My thoughts on being the Director of Care at Erskine – a seven months reflection on life after 32 years working in the NHS.
This blog was first published on letstalkaboutdementia.wordpress.com
Care of the older adult has been my first passion since becoming a nurse 32 years ago. Having left the NHS seven months ago (latterly as Associate Nurse Director/Lead Nurse in Ayrshire), I joined Erskine (aka Erskine Hospital) where I continue to work in an area of care that excites me.
To be realistic my knowledge of care homes was limited, my mum, who had dementia, had been in one for the last four years of her life, care there was good, but all I did was go in, visit my mum, make sure she was ok and had what she needed – she would occasionally come home for a short time, but she grew increasingly anxious when outside the care home, so the frequency of these trips out diminished. I had little idea of the complexity of care carried out daily in the Home, in many…
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My blog on life after 32 years as an NHS Scotland nurse.
First posted on the AHPScot.wordpress.com blog site
Care Homes by Derek Barron. Director of Care, Erskine.
After 32 years working in the NHS, latterly as Associate Nurse Director/Lead Nurse, I left last year and joined Erskine (aka Erskine Hospital).
So six/seven months into post what can I share, what have I learnt and what is next?
Firstly a little about Erskine, what made me want to go and work there – “it is Scotland’s foremost provider of care for veterans and their spouses, Erskine offers unrivaled nursing, residential, respite and dementia care in our four homes throughout Scotland for UK veterans”. OK, that’s the corporate lines, but what’s it really like?
Well, let me tell you – it’s a dynamic environment which focuses on rehabilitation; the maximising of our residents abilities.
Care is founded on relationships, with an underpinning human rights approach.
More corporate jargon? What does that really mean?
It means we strive to maximise the choices…
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Attitudes and values
I once read a blog which stated when people ‘fail’ to fit into a job it’s usually not due to lack of skill, it’s more about attitude – this strongly suggests that when interviewing we should be interviewing for attitude and values – and of course there is other evidence to support this. The implicit thought is we can train for skills and knowledge once the person is in the role – which for me begs the question of the competence of competence based interviews!
I was mindful of this as we shortlisted for our Clinical Lead and House Manager posts last week and as I prepare to lead the interviews later this month.
I’m also thoughtful of the message, as we can’t interview exclusively on attitude and values – we do need an element of technical competence (depending on the job role). The key therefore is finding the balance – it’s more difficult to find that balance than you would think, or so it appears from some of the applications I read.
A useful yardstick for me is to refer back to something that was said by Professor Paul Martin (at that time CNO Scotland in 2007 that really stuck with me – he was addressing around 100 nurses at an event in Ayrshire – “are we technicians in a caring environment, or carers in a technical environment?” The balance between them, as I said earlier, is, for me a critical factor.
Complexity of Care
Since moving to work in a care home setting (Erskine) six months ago I have been struck by the complexity of care that is delivered every day by highly skilled and knowledgable care teams – is it perfect? well no, it isn’t – but what does perfect mean? As I reflected back on 32 years working in the NHS I couldn’t find that one area I’d worked in which delivered perfection – that team or service where everything was absolutely right and nothing needed development or improvement – and I worked with someone wonderful, inspiring people and teams, but even so none were perfect.
And so, as I return to my original train of thought and the question asked by Paul and relate it to my current quest – what I’m looking for are people who are carers, prepared and equipped to work in a technical environment. Care however is the pre-eminent, underpinning quality that I want to see shining through.
So what are the things I’m looking for when interviewing, and of course what are suitable questions to establish these attributes.
‘Tell me a time when’ question, in relation to care delivery, is both good and bad. It’s good in that it should put the interviewee in control and they can shine, this should bring out the inner warmth, it’s also a useful opportunity for the candidate to show where, in the past, they’ve influence without authority, which is of course a higher skill than being able to direct because of positional authority.
The other side, the bad aspect, as it were, of the question, is that interviews aren’t about gushing, it’s not about competence in telling stories, it’s about us, the interview panel, being able to feel the underlying care and compassion and being able to understand why this event was important to the interviewee and why it stood out.
So, as an interview panel we are looking for leaders who are less about control and more about influence; leader who are able to transform and adapt themselves to meet a wide range of challenges. Control is not the goal, leaders need to support and enhance their adaptive capacity and that of their team in pursuit of the organisation’s goals.
But at the very heart of what the leader does is an unbreakable golden thread taking all their actions back to the individuals for who they deliver care – if the leader can’t make those links…… !
Coachability – mentorability
Can the individual accept and action feedback from others – whether that’s their line manager, their colleagues or most importantly those they are providing care with? How can they demonstrate this? For me the most dangerous person to employ is the one who knows it all, they don’t need or embrace feedback – they lack insight into areas of both strength and weakness – usually because they’re brilliant at everything (or so they think)!
A key area, but one that is ‘difficult’ to measure at interview is emotional intelligence (EI). How much understanding does that individual have on their impact on others (and of course ability to regulate their own emotions). While this may be easier to evaluate if it’s an internal candidate being interviewed, careful questioning can draw this out from all candidates e.g. what impact are they having on the panel as they engage with the interviewers – feel the impact, not just the words but the totality of engagement.
I‘ve involved those that use services on interview panels previously, in this approach aspects of the interviewees EI can be observed and experienced from different dimensions.
One hugely successful interview I was organisers involved people living with dementia and their carers – every single ‘interviewer’ (based on feelings and engagement) picked the same candidate as the ‘technical’ interviewers. The successful candidates ability to engage with, and move between different complexities of interviews meant they were able to demonstrate their ability to judge the needs of the range of interviewers emotions.
Motivation – such an easy, trip of the tongue type of Q&A. Often superficial and bland. Whitney (1997) said “It’s better to be prepared for an opportunity and have none, than to have an opportunity and not be prepared”. I used to like asking the ‘how have you prepared for this interview?’ question – unfortunately the answer it frequently elicited let candidates down. Cramming in last minute reading and chatting to a few people is superficial and unimpressive.
When I’m interviewing I’m looking for the a description of the path that led the person to thinking this job was right for them. I always expect contact to have been made prior to interview (but I also like to see it made pre-application completion/submission). Only once the longer term path has been explained do I like to hear about the last minute reading, don’t start off there. So can we, the panel, understand the candidates motivation?
Technical competence: Can the individual demonstrate they have the technical skills/knowledge and aptitude to do the job?
Herein lies the rub, even the best skills/knowledge don’t really matter if the person isn’t open to improving, if they don’t have the underlying warmth of care, if they alienate their colleagues or if their approach feels at odds with the organisational goals and values.
Attitude/approaches that work in one culture don’t necessarily fit into another one – it is the interview panel’s role to first understand their own organisation and secondly to consider the interviewee in that unique context.
If I think about current staff that exemplify the organisation’s values, I am likely to be looking for new staff that can continue to build on these attributes (always bearing in mind we are not looking for clones!). What three or four things make the current exemplary staff ‘successful’? These are likely to be factors to consider with our interviewees – how well do they match those attributes? – of course a little bit of creative differentiation can support the organisation in not becoming stagnant. However interviews can be an opportunity to send reaffirm messages across the organisation of the values and beliefs we expect throughout the organisation.
So while the interviewees may be nervous as they prepare for their interview that interview panel itself should also be nervous, they have a huge responsibility – a decision they make may impact positively or negatively on the organisation for many years to come.
Let’s hope the interviews are very difficult for the panel as all our candidates excel. No-one said it was supposed to be easy – not for the interviewees nor for the panel.
Job application form
Some of the application forms have brought a smile to my face while others leave me shaking my head in disappointment.
I’m sure there are guru HR professionals would be able to articulate what I’m about to say much better than I can – however in this blog I’m going to reflect on my recent experience; if you are about to apply for a post I hope it might be helpful, if you’re about to be interviewed then my previous blogs related interviews may be of interest.
Second thing, having decided you do want the job, look at the advert, look at the job description and start to think about what value you bring to the post – not every staff nurse or senior charge nurse job is the same.
This is going to help you when you start filling in the application form.
Third thing, and I am astonished, indeed somewhat baffled that applicants don’t do this – if the advert gives you the name of someone to contact for an informal discussion – why on earth would you not do so?
Do you really need a written personal invitation to make contact?
There are two major reasons for making contact at this early stage:
- It will give you the opportunity to find out if the area is somewhere you actually want to work – what are the beliefs and values of this prospective employe?
- It gives you an opportunity to demonstrate to the people who may or may not shortlist you that you are keen to work for us, that you’re knowledgeable about the job and have the skills required.
The last round of interviews I was involved in there were 14 applications for four posts. It is highly unlikely we are going to shortlist all 14 (i.e. it’s a ‘short’ list that we’re tasked with creating), my role in shortlisting is to select the best candidates who we might be interested in employing, that means every bit of information you give the shortlisting panel is critical in you getting to the next stage. Someone who has made contact to find out about the area will, in my view and experience, have a greater chance of being shortlisted.
Only now should you be thinking about the job application form – it’s your second window for prospective employers to look into, and potentially the first one for some members of the shortlisting panel.
Let’s cut to the chase, if you can’t be bothered spending time on your application, if it’s full of mistakes and typos why would I or my colleagues want to shortlist you?
Do you really think that is the kind of nurse we want working for us? One who’s paperwork appears to be of little interest to them, despite the importance of the form – how might that translate into their written clinical records?
I have been disappointed with the lack of or limited post registration learning and development that is evident from application forms. Within my Board there is little excuse as we have actively supported post registration education over many years, not only via our SLA with the University of the West of Scotland, but also via a variety of post registration funds including some directly given by the Scottish Government.
Job role and function
My disappointment re post registration education was nothing compared to my concerns when I read the entries related to the current ‘Role purpose/Summary of Responsibilities’ of some applicants. Telling the shortlisting panel that your role is a series of tasks that seem to have very little to do with a person centred approach to care is unlikely to impress us.
These are actual examples from the past year: I wouldn’t mind if these things were listed last, however they play an unfortunate pre-eminent place on the form.
Complete the ward diary – undertake a smooth handover between shifts – I am often left in charge of the unit – order medicines/restock medicine cupboards – run the ward efficiently, using clinical observation sheets – run my caseload efficiently – liaise with the GP – prepare for and take part in MDTs – responsible for ward off-duty – cover duty system – I provide basic nursing care.
Is any reader of this blog inspired by this list?
I can assure you I am not, and in my recent shortlisting meeting neither were the two Senior Charge Nurses who were shortlisting with me.
Schein (2013) in his book ‘Humble Inquiry’ notes
“We think of task orientated relationship as impersonal and emotionally neutral”……. “… by contrast, a person-orientated relationship is expected to be more emotionally charged because one or both parties are interested in each other …”
In their application forms, few explored, what I consider to be the real purpose of the nursing role, as Schein notes above “because one or both parties are interested in each other …”
The caring role of the nurse should be the focus throughout the application, but it should most definitely feature prominently in your current role descriptor. When I read an application I want to be able to ‘feel’ the nurse’s caring approach exude from the page, I want to be able to understand the values and beliefs of the nurse writing that statement.
Of course tasks are an aspect of the nurse’s role, but it shouldn’t be the first thing mentioned and it shouldn’t be the thing that takes up the most space.
Rights, Relationships and Recovery
While not wishing to suggest stock phrases that can simply be regurgitated I’m hoping and expecting to see how you, the nurse deliver care; that you understand the preeminent place the individual who uses our service deserves to be in your application. In 2006 (refreshed in 2010) mental health nursing had its own strategy for continuous development of our profession; it was called Rights, Relationships and Recovery.
I fully expect to see in applications for a nursing role in Ayrshire & Arran that nurses know their role in upholding the rights of people in our care, that care is based on relationships with those we are in contact with and that a belief in recovery is a driving principle of the nurse writing the statement.
Also, when I read the current role that a nurse recognises the importance of engaging with carers, it can’t help but bring a smile to my face – and over the last year I’ve read several.
A role description will be able to articulate the writers belief in involving carer, of supporting them to be involved in care episodes where possible. Carers usually know their relative much better than we, as professionals do, they can help wrap care round the individual – I really want to see view point expressed in the job application form (and of course that’s it’s demonstrated in actions).
For those of you who have filled out an NHS Scotland application form you’ll realise that I’ve only covered the first few pages. Next week I plan to cover the rest of the application form and include some pointers of what to do, as well as what not to do.
Let me know your thoughts on the items in this blog, or if you’ve got specific questions you would like me to address.
Fear, shock and denial
Dementia, rather like the word cancer, can often stir negative emotions. There can be an element of fear, shock and/or denial when we think about it, the overwhelming thought of losing one’s identity or the impact on someone close to us can create a rising sense of panic. Despite this reaction, the term itself is not well understood. Although it is true to say that dementia will often be an irreversible, progressive and life long condition – that is, once you’ve got it you will always have it, it does not need to be a life limiting condition in the early stages, nor for that matter for some considerable time in most types of dementia.
In short, the earlier a diagnosis is made the better opportunity that exists to slow the progression of some dementias – medication has an important role to play in slowing down…
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Instantly two questions spring to mind 1) what do I mean by leadership? and 2) what is social media?
Malby in 1997 described leadership as “an interpersonal relationship of influence, the product of personal character rather than mere occupation of managerial positions”. Bennis and Nanus add to this by described leadership as ‘influencing and guiding’ as having a ‘future focus’, a ‘vision for the future’ while remaining in the present.
The key aspects that interest me in relation to digital and social media leadership is the ‘interpersonal relationship’ and ‘influencing/guiding’ components of these descriptions. To me they are key in my own engagement with social media, my own role as a leader.
So, what is social media – it’s those…
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