Public Health Nursing Report of a survey of perceptions of the value and contribution of nurses and midwives to public health in the UK

Transcription

1 Public Health Nursing Report of a survey of perceptions of the value and contribution of nurses and midwives to public health in the UK Acknowledgements: Project Lead: Helen Donovan, Professional Lead for Public Health Nursing, RCN, UK Project Consultant: Nigel Davies, Independent Consultant Survey Team: Anda Bayliss and Adrian Baker, Research & Innovation Analysts, Standards, Knowledge and Information Services, Royal College of Nursing.

2 RCN Public Health Nursing Survey We sought to better understand: Aim The role of nursing and midwifery staff in public health and how their roles are valued; What and where the gaps are in nursing knowledge and education in relation to public health services. To explore the perceived value of nursing in public health. Research questions What is the perceived nursing contribution to public health What are the gaps between perceptions and expectations and need?

3 Methodology Survey: Questions principally based on domains outlined by the Faculty of Public Health Limited to 23 questions, with closed questions to ensure a common understanding and three general open ended questions. An Online web tool (Smart Survey ) was used with one-month (May 2015) for completion. Sample: Commissioners or those setting-up or designing service specifications for PH were targeted. A snowball sampling method was used to reach networks and suggested contacts based on the inclusion criteria: The survey invitation was sent to a large yet targeted population utilising the RCN database Non-RCN members based on a targeted list identified by the project team from wider PH and health and social care networks

4 Demographic and response data 219 people completed the survey. Almost as many attempted to start the survey but were filtered out at the first question because they were not directly involved with commissioning or designing services. 85% of responses were based on individual opinion rather than on behalf of organisations. The majority (80%) were from either commissioners or providers of services. Other responses included health boards, independent consultants, nurse practitioners/ educators.

5 Current nursing involvement Areas of Involvement - Top 5 and Bottom 5 areas 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% The top 5 areas nursing is most frequently involved in are all associated with the Faculty of PH domain Improving Services Conversely, the 5 areas in which nursing is rarely involved are in health protection or in health improvement.

6 Actual vs Desired nursing involvement In all areas respondents believed nursing should be involved in public health more than it currently is. Notable differences (i.e. > 40 % points) between desired and actual involvement in 6 areas Commissioning also had a slightly smaller but still sizable difference Difference between frequency of current and desired nursing involvement in public health Always or often frequently involved Always or often should be involved

7 Perceived quality of nursing contribution Top five areas include items from all three public health domains (service improvement, health protection and health improvement) In the areas rated low for the quality of nursing contribution respondents still believed that nursing should be involved In all areas a % believed that nursing should be involved (previous slides) in PH compared to satisfaction with nursing contribution. 100% 80% 60% 40% 20% 0% Perceptions of nursing contribution - Top 5 and Bottom 5 areas

8 Satisfaction with nursing skills and knowledge 100% 80% 60% 40% 20% Satisfaction that nurses have required skills, knowledge and expereince - Top 5 and Bottom 5 areas 0% Very satisfied or satisfied Dissatisfied or very dissatisfied The top five satisfaction areas contained items from all three public health domains. > 33% were dissatisfied in the areas of: Commissioning Housing and homelessness Employment Service planning showed a mixed picture of satisfied and dissatisfied

9 Reasons for utilising nursing in public health services 7% Reasons to access or employ nursing in PH services Local knowledge 10% 13% 24% 23% 28% 30% 46% 43% 44% 55% 69% Commissioning public health services Convenience Flexibility Financial considerations Communication skills Research skills Competence Compassion Top 5 reasons Care specialist Competence Local knowledge Commissioning public health services Communication skills. Out of necessity Care specialist Other (please specify):

10 Challenges to utilising nursing in public health services Top 3 challenges to commissioning care. (Themes from open ended questions) Lack of resources Current capacity Funding and costs Issues with knowledge, training and skills Depth of knowledge required Challenges with nurse education Lack of skilled staff Problems with commissioning Shortage of professionals, particularly nurses, in commissioning; Lack of understanding by commissioners with regards to specialist roles Challenges in having effective commissioning in a changing commissioner and provider landscape

11 Skills looked for when designing PH services The survey asked for top 3 skills looked for when designing public health services with nursing teams. (Themes derived from open ended questions) 4 types of personal qualities and competence came out strongly (> 50% of responses) - out of 17 themed qualities. Local Knowledge Communication Some mentioned interpersonal communication Project and Research management skills Behavioural Characteristics (Care, Compassion, Determination, Motivation, Commitment)

12 Strengths and limitations of the survey Sample: By targeting a narrow and defined population, we have been able to highlight specific areas for discussion, which may not have materialised with a broad brush approach. However, in attempting to be as specific as possible in defining the study population and targeting participants it is possible that some relevant participants were lost at the filtering question stage. The analysis focused on descriptive statistical approaches and looked at comparisons within categorical variables. A more sophisticated inferential approach was not considered appropriate given the sampling method adopted and the purpose of the survey. This survey is a baseline snap-shot that has the potential to be revisited at later stages to give trends over time, inform public health nursing strategy and be used by the RCN to lobby for further investment. A number of points raised can be explored in the interview phase of the project.

13 Discussion points There were a number of positive messages from the survey: Clinical governance and clinical effectiveness featured strongly Nursing input related to the Improving Services domain were consistently in the top five areas for actual and desired involvement, perceptions of quality, and skills and knowledge. The belief from commissioners that nursing should be involved in these areas is very encouraging. However, PH nursing scored poorer some areas of health protection suggesting this is an area for greater investment. Nurses were perceived to rarely or never be involved in radiation, chemicals and poisons and environmental health hazards Employment and housing and homelessness, and commissioning also had low ratings The desire that nursing should be involved in these areas was relatively high suggesting a gap in demand and supply. For knowledge and skills, it appears that respondents had mixed satisfaction in some sector-specific areas. Further exploration is needed to clarify how best to fill the gaps in knowledge and skills whilst recognising the acknowledged added value public health nurses bring for employers in terms of transferrable skills such as local knowledge and communication skills. This may signify the level of importance and centrality of the nursing contribution to public health and the necessity to match this with increased investment in knowledge and skills in targeted areas