Executive Summary. reputation as a place of choice for patients and other service users.

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1 5 YEAR NURSING STRATEGY

2 Executive Summary The Walton Centre NHS Foundation Trust is the only specialist trust dedicated to providing neurosciences treatment care, and we pride ourselves on being a Our care and purpose-built facilities enable us to provide first class services, and the highest standard of nursing care and clinical outcomes. The NHS has made great progress over recent years to give patients fast access to care, reduce infections and improve the environment for patients. Nurses have been crucial to this success nationally and at the Trust. There are many drivers for producing this five-year strategy. These include: the increased expectations of our patients and their relatives; the Francis Report and Ombudsman Reports; the changing face of education for nursing; medical workforce challenges; and the mission to provide care that is safe, effective and personal. This strategy is aimed at all nursing staff - Registered General Nurses, Assistant Practitioners and Health Care Assistants. One of the aims of the Trust is to improve the quality and range of our services and ensure that we reach the highest possible standards, for the benefit of our The Trust recognises that nurses are fundamental to providing high quality patient-centred care. Our nurses have a crucial role in ensuring we maintain our 2 centre of excellence. reputation as a place of choice for patients and other 3 service users. patients. To achieve this aim and the overall objectives of the Trust s strategy, our nursing workforce needs a clear delivery plan that is meaningful and measurable. The Walton Way has been developed by our staff and plays a key role in how we deliver a quality, patient-centred service. These values are: Caring Dignity Respect Openness Pride. The Trust s nurses are already a dedicated, knowledgeable workforce and this strategy sets out how our nursing community will continue to go above and beyond to provide a gold standard service to ensure that patients have a positive patient experience that is safe and effective. This strategy will support the Trust s five-year strategic goals by focusing the direction of nursing and quality. You can see first-hand the dedication and hard-work that our nurses invest every day of the year. Their enthusiasm and professionalism is what makes the Trust a special and unique place to work. I am proud of the nursing workforce at our hospital; with their support we will as a profession build on our success over the past year by implementing this strategy, ensuring that the care we provide is what we would expect for our family, friends and loved ones. Lisa Grant Director of Nursing and Modernisation

3 Executive Summary The Trust s strategic vision for the future is: To provide our patients with excellent neurosurgery, neurology, pain and spinal services, built on research and education and delivered with care, dignity and compassion in line with the Walton Way. The nursing vision to support this is: To work in partnership with patients, their families and carers to provide a level of care that arrangements and sound business infrastructure. clinically effective 4 5 we would expect for our families, loved ones and friends. The Trust s mission that defines what we do, is: To provide an excellent standard of treatment, care and patient experience in the most appropriate place to meet the individual needs of our patients. Our strategic goals, which shape our objectives, are: Be World Class We will provide world class patient care and experience, recruit and retain world class workers and undertake pioneering world class research, development and education. Always Caring We will provide excellent patient care, experience and environment supported by sound governance Forward Thinking We will be forward thinking, which will enable our patients to access high quality services in a timely way and in the location of their choice so that we are the provider of choice in our field. Working Together We will work with our staff, governors, members and other stakeholders so that we can respond to opportunities to improve services for patients, their families and carers within our financial limits. Quality Our definition of quality is defined by our values and specifically means that we will provide care which is personal and provides the best experience for patients safe evidence-based best practice timely in terms of access for the patient in the right place for the patient gives value for money for the taxpayer We will demonstrate the benefits of our world class quality care by the experience of each and every one of our patients. We will seek feedback at every appropriate opportunity in our quest for continual improvement of our provision. We are genuinely committed to using patient feedback and other service users opinions to shape the way we provide care for patients; we will always continually strive to improve the care we deliver on an ongoing basis. I love being a nurse because it gives me immense satisfaction in making a difference. Michelle Rackham, Matron

4 Strategic Objectives In consultation with staff across the Trust, the senior nursing team have developed five objectives for the next five years. These objectives support the delivery of the Trust s five-year strategy and also support the delivery of the Patient Experience Strategy, a two-year strategy which was developed in I choose to be a nurse at The Walton Centre because it is a centre of excellence and I have such a variety of enjoyable roles within my job. Being a nurse can be emotionally challenging but extremely rewarding and I love it. 6 7 Chris Jessop, Infection Control Associate Nurse Specialist

5 Objective One Improve the quality of our existing services by focusing on three stretch targets, relating to care Objective Two To deliver safe, effective and compassionate care that will improve the patient experience and the experience of patient families/carers The Trust will improve its outcomes against three measures chosen by Governors, who are representatives of our members. In consultation with Governors, we will determine three priority areas every year for which we will improve patient outcomes. The nursing workforce will support the delivery of these outcomes and will report the progress made through the Quality and Governance Committee. Stretch Targets 2012/13 For these targets are outlined below, alongside the measurement that will be used for the achievement of the indicators. Measure of Achievement The Trust is committed to ensuring the care we provide to our patients is safe and effective; as a nursing profession we want to ensure that the care we provide is the very best that we would expect for our family, friends and loved ones. This commitment, alongside key areas of work that the Trust has chosen to focus on, will ensure continual improvement of the quality of our services. Objective 2 is underpinned by recommendations sought and provided following external reviews requested by the Trust which outlined key work streams that will be taken forward. In 2011, with the help of patients and carers, the Trust 8 developed a two-year Patient Experience Strategy for 9 patients and carers. The nursing workforce has supported 1. Timely admission and discharge 1. Reduction in LOS by 0.5 of a day the delivery of the first year of this strategy and is key with an appropriate level of in ensuring its success. Patients are at the centre of 2. Successful roll out of nurse support. all we do: therefore, to ensure that we provide safe co-ordinator role compassionate care that our patients tell us is effective and which meets their needs, we will measure progress 2. Appropriate and timely information towards this objective against the following targets. given to inpatients on admission, discharge and to outpatients. Accurate discharge information to be provided to GPs within 48 hours. 1. Production of a discharge information pack. A 2% improvement in the National Inpatient Survey questions relating to discharge and information. Sustained improvement in monthly internal patient surveys. 2. Implementation of the Inpatient and Outpatient Action Plans. 3. Communication CQUIN met.* 3. Reduction in falls. 1. A 5% reduction in falls. 2. Falls CQUIN met.* * The CQUIN milestones can be found within the Quality Account Document and in future accounts

6 We will ensure that our patients, their families and carers are treated at all times with The Walton Way Values which are: dignity, respect, openness, pride and caring by implementation of the following: We will revise the patient information leaflet and ensure this is accessible through pre-operative assessment clinics and on our website. We will ensure all elective patients receive this information with the option of receiving the patient information DVD. We will monitor the success of this through in-patient surveys. This is a key commitment outlined within the Patient Experience Strategy. The nursing profession will in partnership with external stakeholders continue to work towards continual excellence through the delivery of excellence in nursing care : We will be open and transparent with patients and visitors using electronic quality boards to share real time information about ward/department areas on infection control, safety metrics and patient experience feedback. We will provide a programme of training for the We will participate in local, regional and national dignity champions and cascade training for all staff pilots that share information to improve patient across clinical and non-clinical areas. We will recruit a Tissue Viability Nurse who will work safety. We want to be able to demonstrate that over 10 across the Trust to reduce the number of acquired 95% of our patients receive harm free care. 11 pressure ulcers. We will work with other stakeholders to ensure information about support networks is made available to patients at each stage of the patient journey. We will work with charitable organisations to provide information packs that are easily accessible and that can be provided at the point of discharge. We will review progress against the Patient Experience Strategy annually, ensuring that we are on track and continually improving the patient experience. We will fully embed the patient choice care plan across the Trust and undertake a review of its effectiveness through patient and staff feedback. We will review its effectiveness and report this through the Operational Nurse Group. We will build a programme of training for staff that is customer/patient focused. We will monitor success through patient feedback from surveys, comments and complaints. We will provide a programme of training for all nursing staff on caring for patients with dementia. We will monitor its effectiveness through staff feedback and through the Patient Experience Group. We will undertake an annual acuity review in line with our nursing establishment. We currently undertake unannounced spot checks on the meal times service. We want to enhance this and involve the patient voice group in this work. We also want to undertake a further audit of the ongoing risk assessment of patients and in the involvement of dietetics. We will address all of the recommendations following the NPSA external review of in-patient falls and will continue to review all falls with harm through the Falls Committee. We will release a senior nurse to undertake falls research that is specific to our patient speciality and publish its findings. We will be able to demonstrate a year on year 5% reduction in the total numbers of falls with harm. We want to build upon the work we have been undertaking in relation to wound management with the view to reducing the number of hospital acquired pressure ulcers. We will request an external review of our internal tissue viability policies and procedures and set an action plan for improvement following any recommendations. We will release a nurse to undertake a specific piece of research on the acquisition and management of pressure ulcers within the Trust in conjunction with our neurosciences speciality and publish the findings of this work. We will launch a Trust campaign dedicated to reducing the number of avoidable hospital acquired pressure ulcers.

7 We will ensure that there are policies and The senior nursing team will ensure there are procedures in place for safeguarding children, continuous measurement methods put in place to young people and vulnerable adults by: sustain improvement of the Trust-wide nursing indicators through leadership and support by: Ensuring our safeguarding structure is fit for 12 purpose. Working with IT and commissioners to embed a live 13 We will ensure there is a sustained improvement in the reduction of hospital acquired infection by implementation of the following: We want there to be a clear message across the Trust for all staff, patients and visitors on our infection control commitment and work streams. We will publish a three-year strategy that will set out our work programme and our commitment to continually improve the service that we provide for the benefits of our patients. We will continue to provide a clear commitment to a clean, safe hospital that is visible to all. We will measure success by keeping below trajectory for our infection rates and by achieving a score of Excellent in the Patient Environment Action Team (PEAT) annual inspection. The Trust commissioned an external review of infection control policies and procedures in We are implementing the recommendations from that review. We will continue to be open and transparent about our management of infection control and will strive for continuous improvements through benchmarking, the implementation of national guidance and policy and audit. We will ensure that the delivery of medicines management is safe and effective by implementation of the following: We will request that all registered nurses are competency assessed in numeric skills and relevant aspects of the Trust s medicine management policy. We will ensure nurses are involved throughout the process of electronic prescribing and will identify key trainers to support staff in the implementation of this project. We as the nursing profession will lead discussions with the multi disciplinary team (MDT) on how the Trust can facilitate patients self medicating when they choose to and when it is deemed clinically appropriate. We will, in conjunction with the patients who use our rehabilitation services, ensure that our rehabilitation unit is equipped to encourage patients to self medicate under supervision from nursing staff when it is deemed clinically appropriate. Holding a Safeguarding Committee meeting at least three times a year. Revising safeguarding policies incorporating up-todate guidance and legislation as and when this is required. Providing level 1 and 2 training for all Walton Centre staff via e-learning for safeguarding children. We will have plans in place for the delivery of vulnerable adult training via e-learning. Additional training plans for the Deprivation of Liberty (DOLS) and mental capacity will be made. Providing clinical feedback and supervision for each safeguarding referral so that we learn lessons and share good practice. Being fully involved in any serious case review and feedback lessons learnt to the Safeguarding board and relevant leads. Working with commissioners following legislation to develop a framework of measurement for safeguarding adults. electronic system that will be used to performance manage wards and departments to ensure the data we collect with regard to patient care and nursing metrics is quality assured. Continuing to utilise the Energising for Excellence tools putting ourselves forward to be involved in future pilots and work streams. Developing a new report that can be shared across the Trust on the quality of care delivered to our patients using both quantative and qualitative data. This will be presented to the board of directors for assurance.

8 Objective Three The Trust will integrate its workforce, education, training and research to improve the patient experience The Trust s five-year strategy outlines its commitment to research. Objective 6 of the strategy states that the Trust will: Develop an ambitious programme of research and innovation to ensure that the Walton Centre is a centre of excellence for research. Developing a nursing culture of research: We want to have an established link nurse group that has a programme of planned research which links into the Trust s strategic goals and the patient experience strategy. We will establish a research link nurse group that is represented by all nursing staff across the Trust. We want to have in place an internal nursing research review body that will assess research proposals for viability and ensure that they are undertaken in line with the Trust s strategy whilst improving patient safety and experience. We will therefore establish a We want to create opportunities for nurses to undertake research that can support their professional development whilst also positively impacting on the patient experience. We will create those opportunities through releasing nursing staff to undertake specific research that will improve the patient experience. Developing a culture that embraces continuous professional development: Currently we offer a preceptorship programme for nursing staff new to the Trust and have practice educators to support this. We want to develop a core preceptorship programme for all nursing staff to attend extending preceptorship with study days specific to nurses areas of work. This objective is supported by The Trust s Management, As a profession we also understand how important Education, Leadership and Talent Strategy (MELT) which We want to continue to work in partnership research, training and education and continuous sets out the Trust s approach to manage, educate and externally with regards to the funding provision for professional development is, not only to ourselves but lead its staff as well as identifying and retaining talent. professional development. to our patients. We will therefore work in partnership review body that has input from senior nursing staff, 14 clinicians and training and development. 15 The strategy also highlights that the Government s Strategy for UK Life Sciences outlines how there will be considerable investment in the development and commercialisation of research. The Trust therefore plans to collaborate with local universities in the North West and Wales in lobbying for a broader neurosciences presence. The Trust will also explore the option of an academic unit on the Walton Centre campus. The nursing profession recognises the importance of research for our patients and for enhancing our clinical practice to benefit patients. We acknowledge that in the past this has not always been an opportunity given to, or taken by, nurses. In light of this, we recognise that we need to understand the reasons that have prevented nurses from undertaking research and create a culture of research across the profession. with departments to ensure that we have a workforce that can embrace and drive this objective ensuring the organisation is World Class and Always Caring. We will measure progress towards this against the following targets. Staff have the opportunity to attend CPD courses at HEIs, however, we want to have an established self propelling education group to identify learning activities throughout the Trust and encourage shared participation. We want to develop a programme of sessions that staff will be required to access to update their knowledge, skills and competence and establish a baseline of competencies required by all nursing staff. Seeing patients recover from illness or injury and knowing you have had a part to play in their recovery is one of the most satisfying and rewarding things ever. The Trust has begun to roll out clinical supervision across the Trust and will measure its impact and success to ensure it fits the needs of all of our nurses. Nadine Daniels, Caton Ward Manager

9 Objective Four Strengthen nursing leadership across the Trust by developing a culture of innovation that will deliver an improved patient care experience Apply evidence based practice We will review all of our nursing documentation to ensure it is evidence-based, fit for purpose and reduces repetition. By doing this we wish to reduce the amount of nursing paperwork to give nurses more time to be with their patients. We will review our nursing risk assessments and care plans to ensure that they meet the needs of our patient speciality. The Trust s five-year strategy outlines some challenging objectives in the forthcoming years. This includes enhancing the quality of our services in neurology, neurosurgery, anaesthetic, pain and rehabilitation services. To support the delivery of these objectives, the nursing strategy has identified the need to ensure our nursing leaders and leaders of the future are equipped with the knowledge, skills and tools to deliver our future ambitions. We will support students during their time with To facilitate this, it is recognised that nursing leadership We will build into all nursing leaders job plans us and offer the opportunity to develop their requires development so that it continually creates a We will establish an evidence-based nursing clinical time to spend working alongside their teams project within the management module with the culture of innovation and challenge that will impact group that will open the doors to all of our staff to support and develop clinical practice. senior nursing team so that they can assist in the positively on the patient experience. 16 for the resources available through the National 17 Benchmarking Neuroscience Group. This group will monitor practice and refresh policies and processes in line with evidence-based best practice for nurses. Improve pre-registration education and training We will participate locally, regionally and nationally in discussions about the shape of nurse training and education. We will lead in influencing what neuroscience training and education for nurses should look and feel like and work collaboratively with universities to ensure that our students have the best learning outcomes. development and improvement of quality indicators at the Trust that will have long term sustained and measurable improvements for patients. We will measure progress towards this against the following targets. We will give leaders the right tools for the job: All nurses at the Trust will have signed to agree to the Royal College of Nursing - Principles of Nursing Practice whilst working at the Trust. This will also be added to relevant Trust policies and outlined at induction. We will give leaders time to lead We will also ensure our leaders spend time working with staff so that they know that all of the care we provide is the right care provided to the highest standard.

10 Objective Five We will be an employer of choice and recruit excellent employees; we will attract the best nurses due to our world class reputation and working environment. We will ensure that we have the appropriate number of nursing staff who have the right skills to deliver a high quality service. This objective is supported by the Trust s People Strategy and workforce plan which clearly sets out the requirements to enable the Trust to meet both current and future workforce requirements. We will build on this success by the delivery of the following targets. We will ensure that we have the right nursing workforce with the right skills for our patients needs. Having demonstrated our success in the Health Service Journal we were recognised in the top 100 Employer Awards 2010 being named as the top Specialist Trust in the country, fifth overall and first within the North West. In the 2011 staff survey, we saw an increase in the We will undertake an annual acuity review in-line with the nursing establishment working closely with the Human Resource Department to assist in the development of workforce planning. numbers of staff who would recommend the Trust as an 18 employer. 19 Establishing a voice for nursing through committee structures We will launch a Nursing Council that will be held at least three times a year. The terms of reference and membership will be discussed with the entire nursing workforce to ensure representation from across all clinical areas. The Nursing Council will take responsibility for delivery of this five-year strategy and will be chaired by a member of the senior nursing team. Development of Ward Accreditation Programme We will develop a nursing ward round so that we are assured that each ward is safe, effective and personal to patients. We will use this ward round to develop a ward accreditation programme that will accredit every ward as bronze, silver or gold. This will be monitored for sustained improvement. The nursing strategy epitomises the values and behaviours nurses are recognised for and sets out a clear vision for all nurses to deliver excellence in patient care. Moya Sutton, Deputy Director of Nursing In 2012 we held our first Nursing Awards ceremony at the Trust, which celebrated nursing at its best. The feedback following this event has been positive and will be used going forward to ensure we always take time to thank our staff for their commitment and work.

11 We will create an advanced nursing structure that supports the medical workforce, enhances patient care and the experience of our service users. We will review all specialist nurses posts ensuring that their titles are a true reflection of their role and that they are supporting service/pathway needs. We will always recognise our staff s hard work and commitment We will continue to host an annual Nursing Awards to recognise the nursing profession and its commitment to our patients and the Trust. We will develop a clear progression plan for nurses wanting to develop their clinical practice and knowledge and support them in their education and study. 20 We will support the medical workforce by exploring opportunities for creating Advanced Nurse Practitioner 21 posts. We will review the success of the Advanced Nurse Practitioners posts and continually strive to improve the advanced nursing service we deliver. We will review the role of the specialist nurse and their teams ensuring there is a clear framework of responsibility. We will review new initiatives, for example the Advanced Neurology Nurse Specialist roles, to ensure that they are effective and meeting the needs of our patients. We will support the delivery of safe care by providing an out of hours service to support patient admission and treatment that is nurse-led. This service will also create opportunities to expand nursing knowledge and skills. I enjoy looking after patients; I have worked in other Trusts and this Trust delivers the best standard of care. Sue Maclean, Intensive Care Unit Nurse

12 22 23 When I left school I wanted to be a nurse, to help improve the lives of others. I have been interested in the care of neuro patients since my placements here during nurse training and it is a great place to work. Renae Carney, Intensive Care Unit Nurse

13 24 The Walton Centre NHS Foundation Trust Lower Lane Fazakerley Liverpool L9 7LJ Tel: Fax: