Organisation

East Sussex Healthcare Trust.

What was the aim/problem?

The PNA’s role is to facilitate Restorative Clinical Supervision (RCS). The aim of RCS is to offer staff a safe environment to process experiences, reflect constructively, study options and increase levels of resilience. This in turn empowers individuals to recognise what actions they can take to improve their working life and reduce stress. The ultimate aim is that this continuous process of improvement will become an intrinsic part of professional practice. And so, it is essential that RCS is embedded into clinical practice.

Introducing the PNA role to the community was challenging. There was little understanding of the PNA initiative within the Trust and even less was known within the community setting. Upon completion of my training there was only myself and one other nurse (who was midway through her course) within the community setting for the Trust to have the PNA qualification.

What was the solution?

My initial directive was to enlighten staff within the community of the PNA role and the benefits of RCS. Introductory emails were sent out to over 100 nurses, across the 3 community sites. This was received very well and really put the foundations in place for me to begin planning for the RCS sessions. Management were approached and protected time was secured to enable me to facilitate RCS.

My intention was to start within my own locality and once RCS was established within the team I would reach out to the other localities. I proposed one day a week dedicated to the PNA role, 4 sessions a day on a rolling programme over a 6-week period. This would enable me to establish RCS within my locality first, with a view to subsequently extending to the other localities.

1:1 RCS sessions have been relatively easy to organise and facilitate. Interestingly, the majority of staff within my locality indicated a preference for 1:1 sessions. The sessions have been received so well with very positive verbal feedback. As one nurse expressed;

“Our 1:1 enabled me to recognise that I am a valued and important member of the team. I felt empowered to change my perspective and to build resilience in times of stress and not just walk away from my job. It also made me realise that it is ok to look after myself too”.

What were the challenges

Disappointingly, I only received 5 responses to my introductory emails. Feeling very down hearted that emails were not the best way to advertise the role, I decided that something visual may get the teams attention. So, I designed a caricature poster and a succinct information notice. This was again distributed to the community sites to display. This triggered a few more enquiries but I still felt that promotion of the PNA role needed to make more of an impact. I wanted to seize the nurse’s attention and provoke intrigue. So, inspired by a video I had watched during my training (twitter.com), I decided to produce a short-animated video that really encapsulated and celebrated the PNA role and the benefits of RCS.

Group sessions have been more challenging. Operational and staffing pressures have meant that the community teams cannot afford for 4-5 nurses to be away from practice for one hour, at any one time. In community nurse language this would translate as 20 units of time or 10 patients not visited. This would have a detrimental and disastrous impact on our work and our patients. Furthermore, my initial proposal of weekly sessions across the localities has been logistically unfeasible. Time, travel and staff shortages have all meant that I have had to revisit my initial proposal and negotiate a different approach. For the interim online RCS sessions have been utilised but they are not ideal as they lack tangibility. This has been frustrating as I recognise that staff need RCS now more than ever.

To combat this drawback, I decided to format a shorter session which the teams could incorporate into the end of hand over sessions. This entailed the introduction of the “Stress Bucket” (Brabban and Turkington, 2002).  The initiative being that, during the working week staff write down any stresses, concerns and niggles that are weighing them down, and place them in the bucket. At the end of the week we take the time as a team to read through all the notes. The team work together to assess, reflect, and resolve those issues. One by one the bucket is emptied, and we agree as a team that we are content with the resolutions and can therefore move forward into a new week, free from the weight of the contents of the bucket. This strategy has worked so well and has really bought the team together by encouraging effective communication and understanding. The provision of cake and biscuits also makes it worthwhile!

In addition to this I also created a “Shout out Board” which is on display in the staff area. Small notes of gratitude for one another are pinned onto the board. These affirmations however big or small are so important to staff morale. By saluting staff performance, we can inspire positive behaviours. Having a special mention puts a smile on everyone’s face and, smiles resonate with everyone.

What were the results?

The results of RCS are in the primary stages of being collated. Experience so far has made it clear that written feedback forms are not effective. To measure these too early would not give a true reflection on the benefits of RCS especially after what has been an unprecedented, demanding, and challenging time for the community teams.

What were the learning points?

Setting up online feedback has been the way forward. Further analysis of effectiveness, collation of data and themes, and evidence of improvements to attrition and retention are planned for the future.

Next steps

I hope the future sees more community nurses enrolling on the PNA training. The more PNAs we have the easier it will be to embed RCS into everyday practice so that we can ensure that this initiative has a lasting effect. The enabling role of the PNA in facilitating RCS has been clearly evidenced to be effective and valuable. Empowering staff through a reflective process enables them to share experiences, learn from those experiences and make changes to improve clinical development and practice. This improves working relationships and understanding, decision making, future care, well-being, and role satisfaction.

Want to know more?

Michelle Bridger, Community Staff Nurse, m.bridger@nhs.net