Monday 28 October 2013

Getting our nursing uniforms and meeting the teachers

This week we settle into our new home, get our uniforms (at last!) and meet the teachers...

In the early days of these nurses residences (before my time as a student), a ‘Home Sister’ would stay onsite and ensure the rules and regulations of the Hospital were upheld, including the moral conduct of its nurses. Homes were strictly single sex and there was no staying out late at night and certainly no sneaking in boyfriends. Even in my day there was a Home Warden who kept an eye on us although fortunately (given how close we were to St.Albans’ plentiful choice of 53 pubs) there was no late night curfew.
Slightly before my time..
We had to keep our rooms clean and were responsible for laundering and ironing our own clothes, which usually meant several ironing boards cluttering up the corridors. Each room had a single window and a deep window sill inside and out and it was common to see pairs of shoes on the outer sill, being given a much needed airing after a long run of shifts.
The Church Crescent site also housed two elderly care wards and a canteen. We congregated in this canteen on the next day for breakfast but I don’t remember ever going back afterward. Despite the fact that breakfast was very cheap, it was also very early and awkward shift patterns soon made us value every spare minute in bed. We didn’t turn down the free meals on night duty though, left over from the day shift they were left in the chiller cabinet in the big canteen on the main hospital site on Normandy Road. First come first served, so early break on a night shift was very popular. Like most students we didn’t waste a chance to turn down a free meal often.                 

Over the next few days we were issued with our uniforms; pale blue check dresses (standard NHS wear), mid-blue nylon webbing belts (called Petersham belts) and dark blue thick wool cloaks with a red lining. One of the last groups ever to be issued them, I was to regret ever letting mine go at the end of the training although we were told we could keep them if wanted. The ladies in the sewing room (yes, there used to be a sewing room in all hospitals) did alterations as necessary, fitted the belts individually and gave us our caps; stiff card with a thin blue strip around the top to denote our status as first year students, held in place with white Kirby grips. We had been told to bring flat black shoes and pale brown tights to complete the look. When everyone was properly uniformed, a class photograph was taken outside on the lawn by the School and at last the May 1983 set was ready to go.

The School of Nursing was situated in its own building on the main hospital premises at the Normandy Road site. It was a single storey building staffed by nurse tutors and clinical nurse teachers. The two nurse tutors, Mrs. M. and Mrs. Lewin dressed in white uniforms and taught us the theoretical aspects of nursing care such as anatomy and physiology, diseases and conditions and the function of different body systems.
They also taught us clinical skills such as how to pass a naso-gastric tube correctly. This we did on each-other in the mock ward area, withdrawing gastric fluid to test for hydrochloric acid with a strip of litmus paper and puffing small amounts of air into the stomach (we hoped) with a syringe whilst we listened with a stethoscope for the tell-tale gurgle of stomach contents. There were no guide-wires or positional check x-rays as became the norm later. Naso-gastric tubes  (Ryle’s tubes were used for feeding as well as drainage) then were uncomfortable and inflexible, making us cough and gag as they went down, so practicing on each-other made us much more careful when we passed them on real patients, knowing full well how unpleasant it was. Fortunately we weren’t required to try out urinary catheters on each-other.

Mrs. M. was the more senior of the two tutors and was rather scatterbrained and accident prone. She often fell over things in the classroom and although very kind she did seem to lack the kind of everyday common sense required to make an efficient and effective nurse. She once instructed us in ‘washing the bed bound patient’s hair’ using the resuscitation model (known by students everywhere as Resusci Annie) as the surrogate patient. When Annie’s blond nylon hair was shampooed it became badly knotted so Mrs. M told us to remove her head and bring her into the class to dry her hair with the hair dryer whilst she carried on with the next lecture. Annie’s head was sat on the front desk and the hair dryer set to warm. Within minutes the nylon hair meshed together in a melted clump and the smell of burnt plastic filled the room. Poor Annie never did recover her looks nor Mrs. M her composure.                                                                                                                                     

The clinical nurse teachers were Ita Blakey, Laureen Hemming and Peggy Morris (of course they were not known by their first names any more than school children call their teachers by their first names now) . They dressed in dark green nurses’ uniforms and taught us on the wards, focusing on the more practical aspects of nursing care such as how to perform a bed bath and how to set up a sterile field for a wound dressing. They also oversaw the four practical exams we each had to do as students; total patient care, aseptic technique, medicines round and ward management. These were nerve wracking and necessary, each successful one marking another step toward the final exams and (hopefully) qualification.                         

Next week: being assessed in practice!

Sunday 20 October 2013

Starting my training - 30 years ago!

During my time as a nursing assistant in paediatrics at the QEII in Welwyn Garden City, I started applying to become a student nurse. At the time most nurses were trained in a School of Nursing attached to an acute hospital. Training was delivered by the nurse tutors who taught nursing theory in the classroom and clinical teachers who taught practical skills on the wards. It led to the qualification of either State Enrolled Nurse (2 years) or State Registered Nurse (3 years), a two tier system bought in when nurse training was standardised as part of the NHS formation in 1948. Once qualified the SEN worked at a mainly practical level and always under the supervision of the more SRN nurse. Opportunities for promotion were limited although many enrolled nurses were highly experienced and skilled at what they did. The State Registered Nurse worked as the more senior of the two and was able to progress to senior staff nurse, ward sister, nursing officer, matron etc. As a registered nurse, she or he was able to make decisions about patient care including the management of wound care, drains, drips and sutures, administer a wide range of drugs including controlled and intra-venous drugs, accompany the doctors on ward rounds and lead the nursing team as required.

As the training for SRN was more demanding that of SEN, Nursing Schools required their SRN applicants to have a minimum of 5 O’levels. The more popular Schools could demand A levels as well. Some training places were highly sought after, a relic of the times when training schools around the country offered vastly different types of nurse training programmes. The best of these (includng of course Florence Nightingale's own school at St.Thomas') would only select well-educated young women from 'good' families.  Living close to London, I was within easy reach of Barts (St.Batholomew’s Hospital) and Guys and St. Thomas’s (before the merger), three top Schools which were still taking their pick of well qualified school leavers. However, as I was not an overly well qualified school leaver I decided to apply to the slightly less prestigious (although still very sought after) Hammersmith Hospital in West London, on the basis it was in London and therefore I would have a good social life. Although Hammersmith did accept O’level applicants they made it clear that A level applicants would have priority unless the O’level candidate was of exceptional quality. I was lucky then to get called for interview, probably on the basis of my nursing assistant  experience rather than my rather paltry collection of hard-earned O’levels.

The grand old Hammersmith Hospital in 1984                                                                                                                                                                             All I remember about the interview was that the hospital interior was beautiful. All varnished wood and tiled floors, with big heavy doors and tall windows. It looked grandly old-fashioned and seemed full of important people but sadly I was not to become one of them. After sitting through an interview paneled by three stern faces, they very nicely said good try but no can do. I didn’t really mind, I had been offered a training place in my home town at St.Albans City Hospital (SACH) and was happy enough to go there. With a full social life and a lot of friends in the area, a nursing life on the doorstep of my childhood home suited me fine. There would be time enough later for moving further afield.

I started my nurse training in May 1983. Our group of 18 were partnered with a similar sized cohort who were based at my previous hospital the QEII Hospital. Our first and the third years would be spent at SACH and the second year at the QEII, whilst the partner cohort would spend their first and second years at the QEII and their middle year at SACH. Our group was all female, all Caucasian and all 18 years old bar two, another girl and myself. Both of us were just 19. We were a very typical nursing student group of the time, predominantly Caucasian, boys a rarity and English our first language. The age, cultural and academic diversity brought about by the NHS’s widening participation initiative was still some way off.

The class of 1983, I am back row 7 from the left!

On our first day we arrived as directed at the School of Nursing for our welcome talk. Most students were accompanied by either one or both of their parents. There were girls there from Somerset, Corby, Cambridgshire, Bedfordshire and Wales, each with a stack of luggage ready to move into the nurses’ home. Only I was without luggage because I lived so close to the hospital it was easier to move all my stuff straight into my room from home. I was glad in the end to have stayed in my home town, less adventurous than some perhaps but I had no home sickness or nerves to contend with either. I was already used to working shifts, I was familiar with hospital environments and routines and I couldn’t wait to have my own space away from home. Close enough to see all my friends, but far enough away to have some privacy.

Like most hospitals at the time, SACH had its own student accommodation (perhaps one reason nurse training was popular). This was housed in two ‘homes’; Church Crescent and Osyter Hills. We were given rooms in the Church Crescent Home, which was just a short walk from the hospital’s main site via the Folly Lane allotments (creepy in the dark). The Church Crescent site had been in use for medical purpose since 1887 when it was bought for £750 in-order to re-house the St.Albans and Mid-Herts Hospital and Dispensary which was then situated close to Holywell Hill, some short distance away. The new Hospital and Dispensary accommodation was built for just £3,750 with the aid of various donations, bequests and subscriptions.
The Oyster Hills Home at the top of Waverley Road was built originally on the land known as Oster Hills. Initially a privately owned eight bedroom family house sitting on the brow of a hill surrounded by orchards and paddocks, it then became a registered asylum in 1834, licensed to receive ‘no more than 15 lunatics at one time’. By 1851 the census records show it as family residence again, albeit lying alongside the St.Albans Workhouse which was built just down the hill on corner of Waverley Road and Normandy Road (then called Union Lane) in 1836-7. 

The Church Crescent, Oster Hills and Normandy Road sites were three parts of the four piece jigsaw that made up St.Albans City Hospital by the time I went there as a student nurse. The missing fourth piece originated as The Sisters’ Hospital, built by Sir John Blundell Maple and handed to the City in 1893 for ‘the benefit of the inhabitants of the city and the immediate neighborhood who might be suffering from infectious disease’.
The Maple Block, built by Sir John Blundell Maple
These four jigsaw pieces became one at some point and the resulting hospital a jumble of styles from the once grand house Oyster Hills House, to the sturdy red brick of the Church Crescent and Normandy Road buildings and the single storey ‘bungalow’ style infectious diseases ward, St.Stephens. More recently a multiple storey high rise building called the Moynihan Block was built to house the growing city population; it opened in 1970's (exact date proving elusive). The wards in the new block boasted a modern layout known as the ‘racetrack’. Unlike the traditional nightingale wards with beds arranged linear fashion down the length of each wall, the racetrack wards were shaped like a chunky number eight with beds arranged in 6 ‘bays’ of 4 beds each plus a number of individual side rooms. Sluice, linen store and treatment rooms were centrally located and therefore easily accessible from wherever the nurses were working. It sounds pretty standard now but in those days it was considered a very 'modern' build.

The Church Crescent nurses’ home was a two storey block with single rooms on each floor, shared bathroom areas and a communal kitchen on the ground floor. There was a television room downstairs and the only way to make or receive a call was to use the pay phone on the landing. Each room had a wash basin, a single bed and a small wardrobe, a chair and a chest of drawers. There was not a lot of room in the room but we could add our own things including a TV if wanted. My TV sat on a small table at the end of the bed and could be turned on and off with a carefully maneuvered snooker cue (I did not actually play snooker I hasten to add). There was of course no remote control. We brought our own kettles, saucepans, plates etc. and some girls even had small fridges. For the rest of us it was a question of leaving provisions in the communal fridge and hoping they would not be raided by someone else.

After being there a while I bought a Tower slow cooker and would sometimes make a casserole or minced beef, leaving the dish to cook slowly on my bedside table whilst I was on shift. I also perfected the art of cooking eggs in a boiling kettle (half-fill with cold water, flick switch and bring to boil, turn off straight away, leave for 5 minutes, remove and eat). When I eventually obtained a mini second-hand fridge, there was so little of nutritional value to put in it I hardly ever opened it. Also, I was smoking at this time (yes, I am suitably ashamed), usually packs of 10 John Player (10 because it was all I could afford and JPs because I misguidedly thought the black packet was cool). On one memorable occasion I lost my cigarette packet and a Mars bar having just bought them in a nearby shop in Folly Lane. I hunted high and low in the room then walked back up the hill searching the ground all the way and even asking in the shop to see if I had dropped them there. So rarely did I look in the fridge it was days before I thought to and found both Mars and cigarette packet nestling side beside in the otherwise empty fridge. I have to say my flirtation with smoking was relatively brief, my love of chocolate lasted decidedly longer.

 Next week: Getting started.. 

Sunday 13 October 2013

The case of the disappearing baby

Working as a nursing assistant on a paediatric ward 30 (long) years ago...

One baby I nursed on the ward was Iain. He suffered a brain trauma at birth which left him mentally and physically disabled. He required a lot of help with feeding and took a painfully long time to take his bottle; barely did he finish one feed than it would be time to start another. As Iain’s parents didn’t come often it usually fell to one of the ward staff to sit and coax him through each feed and whilst I had no aspirations to become a children’s nurse, I never minded landing this particular job; sitting quietly with Iain in his little side-room day, feeding and day-dreaming, the hours just sliding by from one meal to the next. Iain was with us for months and when I left he even 'came' to my leaving tea on the ward.

Another group of children who demanded a lot of emotional resource were the non- accidental injuries or ‘NAIs’. Periodically, a child would come in with unexplained bruising, a greenstick fracture of the forearm (twisted and snapped under a force such as when a child is swung around by the arm, for fun or in anger) or worse. Wherever intentional injury was suspected the social workers and police became involved and the child would be put under close observation. The procedures then were clearly focused on the child’s well-being and safety but the processes for ensuring these are much more rigorous now and suspicions more readily aroused. That aside, when a ten month old baby came in with a badly scalded bottom, the consultant paediatrician immediately suspected NAI. The little boy’s buttocks were bright red and the skin was blistered and raw; he cried constantly with the pain. His mother was from a traveler family who lived locally and she said she had accidently run the bath water too hot and his bottom had scalded as she sat him in the water. The consultant pointed out the perfectly round nature of the burn, the exact contour and size, he said, of a cooking ring on an electric hob, right down to the blistering concentric rings. He said it looked to him as though somebody had sat the baby straight on a hot hob and that, he said, was unlikely to have been an accident. The Mother looked sullen but did not deny it.  The baby's burn was dressed with paraffin gauze and he was given a strong analgesic for the pain. Eventually he settled with the help of some warm milk and was put in a cot in a side-room to rest.
At that time security in general hospitals was relatively low key and on the children’s ward the main concern was to prevent children leaving rather than to stop anyone coming in. Handles were placed high on the entrance doors to prevent any ambitious youngster reaching them and the doors were locked at night. Parents were allowed fairly free access particularly those of the very young or very sick children but other visitors were expected to adhere to the fixed times of the afternoon and evening visiting times. Parents of babies (usually the mother) often stayed overnight in the side-room on a z-bed, not very comfortable but it enabled them to be close by which was important for the well-being of both parent and child.

Several days later, as I sat on my supper break in the ground floor waiting area near the hospital shop, I noticed two members of this little baby’s family entering the ward. It was visiting time and there was a certain amount of movement in and out of the ward but I happened to notice the same two people leaving again not long afterward and remember thinking what a quick visit. When I returned to the ward shortly afterward it was to find that the baby had gone missing. I recalled that one of the baby’s visitors was carrying a blue hold-all and I realised with a sick feeling that I had watched them carry the baby out of the ward and right past where I was sitting. Security in those days may have been low key but the alert went out swiftly and the porters (who doubled as security) were out in the front car park in minutes. The family was just minutes away from driving off, the baby still in the zipped up hold-all but fortunately uninjured. He was put under a formal protection order and the family cautioned.

I often wonder what happened to that little boy. Nowadays of course access to paediatric wards is strictly controlled but what a field day the papers would have had with that one had they known………….

Next week: At last, applying to be a student nurse

A back to front hospital, steam tents and gloopy feeds

After leaving Napsbury I went to work in the Queen Elizabeth II (QEII) district general hospital. The first full hospital to be built by the NHS, the QEII provided healthcare services to the people of Welwyn Garden City and the many villages in the wider surrounding area. The same villages also gave their names to the wards; Datchworth, Digswell, Codicote, Ashwell, Essendon, Knebworth and so on; from these I learned the village names of east Hertfordshire long before I ever knew where they actually were.

The hospital was 5 stories high and was ‘T’ shaped in design. The wards in the main building (the cross bar of the ‘T’) were organised into straight corridors with 4-bedded bays to one side and single rooms to the other. Half way along each ward there was a nurses’ ‘station’, a communal desk area where patient records were stored and the ward clerk manned the phone. The station was flanked on one side by a door to the clean sluice and on the other by a door to the dirty sluice. Commodes, bedpans and urinals were stored in the sluice areas along with the automatic bedpan washer. At the time we used paper bedpan covers to cover the contents of the bedpans and urinals when carrying them from patient to sluice. The covers were supposed to be thrown away prior to placing the bedpan or urinal in the washer, slamming the door shut and hitting the start button. Frequently though, the cover and several ‘disposable’ wash cloths would go in to the washer as well bringing things to a grinding halt more often than not. The engineers who had the unhappy job of repairing the machine (usually on a Sunday morning) were not best impressed by the nurses' continued failure to master the basic rules of using the machine properly. Not surprisingly, having the sluice right behind the nurses’ station also made for some unappealing smells and sights during shift handover or whilst talking to relatives, as well as an awful lot of noise when it was operating fully. 
Opposite the nurses’ station was the patients’ day room, a feature less well used in acute hospitals nowadays as patients who are well enough to watch television in a hospital day room are usually deemed well enough to do it in the comfort (or not) of their own homes. In the bed areas, each 4-bedded bay had large windows facing out toward a wide green lawn at the back of the hospital. The rear of the lawn was screened by tall, densely packed trees. In the misty early mornings, as the dark night hours receded, you could see rabbits and the occasional Mumjac deer nibbling at the grass, quite unfazed by the hospital’s close proximity. I thought this little touch of countryside was a thoughtful consideration of the hospital architects. However, not long after starting there I was told that the entire hospital had been built facing the wrong way round in which case the view was only ever intended for the sight of the x-ray and laboratory staff whose accommodation sat in the upright bar of the ‘T’. I never did find out if this accidental reversal was really the case but if it were it was a happy enough mistake.

After an induction period on an adult ward, I was put to work as a nursing assistant on the ground floor children’s (paediatric) ward. The layout on this ward differed to the adult wards in that it had side rooms either side of the ward corridor as you entered with just two bay areas beyond the mid-way nurses’ station. The ward walls were painted bright colours and curtains screening each bed were patterned with cartoon characters. We cared for very young babies (any baby not requiring neonatal intensive care) through to young teenagers aged 15 to 16. Side rooms tended to be reserved for the babies, the infectious or the very sick and it was in this part of the ward that I was often required. My main duties as a nursing assistant were to clean and set up equipment, make cups of tea for parents and help with feeds and feeding.

At that time (1982) hospitals were still providing nappies and feeds for babies. Nappies were the white toweling washable kind posing two problems, namely getting them on and getting them clean. Getting them on required a bit of a knack as well as an amenable baby, getting them clean required a trip to the sluice to get rid of any solid content and then a drop in the nappy bucket ready for laundering. These were large white plastic buckets with lids, two buckets to each room. Every day the buckets would be emptied and the nappies sent to the laundry for washing, the buckets would then be soaked in a chlorine solution, drained and dried for re-use. This was the responsibility of the nursing assistant on duty and basically required a lot of time in the sluice with smelly nappies and buckets. 
Another important part of the daily routine was the making of all the milk feeds for the babies. The nursery nurse would organise which feeds were needed and when. Working in the designated feed kitchen (known as the milk kitchen) we would start every day by cleaning the kitchen from top to bottom. We followed a strict cleaning routine which was followed to the letter every single day and included ensuring the bottles and teats were washed and sterilised ready for use, wiping all the surfaces with disinfectant and mopping the floor. After cleaning, the feeds were made up according to each baby’s requirements and each bottle labeled as to when it had been made, when it should be given and to whom it belonged. 

Whilst cleaning buckets, bottles and kitchens presented no problem to me, the making up of the milk feeds was a constant challenge. No one feed ever seemed to be the same. Depending on their illness babies might need a lower strength feed, a more concentrated feed, a small volume feed or most troublesome of all, a thickened feed. The babies who needed this latter type of feed would typically be those with palette abnormalities or severe gastric reflux; babies who either lacked control over their swallow or who could not keep the milk down. For these babies, the feed would be thickened by a gum based thickening agent and, if the baby had difficulty sucking, we would also enlarge the hole in the teat with a snip of the scissors. The thickening agent came in powder form and was added at the time of making the feed up by mixing it with boiled cooled water and milk powder to form a smooth paste (like making powdered custard). Then more boiled cooled water was added until the feed volume was correct. A notoriously temperamental agent (certainly in my hands anyway) the smooth paste would inevitably turn lumpy as the water was added and despite my best efforts, which included a small metal sieve and a lot of frantic bottle shaking, the feed would nearly always end up lumpy and unusable. I am happy to say my unsuitability for this task was quickly recognised and I was moved to other duties. Interestingly though, my custard making skills are unaffected.

The role of the nursing assistant on a children’s (paediatric) ward was less ‘hands on’ than that of a nursing assistant in a psychiatric ward for elderly women. The care then, as is now, was family focused and washing, feeding and entertaining was done wherever possible by the parent, particularly those with babies. With the qualified staff managing surgery lists (an endless round of circumcisions, tonsillectomies, inguinal hernia and pyloric stenosis repairs) carrying out complex care and administering medications, the nursing assistant was left to do all the various background jobs required to keep the ward running smoothly. Aside from cleaning nappy buckets, the nursing assistants stripped, washed and made-up countless cots and beds (the turn-around times in paediatrics often were and still are, very fast), carried out simple observations, fed any spare babies, doled out tea and sympathy where necessary, said goodbye to the better and hello to the poorly.

When children were admitted we would be told before-hand what they needed and this often involved setting up some kind of equipment. Monkey poles and steam tents were commonly called for. Monkey poles are metal poles that lock on to the base of the bed at the head end and arch over the patient’s head. A strap hangs down in front of the patient so that they can lift themselves higher up the bed or over to one side. For a young child with a broken leg in a plaster cast, the monkey pole allowed some freedom to shift position and to do muscle building exercises. The pole also allowed the more playful children to swing side to side when we weren’t looking which wasn’t particularly good for knitting together broken bones. The children on traction, weighted down by weights or water bags (to stretch limbs or re-position fractions) would lift, swing and twist in such imaginative ways, it was a surprise really that some of them ever healed.

The other piece of equipment commonly used was the steam tent. This was a metal framed tent with a plastic covering which was set up to enclose an infant cot. At the back of the bedstead hung a motorised chamber which was filled with ice. A big piece of plastic elephant tubing connected the chamber to the tent and when the motor was turned on the tent filled with a steam vapour which was intended to help the child breath. Used for children with croup it took a while to set up and had to be regularly topped up with ice from the ice-making machine in the kitchen. Sometimes there would be 3 or 4 children sitting in their tents steaming away, the steamer motor chuntering away in the back ground. Of course my description is reliant on a rather a long ago memory so the details are not necessarily replicable (or safe!).

Next week: At last, applying to be a student nurse

Friday 4 October 2013

My first death and an end of another sort

Despite that situation in the early days I settled and became very happy on Lilac. I learned a lot about people as well as the world of work in general, coping with shift patterns, early mornings, late nights and regular weekends. I saw my first death on the ward too, an elderly lady who died in her sleep and was found by the staff when the night shift handed over. I went with Eileen to lay the lady out, in what would now be considered the old fashioned way. We washed her, removed her false teeth and packed her rectum lightly with cotton wool to prevent any faecal leakage. Then she was wrapped in a cotton shroud, with a tiny frill at the neck. The sleeves of the shroud were secured with a bow at each wrist and her hair was combed out. A name bracelet was put first on one wrist and then on the opposite ankle; her big toes were tied together with a small cotton bandage before her ankles were secured with the same. The window closest to the bed was opened (to let her soul slip out, Eileen said) and then she was wrapped in white sheet from head to toe, the loose corners were taped into place and she taken away to the mortuary in a large rectangular metal box on wheels. I hadn't known the patient and there was no family that we knew of but we did our best to care for her respectfully and kindly even after her death. Sadly though, the health service has yet to find a way of transferring the deceased away from a ward in anything other than the rather obvious and eye catching metal box on wheels.

It's not clear what impact a death on a ward full of patients with severely impaired cognitive function has on the patient themselves but the death of a patient on any other ward leaves an inevitable ripple in its wake. Years later, as a Sister on an elderly care ward where deaths were not uncommon, we would sit and quietly explain what had happened to the other patients in the vicinity. It allowed patients to pay their respects and, if needed, raise issues or concerns of their own. Hopefully, we offered them some reassurance as well - that we respected and cared for the dead as much as for the living. It is important to recognise that the patient community on a ward experiences the same events that staff do but from a very different perspective; nurses need to pay attention to this in their actions and words. It doesn't always happen though, I have on occasions seen staff whip round the curtains at the site of the metal box and shoosh away the visitors without a word of explanation :(

Compared to my friends who had stayed on at school I had seen a very different side to life during my time at Napsbury and learned much that was to stand me in good stead in later years. However, I always knew that psychiatric nursing was not for me and when I was eighteen and a half I left Napsbury to work as a nursing assistant in a general hospital. At my leaving do, the duty Nursing Officer presented me with a beautifully wrapped parcel on behalf of the ward team. Everyone clapped as I opened it and much to my embarrassment out fell a black lacy bra and pants! Napsbury, was a truly one off place to work.

There were still other institutions like Napsbury Hospital in England in the 1980s, but the era of providing mental health care in such splendid isolation was drawing to a close. Public concern about the quality of care provided for sufferers of mental ill-health and physical disability in large scale institutions had increased over the years, fuelled by periodic allegations of poor care by the media. Politically, the long slow move towards providing an alternative option through the provision of care in the community started in the 1950s, driven primarily by humanitarian and cost considerations. But it took until 1990 to create the legislation that would enable the large scale changes required to take place. The first concrete steps toward change took place in 1988, on the publication of the Griffiths Report 'Community Care: Agenda for Action', which set out recommendations for determining the responsibility for providing care for long term dependents such as the elderly, the disabled and the mentally ill. This was followed in 1989 by the Government’s response in the form of a white paper called ‘Caring for People: Community Care in the next Decade and Beyond’. This paper endorsed the need to define the individual responsibilities of health and social agencies as well as identifying the need for ‘the development of needs assessment and care management’ and ‘a new funding structure’. The final steps in the move towards a national framework for care in the community, with the needs of individual patients at the heart of the health service structure and the funding set to stay with the patient, were taken on the enactment of the National Health Service and Community Care Act in 1990.

Napsbury at the end

Napsbury was really a unique and special place to work in but society had rightly recognised the need to care for its own in a more humane and more dignified environment and in 1998 it closed its doors for the last time having provided mental healthcare to the people of Hertfordshire and North London for almost a century. The experiences I had there and the people I met have had a huge impact on my life and my career and I thank them all (even the ghastly Jackie) for being such an important part of my formative nursing years.

Bullies - nothing new in the NHS

The first time I was bullied, I was about 6 years old and my tormentor was a girl called Rhona. She was a year or so older than me; she would wait for me at the school gate and when my Mum was safely out of the way, she would call me names, pull at my dress and push me in the back. I never knew why but I was a) chubby b) about the only child in the school who wore a uniform; apparently reasons enough to single me out as worthy of her attention. 

The second time I was bullied I was working at Napsbury and this time it came courtesy of a female member of staff called Jackie. Jackie worked upstairs on Lime ward and was good friends with Eileen the other nursing assistant in my team. She would come down to share a cigarette and a cup of tea with Eileen whenever they were on shift together. Jackie was not happy that I had the position on Lilac, she had hoped to transfer there herself. She was also not happy that Eileen had taken me under her wing since I had arrived. I of course knew none of this but Jackie made it very clear she did not like me, she would get up and walk away if I came to the table or turn her chair away and start a conversation with her back to me. What I didn't know was that she was also spreading some horrendous rumours about me behind my back . When I did eventually find out it explained an awful lot about the funny looks people gave me at times! For a while I was very unhappy at work but Jackie's behavior came to light eventually and I came to understand her unpleasantness was rooted in her jealousy of my friendship with Eileen. I was seventeen and a half and Jackie was in her forties and should have known better - I had much to learn about working with groups of women. 
Nowadays, there is much talk about bullying and harassment in the health service. Whether it be on a 1-1 basis, insititutional, top downward, peer, managerial, from relatives or patients (yes it happens that way too) or from colleagues, it is always wrong. The problem is that a bullying is a way of being, you can't switch it on and off and if you can't be kind (or at least respectful) to your work colleagues you will not be kind to your patients. I salute the Graham Pinks and Helene Donnellys of this world, who have spoken out about poor standards, harassment and bullying in the workplace, sadly, in both their cases, on a large scale. However, whether it be on a small scale or a grand scale it is never acceptable. It will ultimately always come back on the patient in one way or another, and for that reason alone it must be stamped out.

Next, the end of a (psychiatric) era...