Nursing Associates …

06 March 2018

Theresa Shaw, FoNS CEO

The announcement that a new nursing associate role was to be established back in 2016 quickly provoked debate and divided opinion.

Like many, I was a little sceptical not least because as a nurse educator in the nineties, I supported several cohorts of enrolled nurses through the conversion course. I felt privileged to work with them and see them thrive and grow in confidence as they progressed through the programmes and achieved first level registration. So with the new proposal, I was also concerned that we may be stepping backwards, both ignoring the evidence base for care outcomes when nursing interventions are delivered by registered and graduate nurses and potentially opening the door again for two levels of nurse. Yet I also listened to many Nurse Executive Directors and Chief Nurses talk about the growing vacancy rates and concern that the skill mix of the existing workforce delivering care may not be adequate to meet care demands and the potential for care failures.

Last year, I was invited to chair a conference on the nursing associate role. I accepted in the main because I realised that beyond media reports and conversations, I knew very little about the role, the nature of nursing associate training and plans for regulation. I found the day really illuminating. There was some compelling evidence presented regarding not just the national but global nursing workforce deficits; some quite reassuring details about the training programmes and strong messages for ensuring robust regulation. What I found most heart warming was listening to presentations from trainee nursing associates themselves, hearing about their career journey to date, the value of the training and their absolute commitment to person centred care – in my mind these caring and articulate individuals could easily have been student nurses. Indeed, quite a number aspire to be graduate registered nurses but this is not an option for now for a range of reasons; some do not have the appropriate qualifications to enter graduate education at this time and for many, family and other commitments mean becoming a full time student is not an option (and of course the loss of the bursary is another factor … for a later blog perhaps!).

I came away from the day feeling much more comfortable about nursing associates and the value they could add to the nursing team within their scope of practice. Some of my worries now are not so much about the role but rather about the nursing associates themselves and how they feel they are perceived by the profession. Indeed, I have experienced a few somewhat surprised looks when I have said I think the role could be positive. So last week, when I saw the ‘Punch Line’ cartoon in the Nursing Standard, page 31 offering a nursing associate going on her first shift a flak jacket I felt compelled to write! Whatever the view of professional nursing with regards to this new role, it is here now, and I believe teams delivering care in the frontline of practice are going to be quite impressed with the level of skills, competence and compassion nursing associates will offer; but above all else I hope as a profession, we can be kind and welcoming.

Cartoon from Nursing Standard, Vol 32, No 27, 28 February 2018 page 31

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Three years on … an Australian researcher’s reflections on the impact of attending the IPDC Foundation Practice Development School hosted by FoNS in 2015

27 February 2018

Anne Williams, Prof Health Research, Murdoch Uni; Research Consultant, Sir Charles Gairdner Hospital

In April 2015, I attended the IPDC Foundation Practice Development School hosted by FoNS at Herstmonceux Castle in East Sussex. Travelling from Perth Western Australia, the school was a time of intense learning for me. It also increased my self-awareness and connection to nursing. This experience has led me in some wonderful new directions and really enriched my work as a nurse researcher.

Anne Williams and Jo Odell at Herstmonceux Castle, April 2015

Reflecting back now over the past three years, there have been numerous times when what I learnt at the school has influenced the things that I have done. The school unlocked some of my inhibitions and extended my confidence to use creative arts and humor at work. The results of this have been quite infectious! Let me give you a few examples …

Research Week 2015

Each year Sir Charles Gairdner Hospital holds a ‘Research Week’ to highlight health research through activities and presentations. One of the activities in October 2015 was a fun multidisciplinary research debate on the topic: ‘Are Department of Health funds better spent on research or education?’ With only 24 hours’ notice, I was asked to be the nursing representative on the team defending the use of research funds. Having minimal experience in debating, it really was quite a challenge! However, feeling more confident after the Practice Development School, I decided to give it a go. Using ideas from the movie ‘Back to the Future’, I reflected back on how we nursed patients 30 years ago compared to today and I helped my team to victory, cheered on by the strong nursing contingent in the audience!

Nursing Extravaganza

To celebrate all the great things that we do in nursing, Sir Charles Gairdner Hospital has for many years organised an annual fun event called ‘Nursing Extravaganza’. It is always held at the end of the year and nurses throughout the hospital are asked to showcase the innovative work that they do using displays. Ward nurses visit the Nursing Extravaganza and there are free ice creams. In 2015 the Centre for Nursing Research, where I work, decided to go with the mad professor theme. We all dressed up as Einstein look-a-likes and each of us had a nickname based on our area of research interest/expertise. I was named ‘Wilhelmina Wellbeing’ and I dressed up in a crazy purple wig, wacky glasses and white laboratory coat.

Anne Williams and Dr Susan Slatyer at Sir Charles Gairdner Hospital’s Nursing Extravaganza December 2015

Wellbeing Activities

One of the research projects we have been working on is all about improving the wellbeing of cancer nurses. Following the school, I found myself more open to using innovative techniques to promote wellbeing. ‘Laughter Yoga’ is a relaxation method that particularly captured my attention, and so to find out more I enrolled in a course to become a Laughter Yoga Leader. Laughter Yoga is a group activity designed to reduce stress. Fake laughter occurs alongside various playful activities, handclapping and breathing exercises. It is bizarre and ridiculous, but it’s fun and it works! We recently included some Laughter Yoga in a wellbeing workshop for cancer nurses and it was extremely well received!

Another wellbeing activity initiated for the nursing academics at my university was a ‘bushwalk’ (a walk in the park), followed by a picnic and a group activity in which we all made ourselves hippy-type headbands in the colours from the flag of the Aboriginal people of Australia. The use of creative arts in this instance, really enriched the experience and lifted the mood of those who attended.

Anne Williams, Emily Allen and Anne Matthews following a wellbeing bushwalk December 2015

More Reflections

In my previous blog about the Practice Development School (12th May 2015), I reflected on the importance of having the confidence to speak up and to contribute to positive change in the workplace. I have felt more self-assured since the school and have made a conscious effort to speak up more about things that matter. Part of my increased confidence I think stems from working in environments where I feel supported and connected to caring colleagues. Attending the school highlighted that we can all contribute positively to the culture of the place where we work, and creative arts and humour can be part of this. I commend the ongoing work of FoNS in this area. I highly recommend the Practice Development School held in the beautiful environment of Herstmonceux Castle and hope that many more nurses get the opportunity to experience this potentially life-changing experience.

Acknowledgements

I would like to acknowledge the support of my wonderful colleagues who appear in the photographs accompanying this blog: Emily Allen (Murdoch University), Anne Matthews (Sir Charles Gairdner Hospital), and Dr Susan Slatyer (Curtin University & Sir Charles Gairdner Hospital).

I would also like to acknowledge the inspiring Jo Odell, Practice Development Facilitator at FoNS, who I studied with at London South Bank University and reconnected with at the 2015 school after 30 years.

Nursing Now!

20 February 2018

Professor Dame Donna Kinnair, Director, Nursing, Policy & Practice at the Royal College of Nursing

I seem to be always talking about the challenges to nurses and our profession and recently it hasn’t made good reading. Shining a light on the current issues facing how we deliver high standards of care, how we influence the policy agenda with a government that doesn’t want to listen, and how we safeguard the health and welfare of nurses in the current climate of 40,000 vacancies. It is also  my role to shine a light on the value of the profession and why I am personally supporting Nursing Now!  

Nursing and midwifery are professions that touch the lives of everyone, and reach into communities throughout the globe. In order for us to transform our world we need a profession that demonstrates little self-interest but exists to improve the lives of others. Our leadership is crucial in terms of improving the health and wellbeing of societies and we know exactly what it takes and how to enable communities for positive change. Although often neglected in terms of being mentioned, if we look at many of our public health campaigns, such as managing the outbreak of ebola or reducing tuberculosis, delivering care at a bedside or the historic improvements in health care, nursing has been central to them. There is often very little mention of nurses in any of the media coverage but it is nurses on the ground who are interacting with communities, working with them, educating people, innovating and implementing the strategies for health improvement. We, by working with people, whether as  patients, as families or communities, recognise how best to improve health, promote social cohesion and support social protection. Nurses are enablers for positive change and a vehicle for economic growth. It is this knowledge that makes us key to policy development and decision making for health improvements.  

The Royal College of Nursing is a huge supporter of this campaign as Nursing Now  raises the profile of nursing globally by encouraging solidarity and support across borders. It advocates for nurses to be more central to health policy leadership and ensure that nurses can use their skills, education and training to their full capacity in order improve health. It is a foolish society that undervalues or underutilises those that can contribute so much to this country’s development and improvement.

We aim to make those leading our society take notice of nurses. Get involved in this campaign – it launches on the 27th February.

You can read more about Nursing Now hereNursing Now! is a programme of the Burdett Trust for Nursing.

Beyond Patients First

13 February 2018

Jilly Ireland, Professional Midwifery Advocate

I received a pack of nicely produced A4 ‘Improvement Insights’ from FoNS in the post the other day (‘Bump, Baby and Beyond’ – creative ways of designing antenatal preparation sessions in collaboration with women). It summarises the Patients First Programme project I was involved in for eighteen months from 2014 to 2016. During that period, I benefitted from collaborative learning with other teams in the workshops and from ‘living out’ the service improvement as it evolved with mentoring support from FoNS’ practice development facilitator, Jo Odell.

The experience validated a lot of the feelings and experiences I had from a long working life in the NHS. I have seen changes imposed without consultation with those the changes affected most and I have seen better service improvement which had an eye for sustainability and ongoing evaluation from all stakeholders, including users. The input and support we had from FoNS gave validation not only to the ‘feeling’ that this is the right and correct approach but also the evidence. A powerful double effect.

This has meant that the effect of being a participant on the Patients First Programme has carried on in my career and in my life away from work. I have been using creativity more. I have written a poem and lullaby based on the knowledge base around mothers’ wellbeing and foetal development (Ireland, Evans and Buisson-Lex, 2016) and how wellbeing in pregnancy can be addressed at least in part by introducing crafts (Ireland and Croucher, 2017). Having the bursary and workshops facilitated expansion in my knowledge in this area and my abilities to share and use it in a variety of impactful ways.

My current post as a Professional Midwifery Advocate involves supporting staff through restorative supervision. Our Head of Midwifery in Poole, Sandra Chitty, has allowed the role to evolve and hopefully become what our staff group needs. I have spent several months gathering information from the whole workforce and from service-users. Some examples of engagement activities are:

  • ‘Whose Shoes?’ workshops, whereby staff from a variety of areas and disciplines and across different Trusts; service-users and user group representatives; providers (CCG) and others affected by maternity care issues have worked together to elicit the main issues requiring attention
  • Sharing colleagues’ insights and working towards personal and group solutions at workshops during mandatory update days
  • Breakfast workshops using ‘forum theatre’ to facilitate midwives’ learning around the new birth ‘de-brief’ appointment to be offered to each woman 21-28 days after their babies’ birth (RCM Better Births)
  • Attending external training (e.g. motivational interviewing) and procuring bespoke maternity training for community midwives (to start May 2018)
  • Developing a ‘birth afterthoughts’ service for women so that those who need it can come and discuss their experiences with an experienced midwife who may be able to ‘fill in gaps’ in their memories; make sense of what happened and the most frequent comment made in the evaluation form – have their feelings validated
  • ‘Work afterthoughts’ service for staff – guided relaxation following update days (to start at the end of January 2018)
  • Professional Midwifery Advocates across the South Coast have organised a multi-Trust working group so we can provide each other with support and share knowledge and particular expertise across the whole area

Currently I am preparing to calculate a whole staff measure of ‘self-efficacy’ which will form a baseline measure against which we can compare repeat results in 6 and 12 months’ time. The questionnaires will be filled out anonymously and a copy kept by each individual staff member and used to aid reflections for NMC re-validation and, in the case of non-midwife staff, for their development/appraisal discussions if they wish. The data will be used as evidence of staff support for CQC evaluations in future.

My current role requires and uses facilitation and engagement more than any other I have held. Being part of a FoNS programme has been fundamental in validating my beliefs and helping me to hone the skills required to turn beliefs into actions. Thank you FoNS!

References

Ireland, J., Evans, R., Buisson-Lex, R. (2016) ‘Bump, Baby and Beyond’: Participant-led Antenatal Sessions using Creative Collaboration. Journal of Health Visiting. Vol.4. No. 5. pp. 248–253 and reprinted in British Journal of Midwifery (2016) (Published Online: September 01, 2016).

Ireland, J. and Croucher, H. (2017) ‘Knitting Quitters’. The Practising Midwife. Vol. 20. No. 4. ePub. April 2017. Royal College of Midwives. Retrieved from: http://betterbirths.rcm.org.uk/ Accessed 19/01/18.

Developing and embedding effective workplace cultures that are also good places to work

06 February 2018

Kate Sanders, FoNS Practice Development Facilitator

The topic of culture in health and social care has been much spoken about for several years now, and yet, there is still work to be done to understand the nature of those workplace cultures where care is effective, safe and person-centred, and staff experience them as good places to work. How would we recognise these cultures and how would we develop and embed them?

Back in the late 2000s, as part of FoNS’ participation in the International Practice Development Collaborative (IPDC), I was involved in some work with Kim Manley, Shaun Cardiff and Jonathan Webster to deepen our understanding of effective workplace cultures in health and social care, culminating in the publication of an article in 2011: Effective workplace culture: the attributes, enabling factors and consequences of a new concept. As time has moved on since then, and our knowledge and understanding continue to develop, we met in early 2017 to discuss how we could update this understanding, in light of contemporary health and social care.

To begin this process we created a blog site: https://effectiveworkplaceculture.wordpress.com/, each posting a blog to introduce ourselves and to share our interest in workplace culture. If you haven’t already visited this site, I encourage you to do so.

As we now approach the spring of 2018, we are starting a collaborative inquiry which we invite you to be part of. This commences with a Twitter Chat on 12th March 20.00-21.00 hrs GMT (21.00-22.00 hrs CET), using the hashtag #EWCulture, to explore four questions:

  • Why should we concern ourselves with workplace culture?
  • What if you came to work tomorrow and found yourself in a really good and effective workplace culture, what would it be like?
  • How would others (delivering and experiencing care) know that it is an effective culture and a good place to work?
  • How can we develop and sustain good and effective workplace cultures?

For further information about the Twitter Chat, please click here.

We very much hope that you will participate.

Dear team …

Siobhan Weaver, Lead Nurse, Children’s Continuing Care Team and 2017 Richard Tompkins Scholar

“Dear Team,

 This week at Herstmonceaux Castle I have been learning about practice development. What I have experienced has been a personal journey of discovery. What I have learnt is that it is people who hold the answers; that using creativity alongside questioning and enquiry will enable great, meaningful and positive learning to happen. I would like to share this with you all.

You can support me by being open minded to what I show you and join in if you feel this is right for you. If you are worried, talk to me and tell me how we can work together to change and learn,

Love Siobhan x”

So this was my starting point as I left that beautiful week that was the FoNS hosted practice development school 2017. I have a job to do, I am ready and energised to make a change in myself. It’s a different kind of energy than I am used to though. It’s not the fizz popping, ‘tigger’ style enthusiasm that I have (occasionally) been known for – you know the one…. the overwhelming, over-riding, million miles an hour and already 10 points ahead energy. If I sit quietly, I can feel it deep within me. It’s a step back and watch energy and I am practicing funnelling it in a completely different way.

So, my starting point … ‘talk to me – I will listen’. Active listening has never been one of my strong points. I know this now because so much of my calm energy is needed at the moment to make sure that I do it well. I am having to physically and mentally concentrate (hard) on doing it. My mind still likes to wander. I find a thought stream can take over and, if left unchecked, will consume my active listening, polishing it off in one swift gulp. I find I sometimes jump in with more directive (closed) questions, which are really just dressed up solutions (solutions, solutions) instead of allowing the silence (sometimes long, sometimes uncomfortable), facilitating the space for the person to find their own answer. I still find that I am more guiding that I really would like, but I am working on it.

‘How are you keeping this up?’ I was asked a few days ago by a colleague. I am writing reflections, nearly every day, for the first time in my nursing career (oh, how I wish I’d listened more thoughtfully to my wonderful personal tutor 20 years ago!). The reflections are personal and cathartic, enabling an exploration of the emotions that I experience on a daily basis …’a step back, to take a step forward’ and hey … better late than never! They are aiding my learning, helping me discover (and rediscover) things that would have remained invisible to me. They create an energy of their own that sustains me and enables me to continue to improve my active listening skills. They are my memory to look back on lest I forget.

Recently I listened to a podcast from the Accidental Creative. Todd Henry shared his thoughts on 3 daily practices that he thinks can improve your life.

1) STUDY everyday (just 20-30 minutes of learning about something important to you),

2) REFLECT on the learning

3) take a WALK to help unlock the creativity in your learning.

I’ve been doing all three of these and I can tell you it’s working for me. My learning is taking me on a wonderful journey – and my ultimate destination? To help co-create the right conditions in the workplace environment to facilitate person-centredness, learning cultures, wellbeing and healthfullness. It feels a big goal to achieve, but every journey starts with just one step and I know it is in the right direction.

Click here to visit the 2018 Practice Development school pages

Why I am pleased that nurses are leaving the NHS

23 January 2018

Michael Traynor, Middlesex University

I woke up last Tuesday morning to the BBC’s headline story that 3000 more nurses left the NHS than joined last year – and that many of those who are leaving are young – under 40 (http://www.bbc.co.uk/news/health-42653542). Not surprisingly the CEO of the Royal College of Nursing commented on the story saying that many nurses leave because they feel that with current poor levels of staffing they cannot deliver the standard of care that they believe is needed by their patients. They feel there is ‘no alternative than to leave’, she said. I am pleased that this is happening.

I recently wrote a book called Critical Resilience for Nurses. In it I voice unease at the recent promotion of resilience in nursing. Some nurse leaders and researchers along with, I imagine, many politicians are grasping at the straw of resilience as the NHS falls apart due to a series of policy decisions on the part of our current government. Resilience is a characteristic way of getting individual nurses (and others) to feel some personal responsibility for invidious system problems—on top of the responsibility they already feel to provide decent care for their patients and clients. Many nurses have been naively drawn onto the bandwagon of resilience believing that it can help individual nurses in some way, usually to stay at the bedside a little longer.

One of nursing’s worst tendencies is to cope. Or rather to acquiesce to gradually increased pressure and falling standards. I believe that policy makers and managers have come to rely on this professional ‘flexibility’. Under immense pressure themselves, they end up exploiting it. In my book I encourage nurses to join together to inform themselves about the causes of the specific problems they face—and do this in detail to avoid the possibility of critique turning into complaint, which too often is unproductive. Doing this can place them in a good position to influence and resist. If this strategy fails then I suggested that leaving the service could be a positive action, not the sign of weakness and failure that so many studies of resilience assume. If enough nurses refuse to work in a toxic system, governments and policy makers are forced to respond as I believe is happening todayThat the government response is good for the NHS, its users and employees is far from certain so nursing’s professional bodies and trades unions need to work to influence the nature of that response. But for me, the promotion of resilience is part of the problem. Leaving, painful and costly as it is, could be part of the solution.