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Found 56 results
  1. Content Article
    Key points Recurrent nurse workforce shortages are a global issue, also in high-income countries. Implementation of safe staffing policy measures largely varies across the world. Mandated patient-to-nurse ratios are the most straightforward policy to ensure staffing levels. Our overview of policies from various high-income countries may guide future decision-making.
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    The first presentation draws on a recent National Institute for Health Research (NIHR) funded mixed-methods evaluation of the translation into practice of several ‘post-Francis’ policies that have aimed to improve openness in the NHS, and identifies key conditions necessary for policies to make sustainable impact on culture and behaviour. The second presentation reflects on material from a forthcoming book which will offer unfiltered accounts from patients, carers and healthcare professionals about their good and bad experiences of how care is organised, from birth up to the end of life. Their testimonies indicate the salience of kindness and attentiveness combined with efficiency and competence. Finally, the context for a culture of openness and for patient-centred services will be presented, alongside the development of a culture change programme which is being used in 70 Trusts in England. Significant and unacceptable variations in the availability of high quality care and in staff wellbeing persist across the NHS and social care, exemplified by very different COVID-19 experiences across the sector. How far does this kind of research on culture and these kinds of programme interventions help us to gain whole system traction in this important area of laying the conditions for reliably compassionate patient care? How can positive cultures and new working practices that have developed during the COVID-19 pandemic be sustained?
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    The MHOST can be used in any mental health hospital within England, covering the following specialisms: Working age adult admission wards Old age functional and dementia wards Forensic (high and medium secure wards) CAHMS tier 4 wards Eating disorder wards Perinatal wards Psychiatric intensive care units Low secure and rehabilitation wards. The MHOST is part of a suite of Safer Nursing Care Tools (SNCT), delivered by the Shelford Group chief nurses in partnership with Imperial College London, which include those for adult in-patient wards, acute medical units and children and young people’s wards. The SNCT is endorsed by NICE and supported by NHS Improvement and NHS England. The SNCT are widely used across NHS organisations in England, as well as in private health providers and in many overseas healthcare organisations. Kenny Laing, deputy chief nurse at Midlands Partnership NHS Foundation Trust and national lead nurse of the MHOST, said: “The Mental Health Optimal Staffing Tool is an innovative, yet simple to use, way of helping to ensure that mental health hospitals can make evidence based decisions on safe staffing levels that support patients’ needs. This new tool will not only help to improve the care and outcomes for some of the most vulnerable patients, it will also help to improve the working environment of staff in the mental health sector. I would urge all mental health hospitals to use the MHOST to guide them in their safe staffing decisions.”
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    Although participants tended to feel a general obligation to work during an influenza pandemic, there are barriers to working, which, if generalisable, may significantly reduce the NHS workforce during a pandemic. The barriers identified are both barriers to willingness and to ability. This suggests that pandemic planning needs to take into account the possibility that staff may be absent for reasons beyond those currently anticipated in UK planning documents. In particular, staff who are physically able to attend work may nonetheless be unwilling to do so. Although there are some barriers that cannot be mitigated by employers (such as illness, transport infrastructure etc.), there are a number of remedial steps that can be taken to lesson the impact of others (providing accommodation, building reciprocity, provision of information and guidance etc). The authors suggest that barriers to working lie along an ability/willingness continuum, and that absenteeism may be reduced by taking steps to prevent barriers to willingness becoming perceived barriers to ability.
  11. Community Post
    I am interested in what colleagues here think about the proposed patient safety specialist role? https://improvement.nhs.uk/resources/introducing-patient-safety-specialists/ https://www.independent.co.uk/news/health/nhs-patient-safety-hospitals-mistakes-harm-a9259486.html Can this development make a difference? Or will it lead to safety becoming one person's responsibility and / or more of the same as these responsibilities will be added to list of duties of already busy staff? Can these specialist be a driver for culture change including embedding a just culture and a focus on safety-II and human factors? What support do trusts and specialists need for this to happen? Some interesting thoughts on this here: https://twitter.com/TerryFairbanks/status/1210357924104736768
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  13. News Article
    The Royal College of Nursing (RCN) has issued a warning about insufficient staffing in the NHS in the wake of a mental health trust being downgraded. Earlier this week, Tees, Esk and Wear Valleys (TEVW) NHS Foundation Trust being rated as "requiring improvement" by the Care Quality Commission. It had previously been rated as "good" but inspectors said some services had deteriorated. Among the concerns raised were ones over staffing, workload and delays. Glenn Turp, Northern Regional Director of the RCN: "The CQC has rightly highlighted some very serious concerns and failings which call into question whether this trust can provide safe patient care. After the very tragic and sad deaths of two vulnerable patients last year and the findings of the CQC, the trust and NHS commissioners must take immediate action to ensure patient and staff safety." "They have a responsibility not to commission and open new beds with insufficient nursing staff to provide safe patient care. Having the right number of nursing staff with the right skills in the right place at the right time is critical to protecting patients. It also protects those staff who too often find themselves struggling to maintain services in the face of nursing vacancies." Read full story Source: The Northern Echo, 7 March 2020
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    The Gloucestershire Hospitals NHS Foundation Trust combined learning from Nottingham’s model and project meetings with education and operational colleagues to determine what would work best for newly qualified staff in Gloucestershire. This programme offered the trust’s most talented newly qualified recruits leadership development, including a diploma in leadership and management, quality improvement training, leadership coaching, facilitated action learning sets and mentoring opportunities with the Chief Nurse. It also resulted in improvements to retention, with all fellows reporting they now felt they had the courage, confidence and skills to pursue their next role within the trust.
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    The pilot included five key elements: Conducting semi-structured interviews with a sample of clinical and non-clinical staff who had been directly involved in a patient safety incident, adverse event or medical error in University Hospitals Leicester and Nottingham University Hospital to explore the impact this had on them and the type of support they would have liked to receive. These were transcribed and thematically analysed to identify core themes. Developing a three-tier second victim support programme and including training peer supporters (tier 2). Piloting of the model. Evaluating the pilot by interviewing staff who had accessed the peer support. A final report which included recommendations based on findings from the scoping project.
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    We have all heard of the terrible stories of nurses going to the coroner’s court. These stories have been fed to us by our seniors, our mentors, our lecturers since we were students. "If you don’t document properly, you will end up in the coroner’s court, you might even get struck off!" These stories strike the fear of god into you. No one wants to go to coroner’s court, no one wants to be criticised for the work they have spent years training to do. No one wants to be publicly humiliated. This is my story of what happened when I attended a coroner's hearing on a patient who was in my care. I was a band 6 at the time. It was a usual day on the medical ward. Busy. I had a bay of six patients. Three of them were fit for discharge, but no community placement for them to go to, two medical patients and one who was a surgical patient. The surgical patient was under the medics and the surgeons. He came with abdominal pain; he was waiting for a surgical review. Many patients are under numerous teams on the medical ward. One of my roles is to ensure that they get seen by each team every day to ensure a plan for treatment. Today was no different. The patient was seen by the medical team who said "await surgeons". I chase up the surgeons, but they are in theatre. From experience I know that they will be out of theatre by late afternoon – so hopefully I can catch them then. In the meantime, the surgical patient becomes unwell. His blood pressure drops, his NEWS of 5 from 0. He is tachycardic. I call the medics who attend – they want me to call the surgeons… no answer. Intensive care team arrive – to this day I’m not sure how they knew to come, perhaps one of the medics called them? The intensive care doctors I hear raging down the phone at a poor surgeon who is in theatre. The surgeon comes to the ward and soon realises the gravity of the situation. There are discussion that are being had away from the bedside – I’m not sure what was being said or plans that were being made. I was not part of the process. I’m busy doing observations every 5 minutes as requested, plus trying to look after my other five patients. All of a sudden we are going to theatre. I’m still unsure what’s going on. What’s he going there for? The patient looks really scared. I bet I look scared too! I help wheel him down to the operating theatre. As soon as we arrive in the anaesthetic room he has a cardiac arrest. We try and resuscitate him to no avail. I went back to the ward; bewildered, sweating from doing chest compressions, confused and with tears in my eyes. I have a quick cup of tea and I’m back out on the ward again. Three months later my manager asks to see me in the office. ‘What have I done wrong?’ When anyone asks for you to come to the office, its usually bad. They ask if remember the surgical patient who arrested a few weeks back. Of course, I do. I had been thinking about it ever since. I had been worrying about it. I felt it was my fault. They tell me that the case is going to the coroner's court and I was to be called as a witness. I cry. That’s me done then. I’m going to be struck off. I’m going to be found out that I am a rubbish nurse. My manager was amazing. They had experience in these hearings. They explained the whole process. From what would happen from now until the end of the hearing. That afternoon I was contacted by the Trust investigation team. They were lovely too. They asked me exactly what happened and help me write a statement. They put me at ease. It was made clear that what happened was not my fault and that they want to find out what happened to prevent it happening again. The next week or so I had contact with the Trust legal team. I had never spoken to a legal team before in my life. I did feel as if I was a criminal at first. The legal team were also brilliant. They spoke through the actual process; who was in the room, the layout of the room, what questions I might be asked, what the outcomes often are. They gave me advice on how to answer questions; answer what you know as fact, not opinion. If you don’t know, say you don’t know. Be honest. I had two further meetings with the legal team and the investigating team. This was to check I was ok, to make sure I was supported. For what could be an extremely stressful period of my career, was made so much easier by people taking the time out just to check I was ok. I carried on working throughout this period and working with confidence. The hearing came. I knew what to expect. I knew the layout of the room. I knew the patient’s relatives were in the front row, I knew I had to swear an oath, I knew I had support from my Trust. I was able to speak freely – even the bad bits; no covering up or making excuses for others. I was asked what happened that day. I was honest. I didn’t know what was going on. I didn’t know what was wrong with my patient. I was not used to caring for surgical patients. Admitting that I ‘didn’t know’ was awful. I should know, shouldn’t I? When I was saying this, I could feel the eyes of the patient's widow bore into me. I had let my patient down and I had failed. The coroner asked me many questions related to escalation of care to seniors, the policy, my adherence to the NEWS policy – to which I had followed. My part was over in a flash. The next was the surgeon, who got most of the grilling. Why was he not there, where was his documentation, why did he not come when asked repeatedly? It wasn’t his fault either. He was in theatre with another patient. He can’t be in two places at once. I felt really sorry for him. I hope he got the same support I did. The outcome of the hearing was to issue a regulation 28. This ensures that a report is sent to the government by the Trust as the coroner believes that action needs to be taken can to prevent future preventable deaths. So, what happened then? I went back to work and carried on as usual. The ward where I worked no longer takes surgical patients. They made a new unit called the ‘surgical assessment unit’ where surgical nurses care for this cohort of patients. I wanted to share this – yes, there are many issues surrounding this, but the point I wanted to get across is that the investigation team, my manager and the legal team supported me through this difficult time. I am not sure if other Trusts have this level of support for staff attending coroners court.
  19. Content Article
    How will this programme help trusts? What does the programme consist of? Further information
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    The growing global evidence that Anne Marie and academic colleagues have gathered shows we need more nurses, with the right skills and support, if we want to reduce patient mortality and improve nurses’ wellbeing. The RCN has used this research to create the aims of its safe staffing campaign and to tell all four UK governments what nurses and patients need now.
  22. Content Article
    The study notes that long-term conditions are often not recorded on administrative data and the lack of recording may be worse for weekend admissions. Studies of the weekend effect that rely on administrative data might have underestimated the health burden of patients, particularly if admitted at the weekend.
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    Sometimes, you have those days where you have had enough. ENOUGH. That’s really where the Genie started. I began my career in the private sector, joining the NHS as an ‘experienced hire’ some five years later through ‘Gateway to Leadership – Cohort III’. I probably should have known that a moniker based on the Roman army was telling me something. I had moved from an organisation where the worst thing that had happened was moving the water machine, to an organisation where the water machines had been removed some years before for "cost improvement" purposes. The organisation was struggling to cope on a number of levels, and there was no single answer to solve any of the issues. Sticking plasters were used to cover gaping holes, and we had significant clinical and financial issues. Please don’t misunderstand. I had a baptism of fire, with many incidents I wouldn’t want to put into print, but my wholehearted support of the healthcare workforce, of their resilience and humour, their ability to innovate, and their willingness to stand up and fight, was sown in those first few weeks as a fresh-faced newbie with a desire to change the world. I was approached to join another organisation in those heady days of ‘turnaround’ which gradually became ‘transformation’, as realisation dawned that death by a thousand cuts wasn’t actually saving any money, was impacting on care quality, and maybe (just maybe) we needed a different approach. I was often asked to work with the nursing and midwifery teams based on experiences in my first NHS trust. The issues were often the same. Finance and HR had data – not necessarily matching data – and nursing and midwifery had ‘professional judgement’. Somehow that didn’t hold as much weight, so working together with nursing from ward to board, we would produce our own data based on care levels, costs and WTE, so we could come to the table to ask some really simple questions: “Would you want to be cared for on this unit based on the care that is available?” It made a huge difference, and started to change the conversation from one of conflict and protectionism to one of collaboration. After seven years of working through the same issues in each organisation it reached that point again. Surely there must be a better way? What would happen if we could extend our single organisation work to one that could look at variation between organisations, and include outcome measures, and look at workforce planning across all settings of care? So, with an idea in our minds and a plan to do good, Creative Lighthouse Ltd was formed. Establishment Genie was born in a shed and has been both kicked and nurtured by some wonderful critical friends and safe staffing experts. The hard work, bloodied knuckles from knocking on so many doors, and the highs and lows of running a tech start-up in a sector that often doesn’t embrace technology started to pay off. The Genie achieved NICE endorsement in April 2017 and was awarded a grant by Innovate UK to develop and test the Genie across all settings of care. We have now worked with front-line staff from more than 500 teams and organisations to review, remodel and report on their workforce, supporting them to meet the challenges of safe and affordable care with a backdrop of clinical and financial shortages, and track their progress using outcome measures to show that they are improving quality of care. However, the journey doesn’t stop there. Dear reader, to paraphrase poorly, I have a dream. I have a dream that one day every health and social care organisation will put workforce at the centre of all their planning processes. A dream that all health and social care organisations will use the same approach to plan their workforce and share outcomes and data for the benefit of all, and the future of health and social care. A dream that our frontline health and social care leaders will work beyond professional and organisational boundaries to ensure that every person has the best and most appropriate care, provided in the most appropriate place, with the safety of every individual at the core of every action and intervention. Thankfully I love to travel and cannot wait to meet more innovative disruptors who share that same dream. Jump onboard – it’s going to be one heck of a ride! Read on the hub case studies showing how trusts are developing their approach to workforce planning.
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