Doubts

Sissinghurst, June 2012

Last week was a difficult week at work, for a number of reasons. Firstly, both of my peers were on holiday, leaving me and the two seniors covering their wards as well as our own. Luckily, things were quiet, otherwise I'd have had a worse week than I did. I had to give up my outpatient clinic, though, and I missed it.

As well as the greater workload, I had some challenging patients. Not that they were challenging people, but their situations were complex, difficult and depressing. And a patient that I'd spent a lot of time with, and really tried to help in many different ways, died. I'm not usually affected by this, but on this occasion I spent a minute in silent contemplation when I found out.

I'm also annoyed at having so little time for thinking, and when I did stop to think this week, I was assailed with doubts. Was that the right treatment? Should I have considered other alternatives? Did I really do my best for that individual, or am I just going through the motions? Am I doing a good job?

I have to admit that this job has not improved with time, and my original thought when I started the whole process of retraining for this new career still holds true: the hospital setting is not where I want to end up. I look forward to my outpatient clinic with eager anticipation that I don't feel for another day on the wards. I am frustrated by my role in nutrition support, which doesn't seem to utilise much of the enormous body of knowledge that I acquired during the degree, and gives me little opportunity to promote behaviour change, which it turns out is what I am really interested in. Working on the wards does not inspire me.

I was discussing this preference with a colleague, who described a similar level of frustration with outpatient work. She finds it frustrating that outpatients come to the Dietitian for advice, but then often don't follow that advice and either don't return, or come back without improvement. She is much happier to work in the ward environment, where we might have a little more influence over whether our advice is put into practice or not.

I feel the opposite: an outpatient has the choice whether or not to follow my advice, and my job is to help them find the right path, tailoring and tweaking my advice to take account of their lifestyle and supporting them in reaching goals that I may have helped them to choose. I find the ward environment frustrating because there are so many institutional variables that prevent patients from achieving nutritional objectives, which are mostly imposed upon them. I acknowledge that I have no control over how a free-living individual chooses to eat and drink, but we ought to be able to do better on the wards, and often we don't.

I have applied for another job in a different NHS Trust, and have told the Dietetic Manager (because I had to list her name as a referee). The good news is that I have been offered an interview; the bad news is that it is scheduled in the middle of our planned holiday in the South West. We are adjusting our plans so it shouldn't disrupt the holiday too much.

I think that it is appreciated that when one has a temporary post covering maternity leave (or in my case, two days permanent and three days temporary per week), one has to take up opportunities when they present themselves. But I don't think that the Dietetic Manager is aware of the main reason for me applying for the job: it is in Primary Care rather than the hospital setting. Finding myself in the position of anticipating an interview, only seven months after the end of the last round of interviews, makes me rather apprehensive and a little sad. Interviews really are painful, and not just because of the Lady-shoes. And this time I have to do a presentation.

It is also for a job that is a higher grade than the one I have at present, and this seems very precocious given than I have only completed six months in a Dietetics role. The same Trust is recruiting for posts at my current level as well, but because the students in the year below mine have now graduated and are looking for their first jobs, the vacancies at that grade closed almost immediately, well before I could put together my application. If I am given the role I have applied for, it is possible that I will be senior to Dietitians who have more dietetic experience than I do. That is a sobering thought.

Looking on the bright side, there are many positives to offset the negatives in my current job. My colleagues really are the nicest people I have ever worked with, without exception - if I get the new job, I shall be truly sorry to leave them behind. And aside from work, when we happened to mention to Smurf that it was my birthday on Monday, he offered us a free meal in the pub, which we had on Tuesday. I've played badminton twice this week, watched two films, we had dinner in Wofon, and while writing this I'm sitting on the sofa with Mr A opposite, in my pyjamas, with a nice cup of tea and some birthday chocolate. Things could be a lot worse.