A good friend and colleague, Dr Mark Davies, blogged this week and set me thinking. His blog was his reflections on leaving general practice having been a GP for 21 years; what things had he wished he had known at the start of that journey. This blog is my attempt to guide 19 year old Anne on her journey and career in nursing that started on 31^st January 1983 – what #5things would I like to tell myself.

They are not listed in any particular order:

1.    Put your hand up

It took me a while to learn this but I did get it in the end – when there are jobs to be done, projects to develop and deliver – put your hand up. It doesn’t matter what the project is really and in many ways the projects that no one else really wants to do have been the most rewarding. I learnt slowly that my nursing career was often enriched by un-expected things. I think the point where I really got it was when I became fascinated by complaints from patients and their friends and families. I didn’t think what we did with these precious letters was right, so I set about looking into the process as a project for a management course. I ended up telling the Chief Executive that the organisation should have a complaints manager and that should be me. He offered me the job and I never looked back – it was one of the best opportunities I have ever had to really understand the experience of patients.

Never fail to volunteer – you are unlikely to regret it.

2.     We never know the impact of what we do

I remember once meeting a nurse on a platform at a local station. She knew me but I didn’t know her. She approached me and told me that she had been a student on the ward where I had been a ward sister many many, years ago. I, sadly, couldn’t remember her. She went on to tell me how that ward experience had been fundamental to the choices she went on to make in her nursing career.

I think it’s scary to think that people watch us all the time and we may make an indelible mark on their lives. Patients will remember if we were kind, or not. Relatives will remember if we were helpful and smiled. Students will remember if we were patient and supportive.

Being watched all the time can be a burden but it can also be a fantastic opportunity to make a real difference.

Hold that thought in your head in everything you do.

3.     The importance of rehabilitation

I learnt this far too late in my career, I wish I had known it 30 years ago – the importance of rehabilitation and letting the patient set their own targets.

I have worked in acute settings for nearly all my hospital career. I was always in settings where we were dealing with the most acute type of medicine; chest pain and respiratory failure in the main. Looking back it strikes me that we had a ‘fix them up’ attitude and ‘get them home’.

More lately I have spent a small amount of time working with a fabulous advanced nurse practitioner in elderly rehabilitation and I learnt so much.

The most powerful thing was asking an elderly patient ‘What’s the best that you think you can be?’ then working with them on helping them achieve their goal.

I believe that we should have patient driven care – the phrase patient centred care no longer satisfies me.

My learning – how can we support people to take as much control as they feel able to take and achieve their own goals?

4.        Politics (small p) is not a dirty business

When I was a fresh faced staff nurse I didn’t believe I needed to understand or get involved in politics, but I was wrong. Over time I came to realise that power and politics go hand in hand and even if you don’t want to dabble in the Machiavellian arts you need to understand them.  It’s naïve to think that you can get difficult things done unless you understand where the power is and how it all works. I still think it would be simpler not to need to understand these things but I now know that that is unrealistic.

Get to know where the power lies and how the system really works if you want to do things for good.

5.        Love yourself and be kind to yourself

Like many people there is no one harder on me than me. I drive myself hard, I take on too much and I hate it when I do something that hurts someone or is tactless; beating myself up through sleepless nights and tears is not unknown.

But I have learnt that no-one is perfect and that I know I am essentially a good person and although I still find it hard I can forgive myself more readily.

I have learnt to love myself a little and try harder to be kind to myself.

#5things I wish I had known. I am sure there are more and these are the things that came into my head today – I am sure my learning is not done yet!