Without wishing in any way to contradict the experiences of Tina Donovan ('I wish I had left the NHS years ago', letters, 29 July) my own experience might give heart to those of us determined to stay.

After several decades with a major multinational corporation, the past 10 years at senior management level, I joined the NHS last year with the hope of bringing private sector skills and experience to a part of the service that seemed to need them - namely, strategic procurement.

It's not just in my specific professional area of interest that I find use for transferable private sector management skills, which may have been needed in Ms Donovan's discouraging environment. Indeed, I have seen elements of that same environment, but would encourage colleagues to view them as a challenge we strive to change, rather than to regard them as problems that have been put in our way.

The best managers are those who are able to operate effectively in an environment of continual ambiguity - and we have more than our share of that in the NHS. Management practices need to refocus on how best to operate in that mode rather than spend a lot of time seeking to clarify the uncertainties before proceeding.

So my message is similar to Ms Donovan's: don't let it get that bad. Do something about it, but only leave if you feel you can make no further contribution to an organisation worthy of our efforts and which is going through operational and organisational ambiguity.

I feel like Ms Donovan: it feels great to have taken the plunge.

Danny J Morgan

Director of purchasing

York Health Services trust