Developing the role of nursing in enhanced care home health

A specialist nurse and independent care sector programme lead outlines her personal journey working together with partners to develop and deliver excellent residential and domiciliary care across Nottinghamshire.

Since I qualified as a nurse in 2013, I’ve used my five years of previous experience of working in residential and domiciliary care to support other staff in the sector to deliver the best possible care.

My journey from care worker to specialist nurse with a regional remit has been one of both personal development and making new connections among the many people and agencies that support our vulnerable residents. And it’s taken me to the point where, as a programme lead, I can now help others deliver on the enhanced health in care homes framework.

I began my career in healthcare as a carer in 2008 and have worked in both residential and domiciliary roles. My experience in the sector taught me that care homes and their residents would benefit from greater links with health services.

While working as a community nurse for Nottinghamshire Healthcare NHS Foundation Trust, I completed a project to provide education and resources to care home staff aimed at reducing pressure ulcers. I then began to explore wider opportunities for closer links, and when I created a business case for a specialist nurse to support care homes, I was delighted that my managers recognised the potential benefits and agreed to support the new role, creating two posts for the area.

I applied for one of those roles and in January 2016 my colleague and I started going into care homes with high numbers of hospital admissions to put care plans in place and assess patients for onward referral to community-based services. We also looked at the needs of each care home and delivered or sourced tailored training.

We gathered baseline data to show the positive impact we were having and were able to provide evidence to the clinical commissioning group, which secured an increase in staffing for the team.

In May 2017, I jumped at the chance of a secondment opportunity hosted by NEMS, Nottingham’s out-of-hours provider, and funded by the Strategic Workforce Group, looking at why care homes were accessing out-of-hours and urgent care services.

I began working on the project two days a week, balancing it with my clinical role. I also worked more closely with the local authority, developing an educational resource for care homes which covered clinical observations, sepsis, delirium, end-of-life care and communication with healthcare professionals.

In December 2017, I left my clinical role to focus on the project work with NEMS and on delivering learning and development sessions to the independent care sector. One of the challenges I found was a lack of communication and collaboration on the ground; there were so many areas where good work was happening, I wanted to be able to share this with others.

I established a community of practice for those working in and with care homes to meet regularly and share best practice, develop networks, find out about local developments and improve relationships.

I already had contacts as I started actively networking when I took on the specialist nurse role. I expanded that reach by knocking on doors and meeting with other providers.

The group has evolved over the last 18 months and now has more than 150 members from 30-plus organisations. We meet bi-monthly and have new faces joining all the time. We recently made the important move of extending the group to include domiciliary care following a conversation with local providers. They felt that the support available was focused on care homes, without access for domiciliary care providers; this was something I was happy to help remedy.

My journey of reaching out in ever-increasing circles continues, with the development, together with the local authority, of a new training programme which sees staff from independent care homes becoming ‘champions’ who take their learning back into the workplace to improve practice.

I’m now working on a programme across the Midlands and East, looking at the implementation of the enhanced health in care homes framework and how Health Education England may be able to provide support.

Working together, colleagues across the county have been able to develop an understanding of the framework, address the challenges and agree how we will work together, and we’re developing skills through the community of practice, supporting the key element of workforce development in the framework.

There are so many people working in this area with so much passion and so much to share, it’s crucial we find ways to come together and learn together. As a nurse, I’m proud to support Nottinghamshire in leading the way.

Nicola Payne

Nicola Payne worked as a carer before joining the NHS in 2013 as a community nurse with Nottinghamshire Healthcare NHS Foundation Trust. She started in the role of senior staff nurse for care homes in January 2016 and joined NEMS in May 2017.

She is involved in a number of projects across Nottinghamshire and works in collaboration with the local authority.

In her current post of independent care sector programme lead, her role is to scope the Midlands and East area to understand what the workforce development needs are in relation to the implementation of the Enhanced Health in Care Homes framework.

One comment

  1. Christine Johnson says:

    Nicola is a delight to work with. The ultimate professional.
    She has diligently achieved all of the above, and more, in an area often forgotten by many or in the “too difficult box”.
    Well done!
    Kind Regards
    Christine Johnson, Chair, Nottinghamshire Primary Care Workforce Group.