Finland to United Kingdom to Bahrain

MANAMA, Bahrain—There could be no greater contrast than between the lush greenness and clean air of Finland and the scorched, dehydrated, and dusty landscape of Bahrain. That contrast is even more striking when you have only 24 hours between the two places with a very short visit home. The visit home was even shorter than planned, due to being stranded in Helsinki by one airline, having to transfer to another airline and another city in the UK, and finding my way home after public transport was closed. Such are the joys of international travelling, which some look upon in envy. As ever, I thoroughly enjoy what I do around the world, but the process of getting there can be tedious.

Finland

I was in Turku, as I was last year at this time, to give sessions on writing for publication to postgraduate research students at the University of Turku. This time, it was a Journal of Advanced Nursing (JAN) show, as I was with fellow editor and Hull colleague Mark Hayter, PhD, FAAN, professor of sexual and reproductive health at the University of Hull. The sessions were enjoyable, and the students interacted well.

The weather was fantastic, the food excellent, and it is always good to catch up with international colleagues. If there is a link between Turku and Bahrain, it is the open-access journal I edit, Nursing Open. One of the editors, Riitta Suhonen, PhD, RN, works in Turku, and, here in Bahrain, I am with Seamus Cowman, PhD, FAAN, who is now head of nursing at RCSI Bahrain, affiliated with the Royal College of Surgeons in Ireland (RCSI). Cowman is another editor of Nursing Open and, incidentally, the first Irish nurse to be elected a fellow of the American Academy of Nursing.

Bahrain

Bahrain continues to develop since my previous visit and, despite the desiccated landscape and dusty Middle Eastern backdrop, it has paradisiacal elements as land is reclaimed along the coast and small, exclusive communities emerge. I should be used to living in hotels—not all of which are five-star, believe me—but the luxury of the Gulf Hotel, Bahrain, and the tranquility and service of its Platinum Club provide an insight into a lifestyle that, but for generous hosts, I will never be able to afford. The dilemma is: Do you eschew it for fear of getting used to it and missing it; or do you indulge, knowing it will rarely be on offer again? As I stare out over the night lights of Bahrain from the top floor of the hotel and the waitress pours me another (free) drink, I think you see how I solved the dilemma. I’m going to miss this one day!

The purpose of my visit to Bahrain is to work as an external examiner on the master’s in nursing programme at the RCSI. I examine the same programme in Dublin, and part of the job is to ensure that the same standards are applied in both locations, on behalf of the RCSI and on behalf of the National University of Ireland, which is the degree-awarding body.

The Nursing Open theme continues, as one of the editorial board members, Catherine McCabe, PhD, RN, assistant professor, Trinity College, Dublin, Ireland, arrives today in her capacity as external examiner for the undergraduate nursing programme. I am very pleased that my contract has been extended for another year and that I will also be starting as an examiner next month at Sultan Qaboos University, Oman. By sheer coincidence, my fellow examiner is none other than Cowman from RCSI. The Honor Society of Nursing, Sigma Theta Tau International (STTI), is represented here by the relatively newly formed Rufaida Honor Nursing Society, which is seeking to become a full chapter of STTI. Catherine O'Neill, senior lecturer, RCSI Bahrain, played a major role in establishing it, along with local colleagues.

Running, climbing, and football

My efforts to get out on the rocks are being thwarted by an inordinate amount of travel, both in and out of the United Kingdom. This is probably the busiest year of my life. However, I continue to train indoors, and combine rock climbing with running. Finland was a joy to run in, but my 0530 run today in 30 degrees Celsius (86 degrees Fahrenheit) to avoid the sun, had me almost at my physiological limits. I don’t understand why this should make your legs feel as if they had lead weights attached. In addition, the expatriate workers waiting for their transport to work shared incredulous looks as I panted past. To make a living, they are forced to work in this heat. I could be in bed in an air-conditioned room.

Finally, the UK football (soccer) season has ended, and the highlight of the English season, the Football Association (FA) Cup included, for the first time in the club’s 110-year history “The Tigers,” my local Hull City team. The match was played at Wembley, the 90,000-seat national football stadium in North London. The opposition was the mighty Arsenal, a North London club, and 25,000 of us made the journey south to watch the game, including the three Watsons pictured.

We lost, but only after taking a 2-0 lead and taking them into a period of extra time. Nobody expected that, and I think we were happier than the Arsenal fans. We stayed to see Prince William award the FA Cup runners-up medals and departed, elated. My voice took a week to recover, and I look back on what was, surely, a once-in-a-lifetime experience.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

The cabbie test

HULL, United Kingdom—Wherever I go, cabbies (a UK expression for taxi or cab drivers) are never backwards at coming forwards with their views, whether in London, Dublin, Washington, D.C., or my hometown of Hull. Race, religion, or politics—no subject is off the agenda, and they tend not to care what your views are; only giving you theirs. I have twice had vociferous views on nursing expressed to me, always with frank disgust at the thought of nurses going to university.

Many years ago—1999 to be precise—I was the first professor of nursing in Ireland and part of a government committee charged with the task of establishing nursing degrees in that country. While en route from the Dublin airport to my apartment, the taxi driver asked what I did. I told him, and he “let fly” with a stream of invective about the move of Irish nursing education into universities. I thanked him for his views and took a mental note never again to tell a taxi driver what I did, exactly.

However, this week, on my way home from the railway station, lulled by a false sense of security, I told a taxi driver my occupation—and promptly regretted it. He had, at one time, worked as a nursing auxiliary, and his view was that everything nursing stood for had been lost with the move of “nurse training” into universities. My mind drifted to gratitude for that “loss.” I, too, used to be a nursing auxiliary, and I recall patients tied to chairs; tea, sugar, and milk being served in the same pot; medicines being forced on patients; and stealing from clinical areas on an industrial scale. But I kept quiet; I just wanted to get home to bed.

I have decided to inaugurate a new test—the “cabbie test.” Cabbies seem to be a barometer for the extremes of public opinion, and the opinion expressed by my drivers is not uncommon amongst the UK public. I rarely meet anyone who is glad about nurses being educated in universities, and I reckon that, even if public opinion were changed, we could not be sure it was permanent until a taxi driver asked what I did and then expressed support for university-educated nurses. When that day comes, if ever, I’ll know that a major milestone for the image of nursing has been achieved.

Running and climbing

I mentioned in my last entry that, for months, I had not broken 22 minutes in the local Saturday-morning 5 kilometre race. Well, last weekend I achieved a time of 21 minutes and 2 seconds, beating my daughter, who is an army physical-training instructor. Competitive or what! I now have 21 minutes in my sights, and, since Christmas 2013, have put the first 1,000 miles on my GPS watch.

My oldest daughter is a rock climber, and she borrowed some equipment from me this weekend to do some real climbing. During these cold, wet months, we mainly climb indoors, but my daughter—a cardiothoracic intensive-care nurse—is clearly getting outdoors. I’m keen to follow. A day on the rocks, with its unique combination of pain and terror, is one of the best forms of meditation available. It will take my mind off cabbies.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

Inane matters

CORK, Ireland—A short break from this blog has given me time to do the first full entry on the brand-new Journal of Advanced Nursing blog, which has had more than 400 views since June. I also publish our newsletter for the Faculty of Health and Social Care at Hull as a blog, and my own blogs have been updated. I was pleased to see that my “Four things about ... (a simple approach to anatomy and physiology)” has had more than 84,000 views. Forgive the blatant plug!

Since my last entry, I have been: 1) enjoying some extreme weather in the United Kingdom (30 degrees Celsius, or 86 degrees Fahrenheit, is considered extreme in the U.K.), 2) working hard on a research-grant proposal, 3) rock climbing, and 4) running—poorly—in a set of league races. My work as editor-in-chief continues, and it has brought me to Cork, Ireland for the annual meeting of the International Academy of Nursing Editors, a group that suffers from the acronym INANE.

This is my first time at INANE, and I was asked to chair an early morning “Town Hall” meeting on hot topics in editing. We covered several topics, including open-access publishing, succession planning for editorial positions, and the training that those new to editing might require. INANE is a truly international organisation, and this meeting, hosted by the Department of Nursing and Midwifery at University College Cork, attracted more than 100 people—mostly, but not exclusively, editors from 16 countries.

This is the first of three weeks of travel. After returning to the U.K. from Ireland, I will spend a week in Taiwan and the following week in Australia, which is where my first contribution to Reflections on Nursing Leadership magazine, the progenitor to my “Hanging smart” blog, was written. Naturally, I intend to send my reflections on these visits.

I rarely visit Taiwan without some hilarious incident, usually at my expense. For example, a few years ago I sent some clothes to the local laundry, which phoned my Taiwanese colleague, whose cell phone is always on speaker, to enquire if I wanted my underpants (“shorts” in the United States) pressed. The secretaries in the open-plan office were unable, despite considerable effort, to suppress their laughter. When the exchange was translated to me, I laughed, too—eventually. I will be surprised if there is nothing to report next week.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

A quick visit to Rome

ROME—Frequent visits to Italy make me appreciate my proximity to continental Europe. Running along the banks of the Tiber at 6:30 a.m., with Rome waking up around me and the sun already burning the top of my head—much less protected by hair than it used to be—is one of the most memorable things I have done this year. Rome is beautiful. It certainly represents no hardship to visit these visually stunning and deeply historic places, so easily accessible from the United Kingdom.

I am here at the invitation of Gennaro Rocco, president of Ipasvi (Nursing Board of Rome) to deliver a paper, “The ethics of publication,” at the Ministero della Salute (Italian Ministry of Health). Rocco is the epitome of Italian style, manners, and leadership. He has been elected to his presidency for more than a decade, and his vision and drive have helped Ipasvi establish a Centre of Excellence for Nursing Culture and Research.

My role at the Centre of Excellence, along with other international advisers, has been to provide advice on academic publishing with a view to helping Ipasvi develop the first Italian academic nursing journal. Once again, I have been reflecting on why I am here and why I should be so lucky to visit the capitals of the world, to work with the cream of international nursing, and to do so at no expense to me or my university. Another chance encounter, the subject of a recent post, played a part.

In 2004, I co-organised a symposium on quantitative methods in nursing research at the annual International Research Conference of the Royal College of Nursing of the United Kingdom. The symposium was well attended and very well evaluated. However, the most important outcome for me was my first meeting with Alvisa Palese. Flamboyant, immaculate, and affectionate—in a word, Italian—she enthused about the session, and I have been in contact with her ever since. She is now my PhD student at Hull. This contact led to a regular series of workshops delivered to Italian postgraduate nursing students in Trieste and Genoa. These students are pioneers, especially the doctoral students, as doctoral-level education for nurses is a fairly recent development in Italy.

This has been a very short visit, but one worth reporting on, as I think that the Centre of Excellence for Nursing Culture and Research is going to become a major force for nursing change in Italy. There is such a centre in Spain, which is similar to, though slightly ahead of, Italy in development of nursing education, but I know of no other centres like this anywhere in the world.

What struck my U.K. colleagues and me most was the integration and common purpose amongst nurses engaged in professional regulation, clinical practice and education. I have also witnessed this in the United States and Australia. Sadly, in the United Kingdom, there is a void between clinical practice and academia, and our regulatory body is not especially proactive in developing the profession. We were there to advise, based on our experience, but we would give a great deal to have a Gennaro Rocco in our midst, and I envisage a day, not too far away, when senior Italian nurses are advising us in the United Kingdom. Moreover, I welcome that day.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

'You have to have an assessment!'

HONG KONG—I am easily irritated by what I take to be stupid comments or questions, especially ones that convey a bureaucracy with which I don’t agree.

“You have to have an assessment” was the response in Hong Kong when I tried to use an indoor climbing wall.

“But I’ve been climbing for nearly 30 years,” I replied.

“You have to have an assessment!” was the firm response with that “the-issue-is-now-closed” look that the charming but invariably inflexible person behind a desk in Hong Kong conveys so well.

“Can I have an assessment?” I asked, conceding that safety is an important issue and that they had no proof I could climb safely.

“You have to make an appointment” was the reply, at which point I turned and walked out, deciding that my training regime would have to be suspended during this trip to the Far East.

The incident reminded me of a friend who graduated as a nurse in the United Kingdom and, after moving to Hong Kong, was required to pass a local exam prior to practicing. As she had graduated from my own alma mater (Edinburgh) and from the school where I first taught, this offended me ... until!

We do exactly the same in the United Kingdom to all incoming nurses; we even ask native English-speaking nurses (North Americans and Australians) to take an English language test (IELTS or TOEFL) to quite a high standard before they can register. They also have to have a period of induction prior to practice. The Australians have reciprocated by insisting that incoming nurses also take an English test, including native UK nurses.

I have mixed feelings about the need for all this assessment and for the resulting assessment industry that has grown up around it (a view I won’t be expounding on too much at the reception I’ve been invited to attend by the Commission on Graduates of Foreign Nursing Schools during the upcoming meeting and annual conference of the American Academy of Nursing in Washington, D.C.). I can see that safety is paramount, and guaranteeing the competence and educational level of everyone arriving from a foreign country with a nursing registration is crucial and, probably, impossible without a formal approach. However, when I arrive in Washington, DC, as I could do here in Hong Kong, I can produce my driving licence and hire a car with the likelihood of killing a great many more people than if I turned up to work as nurse. This is only an analogy. Nursing is infinitely more complex than driving, but the principle applies, and I see no efforts in any country to streamline and accelerate the processes.

I have no solution to the problems encountered by nurses who wish to migrate or just gain experience outside their own country. In fact, I can acknowledge that there is a need for some “barriers” to free movement of registered nurses. I know very well how a rash of scandals involving non-native nurses in the United Kingdom leads to calls for tighter regulations. In addition to protecting patients, these regulations protect the nurses from beyond our borders who are practicing safely and making a major contribution to our National Health Service. All this is notwithstanding the fact that registered nurses from anywhere within the European Community can work in the United Kingdom without let or hindrance, including an English language test.

So, I did not manage to do any climbing in Hong Kong. But if you have read this entry to my blog, I hope you will think I have made reasonably good use of the time that was freed up.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.