”

Why am I telling you this story? Well, it really is about asking for help and caring for ourselves. With hindsight I know I should have asked for help, I should have cared for myself more, I should have taken time out.  So back to @ruthalexsanders question why do we find it so hard? I think there are many reasons, for me I think that caring for people who had multiple health problems made my own “stress” seem insignificant, so I felt I should just stoically carry on.  In addition to this I can see now that I had no real support network, no one to ask me “are you ok?’ or “have you had a break” I also think that there was part of me that wanted to show people I could cope and I could do this.

Of course this was over 10 years ago now and since then I have had a beautiful girl (who is now 8!) I never returned to that job but I did start to take care of myself more, develop support networks and now spend a lot of time, when on shift, checking colleagues are ok and telling them to take a break … because I know how important it is to take time to care for ourselves.

I hope that by sharing my story it will help others to reflect and understand the importance of caring for themselves. It’s so very important to take a little time out – remember care and compassion starts with us.

It feels almost like it was yesterday – my exit interview at the nursing agency I worked for – I can hardly believe that it is actually getting on for 3 years ago now, but I will never forget the words of the manager who conducted that interview.  This was the manager who would laugh and say “Twitter!” every time he passed me who told me at my exit interview that I “would never make it on my own.” I have an awful lot to thank him for, as without his words there would have been many times when I would have given up – but his words of advice translated into a challenge for me … along with the belief that I have never been on my own!

So much has happened since that day that I sometimes have to take time to just breathe.  WeNurses has become a wonderful and supportive community of nurses and has been duplicated across healthcare professions. Coming from a place where I had no support and rarely discussed anything with another nurse (except day to day patient care) connecting and supporting is something I feel very passionate about – no nurse, or healthcare professional, should ever feel that they are alone.  Through support and discussion we CAN make a difference – one conversation can make one difference to one person, which if in turn can improve the care of just one patient then it’s all worthwhile…. We should never underestimate the significance of starting a conversation that matters.

I have been overwhelmed this year by the recognition that I have received and it seems that 2015 is off to a flying start with the publication of The Queens New Years Honours List.  I feel humbled and honoured that people took the time to put my work forward.  It’s been quite a journey but I have been lucky that throughout I have never been on my own.

Since the day that I walked out of my exit interview and made, what seemed to be at the time, a huge jump off a very high cliff I have learnt so much …but one thing that sticks with me is this quote:

No one can doubt that social media was not taken seriously within healthcare 3 years ago, it was ignored, laughed at and shunned .. social media was not a serious or professional form of communication …. However things are changing and through drawing a circle and ensuring that everyone feels valued and included via open conversation we can make a difference.

Thank you #NurseCommunity, we have come so far and we have a long way to go but we wont be on our own.

I have been thinking a lot lately about the student nurse journey and becoming a newly qualified nurse, Twitter has been awash with nurses starting out, student nurses qualifying and newly qualified nurses getting their first jobs.  In addition to this #WeNurses this coming week discussing Supporting Nurses With Specific Learning Needs on Tuesday and Nurse Training: Starting Out on Thursday. AND then I read this heartfelt yet amusing blog by @KarenDawber - Letter to a Newly Qualified Nurse.  Karen writes some amazing advice to her younger self in a letter entitled Dear Me.  So i started to wonder what would i say to the newly qualified me? So Karen I am unashamedly following your fabulous lead and have written my own Dear Me letter:

Dear Me,

Can you please put down that letter from your boyfriend (after all you have read it six times already and he turns out to be really irritating anyway!) and spend a little time reading this advice from an older and wiser you.  Its now 2014 and you have been a qualified nurse for a whopping 18 years and OMG things have changed ….. your future is A- MAZ-ING.  However this letter isn’t about spoilers its about advice so here goes:

1.  Take time to breathe – make sure that no matter how busy you are or how many patients you have when things get tough take some deep breaths and re-focus.

2.  You will cry ….. lots, but thats not a bad thing as it means you care however please don’t cry alone, when you head to the linen cupboard take a friend and share your thoughts and feelings.

3.  Never stop being you – never stop being a passionate and caring nurse.  You will meet some people along the way who are .. how shall I say this … ermmmm .. not so caring …. don’t get sucked into their way of doing things and don’t be disheartened by their way of doing things.  Always be you as you nurse compassionately and thats something to be proud of.

4.  Be brave – this is a tricky one that you will struggle with throughout most of your career, but by having a little courage when it matters you can achieve some wonderful things.

5.  Believe in yourself – starting out as a newly qualified nurse is scary and a huge responsibility but have a little confidence in what you have learnt at uni.  There are many things you have yet to learn but just ask, its fine not to know everything

Well thats it ! Have a wonderful first 18 years .. you will love it

Oh and before i go – when you move to Bristol and move into your own flat remember to look up when trying to back your car out of the car park … the guy thats stood there laughing is worth getting to know.

Lots of love

Tree xx

Huge thanks to @KarenDawber for inspiring me to write my letter – it has made me realise just how far i have come and just how proud I am (and always have been) to be a nurse.

Foreword

After my first day at RCN Congress this year my initial thoughts were “funny old day” It was pretty amazing to meet so many wonderful and passionate Tweeting nurses however it felt “weird” to not to have the #nursecommunity invited in via a Twitter wall in the main hall.  I also have some mixed feelings regarding Peter Carter, who seems a very pleasant person but is not interested in Twitter.  So please bear with me, this is not my usual blog style however I wanted to write an open letter which documents why I believe nursing leaders should Tweet:

Dear Peter Carter,

Thank you very much for popping by our #RCNcongress #RCNtweetup today I was very sorry that you had to dash off but great that you stayed for a picture:

I was disappointed to hear that Twitter doesn’t interest you however also understand that sometimes it is difficult to understand and see the value in new technologies, even the telephone at its conception was hailed as “not a serious means of communication”

I thought it might be a good idea to put together some points for you to think on at your leisure (as I appreciate how busy you must be) as to why social media is fast becoming a serious means of communication and why I believe all nursing leaders should be interested in it (in no particular order as each is of equal importance) :

• Digital natives – the generation now qualifying as nurses, and indeed making their own decisions as patients, have never known a world without the World Wide Web and coming fast up behind them is a generation who will have never known a world without social media.  This is the way that people are communicating, email is becoming old fashioned and the telephones primary function is no longer to make a phone call.

• Being a nursing leader – as nurse leaders we need to communicate with people how they want to communicate, there is almost 20,000 nurses that I know of who want to communicate via Twitter …. And are!

• The voice of nursing – the RCN proudly have a strapline that they are the voice of nursing so what better place to listen to that voice than on Twitter, where not only can you listen on a micro level to each individual but through the use of data and social media listening tools can also be done on a much wider level.

• The nurse’s voice – this is the age where the individual matters and that means each and every individual. Nurses are finding their own voice via Twitter, Twitter discussions and sharing blogs and videos via Twitter, each nurse has their own voice should they so wish.

• People not organisations – Twitter is about people, it’s not about organisations, it’s about people engaging with people.  Corporate accounts are ok but people are pretty fantastic.

• Transparency and openness – in this new age of healthcare transparency and openness are king and rightly so! The transparency and openness that Twitter affords is unprecedented. This should be celebrated and embraced.

• Being a visible role model – as a nursing leader it is important to be a role model, to engage and be engaging.  Every nurse is important, every nurse adds value and it is the responsibility of nursing leaders to not only acknowledge this but also to role model this. If we don’t make time to listen to people, in any space, what message does that send out ? 

• Connecting beyond geographical locations and hierarchical boundaries – in a forum that is so open the possibilities are really endless.  The traditional hierarchies that stifled healthcare are ignored in our Twitter spaces to the benefit of healthcare, student nurses can talk to chief nursing officers and more importantly chief nursing officers can talk to student nurses.  And there are no limits to this, ideas, experiences, expertise, resources, evidence and opinions can be and are shared on a global scale.

Twitter is full of passionate, proud, caring nurses who are leading the way through the use of a technology that enables us to communicate in a way that we have never before.  I am proud to be a Tweeting nurse and sad that a nursing leader is not interested in the value.  However I also know that actually at the end of the day if you are not passionate about communicating with nurses in this way then being in this space is not for you.  I am not saying Twitter will change the world but I know that if one conversation with one nurse makes just one difference to one patient then it’s worthwhile.  The conversations, the sharing, the support, the exchange of ideas, experiences, practice based evidence, and opinion’s via Twitter will go on with or without you … if you want to listen you know where we are and you are always most welcome

Kindest Regards

Teresa Chinn

RN and Proud Tweeting Nurse

Thanks for bearing with me everyone and please feel free to add your thoughts below

I am not sure how many times in my nursing career I have written Mrs Y is at risk of falls because of reduced mobility due to X,Y or Z but I am pretty sure that it must run into the thousands, however they do say until you walk a mile in another mans shoes (or not as the case may be here) you can never really understand anything from another persons perspective.  Well how right “they” were !!

About 10 days ago now I was rushing around in the garden when I had the misfortune to stumble and fall.  Now please don’t laugh but I fell over a hole that had been filled in … my husband had dug a large hole in the garden which whilst it was a hole was perfectly safe in a “I’m a large hole and its obvious” sort of way, but once the hole was filled in it seems that the uneven ground was less obvious to me ! My foot twisted and the pain was immediate and quite intense.  With some drama (involving neighbours peering over fences and said husband attempting a rescue) I managed to get inside, and my ankle started to swell to the size of an orange and the pain was just awful…. We decided that a trip to the minor injuries unit was definitely in order.  To cut what is turning out to be a long story short (apologies I will get to the point soon!) I hadn’t broken my ankle it was just a sprain, of course I say just but the reality was that this would effect my life for a good few weeks to come.

They say that nurses make the worst patients and I have to say that for the first two days when all I could do was sit with my foot up I was the worst patient ever! The pain made me grumpy, the lack of exercise made me fidgety, nobody seemed to understand just how many cups of tea I need in a day and most of all I was really quite cross with myself for letting it happen in the first place.  As we only have an upstairs loo this made things even more tricky and I started to really realise how even a small deterioration in mobility can not only place someone at high risk of falls but also effect them in every way.

As I started to recover my cross feelings were replaced by sheer belligerence and I became the uncompliant patient.  Having several events to go to I was determined to wear heels and I stubbornly refused to listen to anyone who said I shouldn’t.  Yes this did cause me some pain, I did put myself at greater risk of falls and I did end up with a very swollen foot at the end of the night, but looking back would I have changed anything I did? The answer is a resounding NO! Wearing heels put me back in control, it made me feel normal again, it helped me get back to being me and this was important.

This may seem to be a bit of a silly story but this chain of events made me reflect greatly on “reduced mobility” and how we sometimes miss the real implications of this.  Loss of mobility can affect a persons whole life, it can make them cross, grumpy, difficult and uncompliant and as a nurse I need to remember this and work with the people I care for to develop a way forward that works for them.

As for me I am now being a little more complaint and am sat with my foot up writing this …. But also considering if tomorrow is too soon to get back on my exercise bike

A few weeks ago I had my own words read out to me (and many others) at a conference.  Now it’s always a bit weird when someone quotes something you have said but on this occasion it was on a whole new level ….

A while back I wrote a blog that wasn’t my usual type of blog, it was called Falling through the gaps and it was a very personal account of a friend’s miscarriage.  The reason I wrote it was that I felt so saddened by what had happened that I really felt I needed to express this in some way.  Then out of the blue I received a tweet from Kath Evans (Head of Patient Experience at NHS England) asking if she could read my blog at an upcoming conference that both she and I were speaking at.  It seemed that people had been talking about and reading my blog about my friend’s traumatic event and it had become part of a chain of events to create change.

It was one of the strangest and most emotional experiences I have had in a long time, sitting and listening to someone else read my words.  I watched as the people in the room fell very silent and listened to Kath and saw the effect of my friend’s story on the people listening.  It was the first time I had heard the words spoken aloud and it was as if I was immediately transported back to the day I wrote it, all the emotion of saying goodbye to a little boy that never lived came flooding back to me.

I have written so many blogs since I started my social media journey and as anyone who blogs will tell you we never really know where our words go, who they affect and the ripples they cause.  I have always measured social media success by the power of one, if my words have an effect on just one person then they will have had an effect on one person! However that day, sat in that room, listening to Kath and watching the reaction I was very humbled that my words touched so many and that my friend’s story really was being heard.

I told my friends story not because I wanted to make change, not because I wanted anyone to listen but because it was a story that needed to be told.  The events that led to “falling through the gaps” really did shake my very core and there was a voice inside of me that had to be given the chance to speak.

Social media is a powerful thing, it allows many people to tell their stories and gives them the opportunity to be heard.  If we listen, and I mean really listen, we can learn and we use these stories to act and to make change.  As I left the conference that day Kath gave me a copy of NHS Improving Quality “A review of support available for loss in early and late pregnancy” My friends story cannot be attributed to single handedly bringing this about but it is one of many stories that have been listened to and will result in change and improvement and somehow this makes this event make sense.  We can never change what has happened but we can listen, learn and improve… My hope is that as a result of the ripples that were made using social media we will be able to catch a few of those falling through the gaps.