Feeling so depressed about work, 13 years in the NHS and feel I might have come to 'the end of the road'....

[anyadviceoutthere]

Have worked as a nurse for 13 years and have mostly loved it....am now in a senior clinical (but not managerial) role and have my own caseload etc.

Over the last 18 months to two years the emphasis has been changing slowly but surely from clinical/client centred work to increasing levels of admin/financial stuff which is now making it impossible to work effectively as a clinician.

Final straw is that we have new management structure and now have managers who, whilst should still be carrying reduced caseloads have made it categorically clear they will not be doing any clinical work. It is also clear that they do not have the clinical expertise or experience to work at an advanced level which effectively leaves the team withour clinical leadership a really scary prospect.

We had a meeting on monday where we were supposed to be 'working out some of the issues', several experienced members of staff are leaving now and we 'the team' are being asked to problem solve how to hold everything together, the senior clincians have again made their position clear that they will not be taking on even a small caseload.

It would not be so bad but they are continually arriving late, going early, disappearing whilst 'on the job' etc etc etc.

I feel like waliking too but feel that would be admitting defeat.

Any words of supposr or wisdom would be much appreciated.

[andiem]

hi any posted but it got lost in the down time.
I left the nhs to become a lecturer and really enjoyed it pay and conditions were better and I was much less constrained and managed my workload
I left to stay at home with ds2 in may but never regretted the move if you like teaching this something you could think about

[DKMA]

Or work for a pharma company perhaps?

[anyadviceoutthere]

Thanks for the replies. Have though about pharma company, worked in clinical trials for a few years so know a bit about the industry but what puts me off is the travelling!

Are any other people experiencing similar problems?

[foxymagoo]

I work in HR for NHS (not operationally, on project) and have had many meetings with unhappy nurses over the past few years.

Some questions to ask:

Does your Manager's Manager know they are not undertaking any clinical work?

Do you have an up to date job description which reflects your increased financial/admin duties? Everyone should have had an Agenda for Change job description which was a snapshot of their job in 2004 but many jobs have evolved past then.

Do you have admin staff who could take some of your admin work off you?

Could you compile an 'at a glance' report on how patient care is suffering due to your increased admin time with no reduction in caseload?

Have you sought advice from your HR Adviser? Everyone member of staff has one they can go to.

[foxymagoo]

Or are you in the Union? Your staff side rep. could support you if you felt you had to 'whistleblow' your Manager over their poor timekeepng etc.

[NigellaTheOriginal]

yes same where i work. senior nurse managers don't do clinical stuff. they just like to tell the rest of us how badly we are doing it. pisses me off too. and leaves wards run by junior staff witout much experience and no senior backup or lead. the NHS is in a shocking state but i don't have the answers how to fix it. just work in dangerously overworked understaffed wards where patients get a raw deal. and manager types don't care because they want targets met or they get a bollocking from further up the line.
tis crap.

[anyadviceoutthere]

Hi Foxy
yes managers manager does know about the problems as numerous staff have written to her/ met with her independently and we are also starting to get complaints from outside the organisation. She seems very invested in supporting these people at all costs. I think that she is secretly quite angry that no-one from within the team 'stepped up' to take the senior posts and you get the sense that now she thinks we should just put up with these people at all costs. It is in the job descriptions that they will work a reduced caseload but they just refuse to do so- how can that be possible!!??

We have some admin support but the admin staff are really struggling too!!

I am in a union, the RCN but to be honest have found them pretty useless in the past, we have no-one local anyway to represent us.

People are just leaving, its so demoralising to see really great committed staff going like this.

[llareggub]

This sounds like a perfect opportunity for you to step up and start improving your union. If the RCN isn't representing your views effectively, then become a shop steward. You can then directly access and harness the full resources of the union.

Phew. It isn't usual for me to recommend this sort of approach as I also work in HR but it might be a constructive road for you to take.

I guess you do need to work out whether your vocation lies within the NHS or in alternative career paths.

[foxymagoo]

Have you thought about taking this all the way to the top of the tree - your General Manager or equivalent? They can't afford to lose staff as it costs them dearly to replace and train them.

The fact that the new Managers are refusing to carry out the casload even though its in their job description is grounds to raise it as an HR concern as they are potentially on a pay band they shouldn't be. How can they keep up their professional registration if they're not seeing patients?

At our healthboard any member of staff can seek advice from a Union rep. You don't have to be affiliated to one...

[anyadviceoutthere]

llareggub

have actually considered being a rep but then wondered how on earth I would fit this in too lol!! Might take your advice and look into it now though.

Do you mind me asking, do you work in HR in the NHS? If so does this type of thing happen much, ie more senior people shying away from clinical responsibilities. Its just unfathomable to me, why go for a higherbgraded position if you don't have the know how or willingness to undertake the duties. It can't be all about money as there is not a massive difference. Hmmmmm.

[foxymagoo]

People love having 'Manager' on their badge!

[anyadviceoutthere]

Hi again foxy

I think we have kind of decided that we will have to (if we do take things further) do it en-masse. Several people have been singled out, including one member of staff who had severe antenatal depression, was off sick for a few months and then got told she should hand her notice in as she couldn't 'sit crying at her desk all day'. She made a complaint to Hr but because she wasn't up to taking out a formal grieveance nothing could be done. There are lots of examples like that. Stuff I would never have imagined would go on in the NHS!!

[llareggub]

I don't work for the NHS, but I do work for a very similar organisation who employ people who work in multi-disciplinary teams alongside NHS staff.

I have to say it is probably fairly usual within my organisation for managers or senior staff to take on more management or strategic responibilities over clinical (or in my case, provider) roles. In social care, we have ensured that the supervisory responsibility for complex cases is picked up by Senior Practitioners, who are paid more to mentor and coach less experienced staff and allocate cases. Senior managers take on the leadership and strategic service development and have minimal (if any) operational caseload.

So I guess I can see where your manager may be coming from, but if it is merely a case of her refusing to take on the clinical work, then that is probably a performance issue rather than the approach described above.

With regard to the trade union stuff, you'd be entitled to "reasonable" time off to train as shop steward and to carry out trade union activities.

[foxymagoo]

Unfortunately you do have to take these things all the way to see a result. HR are duty bound to see it through to ensure fairness if you do decide to complain en masse.

I am at the ante-natal depression story...

What also saddens me is that so many staff take their Manager's word as the gospel and don't think to check out if they are following agreed procedures which the NHS is swaddled in.

Thee should be a 'Dignity at Work', 'Grievance' and 'Whistleblowing' policy at your work as these are NHS UK wide.

[nooka]

If you really think that patient care is suffering (and you can evidence this) then you should pursue this. You could go down three routes. 1) You could think about taking about a grievance: look at your trusts policy, and go and see a HR advisor; 2) you could think about whistleblowing: look at your trust policy and then go and see someone senior in your nursing structure (the Director of Nursing considers these at my PCT); or 3) you leave.

For the first two cases you need to document the problems. Record the times where the managers are late, don't do clinical work when there is a need etc. It's all about gathering evidence, because without evidence no one will act. Good luck with whatever you choose to do, my only advice is not to do nothing.

[anyadviceoutthere]

Hi again LLareggub

No one expects the senior Parcts to carry a full caseload- we realise they have other duties which we do not, but they took the role on knowing it waqs a clear 50/50 divide between clinical (supposedly more complex cases) and line management /supervisory responsibilities. The underlying cause is basically a lack of competence which is driving them to avoid the complex work.

There are two levels of management (completely non clinical) directly above them but still within the immediate service, can we raise a grievance or something to these two people regarding the lack of clinical work they are 'not doing'. Is it likely to be fruitful? I am just not sure.

[anyadviceoutthere]

Thanks everyone for your replies, lots of things to think about here. Will check in again tomorrow.

[llareggub]

Yes, you could, although you should look to exhaust all of the informal routes before resorting to a grievance. I should point out that you may not be aware that action is already being taken. For example, if your manager's manager is taking action over performance then he or she wouldn't be able to discuss that with you.

Ultimately though, you need to see some changes. I'd probably be looking to resolving these things without going down the grievance route as it can be very stressful. Could you make an appointment to meet with your Head of Service or whatever the NHS equivalent is?

[1dilemma]

what kind of work do you do? what kind of admin? what reasons are the tier above giving for not doing clinical work?

I wouldn't assume the NHS is a 'good' employer it's very size makes it totally dependent on practice at an individual level

[ahfeckit]

I'm sorry you've been having such a hard time at work. This is what puts me off going back into the NHS to work, it's all so depressing at times (and that's working p/t!!).
Hope you can find a solution soon.