Thursday, 9 February 2012


The view of trees and plants from an Italian window
View from a window, on holiday in Italy, 2006

It's never what you expect. I had three days of mandatory induction - three days! - and feel about as induced as one could possibly feel, but I didn't anticipate which would be the stand-out presentations on each day.

The format was dry as dust for two days - a lecture theatre, Powerpoint presentations, a succession of speakers given time to do their thing and then move on. Values, policies, standards, guidelines, procedures, and "just call us if you need any more information." An overview of the Trust, an introduction to the NHS Constitution, Foundation Trust status, Fire Safety, Hand Hygiene, Blood Transfusion Theory (how to get units of blood when you need them - I don't), Fraud Awareness, Health, Safety and Risk Management, Environmental Management, Child Protection, the Library, the Faith Centre, Thromboprophylaxis (national rules about venous thromboembolism risk assessment), SBAR (a communications framework), the Mental Capacity Act, Dementia Awareness, Safeguarding Vulnerable Adults, Equality and Diversity, Information Governance, ICT and clinical systems. Oh boy.

Among all these, the only ones that had any sort of audience interaction were the Health & Safety and the Equality & Diversity sessions (and the hands-on ICT of course). All the rest - all of them! - were just delivered from the front, following the Powerpoint tradition. Given that the subjects are unlikely to delight a broad (and bored) audience of new employees, I was only thankful that each session was short. Health & Safety was a relief because we were invited to participate. Equality & Diversity was a whole hour, which I thought would be a bit much, and was more than any of the other speakers got, but turned out to be the best of all.

With my background working in disability, I wasn't sure what might be new to learn. Since I left my last job, the Equality Act has not only combined all the existing discrimination legislation into one place, but introduced three new anti-discrimination categories: pregnancy and maternity, marriage and civil partnership, and transgender identity.

The last was completely new to me, and raised some very interesting and, at times, heated discussion from the room. The essence of the law is that it applies from the day that the individual makes the decision that they wish to change their gender - if on Monday morning a colleague turns up for work and requests that s/he be treated as the other gender, then from that point onwards they are protected from discrimination. They should be addressed in the appropriate way, given use of the facilities appropriate to their chosen (rather than birth) gender, and generally treated in a way that respects their choice. The point was made that it doesn't matter what we think about this, it's the law.

Not only that, it is also an offence to disclose their transgender state to anyone else. The practical example was given of a woman being placed in a bed in a women's ward but who still retains some of the physical characteristics of a man. If the other patients complain, then alongside dealing with the situation, there is the question of how they found out, and whether a member of staff had carried out an illegal act by revealing confidential information. I also learned that at some point it is permissible to apply for a certificate of gender reassignment (this might not be the official name), at which point all records relating to a past where the gender was different may be removed, and disclosure is then only required in the circumstance of Criminal Records checking. And, apparently, wishing to become a member of the priesthood.

By this point the hour was up, and I was disappointed that we had so little time! Lots of issues were raised and not resolved, but there was certainly something new there for me to think about, and not at all where I expected.

Day three was a little more hands-on, with Manual Handling, Resuscitation, and Conflict Resolution. The bleedin' obvious was reiterated in handling of objects, including how to take a trolley safely through a doorway. I didn't have to stay for the patient handling session, but I thought it would be interesting, and it was. The newest technology to help nurses are Slip Sheets - sheets of fabric with one ordinary and one extremely slippery side. The sheets are placed in various orientations to allow patients to be moved where previously they had to be lifted using potentially back-threatening movements, e.g. patients are now moved from one bed to another by sliding rather than lifting. These sheets can be used in all sorts of circumstances, from moving a patient up a bed, helping them stand, sit and rotate into bed, and reduce the likelihood of damage to fragile skin by eliminating friction between the body and the bed (or other) surface. A great step forward.

The Resuscitation session found me and five nurses (all the other inductees in clinical roles were nurses except a few doctors, me, and one radiologist) taking turns to initiate CPR (calling for crash team/cart), doing chest compressions, squeezing the ventilating air bag thing (no mouth-to-mouth any more), and using the defibrillator. I was very surprised that even the nurses with years of experience behind them had never used the defibrillator or taken any sort of lead in resuscitation - they said that in the past, it was always the job of a doctor. It seems that in this Trust, it is thought worthwhile to start CPR before the doctors and the crash team arrive, which seems eminently sensible. I still hope that I don't have a patient going into cardiac arrest in front of me, despite the training.

I anticipated that Conflict Resolution would give us some tools to deal with conflict, stop a situation escalating into violence, that sort of thing. In fact, the session would more accurately have been called Conflict Identification And Communication Tools Theory, and the final part was focussed on contradicting the general view that we're not allowed to hit patients. The trainer assured us that we were definitely allowed to hit patients, or anyone else who is threatening us to the extent that we fear that we will be hurt. I don't think I'd have the courage to hit anyone in anger, but I suppose it's nice to know that I can.

1 comment:

  1. Reading this has reminded me of why I had to leave the NHS recently. I worked at the NHS for 10 years and got to the point where I couldn't stand the excessive bureacracy and box-ticking culture anymore. So glad I left the NHS.


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