For us at Below Ten Thousand it was easy. To teach our students in Recovery, we used a deck of cards.
Hearts, clubs and diamonds represented hierarchies in the clinical spectrums of cardiovascular, respiratory and pain management, which form our core clinical competencies.
Then there is spades.
Spades represents the 25% of all knowledge, the stuff we NEED to know but we are NOT taught in our nursing curriculums, AKA the non-technical skills and knowledge that keeps you most safe most often throughout your career.
Spades? Because spades help you shovel your way out of th
“Maybe I spent thirty years in the wrong job”
I’ve thought that sometimes as I’ve reflected on my career as a nurse.
But that’s not it.
Nursing should be the greatest job in the world, and it was, but over thirty years it has reverted to a state of constant panic as resources have become overwhelmed and too much has become expected of too few.
Lanyards expect magic, but magic cannot obliterate the logic of simple mathematics
Nor will they listen to the non-magical solution I used to present to them:
“Operating lists are manufactured workloads. Use your last f
I must apologise for my bluntness.
What fires me up is my sadness.
Your loss of your beautiful girl is more than I as a parent could ever bear.
I am still flabbergasted:
Why cant we see that intellectual arrogance on the part of individuals and institutions causes so much suffering?
I’m so sorry if my analogy caused you grief.
Your friends can consider ME delusional as well.
Deluded enough to see that if we accepted the same level of treatment risk from our automotive mechanics, 1 in every 200 cars would be irretrievably broken down by the side of the road, we would be MAD as hell, and we would want to know WHY we were being left down so badly by those we hoped most to be able to trust!
It’s not you who is broken.
It is healthcare’s system of work which is broken.
What makes it culpable is the fact that it continues to protest that the systems of work imposed on all
I guess my question finishes up being:
”How can we pretend to meaningfully engage patients when right from the very start we create an invalidation and dys-equilibrium from which the consequence of patient harm will, with certain probability, arise?
I used to always point out to friends that the doors to birthing suite had ‘push’ written on them whilst the doors to the caesarean theatre said ‘Pull’.
But jokes aside, the subliminal rhetoric that greets us often says more than we hoped
for example, at my home hospital:
the hospital entrance hand rub station completely empty of product day after day;
the splits in the vinyl of the waiting room chairs;
the state of equipment and trolleys parked along the corridor,
all scream of hypocrisy, reinforce that the patient and the respect owed to them of are insignifi
Adrenaline is a phenomenal chemical. Patients marinated in endogenous adrenaline have a stormy Perioperative course.
Veins are hard to find, higher doses of induction agents are required, blood pressure is more labile, airways more reactive, post operative pain more resistant to standard therapy regimens.
My feeling is that the hospital environment does little to dissipate this anxiety, and we could almost be accused of deliberately inciting anxiety by virtue of the patient’s lived experience.
My feeling is that this big miss in the therapeutic experience could be said to be a
I’m not sure about the contestants, but I know the NHS would win a Great Leap Forward in Safety culture and consumer confidence.
Once people used to watch ‘Air Crash Investigation’.
Now they watch ‘Scully’ and read ‘Flight QF32’.
Actually, having thought about prizes, I DO know!
The contestants could win a week with Patient Safety Learning. That would do me!
What a powerful motivator for continuing to share your work!
I am in awe of the skill you have in connecting with people and igniting their aspirations!
This lady will be no different and I can already see the grace that envelops her the moment she realises that her experience has not just been acknowledged at a deep level, but transcendently acted upon.
“I decided not to agree or disagree. I stated facts. Facts that could not be ignored.”
I LOVE this!
This is nursing at its finest.
“When you have eliminated the impossible, whatever remains, however improbable, must be the truth.”
The truth is that the nurse has found a way to authentically represent the family’s concerns and the nurse’s professional judgement by rejecting the impossibility of doing nothing.
Show me a hospital full of nurses like this, and I will show you a place where miracles occur for free every day!
I’m going out on a limb, here.
I’m going to say that as hospital employees, we are taught jobs.
We are not taught how to be custodians of a shared space that aspires to heal.
The way we converse in a lift, the way we smile, or not, at strangers and the way we stop, or not, when we sense that someone is lost, all counts towards the metrics of an organisational culture.
Healing is a subconscious process as well as a physiological one.
Engagement starts with the sum total of all these inputs, and whether that sum total is positive or negative.
I’m happy to be w
I guess my theory is that healing doesn’t start in the ward or the operating theatre or the ICU.
It starts in the corridor.
There is so much happening in that simple shared space.
It is where a hospital really declares itself.
The patient information plastered on the walls challenges patients to believe they are under-qualified;
The labyrinth reminds them that they are novice travellers in a stark strange world;
Conversations overheard, sights and sounds and smells all contribute to the feeling that they are trespassing in a world beyond their control and und
When you enter a hospital, be it as a patient or a member of staff, an interesting thing happens.
The glass doors close behind you and you are irretrievably in a different existential space.
Outside, beyond that threshold is the material world.
But inside you are a new Jonah having been swallowed by a mammoth whale
I’m interested in exploring that existential space in the interests of quantifying the healing environment.
Claire, I agree!
Being a clinician is such an incredible job. Every patient is a potential test of the sum total of all your knowledge and skill.
Looking into the profession from the outside, as I now can, what we manage each day is incredible and just being there takes guts.
I’m sure you find the same, but walking into work each day, I used to love that I could achieve small miracles with nothing more than my brain and my hands, but it took all I had to give, plus more, which is where the courage comes in.
Layer over that a positive Safety culture that embraces opportun
Would really like a coffee and a Round Table right now!
Feel free to suggest a better image, because the sword in the stone has certain mythological connotations which may or may not be helpful.
For me it bears the image of a will to advocate in the face of a need for change 🙂
All swords work best when emotional intelligence and intellectual humility reign receptive over the change environment to such effect that the sword need never be used.
Inference born of my own wishful thinking?
For me, the principles of graded escalation would be inscribed along the blade.
When John and I introduced Below Ten Thousand to our audience, we relied heavily on creating the image of a plane skimming the treetops
The image formed a Cognitive link to an action which invoked a behavioural team response which then optimised the performance environment.
Creating the image contributed to our success.
To help clinicians (wanting to improve patient and staff safety using ideas born of their own reflective practice) be brave in the face of hierarchal opposition, I’ve recently settled on the image of the ‘sword in the stone’.
Your thought, please!