The Chief Nurse at the Royal Liverpool and Broadgreen University Hospital NHS Trust (RLBUHT) led on a programme of work to refine the skills and training programme for staff to address unwarranted variation in health and safety training and appraisal compliance across the Trust. The new programme has delivered improved experiences, outcomes and use of resources across the Trust.
Where to look
The Long-Term Plan (2019) highlights that the NHS is the biggest employer in Europe, and the world’s largest employer of highly skilled professionals. However, over the past decade, workforce growth has not kept up with the increasing demands in the NHS. At RLBUHT, the chief nurse identified that this was having an impact on staff morale, which was identified through lower than average scores in staff motivation. Further, the annual survey also identified unwarranted variation in low compliance rates for health and safety training and appraisal completion at the Trust.
The NMC Code of Conduct (2018) identifies that staff must ensure that patient and public safety is upheld, working within the limits of their competence and that employer organisations should support their staff in upholding the standards in their professional Code as part of providing the quality and safety expected by service users and regulators. A closer review of practice at the Trust identified that staff were not routinely collating the evidence of competencies. Also, standardisation of the education and training provision to ensure staff were up to date was not in place, which would support staff and managers in meeting and evidencing competence and skill sets in specialities areas.
What to change
When reviewing the unwarranted variation in health and safety training and appraisal compliance across the Trust, the Chief Nurse identified an opportunity with the senior nursing team to improve the provision of training and education for their staff to tackle the triple aim of better outcomes, experience and use of resources. This training and education programme needed to include:
- A comprehensive framework of necessary competence and skills;
- An education schedule; and
- A celebration event to mark successful implementation.
The Chief Nurse, in collaboration with key stakeholders such as the Head of Professional & Practice Development, Directorate leads and Clinical Leads developed a programme based on the Trust’s core values, specialities and competencies.
How to change
The RLBUHT nurse programme is a bespoke education initiative that aims to provide the Trust’s nursing workforce with the knowledge and skills to allow them to nurse confidently and competently in their speciality. The programme design includes a competency based portfolio and a one-day study day which is delivered by the University of Liverpool. The programme is usually completed within 4 months.
The competency document is divided into 2 parts:
- Core competencies: Aligned to the Trust’s values, quality objectives and priorities;
- Directorate specific competencies: These were developed by key staff working in the various specialities, and are the competencies considered fundamental to the delivery of specialised care for patients.
Achievement of individual competencies may be verified via self-assessment (with evidence such as reflective logs to support), or peer assessment. Once all competencies are complete, line managers are responsible for ‘final sign off’.
The study day was developed and is facilitated by staff from the University of Liverpool. Primarily the day aims to provide an environment in which participants can engage with other nurses to foster a sense of community and to explore the values and behaviours of an RLBUHT nurse. The study day includes: An introduction to the competency document – this includes highlighting reflection as a requirement for revalidation with the Nursing and Midwifery Council, an introduction to human factors and patient safety and an update on finding the evidence to support evidence-based practice.
Better outcomes – The Trust have standardised their training programme to support all registered nurses to have the skills and the support to provide the highest standards of nursing care. To date 1,600 staff have completed the course successfully. Associated with the new programme, the Trust has seen an increase in early identification of patient deterioration, as well as a decrease in incidence of patient falls, a reduction in pressure ulcer incidence and an increase in reporting of clinical incidents. Each of these are key elements of the study day. The programme has anecdotally had a positive impact on staff morale, with the study days providing an opportunity to network and develop resilience. It also provides the senior nursing team with an avenue for further staff engagement to discuss national, regional and local initiatives and any relevant concerns and feedback.
Better experience – The feedback from staff regarding the programme has been positive, including:
“I enjoyed completing the competencies and having evidence based documentation of my professional skills”
“The competencies ensured I reviewed basic areas of practice and ensured I was up to date”
“I am better aware of the Trust’s vision for the future”
“When I started the portfolio, I realised that I was a very skilled nurse…It gave me the confidence to be a better nurse.”
Better use of resources – An audit carried out in early 2018 identified that:
- 54% said that the programme further supports the nursing workforce to achieve competencies;
- 69% reported that the programme has helped in the achievement of competencies;
- 85% said that the programme benefits patients;
- 88% think that the programme will support them in their NMC revalidation.
Due to the success of the programme, the RLBUHT Nurse Core Competency Framework has now been endorsed by the National Institute for Health & Care Excellence (NICE). The programme has been accredited by the University of Liverpool’s CPD Framework. Some staff have expressed interest in being able to gain academic credit for completion of the programme. This is facilitated by the University and staff can link their work on the RLBUHT programme with Negotiated Work Based Learning modules. The programme has extended to Dental Nurses, Allied Health Professions, and Healthcare Assistants.
Challenges and lessons learnt for implementation
Engaging key stakeholders and getting feedback from staff as the programme has developed has been extremely important to the success of the programme. S have contributed and been part of the change in practice and culture, particularly in ensuring competencies are relevant to staff which keeps everyone engaged in this process.
For more information contact
Royal Liverpool and Broadgreen University NHS Trust