FACING THE CARE CHALLENGE IN PRACTICE

1. FACING THE CARE CHALLENGE IN PRACTICE Reflections of a Chief Nurse Mandie Sunderland

6. WELCOME TO MY WORLD! • 5,000 Nurses & Midwives / 10,000 staff • 3 hospital sites • Breach of authorisation with Monitor – removed August 2010 • 3 conditions with CQC Registration • Staffing • Safeguarding • Appraisal • Rule 43 (Coroner) • All have nursing involvement • Reputation re standards of nursing care • Same commissioners as Mid Staffs

7. NURSING – OUR PROFESSION • Adverse media stories • Inquiries / Investigations / Reports • Public perception • ‘Fit for Purpose’ debate • NMC Consultation • Media coverage ‘too posh to wash’! • Personal experiences • SUI’s • Coroners Verdicts • Complaints • Disciplinaries • NMC Referrals

8. THEMES OF QUALIFIED NURSES & MIDWIVES DISCIPLINARY CASES 2008/10 • Professional conduct – medicines - failure to follow policy (inc several fatalities • theft • Professional conduct – patient observations • failure to escalate (inc several fatalities) • failure to document • Professional conduct – personal - attitude / behaviour • communication • internet abuse • Professional conduct – other • documentation • confidentiality

9. ISSUES • Recruitment • quality of applicants • Medicines Managements • numeracy • standards / policy for medicines administration • basic knowledge of safe practice • Provision of fundamental care • knowledge of ‘basics’ • appetite for ‘basics’ • inability to plan care • Knowledge of accountability both professional / personal • aware of NMC but no in depth knowledge • ‘someone else’s fault’

10. HEFT SOLUTIONS • Pre interview tests re drug calculations for all RN’s • original pass mark 100% (achieved by 10%) • given calculator and formula card • no time restraints imposed • Pass rate revised Oct 2099 • pass rate between 60 – 80% can proceed to appointment if interview exceptional • Manager to develop PDP to ensure completion of medicine administration competency • Score of 60% not employed • Assessments for adults / paediatrics / neonates

11. EXAMPLES OF QUESTIONS OF MEDICINES ASSESSMENT • Patient A requires 30mg of oral Prednisolone; you have a stock of 5mg tablets. How many tablets do you need to give? • Convert 400 micrograms into milligrams • If there is 80 mg of Gentamicin in 2 mls how much Gentamicin is in 0.5ml? • You need to administer 40 mg the vial contains 50mg in 2 mls. How many mls do you need? • You need to give 100 mls of Metronidazole over 20 mins. What is the hourly rate in mls? • Your patient weighs 65 kg the drug prescribed on 7mg per kg. How many mg are required?

12. MEASURING FUNDAMENTALS OF CARE • Development of Nursing & Patient Experience Metrics • Originally 8 indicators • Medicines administration • Falls • Nutrition • Tissue Viability • Infection Prevention • Patient Observations • Pain Management • Continence Management • Electronic real time reporting • Peer review – ‘Back to the Floor’ • Assurance process in place • Consequence to poor performance / celebration of good practice

14. Progress – October 2010 • Trust remains GREEN overall and has stayed at 90% • 1 ‘RED’ ward October 2010 (2 ‘RED’ wards September 2010) • 3 wards slipped from ‘GREEN’ to ‘AMBER’ • GHH slipped from ‘GREEN’ to ‘AMBER’ overall • Pilot of Metrics 2 commencing November 2010 - Additional indicators for Diabetes Management; Discharge Checklists and Assurance Bar chart to demonstrate Red Wards : Green Wards January 2010 – October 2010

15. METRICS RESULTS OCTOBER 2010 Critical Care Theatres Paediatrics Neonates

16. QUESTION Do we have a fundamental problem with the knowledge base of our nursing workforce? ?

17. VITAL Virtual interactive teaching and learning Education tool to acquire knowledge and skills that confirm core standards for safe practice Profession / role specific modules in development VITAL for nursing E learning foundation module related to fundamental safe practice Integrated training needs analysis and learning intervention

18. VITAL - premise • Registered nurses first • MS to write to every nurse • HEFT Context around professionalism promoted • Core safety - linked to metrics • Linked to other trusts • Probably badged • Life span – patient journey focused • VLE user support

19. ACCESS • Access via HEFT Faculty website (www.) • Platform: MOODLE on-line virtual learning environment • Trust specific reports produced • Will inform national research project on current state of nursing knowledge led by HEFT Faculty in collaboration with participating partners

21. INDICATIVE NURSING CONTENT TBC

22. Further face to face education and training modules as required STEP OFF / OR VITAL for nurses Programme Framework

23. VITAL – Proposed Assessment Scheme - Congratulations -Successfully passed VITAL Module Possible Outcome ongoing performance support. Glossary Module on MOODLE called VITAL VITAL contains Units of learning e.g Safeguarding

24. VITAL-Ready to go

25. NEXT STEPS • Inclusion of Midwifery 2011 • Development of Trust badge to epitomise ‘HEFT’ Nurse/Midwife • Utilisation of VITAL pre recruitment? • Allow access from home to all nurses and midwives • Assurance to Trust Board, Regulators, patients and public that our nurses are knowledgeable and competent

26. THOUGHTS FOR THE FUTURE • Move to graduate status – excellent news! • Fit for purpose debate continues • Yet another review of pre reg curriculum?? • Explore potential to enable mandatory training and competency ‘mania.’ • Public confidence – jury remains out! • Recent events • Recommendation 4 • “The Trust, in conjunction with the Royal Colleges, the Deanery and the nursing school at Staffordshire University, should • review its training programmes for all staff to ensure that • high-quality professional training and development is • provided at all levels and that high-quality service is • recognised and valued.” • The Mid Staffordshire NHS Foundation Trust Inquiry

27. BLASPHEMOUS THOUGHTS! • No pilot of P2K • Concerns over pre-reg practice experience/assessment of clinical skills/progression to registration • HEFT Faculty of Nursing & Midwifery • Pilot of 30 students (pre-reg training) • External evaluation of end product • Total ownership of whole experience • Work with academic partner • Academic credit given to practice • Ownership and commitment from practice • Value for money • Fits with new policy direction • Logistics becoming easier e.g. amalgamation with community nursing • Appetite from patients / public / practitioners

28. 4.32 – ‘Each year several billion pounds are spent on central funding of education and training for NHS staff through the Multi-Professional Education & Training levy, in addition to investment by NHS organisations in their own staff. A top-down management approach led by the DOH does not allow accountability for decisions affecting workforce supply and demand to sit in the right place. It is time to give employers greater autonomy and accountability for planning and developing the workforce, alongside greater professional ownership of the quality of education and training ……………….. • Healthcare employers and their staff will agree plans and funding for workforce development and training; their decisions will determine education plans. • Education commissioning will be led locally and nationally by the healthcare professions ………. Mechanisms will be put in place for nurses and midwives and allied health professionals. • The professions will have a leading role in deciding the structure and content of training and quality standards. • All providers of healthcare services will pay to meet the costs of educatioin and training. Transparent funding flows for education and training will support the level playing field between providers.’ ‘EQUITY AND EXCELLENCE – LIBERATING THE NHS’ JULY 2010