Borderline States, Madness, Psychosis, Reflective Practice, The Inner World, Ways of Being


It is more than 30 years ago that I joined the NHS as a psychiatric nurse. I’d like to say that I was a shy, anxious rookie who was scared of everything and everyone. I wasn’t. I was 30 when I began my nurse training, having worked in homeless hostels for a couple of years and having taught for a few years before that. (Working with homeless men was much easier. And safer!) I knew my own mind then as I do now. I was a staff nurse for a number of years before daring to try to become a manager. (I had successfully managed shifts for years but with the luxury of not being called “Manager”. I decided that if I was ever to go into lecturing I had to have been a manager-even if it killed me!) So I took on my first manager’s post and made a number of important discoveries. Firstly I am not a “natural” manager. I don’t do rules, regulations and  policies.(Not unless I have to or can see some point to them.) Secondly that I am a “natural” leader. People will follow me even if I am being destructive which has been known! I made other discoveries but these are not too important right now.

My early experience of the NHS was of an organisation that allowed one to think. To consider why some things happened this way. Was there a better way of doing things? If we did this, what would happen? There was, mostly, a generosity of spirit. I remember even as Team Manager being given time to work in the psychotherapy department once a week and to run a psychodrama group once a week. I left the NHS a decade ago because I felt that my ways of working and thinking were not wanted. I lectured for eight years before leaving university for the same reason  (I am allergic to being micro-managed.) Rather naively I thought that I could return to front line service as a nurse, acknowledging that there might be some tensions. I lasted slightly over three months before handing in my notice. I left a week ago with mixed feelings. the staff I worked with have been kind. Many of my patients have proved very rewarding. But…

In the Trust to which I made my ill-fated return to the NHS we had a system called RIO- probably an acronym of some sort. Our daily task was to feed the beast with information. Where were we? How long had we taken? What was the outcome? What future plans did we have? Who else knew about us? Did we use the toilet wherever we were? With what result? and so on. My favourite RIO moment was when I had come back from seeing a patient. I sat down to feed RIO. I told it where I had been and when and why. I told it the outcome and gave it the date of my next meting. It paused. burped and told me I had an “outcomed appointment”. I asked my colleagues about this. They told me it meant I hadn’t told RIO that I had told it what it need to know. (Or something similar.)

I could-and should- have made more of an effort to love RIO. It was only trying to be helpful. It couldn’t help its programming. But… I’ve spent a lot of years as a nurse and as a therapist. (And a lot of money as well.) I expect to have my integrity honoured and my skills valued. I do not expect to spend 30 minutes telling a statistician somewhere how I spent my time with my patient- particularly when I’ve already told RIO. So I’ve hung up my syringes and retired. Sort of. I have a counselling business to build. Where I can see my patient in peace.

P.S.  The doughnuts. When  I was a team manager I  always brought in a big bag of doughnuts for our team meting. It gave people a quick blood sugar fix. It made it hard for them to criticise me with a mouthful of doughnut. And it gave a sense of generosity. A small way of saying “Thank you.” I probably couldn’t do that today. RIO wouldn’t like it…


2 thoughts on “Doughnuts

  1. Ian Kitson says:

    You have summed up the entire public sector today perfectly. The system, the process is everything.

    Individuals working in whichever service it may be are no longer valued for themselves, there are no characters who have earned the respect and trust of senior management and colleagues alike.

    As for clients, customers, patients they are numbers, outcomes, statistics not people who just need a hand along life’s way.


    • I agree Ian. It’s a shame. I was taken aback ,in the brief time I went back, how much everything was outcome focussed. Now that’s fine if I have a broken leg. I can predict that in X months it will heal. Much more difficult with emotional problems where healing is so bound up with the relationship between the patient and their nurse / therapist etc. where time needs to be elastic. Which is the pleasure of working privately. I don’t have those demands on me. I can see a patient for as long as necessary-even though it made better financial sense to discharge them early. I don’t miss the NHS that has now emerged from the ruins of endless political football matches. (And I’m far too volatile and difficult to be able to sit back and say ‘Hey sirrah. sirrah’ But that always was my style!
      Thanks for reading my blog and for commenting .It’s always good to hear your opinion.


Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )


Connecting to %s