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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].

NHS and social care continues to have significant challenges. This blog cannot change that but it offers food for thought on how to stay afloat.  It’s been a while since I have posted a blog. I continue to coach NHS colleagues – their calmness, focus, resilience, professionalism and ‘can do’ shining through in spades. Inspirational, appreciative leaders of teams, small and large. Our current systems and challenges are too complex to have one person at the helm taking all the decisions. We need leadership at all levels. Great leaders inspire people to have confidence in themselves. Whether you are part of a team, a team leader or leader of many, here’s four things to contemplate: 1. Reality check The Covid aftermath, understandable unrest and general distress and frustration have impacted, of course they have, but we have a dedicated, professional, caring workforce. 2. The power of appreciation Take a moment to identify and reflect on your contributions and those of your colleagues. Appreciate those contributions. Make time to share them with each other. Individually and collectively feel proud. 3. Strengthen your resilience I can’t remember where I read this, but a simple way to focus the mind and build your resilience is to start each day with this simple reminder: I am … add in the words that best describe your talent and experience. I have … add in things that support and energise you at work and home. I will ………..your intentions for that day, this week. 4. Look out for each other Tune in. Sometimes we just want someone who will listen, a space to talk to a colleague, friend, coach, mentor. If you don’t already have this, think about who could help. In my experience, how we care for each other and appreciate our respective contributions helps to sustain us on the brightest days and the not so bright. Thanks for reading this. I have used this quote before but it seems apposite just now: "She stood in the storm and when the wind did not blow her away, she adjusted her sails." Elizabeth Edwards. Further blogs from Sally: Keep your light shining bright – three tips Swimming with the tide Standing tall in the storm

CORESS invites you to join their free educational webinar and hear from four speakers as they talk about their area of expertise in relation to patient safety. Programme overview: 14:00 - Introduction to CORESS and Welcome - Professor Frank Smith, Professor of Vascular Surgery & Surgical Education, University of Bristol and North Bristol NHS Trust and CORESS Past-Programme Director 14:03 - Symposium Programme Overview - Miss Harriet Corbett FRCS Paed Consultant Paediatric Urologist, Alder Hey Children’s Foundation NHS Trust, British Association of Paediatric Urologists and CORESS Programme Director 14:05 - SPOT Programme: The National inpatient PEWS Chart - Professor Damien Roland, Consultant in Paediatric Emergency Medicine, Head of Service Children's Emergency Department, University Hospitals of Leicester NHS Trust 14:30 - Championing Patient Safety with Evidence Based Medicine - Robotically Assisted Surgery - Dr John Burke, Chief Medical Officer, AXA Health 14:55 - What’s new at HSIB - Saskia Fursland, National Investigator, HSIB 15:20 - Patient Safety in a Medico-legal Context - Dr Michael Devlin, LLM, MBA, FRCP, FRCGP, FFFLM , Head of Professional Standards and Liaison, MDU 15:45 - Symposium Summary and Close - Harriet Corbett, CORESS Programme Director Intended Audience: This session is for Consultant Surgeons, medics, students with a surgical healthcare background and those in healthcare and insurance sectors with an interest in surgical improvement and patient safety. Register

The first event of its kind in the UK, Nursing Live will bring thousands of nurses together to enjoy a packed day of high quality professional development, peer-to-peer collaboration, interactive activities, and much more. Featuring over 100 presentations, demonstrations and masterclasses – together with special zones focused on the very latest clinical and technological advances in all aspects of healthcare – Nursing Live will support your CPD progression, develop your skills, and inform your practice. The event will also give you access to a wide range of self-care guidance and lifestyle resources designed specifically for nurses. This means you’ll get the chance to enhance your career, and boost your personal well-being, all under one roof. Register

This one day virtual masterclass facilitated by Mr Perbinder Grewal, will focus on how to deal with difficult people. Do you have someone at work who consistently triggers you? Doesn’t listen? Takes credit for work you’ve done? Wastes your time with trivial issues? Acts like a know-it-all? Can only talk about themselves? Constantly criticises? We will discuss strategies and tools to improve communication and interactions with others. For further information and to book your place visit https://www.healthcareconferencesuk.co.uk/conferences-masterclasses/how-to-deal-with-difficult-people or email [email protected]. hub members receive a 20% discount. Email [email protected] for discount code.

While scientific breakthroughs are giving people with breast cancer more hopeful outcomes, much improvement is needed in cancer diagnosis and treatment rates, which have seen further setbacks as a result of the disruption caused by the COVID-19 pandemic. The COVID-19 legacy has also transformed many practices in cancer care and research settings. So, what does this mean for nurses working in breast cancer today? This timely and up-to-the-minute webinar offers you a chance to benefit from the latest research and guidance on breast cancer care, from screening through to treatment. With a firm focus on the role of the nurse, this event will create a supportive environment in which you can hear from experts, ask your questions and engage with a community of breast cancer nurses facing the same daily challenges as you. Register

This masterclass will focus on developing your role as a SIRO (Senior Information Risk Owner) in health and social care. Key learning objectives Understanding the role of the Senior Information Risk Owner. Identifying Information Risks across the organisation. Working with others to mitigate the risk to patients, staff and organisation. Confidence that all reasonable technical and organisation measure are in place. Giving assurance to the Board that risks have been considered, mitigated or owned. Understand the requirements of external confidence that policies, procedures are in place to deal with Data Breaches. Facilitated by: Andrew Harvey IG Consultant BJM IG Privacy Ltd. Register hub members receive a 20% discount code. Email [email protected] for discount code.

People invest time in hearing a story. Whether you want to influence key decision makers or develop a stronger rapport with your audience, telling a story helps you convey essential pieces of information in a relatable, memorable and humanistic way in a professional environment. By examining the stages and structure of storytelling, and how you can apply it to your organisation, the Storytelling to Influence: Speaking and Presenting course explores useful techniques that enable you to hook your audience and become a more powerful verbal communicator. Through a range of practical exercises, led by RADA trained, Sandra Miller, leave the day knowing how to make a lasting impression in the workplace. Learning outcomes Make a more powerful impression in meetings and presentations. Relay information in an experiential manner for greater impact and understanding. Use compelling stories to appeal to listeners’ emotions and drive your points home. Win over, influence and gain the trust of key stakeholders, service users and colleagues. Register

This national learning event will bring together clinical and improvement leaders involved or interested in the Scottish Patient Safety Programme. Aims of the day: Explore the organisational and system wide conditions that enable the safe delivery of care amidst increasing system pressures Learn how The SPSP Essentials of Safe Care are supporting improvements in safety Provide a forum for leaders and teams working across all aspects of SPSP to come together to share and learn This event page is for delegates wishing to attend the morning plenary sessions only as a virtual delegate. Agenda: 10:00 - Chair’s Welcome (Professor Sir Gregor Smith, Chief Medical Officer for Scotland, Scottish Government) 10:10 - Ministerial Address (Maree Todd, Member of the Scottish Parliament & Minister for Public Health, Women’s Health and Sport) 10:25 - SPSP Update (Joanne Matthews, Head of Improvement Support & Safety, Healthcare Improvement Scotland) 10:40 - Plenary Session (Professor Mary Dixon-Woods, Director of THIS Institute & The Health Foundation Professor at the University of Cambridge) 11:25 - Plenary Q&A 11:40 - A System View (Robbie Pearson, Chief Executive, Healthcare Improvement Scotland) 11:50 - Chair’s Summary ((Professor Sir Gregor Smith, Chief Medical Officer for Scotland, Scottish Government) Register

Future Surgery, brings together surgeons, anaesthetists and the whole perioperative team. Designed specifically to meet the training needs, promote networking and develop a stronger voice for all surgical professionals and their multidisciplinary teams in perioperative care. Our CPD accredited speaker programme explores disruptive technology, connectivity, human factors, training and research to support the transformation of the profession and the improved care and safety of patients. Future Surgery is the biggest gathering of surgical and operating theatre teams with over 110 expert speakers – in keynote sessions, panel discussions and workshop sessions, covering all that is new in the field of surgery. Register

Govconnect are delighted to announce that the 3rd Annual Improving Patient Safety & Care Conference, will be held at the RSM in partnership with Patient Safety Learning. Supporting STPs/ICSs and healthcare providers to implement features of the NHS Patient Safety Strategy can only be achieved through the joint efforts of multiple organisations, and for the last 3 years, the Govconnect’s Patient Safety series of webinars has provided the platform for discussion to shape a better policy in order to better deliver the commitments of the strategy. Improving Patient Safety & Care 2022 allows government departments, arms-length bodies, the NHS and local authorities, research institutions, and the charity and voluntary sector to hear from senior leaders from many of the key partner organisations involved in implementing the patient safety strategy. Speakers at this event include: Dr Una Adderley, National Wound Care Strategy Programme Director, AHSN Network Cheryl Crocker, Patient Safety Director, AHSN Network Sir Robert Francis, Chair, Healthwatch England Dr Nigel Acheson, Deputy Chief Inspector of Hospitals, Care Quality Commission Helen Hughes, Chief Executive Officer, Patient Safety Learning Peter Walsh, Chief Executive, Action Against Medical Accidents & WHO Patients for Patient Safety Champion Agenda Register We are delighted to announce we have a number of fully funded tickets to offer. Please use the following code when asked at the cart on the registration page: IPSC22GUEST

In its 15th year, the HSJ Patient Safety Congress is the largest annual event to unite patient safety leaders, front-line innovators, national policymakers and patient representatives from across the UK to learn and exchange ideas that will transform patient safety and standards of care. Patient safety is a field that never stands still. Practitioners across the patient pathway are dedicated to continuous improvement and improving the patient experience, ensuring equity of care for all and optimising outcomes. As a result of this Congress, changes have been made to medical textbooks and led to new research being commissioned. But more importantly, it is through this event that changes are made within teams and organisations that help save lives. This year’s Congress will address both new and long-standing patient safety challenges, offering new insights, practical ideas and actionable solutions to help improve care in your organisation: Building a restorative culture. Integrating human factors approach to improve safety. Focusing on patient safety in non-acute settings. Practical approaches to patient and family engagement. Safety and equality in women’s health. Protecting and supporting our workforce. Improving governance and regulation to achieve consistent care. Encouraging clinician-led innovation. Examining safety for vulnerable people. Recognising and responding to the deteriorating patient. Breaking the cycle of repeat errors to advance the safety agenda. Responding to catastrophe in a healthcare setting. Reversing the impact of normalised deviance on patient safety. Eliminating unnecessary deaths in a post-pandemic. Register

In a new series of blogs, Dawn Stott, Business Consultant and former CEO of the Association for Perioperative Practice (AfPP), discusses how coaching and developing teams can support patient safety and its outcomes.  In part one and part two, Dawn looked at the strategies and coaching methodologies that can be used to develop individuals and to support patient safety, and discusses the indicators of improvement, prosocial behaviours and the importance of good communication to improve culture and, ultimately, patient safety. In the final blog of the series, Dawn discusses the importance of reflective practice and how it encourages  learning and growth, and helps us to identify and address challenges. Reflective practice is the process that you can go through to engage in thoughtful and purposeful consideration of the experiences you have had, the actions you have taken and the outcomes of those actions. It involves a conscious effort to gain insights, learn from experiences and enhance your professional and personal development. Reflective practice is used in various fields but is used a lot by healthcare professionals to analyse patient interactions, clinical decisions and the overall delivery of healthcare interventions. To be able to engage in reflective practice it is important to understand your own thoughts, feelings and reactions to different situations. An open and honest mindset is key to achieving this. The ability and willingness to consider different perspectives is important – to challenge assumptions, your own and those of others. Your coach should encourage you to analyse and evaluate experiences, actions and decisions to identify strengths, weaknesses and areas for improvement. Part of the reflective learning process is viewing experiences as opportunities for learning and growth and actively seeking ways to expand your knowledge and improve your skills. During my tenure at AfPP a colleague introduced me to a book called ‘The Three Minute Diary’. The diary provides you with an opportunity to reflect on your day and document experiences that in turn facilitates the reflection process. It asks what has been good in your day, what has been bad, what you were grateful for, etc. I found it invaluable, and I still dip into it when my pathway has become a little blurred and I need clarity. From experience I know that it is very easy to walk away from a fiery or difficult situation and think about what you should have said. I call this the ‘if only’ scenario. If only I had said that. In the heat of the moment, we often forget to breath which in turn stops us thinking and behaving effectively. Reflection isn’t only about thinking about what we should have said but also about enhancing our ability to identify and address challenges through thoughtful and clear analysis of the situation, which often provides you with alternative solutions. It can deepen our awareness of personal values, beliefs and strengths and also our areas of improvement. This will support our ongoing learning and development, which contributes to our professional competence and effectiveness; resulting in heightened empathy and understanding of the perspectives of others, which can lead to improved interpersonal relationships both at work and at home. We all want to be good decision makers and reflective practice can encourage us to review the decisions we have made and, in the future, consider the potential consequences and ethical implications of the choices you make. Reflection supports continuous improvement in work or practice by identifying and addressing areas that can be refined. It aids personal growth, self-discovery and achieving any life goals you have set for yourself. Reflective practice is dynamic and an ongoing process that contributes to continuous learning and improvement, fostering a mindset of curiosity, openness and adaptability. The bottom line is that with coaching, people can become better at what they do and in a healthcare setting that is so very important to the safety of the patients. Coaching is a very undervalued business tool that can be important to any professional no matter where they are in their career. Great athletes at the top of their game have a coach. Brilliant singers have voice coaches to keep them hitting the right note. We all reach our limits and are unable to improve because of the complexity of things going on around us – an external pair of eyes can help us focus on the blurred edges and help us to continue seeing the bigger picture. However, we do have to feel safe in our environment to be able to speak openly and offer support and guidance to people who don’t always want it. Psychological safety is a shared belief that the environment is safe for interpersonal risk taking. It’s tough at the top and it’s tough to be a patient – so you should invest in yourself to ensure patients are kept safe. It’s not about how good you are right now, it is about how good you can be, or are going to be that really matters. Any improvement, big or small, can impact greatly on patient safety and healthcare outcomes. Further blogs from Dawn: To coach or not to coach? Part 1 To coach or not to coach? Part 2 Developing cultural change in healthcare: Part 1 Developing cultural change in healthcare: Part 2

In a new series of blogs, Dawn Stott, Business Consultant and former CEO of the Association for Perioperative Practice (AfPP), discusses how coaching and developing teams can support patient safety and its outcomes.  In part one, Dawn looked at the strategies and coaching methodologies that can be used to develop individuals and to support patient safety. In part two, Dawn looks at how coaching can improve individuals, and discusses the indicators of improvement, prosocial behaviours and the importance of good communication to improve culture and, ultimately, patient safety. Coaching can often make sense of the chaos around us – we don’t bring our best self to the table when we are functioning under stressful circumstances. Inner self-empowerment through coaching involves helping individuals tap into their inner resources, their strengths and potential to overcome challenges, achieve goals and live a more fulfilling life. It is a personal strength to be able to reflect on a given situation, previous behaviours and improvements for the future. In healthcare, professionals can be asked to act as a mentor or coach for a new member of the team or an apprentice working in the department. For any coach, recognising improvements in the abilities of others and their skills can be subjective and the signs may vary depending on the nature of the skill or activity. Some common indicators that someone has improved could be: A consistency in their performance and delivering high-quality work or positive results is a good sign of improvement. Especially if it is benchmarked against a starting point. As individuals become more skilled, they tend to perform tasks more efficiently. Improved efficiency may include completing tasks in less time, using few resources or achieving better outcomes with the same amount of effort. Confidence tends to grow as skills improve. As a coach you may notice your mentee becoming more assured in their abilities and it may be an indication that they have become proficient in the task. With improved skills often comes adaptability. Someone who has improved at their core tasks may demonstrate a greater flexibility and improved problem-solving skills. If mentors, peers or supervisors are providing positive feedback it suggests that the mentee’s skills have advanced. Continued learning and commitment to personal development are indicators of improvement. Someone who actively seeks new knowledge, embraces challenges, and learns from experience is likely to have improved over time. Depending on the nature of the skill, measurable improvements can be a straightforward indicator. Advanced skills often lead to innovative thinking. If someone starts to come up with creative solutions, introduce new ideas or contribute to the improvement of processes, it is a sure sign of growth in their abilities. Improvement is a gradual process and different skills may manifest progress in various ways. Additionally, it is essential to consider the context and specific criteria relevant to the skills in question. If you the coach encourage kindness, it is a prosocial behaviour that can benefit society as a whole. These behaviours are often characterised by selflessness, co-operation and a concern for the wellbeing of others. Prosocial behaviours can manifest in various ways and in different contexts, which include: Kindness and courtesy: behaving in a considerate and polite manner towards others, promoting positive interactions in various settings. Helping others: assisting someone in need. Sharing and co-operation: pooling resources, information or skills with others and working collaboratively towards a common goal. Leaving your ego at the door and knowing that a joint success is as important as you achieving something alone. Empathy and compassion: understanding and sharing the feelings of others and showing compassion in response to their needs or challenges. Altruism: engaging in actions solely for the benefit of others, even when there is no apparent personal benefit. Conflict resolution: using communication and problem-solving skills to address conflicts in a constructive and non-aggressive manner. It is safe to say that coaching can play a strong role in fostering prosocial behaviours by building self-awareness. A coach has the gift to help individuals understand their values, beliefs and the impact of their actions on others. By providing individuals with different perspectives, the coach can encourage individuals to develop an empathetic approach to given situations. In my career journey, I have spent a lot of time with different types of people, working in different environments, latterly and mostly in healthcare settings. I have been fortunate enough to develop training packages, deliver training, encourage change and manage complex strategies in support of patient safety initiatives. Every time I ask the same question to different teams at all levels of the career spectrum – "how good is your communication?" I would say that 80–90% of people would say their communication was good but that of other’s was not as good as theirs. We have a pre-conceived idea that we are great communicators, but the reality is that we are not. We can always improve and for a coach to help strengthen the communication skills of an individual is one of the most important elements within their role. Promoting active listening to enhance interpersonal relationships is a key fundamental of good communication. Goal setting is key to coaching, giving the mentee tasks as part of the coaching programme is important and if the coach can assist individuals in defining and working towards goals that contribute to the well-being of others or society, that is a great achievement. Ultimately, coaching for prosocial behaviour involves guiding individuals towards a mindset and behaviours that contribute positively to their social environment and the well-being of others around them. Supporting individuals to cultivate a growth mindset and promoting the belief that they can develop and improve themselves through effort and learning is crucial. In part three, Dawn will discuss the importance of reflective practice and how it can be used to analyse patient interactions, clinical decisions and the overall delivery of healthcare interventions. Further blogs from Dawn: To coach or not to coach? Part 1 Developing cultural change in healthcare: Part 1 Developing cultural change in healthcare: Part 2