PNA paediatrics


Blackpool Teaching Hospitals NHS Trust.

What was the aim/problem?

The Quality Improvement Project (QIP) is intended to improve staff morale and increase knowledge in relation to physical and mental/emotional health which will, in turn, equip staff with the tools to develop their self-resilience in a working, (and non-working), environment. Nursing has been listed as one of the most stress inducing job roles due to its fast-paced, complex nature (Keykaleh, et al., 2018).

Research into the stressors of day-to-day working life on paediatric nurses working on general medical/surgical wards is an area that is not very expansive. Historical research looking at stress in nursing also alludes to this as Doman (1997) commented on the existence of research into stress in nurses caring for children with specific conditions such as cancer or in ITU, etc. but having very little published work for those paediatric nurses working in generalised paediatric ward environments.

The term burnout has been identified as “psychological strain resulting from occupational stress” (Firth and Britton, 1989).

Buckley et al., (2020) investigated the causes of burnout in paediatric nurses and found that there is a considerable supply of literature on burnout in healthcare professionals but looking at burnout in paediatric nurses were a lot sparser.

They went on to recognise that paediatric nursing consists of a specialised anthology of skills required to provide care for vulnerable and complex children and their families.

They therefore conducted a study and found burnout was rampant in this subgroup of nurses, with the outcomes of this resulting in the well-being of the nurses and retention, with this having a consequent direct impact on patient safety and satisfaction.

Even prior to the COVID-19 pandemic, West et al., (2020) reported that the healthcare workforce was struggling to cope and that there were 43,590 nursing vacancies in England. As part of the King’s Fund report titled ‘The Courage of Compassion’, staff stress levels, presenteeism (i.e. exceeding rostered work hours), absenteeism, turnover and plans to quit were at worrying levels amongst nurses in 2019.

They highlighted that the health and wellbeing of nursing staff was absolutely integral to the quality of care they can provide for their patients and therefore, ensuring that the ‘The ABC Framework of Nurses’ and Midwives’ Core Work Needs’ was met in working environments, people needing to access health and care services would be met with effective, safe, professional and compassionate care. (West et al., 2000, pp.30).

Whittaker (2020) states that the psychological effects of COVID-19 will present the healthcare workforce with one of the biggest challenges its ever encountered, and, particularly children’s nurses will be combating the pandemic’s impact on the patients they care for, for which their resilience mechanisms will need to be more robust than ever.

Yan et. al (2021) conducted a very recent study into the stress levels in paediatric nurses during the SARS COVID outbreak in China where they found that focus needed to be on conducting timely interventions for staff to decrease levels of stress and promote mental and physical health. This is echoed in the NHS Constitution for England as one of the pledges to the workforce promises to “provide support and opportunities for staff to maintain their health, wellbeing, and safety” (Department of Health & Social Care, 2021).

What was the solution?

It will be implemented on the Children’s Ward at Blackpool Victoria Hospital with the nursing staff.

The QIP has been dubbed the ‘Calendar Project’ and consists of highlighting specific notable events throughout the year that will provide education for staff and patients, commemorate certain occasions and provide opportunities to boost staff morale.

Commemorative events include World Down’s Syndrome Day, Birthmark Awareness Day, Epilepsy Day, etc. where staff who have a vested interest in these topics will work in conjunction with the ward’s Play Team to create informative boards to be displayed related to the subject. The ward will be decorated to align with the theme of the day, staff will wear corresponding coloured ribbons (either in their hair or on their uniform), sparking interest/curiosity in both patients and other healthcare professionals, thereby paving an opportunity for education, and there will be themed snacks available for the staff.

Specifically focusing on promoting physical health, events like Breast Cancer Awareness Day will see staff (and patients) being encouraged to carry out regular breast checks and will be given handouts with instructions/visual aids instructing them on how to do so. Looking at the promotion of mental/emotional health, events like ‘Relaxation Week’, ‘World Laughter Day’ and ‘World Smile Day’ will consist of having an informative board on providing staff with tools on how to use techniques, such as grounding, to improve mental resilience. For World Laughter Day, staff will wear badges with the words ‘Ask me my joke of the day’ on them to invite others to tell each other jokes. For ‘World Smile Day’, staff will be encouraged to do a random act of kindness to inspire a smile on a colleague’s face as well as there being a board in the staff room for staff to put up post-it notes with anonymous words of kindness for other staff members.

Events to boost staff morale include World Book Day, Make Music Day, Pancake Day, etc. where staff are encouraged to dress up in costumes and fun activities will be facilitated by myself and the Play Team with both staff and patients getting involved. For example, on Make Music Day, different musical instruments will be available for individuals to try and/or to play.

What were the challenges

The QIP’s goal is to improve staff morale, empower staff and equip them with the tools to develop resilience via events focused around mental health as aforementioned, drawing on elements of restorative supervision.

For example, the mental health information board would have grounding techniques on it for staff to implement in daily life and avenues they could access like mental health support services.

The goal is attainable as in terms of materials and their costs, for the ribbons, each staff member will have their own set of coloured ribbons for them to keep and wash alongside their uniforms.

The decorations used on the ward and information boards can all be created with materials available to the Play Team as well as coloured printing.

One of the main barriers to restorative supervision has historically been time constraints due to the demanding nature of the nursing role (Brunero & Lamont, 2012). To combat this, the QIP mainly involves coordination and planning of the project which can be done by myself. The main element of the QIP that will be needed is allocated time to plan the events that will be focused on which can be authorised by ward managers and matron of the ward.

The role of the PNA is a relatively new one and was introduced for nursing staff in the midst of the pandemic. As the Chief Nursing Officer for England, May (2021) states, “PNAs will facilitate restorative supervision to their colleagues and teams in nursing and beyond. It will equip them to listen and understand challenges and demands of fellow colleagues, and to lead, support and deliver quality improvement initiatives in response.”

As the nature of ‘The Calendar Project’ is everchanging in its execution on a monthly basis, the QIP provides ample opportunity for the PNA to incorporate elements of restorative supervision to encourage resilience in different ways as there is no set format for effective restorative supervision (Macdonald, 2019). For example, focusing on the enhancement of resilience for staff, ‘Relaxation Week’, ‘Mental Health Day’ and ‘World Laughter Day’ provide a platform for signposting to mental health service support.

As the PNA, the QIP’s coordination and planning of the project which will mostly be facilitated by myself, however its success will depend on interprofessional working by collaborating with other Nursing staff, as well as the Play Team.

Involving staff in the QIP will lead to a sense of belonging for staff and enhance overall staff wellbeing and boosting morale as encouraging collaboration in supportive work environments helps to empower nursing staff (De Almeida Vicente, Shadvar, Lepage, & Rennick, 2016).

What were the results?

The project remains ongoing but has received an abundance of positive feedback, not just from staff and colleagues (even beyond the ward itself), but patients and their families too. Staff have reported an increase in morale and have reported feeling like they are looking forward to come into work and always excited for the next event. At the end of the year, I will be collating feedback in the form of a questionnaire to ascertain the effectiveness of the project.

What were the learning points?

The QIP has highlighted the importance of needing to look after the staff and their wellbeing.

Next steps

The QIP is still in the process of being developed as this is its initial stage but is more established as it has now been ongoing for 6 months. It has received accolades from the Trust and patients and general public however there is still work to be done in terms of cascading the project.

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