I would like to take this opportunity to thank the Florence Nightingale Foundation for their support and encouragement through this year as a scholar, and The Burdett Trust for Nursing who sponsored the scholarship. At the outset of the journey, when I attended for interview, I described myself as potentially a ‘needy scholar’. I was unsure exactly what I needed, or even wanted, to achieve. Over a year on I understand entirely that the path that was cohesively influenced by the Foundation, my mentor, life’s events and my own needs was never meant to be definitive- I do however have excellent building blocks and contacts to take the learning and development well beyond the year. I hope I am right in my interpretation.
My thanks also go to Plymouth Hospitals NHS Trust (PHNT), and most specifically to Mrs Ann James, Chief Executive Officer, and my Mr Greg Dix, Chief Nurse. I have been fully supported and encouraged in taking time away from the trust to attend Florence based activities. Additionally, huge interest has been shown in what these have been and how I can bring learning back to the Trust. As the second scholar at PHNT in two years this ongoing commitment of the trust to support the work of the Foundation is clear. I have been encouraging many colleagues to apply to maintain the presence of the West Country, and PHNT specifically, on such nationally recognised programmes.
My mentor, Marie- Noelle Orzel, has been suitably challenging and honest. I recall after the second telephone session (thanks to the inhibiting geography of life in the West Country) feeling a bit as one does ‘post interview’. However, I now find myself far better placed at mentoring others, in making them seek solutions, based entirely on the style and commitment of Marie- Noelle. In challenging, encouraging and, when appropriate, empathising with the loneliness of command she has been both influential in her mentoring of me and the development of my own mentoring style
I would also like to thank my fellow scholars for making it a very interesting journey.
Personal leadership development;
Like many, I had undertaken numerous management courses in my career. They are the easy ones if we are honest – fundamentally formulaic and prescriptive.
To tackle leadership is far more challenging; there isn’t an approach or a response that is ‘right’. It is imperative that you know yourself and your leadership style to be able to gain anything. Of course that undertaking opens up areas that one may rather either pretend were not there, or have little concept of.
I was not surprised when my Myers Briggs came back as an INTJ. Sue Machell informs me this is the second rarest of the 16 combinations and I share my profile with Barack Obama. What that quite tells me I do not know, but I like an interesting fact!
I have to work hard to not be introverted when it really doesn’t wash for the situation I find myself in. This isn’t based on shyness as some may think. It is more about being contemplative and wanting a lot of detail. I struggle with ‘small talk’ and like to respond to something a bit more profound. I am acutely aware, and therefore work hard to ensure, that this does not end up looking like snobbery or any lack of interest.
My gregarious ‘E’ partner jokes that I don’t like people. This is absolutely not true, and indeed my approach is more based on really wanting quality of information and an understanding of friends and contacts, rather than dilution which I feel happens all too easily with a superficial approach. Luckily we are all different!
So the leadership courses I have undertaken as part of my scholarship year have indeed challenged me. I am normally a confident presenter on a serious subject with appropriate research. I have the capacity to take on and keep a lot of information which I now understand is my crutch. The spontaneity of presenting at Rada and Aspire programmes have made me draw upon different skills; those of practical breathing and self-belief.
Career leadership objectives
At the start of my scholarship year, the one question I really wanted to answer was “Do I want to be a Chief Nurse?” When my next comment is that I am further from making that decision now that I was then, I clearly need to explain why I genuinely see that is such a positive thing.
I had embarked on this journey thinking it was the question to answer, and that spending time with Chief Nurses who so generously welcomed me into their Trusts and shared their roles with me, would assist me in that.
However, twenty years in Women’s and Children’s is a hard habit to break. I have looked at all of my transferable skills. Indeed Liz Robb has personally been hugely encouraging about Part 10 of the register being just as relevant to achieving such a position as an entry in Part 1. But the strategy of Women’s Services is at my core. I have been very lucky in my career to have had the opportunity to take on a department that was ripe and ready for change and development. I have been supported in doing so by a Board that understand my vision and support it entirely and a team that, in the main, are willing to have the challenges that come with change as they can equally see the ultimate vision.
The patient care improvement project that is being worked on during the Scholarship
The need for Midwives to maintain a full skill set and be able to work across all settings is multi- factorial.
As a manager within Maternity Services it is essential that I can have staff that can respond to the peaks and flows of service demand. I recall it being brought to my attention when I was a very new into PHNT that the Labour Ward was exceptionally busy. The inability to be able to pull a member of staff from any of the other clinical areas to assist was both unfair to the women who were labouring and receiving nothing like one to one care in labour, and a sad indictment of the fragmentation of the service within PHNT, but indicative of that at many Trusts.
The Kings Fund in their document ‘Safer Staffing in Maternity Units’ encourage leaders within Maternity Services to consider not the finite number of staff within maternity settings, but the flexibility of workforce. The translation of this is ensuring a workforce can be fully deployable to follow the natural variance in workload across all maternity settings. This doesn’t dilute skills; the juncture of qualification does not see newly qualified Midwives with a dilute skill set. It sees graduates able to undertake clinical skills in all settings underpinned by background knowledge of pre conception through to 28 days postnatal.
More importantly however is that families accessing care should be able to be cared for by staff that understand and can articulate the entirety of their maternity care. Only with the knowledge of the entire pathway can holistic care start to be considered. A fragmentation of the service fails women and their families with regards to continuity, but also in ensuring that the impact of care provided, or of a clinical presentation with its implications, can be truly understood.
Currently the motivation to change is not driven by a national agenda. It is down to individual leaders in individual services to interpret the guidance available accordingly. At the outset of my appointment as Head Of Midwifery at PHNT I found a ward where Midwives had not touched a pregnant woman in excess of thirty years in some cases. Working solely with babies, they were still able to call themselves Midwives but, if their ward was empty could not transfer their skills anywhere, or if they were asked any questions about another part of the care pathway that had to refer this to ‘another midwife who knew about that bit’
This set- up is replicated and acceptable. The aim of project was to embed a fully rotational programme within my own Trust and start to have some national influence on the make- up of Maternity Services staffing and the requirements for Midwifery registration.