Striving for the Best

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Nursing and Midwifery Strategy
Striving for the Best and Making the Difference
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Why a Strategy?

• NHS plan.
• Made a clear recognition that a critical success
  factor for achievement is the contribution of
  nurses, midwives and health visitors.
• In recognition of this vital role the Department
• of Health produced a strategic intention
• through their document Making a Difference
• in 1999.

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Who is the Strategy for?

• The Nursing and Midwifery Strategy is directed
  at all members of the nursing and midwifery team
  from health carer through to all registered
  roles in nursing and midwifery. Whilst working
  in partnership with the multidisciplinary team
  is seen as vital to success, the Strategy
  provides clear direction for the unique
  contribution which nurses and midwives make to
  healthcare at South Tees Hospitals NHS Trust.

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Key Areas

• There are seven key areas that have been
  identified -
• Working with Others
• Leadership
• Life Long Learning
• Improving Working Lives
• Career Structures and Roles
• Standards of Care
• Research / Evidence Based Practice
• The Strategy is expected to span across 5 years
  (2004 to 2009)

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Vision

• To have empowered nursing and midwifery teams who
  are supported and equipped to provide the highest
  possible standards of care to patients and their
  carers within a Healthcare Governance framework
  through
• Partnerships with patients, the public and other
  care professionals.
• The provision of access and support to life long
  learning, which will underpin the delivery of
  evidence based practice.
• Support to nurses and midwives in achieving an
  acceptable work/life style balance.
• Supporting the development of strong nursing and
  midwifery leadership at every level.
• Ensuring that the nursing and midwifery
  contribution to patient care is recognised and
  valued throughout the Trust.

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Aims

• To provide a vision for taking nursing and
  midwifery forward in line with national and local
  guidance.
• To demonstrate the contribution of nurses and
  midwives to the Clinical Governance Agenda.
• To give nursing and midwifery within South Tees
  Hospitals NHS Trust clear goals, aims and
  objectives to work toward the vision.
• To ensure clear and consistent/standardised
  actions within all clinical areas.
• To provide nurses and midwives with a framework
  to ensure the highest possible standards of care
  are provided to patients and
• their relatives/carers.
• To aid and guide staff, departments and services.

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2006 Review of Progress

• The following 4 areas whilst important to assess
  had been reviewed at some level under other
  audits
• Improving Working Lives
• Career Structures and Roles
• Standards of Care
• Research / Evidence Based Practice.
• The key priorities and therefore targeted for
  initial audit where
• Working with Others
• Leadership
• Life Long Learning

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Scoring structure

• A score of weak which would be Red would be given
  for those who scored 25 or below.
• A score of fair which was Amber would be given
  for those scoring 26 50
• A score of good which was Light Green would be
  given for those scoring 51 - 75.
• A score of excellent which was Green would be
  given for those scoring above 76.

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Working with Others

• The key issue in this section is
• Nurses and Midwives will demonstrate effective
  partnerships to enhance care to patients.
• There are three objectives within this section
  with nine action points for success

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Total Trust Scores
11
Divisional Scores
12
Top 3 Scores

• Objective 1.2 Action point 2
• Each clinical area will demonstrate that it has
  used joint working to improve aspects of care
  delivered in their department
• Objective 1.3 Action point 1
• Each clinical area will demonstrate how
  nurses/midwives have worked with other agencies
  to enhance the service to patients
• Objective 1.3 Action point 2
• Where patient care passes between clinical
  settings/across agencies the clinical area will
  demonstrate that they have agreed joint policies

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Lowest 3 Scores

• Objective 1.1 Action point 1
• The ward/department leader will develop a policy
  that outlines its approach to involving patients
  and public in the enhancement and development of
  its services
• Objective 1.1 Action point 2
• Consultation will have taken place with patients
  and public when all changes/processes/service
  developments are implemented on the
  ward/department
• Objective 1.1 Action point 4
• A variety of methods will be utilised to involve
  patients and the public in service delivery and
  development

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Leadership

• The key issue in this section is
• The nursing and midwifery workforce need to have
• opportunities to develop an effective leadership
  structure.
• There are four objectives within this section
  with thirteen action points for success

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Total Trust Scores
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Divisional Scores
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Top 3 Scores

• Objective 2.1 Action point 1
• A line management structure will be available in
  all clinical areas that clearly demonstrate lines
  of responsibility and accountability within the
  structure and matches that of job descriptions.
• Objective 2.1 Action point 2
• All nursing and midwifery clinical leads within
  each clinical area will have an appropriate job
  description reviewed within the previous 3 years
• Objective 2.3 Action point 2
• Via a portfolio each clinical area will
  demonstrate the changes in practice to improve
  patient care, each department demonstrating at
  least 2 improvements per year.

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Lowest 3 Scores

• Objective 2.3 Action point 1
• All clinical areas will demonstrate that they
  have created a culture of empowerment within
  their team via staff audit.
• Objective 2.2 Action point 2
• All clinical leaders will demonstrate continuing
  professional development via a portfolio of
  evidence, which will be assessed through the
  appraisal system.
• Objective 2.2 Action point 3
• All clinical leaders will demonstrate, at
  intervals of no longer that 3 years evidence, via
  demonstration and development, enhancement of
  leadership skills.

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Life Long Learning

• The key issue in this section is
• The training and development needs of the nursing
  and midwifery team will be clearly identified.
• There are three objectives within this section
  with twelve action points for success

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Total Trust Scores
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Divisional Scores
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Top 3 Scores

• Objective 3.1 Action point 4
• All clinical areas will demonstrate the use of a
  variety of methods to develop nursing and
  midwifery staff E.g. Mentorship, Secondments,
  Training and development, Project work,
  Leadership development etc
• Objective 3.3 Action point 3
• All nursing and midwifery clinical areas will
  demonstrate via a register that staff have been
  trained to conduct emergency procedures as
  outlined within the CNST guidance.
• Objective 3.3 Action point 4
• All nursing and midwifery clinical areas will
  demonstrate that they have appropriate teaching
  packages and resources available to all staff.

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Lowest 3 Scores

• Objective 3.2 Action point 1
• Within all nursing clinical areas awareness of
  the concept of clinical supervision will be
  raised to ensure that staff are aware of the
  benefits.
• Objective 3.1 Action point 2
• Within the ward/department the nursing staff
  should agree the aims, process and outcome of
  clinical supervision.
• Objective 3.1 Action point 3
• Plan, deliver and evaluate the effectiveness of
  clinical supervision within all nursing teams.
  Evaluation should include audit of the process
  and staff satisfaction.

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Conclusion

• The results have demonstrated a fairly high
  standard of compliance with the strategy in the 3
  areas reviewed, in particular the Leadership
  section.
• However there is a lot of disparity between
  Divisions and indeed between wards and
  departments within Divisions and if we are to
  gain an overall high standard work is needed to
  achieve an even compliance with the standards
  across all areas.

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Working with Others

• 83 percent of areas scoring above 50 percent.
• 17 percent scored below 50 percent with 3 percent
  scoring below 25 percent (weak score).
• As the ethos of the NHS and many of its National
  Service Frameworks (NSFs) promoting joint
  working with partner agencies and the public this
  is an important area in which the nursing and
  midwifery team can develop.

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Cont

• As the lowest scoring objective was 11 about
  patient and public involvement the awareness of
  ward and departmental teams of the patient and
  public involvement policy and forums may need to
  be raised and assess the local level impact and
  expectation.

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Leadership

• The best scoring section
• 94 percent of all areas scoring above 50 percent
• Only 6 percent scoring below 50 percent with no
  area scoring below 25 percent.
• The success here may rely on the increased
  emphasis in previous years on leadership
  -Excellence Model / direction to develop diploma,
  degree and masters education / NHS emphasis on
  leadership with national projects

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Cont

• To maintain the Leadership standard attained and
  build on it there needs to be a continued
  emphasis. An opportunity to ensure that this is
  in the Key Skills framework for leadership roles
  and is reviewed as part of job descriptions will
  help to place important emphasis in this area.

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Life Long Learning

• Least well scored of the three sections
• 70 percent of areas achieving scores above 50
  percent.
• 30 percent of areas scoring below 50 percent
  however importantly there was no area scoring
  below 25 percent.
• Considerable divisional variation in the scores
  with two Divisions contributing the majority of
  the over 75 percent scores.

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Cont

• To improve in this section objective 31 requires
  Nursing Directorate Emphasis (as commenced) in
  order to achieve a robust and sustainable
  solution to the implementation of clinical
  supervision for nurses.

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Recommendations

• Raise the awareness across all wards and
  departments regarding the Trust Patient and
  Public Involvement Strategy and Forums.
• Review the role of the Trust Strategy for Patient
  and Public Involvement and the expected actions
  at Divisional and ward and departmental level.
• To consider Divisions producing a Divisional
  action plan with annual update in relation to
  patient and public involvement.
• Ensure the leadership requirements are part of
  all appropriate job descriptions.

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Cont

• Ensure that all appropriate KSFs have leadership
  development as a component and that this is
  monitored through annual SDR. As part of the SDR
  process evidence and portfolio preparation should
  be available.
• Consider annual review of the leadership section
  as part of the corporate annual Staff
  questionnaire.
• Develop a robust and sustainable policy and
  process for the implementation of clinical
  supervision for nurses across the Trust.

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Cont

• Develop Divisional action plans for the third
  section audited Working with Others.
• Consider merging Divisional Action plans to a
  Corporate action plan for each of the sections.
• Consider review of the other sections of the
  Nursing and Midwifery Strategy audit during 2007
  (section 4 to 7).
• Consider how other corporate audits link to each
  section of the Nursing and Midwifery Strategy and
  consider amalgamation of audits to prevent
  duplication.