Feb 192019
 

In this Blog, Richard Desir, Senior Workforce Transformation Nurse, Aneurin Bevan University Health Board and All Wales District Nursing Workforce Operational Lead shares the journey of the development of an evidence based workload and workforce tool and Interim Nurse Staffing Principles for District Nursing.

The All Wales District Nursing workforce and workload group is tasked to develop a District Nursing Workload and Workforce Tool that has been evidenced within the Welsh context, that would assist Health Boards in community nursing workforce planning. This important work will positively contribute to the delivery of care to patients in their own home and help shape the workforce by ensuring the safe and effective deployment of district nurses to meet the needs of the populations they serve.

A triangulated approach will be used when calculating the number and skill mix of nurses required within District Nursing Services, which takes into account:

  • Patient acuity and dependency
  • Quality audit
  • Professional judgement

The group has undertaken a staged approach to developing the learning and evidence base with each stage of the development of the Quality Audit tool and the Welsh Levels of Care, using service improvement methodology Improving Quality Together 1000 Lives (2014), each phase follows the Plan, Do, Study, Act (PDSA) cycle.

Under the leadership of Paul Labourne, Richard Desir and Katrina Rowlands the All Wales District Nursing workforce group have embarked on a remarkable and ambitious journey to journey to create the evidence to:

  • Determine what is quality and how this can be measured and articulated?
  • Develop and test an acuity and dependency tool to help assess workload.
  • Explore how professional judgement is used to inform decision making the associated factors

Throughout 2017/18 over 600 frontline District Nurses and management teams have engaged in workshops held across Wales to explore how the ‘Welsh Levels of Care’ could be used as an acuity tool within district nursing and sessions have been held to inform the further testing of the District Nursing Quality Audit.

The testing of the quality audit tool has resulted benefitted patients and district nursing teams by triggering:

  • Systematic roll out of National Early Warning scores within district nursing
  • Systematic roll out of “what Matters to me “ framework
  • Systematic improvement to equipment available to district nurses
  • Systematic capturing patient outcomes and experience to inform service improvement
  • The early digitalisation of capturing data and using that data digitally
  • Creating new evidence
  • Energising the district nursing workforce

The Chief Nursing Officer in Wales requested that an interim set of guiding nurse staffing principles for district nursing be developed and implemented to support the preparation for extension of the Act while the work to develop an evidence based workforce planning tool for District Nursing is undertaken. In September 2017 the District Nursing Staffing Principles were launched. These are monitored biannually and individual feedback provided to each organisation involved.

The implementation of the district nursing staffing principles has enabled a baseline assessment of services to understand where service development is required.  Enabling district nursing teams to be well defined, well led, and well supported.  They have highlighted areas where demand and capacity may be mismatched and further work is required.  It has introduced additional skill mix to district nursing such as administration support that has released time for patients.  The iterative assessment of the principles and the feedback given is supporting organisations with their development of the core universal nursing care at home service recognising the unique contribution district nurses play in the management of population health, improving public health and keeping the patient at the centre of care.

If you would like to find out more about the work undertaken by the District Nursing work stream  please email richard.desir@wales.nhs.uk or Katrina.Rowlands@wales.nhs.uk

Aug 082018
 

Dawn Parry, Paediatric Project Lead

As I walked to a meeting in the Children’s Hospital for Wales recently, I found myself reflecting on how much has happened since I came into post in January, when prior to my current role, I was based at that very hospital.

My nursing career commenced  in 1984 when I started my RGN training in Bangor, North Wales, close to my home town on Anglesey. Upon qualifying, I started as a Staff Nurse on the paediatric unit before obtaining my RSCN in Great Ormond Street in 1989. I then moved to Cardiff where my career has progressed to the present day. I feel I have been fortunate to have insight into paediatric nursing in both rural and urban settings, in tertiary and district general hospitals. This insight has proved invaluable to me in connecting with new colleagues from hospitals across Wales and to understand some of the pressures they experience and the challenges they seek to overcome.

Not all the changes I have seen during my career have been positive, but the introduction of the Nurse Staffing Levels (Wales) Act, 2016 I believe will be one of the most important changes I have witnessed. I consider it to be a positive step for health boards, nursing staff and most importantly, for our children, young people and their families.

The  All Wales Nurse Staffing Programme supports NHS Wales in meeting the requirements of the Nurse Staffing Levels (Wales) Act, which places a legal duty upon health boards and trusts to ensure that they are providing sufficient nurses to allow nurses time to care for patients sensitively.

The role of the paediatric work stream is to devise an evidence based approach to determine appropriate staffing levels within identified paediatric inpatient wards. The approach must be evidenced in the Welsh context and follow a common model of triangulation, which centres on three critical sources of knowledge: patient acuity, quality indicators and professional judgement. To date, 18 inpatient paediatric wards over the five health boards have been involved in capturing the acuity data for the audits on a twice daily basis.

In June this year, we hosted a successful paediatric event where paediatric nurses came together from across Wales to share their knowledge and expertise in reviewing and revising the new draft paediatric Welsh levels of care in preparation for testing on the wards.

My enthusiasm for this project has intensified during this time, due to fantastic reception I have received from colleagues across the whole of Wales and the sense that something very significant can be achieved through collaborative working, forming partnerships and support systems that could potentially transcend the aims of the current project.

Aug 082018
 

Dawn Parry

Wrth i fi gerdded i gyfarfod yn Ysbyty Plant Cymru yn ddiweddar, dechreuais fyfyrio ar faint sydd wedi digwydd ers i fi ddechrau yn y swydd ym mis Ionawr, oherwydd cyn fy swydd bresennol roeddwn yn gweithio yn yr union ysbyty hwnnw.

Dechreuodd fy ngyrfa nyrsio ym 1984, pan ddechreuais fy hyfforddiant RGN ym Mangor, Gogledd Cymru, ger fy nhref enedigol ar Ynys Môn. Ar ôl cymhwyso, dechreuais fel Nyrs Staff ar yr uned bediatrig cyn ennill fy RSCN yn Great Ormond Street ym 1989. Yna, symudais i Gaerdydd lle mae fy ngyrfa wedi mynd o nerth i nerth hyd heddiw. Rwyf wedi bod yn lwcus i gael mewnwelediad i faes nyrsio pediatrig mewn lleoliadau gwledig a threfol, mewn gofal trydyddol ac ysbytai cyffredinol rhanbarthol. Mae’r mewnwelediad hwn wedi bod yn amhrisiadwy i fi wrth gysylltu â chydweithwyr newydd mewn ysbytai ledled Cymru ac i ddeall rhywfaint o’r pwysau sydd arnynt, a’r heriau maen nhw’n ceisio eu goresgyn.

Nid yw’r holl newidiadau yr wyf wedi’u gweld yn ystod fy ngyrfa wedi bod yn rhai cadarnhaol, ond yn fy marn i, bydd cyflwyno Deddf Lefelau Staff Nyrsio (Cymru) 2016 yn un o’r newidiadau pwysicaf yr wyf wedi’u gweld. Rwy’n ystyried hwn yn gam cadarnhaol i fyrddau iechyd, staff nyrsio ac, yn bwysicaf oll, i’n plant, pobl ifanc a’u teuluoedd.

Mae Rhaglen Staff Nyrsio Cymru Gyfan yn cynorthwyo GIG Cymru i fodloni gofynion Deddf Lefelau Staff Nyrsio (Cymru), sy’n gosod dyletswydd gyfreithiol ar fyrddau iechyd ac ymddiriedolaethau i sicrhau eu bod yn darparu digon o nyrsys i roi amser i nyrsys ofalu am gleifion mewn ffordd sensitif.

Rôl y llif gwaith pediatrig yw dyfeisio dull ar sail tystiolaeth er mwyn pennu lefelau staff priodol o fewn wardiau cleifion mewnol pediatrig a amlygwyd. Rhaid rhoi tystiolaeth mewn cyd-destun Cymreig i’r dull, a dylai ddilyn model cyffredin o driongli, sy’n canolbwyntio ar dair ffynhonnell hanfodol o wybodaeth: aciwtedd cleifion, dangosyddion ansawdd, a barn broffesiynol. Hyd yma, mae 18 o wardiau pediatrig cleifion mewnol dros y pum bwrdd iechyd wedi cymryd rhan mewn cofnodi data am aciwtedd ar gyfer yr archwiliadau ddwy waith y dydd.

Ym mis Mehefin eleni, cynhaliom ddigwyddiad pediatrig llwyddiannus lle daeth nyrsys pediatrig ynghyd o bob cwr o Gymru i rannu eu gwybodaeth a’u harbenigedd am adolygu a diwygio fersiwn ddrafft lefelau gofal pediatrig newydd Cymru i baratoi ar gyfer profi ar y wardiau.

Mae fy mrwdfrydedd am y prosiect hwn wedi tyfu yn ystod y cyfnod hwn, yn sgil adborth gwych yr wyf wedi’i dderbyn gan gydweithwyr ledled Cymru, a’r teimlad y gellir cyflawni pethau arwyddocaol trwy weithio gyda’n gilydd, creu partneriaethau a systemau cymorth a all fynd y tu hwnt i nodau’r prosiect presennol.

May 112018
 

Joanna Doyle, All Wales Nurse Staffing Programme Lead speaking at Quality 2018

I attended the IHI Forum in Amsterdam in May 2018 as part of the 1000 Lives team, showcasing the quality and safety work that is being undertaken in Wales. The Nurse Staffing Programme supports NHS Wales in meeting the requirements of the Nurse Staffing Levels (Wales) Act, which places a legal duty upon Health Boards and Trusts to ensure that they are providing sufficient nurses to allow the nurses time to care for patients sensitively. As Wales is the first country in Europe to legislate on nurse staffing levels, the forum provided the opportunity to showcase the ground breaking work that is being undertaken in Wales, which is generating international interest. As the All Wales Nurse Staffing programme lead, I was delighted to have the opportunity to deliver a poster presentation on the programme of work to healthcare professionals and managers from across the world. The Nurse Staffing Act will prove influential in empowering nurses, providing them with the evidence they need to support their professional judgement when determining the nurse staffing levels they require to deliver safe and effective care to their patients.

The Forum provided the unique opportunity expand my knowledge on a range of quality and safety projects and initiatives. I was able to network with professionals who are actively involved in quality improvement, and have a keen interest in improving the quality and safety of care provided to patients who access healthcare services. The breadth and scope of experience and expertise was extensive and enlightening, providing much food for thought.

I also gained further experience presenting on the national nurse staffing work, this time on an international platform, I was able to talk to delegates from different countries about the challenges they are encountering in relation to nurse staffing within their areas and  how they envisage the Nurse Staffing Programme will benefit patients, nurses and health boards within Wales. Many delegates were keen to find out more about the national programme of work which they acknowledged was a positive way forward with many benefits for stakeholders.

I gained a wealth of knowledge about new and existing quality and safety initiatives that are being introduced in different countries, and this information has provided me with lots of ideas to share with members of the All Wales Nurse Staffing group and colleagues involved in this programme of work.

May 112018
 

Joanna Doyle, Rheolwr Rhaglen Staff Nyrsio Cymru Gyfan

Mynychais Fforwm IHI yn Amsterdam ym mis Mai 2018, fel rhan o dîm 1000 o Fywydau, yn arddangos y gwaith ansawdd a diogelwch sy’n cael ei gyflawni yng Nghymru. Mae’r Rhaglen Staff Nyrsio yn cefnogi GIG Cymru i fodloni gofynion Deddf Lefelau Staff Nyrsio (Cymru), sy’n gosod dyletswydd gyfreithiol ar Ymddiriedolaethau a Byrddau Iechyd i sicrhau eu bod nhw’n darparu digon o nyrsys i ganiatáu amser i’r nyrsys ofalu am gleifion yn sensitif. Gan mai Cymru oedd y wlad gyntaf yn Ewrop i ddeddfu ar lefelau staff nyrsio, rhoddodd y fforwm gyfle i arddangos y gwaith arloesol sy’n cael ei wneud yng Nghymru, sy’n ennyn diddordeb rhyngwladol. Fel arweinydd Rhaglen Staff Nyrsio Cymru, roeddwn yn falch iawn o gael cyfle i gyflwyno poster ar y rhaglen waith i weithwyr gofal iechyd proffesiynol a rheolwyr o bob cwr o’r byd. Bydd y Ddeddf Staff Nyrsio yn ddylanwadol o ran grymuso nyrsys a rhoi’r dystiolaeth sydd ei hangen arnynt i ategu eu barn broffesiynol wrth bennu’r lefelau staff nyrsio sydd eu hangen arnynt i gynnig gofal diogel ac effeithiol i’w cleifion.

Fe wnaeth y Fforwm ddarparu cyfle unigryw i ehangu fy ngwybodaeth ar amrywiaeth o brosiectau a mentrau ansawdd a diogelwch. Roeddwn i’n gallu rhwydweithio gyda gweithwyr proffesiynol sy’n ymglymedig â gwella ansawdd, ac mae gen i ddiddordeb brwd mewn gwella ansawdd a diogelwch gofal a ddarperir i gleifion sy’n cyrchu gwasanaethau gofal iechyd. Roedd ehangder a chwmpas y profiad a’r arbenigedd yn helaeth, yn goleuo, ac yn darparu llawer i feddwl amdano.

Hefyd, enillais fwy o brofiad yn cyflwyno ar waith staff nyrsio cenedlaethol, ar lwyfan rhyngwladol y tro hwn. Bu modd i mi siarad â chynrychiolwyr o wledydd gwahanol am yr heriau y maen nhw’n eu hwynebu mewn perthynas â staff nyrsio yn eu hardaloedd nhw a sut maen nhw’n rhagweld y bydd y Rhaglen Staff Nyrsio o fudd i gleifion, nyrsys a byrddau iechyd yng Nghymru. Roedd llawer o gynrychiolwyr yn awyddus i ddarganfod mwy am y rhaglen waith genedlaethol, y gwnaethant gydnabod yr oedd yn ddatblygiad cadarnhaol â llawer o fuddion i randdeiliaid.

Enillais gyfoeth o wybodaeth am fentrau ansawdd a diogelwch newydd a phresennol, sy’n cael eu cyflwyno mewn gwledydd gwahanol, ac mae’r wybodaeth hon wedi rhoi llawer o syniadau i mi eu rhannu ag aelodau o grŵp Staff Nyrsio Cymru a chydweithwyr sy’n ymwneud â’r rhaglen waith hon.