Eileen Kearney: Grattan Street, Healthcare, Working Life

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Intro

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Background

Started in Grattan Street 2002 had been in different positions but haven been there full-time since 2012 as Assistant Director of Public Health Nursing. Covers the nursing staff for the City North-West area population 27,000. 10 area PHNs [Public Health Nurses] community RGN teams (Registered General Nurse). Eileen is PHN, RGN and registered mid-wife. You have to be an RGN to become a PHN.

Worked as an RGN first in the community in North Cork prior Grattan Street. Then did PHN course in Dublin UCD (University College Dublin). Returned to Grattan Street, work as PHN on the ground, in schools, preschools, inspecting in nursing homes, assistant director of PHN since 2009. She was in two other sectors before that. 

0.02.04 - 0.04.21

Childhood in Waterford

Born a long time ago! In Tallow west Waterford. From family of 7, has an older brother and four younger brothers and one younger sister. Father was a butcher, family business.

Went to school in Tallow, then Loreto in Fermoy and then to the Mercy Hospital and did RGN training, then Dublin to Hollis Street for midwifery training. [Eileen’s phone rings but she mutes or turns it off and continues the interview]

There were about four butchers in Tallow but now only a Supervalu. She remembers her dad singing and whistling below in the shop when she was in bed in the morning. He and his father were good singers and whistlers. Remembers sawdust in the shop and it going all over the house. Father and mother going to the marts getting sheep and animals coming to the back yard and into the slaughter house. Grew up with it so didn’t see anything unusual in it. Good happy childhood.

Brothers and her all involved in sport. She and parents played tennis. “We were brought up in a tennis court” played some hockey in school. Lots of sports, golf as well. But now doesn’t have time with work.

0.04.21 - 0.06.36

House at Home Growing up

Two storey house on the street. Shop was attached to it. Downstairs there was a living room, a kitchen and a back kitchen and a room off the shop and four bedrooms upstairs and a bathroom, a big garden, a shed and a slaughter house.

Grew up as an only girl, her sister is 14 years younger. She had gone to boarding school/secondary school by the time she was born. Had lots of friends in Tallow, still has them, still keep in touch. Did a lot of work in the house, as she tells her mother who’s now 92. They were all given jobs to do. She had to hoover the sawdust. She was involved in the weekly bath for her brothers, making sure their shoes were polished every Saturday evening. Thinks that today it is different, perhaps because of parenting. Dad died 10 years ago suddenly from a heart attack which she says was lovely for him. Siblings all alive, one in England. 

0.06.36 - 0.10.57

Produce in the Butchers Drisheen, Tripe, Black Pudding. And the making of them.

Meat was sold in the butchers and some onions. Mother made drisheen and black pudding every Thursday to be ready for Friday and Saturday. Sometimes she would get some tripe from the market in Cork and it would be sold in their shop. They didn’t make the tripe themselves but they did the drisheen and black puddings using the serum.

Serum from the blood and milk and pepper was used in it. It is supposedly good for you. And they ate that every Saturday night on top of sausages and rashers and they keep that tradition going but without the drisheen. Very mild flavour. It’s the frying that gives it a flavour. Maybe someone who wasn’t used to it might find a stronger flavour. Doesn’t remember the flavour of any herbs. It was a light grey colour in comparison to black pudding. Possibly some kind of sausage meat added to the black pudding. There was a machine where it would come from.

Serum is separation from the blood when it is allowed to settle and there is a strainer. You use what floats to the top and discard the rest.

Father and sister loved tripe but Eileen never “acquired the flavour for tripe” served “with boiled onions and milk”.

Eileen doesn’t remember the butcher shop selling pork. But she thinks she might be wrong about that because her father kept a pig and he won a trophy for his prize pig when Eileen was about 7.

0.10.57 - 0.15.09

School, Corporal Punishment, going home for Dinner

School in convent in Tallow. Carmelites enclosed order still in Tallow, they didn’t teach but it was in their area. Boys had a separate school at the time but now it is co-ed: boys and girls. Enjoyed school. Reasonably well-behaved because terrified. Teachers could slap you, corporal punishment. Eileen didn’t get slapped often because she was a good girl. Remembers a small ‘roundy’ stick which would be used to hit children around the knuckles. Some teachers had less patience than others and found it difficult but the students didn’t understand that. She is glad corporal punishment is gone because it lowered self-esteem, and put you at a disadvantage. It wasn’t just the slap, it was that someone had carried it out on you. You felt brutalised. It was very common, right up to the time her children were in primary school, some of the teachers at the ends of their careers there had a reputation for corporal punishment.

Would get a slap if they thought you weren’t paying attention or if you were talking to someone.

Spoke about corporal punishment with her friends subsequently. And she discovered terrible things that happened to people which she wasn’t aware about at the time. Slaps across the face, pulling of ears, hit on the head. “You were an easy target. They had the power.” It was difficult. She thinks that if you were involved in sport you were treated a bit differently, though not if you were academic.

They had outside toilets in primary school- “leaves and cold and wet”. Was able to go home at lunchtime and have dinner. “My wonderful mother had my dinner ready every day. For the nine of us.”

0.15.09 - 0.15.48

Dinner and Types of Foods

For dinner they would meat that hadn’t been sold in the butcher’s shop. They might have steak for a treat on Thursday night but usually more reasonable cuts of beef and lamb. Always meat, vegetable and potatoes. Mother was a great cook and baker so they always had something sweet to eat as well.  

0.15.48 - 0.19.01

Secondary School Boarding School

Boarded in Loreto Fermoy, her brothers went to De la Salle in Waterford. Her parents worked hard to get them that education. Her mother had boarded but her father had left school early. Some of her friends from home went to Loreto as well and she also made new friends there. There for 5 years. Happy enough time. Initially allowed home every third weekend, eventually allowed home every weekend. As an only girl it was good to be around female company, she thinks she would have just been bossing the boys around at home.

First impression was of the structure of the place: all your recreation time was spent in the one place. And you were there with your class, it was all set out for you and you had to fall into line. “I wasn’t unhappy there.” Calls by day, hockey in afternoon- sometimes go to Cork for a match. Every Saturday they were not at home they went for walks, they walked through the town, on parade in their uniforms. Had music at night in the social room listening to records. Abiding memory is of seeing Dana winning the Eurovision. Maybe she saw something about Bloody Sunday as well.”

0.19.01 - 0.20.36

Career Choice. Nursing. Mother’s education. Role of Religion. Mercy Hospital

“For some reason I always had nursing in my head.” Maybe because her mother said she would have done nursing if she could- she had left school after her Junior Cert and did a year in a technical school where she got her baking skills. Mom was a great worker so thinks she would have made a great matron rather than a nurse because she would have wanted everything done properly. Eileen says she may have some of those traits herself.

After Eileen’s training when she went into the hospital she felt claustrophobic “for some reason it didn’t sit well on me.” She did 3 years in the Mercy. There were nuns there at the time: “Great fun, hard work.”

0.20.36 - 0.22.07

Role of religion in the Mercy Hospital.

The rosary was said every night on the wards. Had to go down on your knees at 6 o’clock and shout out the decades of the rosary. Biggest thing was that they had to know the joyful, glorious and sorrowful mysteries. They went to mass every morning around 7am when they stayed in the nurses home for the first year and a half. Nuns were strict. She was only 17 when she was there so she thinks it might have been good. She didn’t regret doing nursing but she didn’t take it too seriously either.

0.22.07 - 0.23.18

Nursing Training in Mercy Hospital

Three years training but only got a certificate. Learned anatomy, physiology and putting it into practice and managing patients/clients, eventually managing a ward. Managing night-time with patients coming in. managing a children’s ward. Dealing with everything: clinical care, surgery, people dying. Children dying. Recalls children dying in St. Anne’s Ward that will never leave me. Delighted to see the Mercy is busy and expanding. She has fond memories of it.

0.23.18 - 0.26.55

Route to PHN and Grattan Street

Did a little bit of work there wasn’t much work for qualified nurses at the time. Went to Fermoy Hospital, a community hospital. Worked there for a few months. Went to Hollis Street and spent a year there- very interesting. Opening into a different experience in the capital. She was madly in love at the time came home frequently. Eventually went back to Fermoy Hospital and got married at 23 in June, and by October of the following year she had her first son and so gave up nursing. Husband was self-employed and was often away and she felt one of them needed to be there they had three children. When the children got older she decided to do a course in fitness and taught exercise classes for 8 years. She had tried to get into PHN but hadn’t enough experience. She met a friend in Fermoy in 1998 and she said why not go into the community they are looking for RGNs in North Cork. She applied, got it and then “got the bug for the community” and applied twice to UCC for PHN course and they didn’t think she was suitable. She was accepted in Dublin and found it challenging. She was 47 at the time. She was up there for three week period. She came home every weekend. She came home on placement for a two week period placed in North Cork. That’s how it operated for the academic year. it was manageable and she had always wanted to do it.

She was going back into a group of nurses who had been working, who knew everything, who knew computers and Eileen could barely send a text message on a phone. She was accomplished at essays by the time she was finished. She entered Grattan Street 2002.  

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Public Health Nursing

Eileen enjoyed the freedom of PHN, didn’t like the constraints of the hospital and the regimental nature of it. PHN suited her. Liked going into clients’ homes and fitting in with them rather than them fitting into a structure in a hospital.

She wonders about the broad, complex, extended and manic nature of what is being attempted in the community now. She hasn’t been out working in 2009 but she has been working managing staff inside and supporting them in client management.

0.28.25 - 0.33.06

Role of Public Health Nurse

Looking after clients from the ante-natal (pregnancy period) to the end of life care. Anything and everything in between that. A huge sphere. Looking after mums to be, babies, mums after birth, young children, acute discharges who need support around wound care, clients with mental health, addictions, disabilities, older adults, dying and palliative care. Thinks it’s now too broad now because the type of discharges are very complex, almost providing a hospital type care within the community. Sláinte Care- clients being discharged into the community. Eileen doesn’t think this can happen until they had sufficient resources to match the numbers being discharged to them, she needs an increased budget. City north west is an area of great disadvantage there are 20 DEDs (Electoral Divisions) in it 15 of which are designated as disadvantaged or very disadvantaged. Lots of complexities around parenting. This leads to children with behavioural issues. Eileen is always advocating for early interventions. Role of PHN was always health promotion and illness prevention. More hands on now doing clinical, assessments, referrals, ordering supplies, reviewing things. So what was formerly the PHN’s main role is no longer their main role. Early intervention is key, it would be very beneficial.

In the city northwest area there are many non-statutory bodies area-based childhood programme, (Atlantic Philanthropy was supporting this for a while now it’s Tusla) they support families, parents, teachers, childcare workers increasing capacity around infant mental health. Springboard run by Tusla which support families. “Niche” in Hollyhill a family support agencies, and Barnardos as well. Eileen is involved with all of them in child welfare and protection. Would like to get the issues resolved at child welfare stage. Everyone that comes to work here gets great experience but no one stays for very long. Lost two staff in April. 1.5 staff were on maternity leave and not replaces and another 2 going on maternity leave.  

0.33.06 - 0.35.30

Turnover of Staff

Turnover due to the challenging work. Often chasing people, offering them appointments to bring their children, but they don’t. When you go back they won’t answer the door, or their phone, and change their phone number, or don’t tell you that they’ve moved house.

Not all people they deal with are like that but a core group are because they have had no parenting themselves and the cycle continues of disadvantage, poverty, poor education and housing, unemployment. “Entitlement stage” their parents were entitled to everything. In PHN there is no entitlement which they try to get across.

Eileen thinks that people born and reared in poverty and with poor parenting have no chance of catching up because they don’t realise the level they are at. Eileen doesn’t know where to break that cycle though she thinks that PHN plays some role. Places in Dublin and Limerick also have areas of disadvantage.

Eileen think that sometimes her staff give people what they think the people need but it may not be what they really need and sometimes the staff can’t get that information from people. It’s all about building relationships but it’s hard to build that relationship when people don’t want what you have to offer people.

0.35.30 - 0.40.25

Child Development Problems- Multiple Causes, Complex Solutions

Should they ensure that all children in primary school are fed? Or is that too late? An infant mental health specialist with young Knocknaheeny area child-based programme 0 to 2 years is pivotal in nurturing and bonding and if it doesn’t happen children end up with low self-esteem or behavioural problems. These become bigger problems later as the children have not developed skills in coping because they haven’t been shown them. And if it’s not there by age two they miss out on a lot. Ante-natal period classes with Young Knocknaheeny to build a relationship with the mothers when they have their babies which they have to see until they are 5.

There are a lot of services for people but sometimes they don’t want to be seen as a target for the services, they don’t want to be seen as different. Eileen was initially shocked by that attitude, someone said “another service being thrown at us” and maybe they were saturated with services and it wasn’t something they wanted at all.

If Eileen knew how to break that cycle she would patent it.

She read an article by someone in charge of Bessborough- how can we expect young mums to parent a child when they were never shown and they had no role model. How to build trust and build a relationship because they can be very wary and distrustful of services. Parents think that if they don’t do what the PHN says or thinks is right that there could be child protection issues involved because this happened a lot in the past and sometimes a child was removed. But for social workers the last resort is to remove a child- the child as almost always better with the parents from their point of view. Eileen thinks that approach is a bit unusual, especially if there is no bond between parents and the child.

Sometimes a child is removed for a period of time, and there are health professional meetings, case conferences, families come together and everything is discussed. Sometimes it doesn’t work but you have to try. In those cases there is a health professional meeting or a case conference meeting and the children go into foster care and maybe go back to the parents after a period.     

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Social and Medical Issues in North Cork Area

Most of the moms are single with different partners for the different children. Housing is an issue, expenses for school, dependence on drugs, alcohol, polypharmacy, mental health, self-neglect. A number of clients are alcoholics who come home and expect the HSE to provide services. They can refer clients to the mental health services but the client has to agree to go. And there is a lot of that.

Lots of young people with disabilities which she was surprised at she felt she had been very “sheltered”. When she came from North Lee so many people had disabilities or something wrong with a lot of people. The stats are quite high. North Cork is rural but North Lee is exceptional.

One third fit into that category. Mental health and addiction issues are shocking. Grandparents are minding grandchildren because their children aren’t capable.

She had no exposure to this until she arrived and so she was unprepared for it.

Eileen could retire any time she wants but she likes the work but will retire in a few years. She tries to make a difference.

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Compares Grattan Street to new St Mary’s Primary Care Centre. Car Park issues.

Get pleasure from the new building in St Mary’s so different to Grattan Street. When in Grattan Street they loved it and linking in with the team and got stuck in the car park. Eileen had a database with all the cars and numbers and if anyone was in a parking space who wasn’t registered they would get a note on their car. The car park nearly broke their hearts. Eileen was in a 7:20 every morning to get the parking space and would dread having to go anywhere because your space would be gone.

When she went there as a novice PHN she didn’t like the outside of the building but once inside she felt comfortable there, and the staff were nice in there. They always knew if someone was sick or had a bereavement.

When she left Grattan Street she had a room there but it is now full with other things and incontinence wear. Jokingly blames Sean Higgisson the porter for this.

Some of the rooms in Grattan Street are beginning to look neglected and old.

Some of the team are not looking forward to moving up to St Mary’s. They are anxious about the move. But many with Eileen were as well before they moved but at least her team are all in the one place now. She feels they are well-settled in St Mary’s now and they like it and she told Sean the porter and Celine in admin this. They’re not really missing Grattan Street.

0.49.40 - 0.57.13

Typical Day in Grattan Street and Changes. Hospital Discharges.

Arriving in Grattan Street first it was similar to what she had been used to in North Cork. (North Lee is from Youghal to Macroom) Was in Mayfield for a year. Was in Glanmire St Stephen’s for 2 years. 2012-2019 in Grattan Street.

A typical day in Grattan Street was getting there early to park the car to be able to get out quickly. When traffic in Grattan Street became one way it really affected staff in Grattan Street- previously they were able to leave and go up Shandon Street but now they have to turn through narrow streets. Doesn’t feel they were told or consulted about that change.

After getting their early she went for a walk because initially she didn’t have a key to the health centre. Walk to the quays, North Main Street into St Francis Church to pray for everyone (and for herself not to kill anyone). Back to Grattan Street, Sean would be there, have coffee, reply to emails, manage staff annual leave, sick leave professional development, pre-discharge meetings. She is on various boards and bodies which entailed various meetings. Would go St Finbarr’s [Hospital] head office once a week. Busy. Trying to find solutions to problems. Would think of something in bed at night but forget it by the time morning comes. Sometimes write a note in the phone and go back to sleep.

In Grattan Street working with clients, working through correspondence, going to meetings: multi-disciplinary teams with more views, suggestions and options. Could be about a client having issues with self-neglecting, a client who deteriorated and needed extra supports.

Mercy today for pre-discharge meeting for a very complicated case coming home. Previously the person had been discharge and within 36 hours he was found on the floor and the door had to be broken down- required the Gardaí, ambulance, nurse and home help. He refused to go to hospital. The following morning he was unwell again and he was sent to hospital. Now they want to send him home again.

Many complexities come from not having next of kin and the nurse shouldn’t have to take on that responsibility.

Capacity bill. Not always safe discharges.

Reiterates connections with Young Knocknaheeny, Niche, Barnardos, Springboard. Try to link in with other groups and social work but feels they need to focus on their own work. Their cases are too big to be involved. Feels pulled and dragged a lot. As a PHN you are a manager of an area of 3,000 population which isn’t huge but the complexities make it hard. In a rural area there might be a population of about 5,000 but they wouldn’t all be active.

0.57.13 - 1.01.40

Social Aspect

Aoife O’Brien is great to get people together, comes up with idea, advertise, follow up, plan order things, get back to people and doesn’t force people and takes photos. Eileen takes pride in the Christmas party and restarting it. It’s the only time they really had events in Grattan Street.

Allows you to have fun, eating and relaxing and speaking about plans. Someone made punch but with the change in driving laws and when that woman left they didn’t have it anymore. Lots of young people in Grattan Street now who go out after work to a bar but Eileen wouldn’t have done that. There was a lot of moving or transferring staff and they would do something for them like a lunch. Mixed well with admin, nursing, podiatry, school nurses, ophthalmology. Everyone knew where everyone was.

When they came to St Mary’s first in early February (5^th & 6^th of February after the nurses strike) they really missed the other teams.  Expected the other to follow shortly after but they haven’t. When meeting people in the corridor in St Marys there might not be eye contact and they aren’t used to that coming from St Mary’s. Now they are smiling and saying hello. They are integrating into the new building. When people finally come up from Grattan Street it might be easier for them now that Eileen’s team has managed the transition.

1.01.40 - 1.07.10

Everyone loves Grattan Street

Some people wanted to leave but only for parking. Grattan Street reversing out and cars double parked on both sides. Saw a lorry bringing in windows for a school extension. People in the school sometimes try to take their spaces. The lorry reversed in- surprised how good a driver he was.

Teams close together in Grattan Street but separated now in St Mary’s. Podiatry will come up. Home Support Service is in St Marys. PHN have rooms for clients downstairs. While everyone is in St Mary’s they are separate. They are beginning to get used to all the space.

Thinks it’s more productive in St Marys.

Sector 4- City Northwest touches on the Mardyke and Western Road a bit but most of it is on the Northside. It made no sense for staff to be based in town and come up to the Northside and then back down. Grattan Street Health Centre is part of Mayfield Sector 3- City North East. So really they were in temporarily lodgings there. In St Mary’s can respond to thinks more quickly, nurses can do their calls more easily. Can’t think of negative things, maybe the room with 20 of the nurses instead of 2 to 5 people. But people are getting used to it.

Some health centres have a mix of disciplines but in St Mary’s it’s all nursing which Eileen prefers.

Canteen in Grattan Street was homely and functional. But in St Mary’s it’s clinical, not big and equipment is ok but it’s very loud. Eileen goes there when it’s quiet and looks out the window at the trees which has a preservation order on them.

1.07.10 - 1.11.08

Interaction with Surrounding Grattan Street Community

Fraught interaction with the surrounding area in Grattan Street to do with the car park. There’s 6 parking spaces for anyone. And the ones at the back wall and the other side area for HSE. There might not be enough space for residents. And HSE staff would try to get in early enough for a space. They had a good relationship with the school [Education Together] until they started taking the HSE parking spaces. Sean had a good relationship with the school and the locals because he would have more dealings with them. Only the back door of people’s houses were connected with the car park their front doors faced elsewhere. There was a hall. And the area in which Grattan Street is located isn’t covered by the PHN area that Eileen was in, it was covered by Mayfield. So Eileen feels they were a bit disconnected from the Marsh.

Not much interaction with shops.

Raised blood pressure due to the car parking and arguments and they nearly shot each other over it!

Eileen told someone that they couldn’t park there because they weren’t working there and she was shocked at the angry verbal abuse she got after it. Sometimes arguments would start badly but in the end they would be smiling and wondering what all the fuss was about.

1.11.08 - 1.14.18

Describe Grattan Street

A happy place to work. Liked the building and its peculiarities, its rattling windows. Arguing to get a new window where the bottom part was falling out and tin foil was blocking the gap. In her room the wind was coming in and the window wasn’t replaced. Bars on the window. And obscure glass so you could only see out when you open the top.

Thought that the two stairs going to the 2^nd floor in Grattan Street was cool when she was there first and the gallery all around and the open space it created. An old quaint building being pushed into something it was never meant to house. Glad to hear that there is talk of people going in there.

The gallery made things different. And you could see if someone was waiting for you and have a bit of craic. An opportunistic up and down conversation. Not as easy to catch people in St Mary’s. “We will always have happy memories of Grattan Street. Always. And I’m sure it will become even more embellished with time.”

1.14.18 - 1.18.30

Why do people like Grattan Street?

Eileen thinks it’s partly because of the people working there. The building lends itself to that. They got something good from the building.

When you entered the building there were no lights on you had to go to the reception area to turn them on.

One morning she heard something flush when she went in. She locked herself in her office. And called Sean (Higgisson the porter) who said the toilet just flushed itself- another peculiarity.

Sometimes people were difficult in Grattan Street and Sean was calm and dealt with it.

Being near town gave you lots of options for places to go which isn’t the case in St Marys.

Someone could come in shouting and verbally abusive and demanding to see someone.

Someone collapsed once and Sean had to get him to the Mercy Hospital in wheelchair.

Try to diffuse the difficult person- Sean would be good at that and might get someone else to assist. Sean gives a relaxed attitude and talks to people. He would keep it from escalating. Eileen thinks she might not be so calm!

1.18.30 - 1.20.02

Varying Views of Grattan Street Medical Centre

Other people who came to Grattan Street may see it as shabby, or somewhere they didn’t get what they wanted. Or there was no proper queue or waiting too long for something. They might have had trouble parking.

Another person might think it’s convenient in the city centre and an interesting unusual space. “But they won’t ever see it the way we saw it. We felt we owned it. Or it owned us, you know that kind of way. Sometimes it just felt like something wrapped around you.” Felt good there. “Everyone loves Grattan Street. Put that on my epitaph.”

1.20.02 - 1.21.00

Definition of Patients and Clients

Call people clients when working with them in the community. Patients in the hospital. Clients because they have some need but it is not always an illness. It’s always been like that in the community setting.

1.21.00 - 1.23.15

Anything you would change about Grattan Street besides the carpark?

Could have been painted. Paint the door. Make it more attractive people to get a better sense of the place before entering. Improve the exterior to make people aware they were going someplace nice. The building needs it. Down and outs sleep out the back of it so there is lots of rubbish out there. Some clear glass in the office and take away the bars. Improve the canteen a bit.

St Marys is fresh, new and practical.

Grattan Street not much can be done with it.

1.23.15 - 1.24.28

Unexpected Responsibilities and Workload

Eileen didn’t expect when she started out to be working so hard and carrying so many responsibilities at the age she is now. There was no reflection on where you were going at the time she started.

She always wanted to work in community not hospital.

1.24.28 - 1.26.15

Future of Grattan Street

Would like to see it occupied and whoever was in there was happy in there and the building was looked after. Nearly better to close off the car park. Eileen thinks it can never be sold off. And she would like services to be in there because it is an ideal central location.

H111 European Health Insurance Card is done in Grattan Street. There’s a box shaped reception which was thrown up and is not in keeping with the building she would like to see that changed. Plaster on the walls. Holes in the ceiling.

1.26.15 - 1.29.13

Vaccines, School Nurse, Grattan Street Ghost.

Vaccines- had to mind the fridges when she was a schools nurse. School nurses had to deal with AMO Area Medical Officer now called Community Medical Doctors. The room the fridges were in had no air-conditioning or coolant and sometimes the temperature would get too high.

As a school nurse she would have to take the vaccines in and out and maintain the cold chain in the transfer of the vaccines. In St Mary’s there will be a cold room for those fridges.

Never saw the ghost. And she had plenty of time to appear when she was there alone in the morning.

Grattan Street was special. Met people with different problems.

Outro. Interview ends.