Nursing in Dorset Conference Friday 10 May 2019 Welcome Vanessa - - PowerPoint PPT Presentation

Nursing in Dorset Conference

Friday 10 May 2019

Welcome

Vanessa Read Director of Nursing and Quality, NHS Dorset Clinical Commissioning Group Get involved

• Follow us @dorsetccg #INDDorset
• Post it wall

National Perspective on Nursing

Sue Doheny Chief Nurse, South, NHS England

Dorset’s Integrated Care System (ICS) and new models of care

Dawn Dawson Director of Nursing, Dorset HealthCare

Where we are now and how we got here

Clinical Services Review & Mental Health Acute care Pathway 2014-17 Five Year Forward Plan GP Five Year Forward Plan 2014 – 21 Sustainability & Transformation Plan (STP) 2016 Dorset Integrated Care System (Our Dorset) 2017 Long Term Plan 2019 -2029

We are here

Integrated Care System

All GP practices have to join a primary care network

Primary and community care services get a bigger chunk of the NHS budget

Mental health services are also getting a funding boost

Urgent and emergency care service reform continues

Workforce planning will be less disjointed

A new commitment to improving prevention and tackling health inequalities

A ‘digital first’ option for most patients by the end of the decade

Thank you for listening

Dorset Nursing Workforce

Sarah Tilbury

System Apprenticeship Development Lead

Tina Collinson

Workforce Planning Lead, Primary & Community Care

Re Reta tain in - At Attr tract act - Re Recr cruit it

Under nderstanding standing a W a Workforce rkforce Pla lan n

• What does this mean?
• Why is this important to Dorset?
• What is happening?
• Where we are heading - along with your views

Ex Example ample Heat at ma map

Wh What do at does thi es this real s really mea ly mean n for N for Nursi ursing in Dors ng in Dorset and et and wha what acti t action is be

• n is bein

ing g tak taken? en?

• System agreed money of £675,000 for

four years

• 50 new places for Adult & Mental

Health Nurse Apprenticeships

• Cohort commence September 2019

Strate trategic gic Inv nvestment estment

New to role Confident / Competent Developing Experienced Advanced

To develop and implement a consistent career framework for Dorset

Re Retaining taining our ur Nu Nursing sing Workforce

• rkforce

• Student Nurses / Placements
• Careers Fairs
• Targeted recruitment campaigns
• Need to consider the future role of the nurse, the skills and expertise
• Move away from traditional ways of working and roles advertised
• Showcasing new roles / new ways of working - opportunities to be creative
• www.doorwaytodorset.nhs.uk and www.joinourdorset.nhs.uk

Attracti ttracting ng our ur fu future ure workforce rkforce

• Local; regional; national and international
• Exploring opportunities to work together across all settings, including primary care,

community care, acute, mental health and learning disabilities

• Portfolio Roles / career flex / rotation
• Joint recruitment process
• Actively connect with students and newly qualified staff

Re Recruiting cruiting ne new w workforce rkforce

Apprenticeships

• Level 2 / 3 Healthcare Support Worker
• Level 5 Nursing Associate Apprenticeship
• Level 6 Registered Nurse Degree Apprenticeship
• Level 7 Advanced Clinical Practice Apprenticeship

De Developi veloping ng our ur fu future ure workforce rkforce

Ongoing CPD Opportunities

• Leadership & Talent Management
• Clinical skills development and expertise
• Mentorship

Next steps…

Why do nurses leave or stay?

A collaborative project

• n improving nurse

retention

Dr Janet Scammell, Associate Professor, Faculty of Health and Social Sciences Bournemouth University

www.bournemouth.ac.uk 27

Overview of presentation

• Global factors impacting on nurse retention
• Why do nurses leave the profession?
• Burdett Trust for Nursing funded project:

Exploring a universal, evidence-based model for improving nurse retention: TRACS

• Current progress
• Transferability

www.bournemouth.ac.uk 28

www.bournemouth.ac.uk 29

UK Context

www.bournemouth.ac.uk 30

www.bournemouth.ac.uk 31

Nurse student applications: Update for Sept 2018

https://www.ucas.com/file/196141/download?token=7YGpH k71

• Applicants declined for 2nd year running (7.6%)
• Acceptance rate increased
• Acceptance numbers (those that start) remained the same

www.bournemouth.ac.uk 32

Why do nurses leave the profession?

• The RN4Cast European Study
• 42% of nurses in England suffering burnout, the highest level

by country

• Burnout is associated with certain care settings including

working with older people

• Leadership styles based on relationships as opposed to task

were associated with job satisfaction and increased retention

• Poor nursing leadership was linked with staff stress/low

resilience.

• Key factors in intention to stay - Engagement and Burnout

www.bournemouth.ac.uk 33

www.bournemouth.ac.uk 34

Case study

• RBCH NHS Trust
• Serves urban and rural population of 550,000
• South of England: tourism key industry
• High % of older people
• 10% RN standing vacancy
• Older Person’s medicine directorate (OPM) - highest

staff turnover (11.72%)

• Staff survey data (2016)
• Low participation rate OPM nurses
• Absentee (sickness), monthly staff turnover, % of vacant posts

higher in OPM

• Key issues: resources, valuing work, appraisals, communication

www.bournemouth.ac.uk 35

TRACS study

• Aim: to investigate whether retention of registered nursing staff in one hospital can be

improved through the development and implementation of an evidence-based retention model (TRACS).

• Collaborative ‘bottom-up’ approach designed to engender staff empowerment in the

process

• Joint project - Bournemouth University Faculty of Health and Social Sciences (FHSS)

and the Royal Bournemouth and Christchurch NHS Foundation (RBCH) Trust.

• Funded by Grant from the Burdett Trust for Nursing; project timescale June 2017-

May 2019

www.bournemouth.ac.uk 36

Implementation of TRACS approach: supporting cultural change

Support Transition Resilience Authentic Leadership Commitment

www.bournemouth.ac.uk 37

Design: mixed methods

Phase 1 Collate baseline data (NHS staff survey)

Aug-Sept 2017

Phase 2 Pre-intervention Survey of RNs from two directorates using Maslach Inventory and Practice Environment Scale Nursing Worklife Index (PES-NWI)

Oct-Nov 2017

Phase 3 Consultation exercise to inform development of retention strategy

Dec’17- May ’18

Phase 4 Implementation of TRACS approach: Older Person’s Medicine (OPM) directorate

July’18 – Feb ’19

Phase 5 Post intervention survey

April-May ’19

Phase 6

Dissemination

May-Sept ’19

www.bournemouth.ac.uk 38

Implementation of TRACS approach: supporting cultural change

Wellbeing Mentoring and Leadership Supervision Participatory decision-making Valuing Contribution Career support

www.bournemouth.ac.uk 39

Current progress and Next steps

Phase 4: Interactive web portal: http://support4nurses.uk/

• Piloted with senior nurse students
• Implemented and promoted within OPM with feedback survey

Jointly developing a nurse retention strategy Band 5 development programme Coaching following preceptorship Q&A section of education dept website Retention champions? Facebook closed groups? Joint BU/RBCH Career and development clinics OPM qualitative data collection Phase 5: post intervention survey (on-going); Phase 6: dissemination

www.bournemouth.ac.uk 40

Transferability

www.bournemouth.ac.uk 41

Any questions?

Contact details: Janet Scammell

jscammell@bournemouth.ac.uk

TRACS website:

https://research.bournemouth.ac.u k/2019/04/the-improving-nurse- retention-conference-2019/

www.bournemouth.ac.uk 42

References

• Chenoweth et al. (2014) Attracting and retaining qualified nurses in aged and dementia care: outcomes from an

Australian study. Journal of Nursing Management 22:234–247.

• Cummings et al. (2010) Leadership styles and outcome patterns for the nursing workforce and work environment: a

systematic review. International Journal of Nursing Studies 47(3):363-385.

• HEE (Health Education England) 2014 Growing Nursing Numbers. Literature Review on nurses leaving the NHS.

Available at: https://www.hee.nhs.uk/sites/default/files/documents/Growing%20nursing%20numbers%20%E2%80%93%20Litera ture%20Review.pdf

• Heinen et al. (2013) Study to determine factors associated with nurse retention in a cross sectional observational

study in 10 Euro countries. International Journal of Nursing Studies

• Lake, E (2002) Development of the Practice Environment Scale of the Nursing Work Index. Research in Nursing

and health 25 (3):176-188

• Maslach, C. and Jackson, S (1981) MBI Human Services Survey Available at: http://www.mindgarden.com/117-

maslach-burnout-inventory

• NMC (2018) The NMC Register. Available at: https://www.nmc.org.uk/globalassets/sitedocuments/other-

publications/the-nmc-register-2018.pdf

• RN4CAST. Nurse Survey in England 2012. National Nursing Research

Unithttp://www.kcl.ac.uk/nursing/research/nnru/publications/reports/rn4cast-nurse-survey-report-27-6-12-final.pdf

• UCAS (2017) 2017 End of Cycle Report. Available at: https://www.ucas.com/corporate/data-and-analysis/ucas-

undergraduate-releases/ucas-undergraduate-analysis-reports/2017-end-cycle-report

Coffee Break

Presentations from nurses in Dorset

Introduced by Pam O’Shea Deputy Director of Nursing and Quality, NHS Dorset CCG

The development of an Advanced Nurse Practioner led service

Clare Byrne Advanced Nurse Practioner Royal Manor Health Centre and Lecturer Practitioner, Bournemouth University

What is an Advanced Nurse Practioner?

?

Autonomous practice Critical Thinker Innovative practice Advanced decision making and problem solving Management/ leadership Value based care

Department of Health Position Statement November 2010 Health Education England Framework November 2017

Reshaping the workforce to deliver

Advanced practice roles offer opportunities to fill in gaps in the medical workforce; improve clinical continuity; provide mentoring and training for less experienced staff as well as offering a rewarding clinically facing career option for experienced staff” ‘Reshaping the NHS Workforce’ 2016

Royal Manor Health Care

Approx 13, 000 patient population 4 GPs 6 ANPs 5 Practice Nurses 2 HCAs

What were the drivers for change?

for change?

• Patient access to timely

healthcare

• Supporting GP

workload

• Developing services for

Portland

• ANP development
• Discussions with GP partners, Practice

manager & ANP team

• Team approach through meetings with

clinicians and reception/admin staff

• CCG support with Patient engagement

meetings

• Publicised with support of local media

services

Patient and Staff feedback

Appointment with ANP Or Seen by ANP in ‘Walk In’ appointment ANP arranges for immediate GP input by duty GP PATIENT ACCESS TO APPOINTMENTS ANP books future appointment or via reception Patient treated & no further follow up is needed ANP refers to external services ANP books future appointment with GP due to complexity GP will reviews GP refers to external services

The new plan

• Review
• ANP caseload
• Multi-professional ACPs
• Community services

under one roof

• Nurse Partner
• Employ GPs

An integrated approach to e-health, data collection and patient-reported

• utcomes in outpatient

care

Pearl Avery IBD Specialist Dorset County Hospital

For more information Contact Clare at cbyrne@Bournemouth.ac.uk or clare.byrne@dorsetgp.nhs.uk

The benefits of eHealth for

• ur IBD patients

What is eHealth or Digital Health?

The RCN defines this as Concerned with promoting, empowering and facilitating health and wellbeing with individuals, families and communities, and the enhancement of professional practice through the use of information management and information and communication technology (ICT).

Importantly, they go on to say…

There is more to eHealth than just technology. It is about finding, using, recording, managing, and transmitting information to support health care, in particular to make decisions about patient care. Computers (and other ICT devices) are merely the technology that enables this to happen.

eHealth covers:

• Electronic patient records
• Electronic communication with patients and professionals
• Telehealth/telecare
• Information management
• Information governance
• Personal health records

eHealth in IBD Dorset County - background

• Participating in IBD Registry since 2015
• Using the IBD Registry InfoFlex patient management

system (PMS)-

• Electronic patient reported outcome measures (PROMs)

Benefits to patients - efficiencies

• Deal with queries efficiently
• MDTs - Improved decision making at point of care
• Increased efficiency even as patient population has grown
• Supports remote monitoring, reducing hospital visits
• System generates GP and patient letters
• Better continuity of care

Case Study

Patient A 32 year old man Called the Advice line on no medication UC and Auto Immune Hepatitis intolerant of Azathioprine weaned from Tacrolimus 12 months before. Information was available on the clinical management system 2 mins to find this

• ut

Patient signed up to the IBDoc Calporotectin test using APP and web portal. Treatment decision next day to escalate to biologics.

Case Study

Patient B

• CD age 24 female with perianal disease seton in situ and on adalimumab
• Patent Reported Outcome Measure (PROM) completed by patient before

appointment scored 2 with a general well being score of 50 out of 100

• Patient attended clinic asked how she was and she said FINE
• Clinician able to help patient agenda set with PROM information and unpick

the FINE into the reality of concerns; over output from fistulae; Fatigue and

• ngoing treatment options.

Case Study

• Advice line contact
• UC Flare patient unsure of medication dose and what to do symptoms

are distal despite having Total colitis.

• Clinical Management system record shows on Mesalazine 1.6g a day.

Has never tried rectal treatments.

• Clinician able to help patient to optimise treatment on the first

contact.

Benefits to clinical team

• Helps us streamline our processes and focus on delivering

patient-driven care

• Easier auditing
• Virtual MDT meetings
• Better view of IBD population
• Tracking all helpline calls allows us to show value of nurse

specialists

Downsides

• Only as good as the data you put in
• Entering data takes time and planning
• Need to consider patient
• Move the furniture!

Development and setting up of a Telehealth Servcie for palliative care patients

Emma Randall, Community Nurse, Weldmar Hospice, Dorchester

Why pilot this at Weldmar?

• Rurality – clinician travel.
• More patients needing specialist palliative care
• Clinicians access to patient data

My post

• Telehealth pilot lead - funded by Macmillan.
• Working closely with Weldmar Community Nurse

(WCN) team

Telehealth PODS

• 15 PODS
• Patients use daily and

feedback

• Questions - IPOS scoring

system and Barthel Index

• PODS - skype call

Results from PODS

• Results stored on PODS
• Home and remote access

to results

Telehealth Pilot

• 47 patients aged 34 – 93
• Questionnaire sent to 32 patients, 84.4% response rate

Patient Feedback

• “Saves time by not having to wait in for a nurse”
• “Daily record for me as to how I have felt”“
• “It is great fun, I have had a very good experience of pilot and it

has put my mind at rest.“

Mr B

“I am very happy to complete the questions daily and my mind has been put at rest by being part of this pilot. My Weldmar nurses are great and there is always someone at the end of the phone. Taking part in the Telehealth pilot has been great fun”

Carer Feedback

“My wife thinks it is useful to have a log of symptoms and to know they are

being reviewed” “They think it’s a good idea especially given our rural location.” “Great to have the history tab as family who live away can look at history

• f symptoms when they visit”

Skype Consultations – Clinician Feedback

• Observe a patient’s body language
• Visually assess a patient’s condition
• Keep in touch with patients

Staff Feedback

• Easy access to results
• “Prompted me to call a patient when they had scored highly
• n a symptom that had previously been well managed, or

was a new symptom.”

Telehealth – the benefits

• Patients - control and self-management
• Symptoms monitoring

Thank you Emma.Randall@weld-hospice.org.uk

Pre-hospital critical care nursing

Stuart Cox, Trainee Specialist Practitioner Critical Care Owen Hammett, Specialist Practitioner Critical Care Dorset and Somerset Air Ambulance

Pre-hospital Nursing

Stuart Cox Owen Hammett

Content

• Nursing within SWASfT
• What is PHEM/Critical Care
• Dorset and Somerset Air Ambulance
• Our experience
• Global picture of evidence
• Nursing role
• The future
• Discussion

Nursing roles within the SWASfT

• Clinical Supervisors
• Ambulance Nurse (trial starting July 2019)
• Mental Health
• Education
• Governance and Quality
• Research
• Specialist Practitioner - Emergency and Urgent Care
• Specialist Practitioner - Critical Care

Specialist practitioner - Critical Care/PHEM

• Critical Care Team
• Patient groups
• 19 hours a day, 365 days a year
• AW169
• Enhanced Care Car
• Anywhere in two counties in

less than 20 minutes

• SWASfT Governance
• Charity funded

What is PHEM and Critical Care?

• ‘Pre-hospital’ refers to all environments outside an ED or a place specifically

designed for resuscitation and/or critical care

• PHEM encompasses the knowledge, technical skills and non-technical skills

required to provide safe pre-hospital critical care and safe transfer

• The PHEM practitioner role is uniquely challenging, requiring the application
• f significant knowledge and skills to a high level

Our background to Critical Care/PHEM

Owen

• Community first responder
• Emergency Nurse
• Critical Care Technologist
• RCN forum Emergency

Nursing

• Dip IMC
• MSc (pending)
• Full time

Stuart

• Critical Care Nurse
• Military secondment
• Fixed wing air ambulance
• RCN forum Critical Care

Nursing

• Critical Care ACCP
• MSc (pending)
• Part time

• Nursing in pre-hospital care internationally is seen as the normal
• 2002 American study
• Trauma patients
• A total of 1193 patients met the inclusion criteria and had the crew

configuration

• No significant difference existed in patient outcomes

• Study assessed the attitudes of each
• thers' professional roles
• Both groups of professionals

acknowledge the advantage of having complementing skills, to improve service

• There is rivalry between nurses and

paramedics

• Nurses in pre-hospital care is

contributing to the quality of service by raising the competence level of the team

• In order to increase the competence in the ambulance

service in 2000 every ambulance should be manned by at least one RN

• Data collection was carried out by a focus group

interview

• The findings indicated an increasing independence in

decision-making after RNs become a part of the ambulance service

Nursing role in PHEM/Critical Care

Clinical

• Training
• Pre-hospital Anaesthesia
• Advanced analgesia
• Resuscitative surgical skills
• Blood product resuscitation
• Ultrasound
• Vascular access

Non-Clinical

• Aviation
• Response driving
• Charity engagement
• Research and audit
• Service development
• Education
• Primary prevention

Benefits

• Patient care
• Inter-professional working
• Clinical development
• Diverse workforce
• Job planning

The future

• SWASfT Nursing Strategy 2019
• Advanced Practice Framework
• Job planning / flexibility
• Ambulance nurse trial - Gloucester
• Faculty of Pre-hospital Care Examinations

Summary

• Nursing in pre-hospital care is in its infancy
• Nursing in pre-hospital care is evidenced based
• Strengthens patient care through interprofessional working
• Opportunities for workforce diversity
• Development of Advanced Practice career pathways

The Ward Leader Leading change and adding value

Jody Bryant Matron for General Medicine, Poole Hospital

Personal reflection

• Standards in ward maintenance
• Standards of care

The ward leader’s role is pivotal in managing clinical services, improving patient outcomes and effective team working.

Key components of the role

• Centre of patient care.
• 24 hour responsibility for

their ward

• Lead the delivery of high

quality care

• Provision of effective workforce
• Role model
• Teacher
• Budget management
• Audit
• Policy, procedure and guidance

development

• Expert practitioner
• Complaints manager
• Business Manager

Qualities

• Innate desire to do the

right thing

• Guardian of the 6 C’s
• Approachable
• Flexible, able to continuously

adapt to change

• Always fair and consistent
• Valuing staff
• No blame culture
• Ability to prevent issues escalating
• Desire to make a difference

Creating the right culture

• Being a role model
• Being present and visible
• Supporting all professionals
• Setting high standards
• Not being afraid to challenge
• Nurses revalidation

As a ward leader you are in an influential role. You can make a real difference

You must become the change you want to see in your team or organisation

Peers and Nurses working in partnership from a lived experience perspective

Jane Carey Kerry Matcham Dorset Mental Health Forum

Lunch

Feedback from workshops and next steps

Chaired by Nicky Lucey, Director of Nursing, Dorset County Hospital

Closing remarks

Vanessa Read Director of Nursing and Quality NHS Dorset CCG