103
Nursing in Dorset Conference Friday 10 May 2019
Nursing in
Dorset
Conference
Friday 10 May 2019
WelcomeVanessa 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 TilburySystem Apprenticeship
Development Lead
Tina CollinsonWorkforce Planning Lead,
Primary & Community Care
Retain - Attract - Recruit
Understanding a Workforce Plan
• What does this mean?
• Why is this important to Dorset?
• What is happening?
• Where we are heading - along with your views
Example Heat map
What does this really mean
for Nursing in Dorset and
what action is being taken?
• System agreed money of £675,000 for
four years
• 50 new places for Adult & Mental
Health Nurse Apprenticeships
• Cohort commence September 2019
Strategic Investment
New to role
Confident /
Competent
Developing
Experienced
Advanced
To develop and implement a consistent career framework for Dorset
Retaining our Nursing Workforce
• 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
Attracting our future workforce
• 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
Recruiting new workforce
Apprenticeships
• Level 2 / 3 Healthcare Support Worker
• Level 5 Nursing Associate Apprenticeship
• Level 6 Registered Nurse Degree Apprenticeship
• Level 7 Advanced Clinical Practice Apprenticeship
Developing our future workforce
Ongoing CPD Opportunities
• Leadership & Talent Management
• Clinical skills development and expertise
• Mentorship
Next steps…
Why do nurses
leave or stay?
A collaborative project
on improving nurse
retentionDr 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
ResilienceAuthentic
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) directorateJuly’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 [email protected]
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 EnglandFramework
November 2017
Reshaping the workforce to deliver
Advanced practice roles offer opportunities to fill in gaps in themedical workforce; improve clinical continuity; provide mentoringand training for less experienced staff as well as offering arewarding 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 ANPOr
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
outcomes in outpatient
care
Pearl Avery
IBD Specialist
Dorset County Hospital
For more information Contact Clare at
The benefits of eHealth for our IBD patients
What is eHealth or Digital Health?
The RCN defines this as
Concerned with promoting, empowering and facilitating healthand wellbeing with individuals, families and communities, and theenhancement of professional practice through the use of information management and information and communicationtechnology (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 out 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 ongoing 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 of 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 on a symptom that had previously been well managed, or was a new symptom.”
Telehealth – the benefits
•Patients - control and self-management •Symptoms monitoring
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
of 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
others' 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
