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...



Split back nighties, Buxton chairs and the 'Bath Book'

I stayed on Blackthorn Ward for a month before being moved to a permanent ward called Lilac, an elderly care ward with 26 long-term female patients. All the wards were named after plants or trees; Lavender, Beech, Ash etc. The one above us was Lime and it housed the male elderly care patients. Far more hands on care required was required in the elderly care wards than in Blackthorn so all the nurses wore uniform. The female state registered nurses (SRNs) wore white dresses, belts and shoes and the ward Sister, who also wore white, had a dark blue shoulder cape to distinguish her from the rest of the team. Male staff wore black trousers and white tunic tops. Napsbury had its own laundry where in addition to patient clothing, towels and bed sheets the staff uniforms were washed and pressed on site. Once a week we would collect our laundered uniforms from the laundry front desk where they were returned to us on an automated hanger system, beautifully ironed and carefully wrapped in a protective plastic bag just like a modern dry cleaners. 

All ward shifts were organised on a rolling rota, the simplest one I have ever worked on where weekends off could be worked out months in advance and ‘doing the off duty’ was a doddle. There were no rotational shifts, staff worked either day or night (although many worked additional shifts to earn extra money). The hospital ran its own bank nurse system and agency nurses were unheard of.  
The majority of the women on Lilac had lived their lives exclusively within the walls of the institution and what faculty they might have had was long since lost after years of hospital routine, limited stimulation and virtually no contact with the outside world. Some  were mobile, able to eat, drink and go to the toilet with relatively little help. However, most were dependent on the nurses for help with moving, washing and feeding. Some would punch and scratch you whilst being washed and others would lie rigid as stone. Sadly, conversations on Lilac were mostly limited to the absurd, repetitive or obsence. Sometimes the patient files gave some insight into what the women's lives had been like before coming to Napsbury which helped in understanding their attempts to communicate and occasionally a small photograph clipped to the folder edge would show a black and white, younger version of themselves, a glimpse into a life lived some 50-60 years before. 

To be in an institution like Napsbury for the best part of a life, with its locked doors, fixed routines and unchanging landscape, would be bound to bring difficulties. Institutionalism was inevitable and no less so for staff. Many people worked at Napsbury for years and had partners or children working there too; there was staff housing on site and a social club too. In many senses it was one big family and although the days of self-sufficiency had long gone, there was still a feeling of belonging to a very singular (somewhat exclusive) community as you drove through the entrance gates each day.
Looking back it is shocking to think how task driven we were but I didn’t know what I didn’t know and because patients were fed and clean and safe I never questioned whether we could do things a different way. In the mornings we washed patients in the dormitory with a screen placed around the bed area. Then we took patients into the day room. We had a few incontinent patients and they were dressed in dresses or nighties with a large slit down the back, so that the garment could be lifted aside as the patient was sat on a draw sheet tucked around a chair. Every two hours the patient would be stood or lifted and the draw sheet beneath changed if wet. They were then sat down again. Patients who were immobile might be sat in a tilt back Buxton chair to prevent them sliding down onto the floor. On Thursday and Friday we bathed all the patients and there was a large book in which we ticked off who had been 'done'. Patients were walked or wheeled to the old fashioned high ceiling, tiled bathroom with a big bath in the centre of the room and a (very antiquated) hoist to one side if needed. Two nurses bathed, one or two dried and dressed. Patients were back in the day room for supper at 6pm. It was horribly task orientated and completely lacking in dignity but in our (pathetic in retrospect) defense, patients were at least clean and pressure ulcers, even in the bed bound patients were unheard of.

Amazingly, we often had a sit down meal on a Friday night if all the work was done early enough. There were two particularly good cooks in our team; Romana, a Spanish nurse and Lily, a Filipino. I remember Romana cooking a wonderful Mediterranean casserole one Friday and her husband, one of the night nursing officers, coming to join us later in the evening when his rounds were done. Another time, Lily showed us how to make roast belly pork, cabbage and noodles, a dish I went on to make many times over the years (until being wholly overcome by vegetarianism). We would put together the tables in the day room, pull across a clean white sheet for a table cloth and sit down about 8pm when all the patients were settled. At seventeen and  a half I made my first ever Boeuf Bourguignon for my friends on Lilac, inspired by the continental creations of my older colleagues.

The patient food was less international in flavour. Breakfast was made on the ward; porridge or cereals and buttered bread. Other food was sent to the ward in covered metal trays to be plated in the small ward kitchen. Scrambled egg, bacon and black pudding were all regular fare in the morning. The ward domestic, Donna, doled out endless tea and coffee; after meals, mid-morning and mid-afternoon. As the youngest pair on the ward, she and I became good friends and not long after I left she also moved on, to train as a mental health nurse. As well as Donna, Lily and Romana, there was also Eileen, an older nursing assistant, who befriended me in the early days. It was Eileen who I worked most closely with; she showed me how to wash and dress the patients, how to feed those who couldn’t feed themselves and how to make beds quickly and tidily.

It was like having an extended family, and despite the heavy work I settled in quickly and felt very much part of the team. Strange then to think then, that Napsbury was the place where for the second time in my life I was to experience bullying. It is something we have heard much about in recent times as staff in the NHS have struggled to cope with increasing pressures and variable standards of care. Where staff have talked about feeling co-erced, harasssed and bullied to achieve the impossible with chronic staff shortages and diminishing resources. Thank goodness my own experience affected nobody but myself and certainly had no implications for the patients.