letter to a newly qualified nurse

Today I have had the pleasure of speaking to Salford universities latest batch of staff nurses. It was also a timely reminder to myself that exactly 20 years ago I was also starting off as a nurse of the future.


Wouldn’t it be fantastic if you could travel back in time and give yourself some tips and advice, well I’ve tried to do just that and here is my letter to myself on my 23rd birthday on the 24th of September 1994, 2 days before I qualified and embarked on my career. 

 Letter to Karen Dawber 24th September 1994

Dear Me

Yes this is you talking to you, 20 years after qualifying, for once in your 20’s sit back and take notice.

Firstly you are going to love the future, mobile phones, internet, fast cars, free view TV, box set binges, Starbucks, subway ……… it’s amazing!

But back to the reason for this letter.

Over the next 20 years you will have some of the most exciting and heartwarming moments as well as some really tough times when you get things wrong. Remember getting things wrong isn’t a reason to punish yourself or sulk it’s an opportunity to learn and do better.

Some days you will want to walk away from work and never come back, some days work will be so wonderful you won’t want to leave. Here’s my top list to you…..

1 – Eating 5 rounds of buttery toast is great at 5am when you are on nights to give you a boost before 6am obs, unfortunately it will come back to haunt you so for gods sake eat a grapefruit instead. Same can be said for Chinese takeaways, full English at a weekend and boxes of celebrations (sorry you’ve not heard of them yet I mean Roses)

2 – Not everyone will like you all of the time, if you expect every person you work with and every patient you ever meet with to strike up an instant rapport you will be disappointed. Don’t try “too” hard but always try your best.

3 – Working 13 nights on the trot is great for extra money for holidays but remember you need to take regular breaks – save up over the year instead & by the way someone will fess up in years to come that you are very grumpy between 3am and 5.30.

4 – Choose your role models well, look at who you want to be like and gain as much from them as you can. But then make sure you give something back and be a role model for others. Remember to thank those that help you, believe it or not you will be thanking them still 20 years from now.

5 – The NHS will change more in the next 20 years than any time in the history of the NHS. Be ready and prepared to make a difference and stand up and be counted. There are times when you won’t understand what’s going on but Trust me nursing leadership and compassionate practice will be at the forefront of every nurses agenda.

6 – Society will change, advances in technology will allow people to be better connected and better informed. Doctors and Nurses will no longer be free from question and scrutiny – there will be a time when the “angel” Halo slips and new words will come into your vocabulary: mid staffs, Francis, C. difficile, morecambe bay, 6 C’s, monitor, CQC, whistle blowing.

7 – Everything usually happens for a reason, there will be times when you think how on earth did it end up like this. Just remember as long as you reflect (yes I mean it fill the diary in – don’t wait till 2009) it’s really useful. Also, Karen, you are not always right, you will make mistakes, we call it human factors.

8 – No matter how tempting, doing early / late at a weekend does not mean you can go out clubbing on the Saturday night (ps you are gonna love Karaoke)

9 – never forget and never forget to remind others of the privileged position you are in, you will experience both the best and worst types of human behaviour and emotions, you will know peoples deepest fears and secrets. Don’t take everything at face value and remember no one comes to work to do a bad job. Everyone has a right to be treated with respect and dignity

10 – most importantly listen, listen to yourself, patients, families, staff absolutely anyone, actively listen and hear what is being said. You will learn more sat having a chat with a patient than you ever will taking a blood pressure or temperature. Knowledge is a gift, never stop learning.

You are going to be really successful and love your job, you will have the opportunities to make a difference to individuals, groups, wards, hospitals and entire communities. Remember how you feel today and how proud you feel for the rest of your career, I wish you luck I know you won’t let me down

Best wishes


PS – taking advantage a bit here……….

Don’t buy the BMW cabriolet – it’s a shed and will cost you a fortune
Don’t even think of getting married (yes you will be able to) until someone different comes around!
That holiday offer for the “vacation club” is too good to be true – save your money
Be careful of the speed camera on the A666 and chorley new road – and bus lanes and jumping red lights in Liverpool

To all the nurses out there, especially the newly qualified and students, good luck and just stop and think what the world will be like 20 years from now…… Trust me it creeps up on you 🙂



LGBT Elderly Care Awareness

An off the cuff conversation and a timely tweet on twitter got me thinking the other day.

The conversation was about tattoos and that, now old adage, “what will we look like when we are in our 80’s?”. Well the answer was pointed out to me “like everyone else” so from being the minority with tattoos (especially women) it’s almost an exception to see 20 something’s without tattoos. How times change.

The tweet was about LGBT and dementia awareness, the suggestion was made why don’t i do a blog so here goes.

I identify as “lesbian” and have been open about my sexuality since the age of 18. Before that, from the age of 15, I frequented the only place that I believed would have like minded people, the one and only gay bar in town. A far cry from the busy canal street in Manchester or other now trendy “gay districts” in every city. 

This was the mid 80’s, AIDS / HIV was a new term and widely known as the offensive “gay plague”, you looked twice before you went in the door of the pub and once in their would still be subject to the “dares” of stag night parties and the odd brick through the window or offensive graffiti.

Once in the bar playing cards, dominos, pool, chatting would be ordinary people having a nice night, albeit a little secretively. I remember the lady at the bar, always in a tux on New Year’s Eve, and in her mid 50’s, the 2 guys that had been together for 25 years but still unable to be open about their sexuality at work.

If you bumped into someone around town, from the “scene” you would nod say hello, but we all kept up the front of a law abiding heterosexual, no hugs and kisses and definitely no flamboyant gestures.

So why is my little trip down family lane so important?

In 1967 the sexual offences act, in England and Wales, decriminalised homosexual acts between consenting men over the age of 21, exceptions to this, the armed forces and the merchant navy. A longer wait for the same in Scotland (1980) and Ireland (1982). What about ladies you may ask? Well (apparently) queen Victoria did not think ladies could do such things so it was never actually illegal to be a lesbian, although publically and for many years all homosexual acts were considered wrong and continued “underground”.

I got to thinking, all those people, I remember so fondly from my youth, are now in their 70’s, 80’s and 90’s. The early parts of their life was spent in a society that did not recognise them or respect their sexuality, partners would be “the friend”, “the lodger” or even the person no one ever mentioned.

I was talking to a lady a while ago, she was in her 90’s and went to great lengths to tell me about her friend, they lived together and had done since the 1960’s, both professional women. The ladies “next of kin” though was a great niece and all liaison about on going care and discussions were had with the niece. The “friend” was told 2nd hand and staff did not even think to have direct conversation with the friend. But then again, the lady insisted that the discussions were had with the niece and not the friend. I may be seeing something that is not there, if not a couple, the ladies had lived together for 50 years and obviously loved each other very much.

So here’s my dilemma, part of me wanted to shout “it’s ok you know, I understand” but then part of me thought if this is what makes everyone comfortable then so be it. After all for over half of their life to identify as same sex was socially shunned and illegal and could result in prison sentences.

So those role models and LGBT friends from my youth are now, probably, accessing mine and your hospital services, as young adults some had secret lives and were subjected to bullying and even imprisoned. Should we treat them differently or go to great pains for them to be able to identify? I don’t think so, we should treat everyone with, dignity, respect, kindness and compassion whilst being aware of the history, context and times people have lived through. Most importantly we must never judge or allow anyone to feel uncomfortable. 

You may think why the big deal, everyone is fine now. Well here is my modern day example…..

“Your next of kin?”



“Civil partner”

“Oh yes, yes, thats ok, that’s nice”

Well yes thank you, I think I kind of knew that 🙂

I really don’t know the best approach to older LGBT, especially if there is some cognitive impairment, but i would love to hear suggestions, after all in another 40 yrs it will no doubt be this elderly lesbian (with wrinkly tattoo) wanting compassionate care.




another reason why I love my job

Ok I know I have been a very poor blogger recently and time is so precious it’s sometimes hard to fit in. So what can I do watch BGT or write about something I’m passionate about?

Well the choice has been made, let’s put some passion back into the blogosphere!

Nurses day 2014

May the 12th, as some will know, was nurses day, @WHHNHS we celebrated this with cakes and a group photo outside out Trust HQ. Associate Directors of Nursing in their “ceremonial dress” …… What do you think, stay or go?

But also what a fantastic, happy, smiling, proud and dedicated group of nurses.

Now here’s a shot that could be 50 years ago…….

Ceremonial Dress

This happy trio certainly brightened up the wards for lots of staff, patients and visitors, almost all comments positive and created quite a talking point.

So what else has spurned me to start up my blog again? Probably one of the biggest change I’ve ever seen in my time as a nurse, I’m not talking about changing services, buildings or staff I’m talking about the “social movement” that’s been ongoing for the last 18 months. Real cultural change that is leading to visible and measurable impacts for our patients with Dementia and cognitive impairment.

On Thursday our “forget me not” ward opened, bringing together all of our hard work. When previewing the ward for the first time I was moved to tears at what we have accomplished and what an amazing, fantastic environment this will be for our patients.

Now I won’t choose to write this in my own words but share the briefing that my senior teams done, it tells our story and the journey we have started, it will never end as we will continue to grow and make improvements. They describe it far better than I could do justice!

Forget me Not and Fiddle muffs Master_1.docx 

So I think I am right to say this has been an exceptional week, exceptional weeks only happen with exceptional staff.

On this week, of Florence Nightingales birthday let us always remember Flo’s words

“The very first requirement in a hospital is that it should do the sick no harm”

I think if we stick to that for basics, we won’t go far wrong!

A massive thank you to all the staff @WHHNHS you do an amazing job, day in and day out.


keeping promises – What’s red and white and sits in a corner?

A few weeks ago I was asked to write a blog post on reflections of being a student nurse, a few moments ago my daughter asked me when I was doing my next blog, so that was the prompt I needed to keep my promise.

In early 1991, aged 19, I found myself going from job to job and finally working behind a bar in the local pub, now anyone knows the local barmaid is agony aunt, excuse maker, peacekeeper as well as server of drinks. I also realised that I loved talking to and interacting with people so like a bolt out of the blue I thought I know I’ll be a nurse, my gran will be proud of me!

So I can remember the entrance criteria was O levels or GCSE’s and I applied to “Bolton and Salford College of Nursing”. The interviews were held over a day at peel house, a tower block in Eccles, we had group exercises and then a 1 to 1 interview. Following that we had to make our way over to Hope hospital (Salford Royal) for medicals.

I had applied for mental health and general nursing, I was given the choice and in October 1991 I commenced on the mental health branch. Remember at this time Salford Royal was still a hospital and not flats (and you had to wear a hat) and Bolton still had 2 hospitals, the Royal and the General. 

I can honestly say I did not know what I was letting myself into…………

On the first day just over 100 students sat in a room and we were all welcomed and told that we were the “managers of the future”, unbeknown to me we were the third group of project 2000 students a new way of nurse training. I remember going home and thinking what on earth is project 2000?

So for the first 18 months we all “learnt” together with a very generic training, each term had a theme, starting with well being, then going through different stages of ill health and age ranges as the training went on. We also spent a large chunk of our training in the community, with health visitors, district nurses and school nurses. When I first hit the wards, I think term 2, I began to understood the difference between P2K and “traditional” training.

On my first ward placement I (and most of my colleagues) had a mixed welcome, from excellent and welcoming to hostility, the reason for the hostility? After our 3 years training we would qualify with a diploma, there was still “traditional” 3rd year students on the wards and the staff were all “traditionally” trained. We were also “supernumery” and we were encouraged to challenge and ask questions, remember at this time 3rd year students could be in charge on nights and included in the ward numbers.

In fairness I can completely understand, now, why staff reacted to us in that way, we appeared in droves, asking questions and remember we had been told we were the future of nursing (and some really believed that and told everyone mmmmm).

Our uniform was white, with red belt and epilettes, we stuck out like the proverbial sore thumb, hence “what’s red and white and stands in the corner?” …… “A project 2000 student”.

More than 20 years on, I am still told “well that project 2000 was the downfall” until I politely remind that I was one of the first P2K students, the usual answer is yes well your more like a traditional one!

Academically we were expected to study and spent 1 day a week at Salford University, the rest of the classroom work was spent at Peel House, we had been split into 2 halves and this made us either “am or pm”, so when in college we actually only went for half a day the rest of the day was for personal study / course work etc. 

I was the morning group and for the first year of my nurse training this suited me very well as I could work night shifts in a nursing home to supplement my income…… Sorry if I ever fell asleep in your lecture, it wasn’t that I was bored! We got paid a bursary of £360 per month with £10 a week for travelling expenses, so the agency work was a bit of a necessity on a positive note I remember we were exempt from “poll tax”!

During my first term I met someone who became my first ever role model and mentor, probably still to this day one of the most professional and intellectual nurses I’ve ever met, you know who you are and if you ever need to understand nephrotic syndrome or pharmacology she is your women!

I look back now in amazement to think I was nearly 20 years old and exposed to a range of experiences that would make you laugh, cry or just be lost for words. It worries me now that we expect relatively inexperienced nurses to deal with, death, terminal illness, abuse and patients friends and families at there most vulnerable. I don’t think any class room teaching will ever fully prepare you for that but high quality mentorship and hands on care in partnership with the theory is a must.

During the first 18 months I had my first exposure to an acute mental health ward and realised that I could not see myself working primarily in mental health. I also had, possible the best experience of my student days, a placement on the acute paediatric ward at Bolton General, I loved it and decided that I wanted to be a children’s nurse. Sounds easy but we had already made our minds up and been “branched” when we started, so I had to apply to change, luckily (for me) someone had dropped out and a place was free, so I found myself in the summer of 1993 on the child branch.

I’m going to blog about the second half of my training next time, but if anyone wants to ask any questions, feel free to comment and I will try and cover next time.


November the month for remembering

November has started and already the nights have drawn in and the temperature has dropped to single figures, Christmas adverts are on TV and Ellie is on her 20th draft of her christmas list, oh dear looks expensive!

But November for me is all about remembrance, remember remember the 5th of November, remember those that fought for our country on the 11th and this year, November 26th, will be the first anniversary of my grandmother, Elizabeth “Joan” Dawber death.

I can honestly say that not a day goes by when I don’t think about my Gran and the profound effect she had on my life, she was my role model, my inspiration and my hero. My gran was a registered nurse, midwife, health visitor and district nurse, quite a collection. My gran took part in the trials of the BCG vaccinations and stacked babies in linen cupboards during the blitz to protect them from falling bombs.

My favourite memories include going for long walks around Rivington, listening to the stories from the war and nurse training, blackberry picking and child hood trips to Devon to visit my Uncle Ronald’s Farm. I have my love of family, the out doors, history and nursing because of my grandma. I love you and I miss you gran.

But I suppose I am lucky, I had almost 42 years of my gran, she lived to the ripe old age of 94, everyday we see on the news young men / women needlessly killed or dying too young defending our country, today on Remembrance Sunday we are reminded of all the fallen soldiers and those left behind. I am blessed and humbled by others.

So when the 26th of November comes round I am not going to be sad, I am going to be thankful and celebrate the 42 years we had together. I am also going to focus on the living and the future and making things better for those that I can influence and make a difference for. From this year on I will no longer be making new year resolutions but grandma resolutions, these are mine:

  • Pip, I love you and I know I can be a pain, untidy, demanding etc, I promise to be by your side forever and to start picking up my PJ’s from the bathroom floor and un balling my socks!
  • Ellie, I love you too, you are my only daughter and I can’t put into words how you make me feel, especially when you run up a £200 iTunes bill or a £70 xbox bill! I promise I will look out for you and love you and support you no matter what choices you may make
  • Dad we are very similar, we both miss Gran, I promise to be more tolerant, but you do try the patience of a saint sometimes 🙂
  • Finally, to every person who comes into my care or sphere of influence, I want to be able, in years to come, that everyone receives the standards of care I would expect for my Gran – the 5’Es – from essential to excellent, or in grans days from the linen cupboard to improving the public health of future generations.

So please join me in remembering but also to looking forward and making a difference, life is too short to have regrets, if you love, admire, are proud of someone, tell them it’s far better to share the moments in the here and now than anecdotally when it’s too late.

Get hold of every day with a new beginning and a sense that we can make positive changes and do our very best. I don’t want to be remembering the NHS in future years I want to be living it, breathing it, working in it and eventually being cared for in it.

RIP Elizabeth Joan Dawber, you are loved and missed by family and friends and will never be forgotten.



witches, ghouls and a bit of Elvis

Well I promised myself I would write a blog a week, oh the best laid plans, but here I go again in an attempt to get going. Over the last few weeks I have learnt more than ever before that family time is precious and you can’t turn back time or even pause it.

Over the last 12 months I’ve been on a “bus mans” holiday with my partner whilst under going some tests, the test results are finally back and although not immediately life threatening we will have to change plans for the future and adapt our lifestyles. Pip has just been diagnosed with multiple sclerosis.

So this made me think how often do we give diagnosis or “bad news” to others and do we really know how it feels to be in their shoes? If you asked me a year ago, I would have said absolutely now I’m not sure, but I know from now on I will try to take the right approach for that individual, one size doesn’t fit all.

So what have we done differently so far? Well everything, we’ve just got back from 4 days at haven in Wales, the weather was truly awful, the entertainment interesting and was full of kids, families dressed up in all manners of spooky costumes.

Ellie dressed as a witch and won the best dressed girl and then the following night won the “Kay T Perry” tribute act dance off. However, confidence took a severe dip when entered “Haven’s got talent” when she got severe stage fright and burst into tears whilst singing defying gravity. So on steps mum, thinking I’ll do it for both of us to cheer her up, guess what, Ellie then ignored me for 2 hours because I got through to the grand final! Back to those good intentions again 🙂

I was forgiven though later, at the final, when my number one fan screamed at the front like she was at a one direction concert, thank you Ellie.

As for pip, she’s walked, albeit with the aid of a pram or a stick at times and danced on the dance floor until she could barely move, maybe not as slick and coordinated as she once was but still a star and an inspiration.

I also met up with “lost” and new family, something I should have done 7 years ago, thank you for pursuing me back into your life and lets never loose touch again. So family is really more precious than anything else but family can sometimes cross over to our professional lives too, the trick (or treat) is to harness the experience and knowledge to do our very best.

Any way, for one night only, I’ve tweeted the link to Karen does Elvis (I couldn’t work out how to cut put it in blog) https://twitter.com/karendawber/status/396751149845729280 Enjoy!

BTW I def will not be giving up my day job lol but may do a further “gig” for children in need…….. But the price would need to be right!!!!!! 


autumn a time for change

ADNS Alison Lynch,Doing the housekeeping and introductions – keeping me organised!

I always feel that the month of October is a month for changes, the trees are loosing leaves, animals are preparing for hibernation, the nights are getting darker and the weather is, finally, turning colder.

In the world of a hospital new students are starting, newly qualified staff are starting and the types of patients coming through the doors change too.

At Warrington and Halton NHS FT October has seen a few significant changes, all, I hope, for the benefit of patients, staff and the local population. The nursing strategy has been launched, the 5E’s – From Essential to Excellent, we are working to change and improve the standards of care and we are seeing real, tangible results: pressure ulcers falling; falls reducing; good friends and family test performance.

Wednesday was also our first (hopefully to be annual) patient safety conference, the day was well attended by over 100 staff and we were honoured to have a range of speakers: Elaine Inglesby – Burke, DNS at Salford; David Fillingham, AQUA; Dr Jackie Bene, medical director at Bolton Royal; colleagues from Hill Dickinson law firm; internal speakers and closing remarks from Gill Harris, Chief Nurse North of England.

But this wasn’t your “bog standard” talk and chalk or death by PowerPoint, we heard some very personal and inspirational stories from a range of dedicated and engaging speakers. Over the next few weeks I will attempt to bring some of these sessions to life in my blog, hopefully I can share some of the important messages, all within the context of patient safety and service improvement.

In the afternoon we had our own version of “speed dating” lots of different stands and initiatives covering a range of subjects and topics from infection control to safe maternity care and early warning tools to mortality data. One thing in common was the joint enthusiasm, willingness and drive to make improvements across a range of disciplines for the benefit of our populations, staff and patients 


The launch of the “NEWS”

So what else have we changed this week, well our wonderful staff health and well being team gave on average 1 flu jab  every 3 minutes with over 700 staff vaccinated in the first week of the campaign, we have seen unprecedented demand for flu jabs, probably due to a well run awareness campaign by Clare Blackman and her team.

So what are my final thoughts on the end of this week and the start of a new one? Well I hope to keep the energy going from this week into the next week, but also take time to consolidate our learning so that it becomes embedded in the organisation. One key message to pass on? Never stop looking for ways of understanding the quality of your care and always be open, honest and learn from your mistakes.

Oh yes and how to insert pictures properly!!!!

48 hours and counting

Well after the roller coaster week of last week I am resting up this weekend in preparation for what may well be the biggest week of my NHS career to date.

On Monday we will be launching our nursing strategy, “the 5 E’s from essential to excellent”, this is following an extensive review of our previous nursing strategy and lots of input from staff, governors and board. Based, loosely, on Maslows hierarchy of needs the strategy describes how by behaving in certain ways we can all go from essential to excellence in the care that we give.

I hope the nursing staff @WHHNHS embrace this and use it as the building blocks for the future. I believe in this and so do the 20 senior nurses that turned up, in uniform, on mass at Board this week to support my presentation and the proposal to board to adopt the strategy

Wednesday will be our first safety conference, held on the Warrington site, with internal and external speakers. We are lucky to have David Fillingham (AQUA), Gill Harris (chief nurse north) and Elaine Inglesby the inspirational director of nursing at Salford, to name but a few speaking.

The conference is the result of learning from a tragic event, several years ago, when a patient died in our care. As a result of this the entire organisation embraced change to make things better and completely review how we manage patients coming into our hospital. Great learning but also a reminder of the impact we have when things go wrong and to make sure this never happens again. Or as the senior nurses mantra goes “not on our watch – never on our watch”

In the afternoon, expertly planned by Alison Lynch, we will have “speed dating” a run through of stands with different groups of staff showcasing their involvement in patient safety initiatives, everything from work around mortality to falls prevention and so much more.

There might also be a few surprises so watch this space and watch my twitter feed @karendawber on what I hope will be more of a rocket week than a roller coaster, here’s hoping and of course starting the week with all of those “good intentions”

Good intentions

About 8 weeks ago I decided to write a blog, as with most ENTP’s I wanted it now! In true “Dawber”style, when excited about an idea I collared Chris Horner and insisted that he dropped everything to show me how to do it. Unfortunately, with all good intentions of doing over the weekend I did a million and one other things first, so sorry Chris 🙂 but here it is.

So I suppose my theme on this roller coaster week is good intentions….

No one comes to work wanting to do a bad job, I believe everyone in the NHS has “good intentions”, no one wants to make a drug errors, cause harm, have a patient develop a pressure sore, delay an appointment or cancel an operation. Yet we know this happens, so why?

I come to work with good intentions, to do no harm, treat staff well do the best for the patients. Yet most days something doesn’t always go to plan.

The week started with an unannounced visit from the CQC, the organisation with the role to register and monitor our hospitals, they arrived at 6pm on Monday and left at 5pm on Tuesday after observing practices and talking to staff, patients and relatives. The inspectors fed back at the end of the day, one saying that one of the wards had “inspirational staff” a moment to be very proud.

Wednesday was Trust Board day, large agenda nursing strategy and dementia strategy presentations, watched by the board and all of the senior nurses showing support, in uniform, truly awesome.

Everyone on a complete high, proud and excited for the future. We also formally signed up to the Nursing Times NTSOS campaign, encouraging staff to speak out when concerned and feel safe to do so.

It came to my attention later that day that some of the staff, in some areas, are concerned about staffing levels and staff being moved to different areas, that’s the low point.

So back to good intentions, we all want everything to be perfect, never be criticised, never get it wrong and always do our best. But sometimes things go wrong, don’t always go to plan and we all think how could we have done that better / prevented that from happening / anticipated that event.

The NHS is a hugely complex organisation, with risky things undertaken, high risk factors, potentially catastrophic consequences when we make a mistake. We must mitigate these risks to the best of our ability.

Hind sight is a wonderful tool but what we actually need is to all keep our good intentions but add to that a dose of tolerance, respect for each other and a culture that allows us to speak up, speak out and do the right thing for the patient.

No one works in the NHS to do harm or a bad job, everyone counts and everyone wants to make a difference.