A Strategy for Nursing and Midwifery 2009-2014 A Passion for Care Compassion for People
Contents Section Page No 1.0 Foreword 2 2.0 Introduction 4 3.0 Person-centred care 6 4.0 Policy and Strategic Context 7 5.0 Investing in Nursing and Midwifery Leadership 8 6.0 Implementing the Strategy 9 7.0 Challenges and opportunities 9 8.0 Strategic Aims 10 9.0 References 17 Appendix Framework to support the implementation of the Strategy 18
A Strategy for Nursing and Midwifery 2009-2014 1.0 Foreword Nurses and midwives make up more than forty percent of the Trustʼs 12,000-strong workforce so they are vital to our success in promoting the well-being of our patients and clients. For this reason I welcome the opportunity to provide a foreword to our new Strategy for Nursing and Midwifery. The vision of the Trust is to be known as a high performing, innovative organisation committed to delivering safe, quality care services that are accessible and responsive to the people who use them, provided in a way that respects the dignity and needs of individuals and delivered by skilled and motivated staff. However, we face many challenges in making that vision a reality. Happily, people are living longer but this also results in an increase in age-related chronic diseases. Family breakdown and an increasingly mobile population are contributing to a loss of supportive relationships, particularly for older people. Levels of mental illness are growing against a backdrop of relatively high rates of mental ill-health in Northern Ireland. We enjoy increasing access to medical technology and health related knowledge, but with an associated rise in the range and complexity of health care interventions. An educated public with ready access to health related information rightly has rising expectations of health care. In the midst of these challenges, I am heartened that our Strategy for Nursing and Midwifery reflects the continuing focus of nurses and midwives on compassion and caring. Not only that, but it provides concrete and achievable aims and objectives, together with a practical framework for supporting the implementation of the Strategy and evaluating its success. All of this whilst seeking to maximise the 2
contribution of nurses and midwives to achieving the objectives of our Corporate Plan and to meeting the Quality Standards for Health and Social Care. When you read this Strategy, you will notice a steady focus on delivering safe, effective, person-centred care. All of us recognise the central importance of achieving this and I am happy to see nurses and midwives taking a lead in this area. However, the Strategy also recognises that nurses and midwives cannot achieve these goals alone. Indeed, all of us - frontline staff, support services, managers and not least our service users - depend on each other to play our part. I am confident that with this common organisational focus, nurses and midwives can significantly increase the safety and effectiveness of care, whilst responding flexibly and sensitively to the needs of patients and clients. I commend this Strategy to you. Please read it, discuss it and above all put it into practice! I can assure you of my continuing support and I look forward to celebrating our success in achieving our common goal of safe, effective, person-centred care. Colm Donaghy Chief Executive Southern Health and Social Care Trust Corporate Plan. 3
A Strategy for Nursing and Midwifery 2009-2014 2.0 Introduction The Southern Health and Social Care Trust is committed to providing safe, high quality, person-centred and compassionate nursing and midwifery care. The provision of such care is set in the context of advances in technologies and therapeutic interventions, demographic and other societal changes as well as developments in the profession itself. The forming of the Southern Trust in 2007 has had a very positive impact on the delivery of nursing and midwifery care through the delivery of more efficient, effective and equitable services. We strive to ensure care is safe and effective and in doing so take account of the expressed wishes of patients and clients to be treated in a way that respects them as individuals. We all agree on this as a priority but recognise that delivering on this in practice can be difficult. This Nursing and Midwifery Strategy recognises the role of nurses and midwives in the delivery of care in promoting the health and well-being of the Trustʼs population. Ultimately, the Strategy aims to support the commitment of nurses and midwives to the delivery of person-centred care and to make this a continuing reality in everyday practice. This Strategy was developed through a process of consultation with Trust nurses, including non-registrant nurses, midwives and senior nurse managers, and was facilitated by the Practice Development Team. Within the context of current and future policy and nursing and midwifery practice, the groups considered the issues around the delivery of person-centred care, the purpose and implementation of the Strategy. The primary aim was to produce a Strategy which is relevant to nurses and midwives in their everyday practice and which reflects the organisationʼs values and objectives. The workshops 4
concluded that the Nursing and Midwifery Strategy should reflect the core elements required to support and develop the nursing and midwifery workforce, namely: - Education, training and career development; Supporting the delivery of care; Managing risks to care; Organising for safe, effective, person-centred care; and Evaluating care. I look forward to supporting nurses and midwives in the implementation of this Strategy and in evaluating the impact it has on person-centred care, the development of the profession and its contribution to meeting the Trustʼs corporate objectives. Francis Rice Executive Director of Nursing, Midwifery and AHP Throughout this document nursing / nurses includes registered Nurses, Specialist Community Public Health Nurses and non-registered nursing staff. 5
3.0 Person-centred care Patients and clients tell us they would like staff to show more compassion, to be courteous, to communicate effectively and sensitively and to protect their privacy and dignity. 1 They report that they have not always received the positive caring experience that we would use to deliver and that they indeed would expect. Patients and clients want to be at the centre of care with services designed to meet their needs and delivered by staff who are concerned with people, their needs, aspirations and fears. In other words they want to be treated as an individual; they want person-centred care. The following is a definition of person-centred care. 2 Person-centred care takes place when nurses, and the organisation in which they work, recognise the high value of an individual and his or her relationships, and as a consequence facilitate the person in making informed decisions about their care, whilst responding flexibly and sensitively to their needs. The quality of care patients, clients and their carers and relatives receive is not entirely the responsibility of registered nurses and midwives. As the definition of person-centred care makes clear, an organisational response is needed. Nurses and midwives work closely with other registered and non-registered staff in multi-professional teams within a wide variety of areas across primary, secondary and community settings. These teams are placed organisationally within directorates and divisions situated in the wider organisation of the Southern HSC Trust. Consequently, this Strategy seeks to include organisational, management and leadership issues which affect the ability of nurses and midwives to deliver safe, effective, person-centred care. 6
4.0 Policy and Strategic Context The Trust is a sizeable complex organisation delivering a diverse range of services, therefore a Strategy for Nursing and Midwifery, is by necessity, focused upon setting out aims and objectives in broad terms. Nurses, midwives and their managers must work together to decide how these objectives should be translated and applied in their own areas of practice and responsibility. They must also take into account the organisational and policy context to ensure nursing and midwifery is working in line with its own values and is meeting wider organisational objectives. 3 Presently the HPSS are required to focus on achieving government targets identified annually through Priorities for Action 4 whilst achieving the standards of care set out in The Quality Standards for Health and Social Care. 5 Nurses and midwives must also practice according to the Nursing and Midwifery Councilʼs code of conduct. 6 For this reason, the Strategy is designed to facilitate nurses and midwives as they: - Practice according to the requirements and values of the NMC Code and associated standards Put into practice the person-centred care required by the Quality Standards for Health and Social Care Make a full contribution to meeting the objectives of the Trustʼs Corporate Plan Demonstrate the steps taken to address the Priorities for Action and the Trustʼs objectives. In efforts to minimise and where possible avoid duplication, a number of objectives within the Strategy are being addressed through such initiatives as Essence of Care 7 and Releasing time to care, the Productive Ward. 8 Their inclusion in this Strategy reflects their continued importance. 7
5.0 Investing in Nursing and Midwifery Leadership The central position of nursing and midwifery within services delivered throughout the Trust, and the size of the nursing and midwifery workforce, signifies that nurses and midwives and nursing and midwifery leadership are essential to the Trust meeting its objectives. The Trust is therefore committed to promoting best practice in nursing and midwifery and to supporting nurses as they seek to achieve their full potential as professionals and team members. The NMC Standards to support learning and assessment in practice 9 require nurses, midwives and their employers to assure the NMC that students undertaking both pre and post registration programmes have been provided with appropriate supervision and assessment of competency by practitioners with the necessary knowledge and competence. The Trust is committed to supporting nurses and midwives as they work towards these standards. The Trust will also work with nurses and midwives to facilitate the development of new post-registration career pathways that will align nursing and midwifery careers with the national NHS Careers Framework and enable practitioners to support the progression of patients as they move between health and illness, dependence and independence; institutional and community based care. 10 8
6.0 Implementing the Strategy This Strategy must work on a number of levels. It must be relevant to nurses and midwives in their everyday work and reflect and embrace organisational objectives. As far as possible, it must avoid adding to the burden of work and must recognise that nurses will need practical support in planning and implementing the Strategy. It must build on the investment in nursing and midwifery leadership that has been at the heart of the development of the professions in the Southern Trust. In implementing the Strategy managers must adopt a transformational leadership approach which challenges unhelpful processes, inspires a shared vision for care and empowers others to play a full part in making that vision a reality. With these imperatives in mind, each ward, department and team will be required to implement a local action plan which meets the broad objectives of the Strategy in their specific area of practice and responsibility. These plans will be coordinated within directorates and divisions to ensure consistency across the Trust. Although the main responsibility for coordinating a local response will be at divisional level, the Trustʼs Nursing Professional Support and Governance Leads will facilitate the Directors and Assistant Directors as they oversee the implementation of this Strategy. A broad framework to support the implementation of the Strategy is set out in Appendix I. 7.0 Challenges and Opportunities This Strategy has been developed in the light of the wider challenges and opportunities facing the Trust and the nursing and midwifery professions. The need to ensure high standards, manage risk, develop services and work collaboratively with other professions has never been greater. As nurses and midwives we face increasing demands and expanding opportunities. Our Strategy maps out ways in which we can meet those demands and take the opportunities open to us. 9
8.0 Strategic Aims 1. Education, training and career development Nurses and midwives can only deliver high quality care if they maintain and further develop the necessary knowledge and skills needed to ensure their competence. The Strategy will ensure that staff have opportunities to gain access to the appropriate and relevant training and education and to evaluate their personal development and performance. Aim: Nurses and midwives will have the necessary knowledge and skills to deliver safe, effective, person-centred care in their areas of practice. What we will do 1.1. Team Managers will ensure that a personal development and appraisal plan is agreed and implemented yearly for each nurse and midwife. 1.2. Team Managers will ensure that all registered nurses take part in supervision at least every six months. 1.3. Heads of Service will ensure that all nurses and midwives access mandatory and developmental training and education to meet agreed organisational and professional needs. 1.4. Heads of Service will ensure that nurses and midwives are prepared and enabled to meet the NMC Standards to support learning and assessment in practice. 10
1.5. Assistant Directors will ensure that mandatory training includes a continuing focus on improving the patient and client experience. 1.6. Assistant Directors will ensure that nurses and midwives have adequate time to meet agreed training needs. 1.7. Executive Director of Nursing will ensure nurses and midwives have access to the the evidenced-base and research necessary to ensure best practice. 1.8. In collaboration with directors and senior nurses, the Executive Director of Nursing will support nurses and midwives wishing to undertake research and identify and implement a framework for post-registration career pathways in relation to nursing and midwifery clinical practice, research and education. * Team Managers includes those nurses and midwives who are Ward and Department Managers and Team Leaders across programmes of care within primary, secondary and community care services within the Trust. 11
2. Supporting the delivery of care and promoting health and well-being Delivering safe high quality care is not just about individual performance, it is also about having a well-managed, properly resourced team, working in an environment that supports a focus on continuous improvement striving towards excellence. Aim: Nurses and midwives will work with their managers to ensure that the necessary resources are available to deliver safe, effective, person-centred care. What we will do 2.1 Nurses, midwives and their managers will ensure that person-centredness is at the heart of everything they do. This will be reflected in the delivery of patient/client care and staff engagement thus promoting a person-centred culture within the organisation. 2.2 Registered nurses and midwives will ensure that non-registered nursing staff are clear as to their responsibilities and are appropriately trained and supervised in carrying out allocated care activities. 2.3 Heads of Service will ensure person-centred care is integral to nursing and midwifery care plans. 2.4 Managers will adopt a transformational leadership approach, seeking to empower their teams to make a full contribution to 12
service delivery and development. 2.5 Heads of Service will work with the operational Assistant Directors and the Assistant Director for Workforce Development and Training to provide a nursing and midwifery skill-mix that enables them to deliver safe, effective care, whilst responding flexibly and sensitively to the needs of service users. 2.6 Directors will ensure all nurses and midwives have timely access to the online resources necessary to support evidence-based health care. 2.7 The Executive Director of Nursing will ensure person-centred care is reflected in the relevant Trust policies and procedures. 13
3. Managing risks to care Nurses and midwives must understand and contribute to the Trustʼs risk management processes so that they can identify those circumstances which may adversely impact on care standards and, in action planning, advise on the resources and infrastructure required to practice safely. Aim: Nurses and midwives will work with their managers to identify and manage risks to the delivery of safe, effective, person-centred care. What we will do 3.1 Nurses and midwives will apply the Trustʼs established risk management processes in the identification, reporting and management of risks to people, standards of care and organisational objectives. 3.2 Team Managers will promote a culture whereby nurses and midwives are free to report risks to people, standards of care and organisational objectives. 3.3 Heads of Service will give nurses and midwives prompt feedback on the organisational response to reported risk. 3.4 Assistant Directors will ensure risks recorded, action planned and managed on the appropriate team, directorate or corporate risk register. 3.5 Directors will ensure all nurses and midwives are trained to 14
identify, report and manage risks through the Trustʼs risk management processes. 4. Organising for safe, effective, person-centred care In order to influence how person-centred care is prioritised and resourced nurses and midwives must consider the wider organisational requirements as well as the needs of their particular ward, department or team. Aim: Nurses and midwives will work with their managers to address the wider organisational and management issues that affect the ability of professionals to deliver safe, effective, person-centred care. What we will do 4.1 Assistant Directors will work with Directors and Heads of Service to address organisational issues in order to continuously improve the quality of care. 4.2 Assistant Directors will provide opportunities for Heads of Service to report on the impact (negative or positive) of organisational arrangements on the quality of care. 4.3 Assistant Directors will work with Heads of Service to ensure service users participate in the planning, implementation and evaluation of care and services. 4.4 Heads of Service will ensure that nurses and midwives play a full role in planning, delivering and evaluating care provided by the multi-professional team. 15
5. Evaluating care Evaluation allows nurses and midwives the opportunity to assess their contribution to meeting the quality standards and to consider the impact (negative or positive) of organisational arrangements on the quality of care. Aim: Nurses and midwives will evaluate the effectiveness and person-centredness of the care they provide and put in place arrangements to address identified gaps in care arrangements. What we will do 5.1 Team Managers will provide opportunities for their teams to reflect on nursing and midwifery practice and to plan and implement local changes to better deliver safe, effective, person-centred care. 5.2 Assistant Directors, in collaboration with Heads of Service, will agree measurable nursing and midwifery outcomes and develop a local action plan to achieve outcomes. 5.3 Assistant Directors will arrange for yearly independent audit of nursing and midwifery outcomes and ensure outstanding issues are addressed. 5.4 Assistant Directors, in collaboration with Heads of Service, will encourage the reporting of complaints and adverse incidents and develop processes to enable a systematic and constructive response by nurses. 16
9.0 References 1 Department of Health, Social Services and Public Safety (2008) Improving the Patient and Client Experience Standards. Belfast: DHSSPS 2 Innes A, Macpherson S, McCabe L (2006 Promoting person-centred care at the front line. Joseph Rowntree Foundation, York. 3 SHSSCT Corporate Plan. Available at: http://www.southerntrust.hscni.net 4 Currently: Department of Health, Social Services and Public Safety (2008) Priorities for Action 2008-09. Belfast: DHSSPS 5 Department of Health, Social Services and Public Safety (2006) The Quality Standards for Health and Social Care. Belfast: DHSSPS 6 Code: Standards of conduct, performance and ethics for nurses and midwives. NMC: London 7 Northern Ireland Practice and Education Council (2007) Review of Essence of Care. Available at: http://www.nipec.n-i.nhs.uk 8 Releasing time to care, April 2007 NHS Institute for Innovation and Improvement www.institute.nhs.uk/productiveward 9 Nursing and Midwifery Council (2006) Standards to support learning and assessment in practice: NMC 10 Department of Health (2007) Towards a Framework for Post-Registration Nursing Careers Consultation Document. London: DH 17
Appendix Framework for supporting the implementation of the Strategy Introduction The Strategy is intended to make an impact on every day nursing and midwifery care. This means that each ward, department and team must have a plan to reach the aims and objectives contained in the Strategy. Obviously, some objectives (for reasons of safety and equity) will be met through processes agreed at a Trust-wide level. However, there will be a need for local flexibility to allow nurses and midwives to tailor care to the needs and choices of individuals. Consequently, some elements of local action plans will be the same across the Trust whilst other elements will be specific to particular wards, departments or teams. Our goal is a coordinated approach, with consistent aims throughout the Trust, yet responsive to local needs and opportunities. The implementation process With this in mind, directorates and divisions must take steps to enable the nurses and midwives working within it to: - Understand the aims and objectives of the Strategy Reflect on current practice in the light of those aims and objectives Develop local action plans, with measurable goals, to meet the aims and objectives Implement local action plans 18
Evaluate local action plans at least yearly and act on that evaluation Each directorate, through the chair of the Nursing and Midwifery Governance Forum, will be responsible for providing a yearly progress report to the Trustʼs Senior Nursing and Midwifery Governance Forum. The Trustʼs Senior Nursing and Midwifery Governance Forum, chaired by the Executive Director of Nursing, will act as the steering group for the Strategy, ensuring a coordinated, consistent approach across directorates and addressing wider organisational issues targeted in the Strategy. Operational Assistant Directors with responsibility for nursing and midwifery governance are accountable through their Care Directorate, but will also advise the Senior Forum, on their directorateʼs progress on implementing the Strategy. The Forum Chair will advise the Trustʼs Governance Committee on the implementation of the Strategy which will be reported as part of the Nursing and Midwifery Governance Report. Although the main responsibility for coordinating a local response to the Strategy lies with the operational Assistant Directors, the Professional Support and Governance Leads (nursing and midwifery) will work with directorate senior managers in a facilitative role to support the development, implementation and evaluation of local action plans in the directorates. Local action plans Of necessity, some elements of local action plans will focus on Trust-wide processes which require a standard approach. However, a significant proportion of the plan will be highly specific to the ward, department or team. Divisions will need to be pro-active in involving local teams in the development of local action plans to ensure ownership, sensitivity to the local context and the flexibility to meet peopleʼs needs in a person-centred way. 19
Wherever possible, local action plans should incorporate existing initiatives or use tools and approaches that have already been developed for use in the health and social services. Tools that emphasise a reflective, person-centred approach, that are consistent with key performance indicators for nursing and which include measurable outcomes are preferable. Local action plans must set out: - Clear objectives required to meet the aims and objectives of the Strategy The evidence base or rationale for the aims and objectives Who is responsible for ensuring objectives are met, and by what date How objectives are to be met, including the necessary processes and resources How and when outcomes of objectives will be measured Which senior manager is responsible for responding to the evaluation of the local action plan The successful implementation of local action plans will often depend on organisational factors that cannot be directly influenced by local teams. Where these are identified, they will be referred to the relevant operational Assistant Director, or if a Trust-wide response is necessary, to the Trustʼs Senior Nursing and Midwifery Governance Forum for decision and action. 20