S6E7 The importance of speaking up for your service Intro - Welcome to Stoma and Continence Conversations from Coloplast Professional. I'm Hannah, Ostomy Care Associate Education Manager at Coloplast. Working in specialist care, I know that stoma, bowel and bladder issues impact the lives of those you care for. This podcast is here to support your educational needs and help you in supporting your patients. You'll hear from fellow healthcare professionals and experts by experience, discuss the latest hot topics in the world of stoma, continence care and specialist practice. Hannah: Hello and welcome back to the podcast. Today we're bringing you another one of our Webinar Wednesday chats, as Paul is once again joined by Dr. Terri Porrett to talk about the importance of speaking up for your service. We start off with Terri going through work left undone and the impact it has on clinical work specialists and the service that they provide. Dr Terri: It happens every day. Now, sometimes what you don't get to finish at work is minute and you go home and you think, you know what, I did a good job today. And there are other days with the huge pressures on the NHS on your service that you go home, and all you can concentrate on is the things you didn't get to do. The time you didn't get to spend with that young woman just about to have formation of an ileostomy and you wanted to spend more time reassuring her before her operation. But you didn't, you had to site her, do what was necessary and move on because there are other patients to be seen. And that causes moral distress. It causes us to really not feel that we are doing a good job, and actually we need to break that cycle. And one of the ways of breaking that cycle is to write down for yourself what you didn't get to do and the rationale for why, and then discuss it with your manager. So moral distress is causing many, many nurses and lots of ward nurses to leave the profession at the moment because every single day they go home totally unsatisfied with the level of care they've been able to give. We don't want that to happen to specialist stoma care nurses, we need you guys so… deal with it. Deal with it by reflecting, jotting down. It's not a disciplinary procedure, it's not a Datix, but use it to have a rational, non-emotional discussion with your manager so that they understand the challenges that you've got. Paul: And again, so many powerful things there. And again, even from personal experience, it's that thing of you do take it home, you try to leave work at work, but that moral dynamic and moral compass, as nurses, it's what we are. It's what we do. You can't disconnect. It's woven into your psyche as a nurse, isn't it? We do struggle. We do, you know, and we talk about advocacy and that sort of thing, and historically nurses find it really, really difficult to praise their service and praise themselves. And I always use, when a patient says, thank you, as a prime example, and it takes a lot for me even to say it now, when somebody says, ‘oh, thank you. You are so kind’. I have to stop myself saying, ‘oh, it was nothing. It's what I do every day…’ Dr Terri: ‘It's just my job’! Paul: No, that person has spent time out of their life to say thank you. There is nothing wrong at all with saying, do you know what? That means so much to me. Thank you for saying, thank you, you know, I really, really appreciate it. It is a powerful thing and it takes a lot. It takes a lot. And the first few times you do it, you go, I felt awkward. But it's empowering at the end of it and at the end it's like, no, somebody said thank you. And we do find it, historically nurses do find it difficult to praise their service, speak up for the vital role that they play in effective, cost efficient, holistic, patient care. What would you say, not just to Clinical Leads, but to all CNSs about the importance of speaking up for their service? Dr Terri: It's absolutely paramount. As we talked about actually last month, as nurses, we say that we're patient advocates. If we do not document and demonstrate the real benefits of our service and personally of what we do, then we are not advocating for our patients and they'll lose that service. It's really, really important, and people have said to me, ‘Terri, I did not go into nursing to write annual reports, I'm a hands-on nurse’. Yeah, true. It never occurred to me. I'd have to do one. Okay. It wasn't something I particularly enjoyed doing, but if I hadn't have done them, the service of the Homerton would not exist in the state that it existed and evolved over the years. Not to big me up. Not, oh look, this is, you know, Terri's got this great. She said, look, my patients, our patients from Hackney now have this extensive range of services. So actually we can't not do it now. We can't not write and demonstrate the benefit of what our services do. As nurses, we do find it difficult to blow our own trumpets and to speak up about what we do. But also we use terribly passive language. We still in the nursing press use, ‘basic nursing care’. There's nothing ‘basic’ about anything that we do. It's the foundation on which every other aspect of that patient's wellness is based, and on our care is based. We use terms like, oh, I ‘just’ sat in with the doctor whilst the patient was being told they’re terminally ill and have a few weeks to live. No, you didn't. You sat there, you brokered the patient's care, you managed their physiological and physical impact of that news there and then, and you were the thing that allowed them to walk out of clinic, rather than remain a distraught person within the consultation room. So there's no, ‘just’ about what we do, and on Apollo, which I know we're gonna talk about a bit more in a minute, Paul, there is a whole section about the right language to use. So if we're empowered with the language to describe our profession, it doesn't seem quite so challenging to write positively about what we do. And we have much as, I hate to say this, we have a huge amount to learn from our American specialist nursing colleagues who have much clearer language specialist nursing diagnoses and actions than we do. And they use those terms a lot. So, the section on positive language and the right language to use describing nursing care is on Apollo. Paul: In the handouts, you will find that there is an infographic for Apollo, and it takes you through all the different aspects of Apollo and all the different tools and the different resources that are there. And again, I'm gonna do another shameless plug. You can actually get to, you can either do it through Google or you can go through the Coloplast Professional website, coloplastprofessional.co.uk and it's under Knowledge Hub at the top, and you'll find the link to Apollo there. And Terri, you know, as I say, this webinar is called Speaking Up for Your Service, Apollo, and the importance of speaking up for your service. Would you mind explaining a little bit more about the history of Apollo and why it was created? Dr Terri: Okay, yes. Now, that is going back in time quite a bit! So realistically, as Clinical Nurse Specialists, we have fantastic clinical skills, clinical knowledge, theoretical knowledge, expert knowledge in our field. But nobody, certainly, nobody ever taught me. I didn't even know what a job plan was. I knew doctors had them, but I didn't know what it was. Didn't know what I needed to put in it. I did, what's a service summary? Oh, that's the front page of an annual report. What's an annual report? What do you put in an annual report? Nobody teaches us these things. And actually, if we're gonna advocate for ourself, our team, and our patients, we need, we need these skills. And so that's exactly what you find on Apollo, so working with Professor Allison Leary, who is a hugely powerful and vocal supporter of specialist nursing practice. We worked with Allison to look at a job planning app. Which is on the website with all of these descriptors about what you do. So it isn't geographical, oh yeah, I'm in outpatients in the morning, then I go to endoscopy. Not geography, but it's about what you do during the day. It's a dropdown menu of the skills that you utilise within that setting. And if you don't understand some of them, like biographical disruption, et cetera, et cetera, hover over the term and it explains exactly what it is. So they're really powerful words. And if we all start using the same language about what we do. If we ban the word ‘just’ from our language whatsoever. So working with Professor Allison Leary, these tools were, were developed and are on the website. So you'll see poor old Homerton Hospital I have utilised significantly templates for their annual reports and things like that. And realistically, an annual report the first time you do it, so it is just horrible. It's boring, it's a pain, but you have to do it, once you've done it once, changing it, updating it each year is a piece of cake. So the first one is the painful one. And I will be quite honest with you. The first time I had to do one, I had like six weeks to do it. And the first couple of weeks my plan was, I'm gonna get in, do my normal routine, do all my ward patients come back from my home visits. I'm gonna do 'em quickly, and I'm gonna spend a good couple of hours each day writing this dreaded annual report. And you can imagine whether I had 5 inpatients or 15 inpatients, I managed to take exactly the same amount of time to do what I needed to do because I didn't wanna do the annual report, and I’d get back to the office and I go, can't do it. So in two weeks I wrote not one word, I didn't even write the title, I wrote nothing! And then a friend of mine said, actually, you can't avoid it. And there's this great book and it was something like, How to Eat a Frog, literally some weird book that told you how to do the things you don't actually wanna do. And what I did was I got into work at the normal time, but I didn't do my normal routine for the first half an hour. I didn't pick up my voicemail, I didn't turn on the computer. Didn’t look at my emails. I didn't look at how many inpatients I've got. Half an hour I did nothing but write the introduction to my annual report, the next day it would be the team outline, and each day I did a section. Six days. I had completed my annual report, not because we were less busy, but I just, I went in, did it first thing in the morning for a set time. I even set the timer on the phone. Half hour, great, done, right! Now I can crack on with the rest of my day. I still got everything else done. But if you try and do it at the end of the day or in between things because you don't wanna do it, you'll make a million and one excuses of things that else that you've gotta do. If we're gonna do top tips this time, Paul, top tip number one. Go in, do whatever you dread doing. Knock it out first thing in the morning before you listen to your voicemails, before you turn on your computer. That's top tip number one. That's only got four left. Paul: So that's brilliant. So yeah, at the end, you've ruined my surprise for you Terri there! Dr Terri: No, I knew it was coming. I knew it was coming! Paul: I couldn't be talking to you and not have a section on top tips! It's almost inbuilt into the human psyche, isn't it? You avoid things that you don't like doing and it's almost that thing of immersion therapy sometimes, isn't it? It's like, and you always used to say to me, and I mentioned it at the last webinar, it's the fear of the blank piece of paper. Oh. I said, if you're doing your Masters, if you're doing your PhD, if you're doing anything, when you first open up that Word document and you are just faced with, I've got 20,000 words to write, and there's not one thing on that page. And you go in and if you don't put your fingers on that keyboard and say, I am going to do an hour of work, you'll never get any words there. And, you know, talking about starting and talking about things that potentially we don't like doing, if someone's never been onto the Apollo, or as I said, like I said, if they're new clinical leads or they're, you know, they've been given the role of. I remember, and again, when I first met you, Terri, when I first started in the role, I had the email from the then CCG saying, you've got a meeting in two weeks, we need to know everything.And it was like, where do I start!? That is almost my next question to you. So if someone's been thinking about speaking up for their service or has been asked to tell people about their service or improving their service, where on earth should they start? What is the order of tactics? Think of all the different things on the website, you know, as you've already mentioned, job plan, service summary, annual report. Is there a kind of perfect journey or a good pathway for somebody to follow? Dr Terri: That's a good question. And one size doesn't fit all. So no, we are not all gonna do things in the same order. But the two things that are absolutely fundamental before you can do anything else realistically, or change anybody's mind about anything is first of all, your actual job description. Your contract, your job description has to clearly say, not in minute detail, but it has to identify the key functions of your role. Not least because otherwise if you are doing things cause you've advanced your service or your role and it's not written down in your job description, were there to be an issue, were there to be a patient complaint. Your manager can go, we never asked her to do that! That's not in her job description! So the first thing which we don't really think about when we're talking about speaking up for our services is actually making sure that our job description is accurate. As I say, not in minute detail, but it covers the key aspects of our role. The second thing, firstly, because it's quite easy and quick, and there's an app that does most of it. I would say the second most useful thing to break yourself into this is the job planning app. Not least because you have the app to help you. You've got all these dropdown menus of things to choose, and then when you click download, it downloads to your computer as a Word document and you can then add one-off different things. You can show it to people, but actually, most people say it takes them about 15 minutes to do a job plan. And that in itself, when you start to show, you know, your manager says, oh, I want you to do so and so on a Wednesday afternoon. Oh, okay, so this is my job plan. This is what the service delivers on the way, which bit of this don't you want me to do so that I can do this bit for you? So it's a really, really powerful tool. So my top tip number two, job description and job plan before you do anything else. Paul: You know, when people ask me where do I start? I would always say, yes, job description. But for me, job plan, because we always say that, you know, managers and all that sort of thing, they don't understand what a CNS does. Be it stoma, be it diabetes, be it any kind of CNS. As I say, a lot of the time you are a very expensive commodity or your team's a very expensive commodity that sits on this spreadsheet, and not being disrespectful, it is just a fact of life. Again, how many nurses actually understand the complexities of their role? And when I get asked, and it's no disrespect because everybody does it. When you are asked to write a job plan, like you said, it isn't a job plan. It's a geographical locator. So Monday morning is telephone, emails that is between eight and 8 30, 8 30 to nine, team meeting, nine till 12 ward reviews. That's not telling anybody what they do, not being funny anybody can come in and say, yes, I'm not a qualified nurse, but I do, I answer my phone, I answer my emails, anybody does that! That's anybody's job plan. No disrespect the domestics, it's like, well, yeah, I do my wards, so I do my ward, I'm on the wards reviewing my role. And it's like, well, yeah, but unless we know what exactly what we do, unless we know the complexities of our role and of our service, then how do we expect anybody else to understand what we do? And that then leads me on to things like service summary. And I know that a lot of people kind of again, almost get a little bit afraid of service summary cause it's like it really is quite complex. It's that balance of good and bad. We've spoke about before, that thing of, well, I don't want people to think that my service isn't good, isn't working. Could you just discuss a little bit more about that balance of good news, bad news, when you're doing service summary? Dr Terri: I think that identifying things that could be done better or aren't being done at all, is the only way that actually we will improve things. Now I know it's quite challenging because you don't want to be the person going, excuse me, this isn't right, we're not, we should be doing this. But we are advocates for our patients and our service. At school, I was always told by the headmistress if I wasn't doing things, Theresa, if not you, who? If not now, when? And these questions at were actually from the first century BC from some philosopher called Hillel or something like that. But actually these words have been used by social activists, people making social change, the suffragettes, you know, people making changes have used these words. And it's true. If I don't write this down in this service summary, who else is gonna do it? Who else knows? Nobody. If I don't do it now, when am I gonna do it? I need to do it now because it's gonna be another six months before. So Sister Gabriel, the headmistress banged this into my head and this has impacted on my nursing career. So if there's something, that is a little bit contentious that actually you don't want to have to do, either as a nurse specialist or as a manager, leader of a nurse specialist team, or as a nurse consultant, whatever. Ask yourself this question, if it isn't me, who's gonna do it? And if it isn't now, when is it gonna get done? So writing things, and it took me a long time I will tell you, in the annual report that I used to write at the Homerton, I think it took two annual reports of identifying the time wasted by nurse specialists on making appointments, answering incorrectly, put through telephone calls and redirecting people, and our clinic letters, doing our clinic letters. And each time I was, I'm saying, look, we need an admin lead within the service for all of these nurse specialists. So I had to do it twice and it was a pain. I had to write in the service somebody. This was a key weakness of the service, but there was the opportunity to significantly improve the timely communication to GPs, et cetera, et cetera, and prevent other issues. If we had somebody administratively doing this for us after two years, two annual reports, them reading it, hooray, we got one! We mustn't give up. If you're not saying things or asking for things just to be awkward. There is a professional reason why you are asking for a change, an addition, et cetera, et cetera. Confidence of your conviction, do it. Cause if not you, who? And as older stoma nurses leave the profession, as they're retiring if we haven't done it, we've left it to you and that's not okay. And if you don't do it, you're leaving it for the next person that takes over your job and it's more difficult and they have to start and get established into the service. And so the when, gets pushed down the line. So yeah, if not me, who? If not now, when? Paul: Brilliant, I love it! And I think I was doing a Masterclass last month and I was talking about ‘going for no’. And you know, if you don't ask, you're never gonna get, but then it was also that thing of, I mean, when we're talking about service summary and the positives and the negatives, and like that prime example is you, with the admin support. Unfortunately, we have to provide evidence and you can go to the powers that be and say, I need admin support. Their first question is gonna be, why? And you can say, until you are blue in the face, well, I've got all this, I've got this, I got this, I got this. If you haven't got it. And again, it's almost like this, the oldest nursing 101, when you first start the nursing profession, if it's not written down, it didn't happen! The same thing here. Unless you prove the need, the powers that be that say, you know, you are going to ask for that clinical admin, they're gonna go… No. Prove it. No, I can't. We can't afford that. But if you've got it written down as a, you know, as a gap or a weakness within your service summary, if you've done it as a case, you know, going back, and again, we will put the, the link for the previous webinar is in the handouts as well, the case study one, providing that evidence. When you are put in a business case, and again, writing a business case is on the Apollo website as well. It's providing that evidence. So if we don't, like you said, if we don't do it, who will? And if we don't provide the evidence now, when will you provide that evidence? Because unless you can prove it. You ain't gonna get it. And we can stand on our laurels and our morals for as long as we like saying, but I know my service. I am the one that knows my service best. If I say, I need this, I need it. It ain't gonna wash! You can't do it, unfortunately. Looking at the time, Terri, are you ready? You've already done two. But it's time for a Terri's top tips. So let's see if we can get five top tips when it comes to Apollo, when it comes for speaking up for your service. Dr Terri: So this is checking whether we've had a senior moment in our recall pool. So the first one was about language, and not dumbing down what we say and going on and using the appropriate language. The second top tip was about, I dunno what it was about, Paul, I've forgotten… Paul: Description of job planning. Dr Terri: That's it! At the basis to all of it. Yes. Then I would say, as we discussed last time, get somebody to look at it for you that doesn't know your service. So if for the first time you're writing a job plan, Get a ward nurse to read who isn't an expert in your service to look and go, oh yeah, I get it. And then you go from there. And that's the breaking bad news. And that's this, get somebody who doesn't know your service, so that I never realised you did that. And then you go teaching there. I didn't get that. And so test it. Always show, show a colleague. Show the asthma nurse specialist, whoever your pal is within the hospital, but who isn't the stoma care nurse. Get somebody to look at it for you. Because they will have, they say, yeah, but you do this, this, and this. Why isn't that in there? Oh yeah, you're right. Number four is we've gotta get with the program. I don't like writing things down, as you can tell, I'm, I love talking, but I don't like writing annual reports. I don't like writing job plans. But actually, I can't function as a nurse in 2023 in the NHS if I don't do these things. It's an absolute requirement. We have to do it, and we have to do it because, we're advocating for our patients. So number four is get with the program and ask yourself this question. If not me, who? If not now, when? And then number five for Apollo. I think really is read, browse. There's some fantastic articles on Apollo. Don't go to it going, I've got 15 minutes to do a job plan and do it now. Have a browse first. There's some fantastic articles talking about positive nursing language empowering nurses. So don't leave it till the last minute when you've got 15 minutes to do the job plan that somebody's asked you for three months ago. Go and have a browse because there's so much written by fabulous nurse advocates that we can learn from. So don't leave it till the last minute. Go over, browse. Hannah: Thanks to Dr. Terri and of course, Paul. You'll find more about everything discussed in this week's episode in a handout we've put together in the show notes for you to download right now. Thank you for listening to Stoma and Continence Conversations, and we'll be back with another episode next week. Outro - Stoma and Continence Conversations is brought to you by Coloplast Professional. To learn more, visit www.coloplastprofessional.co.uk