Since the 1990s, the NHS and other public services have been run according to the diktats of New Public Management – a system that runs public services as if they were businesses.
As well as marketisation/privatisation and treating members of the public as customers, New Public Management:
• Focusses on financial control and increased productivity/efficiency
• Discourages the self-regulatory power of staff by handing power to senior management who use a command and control method of identifying and setting targets and continually monitoring staff performance.
This nurse’s story illustrates the destructive impact of New Public Management on her working life, which led to burnout and then resignation. No wonder the NHS has a staff retention problem.
At the end of May, after 33 years of the NHS and 30 years as a qualified nurse, I handed in my resignation of my senior specialist nurse position. I don’t have another job to go to. At the end of August I finished working out my three months notice period.
My hours were 9-5pm. On a good day I might have left at 6pm. My last day at work, I came in to around 700 unread emails. On a particularly busy day I could work until 11.30 pm after coming home at around 6pm. But sometimes I left work at more like 7 pm with still more work to complete at home.
When I handed in my resignation notice, I had been bursting to tell someone, to plaster it all over Facebook perhaps, but I decided to remain discreet and professional until the last.
I am sharing now to help other nurses not to be drowned in a sea of documentation.
This is my story.
I love nursing but the NHS is being cut to the bone – staff have to do more and more and still provide a good service
There were days after putting my notice in, that I wondered what on Earth I had done. I love nursing. I have had encounters with patients and have helped them and thoroughly enjoyed their conversation and company too. I have dealt with complex wounds and used modern and ancient techniques to begin the healing process. It is thoroughly satisfying work.
But my last days at work were a case in point. A busy week, we had staff on annual leave and long term leave. This wasn’t unusual – we are rarely at full capacity with staff. It had been very busy with referrals so I was seeing 3 -4 patients a day. That doesn’t sound like much.
I worked in the community. On average a visit takes an hour to do the assessment and the wound care. There is also travel time to take into account and my patch is large covering a large town and many smaller villages and towns.
I covered District nurse patients, nursing and care home patients and practice nurse patients, acute surgical discharge patients, GP, and other allied healthcare professionals referrals may also come my way.
Every patient was a new assessment, and needed to be considered as to what referrals need to be made from this point. Documentation after a visit takes a minimum of an hour, not including phone calls.
I recall some days that happened before I left. On one particular day I started work at 8.30 ( officially I started at 9:am). After seeing 3 patients in the morning, I had a SOS call from one of my team to a patient who she had called an ambulance for. I stayed and supported her and we ensured he was safe and the ambulance on the way, before I had to leave for a meeting I was chairing.
I had no lunch. The meeting ran over by half an hour and business was not finished so we had to roll some over to the next meeting. During the meeting a manager was recommending we routinely complete still more documentation.
Then it was to my documentation.
I had to tackle my more than 1000 emails in my inbox in case any were important
I found 3 which needed dealing with.
Once I had my inbox down to a more manageable size, having now stayed 2 hours over at work, I went home at 7 pm, prepared dinner and then sat down to complete my documentation of patient visits for the day.
While my husband was watching my favourite programme of Spring watch, and then watching something about the planets I was continuing to work until 10.30pm ensuring I had completed all the documentation we get told we must complete for every patient we see. This wasn’t a particularly unusual day.
No wonder nurses are leaving in droves
I had no life out of work if I saw more than a tiny proportion of patients. And I had to see more than that because patients can not be kept waiting, this is another issue that more and more, we are being urged that visits are urgent, and so we fit more and more in, thus burdening ourselves more.
We live in a society where litigation is becoming normal. I understand that patients who receive poor care are deserving of compensation. However the NHS is being cut back to the bone. Those working for the NHS are expected to continue to pick up more and more and yet to continue to provide a good service.
The fact that there is short staffing and poor resources is not allowed as mitigation for any “ failure “ in care. Investigations are on the increase. I had not been involved in any serious incident investigations until recently and was suddenly involved in 2 and they were not pleasant. In addition a deranged relative had put in a completely unjustified complaint about me and I was getting zero support from management despite an unblemished 33 year record. It is no wonder nurses are leaving in droves.
Don’t get me wrong, it’s important we have these investigations, it’s important we ensure we are doing everything we should be for our patients. But there must be a better way than this huge burden of documentation which is mainly falling on nurses. And we are drowning.
Permanently, soul breakingly exhausted
I realised indeed I had done the right thing in handing in my notice. This could not continue for me. I feel an inadequate wife, mother, friend and inadequate spiritually as I fail to attend church events and cell groups and fail to do anything charitable any more.
And even with all this work I didn’t finish my work or feel as though I had done it well, there was no thinking time, so it was all reactive. I didn’t feel like I was doing a good job. I didn’t have a life outside work and that has never been my intention. In fact I used to have a full life outside work. Now I am permanently exhausted. Soul breakingly utterly exhausted.
This is what we are doing to our nurses in the NHS
On my last day at work I still felt very tired. I finished work about an hour and 45 minutes late but this was good because I didn’t have any more to do at home. That was absolutely brilliant.
Perpetual anxiety about patients falling through gaps of chaotic IT system
We have had three reorganisations in 2 years. The latest was a change of Trust completely. This affected all our IT systems in particular as well as the rest such as the restructures and inevitable cuts to services. The IT system issues were not fully resolved for 9 months and during that time I was perpetually anxious we might miss patients falling through gaps as systems were in chaos and communication difficult.
Dread, anxiety and stress led to burnout
I returned to work after the long Bank Holiday weekend on my last week at work, not without dread. It’s always so lovely to take a break, but having not even scratched the surface of the email stockpile last week, as I had accumulated them with the previous weeks holiday, I was aware both my senior colleagues were not going to be around and so the entire service rested on me. It didn’t start well.
I am quite disorganised, because of my general mental state. Last year I was off sick with burnout and things haven’t really improved.
Having returned several times to the house having forgotten various items, I was running late. The work that day continued to accumulate as predicted.
Try as I might I could not keep up and finished late daily, continuing later at home despite all the previous admonition from managers and counsellors to ensure I finish work on time.
Despite what they had said, on my return to work after my burnout, they really expected me to work on.
You see I was expected to see my patients in the given timescale, I was expected to undertake thorough comprehensive assessments that I must thoroughly document, I was expected to then take action, such as referring them on, I was expected to supervise my staff, I was expected to answer emails, undertake all my training, attend meetings, liaise with colleagues, provide training education and mentoring to others, investigate incidents , undertake audits and root cause analysis, and fill in any damned spreadsheet they decide to send me.
Which was at least three jobs and then they expected me to take my breaks and go home on time. Which didn’t happen.
In fact, if I wanted to go out for an evening my work would accumulate to the extent I had to put in weekend hours to “ make up for “ having an unpaid “ evening off” I was not contracted for. Because if I didn’t do this I would fall further behind with my records, breach targets and possibly place the patient in danger by not having communicated via the records what I had done.
I was put in charge of my “ illness “ and of making changes to “ get well “ when the issue in the first place was never about me
All the self help books, all the counsellors tell you to do something about your condition. In my case the condition was anxiety and stress caused by burnout.
When I had come back to work, having been exhorted to “ finish work on time, have regular peer meetings, take breaks, leave things to the next day, the following things were not discussed.
What if I can’t finish work on time? Because the very people asking me to are also asking for “ proof” ( documentation) about everything I did with a patient that day. And I can’t limit the amount of patients I see when they have to be seen by a certain time limit and everything is apparently urgent, and when there’s no limits to how many patients that can be referred.
What if my peers ( and me) are too busy to have meetings?
What if I don’t have time for that break? What if work have taken away my office and there’s nowhere quiet to go for a break? What if the break time I do plan gets swallowed up because of complex patients and situations?
What if I am leaving things not just to the next day but indefinitely and still I am drowning in work? I am thinking of the currently 700 and counting unread emails.
However my manager did give me a little pocket book on “leadership”. I still haven’t read it. I have a Diploma in management ffs. I know how to be a leader but I have not got the resources, the office or the time.
You see I was put in charge of my “illness” and of making changes to “get well” when the issue in the first place was never about me. It wasn’t about me and how I manage.
Nurses are leaving in droves for the very same reason, that the burden of paperwork, the litigation culture, the “ prove it” culture is causing intolerable pressure to those who care for you.
I will not miss drowning in emails. On my last day I had over 1000 unread and climbing.
To be fair I may have had a little more time than I give credit to because I had taken to sitting with my head in my hands fairly frequently. This was where I was before my burnout and so I knew I either had to leave or go sick. I am hopefully doing the honourable thing.
I am put on God’s earth to help people and no one shall tell me I cannot
I think I left at the right time. There are stories in the media about a man who has been put on trial and is facing a possibility of 20 years imprisonment for giving migrants water in the desert in another country. There’s stories of a British firefighter facing trial in Europe for rescuing drowning refugees.
In England there are stories of migrants being locked up after seeking medical treatment because their details are handed over to the authorities. Where are these details being obtained from? Treatment is being restricted if you aren’t “eligible”. I want nothing to do with that. I am put on God’s earth to help people and no one shall tell me I cannot.
Drowning in a sea of documentation
My final day continued like any other. It was a surprisingly normal day and I didn’t leave until 7.15 pm because of the enormous amount of paperwork to get through as usual, which I still hadn’t finished. However as usual I had ensured I finished the patient related paperwork as far as I could.
Some of this is a rather bitter diatribe, but actually I am sad not bitter. I have truly loved my years working for the NHS. I truly expected to work as a nurse in the NHS all my working life and retire with some kind of accolade even if it was an A4 printed certificate made on a Word programme by an intern.
But it seemed I was quitting and no one asked me why, or whether I would like to stay if they made some changes. So I guess that told me it was time to go. Life’s experiences have told me to bow out gracefully when no longer wanted around; I learned that in my early teenage love lessons. So I am not going to flog myself to death for a master who doesn’t respect and value me.
Time to say a fond goodbye
In a way leaving was a relief and burden lifting from me but it still feels very sad and I cannot help wondering what I shall do in the future. Nursing has been a huge part of my life and I’m not sure I know how to do anything else except write poetry and rambling posts like this, which I can’t see being very profitable.
Taking back my life
I have so many things I need to do after all. So much I gave up and sacrificed in the last few years, to keep up at work. My health, and the things I really want to do, the things that make me tick – helping people.
So I plan to exercise as much as I actually should, and get fit. And I plan to do the things I wanted to. Go to Extinction Rebellion marches, sort out my diet, plant a wildflower garden. Volunteer with the homeless like I used to. Write. And then perhaps do a bit of nursing on the side. Work to live, not live to work. As was always my mantra before.
I am going to get my life back! So I shall no longer feel ashamed about “quitting”. This is from now on what I am going to tell the people who ask me what I am going to do. I am going to allow myself to get excited and feel empowered. I am going to take back my life.