ACKNOWLEDGMENTS
Finally I would like to express my immense gratitude to the following:
- The Florence Nightingale Foundation and The Burdett Trust For Nursing for their investment and sponsorship and for providing me amazing personal and professional development opportunity.
- My employers Abertawe Bro Morgannwg University Health Board health allowing me to take study leave throughout my scholarship
- Professor Elizabeth Robb OBE, Chief Executive, Florence Nightingale Foundation for her guidance and support and for seeing potential in me to give me this opportunity.
- My mentor Professor Mr John Rivers.
- Ms Janet Shallow, Leadership Programme Manager, Florence Nightingale Foundation for her assistance dealing with enquires and assisting me with booking requests.
- My fellow scholars of the Florence Nightingale Scholar and other professionals for their friendship and support during this amazing journey.
ABSTRACT
The following report will give the reader and insight in to the year as a Florence Nightingale scholar. The report describes the learning and development throughout the year and shares the experiences and opportunities.
While the year has been a challenging year both academically and emotionally, it has allowed the Scholar to make new acquaintances and friends as well as gain in confidence and knowledge as a nurse leader.
The main objectivities of the year for the Scholar was to take time to have reflect and explore my own strengths and weaknesses and to challenge my thinking and approach to leadership to become a confident and knowledgeable, authentic leader.
Exposing one’s own weaknesses can be quite uncomfortable however this was done with expert facilitation so this was seen as an opportunity for development rather than a negative experience. The facilitator and leaders that we have met through the scholarship have imparted knowledge and experience and have spent time with to ensure that I reach my own full potential as a nurse leader.
During the last 12 months I have explored my own values and belief through vigorous personal assessments and using validated tools been able to explore my personality style and leadership style. This then gave me the foundation to build on when looking at the contacts of the year’s programme to ensure I met any training needs identified and importantly had a thorough understanding of myself as a leader.
Using this foundation knowledge, I then explored what available courses where available whether these be thought, e learning or via peer to peer support. The wealth of material available gave me a diverse selection to choose form which would allow me to address my learning needs.
Attending the LCOR (leading change and organisational restructure) gave a valuable insight into the challenges of organisational change and explored different ways of thinking. Challenges around organisational communication and the underpinning politics of organisations were discussed and explored. RADA gave a very different opportunity for learning. The art of communication and understanding how communication can change the content and direction of a conversation and how understanding how effective communication in a deeper context has defiantly affected my day to day communication.
Travelling to Denmark and Sweden gave an opportunity to meet nurses in Emergency Care and understand the challenges they face on a daily basis. Seeing logistically how emergency departments and patient flown systems are set up and how information technology can support their flow and help reduce patient harm.
Canfield women as leaders explored the bias of gender in leadership and challenged personal assumptions and belief of women in leadership. This also have a structured thinking about women in senior leadership positions and whether the reach their full potential; and where they don’t what is stopping them.
Attending the positive psychology and Wellbeing master classes gave me a twofold approach to positive psychology in leadership. Taking a deep dive into our own wellbeing and psychology and then into how we can support and develop our team to empower them to become high achieving teams.
Finally, during the course of the scholarship, I undertook a patient care improvement project. Review of the data identified there was a group of patients that would benefit from an ambulatory care the next steps were to some small tests of change to review if there was a tool that could be used to aide streaming the patients suitable for the unit. The team did a literature review of streaming tools and these were tested to identify the best fit for use with the patients that attended Morriston Hospital where the current medical intake is spread across 2 sites some 10 miles apart.
With Morriston hospital only taking undifferentiated emergency this proved a challenge to the team as patients as many AECU services support a GP intake where primary care has limited access to diagnostics or treatment. However as an emergency department this was completed on admission by the Emergency care team so there was some debate what an AECU would offer differently. During the benchmarking exercise and through the network group, the team were unable to find this approach being implemented on an acute site; however it was recognised from the data there was a group of patients that due to their short length of stay that alternative service may have benefited and reduced an acute admission. The team mapped the existing service provision and was able to identify areas that would have a benefit on the patients’ journey where access early diagnostics or a senior decision maker would have prevented an unnecessary admission.
Review of the workforce required an open mind how we currently work and roles and responsibilities. This included nursing, medical and support staff. Understanding what could be delivered with the current workforce by working differently rather than at extra cost required a review of consultant job plans to allow senior decision maker to be present working alongside in the Emergency department consultant.
One of my strengths identified in the influencing style audit was the strength in visionary and the ability to influence others and encourage them to act differently. These strengths were used on a daily basis to keep the team motivated and to encourage them to work outside their comfort zone and look at new ways of working.
We began small pilots of changes for a week, then a month at a time reviewing the data and impact of the change before moving onto to the next period of change. The team eventually reached a point where the changes implemented could be sustained for longer periods of times and this resulted in patients’ being seen and discharged having received appropriate diagnosis and treatment without admission into an acute bed.
Extending the projects across other specialities such as Surgery and Trauma and orthopaedics have also identified a stream of patients that would benefit from using the AECU where they could have procedures performed by the specialty team as a day patient. These patients can return as day patient to the unit for dressings or check-up rather than be admitted onto a ward.
Patient feedback has been gathered and influenced the project. Patients have given very positive maintaining their independence and only staying in hospital if really needed during their period of ill health has allowed them to maintain control with their lives while being treated.
There were areas that the team are still reviewing and recognised there next stage in the work stream. This is mainly around the sustainability of a service 7 days a week and extended hours rather than 5 days a week between 9-5. This does require investment as the current consultant, nursing and therapies workforce cannot deliver a service across these hours. With an increase in the population of frail older people the support from therapies is essential in the service delivery to prevent hospital admission. This is one key area that the team are focusing on currently.
In the past few weeks the team have been successful in their bid to employ Advanced Nurse practitioner’s to support medical staff with the management of Ambulatory majors’ patients. This is an exciting development as this will complement the workforce and support the service to become more sustainable.
The next phase of the project will be to ensure the area is utilised to its full potential and identifying how the service can be sustained for a 7 day period. A skills review of the workforce is currently taking place to identify any gaps in training and where extended skills can be developed to support a more timely efficient service being delivered.
This has not only affected my professional career and presence but within my personal life with family and friends. The empowerment to build a program specifically to address my own learning requirements explore my ability to do my role and how as a personal exposure to new experiences has benefited me immensely. This year has allowed me to focus on how I can improve myself and others around me. To seek opportunity for personal growth and look for opportunities that I can support in building the success of others around me. Having fed back to my own health board they are keen to ensure I have the opportunity to ensure I share my learning and that I am using my full potential to support leadership with others.