West Hertfordshire Hospitals NHS Trust Nursing and Midwifery Strategy 2003-2006 Progressing Practice: Transforming Care
Contents 2 3 4 6 9 13 16 20 21 23 Preface Introduction Professional Values Leadership Clinical Practice Recruitment and Retention Education and Workforce Development Where do we go from here? References and background reading Additional information
Preface Introduction It gives me great pleasure to write the preface for West Hertfordshire Hospitals NHS Trust s Nursing and Midwifery Strategy. This strategy represents more than six months work undertaken by nurses and midwives in the Trust and has been influenced by national policy, specifically the NHS Plan (DoH, 2000) and Making a Difference: Nurses, Midwives and Health Visitors Contribution to Health Care (DoH, 1999). The strategy has been subtitled Progressing Practice: Transforming Care to reflect a renewed commitment among our nurses and midwives to develop innovative ways to improve the services we offer to our patients and their families. The achievements of nurses and midwives over the last year have been inspiring, particularly given the enormous pressures of work and the rapid rate of change in the NHS. This strategy is an important way of highlighting the pioneering work of nurses and midwives locally, and of looking forward to the next three years with focus and determination. The strategy does not represent an exhaustive list of everything we will do, nor should it stifle local developments within wards, clinical settings and divisions generally. In fact, it should be viewed as a platform from which we are working towards best practice Trust wide. It is recognised that staff are the key to reform and achievement of the modernisation agenda both locally and nationally. Investment in staff development is therefore crucial in meeting service objectives. This strategy has been developed from this premise to ensure all nurses and midwives can exercise their responsibility to make a real difference to patient care. Whilst the strategy details a number of targets focusing on leadership, clinical practice, recruitment and retention and education and workforce development, it can be summarised as aiming to: Develop strong nursing and midwifery leadership Optimise staffing levels Develop staff to their full potential and ensure they are competent to do their job Prioritise and focus on the fundamentals of practice Ensure that nursing and midwifery roles are developed to meet the changing needs of patients Enable innovative evidenced based practice Generate and co-ordinate views of practitioners Finally, I would like to add my thanks to all those involved in taking this strategy forward for their support and commitment. Underpinning the targets are Professional Values which are intended to reflect the philosophy of nursing and midwifery within the Trust and determine the way care is delivered. Gary Etheridge Director of Nursing, Midwifery and Quality Unquestionably, the implementation of the strategy will require considerable collaboration with professional groups both internally and externally to the Trust. It is therefore, within the remit of all healthcare professionals, not solely nurses and midwives, to ensure effective delivery of the targets. 2 3
Professional Values All nurses and midwives employed within the Trust are asked to work towards adopting these value statements: The professional contribution to service delivery is recognised through the participation of the Director of Nursing and Midwifery and other nursing and midwifery colleagues in the Trust s decision making structures, with an emphasis on good team work across all disciplines, valuing both individual and specialist contributions. The personal presentation and behaviour of staff is fundamental to presenting a multi-professional image that engenders confidence. All practitioners working within the organisation will be accountable for their own actions and will actively embrace the principles of life long learning. Care is delivered within a locally agreed philosophy, which is continually evaluated, actively embracing new knowledge and using patient feedback for development. This care should be based on a documented assessment of client, patient and family needs. Staff should identify, initiate and embrace change to improve services and patient care. Care is delivered in a clean, comfortable and well-maintained environment. Care is delivered by a safe number of suitably skilled staff. Care is delivered by staff who are all knowledgeable of the requirements, regulations and policies that ensure the safety and security of clients, patients and staff. Staff will be committed to providing contemporary, innovative, evidencebased practice, acting within agreed levels of competence, Trust protocols and guidelines. 4 5
Leadership Target 2 Modern Matrons will actively participate in action learning sets, in order to develop and enhance effective clinical and operational leadership skills, thereby developing their ability to meet challenging risk management and Clinical Governance objectives and service plans. Director of Nursing and Midwifery and Heads of Nursing/Midwifery Inspirational professional leadership is key to achieving excellence in nursing and midwifery practice. The Trust will identify, nurture and develop nursing and midwifery leaders as role models who will make a vital contribution to the modernisation of health care in the 21 st century. Target 3 The Clinical Leaders Development Programme for G grade nurses and midwives will continue quarterly, with a key focus on ensuring facilitation of the role from practitioner to visionary clinical leader against agreed competencies and performance objectives. Director of Nursing and Midwifery New roles will be embraced and new ways of working will be identified and reviewed in partnership with patients, carers and the multi-disciplinary team. Skills, knowledge and behaviours of effective leadership will be defined in order to contribute to a Trust wide framework to develop these in all staff groups. The following initiatives are aimed at achieving this: Target 4 Explore the need to establish a forum/structured buddying system for Clinical Leaders to share best practice/practical solutions in order to overcome operational constraints. Director of Nursing and Midwifery and Heads of Nursing/Midwifery Target 1 Heads of Nursing/Midwifery will undergo a structured personal development programme that will be crucial to the development of conceptual, analytical and strategic skills. Target 5 Review leadership development programmes/modules so that aspiring nurse/midwife leaders are encouraged and nurtured and their development needs are systematically identified through the appraisal process. General Managers and Director of Nursing and Midwifery Director of Nursing and Midwifery, Heads of Nursing/Midwifery and Practice Development Team 6 7
Clinical Practice Target 6 Continue the RCN Clinical Leadership programme and explore widening access to include other professional groups, ensuring programme objectives reflect changing service requirements. Director of Nursing and Midwifery and Local RCN Facilitators Target 7 All Clinical Nurse Specialists/Nurse Practitioners will have clearly defined roles and competencies in line with a higher level of practice. These roles will be reviewed in terms of their contribution to patient care and the education and support provided to ward/departmental based nurses and midwives. Director of Nursing and Midwifery and Heads of Nursing/Midwifery The challenge for nursing and midwifery is to continue to meet patient and carer needs through new ways of working and effective utilisation of all nursing and midwifery resources within the Trust. Clinical practice will be based on the best evidence available. The specific targets below represent not only discrete and fundamental areas of practice prioritised for development, but also a mechanism for challenging existing practice and exploring new practices to meet ever changing demands. Target 8 The Trust will encourage the development of Nurse/Midwife Consultant posts in relation to national guidance and recommendations, linked to clearly defined service requirements. Target 1 Promote the Trust s commitment for enhancing the quality of patient care by using the Essence of Care framework. Director of Nursing and Midwifery, Heads of Nursing/Midwifery and General Managers Director of Nursing and Midwifery, Heads of Nursing/Midwifery, Modern Matrons, Clinical Leaders and Practice Development Team Target 9 All nursing and midwifery leaders will be encouraged to reflect on and change existing patterns of behaviour and clinical practice in light of evidence based research and approaches/targets to modernise services in accordance with the NHS Plan and Improving Working Lives standards. Target 2 Support evidence based practice by ensuring that all nursing/midwifery development programmes are designed to integrate theory with practice. Heads of Nursing/Midwifery, Practice Development Team Clinical Leaders and Practice Development Team and Clinical Leaders 8 9
Target 3 Reflect new ways of working in order to maximise the potential of the nursing and midwifery workforce and promote and progress multi-professional working by integrating the Chief Nursing Officer s Ten Key Roles for Nurses and Midwives into service delivery. Director of Nursing and Midwifery, Practice Development Team, Heads of Nursing/Midwifery and Modern Matrons Target 7 Develop ways of facilitating a greater understanding of risk management, clinical effectiveness and audit in order to change and improve practice. Thereby, ensuring learning and development as a result of adverse events. Director of Nursing and Midwifery, Heads of Nursing/Midwifery, Risk Manager, Clinical Governance Co-ordinator, General Managers and Clinical Leaders Target 4 Develop a framework whereby complaints and untoward incidents are used positively to influence the developments of practice. Target 8 Ensure all nurses have access to clinical supervision on a regular basis and for midwives statutory supervision to develop and value their skills and competence and enhance team working. Director of Nursing and Midwifery, Heads of Nursing/Midwifery, Practice Development Team and Modern Matrons Heads of Nursing, Midwifery Supervisors and Practice Development Team Target 5 To regularly review and agree staffing establishments for all clinical areas, which take account of evidence based guidelines, budgets and safe levels of patient care. Target 9 Focus on closer collaboration across professional roles and functions, through the development of shared care pathways. Director of Nursing and Midwifery, Heads of Nursing/Midwifery Heads of Nursing/Midwifery and Practice Development Team General Managers and Clinical Leaders Target 6 Review and standardise all nursing and midwifery patient documentation and support work towards the establishment of the electronic patient record. Target 10 To work with colleagues to devise a mechanism to support the supply and administration of medicines under Patient Group Directions Trust wide. Practice Development Team, Heads of Nursing/Midwifery and Head Director of Nursing and Midwifery, Heads of Nursing/Midwifery, of IM&T Practice Development Team and Head of Pharmacy 10 11
Recruitment and Retention Target 11 Strengthen the public health roles of nurses and midwives by focusing on the needs of patients and their families in areas of socio-economic deprivation. Heads of Nursing/Midwifery Target 12 Partnership working with patients and service users will be embraced to ensure that their involvement and contribution shapes the future of nursing and midwifery practice. To ensure success at personal, professional and organisational level we must work to ensure the numbers, skills and competencies of nurses and midwives reflects activity levels across the Trust and can meet future development and demand. Stabilising the workforce will ensure the Trust supports, develops and retains its staff. Director of Nursing and Midwifery, Heads of Nursing/Midwifery, Quality Manager, Associate Director of Communications, General Managers, Practice Development Team and Clinical Leaders This approach will be incorporated into the Trust s Human Resource Strategy, 2002-2004 and supported by the following actions, which interlink with the Improving Working Lives initiative: Target 13 To improve the quality of care delivered locally through the implementation of an Observation of Care strategy Trust wide. Target 1 To improve recruitment and retention rates for nurses and midwives, in accordance with the Trust s Nursing and Midwifery Recruitment and Retention Strategy. Director of Nursing and Midwifery, Practice Development Team, Clinical Leaders and Heads of Nursing/Midwifery Director of Nursing and Midwifery/HR, Heads of Nursing/Midwifery and Recruitment Managers Target 14 In partnership with the Area Child Protection Committee and Designated/Named Professionals agree a local action plan in response to the recommendations as stipulated in the Victoria Climbié Inquiry Report, 2003. Target 2 Identify the implications of moving into the national programme of NHS Professionals, and make the necessary preparations to ensure a smooth transfer. Director of Nursing and Midwifery, Named Nurse, Named Midwife and Named Doctor ~ Child Protection Director of Nursing and Midwifery/HR, Deputy Director of Nursing and Heads of Nursing/Midwifery 12 13
Target 3 In partnership with the HR Department, local job centres, career forums and HEI s, promote educational opportunities for careers in the NHS and particularly for nurses and midwives. Thereby meeting the Confederation s local commissioning targets and promoting the NHS as a model employer. Recruitment Managers and Heads of Nursing/Midwifery Target 7 To ensure that nurses and midwives are enabled to work in flexible ways according to their needs as well as those of the service. Heads of Nursing/Midwifery and Clinical Leaders Target 4 Review the professional development needs of the Trust s temporary workforce i.e. nurse/midwife bank in line with service objectives and in conjunction with NHS professionals. Deputy Director of Nursing Target 8 To support the development of an action plan to address concerns raised in staff attitude surveys. Director of Nursing and Midwifery/HR and Heads of Nursing/Midwifery Target 5 To develop core competency based job descriptions and competencies for staff which allow flexibility to meet the needs of individual specialities. Target 9 Every nurse and midwife who leaves a position in the Trust will undergo an exit interview which will inform the Trusts Nursing and Midwifery Recruitment and Retention Strategy. Director of Nursing and Midwifery, Heads of Nursing/Midwifery Director of Nursing and Midwifery/HR, Heads of Nursing/Midwifery and Clinical Leaders Target 6 Enhance adaptation/supervised practice for overseas nurses and midwives, ensuring competency is maintained through a structured personal development plan, local supportive infrastructure and in accordance with agreed standards. Target 10 Continue to develop and enhance the Trust s Return to Practice initiative in collaboration with the Confederation to reach the desired target levels with specific support to returners post employment. Thereby maximising potential capacity in recruitment and workforce development. Recruitment Managers and Deputy Director of Nursing Heads of Nursing/Midwifery, Deputy Director of Nursing and Recruitment Managers 14 15
Education and Workforce Development Equipping clinical staff with skills for inter-professional working is crucial to securing continuous quality improvement for patients and the development of a dynamic workforce. There is now clear evidence that interprofessional education is an approach which cuts through traditional barriers leading to more efficient and effective practice. Many National reports have elevated inter-professional education very close to the top of the agenda for the modernisation of the NHS. Target 3 Draw upon local expertise in education, training and research to enable greater empowerment of students as learners, recognising the value of work based learning in maximising individual potential. Heads of Nursing/Midwifery and Deputy Director of Nursing Target 4 In collaboration with Hertfordshire Partnership Trust, enhance knowledge and development of skills in managing care for clients with learning disabilities/mental health in the acute hospital reflecting Valuing People ~ A New Strategy For Learning Disability for the 21 st Century (2001). This approach will be embraced and integrated into the Trust s Education and Development Strategy, 2002 ~ 2004 and supported by the following initiatives: Deputy Director of Nursing, Director of Nursing, Hertfordshire Partnership Trust and Heads of Nursing/Midwifery Target 1 An annual appraisal will be provided to all nurses and midwives. The outcome of the appraisal process will inform the Education and Training programme for the Trust, which will meet the needs of the organisation as well as the individual practitioner. Heads of Nursing/Midwifery and Clinical Leaders Target 5 Enhance knowledge and skills of the nursing and midwifery workforce in contributing to the Trust s service and financial framework in line with local and national targets. Heads of Nursing/Midwifery Target 2 Ensure appropriate clinical placements and assessors of a sufficient number are available across the Trust for NVQ/Cadet training schemes and pre-registration nursing/midwifery programmes which incorporate widened access. Target 6 In accordance with the Nursing and Midwifery Research and Development Strategy and Action Plan ensure that all nurses and midwives actively contribute to the research and development agenda, thereby striving to improve clinical care. Workforce Development Manager, Deputy Director of Nursing and Heads of Nursing and Midwifery Deputy Director of Nursing, Heads of Nursing/Midwifery, General Managers and Clinical Leaders 16 17
Target 7 Target priority areas in enhancing knowledge of child protection issues enabling informed decisions on managing multi-professional/multi-agency care for vulnerable neonates, children and young persons. Target 11 Explore the potential for a development programme for administrative and clerical staff to enhance their role in supporting clinical leaders by undertaking additional duties. Deputy Director of Nursing, Heads of Nursing/Midwifery and Workforce Development Manager and Heads of Nursing/Midwifery Named Nurse ~ Child Protection Target 8 Assist the Education and Training Department in developing a standardised Trust study leave policy and establish effective monitoring mechanisms which will record continuing professional development activity. Target 12 Review and ensure the ongoing support to the continuous professional development of nurses and practitioners thereby maximising their potential within the multi-professional team. Director of HR/Nursing and Midwifery and Heads of Nursing/Midwifery Heads of Nursing/Midwifery and Clinical Leaders Target 9 To undertake a Trust-wide training needs analysis in order to encourage proactive commissioning of Pre and Post-registration education. Heads of Nursing/Midwifery, Workforce Development Managers and Deputy Director of Nursing Target 10 Ensure that all clinical staff have appropriate training to develop information and technology skills and data analysis skills. Heads of Nursing/Midwifery and Head of IM&T 18 19
Where do we go from here? To ensure the delivery of the Nursing & Midwifery Strategy it is crucial that a detailed action plan is now developed to implement the four key themes of the Strategy, with targets measured against key criteria for success. Each target will have a realistic timescale identified and will be co-ordinated and progressed by four newly established Focus Groups, each chaired by a member of the Professional Nursing & Midwifery Strategy Group. The strategy will be a live document that is reviewed and revised on an annual basis, with a fundamental review every three years. References and background reading Department of Health (1998). Working Together: Securing a Quality Workforce for the NHS. London: DoH Department of Health (1999). Making a Difference: Strengthening the Nursing, Midwifery and Health Visiting Contribution to Health and Health Care. London: DoH Department of Health (2000). The NHS plan: A Plan for Investment, A Plan for Reform. London: DoH Department of Health (2000). A Health Service of All Talents: Developing the NHS Workforce. London: DoH Department of Health (2000). An Organisation With a Memory. London: DoH Department of Health (2001). Essence of Care, Patient-Focused Benchmarking for Health Care Practitioners. London: DoH Department of Health (2001). Valuing People: A New Strategy For Learning Disability for the 21 st Century. London: DoH Department of Health (2002). Developing Key Roles for Nurses and Midwives: A Guide for Managers. London: DoH Department of Health (2002). Improvement, Expansion and Reform; The Next 3 Years Priorities and Planning Framework 2003-2006. London: DoH Department of Health (2002). Extending Independent Nurse Prescribing Within the NHS in England. London: DoH 20 21
References and background reading (continued) West Hertfordshire Hospitals NHS Trust Department of Health & The Cabinet Office (2002). Making a Difference Reducing Burdens in Hospitals. London: DoH & The Cabinet Office Department of Health (2002). Safeguarding Children in Whom Illness is Fabricated or Induced. London: DoH Laming (2003). The Victoria Climbié Inquiry Report. HMSO Nursing and Midwifery Council (2002). Code of Professional Conduct West Hertfordshire Hospitals NHS Trust (2001). Research & Development Strategy for Nurses & Midwives, 2001~2003 West Hertfordshire Hospitals NHS Trust (2002). Education & Training Strategy, 2002~2004 West Hertfordshire Hospitals NHS Trust (2002). Human Resource Strategy, 2002~2004 Watford General Hospital Vicarage Road Watford Hertfordshire WD18 OHB 01923 244366 Mount Vernon Hospital Rickmansworth Road Northwood Middlesex HA6 2RN 01923 826111 St Albans City Hospital Waverley Road St Albans Hertfordshire AL3 5PN 01727 866122 Hemel Hempstead General Hospital Hillfield Road Hemel Hempstead Hertfordshire HP2 4AD 01442 213141 22 23
For more information contact: Gary Etheridge Director of Nursing, Midwifery and Quality West Hertfordshire Hospitals NHS Trust Trust Offices Watford General Hospital Vicarage Road Watford Hertfordshire WD18 OHB Tel: 01923 217814 Web: www.westhertshospitals.nhs.uk Email: gary.etheridge@whht.nhs.uk This strategy was launched by Sarah Mullally, Chief Nursing Officer, Department of Health on 1st July 2003 Designed by Medical Illustration Mount Vernon Hospital, West Hertfordshire Hospitals NHS Trust 24
www.westhertshospitals.nhs.uk