All-Wales Ward Sister-Charge Nurse Development Programme

All-Wales Ward Sister-Charge Nurse Development Programme Grymuso Prif Nyrsys Ward Empowering Ward Sisters and Charge Nurses

All-Wales Ward Sister-Charge Nurse Development Programme The remit of the education work stream was to develop a programme of preparation for ward sisters/charge nurses that would enable them to function confidently and effectively across all spheres of their activity (Appendix 1). Currently, there is variable training provision for management and leadership across the Welsh NHS Trusts, and lack of uniformity in the content and uptake of these courses, with inconsistency in the requirement for formalised preparation for the roles. Free to Lead, Free to Care envisages a standardisation of competency across nurses holding these roles, with each person undertaking a nationally recognised programme of preparation and preceptorship. Initially, the challenge was to devise a programme to ensure the competence of three groups of nurses, each with differing levels of skill and experience: 1. Aspiring ward managers who are not yet undertaking the role, but who show potential to become ward managers 2. Newly appointed and relatively inexperienced ward managers who are within their first two years of appointment 3. Experienced ward managers who have been in their role longer, or have progressed to more senior ward management roles. These three groups have diverse and differing requirements of a programme that will attest to their competency to practice as ward managers. For the first two groups, more formal taught programme elements may be appropriate to complement work-based learning and role modelling; while more experienced ward managers are likely to have achieved competency at the initial levels but may warrant personal development beyond these. Hence, a programme is suggested that is framed around identifying the individual nurse s needs against competencies identified in Agenda for Change bandings and in the Knowledge and Skills framework that the person is working towards/within. Programme principles The programme is founded on the following principles: Crown Copyright 2010 WAG10-10547 ISBN: 978 0 7504 5846 7 F456 It will acknowledge and build on the nurse s existing knowledge and experience Each participant will have at least one mentor 1 to guide them towards achieving the programme outcome (this may be the preceptor for newly-appointed ward managers) There will be an initial individual diagnosis of need against Agenda for Change (AfG) bandings, Fundamentals of Care and the Knowledge and Skills Framework to identify existing competencies and those that need to be developed. This will be agreed by both the mentor and line manager A programme of development will be constructed to address the learning needs identified and will comprise multiple components as appropriate to each individual such as taught elements, visits, mentoring and supervision, action learning sets, peergroup support and experiential learning and reflection. This will be driven through a learning contract agreed by the mentor and line manager 1 It is acknowledged that some experience beyond the person s immediate clinical environment may need to accessed requiring mentoring in place, for example, a period of community practice.

The duration of the programme, or time within which it will be expected to be completed, will be negotiated with the mentor and line manager Existing provision, such as courses in Trusts and higher education institutions (HEIs), will be accredited within the programme The programme is intended to be work-based, designed to fit the needs of the individual within their sphere of practice A portfolio of evidence of achievement will be the vehicle of assessment, to include the diagnostic needs analysis and learning contract, reflective elements and evidence linked to both AfG banding competencies and patient outcomes where possible Achievement will be assessed by the person s line manager Accreditation of Prior Learning (APL) procedures will be adopted to ensure that all existing experience and achievement is recognised A universal certificate of achievement, from the National Leadership and Innovation Agency for Health (for NHS Wales), will be designed Academic accreditation negotiated by Trusts with their partner HEIs will ensure that the programme is recognised within award pathways where appropriate and desired Assumption of achievement at HEI level 3 (honours) or above as a minimum level of academic expectation will be encouraged The programme should be cost neutral, that is, incur no greater costs than are already committed to continuing professional and personal developmental activities (including annual IPR/appraisal). This may necessitate a refocus, in some Trusts, of the way budgets are allocated. Programme framework The role and expectations of the ward sister/charge nurse provide the indicative content of the developmental programme for preparation for the role, and have been grouped into three themes which support the Free to Lead, Free to Care philosophy. This outline content therefore provides a framework against which all components, activities and outcomes that result in competency can be mapped. Themes Participants will need to build a portfolio of evidence, from a variety of sources, to demonstrate to their assessor that they have achieved competence in all three of the following themes: Understanding the role and managing ward performance Managing people and resources Empowerment

Within each of the 3 themes, the content was identified from the initial work of the educational facilitators group and mapped with KSF dimensions: Managing ward performance (KSF dimensions C1, C4, C5, C6) Being a ward manager roles and responsibilities, authority and accountability Expectations of professional practice, including the Nursing and Midwifery Council s (NMC) Code of Professional Conduct Standards, quality service improvement, development and compliance Patient experience/care Audit FoC, clinical indicators, health care standards Tools for change/improvement Research, audit, monitoring priorities for ward, organisation and Wales Dealing with complaints Customer care Public Patient Involvement (PPI) Ward objectives Change process theory, process and practice Managing people and resources (KSF dimensions C1, C2, C3, C5, C6, G4, G6) Relationships Negotiation Conflict Influence Finance financial instruction, standing orders, involvement in budget setting and spending Stores, linen, equipment Business cases Professional issues, HR policy management Enabling others Meeting etiquette, chairing meetings, role in meetings (participate and chair meetings effectively) Delegation Ward organisation Prioritising Teams, motivation

Empowerment (KSF dimensions C1, C2, C4, C5, C6, G6) Leadership skills and behaviour Decision making Problem solving Influencing, negotiation P(p)olitical awareness, knowledge and understanding Responsibility and accountability Networks, other teams Reflective process and practice Action learning/clinical supervision active participants Business planning and business cases Role model, image Policy/strategy/corporate policies Understanding self and own role Nursing strategy influence and involve Personal key objectives Power using, enabling, in teams, shifting power base The depth of understanding and level of competence to be achieved will be negotiated within the learning contract between the participant, mentor and line manager (as assessor) 2. There are a number of levels of competence and descriptors that could be used for this, if required, and are ultimately dependent upon the participant s employment band and expectations within this. Thus, prescriptive levels are not described within this programme, merely, that appropriate competence, as assessed by the mentor and line manager, will be identified and achieved. Programme components Creating a learning contract A leading principle of the programme is that it is individually designed to meet the learning and development needs of the individual practitioner. This enables a flexibility that will maximise resources to accommodate the practitioner s needs according to their stage of career and unique knowledge, skills and experiential background. A learning contract will ask the practitioner to self-assess their own achievements against the specified competences and agree, with their mentor, where competence has already been achieved and where further learning and experience needs to occur. Following this, learning objectives and an action plan will be framed and mapped against the outcomes. A programme of development will be devised comprising a selection of elements most appropriate to the practice environment of the practitioner and what they need to do to complete achievement of the competences. 2 Consultation with the Steering Group members, Nurse Executives Wales and other key stakeholders led to a consensus that a more prescriptive nature of description of outcomes would be burdensome, result in a tick-box approach that was inappropriate to achieving real outcomes, and would inhibit personal identification of learning need and its remediation.

Part of this negotiation will be a discussion about what type of evidence will be produced that can be assessed to confirm achievement of the competences. For instance, a practitioner may need to develop his or her confidence and experience in dealing with a team member who is persistently late for work. The action plan may include raising this as an issue for discussion at an action learning set; discussing alternative courses of action with a member of the human resources team; taking advice from an experienced ward manager; practising a conversation with a peer; and finally, tackling the team member and setting targets/objectives for the future, and establishing a monitoring and review plan. The evidence produced for the portfolio would be a reflective review of this particular incident and how it had been resolved successfully. The learning contract would include target timeframes for action to be achieved, and would be regularly reviewed as the basis for discussion at meetings with the mentor. Pre-existing programmes A number of programmes, developed by individual Trusts, already exist across Wales. The programmes identified were: Nurse Management Programme Bro Morgannwg NHS Trust Development Programmes for Ward Sister Carmarthenshire NHS Trust Skills 2 Manage Cardiff & Vale NHS Trust Nursing & Midwifery Leadership and Management: Strategic Plan 2008-11 Gwent Healthcare NHS Trust Ward Sister/Charge Nurses/Charge Nurse Development Care Competencies for Newly Qualified Registered Nurse North East Wales NHS Trust Overview of Management Development Provision North West Wales NHS Trust Leadership and Management Development Opportunities Pembrokeshire & Derwen NHS Trust Mapping Exercise Pontypridd & Rhondda NHS Trust Clinical Leadership Programme Royal College of Nursing, Wales Evaluation of Toolkit Programme for Ward Managers Northern Ireland Department of Health & Services & Public Safety REACH Carmarthenshire NHS Trust It is suggested that all of these are accredited as contributory to the programme, that is, that attendance and achievement within them are mapped against programme competencies. It would seem apposite that these programmes are shared across the Welsh Trusts rather than more specifically created programmes designed. Specific attention is drawn to the REACH framework, imported from Belfast and the University of Ulster and supported by the Royal College of Nursing (RCN), which was piloted

in Carmarthenshire. The principles underpinning this approach are similar to that proposed for this programme, and focus on individual achievement of work-based projects by the participant under the guidance of a mentor. One Welsh University has franchised the programme for academic accreditation from University of Ulster. The initial tranche of the REACH programme has evaluated extremely well, particularly with the participants as it is recognised that it focuses on individually defined developmental needs and is based within the workplace. The REACH initiative is recommended as a vehicle that could be used throughout Wales to guide the Free to Lead, Free to Care ward manager development programme. In addition to Trust-led programmes, there are a number of other sources of education, including HEI provision of modules and full awards, the Open University, the RCN, further education colleges and independent providers of specific training. Participants for the programme could elect to include any of these, as agreed with their mentor, as relevant to their developmental needs provided they could be mapped to the competencies. Action learning sets/peer-group support A key component of the programme would be the creation of action learning sets, or peer group meetings that would meet regularly to discuss approaches to challenges generated from the workplace. These would provide a source of both support and learning. These could be facilitated initially by an experienced manager, but then become self-led as time progresses. Independent study Many of the challenges arising in ward leadership and management cannot be addressed by formal learning but require the individual to work by themselves in developing their own knowledge, understanding and skill. This might include, for example: visits to other clinical areas, perhaps outside the employing Trust, to understand how issues are addressed; study time to develop understanding of the current evidence underpinning elements of practice; and working in another environment to gain experience. Reflective learning in the workplace The nature of learning in the workplace is underestimated, yet it is through the exploration of everyday activities and experiences that the majority of our learning for practice occurs. Many of the competences for ward management and leadership can be achieved by observing others confident in the role and exploring these reflectively. Reflective learning, whether in verbal, written or contemplative form, enables conscious recognition of development and capacity. For instance, competences may be achieved by exploring case examples, analysing patient journeys, unpicking adverse events, and/or developing practice initiatives. Role modelling and mentorship Many of the competences to be achieved can be learnt through interaction with others and modelling their behaviour or approaches. A key part of this programme centres around the mentor-participant relationship and how a more experienced colleague can nurture and enable the personal development of another. Each participant will work with at least

one mentor 3 who will provide a consistent source of advice and facilitation throughout the programme, and guide the participant in framing action plans and devising activities that will enable them to complete their portfolio successfully. Building a portfolio of evidence The purpose of the portfolio is threefold: To document the developmental journey of the practitioner through their individual programme To provide a repository for evidence of achievement throughout the programme To provide an artefact for assessment of achievement In addition, the portfolio could be used to: provide an artefact for assessment and accreditation within an academic award in an HEI if so desired provide the basis of the professional profile for periodic registration with the NMC The portfolio will build throughout the programme to enable the participant to demonstrate their growing competence through a variety of components. The portfolio may be structured to suit the needs of the participant, but must contain: 1. their job/role description 2. a skills/knowledge inventory and learning needs analysis, mapped against AfC banding and competencies (the latter to be completed as the programme progresses; a proforma could be developed for this) 3. an action plan and proposed programme to fulfil learning needs 4. reflective reviews/commentaries, of for example cases/courses attended/reading and application, that document development and achievement 5. notes from peer-group/action learning set meetings that document development and growth into role 6. notes/summaries of progress meetings with mentor 7. an evaluative summary of how the outcomes/competencies have been achieved, signed by the assessor Levels of achievement Descriptors of levels of achievement and practice already exist within Agenda for Change banding criteria. Participants will need to identify and agree with their mentor/manager which level they are aspiring to achieve. 3 The working group wished to acknowledge that it may be appropriate for a participant to have more than one mentor, dependent on the competences to be achieved, for instance in specialised areas of practice.

At the initial needs identification, participants will discuss with their mentor which competencies they already possess, how they know they are achieving that at the appropriate level, where they need to focus their developmental effort and how they will demonstrate further achievement (a standard proforma could be developed to record this). In addition, academic levels of achievement may need to be taken into consideration if the practitioner wants to use this work as contributory to an academic award. At a minimum, honours level (HEI level 3) should be aspired to, as this will encompass nurses who qualified through Diploma or other programmes as well as those who graduated with a degree but do not want to progress to a higher level of postgraduate study through professional development. However, practitioners could negotiate to provide evidence which would fulfil postgraduate requirements and contribute to a Master s award. These latter elements would need to be negotiated in partnership with the local HEI. Assessment For the purposes of completion of the programme, assessment of the portfolio will be by the participant s line manager. Where the participant is hoping to use the programme to gain academic credit for a programme of study within an HEI award, the portfolio will also need to fulfil criteria imposed to satisfy HEI requirements. Academic accreditation The primary purpose of the programme is to ensure competency and ability to practice as a ward manager. However, participants may wish to use the programme as part of an academic award. To this effect, the academic level of the programme achievements documented within the portfolio needs to equate to at least HEI level three, or level four for postgraduate awards. HEIs across Wales use different credit rating tariffs for modules and courses which comprise an award. Hence, it is problematic for a programme of this nature to prescribe what may, or may not, be acceptable for different HEIs across Wales. However, every Trust has a close working relationship with at least one HEI with which they contract continuing professional development programmes. Each HEI has agreed that they will work with their partner Trusts to ensure that where desired, the portfolio can either be developed with the needs of a specific award in mind, or that it could be submitted retrospectively for accreditation after the programme has been completed. Additionally, many participants will include designated modules or programmes within their portfolio where the achievements match the competencies required and are used as part of their own programme of development for the role. For instance, a participant may access an HEI module on Leadership and Management which enables them to achieve some of the competencies for all three themes. This theoretical learning would be supplemented by a reflective commentary on a specific example deriving from the clinical environment which demonstrates how that learning has been applied in that setting, and evaluated as to its success. This would satisfy therefore, both the requirements of the academic award, but also ensure that the accompanying skills for practice have also been developed.

Further developments This paper has been drafted for consultation against the principles of the programme. Once these are approved further development on the specifics will need to be done to ensure conformity across Wales. Acknowledgements The principles for the programme outlined above have been devised and developed over nine months by the Workstream 5 working group, shared with the Free to Lead, Free to Care implementation steering group, and subjected to several stakeholder groups across Wales. Many thanks to all of those that have given their time and expertise to devising what could be a unique and influential approach to enabling our ward managers for the future. Melanie Jasper Professor and Head of School of Health Science Swansea University

Appendix 1 Working Group Five Education, Development & Support Recommendation Responsible Body Timescales 25 Empowering ward sisters/charge nurses development programme In order to support and maintain a properly empowered ward sister/charge nurse workforce an All Wales approved empowering ward sisters/charge nurses development programme should be established and places funded by the Welsh Assembly Government. This programme should address human resource and managerial skills and the maintaining of standards around issues such as cleanliness and nutrition/ hydration on the ward. Welsh Assembly Government / Higher Education Institutes By the end of 2008 26 Empowering ward sisters/charge nurses development programme NHS Trusts By the end of 2010 All existing ward sister/charge nurses should complete the approved empowering ward sister/charge nurses development programme and/or have their prior educational learning and/or experience accredited. (APL). 27 Empowering ward sisters/charge nurses development programme NHS Trusts From 2009 Newly appointed ward sister/charge nurses should commence on an approved empowering ward sister/charge nurse development programme as a compulsory component of their induction and/or have their prior educational learning and/or experience accredited. 28 Empowering ward sisters/charge nurses development programme NHS Trusts From 2009 Nurses who aspire to be ward sister/charge nurses should undertake the empowering ward sister/charge nurses development programme as part of their continuing professional development. This would be identified through their individual development plan under the Knowledge and Skills Framework.