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Nurse Appraisal Training Day. Taunton Sept 2012. Those present. Lisa Horman, Blackbrook Surgery Caroline Samuel, St James Marion Baker, Blackbrook Sue Johnstone, Redgate Penny Mabley, Crown Denise Orton, Blackbrook Jill Hellens, Somerset LMC. Tasks for the day(s) – starting point.

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Nurse appraisal training day

Nurse Appraisal Training Day

Taunton Sept 2012

Please do not circulate this document without the authors agreement


Those present

Those present

Lisa Horman, Blackbrook Surgery

Caroline Samuel, St James

Marion Baker, Blackbrook

Sue Johnstone, Redgate

Penny Mabley, Crown

Denise Orton, Blackbrook

Jill Hellens, Somerset LMC

Please do not circulate this document without the authors agreement


Tasks for the day s starting point

Tasks for the day(s) – starting point

  • Establish the purpose of nurse appraisals

  • Create a framework and the relevant forms

  • Consider what the appraisal meeting should include

  • Identify and practice appropriate communication skills

  • Consider the challenges and ethical issues that might arise

  • Know how to produce SMART PDPs

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Hopes before after scores 10

Hopes (before & after scores/10)

  • Understand more about appraisal 4->8

  • Feel equipped for the job 2->7

  • Roll out across the UK!

  • Develop an acceptable framework 0->9

  • More info about the role of appraiser 2->9

  • How it will work and fit in 2->5

  • Non-threatening, positive experience -10!

  • GPs leading by example?

  • Doing it properly, constructively

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Skills brought by the group

Skills brought by the group

  • Nursing experience (lots of it)

  • Mentor in A&E / other / primary care

  • Lead practice nurse

  • Appraisal experience – primary and secondary care

  • Teaching qualifications /experience

  • Previous appraisal course

  • Re-developed nurse appraisal process

  • Clinical supervision (funding problems)

  • Enthusiasm

  • Reflective discussions with colleagues

  • Cytology module development / teaching / assessment

  • Assessment experience – NVQs etc

  • Communication skills

  • Nurse advisor / pastoral role

  • GP appraiser

  • Doctor in difficulty work

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Fears and concerns

Fears and concerns

  • Fitness to practice issues

  • Positivity in the face of adversity

  • Lack of peer appraisal support

  • Time and work-life balance

  • Working in other practices

  • Fitting in with practice development needs

  • Duration

  • Resources

  • Not doing a good enough job

  • How much to take on – boundaries in the appraisal

  • Practice nurse views / acceptance

  • Lack of knowledge / expertise in specialist areas

  • Personal investment / reputations

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What should appraisal include

What should appraisal include?

  • Description of PN’s role(s)

  • Educational needs assessment

  • A healthy dose of reality

  • Stepping stones to longterm goals

  • CPD evidence and reflection

  • Thoughts and feelings about job / role

  • Personal attributes and skills

  • Challenges, barriers and constraints

  • Agreed and clear aims

  • Clear information about confidentiality

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It should not include

It should not include...

  • Pay, rewards and conditions

  • Counselling

  • Disciplinary matters

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Practicalities and decisions

Practicalities and Decisions

  • Clarify numbers (at least 20?)

  • Covering letter

  • Appraisal forms – appraisee form, summary of appraisal, feedback from appraisees, reflection by appraisers

  • Funding and duration (1.5-2 hrs?)

  • Allocation / selection of appraisers

  • Location

  • Overview of forms, PDPs, collation

  • How much detail to go into

  • Writing it up / publishing it

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The appraisee s form

The appraisee’s form

  • Name, job title, workplace, contact details, qualifications

  • Description of roles: clinical; admin / managerial; teaching / research; teamwork and communication; any other aspects

  • CPD records from the last year

  • Career development plans

  • P38 self-assessments

  • Achievements; SEAs / complaints

  • Optional evidence eg PDP, in-house appraisal, audits, reflections etc etc etc

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Other forms

Other forms

  • Summary of appraisal discussion; based on GP Form 4 with our own categories

  • PDP form – use GP form

  • Appraisee feedback – use GP form

  • Appraiser evaluation – we need to think about this

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Communication skills

Communication Skills

  • Active listening, encouraging contribution

  • Body language

  • Open questions

  • Terminology

  • Tone of voice

  • Keeping a positive approach (a la NLP)

  • Non-judgemental, avoiding assumptions

  • Checking understanding and agreement

  • Picking up cues

  • Feeding back and reflecting

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Active listening body language

Active Listening / Body language

  • Utterances

  • Relevent comments / encouragements

  • Eye contact

  • Nodding

  • Expression – matching

  • Layout of room

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Open questions

Open questions

  • What do you mean by?

  • Have you thought about trying?

  • How is this going to affect you?

  • How do you feel about?

  • Could you tell me more about?

  • You mentioned...

  • Avoid “Open-close” questions – immediately narrowing the options before reply

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Moving things on

Moving things on...

  • Summarise / check

  • Ideas and expectations

  • Sign-posting change of tack

  • Linking things

  • CBT – thoughts, feeings, behaviour

  • Thought cascades and hot thoughts

  • Not taking things personally

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Empathy not sympathy

Empathy (not sympathy)

  • Acknowledging but not catching feelings

  • Allowing emotions – giving permission

  • Normalising feelings

  • My friend, John... (avoiding assumptions)

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Nurse appraisal training day

Cues

  • Lack of content / evidence / reflection – MAY mean; lack of confidence, inexperience, anxiety, lack of opportunity, time / payment / work-life balance, lack of motivation, new to the job, fear of the process / confidentiality

  • TMI – MAY mean; over-documentation, ambitious, high-flyer, work-life balance, perfectionism, obsessional streak, irrelevance, lack of confidence, secondary care experience / prior learning

  • Emotional reactions – Upset; (acknowledge and offer discussion), blank walls / defensiveness (reassurance?), deflection / denial (careful!). Matching but not mimicking

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What might we want to use the appraisal process for ourselves

What might we want to use the appraisal process for ourselves?

  • Advice, support, guidance

  • Clinical supervision – prescribing

  • Triage and minor illness

  • Research (reservations)

  • Workload / pressure

  • Time / meeting expectations / admin

  • Lack of control / influence / voice

  • Fairness of allocation of work / time

  • Other interests and challenges

  • Co-morbidities and complex disease

  • Working in different places

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More of our needs

More of our needs...

  • Pressure of work

  • Isolation / all eggs in one basket

  • Not feeling listened to / being solely responsible for a role

  • Lack of support / patient safety implications

  • Outside / non-NHS opportunities

  • Work-related stress and anxieties

  • Role development for the future

  • Tackling repeated frustrations / usual stuff

  • Changing stuff or changing your feelings

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And the rest

And the rest...

  • Time – finishing on time

  • Delegation and lack of personnel

  • Things that don’t happen

  • Intractability

  • Lack of meetings

  • Communication

  • Working towards retirement

  • Catharsis!

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Elements of the appraisal meeting

Elements of the appraisal meeting

  • Opening / scene-setting

  • Discussion related to form

  • Ideas, concerns and expectations

  • Summarising / overview

  • Compiling the ENA

  • Create an agreed PDP

  • Close meeting

  • Write up forms

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Opening

Opening

  • Introduction – check times / protected etc

  • Appreciation for their involvement

  • Their thoughts / feelings / expectations / agenda

  • Reassurance / explanation as appropriate

  • Confidentiality and caveats – “significant cause for concern”

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Opening what worked well

Opening – what worked well?

  • Putting at ease – tone, manner, informal

  • Felt on equal footing

  • Appraisee-centred

  • “We” phrases

  • Suggestions:

  • Rehearsal / crib sheet

  • Practice

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Prompting starting discussion

Prompting / starting discussion

  • Let the appraisee talk initially

  • Can work through the form (highlighter?)

  • Take cues from opening discussion

  • Prompt using their own language

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Exploring issues

Exploring issues

  • Active listening

  • Empathy and undertanding

  • Confidence in the appraiser

  • Summarising / re-capping

  • Asking questions to clarify

  • Avoiding judgement

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Being solution focused

Being Solution-focused

  • Allow appraisee to lead if possible

  • Reflect / summarising / checking

  • Making suggestions (NB “yes, but”)

  • Offer own / others’ experiences (with care)

  • Prior experience and solutions

  • Personal attributes

  • Signpost to other resources

  • Talking yourself into solutions

  • Change, fixing things – knowing when not to

  • Permission for acceptance / in ability to resolve

  • Challenging entrenched positions

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Pdp items some examples

PDP items – some examples

  • Increase pension

  • Mandatory updates and training

  • Supervision for prescribing

  • Overall aims / smaller objectives

  • Consolidating learning from courses

  • JBDI – putting it into practice

  • Patient education group work

  • Succession planning / sharing skills

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Smart objectives

SMART objectives

  • Specific

  • Measurable

  • Achievable – stepping stones

  • Realistic

  • Timed / trackable

  • Outcomes, resources, constraints

  • Personal, not practice

  • Why, what, who, how, when

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Next next time

Next / next time...

  • Review forms / finalise – and try them out before next meeting

  • Keep in touch – email and face-to-face

  • Get started – keep momentum

  • Fitness to practice issues

  • Allocation of appraisees (Jill)

  • Organise another date – Fri 12th Oct am

  • “Social” meeting – Thurs 18th October

  • Educational needs assesment

  • PDP

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