Introduction of the Practice Development Nurse in Intermediate Care Units
Julia Fairhall
Area Head of Nursing and Governance
Sussex Community NHS Foundation Trust
Summary:
Sussex Community NHS Foundation Trust provide NHS community health and care services across West Sussex, Brighton & Hove and High Weald Lewes Havens area of East Sussex. The trust provides a wide range of medical, nursing and therapeutic care to over 8,000 people a day. We work to help people plan, manage and adapt to changes in their health, to prevent avoidable admission to hospital and to minimize hospital stay.
In the central area of the trust we have two community hospitals based in Crawley and Horsham. The hospitals between them have four inpatient intermediate care units which have a focus on rehabilitation.
As an organization we have built in the role of two practice development Nurses (PDN) for our intermediate care units. This team sits outside the ward establishment but is very much part of the team looking at staff development and health and wellbeing.
Our two practice development nurses started at the start of the Covid pandemic and very quickly realized that initially the role the signed up for looked very different and they were very hands on supporting the wards, fit testing, teaching donning and doffing PPE and being a part of assurance re guidance changes and keeping up to date with Covid and information from Public Health England for our multidisciplinary team.
Seven months on they have shown amazing resilience and have worked incredibly hard supporting staff and leadership. They live the values that we hold close as a trust. They spend a lot of time with teams listening, supporting, facilitating problem solving and developing with teams together.
As a pair they are raising the profile of community hospitals and the centre of excellence that they are. They have instilled confidence in the workforce and have challenged staff to look at their own learning and development and encouraged academic learning and reflection in a supportive environment.
Having practice development in place is such a positive move for us as an organisation, there is so much innovation that can help but the teams needed support and their presence has made a difference to staff knowledge and development, health and wellbeing but more importantly has impacted on the quality of care provision.
Background:
Historically in SCFT we have not had practice development roles within our community hospital setting. Last year as a team we made the decision that we needed to invest in our staff and look at how we could support them as individuals, as teams and to support quality improvement within our intermediate care units. The care delivery in the units has always been very good but we wanted to enhance that alongside opportunities and support for staff
We took the decision to invest in Practice Development Nurses and have employed two fantastic individuals who bring a wealth of experience from both the hospital and community setting.
The main remit of these roles is to lead in the development and provision of practice education standards within the Clinical Services and act as a role model for clinical staff which addresses patient needs and ensure the delivery of both qualities safe evidence-based patient care. The role is to support proactively training and development issues arising from clinical and non-clinical incidents across the multidisciplinary team.
Description:
The team commenced role just before the pandemic. They both hit the ground running and although we had organized inductions and work plans, they almost fell apart with the start of Covid.
Our wards were soon filled with a number of patients suffering with Covid and with that brought some steep learning curves for our teams.
Our practice development team became very knowledgeable very quickly about Covid and supported staff with knowledge, learning and development.
They supported the teams with the donning and doffing of PPE, fit testing and preparation and readiness.
The team also were very present on our wards working with staff working through mental anxieties of individuals with conflicting information being shared by the media on Covid and supporting the teams in understanding the battle rhythm approach within the organization and national guidance from Public Health England.
The role has evolved as time has moved forward and they are now embedding their role leading in clinical training, education and induction programs for Nursing/Allied Health Professional colleagues
Through getting to know the teams they have been able to identify learning needs for Clinical Professional staff and develop and deliver education programs to small and large groups to meet identified needs including facilitation and creation of team development and service training plans.
They have had to extend their own IT knowledge and are delivering most of their training by IT apart from competency sign off.
As a team they have also built in reflective practice for both individuals and teams and have a very open-door visible leadership approach.
As a team they
- Effectively manage competing demands of practice and education, related to supporting different levels of learning and development. This involves all staff both clinical and non-clinical.
- Evaluates the effectiveness of education and the impact on service delivery and patient care through audit and benchmarking processes. The team has led on the NHSI quality audit within our units but has adapted the framework to meet the needs of community hospitals. This has also built great relationships with our ward managers and matrons whereby the PDNs have supported the implementation in developing areas the audit identified.
- Facilitates learning by actively integrating theory to practice development. The PDNs are delivering theory training by IT and are following it up with having a presence on the units supporting staff to develop their skills sets. An example of this is the team are now offering localized induction and care certificate for our non-registered workforce and networking groups
- Proactively create a positive learning environment within the clinical services which supports and underpins the principle of lifelong learning, work-based learning and continuing professional development. The PDNs have worked so hard to be part of the teams which is showing in the relationships they have built, staff feel comfortable around them, they are happy to raise any concerns, ask for help and support. The PDNs are also offering career advice and supporting some of our overseas registrants with their NMC OSCEs and confidence building in taking those assessments.
- The team is also timely in working with the teams following Root cause analysis and serious incidents embedding the learning and celebrating good practice.
As an area we have noted a reduction in upheld complaints and this demonstrates the impact of the PDNs in areas such as record keeping where they are regularly peer reviewing with staff and running regular updates and drop-in sessions on areas such as documentation.
This team is just brilliant and exemplars to nursing. They have made such a difference in such a short amount of time and in what one can only call challenging circumstances. The involve all and look at the integrated team as a whole and support and facilitate. The readily available support/reflection has had a really positive impact on staff which in turn has a positive impact on quality safe patient care delivery.
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