You

You matter. So, it is important you understand what is expected of you if you want to be a nurse.

Many new individuals who have chosen to prepare to become a nurse have recently started their professional journey. Academic and clinical staff really look forward to helping you to develop the knowledge, skills and attitudes you need to be a registered nurse. Along with this comes expectations of you, both as a nurse and as a person. As part of your professional life as a student nurse and future registered nurse, it is very important that you are familiar and conversant with the Nursing & Midwifery Council  (NMC) requirements as to your conduct and actions.

Choosing to become a nurse is a big step. Patients and the public truly value the work you will be doing. You will learn about the behaviour and conduct the public expects. It is important that you conduct yourself professionally, at all times, in order to justify the trust, the public places in our professions. Members of the public cannot always see the difference between a student nurse or midwife, and someone who is qualified and registered with the Nursing & Midwifery Council. That is why your conduct is important in upholding the reputation of the professions, both when you are studying and in your personal life. The public has a vested interest in ensuring that future professional practitioners uphold the values and standards of one of the United Kingdom’s (UK) respected health care professions.

The NMC (2015)

How do you meet this expectation? Registered and student nurses all must follow The Code; which is the foundation of good nursing and midwifery practice and a key tool in safeguarding the health and wellbeing of the public and you need to be familiar with it. The pre-registration journey is designed to help you understand the standards required of you, what you must do, and help you to appreciate conduct and behaviour that deviates from the standards expected of you, what you must not do. It is important that you are aware that your behaviour and conduct, both during your programme and in your personal life, may have an impact on your progression on the programme.

Helping you to understand the standards expected of you will give you a strong foundation upon which to base your future professional life and that’s partly the reason why this blog has been developed. Do you want to be a nurse?

Hopefully you are using your directed study time wisely to help you become familiar with our regulatory body and to understand what is expected of you in your professional career.  Neophytes to the profession join at a significant point in the life of our nation and the world. Today’s world is both challenging and exciting but also frustrating and sometimes frightening. It is essential that you are appraised of the current facts; from reputable sources, surrounding health and social care to avoid speculation and promote understanding. You are encouraged to read on to learn more about just some of the current issues and publications which you may find valuable and interesting to the expansion of your knowledge base:

Marmot Review 10 Years On 2020 finds that after a decade of austerity the picture has got worse since the publication of the Fair Society Healthy Lives (The Marmot Review) in 2010. The report by health inequalities expert Professor Sir Michael Marmot comes 10 years after he published a review on the growing gap between rich and poor in England and a worrying north / south divide. Key findings of the review are stark. Deprivation is linked to shorter life expectancy; more deprivation = shorter lives. There are marked regional differences in life expectancy particularly among people living in more deprived areas. Increased mortality rates for men and women aged 45-49 – which may be related to a rise in suicide and deaths related to drug and alcohol abuse. Increased child poverty – more than double the percentage of European countries with the lowest child poverty rates. A rise in homelessness with many people not able to afford to lead a healthy life. More communities with multiple forms of deprivation that have persisted for many years with little prospect of change.

The Royal College of Paediatrics and Child Health (RCPCH) have published a landmark report from into the health and wellbeing of children and young people in the UK. The RCPCH noted that progress in reducing child and adolescent mortality is stalling, a slight rise in infant mortality, reducing smoking during pregnancy has stalled, tackling childhood obesity continues to be a challenge, uptake of vaccinations has fallen. Mental health issues, drug taking and suicide in young people and child poverty have all increased. Progress in reducing smoking during pregnancy has stalled. Arresting the decline in all these areas will rely upon renewing a well-resourced focus on health promotion and prevention; and safeguarding the high-quality provision of universal health services. Prevention really is better than cure.

Concern has been growing since the end of 2019 about the sequela to the outbreak of coronavirus (COVID-19) in Wuhan, China, and in other countries worldwide. You may be concerned about the current situation from both a personal and professional perspective. It is sometimes difficult to analyse the information about such events and determine what robust advice is available to help us understand the consequences and implications of such outbreaks.

The World Health Organisation (WHO) has produced have released a Massive Open Online Course (MOOC) on coronavirus which is free to access and very informative. You may wish to take some time to explore this useful resource. The WHO have also published advice for the public which you may find useful.

Here in the UK extensive planning by Her Majesty’s (HM) Government, including the health and social care system, has taken place over the years for an event like this outbreak. HM Government has a website which directs individuals to the latest information about the situation in the UK, along with guidance for what to do if you think you’re at risk. Take some time to read the current Guidance produced by HM Government for health professionals and non-clinical settings. 3 March 2020 saw the release of the Government’s strategy and action plan for Covid 19. Section 4.48 of the action plan, Mitigate phase – next steps refers to the possibility of bringing nurses out of retirement to help alleviate the pressure on the NHS. Emergency registration will be available for health professionals who have recently left practice so they can be brought in to help contain the infection and administer diagnostic tests. The Prime minister has said that the government will also introduce emergency indemnity coverage for health professionals working through the crisis. The Royal College of Nursing (RCN) also has specific advice regarding Covid-19 on its website. The RCN has also written to its members advising hat they are “keeping a watching brief on issues related to requests for retired members to voluntarily return to work and the potential implications this may have for matters such as revalidation, DBS checks and pension entitlements.  We are also aware of the potential for specific issues for students should universities close”. The National Health Services (NHS) Staff Council have developed guidance on issues to consider when developing local plans to combat coronavirus and good partnership working. The Nursing & Midwifery Council has issued a joint statement from Chief Executives of statutory regulators of health and care professionals about how regulation will continue in light of Covid-19. HM Government is taking steps to counter disinformation about the Covid 19 outbreak. Reliable information is crucial to the management of this outbreak and it is important that you critically review the evidence which is available to you and that you understand that not everything which appears on the internet or which is shared via social media is true. The internet is a valuable tool, but you can also be misled by its content. You may find HM Government’s SHARE Checklist helpful to you in alerting you to disinformation.

Some sectors of our society, such as homeless individuals, are already facing significant challenges in life. Dealing with chronic underlying health problems when living on the streets is hard enough and Covid-19 is yet another challenge to these vulnerable individuals. What does self-isolation mean when you are street homeless and you may be turned away from shelters because of concerns about maintaining public health? Homeless Link has provided a useful summary of current advice sites for practitioners working with individuals who are homeless.

Do you want to be a nurse? Do you want to make a real difference to the lives of people?

Are you ready for the challenges which real people face?

Your own health and wellbeing is important. The WHO  constitution states: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” An important implication of this definition is that mental health is more than just the absence of mental disorders or disabilities. Wellbeing involves individuals realizing their own full potential, coping with the normal stresses of life, being able to work productively and make a contribution to their community.

Your choice to become a nurse is a significant undertaking and maybe you sometimes wonder if you have made the right choice. Universities across the United Kingdom understand that some students experience worries and concerns which they find difficult to discuss with their families, friends or their personal tutor. Universities provide a range of resources to help support students in a variety of circumstances; academic difficulties, managing mental health and well-being issues or the stresses of personal life. Your own health and well-being is important and if you ever need speak to someone, for whatever reason; you need support or someone to listen to your concerns, please seek out the resources provided by your institution. The NHS website provides some useful help if you are feeling stressed, anxious or depressed, or just want to feel happier. Including a useful self-assessment quiz in relation to your mood.

Enjoy your engagement with the people in your care and the demands of the fantastic profession that is nursing. You must always be and do your best; rise to the challenges with which you are faced and have courage to confront that which falls short of the standards you are taught. You must be the tall poppy and stand out from the rest.

 

Xxx

Not so much a word as simply the letter X which has prompted some musings for this blog post, a letter frequently associated with an expression of love for others. Today is Saint Valentine’s day. He was a third century priest martyred and since commemorated on 14 February and connected with love since the middle ages. There are many legends connected with Saint Valentine this video refers to one. Millions of individuals across the world today may be taking the opportunity to demonstrate their love for the important people in their lives.

Perhaps a suitable point to remind ourselves of what it was that made us want to be a nurse. It has been a pleasure and a joy to meet our latest cohort students as they begin their professional journeys. Whilst they may be at the start of their professional journey many of them already have experience of engaging with caring in various settings before they began their studies. Indeed, perhaps it is these very experiences which helped to consolidate their decision to commit themselves to become a professional registered nurse. Several of this new cohort already have an awareness of the 6 Cs and like many neophyte practitioners they have a great desire to exhibit care and compassion. Interestingly when asking students what are the other components of the 6 Cs they frequently refer to “Cs” which are not included in the chief nurse’s original thoughts. Perhaps you might like to contribute to a wordcloud of words beginning with C which help to explain the diversity of the profession of nursing and the individuals who are committed to being nurses.

For many students X may have negative connotations as the symbol is utilised to denote when they have misunderstood or expressed themselves incorrectly in their assessments and assignments. It is hard to be told that we have got things wrong and the majority of students probably do not relish the prospect of receiving an X place against their work. However, it also marks an opportunity for students to appreciate the limits of their competence, understanding and learning to date. It provides the spur to develop an action plan to address any identified deficiencies and so continue to expand and grow their individual professional knowledge base.

Turning that X around is a reminder of the amazing work of the British Red Cross organisation; with their mission to intervene when crises strike anywhere in the world; as well as in the UK, to help anyone get the support they need. Nursing has its 6 Cs and the British Red Cross have seven fundamental principles; humanity, impartiality, neutrality, independence, voluntary service, unity and universality. You may find it interesting to explore these principles in more detail and read about those principles in action all around the world today as the organisation seeks to bring hope in the midst of humanitarian crises. You may even consider supporting them either financially or as a volunteer yourself.

A significant part of the British Red Cross organisation’s work is to encourage individuals to learn simple first aid skills so that everyone, not just student nurses and registered practitioners, can be confident in helping others in an emergency. Students and registered practitioners must always be mindful of what the regulatory Code says they must do to achieve the standard “Always offer help if an emergency arises in your practice setting or anywhere else”.

The X turned around also is a reminder of the country of Switzerland, the destination for some individuals who have taken the decision to end their own lives. Under English law euthanasia is illegal and is considered manslaughter or murder. However, last year, the UK Supreme Court ruled that legal permission would no longer be needed to withdraw treatment from patients in permanent vegetative state. The judgement continues to divide opinion, as well as provoking ethical discussions and challenging religious beliefs. Some individuals regard such rulings as humane and compassionate whilst others are concerned that highly vulnerable group of individuals are affected by the removal of a vital legal safeguard. Earlier this week a video was released of a man who had motor neurone disease and decided to end his life rather than experience the final stages of the illness. In the video he and his wife talk candidly about their experiences of dealing with his condition and fulfilling his wishes. The video culminates in his wife saying “I just wish the law would allow me to have him for a little longer”. This issue is likely to continue to be a subject for much debate and reflection from all perspectives.

is also the means by which we express our opinions and our support. Whether this is in the political arena through our participation in general elections and referendums or engaging in the plethora of surveys which we encounter through our professional lives. Unfortunately sometimes we are sceptical about the impact of recording our X in the political arena but it should not stop us from doing so.
Reference was made to the work of the UK Biobank in a previous post. Respondents across the country; including me, are continuing to complete the surveys sent to us in order to improve the prevention, diagnosis and treatment of a wide range of serious and life-threatening illnesses. The latest survey has been in relation to chronic pain an issue which affects a significant number of individuals across the UK. Hopefully the X’s place within the survey will help to improve our collective understanding of this important matter and help us to develop mechanisms to alleviate chronic pain.

Finally also earlier this week X marks the spot as individuals who played key roles in the development of global positioning systems (GPS) were awarded the £1M Queen Elizabeth Prize for Engineering. GPS touches all of our lives, listen to the judges discussing the importance of GPS.

If you are reading this on 14 February 2019 there is still time to express the sentiments of the day if you have not yet done so to the people who matter most to you.

Wonderful

Wonderful news for the profession; the recent IPSOS Mori Veracity Index published on 18 November 2018 demonstrates nursing once again tops the chart of most trusted professions. When asking student nurses which theme of the NMC Code (2015) (revised on 10 October 2018 to reflect the inclusion of individuals on the new Nursing Associate part of the register from January 2019) is most important to them; first years typically cite prioritising people, second years frequently debate between practising effectively and preserving safety whereas third years consistently favour promoting professionalism and trust. Third year students frequently explain the rationale for this decision as that if nurses and midwives do not command the trust and confidence of patients, people receiving care, other Health Care professionals and the public it is impossible to uphold the other themes within the Code. Nurses occupy a position of trust and are expected to maintain the standards expected of them in upholding the reputation of their profession by the regulator and perhaps, more importantly the public. Members of the public appreciate nurses. It is the things we do and how we make others feel that count for the most in the eyes of our patients and clients not the things we say. Ask many individuals what attracted them to join a health or social care profession and they will respond with “an opportunity to make a difference to the lives of others”. Often it is the small activities we execute for our patients and clients and the way in which we implement our actions that make the biggest difference to their care experience and help to ensure the care received is described as wonderful. Perhaps the promoting professionalism and trust theme is the one which resonates most with the public. Trustworthiness was explored in a previous post in this blog and it may be beneficial to re-visit that post but in doing so please remember that the regulator continues to revise its guidance.

Why; if the public hold the profession in high esteem, do so many nurses seem to dwell on the negative aspects of their role rather than celebrating the positive? This has long been a mystery. It seems that as a profession we are more adept at expanding hours of our time reflecting upon the negative rather than celebrating the positive. Perhaps our engagement with television, radio, newspapers and social media help to fuel our interest in situations where significant improvements could be made. As professionals we should continuously reflect upon our practice to ensure that the care we deliver is based on the most up to date evidence and that we learn from episodes which have been identified as providing less than optimal care. However, we should also not neglect to respond to positive feedback.

Used with permission

Care Opinion recently held a learning event in Manchester for a variety of individuals who wanted to understand the value of feedback from clients. Care Opinion offers an online space where people can post their comments; good and bad, and those caring for them can respond. Many individuals are using the site to express their views about their care, and many experiences which are told are of a positive and complimentary nature. However, it is also apparent that many individuals do not receive a response to their comments or are even sure if their remarks have been received by the right people. The number of comments posted on the site is very small when considered against NHS England’s “Monthly activity data” which relates to the number of elective and non-elective inpatient admissions and outpatient referrals and attendances for first consultant outpatient appointments. Nevertheless the site provides a useful conduit for two-way feedback and has helped both clients and providers to improve upon services, staff morale and encouraged learning in care organisations who have begun to use the website. The patient or client stories are a useful way of helping student health and social care professionals explore and understand contemporary, real patient experiences. Review the site for yourself and read stories posted by clients and service users in the area where you live and work. We should be taking every opportunity, via multiple modes, to be patient / person centred and really listen and respond to the feedback from clients and service users to improve the quality and standard of care which is delivered.

Used with permission

Thinking about person centred care was the focus of an event hosted by the University of Salford on 30 November 2018 at which The Queen’s Nursing Institute (QNI) launched its report “Nursing Care for People Experiencing Homelessness”. The report shares the experiences which homeless health nurses face in the day to day challenges of delivering healthcare to this vulnerable sector of society. The event itself provided an opportunity for individuals, including nursing students, educators, practitioners and researchers; to learn and share ideas about delivering person centred care to individuals who are homeless through hearing from several nurses about their wide range of experiences in supporting homeless individuals. Listening to the person led care of individuals from a wonderful Gypsy and Traveller Community Outreach Nurse was delightful and insightful, emphasizing the importance of creating therapeutic relationships to underpin great care for clients.

Attendees of this inspiring event, were given a hard copy of the “Transition to Homeless Health Nursing Resource”. Hardcopies of the resource can be requested from the QNI’s website.  The QNI website declares “we believe high quality nursing should be available for everyone where and when they need it”. Take some time to explore the wealth of resources the QNI provides to help community nurses deliver the highest standards of care to clients and discover the exploits of some wonderful nurses.

Graduation took place last week at the University of Salford and it was a joyous and happy occasion celebrating the success of the hard work of individuals culminating in the awarding of degrees and acquisition of professional registration. Many students obtained first class degrees and can rightly congratulate themselves in becoming wonderful practitioners. Graduation was described by Jackie Kay; Chancellor University of Salford, as a shimmering, luminous moment as she urged our graduates to give their all, to work for the benefit of others, to be a catalyst for positive change, to seize the opportunities life gives them, to use the knowledge and skills they have gained and to be the best that they can be. Patients and clients across the North West will be recipients of these wonderful neophyte practitioners.

Perhaps you may concur with the Christmas song “It’s the Most Wonderful Time of the Year” that this is the happiest season of all. As you spend time with peers, colleagues, friends and family over the Christmas period why not consider telling them how wonderful they are in what they do and they might even believe you if you tell them often enough. Please also remember members; of all ages, in our communities who struggle all year round because of their physical and mental health challenges and for whom the bonhomie of the Christmas season can be especially painful. Thank you to all those wonderful practitioners who commit themselves to delivering high standards of health care all year round to those in need.