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Martin Hogan

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  • First name
    Martin
  • Last name
    Hogan
  • Country
    United Kingdom

About me

  • About me
    Macmillan specialist Nurse
  • Organisation
    NHS
  • Role
    Nurse

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  1. Content Article
    More information about "The role of the Professional Nurse Advocate: improving both staff and patient safety"
    Martin Hogan, Lead Professional Nurse Advocate (PNA) at Central London Community Healthcare NHS Trust, tells us about the PNA training programme and the impact and improvements it can have on both staff and patient safety. He shares his own personal development from taking the programme, how he has used the skills learnt to educate and support his colleagues, and explains why he is championing the PNA to others and has set up a network of PNAs. After the first wave of the Covid pandemic, I was redeployed from my Macmillan specialist nurse role in acute oncology to intensive care. Up to this point, I had never received any form of supervision. Emotionally, I bottled up the feelings I would have from breaking bad news or a prognosis to a patient and other harrowing conversations. There was no space or time for that in a busy role. However, being redeployed to intensive care I found people did sit me down and we'd openly talk about our feelings, which I found crucial as a form of preventative mental health first aid. Being redeployed from acute oncology to intensive care, I had gone from one highly emotive and distressing role into a role that felt like a war zone. Burnout was high, morale very low and the ability to cope depleted among staff and myself. However, patient care never faulted despite the tsunami of chaos that surrounded us. After the second wave of the pandemic, I decided to continue to champion the voice of my nursing profession and join the Royal College of Nursing (RCN) as the Senior Officer for Surrey. This was a phenomenal opportunity to develop my leadership skills within a local and regional-wide role. During my time at the RCN, I learnt a great deal and supporting RCN members from every speciality and organisation you could think of. We all had experienced similar distress – moral injury. I had always been an advocate for the mental health of my patients and colleagues. But in all honesty, as a general nurse and a former Macmillan specialist nurse, the culture has never been to look after oneself as a nurse. In 2021, my career took me on to working within mental health and education. I supported nurses from every band – newly qualified nurses up to senior management – through either teaching and running educational programmes or supporting people undertaking higher education. At this point, I decided to take the Professional Nurse Advocate (PNA) course at Kingston University. The role of the Professional Nurse Advocate The PNA training programme was brought into nursing from midwifery following the pandemic in response to improving the critical state in which the nursing profession found itself in – with hospitals short staffed, staff with ongoing sustained moral injury, and burnout at an all-time high. The PNA training programme uses the four elements of the Advocating for Education and Quality Improvement (A-Equip) model: Restorative clinical supervision. Personal action for quality improvement. Education, development and monitoring. Advocating for the patient, the nurse and healthcare staff. The programme is MSC level 7 module upskilling Nursing and Midwifery Council (NMC) registrants. The module aims to educate aspirant nurses on quality improvement, restorative supervision, health and wellbeing, leadership, mental health first aid, and education and implementing cultural change. Applying the training As part of the PNA training, I needed to practice my skills and the newly qualified nurses on my preceptorship programme allowed me to offer them support. After just one restorative clinical supervision session, the importance of providing this space more regularly than once a month to my preceptees was evident. I put on weekly drop-in clinics for all newly qualified staff allowing them to drop in and talk about how they were. After 10 months of this I had become known as a “rock” or a “lifeline” – someone external who wasn’t a line manager, someone experienced who could advise and support during the most vulnerable time, the first 18 months, in a nurses’ career. I extended these sessions not just to our new nurses but to anyone NMC registered within my post-graduate portfolio. There was resistance at first, a lack of understanding of the importance of these sessions, but after a session, irrespective of what band people were on, they understood it. The feedback I received was overwhelming; for example, “if it wasn’t for you, I don’t think I would stay in my current role” or “I wouldn’t be able to have got through this situation”. I quickly understood the role of the PNA was bigger than I had imaged. Next steps As the only PNA in the trust at that current time, I felt alone and unsure of what I should or could do next. Taking a leap of faith, I set up a Twitter page to connect and learn from others, while at the same time sharing ideas I had tried. This over time grew and the network it has built has been invaluable to me, the staff I support and, of course, our patients. The network now has over 3,500 followers. This has led to me setting up an informal gathering from people from all over the UK – a 'parliament of PNAs'. This is a learning, sharing and caring space to borrow brilliance from one another, to unify support and drive good practice forward for the benefit of our nursing staff and patients. My personal experience as a PNA in mental health (at the time) showed me that you cannot provide effective care to your patient without having received effective support from the healthcare profession. This wasn’t a new concept to me over the 20 years of my career, but after the PNA programme I felt more confident to act on this, through promotion, role modelling, compassionately challenging culture where this was lacking and educating others on how to do this. As a general nurse learning about mental health, I kept hearing the phrase: "parity of esteem" – no mental health without physical health and vice versa. Although I had always advocated this for my patients, I hadn’t for myself. I felt after completing the PNA course I was a better nurse. I had more skills in my arsenal to provide the most effective care – leadership skills and interpersonal skills, and assessment and implementing cultural change that was sustainable. I didn’t understand to its entirety quality improvement, nor what measures for success meant. But I had them without even realising. I supported 110 newly qualified nurses over a 10-month period with only one person leaving within that timeframe. In comparison, in the previous year more than 10 newly qualified nurses had left within that time. The difference is that they now had a dedicated PNA who used bespoke initiatives to provide support. These nurses provide care to hundreds of patients each year. With clearer, less burnout out minds they were able to not only cope but, more importantly, thrive. I have since moved to a community trust as the lead PNA co-producing its implementation to the entire nursing workforce. Creating initiatives such as PNAs, providing support for the patient safety team or to nurses undergoing investigations, Datix and learning from serious incidents. Conclusions The role of the PNA is ever growing and in my mind applies to everything we do, particularly patient safety. The more support our workforce has through supervision, career development and quality improvement the better able they are to provide effective care. The PNAs have expertise in providing this support, not just when things are going wrong or when your battery is on 25%, but when things are going well also. It is critical that all organisations invest in growing this role and allowing PNAs protected time to deliver at first recovery and then restoration to our nursing workforce in order to support and improve staff retention given the state in which our profession has found itself in over the last two years. I have joined shared governance groups which are chaired by our patients, carers and relatives and the loudest take away message is our patients want and need us to be well and healthy in order for us to look after them. This is a more than a training module, it has been life changing for me and many of the nurses I know who have undertaken the PNA training and it impacts and improves both staff and patient safety. Further information NHS England: Information on the Professional Nurse Advocate Twitter @advocacy_forum To join the ‘Parliament of PNAs’, email [email protected].
  2. Content Article
    In this comic-strip style piece of art, Daniel Locke interviews nurse Daniel Hansen about his experiences during the COVID-19 pandemic. Through the medium of graphics, this interview is increasingly more realistic and powerful
  3. Content Article Comment
    I don’t feel I particularly did this person enough justice. Clearly very effected and disturbed by there experience. I gave a lot of support, but was difficult to capture all the interview. Trying to stick to the point and get the main message across. But clearly a lot more to unpack. For clarity the chief nurse expressed concern on resuscitation guidelines in terms of staff safety. Staff were very vulnerable and at risk with lack of appriopriate PPE. Concern was raised for his staff being put at risk, though understanding the necessity.
  4. Content Article
    This interview is part of the hub's 'Frontline insights during the pandemic' series where Martin Hogan interviews healthcare professionals from various specialties to capture their experience and insight during the coronavirus pandemic. Here Martin interviews a chief nurse of clinical productivity leading dynamic change within culture and governance. 15 years in the post, the chief nurse is responsible for leading improvement in standards of nursing and service. 
  5. Content Article
    This interview is part of the hub's 'Frontline insights during the pandemic' series where Martin Hogan interviews healthcare professionals from various specialties to capture their experience and insights during the coronavirus pandemic. Here Martin interviews an advanced specialist paramedic working in central London with four years' experience of working on the frontline. 
  6. Content Article Comment
    What have been your key take away bits from this, I wonder. Interesting to hear
  7. Content Article
    This interview is part of the hub's 'Frontline insights during the pandemic' series where Martin Hogan interviews healthcare professionals from various specialties to capture their experience and insight during the coronavirus pandemic. Here Martin interviews an oral surgeon who has been in the post for a year in a trust that covers two sites in the West Country. 
  8. Content Article Comment
    . Such an interesting discussion. I was saddened but truely understood why so many of my interviewees wishes to stay anonymous.
  9. Content Article Comment
    Interested to hear you the readers thoughts,
  10. Content Article
    In a new series for the hub, Martin will be interviewing healthcare professionals from various specialties to capture their experience and insight during the coronavirus pandemic. Learning from frontline staff is crucial, now more than ever. Prior to a predicted second wave hitting us, the government and leaders must listen to what has gone well but, most importantly, not so well for both staff and patients. Martin is a passionate nurse working on a covid unit and wants to promote learning to ensure patient and staff safety. This initially started as a way of connecting and not feeling alone but what Martin has found is that there are many voices that need and want to be heard but just don’t know how to speak up and out. In all of the interviews the healthcare professionals wanted to remain anonymous which is indicative of their fear of reprisals from their organisation. In this first interview, Martin interviews a new student district nurse who has been working within the community in the South West. Their role involves supporting care homes with end of life care and assisting in keeping people with long term conditions at home. 
  11. Content Article Comment
    I couldn’t agree with this article more. ive burnt out so much it’s light a fire for me to leave nursing! I look above at the leaders , most have never worked on the shop floor, but they have a masters. So that makes them clinically sound. everyone I speak to feels broke and done. its very sad to hear such a dynamic nurse say this. But I feel exactly the same! Who do you discuss this with? Where do you go from here? difficult time. Needed to be said though.
  12. Content Article Comment
    Thanks for your comment and compassion. I have seen some amazing things from patients, who have made there own PPE. An 8year old girl making plastic visors from staff. Knitting groups making masks. I think from the patient side this has been brilliant. if this was to happen again. I think a local government set up coordinating groups (which I believe there are in some parts of the country) could help, this also as you expressed gives people some helpful purpose.
  13. Content Article
    I was requested to work on a COVID-19 assessment /high dependency unit during the start of the pandemic which, as a nurse, of course I accepted. The national sense of duty was palpable. Thousands of retired nurses would return to the front-line. A huge flurry of national comradery and patriotism made us proud to be the NHS. In this blog I draw upon my professional experience during this time and reflect on how staff and patient safety have been impacted and what has and hasn’t worked well. I focus on five key areas: • Systemic transparency • Raising safety concerns • Staff mental health • After action review • Talking and listening to relatives. Systemic transparency: ‘A fish rots from the head down’ The saying ‘a fish rots from the head down’ describes how ineffective management and leadership can have a huge, detrimental impact on our systems and teams. It can be the root cause of an organisation’s failure and demise. Applied in this case, the government would be the head of the fish and the NHS the body. From the beginning of this pandemic it has been clear to us in the NHS that we haven’t been informed of truths regarding personal protective equipment (PPE), testing and expectations of the health service. Transparency around this would have led to a safer working environment for staff and patients and reduced the risk of harm. If, for example, we had been made aware that additional PPE wouldn’t be available for five days, plans could have been implemented. Clearer ideas could have been put in place with regards to social distancing at work. Clinical leads, chief exec and managers could have better supported the care of their staff, who in turn could have provided better care for their patients. Those poor, ill-informed decisions at the top make it very difficult for those of us further down the fish. This style of leadership leads to reduced levels of engagement by staff, deconditioning of resilience, increased sickness and poor and unsafe staffing levels. We need more transparent communication from the government for patients/the public too. Short and sharp facts. Posters. Avoidance of jargon and mixed messaging during briefings. For example, people were informed they must self-isolate for 14 days if they had recently travelled in a zone 2 at-risk country, however, shortly after the announcement the advice changed to seven days of isolation. This confusion has an impact on infection control and the spread of the virus. Which in turn, impacts our health service and those of us working on the front-line. Raising safety concerns We all knew the guidelines for PPE was substandard and putting us and our loved ones at great risk. Feedback on lack of appropriate PPE fell on deaf ears. There wasn’t clinical time to write Datix reports whilst looking after acutely unwell patients. There was of course the option to complete these outside of working hours but this was not done, due to staff burnout. Fear and loyalty to managers, clinical leads and colleagues also prevented people from escalating concerns. The PPE guidelines differed every shift I had. This of course was due to the shortage. I started off with a surgical mask, plastic apron and gloves and ended my time on this unit with a visor, FFP mask, gown, hair cover and specialist gloves. This alerted us all to the fact we hadn’t been looked after. We had been put at risk. I asked my manager in week four why, as we had been put at risk/exposed, were we not being offered a test. She quoted the policy - “only if you’re symptomatic”. Eventually government standards introduced testing of front-line staff. But there was a catch.... only intensive care and resuscitation staff. I politely challenged this, given I was treating patients with continuous positive airway pressure (C-PAP) prior to and post Intensive Care admissions. Again, this was met with disdain and I was reminded that, “we’re all in the same boat”. Colleagues and I discussed our anger and disappointment with the clinical lead. They agreed with us but felt their hands were tied, as did their lead. We felt that perhaps being interviewed by the news would help our cause. This was flatly rebuked…the communications team would strongly advise against it. Burnt out and gagged we carried on. PPE improved but to this day there has been no offer to test. We need to promote a working environment which allows staff to meet with leaders and to ask questions. For everyone to be given opportunity during work time to debrief and discuss concerns around things that aren’t working or aren’t safe. Staff mental health Early on, the tragic suicide of an Intensive Treatment Unit (ITU) nurse drew attention to the fact that staff mental health was at risk. I believe that nationally, this issue should have been spoken about more, and much sooner. Locally, our psychiatric and wellbeing teams put fantastic support systems in place for staff; virtual clinics, leaflets and regular one-to-one meetings. This had a huge impact. As a team, we utilised whatever we could find. I also instigated a ‘time to talk’ system during work, to debrief as a group. Maslow’s Hierarchy of Needs model could have been utilised brilliantly at the rise of the pandemic. It would have allowed us to be aware of the detrimental impact it could have on front-line staff and what to expect. It would have helped us to begin preparation of self-care. The term ‘corona coaster’ started as a funny meme but quickly became an important adjective to my team and patients. It is used to describe the emotional ups and downs during the pandemic. The shock of hearing 1000 people died in one day, mixed with the panic of ‘how will I fill my day off?’. Giving the shock, grief and stress a name allowed for myself and colleagues to relinquish self-blame from these feelings and to identify the cause. After action review We all know that one of the most effective developmental tools while working on the front-line is to learn from mistakes. What can we take from this? What went well/ not so well? After action review can give a team, trust and/or area time to analyse flaws. The ‘time to talk’ system enabled us to reflect on tasks or areas of concern. For example, “today when Mr X become quickly unwell, I went to help him and he coughed in my face. I didn’t feel I had the correct PPE…” Opportunity to do this with colleagues was hugely powerful and important prior to us going home to our loved ones, who understandably feared our contaminated return. Talking and listening to relatives Supporting patients’ families over the phone became a large part of my role as a nurse looking after people effected by COVID-19. Many of them benefited from having open discussions surrounding their fears and concerns. Mr Z for example, stated he was worried his wife may die, but didn’t want her home yet as he didn’t want to die. This was a very frank and realistic fear. Giving time to talk and listen has proved to be an incredibly important in understanding everyone’s safety concerns. Final thoughts I hope that by sharing our experiences and learning from this challenging time, we can continue to identify how to build a culture that promotes patient and staff safety. Collaboration between managers and front-line workers and capturing the insight of both patients and staff and will be key to this process. Stay safe. Be kind.
  14. Content Article Comment
    That’s brilliant. Is it still successful?
  15. Content Article Comment
    Such an important discussion in this time. yes we are trying our best to preserve life. end of life care is now more than ever important to protect, how and when we go about this. your thoughts for discussion would be appreciated for learning purposes.

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