Engaging your director of nursing/chief nurse

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22 / 4 / 2016 Midnight

The NHS Workforce Census showed the NHS employed 349,000 hospital and community health service qualified nurses in March 2014, equating to 26 per cent of the overall NHS workforce population. It is important to ensure that your senior lead for the nursing workforce is aware of the impact the health and wellbeing of their staff has on the delivery of effective patient care and that they can support and engage with the health and wellbeing agenda.

Some areas that you may want to consider when approaching your chief nurse or director of nursing could include the following. 

'Eighty per cent of direct patient care is given by nurses and support staff to nurses and nurses are proud of giving their best to our communities.  To give of their best, at all times, nurses need to remember that their health and well-being matters.  Employers must take seriously how they build up nurses’ resilience – the emotional labour of nursing takes its toll. Nurturing nurses makes sense and every nursing director should set high standards for their trust’s staff well-being strategy'. Claire Johnston, Director of Nursing and People, Camden and Islington NHS Foundation Trust, September 2012.

Health and wellbeing interventions that contribute to patient care

Research conducted by Aston University shows that:

  • the best predictor of patient mortality is percentage of staff working in well structured teams
  • those working in teams have better health and wellbeing
  • lower mortality in trusts whose staff have opportunities to influence and contribute to improvements at work
  • the percentage of staff receiving well structured appraisals is also related to patient mortality
  • a positive organisational climate is associated with low and declining levels of patient mortality.

The Boorman Review states "Healthier staff, teams that are not disrupted by sickness, or where staff are not under any stress, and lower turnover rates all contribute both to the quality of care given to patients and to patient satisfaction. By contrast, where staff are unhappy and unhealthy, where there are high sickness rates, high turnover and high levels of stress, there are likely to be poorer outcomes and poorer patient experience."

Health and wellbeing key performance indicators that demonstrate effective patient care

Your trust will be able to provide you with your past staff survey results and also any patient surveys the trust has completed. In undertaking  analysis on these data sources, you will be able to identify the areas where staff are engaged in health and wellbeing and how this has affected patient survey scores over the years.

The survey completed as part of the Boorman Review states "Importantly for this report, and for the aspirations of the NHS, over 80% of staff considered that their state of health affected patient care, and virtually none disagreed with this."

In July 2012, Jane Cummings, Chief Nurse for England said:

"I think a good nurse will show care and compassion to his or her patients, but also demonstrate care for a colleague who is having a difficult day. Supporting colleagues is important because nursing is a hard job, and we do have tough days. But, we cannot let our patients down because we are distracted so we need to look after each other as colleagues, so that we can give the best care to our patients. So good patient care and experience is also dependent on good staff care and a positive workplace experience.

To help me develop the vision and most importantly how we are going to involve as many nurses as possible in this, I asked a group of nurse leaders to spend time thinking through some of the issues around nursing and midwifery. Among these issues are getting staffing right and staff experience. My ambition is to involve as many nurses, midwives and health care assistants so that we can build on their experience and use their ideas.  I know from the enthusiasm and energy of this landmark meeting that there is a commitment to improve from nurses and midwives everywhere."

Health and wellbeing supports infection prevention and control

Boorman’s review identified that organisations with high staff health and wellbeing measures had lower MRSA and patient mortality rates as well as better annual health check results. This information indicated that there was a link between health and wellbeing and infection prevention and control.

Another key element in infection control is the uptake among nurses of the flu vaccine. NHS Employers conducted a survey at the RCN Congress in 2012 which showed that only 58 per cent of respondents had received their flu jab with reasons for not having the vaccine ranging from not being offered it as they were students to being needle phobic. 

A report by the Department of Health 'Seasonal influenza vaccine uptake amongst frontline healthcare workers (HCWs) in England Winter season 2014/15' shows that a national vaccine uptake of 54.9 per cent of all frontline healthcare workers were vaccinated with the highest seasonal influenza vaccine uptake amongst GP practice nurses (64.4 per cent) and the lowest seasonal influenza vaccine uptake was amongst qualified nurses (excluding GP practice nurses 48.8 per cent).

This information may be helpful in encouraging your nurse leaders to raise the uptake of the flu vaccine.

Health and wellbeing initiatives enable trusts to tackle violence against staff from services users and their families effectively

The Boorman Review flags bullying and harassment levels as an indicator of health and wellbeing and "that trusts need to tackle vigorously, including thorough training for managers, support for staff who are the victims of bullying and harassment, and other means such as mediation services."

In November 2011, NHS Protect conducted a survey with 404 health bodies which showed the number of reported incidents were 57,830 with 68 per cent of these happening in mental health trusts.

NHS Protect provides guidance, publications and statistics and hold figures for individual trusts.

Effective skill mixing for occupational health nurses

Depending on how your organisation is configured, OH may or may not be managed by the chief nurse. If not, it would be worth informing them of the nursing staffing in OH and the potential for OH becoming more of a nurse-managed service.

All OH teams need both nursing and medical leadership. This is embodied in the SEQOHS standards that all NHS OH units must comply with.

The specialist OH nurses are integral members of the trust's nursing leadership. It is important that they have strong professional links with the chief nurse and the trust's expectations of the senior nurses should be no less than for any other nurse of equivalent seniority. For example, many OH units will be managed by a Band 8 nurse – that nurse leader should contribute to the trust’s wider nursing activities just as much as any other Band 8 nurse.

The nursing skills mix in occupational health will usually be as follows:

  • Band 4 – Health care assistants (HCA) providing clinic services under supervision (e.g. venepuncture, immunisations, screening).
  • Band 5 – general nurses providing clinic services and supervising HCAs.
  • Band 6 – specialist OH nurses with relevant post-registration qualifications performing a wide range of OH activities from health surveillance to dealing with sickness absence referrals.
  • Band 7 – specialist OH nurses with additional leadership responsibilities (such as managing a major customer or leading on audit and accreditation).
  • Band 8 – a mix of nurse managers and nurse consultants. The managers will lead the OH service or key sections of a large OH service.

OH nurse consultants should play a leading role in clinical case management, as well as research, audit, teaching and innovation, they will be recognised leaders locally, regionally, nationally or internationally.

Your chief nurse/director of nursing should be asking:

  • What are current nurse staffing levels like in the occupational health department?
  • Is the OH service consultant or nurse managed?
  • Are the current staff operating at the correct band level?

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