I'm a health visitor AMA

[CosmicTeacup]

I'm going to regret posting this aren't I?

We have standard advice around SIDS but are a baby friendly so cover co-sleeping but I get what you are saying.

If you know parents are doing it and have evidence to support safer sleeping, it neglectful not give the advice.

Lots of nurses don't keep their knowledge up to date or allow personal views to colour their clinical practice which is a wider problem in nursing IMO. It's very frustrating for those of us that do though.

Fellow hv here! Love my job although it can feel like we are very unappreciated in general, especially on here!

Oh gosh. How many hours do you work? I have 300+. It's exhausting. When I worked in another area that was targeted HV service (don't want to go into too much detail as may out myself) my caseload was capped at 110 full-time.

Yes have supervision but only safeguarding. Don't discuss numbers.

HVs are trained to admit they don't know. It sounds like you had a bad experience, not all HVs are the same!

Well in answering my complaint, the PCT accepted that they weren't trained to admit that and as I said upthread, committed to revising the training programme completely. I dread to think how many other PCTs would also accept how woefully inadequate the HV training programme was / is if formally challenged.

I completely agree all HVs aren't the same, you sound competent

No questions but just want to say thanks for the work you do. Bloody love my health visitor.

@achanger I'm full time but large team in a fairly small area. Yours sounds unmanageable! It's sounds like your trust is poor at supporting you too. Please ask for some help if you haven't already, your mental health is important!

@namechangedtoday15 I was very experienced before coming to health visiting and in a job where I was fairly autonomous so admitting that something is beyond my limitations comes naturally! Unfortunately, not all HVs have that experience to bring to the job.

Named it's part of our code of practice not out advice give out advice beyond our knowledge base, although obviously this doesn't always happen! I do think health visiting is particularly bad for it.

Achanger I'm three days and have about 200, a quarter are UPP/UP - so unbelievably stressed it's untrue!

@flowerpicture aah, that's lovely thanks!

I have done, a few times. I have worked through illnesses as I was so worried about how I'd cover the work. I just hope they fill the vacancy soon.

@HVwhyohwhy it's crazy isn't it. I now dread work.

It really is. Sickness is through the roof in our team. The rest of us are nervous wrecks, not sleeping and on the edge of a breakdown!

@HVwhyohwhy I think the problem (as it is in a lot of other jobs) is that the most dangerous scenario is that you think you have the requisite knowledge but don't. You're right that HVs (in my experience) are particularly poor in knowing where that line is.

I agree. There's a saying in nursing that there are three types of nurses:

1. Those that know what they know

2. Those that know what they don't know

You're safe with either of these as operate within their knowledge base. Those that know, know. Those that don't know will ask. Neither will kill you.

Then there's

3. Those that don't know they don't know.

These are the nurses becomes dangerous and are at risk of doing harm.

You absolutely can't know everything as an HV. The job spec is vast. The training not so much. In all honesty I'm surprised more people don't complain.

As an experienced parent, I opted out of the HV system and the supervisor nearly had a canary. She tried to imply it was impossible to do and this was not an optional service. Then she refused to accept our signed letters until we had gone back and forth a few times. Having had children with health visits, I realise what you do. But out of interest, do you understand why parents might find it patronising, contradictory, time-wasting faffing around and feel they're perfectly capable of making a call to the GP re: hearing test and injections? (And spotting anything that is definitely not normal!). I always wondered because there is apparently a theoretical assumption in this country that parents are capable of managing their own children's health. It really didn't seem that anyone in the health service knew about it.

What do you think about baby led weaning?
Do you secretly judge if women don't breastfeed?

How much time is allocated to a routine visit? Do you have to cram loads into one day?

I spent around 5 months with health visitors during my training and I have to say, I was actually quite shocked at how inefficient most (not all) are. In a previous life it was my job to enter departments and assess for inefficiencies so it's difficult for me not to think about that nowadays.

At one point, a new student had started a placement and the health visitor she was with didn't perform a successful visit until her 5th day. She blamed this on people going out as the weather was good (it was), but failed to use any of her time calling ahead to confirm any visits, despite having ample time due to earlier failed visits.

Another team I was with used to huddle for the best part of an hour each morning and each person would list to everyone else who they were going to see and what type of visit it was, or what clinics they were running, what GPs they were meeting with, etc. Which seemed like a good idea in light of how much wasted time I saw elsewhere. But nobody made any kind of record and everyone's diaries were personal written ones, not shared electronic ones. Despite having the right tech to go electronic. So really, everyone just spent an hour listing visits in the hope that some of it may have stuck.

So I suppose my question is, during your HV training, is there any focus at all on structuring your day/week in such a way as to not haemorrhage your time everywhere? Or are there any repercussions should individuals repeatedly and persistently fail to fill their days with the visits and meetings required of them? Is anyone even really checking on an individual level rather than a department level?

@redrobin1001 I do understand that but there are many parents that aren't competent and don't recognise the problems and there are some that are good parents but can be in denial that there's a problem. Offering a service to everyone is the only way to pick some of this up.

@Arlothe7footdinosaur I think baby led weaning is fab, I did it with my own dc, I'm always surprised when I hear other HV pushing purée weaning. I couldn't care less whether women breastfeed! I care that women that choose to bf get support and those that choose not to bottle feed safely. You'd be surprised at what people add to bottles!

@ElderlyKoreanLady there is no specific training on time management. In our trust we use electronic shared diaries for our safety apart from anything else because someone has to know where you are.

In our trust we use electronic shared diaries for our safety apart from anything else because someone has to know where you are.

That's something at least! One of the teams I was with had a safety book but its usage was a bit hit and miss. Another wore security pendants. Those were fab but getting the batteries replaced was such a hassle that people often put it off for weeks. Hats off to you, it's got to be ropey sometimes being a lone worker in a profession that isn't exactly universally loved.

My HV was fab and a huge source of support, so thank you to you. I feel like it's the done thing to dislike HVs in my area but I honestly can't fault mine!

What do you think could be done to improve breastfeeding rates?

Hi. So do you presume parents are incompetent when you visit for the first time and it is our job to prove otherwise to you?

Interesting thread. I have to say, the HV we saw was the "weakest link" in an otherwise exceptional, positive experience of ante-natal, birth and post-natal care. I'm foreign so I wasn't sure what to expect of the HVs, and this thread makes interesting reading.

Ours came to our house on day seven, and we had to hang about all day because no one would give us even a vague expectation of a time. Then she watched me BF, told us she was happy to see books for DD near our bed, and took a very detailed family tree of both sides. At some point she asked us how to spell "Russia". She was due to come back (within a month, I think?) but didn't.

I was so baffled by the experience.

From my own experiences and the experiences of others it seems like a lot of the issues that people have with health visitors stems from the lack of honesty around what the role of a HV is - while they have a health function their main role is child protection and the fact that that isn't made clear I think brings about a level of mistrust and suspicion that isn't necessary. A lot of the mothers I know expected their HV to have a level of knowledge and expertise around the various technical/medical aspects of parenting that HVs just don't have because that's not what their training is for and so that created a real confusion about the HV was 'up to' - why is she even here if she has no clue about this? I think if it was made clear that HVs are there to monitor children and ensure they're not unhealthy/neglected/abused, and to ensure that the parents aren't struggling, then I think HVs' role would at least be clearer to parents. I think the disingenuous idea that HVs are friendly neighbourhood nurses just there to help is really patronising tbh - the role of HVs in keeping children safe is a really important one and there's no need to hide it IMO.