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


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.

The honest side of empathy in leadership

16 January 2018

Carolyn Cleveland, Founder and Managing Director, C&C Empathy Training

“Difficult questions needed to be asked by all; by me, by the clinicians and by the leaders who were setting the scene. What is being experienced? What is being felt?  Most importantly, how is this influencing communication and the impact on long term wellbeing?”

These are some of the words I say at my ‘Journey Through Leadership Using Empathy’ workshops. Words that I use, as I engage on a human level, with the dedicated healthcare staff I work with. The phrase ‘human level’ is key here, as it is the reason I am there in the first place: As a human being, working with other human beings.

Indeed, one of the things I also say, right at the outset, is that I am not there in a leadership, or indeed clinical role. That is an area of knowledge and experience that belongs to those attending and who I will be encouraging to share with me and each other such experiences during the day. No, my role is to share my knowledge and experience of how empathy and emotional awareness, or lack of it, impacts on us individually, organisationally, personally and indeed professionally. My knowledge is not from a text book, even though it has been my area of study for years with counselling and psychology, but from some extraordinary events that brought the presence and absence of empathy and the impact on psychological well-being into a stark realisation for me. From my own struggles to understand and utilise this ‘soft skill’, in the most extreme circumstances, to create optimum outcomes and beneficial ‘hard results’ for all involved.  None more so than when I lost a child in hospital and had to go through a brutal complaints process, led with no empathy, and manage my own psychological well being at the same time.

Let’s face it, most of us, most of the time, are trying our very best to manage our life, our real life, as that is what we share in common, whatever our job role. We may well have family commitments of children and their needs, partners maybe, friends, parents. We will be managing, or not managing other people’s personalities (not easy!). Long work shifts and responsibilities and a multitude of both internal and external struggles. Although we are trying our best, we can often feel like we still are not doing enough. That we are drowning, or failing in some aspect or another, or need to simply ‘pull ourselves together’ and perform more exceptionally.

In the world of social media, we are constantly shown what ‘perfect lives’ everyone else has and what can feel like a scrutinised and procedure driven existence. Soft skills like empathy for others, can feel like the last thing we need to think about developing. After all, 98% of us are hardwired to be empathic anyway, so, yes, I can hear you, ‘give me a break, do I really need to think more about empathy?’  Trust me, I hear your frustration and hear your pain! In fact, often people attending my courses will come in with this thought process already in place. Hard working staff members, with important, demanding and already caring professional roles. But, this is where they find this day a little different because this ‘inside out’ journey through leadership and the role that empathy plays in communication, starts with understanding ourselves and the world we operate in, with honesty. And that honesty is that we are human beings and not perfect.

This honesty starts with me. As group facilitator, it has to. Using my own openness, candour and transparency, staff are encouraged to look at the fuller picture of life without shame, but with thought provoking content, humour and self-compassion. The empathy phenomenon, which is recognised in multiple leadership studies now as ‘the number one skill’ for those in leadership roles to possess is something, I believe, to be incredibly powerful, but not easy always to achieve and is dependent on our own honesty with ourselves. For example, what do we have going on in our world? What are our thoughts about others and self and how are these emotionally motivating our words and actions?

Using authentic honesty and being able to laugh at myself and how I get communication wrong sometimes, yes, that’s right, I do, gives permission for others to own when they get it wrong too and then to start to look at it more deeply. This honesty sits adjacent however to the times that I have found and excelled at empathy in the most difficult of circumstances, reminding staff to recognise when they have too, and to inspire them to see its benefits. As those attending the day examine what it feels like to be really listened to and understood, as well as recognise what psychological harm looks like, they not only learn more about the neuroscience of empathy, but importantly, are reminded what it feels like too. And it feels good. It’s often what makes the difference and forms that all important human connection when circumstances are challenging and not always easy to negotiate your way through. What IS someone actually saying to you? What is THEIR perspective? Are you hearing the emotion? Are you recognising it? Is it fear, sadness, anger, frustration, helplessness? Hearing the emotion is not about absorbing it or ‘fixing it’ but acknowledging it to be their experience. Using the emotional data to understand at a deeper level. Only then can you start to look at meaningful responses and actions.

The journey staff members, including complaints and patient experience teams, clinicians, nurses, matrons and board members go on with me, is not always a comfortable one. Stepping out of one’s comfort zone, challenging one’s thinking and looking more deeply at emotions, is rarely a comfortable process, but one where personal growth and learning can take place. One where authentic empathy can develop. Self-care can be nourished. And we, as human beings, can understand ourselves a little bit more to strive to be the best version of ourselves we can be in our leadership and professional roles and personally, as human beings. With mixed anxiety and depression being the most common mental disorder in Britain and the cause of one fifth of days lost from work in Britain, those in leadership roles, can make an immensely positive difference to the people they lead through developing their own emotional awareness and optimising their empathic attributes, and by caring for their own wellbeing and understanding their own needs too, they are best placed to do this.

Carolyn runs full day workshops on leadership and on handling complaints using empathy and is available to speak at conferences. To work with Carolyn you can contact her on

To read more about the work she does and testimonials, see

Facilitative leadership in creating a caring culture

28 November 2017

Jo Odell, FoNS Practice Development Facilitator

Last week I had the pleasure of leading a workshop at the Nurse-led Clinics 2017 run by Healthcare Conferences UK. The aims of the workshop were to:

  • Enable participants to identify their own leadership qualities and behaviours against a framework
  • Explore the ‘Creating Caring Cultures’ model as a framework for developing nurse-led clinics.

The participants were from a wide range of clinical practice and were currently running nurse led clinics or wanting to develop them in their own sphere of practice.

I started the workshop by describing the resources that FoNS has available to health and social care staff on our website. We then used Evoke cards to introduce ourselves and to share our expectations of the workshop. Participants were then invited to look at the Facilitative Leadership Model

and to select 10 characteristics that they felt they used regularly in their roles. They then looked at these identified characteristics in relation to the three styles: Visionary, Manager, Facilitator. This was an opportunity to identify their strengths but also to think about and discuss the merits of each style. During the discussion we identified different situations in which each style maybe more appropriate within their role and work.

I then introduced the participants to the Creating Caring Cultures animation and resources. We watched the 5-minute animation and discussed each of the ribbons (as in the picture) of the model in turn and the different approaches and methods that could be used under each one. So, for example if you were looking to establish a nurse led clinic it was important to develop a shared purpose for the new clinic, but not to do this in isolation, but in collaboration with patients, staff and other key stakeholders. If you wanted to evaluate an existing nurse led clinic, you could look at the gaps between your shared purpose and what was really happening in practice. You could do this in several ways:

  • Asking staff “what’s it like to work round here?”
  • Ask patients about their experiences in a meaningful way for example using an emotional touchpoint approach

Lastly, we talked about the importance of celebrating success on a regular basis and recognising small achievements as well as formal final evaluation outcomes. We all identified that a facilitative leadership style would be the most helpful when working with these resources. We closed the workshop by sharing individual learning points from the workshop. Participants fed back that they liked the simplicity of the resources and felt they could really apply them to their roles and in relation to working in nurse-led clinics.

If you are a clinical leader and would like to explore the Creating Caring Cultures resources, to get some support to apply these to your own practice and to look at methods and approaches for implementation, come and join us at the masterclass on the 22nd January 2018.

More information and discounts are available via the FoNS website.