- Chief Nurse
Minutes:
Juliette Greenwood, Chief Nurse, gave the following powerpoint presentation:-
Local Operational Challenges
- Workforce Challenges
High vacancy factor
Ongoing utilisation of ‘flex beds’
Corporate workforce consultation
Corporate adult inpatient recruitment
HV availability v workforce trajectory
- Media and Reputation
- Demographics – deprivation, dementia, children and young people, safeguarding complexities, high risk maternity
Significant National Failures
- Winterbourne View
Abuse of patients with complex learning disabilities and missed opportunities (A&E, health assessments)
- Francis Report (2013) and concerns
Standards of care …. Compassion
Accountability
Nurse leadership
Professionalism
Specific needs of older people
Listening and responding to patients and families
Nursing workforce – numbers, skills and competency
Impact and Location Actions
- CQUINS – National and Local ‘Francis Focus’
Friends and Family Test
Safety Thermometer
Patient Experience
Complaints
Safeguarding
Nurse Leadership
Dementia
Death Certification
Nursing Staffing
- Twice per year Boards (in public session) to receive, confirm and publish assurance of safe nurse staffing levels via agreed evidence based tool
- To adopt recommended Safer Nursing Care Tool (SNCT) (via Assistant Chief Nurse Workforce)
- National development of Community SNCT and A&E SNCT
- To look to re-run Birthrate+ (3 years since last review)
- Children and young people workforce – PANDA, PABM, new national models for HV and School Nursing
- Following a year’s work and ongoing scrutiny
Investing in adult inpatient wards 50 wte
Investment in additional RN and HCSW resource align general adult inpatient skill mix against national ‘best practice’ of 65:35 ratio
Ward Sisters/Charge Nurses to be supernumerary
Impact
- Role of the Ward Sister/Charge Nurse – key
Leadership not ‘office based’
Tools for the job e.g. Ward Nurse Accreditation Scheme, local audit program, engage with patients/relatives, Ward rounds
Minimise bureaucracy – enabling time to care and time to lead
Support to staff, students and patients and family
Clarity about professional and personal accountability
- Introduce intentional rounding – impact
- Transparency Agenda
Francis Implications
- Patient Safety Nurse – new Ward level focus
- Nursing Quality Indicators – dashboard – EWS
BoD required to publically discuss in detail twice per year
- Line of sight of immediate risks – HarmFree meeting
- The Emotional Labour of Care – e.g. Schwartz Rounds/Cultural Care Barometer – staff need time and space to reflect
- All student nurses serve Y1 as a Health Care Assistant (pilots in situ)
- Staff engagement strategy – Friends and Family Trust
- Values based recruitment
Consider patient/governor involvement in senior clinical appointments
Appraisal programme – nursing input, patient feedback leading to nurse revalidation
Compassion in Practice 2012-15
- National strategy and implementation plans
6C’s of Care, Compassion, Competence, Communication, Courage, Commitment
Principles of Nursing Practice (December 2012)
TRFT Nurse and Midwifery strategy development (annual work plan)
- Dementia
TRFT Strategy as part of Rotherham Strategy
Dementia Champions ‘Ward to Board’
Workforce development
Carers audit
Environment
Patient Experience
- National Patient Surveys – A&E, Inpatient, Midwifery, Outpatients, Children and Young People
- Friends and Family roll out – maternity pathway, community, Children and Young People
- Patient Experience Board to ‘Ward’
‘touch and see’ i.e. unannounced inspections, Senior Nurse Walkabouts, Patient Safety Visits, Executive Walkabouts
Patient Stories
- Patient Experience – Review and Refresh Strategy
Complaints – our responsiveness, engagement, ownership, upheld or not, lessons learnt, improvements
Looking across pathways e.g. Safeguarding, C&YPS
“You said We did” – local level, Trust, web page
Celebrating Patient Experience Day
Discussion ensued on the presentation with the following issues raised/clarified:-
- An ongoing issue was agency staff. 60 nurses had been recruited as a result of the January Board decision, half of which had now arrived. It took approximately 3 months to recruit from the time of the advert. Recruitment would be taking place again for a further 49/50 posts, a mix of nurses and health care support workers. There was a challenge nationally as a number of Trusts were in the same position and it may be that there may need to be a targeted advertising campaign
- The new posts would be in areas where there had been a need identified to increase the numbers and on patient care areas
- In the main the Hospital used “flexi” staff - predominantly NHS staff and were bank nurses
- From a nursing perspective the staffing ratio was the same 7 days a week
- Rotherham deliberately dif not schedule planned major surgery on Friday evenings and over the weekend. The national pattern shows higher mortality rates at the weekends. Rotherham was well advanced with work to introduce 7 day weeks for all staff across all Wards
- In terms of the position with other Trusts, Rotherham was in the middle. It was a risk for all Trusts if a patient was admitted for non-elective admission on a Friday/Saturday as an emergency
- Patients may be discharged at weekends so 7 day working across the health community, including social care and GPs, to back up the patient’s discharge at a weekend, may need to be explored.
- 60 nurses recruited in last few months
- The Francis Report focussed on nursing care, and the patient’s overall experience and its recommendations concerned actions around medical staff. Validated recruitment had to be the direction of travel
Juliette was thanked for her report.