OK, first things first. It has been an absolutely chaotic time in our first 4 weeks in New Zealand.
OK, it has not been helped by the fact that we actually didn’t do an awful lot that required the firing of brain cells in the 6 months prior to our arrival, but very busy nevertheless . New home. New car. New bank. New tax number. New job. New friends. New bills!
You come to a land 12,000 miles away from home. It looks, sounds, and smells a little like home, a lot like home at times. But there are subtle differences that sort of bite you on the arse at times and make you feel a little inadequate and stupid.
This could be wanting to know the way to the Post Office, erm, surely you mean the PostShop (not to be confused with the Postshop). There is also a clothes shop called Postie…confusing!
This could be wanting to calmly and safely turn left at a junction, until you are suddenly made clear that the car who wants to turn right into your road has priority.
This could be wanting to order a new examination bed and finally discovering that Kiwi’s call them plinths.
This could be wanting to know why why why in a country seemingly committed to bi-culturism and the Treaty of Waitangi, the Pakeha (NZ European’s/White’s) behave so badly towards the Maori (Indigenous population) - especially in private.
Don’t get me wrong, this is a fabulous country. The area we live in is doubly fabulous. The general impression is that New Zealand is a bit like England, but it WORKS. I have been so impressed by fact that people seem to enjoy their jobs and work hard. Good customer service and general cleanliness and politeness are endemic, and it rubs off. I honestly felt a little suspicious about why everyone was so nice. It really isn’t the English way. And for those of you who say it is, you are wrong, we just think we are polite, we are very wrong.
Napier itself is a place that was near levelled by an earthquake in the 1930’s, something you will be told about endlessly. The resulting rebuild created an area of almost unique ubiquitous Art Deco architecture. This is combined with the wide open streets, single level detached properties on decent plots of land, the presence of the beach and sea, Mediterranean climate, Café culture, and comparative affluence, creates an area enabling a high quality of life with a mix of almost knowing smugness. It really is very nice. Maybe too “nice” at times.
It is not the most culturally knowing place in the world or the trendiest. It really could do with some more nightlife. The high quality of life here and general relaxed pace numbs people into a very Kiwi stupor so it lacks of bit of vive about the place. I am almost paining for a bit of grime and a knife crime or five. You don’t realise just how much energy there is in British cities and how much this guides our daily lives. We are also desperately missing the BBC News and Radio, especially politics as this tends to prompt a bit of heated discussion on the sofa on our lazy evenings home. And we are missing regular contact with our friends and families.
Starting work again has of course been the biggest shock. One of the reasons for choosing New Zealand was, I thought, the relative ease within which I could slot into the health system. Although I am still sure that it must be one of the easiest countries in the world that an English trained nurse could migrate to, it has still been surprisingly hard.
I think some of this is that the NHS is not just a health service, it is very much part of the British psyche. Changes in the NHS tend to be discussed widely so knowledge of its workings tends to be become ingrained over time. I arrived in work fresh off the boat and didn’t (and don’t) have a cultural familiarisation on which to build.
Funding arrangements are very different. The British have got used to having a health system free at the point of need. I cannot tell you how dirty it felt when I had to pay for seeing a GP and then pay for each and every blood test that was ordered (I am fine BTW!). Although there are some concessions available for various groups, no Kiwi can get out of paying for a GP visit, which has led to many services been secondary care led, with hospital services facing a dual challenge from both the patient and the GP when trying to discharge care back in the primary setting.
This is a bit bonkers when you consider the distances that patients can travel in order to access health care. New Zealand is VERY rural in parts and it is not unusual for patients to travel 2-3 hours to come to my unit for treatment.
Just some idea about population density here:
Rochdale. Population approximately 200,000. Square miles approximately 20.
Hawkes Bay. Population approximately 155,000. Square miles approximately 5,500.
Crazy eh! And if you want chemo, my “Villa” is the only place you can go!
One of the major problems I have faced is, bizarrely, acronyms. I simply didn’t realise how much health staff (myself included I suppose) spoke in these riddles. It is incredibly isolating not to know the “language”, especially when I spent 3 years training and 6 years working in the “club”. PAL’s doesn’t mean Patient Advice and Liaison Service (Complaints Advocacy) but rather Payroll and….erm, see, I still don’t know! The Health Care Assistants are called Associates and don’t actually do any clinical care (a subject in itself). The Porters are called Orderlies. Estates are called BIEM’s (don’t ask, don’t know). When working with policies, procedures, contracts it is much much worse, with these bloody codes being bounced across the table like ping pong, whilst my brain slowly melts.
Needless to say the learning curve I have experienced in my new post as CNM (any guesses?) – Clinical Nurse Manager, has been so beyond vertical that I think I actually know less now than I did a month ago. There has been so much expectation about my arrival it is hard to anticipate how I will ever satisfy. There is so much to learn, and so quickly. I suddenly need to know everything about everything, when the whole focus of my previous clinical practice has been to narrow and focus and specialise. To try and do this with without an underlining foundation of knowledge in systems, language and process (which I would have in the NHS) is just overwhelming.
That said, people do seem impressed with me. Which is lovely and massively heartening. I really would have left by now if it wasn’t for the Clinical Nurse Specialist’s support and advice and encouragement. Had a major success with getting a room back from a different service resident on the Villa (6 year history, 3 weeks in and Jimbo got the builders in! Oh yes!). I also keep asking the silly questions. My general musings today in a meeting seem to have generated a renegotiation of the contract with the tertiary centre. Health staff the world over spend so much time on the minutiae of “interior design” they don’t step back and see that the building “foundations” are royally buggered and in the wrong place. It is sometimes good to be the outsider.
I am also strangely enjoying being a manager. Sometimes. Sometimes I hate it and just want to go make the patients cups of tea and make a few beds. But sometimes, sometimes it is so empowering to actually be able to make the decisions that you want making and actually get things done the way that you know things should be done. I am probably not the most natural at it in the world. I am probably too nice and always wanting consensus, but I am adapting and learning, slowly accepting that running a unit well is not about making friends and recognising that you will never make everybody happy all of the time. It is strange not been able to be involved in a bitch and a moan. It is also strange when conversation suddenly stops when you walk in the room. Not because they don’t like me, but rather that I am their manager and that changes the dynamic. I did it. People now do it to me. It is just different, and rather odd.
Just as an aside, I’ll finish on something that bridges health and general interest. You cannot sue anybody for personal injury in New Zealand. No “Slips, Trips or Falls? Claim NOW!” No ambulance chasing lawyers in A&E departments. Every employee pays a small premium each month for ACC cover – Accident Compensation Scheme. If you are injured at work or on the road or wherever, this covers you for health costs, lost work time, rehabilitation expenses, whatever. It is great. Car insurance here costs us 38 pounds sterling…for the year! We thought that was the roadside assistance cover or something! At home this insurance would cost us over 1000 pounds sterling for the year, at least. Just a thought for the UK government there. New Zealand copies a LOT of English ideas but the no litigation thing is definitely something that we should try out.
Enough for now!
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