Introduction
This report provides an overview of my learning and reflections during my leadership scholarship, one of the most developmental years of my career. This scholarship was sponsored by the Florence Nightingale Foundation and Health Education England.
Background
I applied for the Florence Nightingale Leadership Scholarship as I am at a point in my career where I am ready to move on to the next level and needed time to explore what that should be. The opportunities offered within the scholarship were unique and offered access to the best mentors/coaches, support and guidance possible as well as a chance to develop a bespoke development programme for me as an individual.
Learning & Development
As part of this year I took every opportunity available to me, even those that were completely out of my comfort zone.
The leadership diagnostics were incredibly useful, the interrogation of what this meant with Sue Machell was enlightening and helped me chose the most appropriate development opportunities to match what I was aiming to achieve.
In June I participated in a study tour across Canada & the States, Chicago and Boston to explore the practices of their health care systems. Looking particularly at retaining the nursing workforce. How they develop staff, how they have changed and adapted to cater for the different generations currently working together and what they have done to stop nurses leaving the profession. Learning from this tour fed in to my patient care improvement project.
The RADA course was in equal measures the most petrifying but brilliant course I have ever undertaken. The techniques to create impact and presence have become part of my daily routine.
I opted to attend the Senior Executive Programme at Ashridge Business School, focussing on strategy development, creation of vision, developmental of teams, personal resilience and mindfulness. The programme gave access to incredible lecturers, resources and excellent opportunity to network with senior executives outside of the NHS.
Having access to personal mentoring as part of the scholarship has been so incredibly valuable. My mentor has coached me, pushed me, told me off, guided me but above all else made me believe in myself.
Patient Care Improvement Project
Having adequate numbers of registered nursing staff to care for patients is essential for good patient experience and outcomes. Nursing is diverse and spans the whole health sector, forming the largest part of the NHS workforce. (NHS Employers, 2015). Much has been published in recent years highlighting the need for nurses to adapt to the future requirements of their patients. Reports such as Willis (2012), Francis (2013), Keogh (2013) all place great emphasis on the need for care to be patient centred, compassionate and well informed. To meet the expectations of our patients, more is expected of both our existing staff and the graduate nurses of the future, with the need for greater acquisition of skills and a requirement for flexibility in their approach.
Retaining nurses within nursing has been recognised for some time as being of concern. In 2014, nursing vacancies were at the highest levels nationally than they had been in 15 years Royal College of Nursing, 2014. Annual figures from 2014 also showed nursing staff were leaving at a concerning rate.
Exit questionnaires and independent market research with our own staff highlighted some key themes as to why nurses were leaving. These included:
– Nurses being unaware of all in-house promotional opportunities available
– A lack of career prospects available
– Minimal support from managers to apply for lateral/promotional roles internally
– Frustrations with repeating trust clearances when applying internally, even though the information is already available and stored centrally on ESR
Opportunities in-house were in fact available, but the formal recruitment and selection process were off putting and existing staff were occasionally overlooked; particularly given the size of the trust and multiple sites. Costs of filling the gaps with temporary workers were rapidly becoming unsustainable from a financial perspective; putting additional pressure on permanent staff to provide cover and ensure the highest quality of care for patients.
A retention plan was developed to stem the flow of leavers, looking at improving job satisfaction whilst supporting personal development, raise morale and confidence.
I was particularly struck by the fact people found moving within their own hospital so difficult and that was if they even knew we had vacancies in the area they were keen to look at, therefore I decided to look at a way that we could help our staff move easily across areas to develop skills and have new experiences
My improvement project focussed, initially on the development of an internal transfer process allowing nurses to easily transit from one area within the organisation to another.
Following successful pilot, the process has been adopted trust wide with enthusiasm and support, opening up to all bands and other professional groups.
This alone will not retain all nurses, so along with this element of my project I also investigated theories relating to generational differences, particularly exploring what the generations in our workforce need to make them feel fulfilled and satisfied in their roles. I compared development opportunities in the UK to those in the States & Canada learning from their extended approach to preceptorship.
The Mind the Gap report looks at implementing strategies to retain our workforce, generalising broadly the characteristics of different generations. I focussed on the generation Y’s having discovered these were the highest user of the internal transfer process. They expect support, are ambitious and have high career expectations, require recognition and feedback. Importantly they are career motivated but not company loyal. The Y generation want to be mentored and coached, will be productive and efficient but need to be given the tools to achieve. This generation born between 1980 and 1994 (23 – 37 years old currently) make up 35% of the workforce.
What the transfer process had done was remove obstacles of the recruitment process and the potential negative experience of being rejected for a role or failing the assessment centre. The career clinic met the need of requiring support to achieve. Importantly for this generation within the workplace they recognise the value of education and development and wish to establish a robust career pathway. Within the workplace they need to feel challenged and have explicit development, supervision and support (Lavoie-Tremblay et al 2010). They do not see themselves working for an organisation for their entire career and are very mobile, particularly if the employer does not meet their need. Understanding this was important for the next stage to my project.
As health care leaders we need to accept this change in view and adapt to allow flexibility within our workforce. Before this can be developed however we need to obtain agreement that skills in one setting are equivalent to those in another, so agree standards of training and competencies. We already have consensus in the main that our students can be employed without further testing at interview stage we need now to agree this for our qualified nurses. A passport of learning is essential to allow free movement and is something I am working on supporting colleagues with a pan London approach.
The final part of my project looks at retention of staff after their first year in practice and preceptorship. The Mind the Gap report (Jones 2015) makes a number of recommendations but two that I am currently looking at as part of my on-going project work.
Jones suggests that employers should consider how they can develop options for early career nurses to be engaged in improvement work or smaller research projects and also should consider models of supervision, mentorship, coaching and preceptorship within the context of meeting the needs of the new generations of nurses. Opportunities to enhance the quality of feedback and support during the transition period and beyond the end of the first year should be explored being cognisant of the honeymoon period and risk to retention. The scholarship allowed me to participate in a study tour to the States and Canada; it was interesting to see how they run internships which vary in length, but between 2-3 years. During this time there is a traditional preceptorship programme but this is extended to include more robust training and development with reward coming from recognition of completion of the programme rather than monetary.
When I returned from study I conducted a number of focus groups talking to staff that had recently completed their preceptorship programme and asked them if they would have benefitted from a longer programme and if so what they would have wanted included. Without exception they agree this would have been useful and a structured approach to learning with some elements of control was required.
I have now developed a plan for a 2 year programme. It includes a traditional 6 month preceptorship with agreed and required educational outcomes but also an extended programme that includes training on how to run a small change project, the expectation being that preceptees will complete an improvement project within 2 years and present this internally and/or externally. Additionally there will be a bespoke development element to the programme where the preceptee will have access to an internal (career and personality matched) mentor and an opportunity to shadow senior staff learning about an area they are interested in working.
This pilot will be fully evaluated over time but is intended to be flexible based on what our staff are saying they need.
Reflections
The past 12 months have truly been the most developmental of my career, a very intense experience. I have greater understanding of what I am good at and have learned to stop being my own worst critic.
The insight I have gained into my own behaviour has been invaluable, the gentle pushing from my mentor has made me move outside of where I am comfortable and to try new experiences.
The networks I have built up during the year have been vast and will be invaluable as I continue with my project and forward in my career, being able to talk to individuals who I aspire to has been invigorating.
Acknowledgements
Firstly and most importantly, I would like to thank the Florence Nightingale Foundation (FNF) for awarding me this Leadership scholarship and allowing me to experience one of the most developmental years of my career, and to Health Education England for their generous sponsorship. In particular at the foundation, I would like to express my gratitude to Liz Robb OBE, Chief Executive, for her support and guidance on receipt of my quarterly reports and Janet Shallow who helped me from interview through to completion.
I would also especially like to thank, Dame Liz Fradd who mentored me through this scholarship and provided support, challenge, guidance, advice and in every conversation a “gentle push” to move outside my comfort zone and believe in my abilities, I will always be grateful
The support from my colleagues and organisation, University College London Hospitals, has been amazing, from allowing me to take time to study to enduring my practice of new ways of working and styles of leadership, (and endless speeches) particular thanks to Geoff Bellingan, Medical Director, Liz O’Hara Head of Workforce Surgery & Cancer Board and Flo Panel-Coates, Chief Nurse.
I would also like to thank my fellow scholars for their support and networking and in particular to Chris Caldwell for allowing me to work with her and share my passion for “joy in work” on the Capital Nurse Programme.
Finally, I need to thank my family and my husband, Roman for his everlasting patience and support as I continue to study, home and away.