RAISING THEPROFILE - nphs.wales.nhs.uk · Health Protection Nurses work as part of an all Wales service based in premises strategically located around Wales. They play a key role

RAISINGTHE PROFILE

The Public Health WalesNursing and Midwifery Strategy

working towards a healthier, happier and fairer wales

May 2014-2017

‘RAISING THE PROFILE’ The Public Health Wales Nursing and Midwifery StrategyWorking Towards a Healthier, Happier and Fairer WalesMay 2014-2017 i‘RAISING THE PROFILE’ The Public Health Wales Nursing and Midwifery StrategyWorking Towards a Healthier, Happier and Fairer WalesMay 2014-2017

With thanks to all nursing and midwifery staff

who took part in the initial engagement exercise

and special thanks to the Task and Finish Group who

supported the development of this document.

Task and Finish Group Members:

Rhiannon Beaumont-Wood

Zoe Gibson

Nicola Hathway

Karen Jones

Claire Lewis

Nicola Meredith

Lin Slater

Gloria Smith

Linda Wood

Mary Bate

© 2014 Public Health Wales NHS Trust

Material contained in this document may be reproducedwithout prior permission, provided it is done so accurately

and is not used in a misleading context.

Acknowledgement to Public Health Wales NHS Trust to be stated.

Images may not be copied, printed or otherwise disseminated

ISBN: 978-0-9572759-9-7

Acknowledgements

‘RAISING THE PROFILE’ The Public Health Wales Nursing and Midwifery StrategyWorking Towards a Healthier, Happier and Fairer WalesMay 2014-2017 ii

Page

Foreword 1

1 Introduction 2

2 Background and Roles 3

3 Theme One: Nurses and Midwives WorkingTowards Healthier Choices and Lifestyles 6

4 Theme Two: Dignity and Respect 7

5 Theme Three: Communication 8

6 Theme Four: Co Production 9

7 Theme Five: Professional Development 10

8 Theme Six: Accountability 12

9 Theme Seven: Revalidation, Appraisal,Supervision 13

10 Theme Eight: Leadership 16

11 Theme Nine: Quality Improvement 17

12 Theme Ten: Research and Development 18

Appendix 1 20

Contents

‘RAISING THE PROFILE’ The Public Health Wales Nursing and Midwifery StrategyWorking Towards a Healthier, Happier and Fairer WalesMay 2014-2017 1

I am delighted to present the first Public Health Wales Nursing and MidwiferyStrategy. This provides a new opportunity to raise the profile of nurses andmidwives working within Public Health Wales, also to our professional counterpartswithin Wales, the UK and internationally. This builds on recognition of the goodwork already undertaken by nurses and midwives working in Public Health Wales.Within the three domains of Public Health many roles are highly specialisedcontributing to a range of services and programmes which aim to improvepopulation health outcomes by leading, mobilising and delivering. Others provideenabling functions which support a range of professionals and stakeholders invarious aspects of quality, safety and health care service improvements.

I am proud of the work we do and thecontributions made both directly and indirectly tothe lives of individuals, families, communities andthe population of Wales. We are keen to continueto work in collaboration with a wide range ofprofessionals and the public in meeting the aims ofthe Public Health Wales Strategy to have ahealthier, happier and fairer Wales.

It is essential to acknowledge the lessons from theMid Staffordshire enquiry and to recognise thatour Nursing Midwifery Council Code is ourframework for safe professional practice, and isequally applicable to all aspects of nursing andmidwifery practice irrespective of the context.Therefore, it is important that nurses and midwivesare able to experience the support of theirprofessional colleagues, that there are clear lines ofprofessional accountability from individual practiceand service/programme areas through to theBoard. Registered nurses and midwives working ina national Public Health organisation can be at riskof becoming isolated due to the smaller numbersof nursing and midwifery colleagues around them.Bringing people together with shared professionalvalues, standards, skills and knowledge isimportant to maintain our focus on doing the rightthings in the right way with an emphasis on dignityand compassion in our work with the public andcolleagues. The aim of this strategy is to provide anenvironment that gives nurses a stronger voice,increased opportunities for them to lead at alllevels and nurture professional development whichwill realise benefits both for practitioners and thepublic we serve.

I am pleased that the Public Health Wales Boardhas welcomed the opportunity to appoint aDirector of Nursing to the Executive team, therebystrengthening the Board in having a professionalvoice and ambassador for nursing and midwifery

contribution working towards the strategic aims ofPublic Health Wales. Nurses and midwivesrepresent the largest professional group in theNational Health Service and have a significantamount of contact with the public as patients andusers of services. The opportunities to influencechange are therefore significant and as yet notfully realised. Increasing the contribution thatnurses and midwives can make to improvingpopulation health and wellbeing is one of our aimsand is identified within the Public Health Walesthree year integrated plan. The Public Health Walesnursing and midwifery workforce can identifyopportunities to influence this agenda throughformal and informal professional networks.

We know that we have significant challengesahead economically, tackling health inequalitiesand improving population health outcomes. Withthis challenge also comes shared responsibilitybetween professionals and the public to worktogether to make Wales a place that is healthy,happy and fair. I have no doubt in my mind that bycontinuing to adapt to new ways of working, inpartnership with the public and colleagues, thenursing and midwifery workforce can make asignificant contribution in transforming fromwhere we are today to where we aspire to be.

I look forward to seeing this strategy being realisedand celebrating with colleagues the positivedifference that it makes.

Rhiannon Beaumont-WoodDirector of Nursing, Public Health Wales

Foreword


This is the first time that nurses and midwives working in Public Health Wales have come together to cocreate a vision and a road map to invest in their professional future, with the aim of contributingsignificantly to the ambitions of Public Health Wales. This strategy has been developed by nurses andmidwives for nurses and midwives, informed by an initial engagement event and a subsequent workinggroup of self selected professionals. Supporting documents have been used to inform this strategyincluding the Welsh Government document Designed to Realise our Potential (2008) and Delivering SafeCare, Compassionate Care (2013).

A key element of bringing professionals togetherwas being able to have a shared understanding ofwhat it means to be a registered nurse or midwifeworking in Public Health Wales. This is veryimportant to ensure we offer safe, evidence basedpractice, a person centred approach, workefficiently and understand how to deliver againsttime and cost pressures.

It is also important that this strategy gives rise tostrengthened leadership and developmentopportunities for nurses and midwives working indiverse roles across the Public Health System.

We want to attract the best of nursing whilstcontinuing to develop and enhance expertknowledge, expertise, and skills, providing anenvironment for students who will experienceinspiring and interesting placements. Public HealthWales nurses and midwives will use their expertiseto positively influence and nurture the nurses andmidwives of tomorrow with an emphasis on healthand wellbeing.

The NHS workforce profile is changing and nursesand midwives of the future need to become moreflexible and develop the confidence to stretch andgrow into new roles.

This strategy identifies ten overarching themes asneeding to further evolve and strengthen. Eachtheme denotes a section of this strategy with avision statement specific to each theme, followedby specific aims and a high-level response as tohow this will be achieved.

Definitions have been provided throughout thisstrategy with the aim of gaining a sharedunderstanding and interpretation of whatmeaning is intended within each section.

Creating actual and virtual environments whichinspires and motivates us as professionals is seen asa necessary ingredient to harness a forwardmomentum in improving our contributions topublic health and the aims of Public Health Wales.Therefore a number of inspiring or motivationalquotes have also been weaved through thisdocument.

We also thought it was important for staff to bevisible in this document therefore a number ofcolleagues have agreed to be featured in thisstrategy with comments that help us to understandwhy this strategy is important to them.

The scope of this strategy is intended for allnursing and midwifery staff employed in PublicHealth Wales who are required to maintain theirregistration for their role. It will also support andprovide a focus for Health Care Support Workerswhere roles closely align to nursing. It isanticipated that Public Health Consultants andPublic Health Practitioners, who are dual registeredwishing to retain their Nursing Midwifery Councilregistration, will be able to access support and gainfrom the intended benefits of this Strategy ifdesired.

A more detailed implementation plan will bedeveloped, in order that the milestones to realisethe aims of this strategy can be monitored andreported back to nurses and midwives working inthe organisation and to the Board.

Introduction

“if you want to go fast, go alone. If you want to go far, go together.”

African proverb quoted by Al Gore.


Nurses and midwives working in Public HealthWales broadly work in the three domains of PublicHealth:

Current service and programme areas wherenurses and midwives are working in Public HealthWales are:-

Health ProtectionHealth Protection Nurses work as part of an allWales service based in premises strategicallylocated around Wales. They play a key role in thedelivery of the health protection agenda andcontribute to implementation of policies,procedures and guidelines and provide an acuteresponse to notification of communicable diseaseand chemical incidents. The role is diverse andconstantly evolving in line with service and publicneed. Functions and responsibilities include:

� Communicable disease management andcontrol and the provision of advice and supportto members of the public, other healthprofessionals and agencies on communicabledisease issues

� Provision of advice and support for infectioncontrol in healthcare premises, residentialhomes and community nursing facilities

� Specialist advice and support on a number oftopics such as Immunisation and Vaccinationprogrammes, Blood Borne Viruses andTuberculosis.

� Contributing to the response for themanagement of chemical, radiation, poisonsand environmental hazards.

Public Health Wales was established in October 2009, many nurses and midwives coming together fromvarious health organisations including the former National Public Health Service and Velindre NHS Trust.

Background and Roles

HealthImprovement

HealthProtection

HealthcareServices

Improvement

“We may not be physically workingtogether every day, but we havecommon goals, and the nursingstrategy helps me see the nurses inPublic Health Wales as a team, ofwhich I am a member, rather thana group of individuals who justhappen to work for the sameorganisation.”

Nicola Meredith

Definition of Public Health Nurse Role: While most nurses care for one patient at a time, public healthnurses care for entire populations. By working with whole communities, public health nurses are able to educate peopleabout health issues, improve community health and safety and increase access to care. Nurses and midwives play apivotal role in contributing to improve and protect health and promote well being by drawing upon their knowledge andskills and offering a first class quality service to the general population.http://explorehealthcareers.org/en/Career/149/Public_Health_Nurse


Blood Borne Virus PrisonNurse Specialist� Implementing and supporting blood borne virus

services across the Welsh prisons. These includeclinical testing services, vaccinationprogrammes, in-reach treatment services andeducational health promotion for prisoners andstaff.

� Monitoring prevalence of hepatitis B and Cwithin the prisons and uptake of hepatitis Bvaccinations.

� Supporting communicable disease managementand control across the prisons.

� Providing educational programmes and supporton the above to prison staff

� Conducting and supporting research to developprison healthcare services

ScreeningNurses and midwives work within the range ofscreening programmes and have varied roles. Thiscan involve giving direct clinical care in addition toproviding co-ordination, leadership andmanagement for the programmes.

Screening Division manages national screeningprogrammes for the Welsh population including:

� Breast Test Wales

� Cervical Screening Wales

� Antenatal Screening Wales

� Newborn Hearing Screening Wales

� Bowel Screening Wales

� Abdominal Aortic Aneurysm Screening Wales

� Newborn Bloodspot Screening Wales

Safeguarding Children ServicesNurses working alongside medical colleagues in theSafeguarding Children Service, provide strategicfocus and demonstrate professional leadership tothe NHS in Wales in order to promote welfare andsafeguard children, including those looked after bylocal authorities. They are a source of professionalexpertise to the Welsh Government and provideprofessional advice, guidance and support toHealth Boards and NHS Trusts. They are membersof the statutory Safeguarding Children Boards andcontribute to Child Practice Reviews (CPRs) andeducation programmes. Working as a team theysynthesise the learning from reviews and alongwith other data and knowledge from research, usethis to support training and further improvesafeguarding practice in health services.

Background and Roles continued

“A challenge every day.”

“We welcome the nursing strategyas this will be the foundation ofdevelopment of nursing withinPublic Health Wales.”

Health Protection Team (Swansea)


1000 lives Improvement ServiceThere are a number of nurses and midwives workingwithin the 1000 Lives Improvement Service whocome from a range of clinical backgrounds. Theseinclude District Nursing, Health Visiting, Midwifery,Intensive Care, Theatre and Acute Care. They areable to bring the perspective of their knowledgeand experience from these backgrounds in to thework and focus of the 1000 lives ImprovementService. All are passionate about consideringchange and improvements from a patient/ publicperspective and recognise the valuable contributionthat patients/ carers and the wider public can maketo improvement.

National Breastfeeding Programmefor WalesA midwife leads the co-ordinating role for theNational Breastfeeding Programme for Wales,providing system leadership, advice and support toprofessional colleagues such as Health Visitors,Midwives and Public Health Specialists. The aim ofthe Programme is to increase breastfeeding ratesthroughout Wales in order to improve the physicaland emotional health of mothers and babies.

Welsh Healthcare AssociatedInfection ProgrammeThe Welsh Healthcare Associated InfectionProgramme (WHAIP) is one part of the HealthProtection services offered by Public Health WalesNHS Trust. Nurses work in WHAIP as part of amultidisciplinary team who work in the area ofhealthcare associated infection (HCAI) andinfection prevention and control.

The team itself provides a range of expertise andskills which advises on HCAIs and relatedprevention and control strategies. Expert scientificadvice is available for the development ofsurveillance programmes and epidemiological andinfection control support is available for theinvestigation of outbreaks or unexpected increasesin diseases in NHS trusts/Health Boards in Wales.

WHAIP provides a framework for NHS Trusts/HealthBoards in Wales to ensure that the methods andprotocols used for the collection of HCAIsurveillance data are consistent on a national level.

WHAIP also collates surveillance data provided bythe NHS trusts/Health Boards and compiles nationalsurveillance reports on HCAI rates in Wales.

From these reports, trends and any areas ofconcern are highlighted to local infection controlteams so that appropriate action can be taken ifnecessary.

Vaccine Preventable DiseaseProgrammeThe nurses in VPDP have a wide range ofprofessional experience, including primary care,school nursing, paediatric, secondary care, healthvisiting and midwifery. These nurses have animportant role promoting immunisation in Wales,helping support service providers reduceinequalities and morbidity and mortality associatedwith vaccine preventable diseases.

The VPDP nurses are key contributors, and oftenlead, on the development of public healthinterventions to achieve these objectives. Theysupport and drive the development of guidanceand also identify examples of good practice, andshare initiatives, with the aim of best protectingpopulation health with education, facilitation andthe development of resources for health careworkers and the public positively influencingimmunisation uptake.

Corporate NursingCorporate nurses consist of the Director of Nursing,the Named Professional for Safeguarding and thelead Nurse for Infection Prevention and Control.Roles include providing leadership, advice,developing strategies, guidance and providing afocus on safety and quality in a range of topics.These include professional nursing issues, serviceuser experience, safeguarding, infection preventionand control. The Director of Nursing contributesmore generally as a member of the Executive teamin providing the necessary assurance to the Boardin maintaining robust governance, accountabilityand the successful delivery of the three yearintegrated medium term plan, which underpins thestrategic aims of Public Health Wales.

Background and Roles continued

“The strategy will help me tounderstand how my role andthat of my colleagues fits withinthe service and will develop inthe future.”

Jane Dyson,Specialist Nurse Immunisation,Vaccine Preventable Disease Programme


Nurses and midwives working towardshealthier choices and lifestyles

Our Vision . . .To recognise our personal challenges and the challenges for others in living healthier lifestyles, bytaking responsibility for own health and aiming to become positive role models.

We aim to . . .� Strengthen our ability to influence healthier lifestyle choices by making changes in our own lives

first, seeking to find opportunities to influence and support those choices in others by making everycontact count.

We will achieve this by . . .

Theme One

Definition of Health: Health is a state of complete physical, mental and social well-being and not merelythe absence of disease or infirmity. WHO (1948)

“The Public Health Wales nursing strategy is the way to take nursingforward in the organisation.”

Leony Davies, Specialist Nurse ImmunisationVaccine Preventable Disease Programme

� Sharing experiences, supporting colleaguesand the public in working towards improvedhealth and wellbeing.

� Actively accessing and promoting support fora range of healthy lifestyle choices relating totobacco, alcohol, exercise, healthy eating,healthy weight, mental health and uptake ofrelevant immunisations.

� Explore specific actions that can be taken tohelp harness motivation and enthusiasm inself and others such as Champions forhealth, Corporate Health standards, localteam and departmental initiatives such asdinner time walks.

� Provide opportunities for all nursing andmidwifery staff in Public Health Wales to betrained in brief intervention andmotivational interviewing techniques, in thecontext of Making Every Contact Count.

“You are as important to your health as it to you.” Terri Guillemets


Dignity and respect

Theme Two

Definition: Organisations and services recognise and address the physical, psychological, social, culturallinguistic, spiritual needs and preferences of individuals and that their right to dignity and respect will beprotected and provided for. Welsh Government (2010)

“Dignity applies equally to those who have capacity and to those who lack it. Everyone has equal worth ashuman beings and must be treated as if they are able to feel, think and behave in relation to their ownworth or value.” RCN (2008)

“Without dignity, identity is erased.” Laura Hillenbrand

Our Vision . . .To ensure dignity, respect and compassion is always evident when providing services to and workingwith members of the public.

We aim to . . .� Provide and promote dignified care and respect in a way that respects people equally both the

public and colleagues alike.

We will achieve this by . . .� Reviewing attitudes, behaviours,

organisational culture and the physicalenvironment where services are provided, toensure dignity and respect is fully evident andin respect of how colleagues work with eachother.

� Driving improvement plans which respondto ‘Doing well, Doing better’ Standard 10Dignity and Respect.

� Identifying how relevant aspects of theFundamentals of Care can be implementedwithin the context of services provideddirectly by Public Health Wales to the public.Welsh Government (2003)

“The Nursing Strategy will raise the profile of nurses and midwives in PublicHealth Wales and beyond.”

Nic Hathway


Communication

Theme Three

“We are stronger when we listen, and smarter when we share.” Rania Al-Abdullah (Queen consort of Jordan)

Our Vision . . .Nurses and Midwives in Public Health Wales will have a strong professional voice, and use it in allcommunications positively influencing the wider public health agenda.

Definition: Communication underpins everything we do in everyday life as well as in professional practice.What we say, how we say it and what we do communicates a multiplicity of messages. These messages aregiven and received both consciously and unconsciously. Sully P, Dallas J (2010) Communication skills for nursing andmidwifery. London. Elsevier Health Sciences

We aim to . . .� Communicate effectively.

� Raise the profile of nursing in Public HealthWales, to ensure there is an appropriate,effective nursing and midwifery voice at alllevels of the organisation.

� Inspire ourselves and others by utilising andadapting to new and emerging methods ofcommunicating effectively with each other,with colleagues and with the public. Bylistening, talking, engaging and supporting.

We will achieve this by . . .� Identifying and sharing networks and

contacts with each other, to support andenable colleagues in Public Health Wales towork and communicate effectively.

� The Director of Nursing providing a voice atBoard level advocating for Nursing andMidwifery and being a conduit for two-waycommunication.

� Establishing and maintaining a Nursing andMidwifery intranet page, which will providerelevant information and links to keeppractitioners informed.

� Undertaking impact assessments oncommunications, to ensure we reachrelevant groups in the best way. DevelopPublic Health Wales nursing networks, faceto face and virtual to share good practiceand support nurses and midwives across theorganisation.


Co-production

Theme Four

Definition: Co-production is the delivering of public services in an equal and reciprocal relationships betweenprofessionals, people using the services, their families and their neighbours. Where activities areco-produced in this way, both services and neighbourhoods become far more effective agents of change.The new economics foundation/ Nesta (2009) The Challenge of co-production

Our Vision . . .To build and nurture equal and reciprocal relationships with other professionals, service users andtheir families to facilitate co-creating and co-producing public health services and programmes withthe aim of improving population health in Wales.

We aim to . . .

� Create an environment which encourages usto collectively develop and share knowledge,skills and expertise together with the publicand those working across the Public Healthsystems.

� Ensure transparent and clear pathways arein place, promoting a culture of continuouslearning which allows improvement,innovation and excellence to flourish.


� Routinely sharing the excellent andinformative work of nurses and midwiveswith the public and colleagues, in order thatthere is a better understanding of the depthand diversity of roles and the workundertaking. Increasing opportunities andcommitments for more collaborative working.

� Increasing involvement, engagement, andvisibility of Public Health Wales nurses inregional, national and international forumsand events.

� Routinely listening to and engaging withpeople. Positively reviewing feedback,lessons learnt, complaints, and service user’sstories to strengthen and enhance PublicHealth Wales nursing roles for the future.

“Good communication helps to buildgood working relationships.”

Viv Breen

‘RAISING THE PROFILE’ The Public Health Wales Nursing and Midwifery StrategyWorking Towards a Healthier, Happier and Fairer WalesMay 2014-2017 10‘RAISING THE PROFILE’ The Public Health Wales Nursing and Midwifery StrategyWorking Towards a Healthier, Happier and Fairer WalesMay 2014-2017 10

Professional Development

Theme Five

Our Vision . . .Nurses and midwives in Public Health Wales will sustain and develop skills and knowledge to forgecareer pathways and maintain a workforce that is highly skilled to deliver first class services.

Definition: The lifelong process of active participation by nurses in learning activities that assist indeveloping and maintaining their continuing competence, enhancing their professional practice andsupporting achievement of their career goals. http://nursingworld.org/ce/ceterms.cfm

We aim to . . .

� Optimise nurses and midwives, experience atwork by providing leadership, support anddevelopment opportunities that will enhancejob satisfaction.

� Develop opportunities that will attract nursesand midwives, will maintain and enhanceskills, to support career pathways both withinand beyond Public Health Wales.

� Ensure access to ongoing professionaldevelopment and lifelong learning.

� Ensure all nurses and midwives in PublicHealth Wales develop and maintaincompetencies that assure a highly skilledworkforce who sustain the highest level ofpractice.

� Review existing roles and support PublicHealth Wales to achieve its strategic goals bydeveloping the nursing and midwiferyworkforce from specialist to consultant levelpractice.


� Developing a framework that will build onnursing skills already acquired, to supportprofessional development and careerplanning identified through appraisal andpersonal development review processes.

� Facilitating career development opportunitiesfor newly registered and existing nurses andmidwives by;

• Offering mentorship and rotationalopportunities across divisions andorganisational boundaries.

• Establishing links with pre-registration andpost-registration nursing programmes.

� Scoping educational and developmentneeds of nurses and midwives in PublicHealth Wales to develop learningprogrammes and enhance secondmentand shadowing opportunities. This caninclude a NHS wide approach andassociation with other agencies andprofessions.

� Introducing a framework that supports thedevelopment of competency based jobdescriptions and evidenced based practicemaintaining a first class service.

continued overleaf


Professional Development

Theme Five continued

“The Nursing Strategy is important to bring nurses togetherand give them a focus to drive Public Health Nursing forwardand as Florence Nightingale said:

Unless we are making progress every year, every month,every week, take my word for it, we are going back.”

Ruth Lawler

We will achieve this by . . . continued

� Underpinning future nursing and midwiferypractice in the organisation by utilising thePost Registration Career Framework fornurses in Wales drawing upon the AdvancedPractice and Consultant Nurse Toolkits.

� Supporting and developing postgraduatenursing pathways for nurses and midwiveswishing to undertake further academic studyidentified through the appraisal process.

“High achievement always takes place in the framework of high expectation.” Charles Kettering


Accountability

Theme Six

“Accountability breeds responsibility.” Stephen Covey

Our Vision . . .A Public Health Wales nursing and midwifery workforce which is supported in upholding allrequirements of regulation in practice, with clear lines of individual and organisational accountability.


Definition: Nurses and midwives hold a position of responsibility and other people rely on them.They are professionally accountable to the NMC, as well as having a contractual accountability to theiremployer and are accountable in the law for their actions. NMC (2014) Regulation in Practice;http://www.nmc-uk.org/Nurses-and-midwives/Regulation-in-practice/ Accessed 10/03/2014

� Embedding standards of the NMC code andprofessional accountability arrangements fornurses and midwives through JobDescriptions, appraisal processes, supervisionand continual professional development.

� Supporting and encouraging nurses andmidwives to raise concerns where theyidentify poor practice and potential or actualharm.

� Ensuring all nurses and midwives work withinand up to their level of competence andscope of practice. Monitored through formalorganisational processes includingprofessionally led performance reviews,appraisals, supervision, mentoring andsupport structures.

� Ensuring there are mechanisms in place toconsider new and existing organisational

policies and protocols, in terms of theirimpact on nursing and midwiferyrequirements to comply with the NMC codeand standards.

� Developing professional reporting structuresthrough service area professional nursing/midwifery leads, reporting to the Director ofNursing.

� Clarifying, within job descriptions, the linesof professional accountability through to theDirector of Nursing for nurses and midwiveseither directly or via senior nurse lead roles.

� Raising awareness of and implementing theCode of Conduct for Health Care SupportWorkers in Wales. We will also establishclear lines of professional accountability forHealth Care Support workers where thereroles closely align to nursing.

We aim to . . .� Provide a working environment that supports

practitioners in maintaining the standards ofthe Nursing and Midwifery Code (NMC) inpractice.

� Identify clear lines of professional nursingand midwifery accountability fromindividual practice to the Board of PublicHealth Wales.


Revalidation, Appraisal and Supervision

Theme Seven

Our Vision . . .A nursing and midwifery workforce that upholds and demonstrates the standards of their professionalcode, and are supported to provide high quality, safe, evidence based programmes and services in linewith the overall quality assurance systems for Public Health Wales to deliver its strategic aims.


Definition: Revalidation is a mechanism for nurses and midwives practicing in the UK to prove theycontinue to remain fit to practice. NMC (2014)

Revalidation promotes greater professionalism among nurses and midwives and also improves the qualityof care that patients receive by encouraging reflection on nurses’ and midwives’ practice against therevised code. NMC (2013)

� Strengthening and adding local andorganisational backup systems to supportcurrent Information Technology systems andprocessess. This will provide additional alertsystems to inform the Director of Nursing andnursing team leaders on any issues arising inrelation to the maintained status of live NMCregistrations.

� Implementing systems that will support anynew revalidation processess dependent onoutcomes from the NMC consultationprocess and subsequent recommendationsand requirements.

� Identifying and establishing a data base ofNMC registrants who are employed withPublic Health Wales in non nursing andmidwifery roles and wish to identifythemselves in order to benefit fromorganisational opportunities in maintainingtheir NMC registration.

We aim to . . .� Ensure that there are robust mechanisms in

place to ensure that all nurses and midwivesemployed within Public Health Wales and whoare required to have a live registration with theNursing and Midwifery Council (NMC) do so.

� To implement and embed a structure tosupport the NMC requirements forrevalidation, ensuring nurses and midwivesprovide safe excellent practice and serviceswhich will benefit and safeguard individuals,families and communities.

� Provide public health professionals who alsohold a live NMC registration and wish tocontinue to do so, with access to appropriatesupport, information exchange and relevantcontinual professional developmentopportunities. This is in order to assist them inretaining their fitness practice, should theywish to avail themselves of this through PublicHealth Wales nursing and midwiferyinfrastructures and communications.



Theme Seven continued

Organisationalvalues and goals

Personaldevelopment (KSF) Performance

JobInformation

IndividualObjectives

Appraisal

High quality patient care

NHS employers 2014

Definition: Effective appraisals are good employment practice, leading to improved staff performance,higher staff satisfaction and better patient outcomes.

We aim to . . .� Ensure that all nurses and midwives employed within Public Health Wales are able to demonstrate to

the NMC that they remain fit to practice, taking into account additional specific regulatoryrequirements for midwives.

We will achieve this by . . .� Having annual appraisals linking individual

contribution and performance toorganisational/divisional/team objectives.Contributing to the overall delivery of highquality and citizen-centred services andprogrammes.

� Developing and utilising appraisal tools thatwill meet the specific needs of nursing andmidwifery practice and NMC revalidationrequirements.

� Ensuring that nursing and midwiferyappraisals incorporate professional elements,to meet fitness to practice needs and thecurrent and future needs of revalidation.

� Providing a structure that supports a processfor gaining feedback from the public andcolleagues which may also be required forrevalidation purposes.



Theme Seven continued


Definition of Clinical Supervision: An activity that brings skilled supervisors and practitionerstogether in order to reflect upon their practice. “Supervision aims to identify solutions to problems,improve practice and increase understanding of professional issues.” UKCC (1996). There are various modelsor approaches to clinical supervision; one-to-one supervision, group supervision, peer group supervision.The choice of approach will depend upon a number of factors, including personal choice, access tosupervision, length of experience, qualifications, availability of supervisory groups, etc.

� Having structures and support mechanismswhich enable managers and professionalleaders to be knowledgeable of and cansupport the nursing and midwifery workforce,both in maintaining their fitness to practiceand requirements for revalidation.

� Creating an environment which supportscontinual reflection on the application of theNMC codes and standards in the work setting.This can be evidenced during appraisals,personal development reviews andsupervision.

� All nurses and midwives being fully engagedwith the revalidation, appraisal and clinicalsupervision processes.

� Developing robust systems and frameworks toensure that all nurses and midwives areinvolved in a form of clinical supervision.Midwives will be supported to comply withstatutory supervision requirements.

� Developing and strengthening professionalnetworks and communities with other nursesand midwives within and outside of PublicHealth Wales.

We aim to . . .� Have a supportive and professional environment where all nurses and midwives will participate in

the formal process of clinical supervision.

“The nursing strategy in Public Health Wales will provide a greatopportunity to showcase the huge contributions made bynurses within Public Health Wales.”

Zoe Gibson


Leadership

Theme Eight

“The task of leadership is not to put greatness into humanity, but to elicit it,for the greatness is already there.” John Buchan

Our Vision . . .To promote effective nurse leadership throughout Public Health Wales to enable world class serviceand programme delivery that will influence and inspire significant improvements in populationhealth outcomes.


Definition: Leadership is defined as influence, that is, the art or process of influencing people so that theywill strive willingly and enthusiastically toward the achievement of group goals.Weihrich and Koontz, 2005

� Nurses and midwives engaging andparticipating in the implementation of PublicHealth Wales leadership framework,identifying any additional gaps which need tobe addressed.

� Enhancing leadership skills for those inprofessional leadership and managerial roles.

� Ensuring that systems of appraisal,supervision, coaching and mentoring, takeaccount of leadership and developmentneeds. With a focus on increasing theconfidence, competence and expectation toeffectively fulfil leadership roles.

� Flexibility in approach and embracing newideas and alternative ways of working.

� Assessing individual competencies andaccessing leadership programmes to supportnurses and midwives in taking responsibilityfor their own leadership development, whileinspiring and motivating those around themin realising their leadership potential.

We aim to . . .� Identify clear organisational leadership

priorities and expectations.

� Ensure staff have equitable access to learningand development opportunities to fully equipthem with the necessary leadership skills.

� Empower nurses to challenge tradition,stereotypes and limitations.

� Identify, nurture and enhance leadershipskills in all nurses.

� Embed and strengthen leadershipphilosophy in all nurses and midwives withinPublic Health Wales.


Quality Improvement

Theme Nine

Our Vision . . .As nurses and midwives play a dynamic and vital role in protecting and improving health in Wales,we will focus on safety, excellence and quality by providing best evidence based practice at all times.


Definition: The degree to which health services for individuals and populations increase the likelihood ofdesired health outcomes and are consistent with current professional knowledge. US Institute of Medicine 1990

Of which encompass six themes:• Safe: avoiding harm to patients from care that is intended to help them• Effective: providing services based on scientific knowledge and which produce a clear benefit• Person-centred: providing care that is respectful or responsive to individuals’ need and values• Timely: reducing waits and sometimes harmful delays• Efficient: avoiding waste• Equitable: providing care that does not vary in quality because of a persons’ characteristics

� Taking responsibility for delivering safe andhigh quality services. Acting swiftly anddecisively to make services better whereimmediate safety is threatened.

� Undertaking audits and actively seeking theviews and experiences of service users to driveup quality, in order to deliver services that arecentred on service users’ and carers’ needs.

� Leading and contributing to ImprovingQuality Together approach (IQT) with supportfrom the 1000 lives plus programme.

� Developing performance frameworks withevidence based standards which can identifyand measure success and highlight areas ofconcern.

� Putting evidence based research into practice.

We aim to . . .� Provide and support services that focus on

quality, safety and excellence, to improvepopulation health outcomes.

� Continuously strive to improve and learn fromservice user experience.

� Inspire others to take responsibility forimproving the quality of service they provideand embed into everyday working.

� Achieve quality, high standards of care andservice/ programme delivery, evidencedthrough reliable recording and measurementsystems which uphold NMC record keepingrequirements.

� Promote and support research developmentand innovation to improve services.

“Quality is not an act. It is a habit.”Aristotle 384BC-322BC, Greek philosopher and scientist, student of Plato and teacher of Alexander the Great


Research and Development

Theme Ten

“Nurses and Midwives are committed by the NMC Code of Conduct to the delivery of care and advice whichis based on the best available evidence.” NMC 2008

Our Vision . . .Our vision is for nurses and midwives, across Public Health Wales, to build capacity and capability toconduct and deliver high quality research to improve and strengthen service delivery and populationhealth outcomes.

Definition: The attempt to derive generalisable new knowledge by addressing clearly defined questionswith systematic and rigorous methods. Health Research Authority

We aim to . . .� Create an environment that encourages and

promotes nurses and midwives to undertakeresearch whether experienced or wishing toembark on research for the first time.

� Conduct well designed and ethically approvedstudies in full accordance with the ResearchGovernance Framework for Health and SocialCare in Wales (2009).

� Develop management and leadership skillsthat encourage and influence engagement inresearch and research evidence.

� Encourage research awareness at all levelsand create a culture in which research anddevelopment is a key component of everynurse’s role.

� Underpin and support developments inPublic Health Wales nursing and midwiferypractice with research programmes alignedto service priorities.

� Systematically reflect and review practicethrough robust audit and service evaluationto ensure effective and efficient approachesare maintained.

� Ensure all nurses and midwives will beengaged in audit or quality improvementrelated activity as an essential part ofpractice.

We will achieve this by . . .� Developing a system and framework for

nurses and midwives which will supportindividuals interested in moving from noviceto experts in research practice.

� Encouraging and promoting nursing andmidwifery research awareness and action,which will enable increased researchcapacity and contribution from theprofession to flourish.

continued overleaf

“Research is creating new knowledge.” Neil Armstrong


Research and Development

Theme Ten continued

“Practitioners often see the gaps that researchers don’t see and are able to work together toconduct studies.” Vangie Foshee, Gillings School of Global Public Health

We will achieve this by . . . continued� Developing a framework and structure that

will encourage and support nursing researchawareness and create research capacity.

� Ensuring an effective interface is establishedbetween the Research and Developmentdivision and the system which will supportnursing and midwifery research.

� Identifying key points of contact who will beresponsible for strengthening links betweenHigher Education Institutions, the CommunityNursing Research Strategy network and otherprofessional bodies.

� Engaging with the Professional andOrganisational Development team of PublicHealth Wales to utilise their support fornational workforce development andinter-disciplinary learning, developmentand training.

� Engaging in the Management and Leadershipdevelopment programme to improvemanagement skills and competencies that willimprove research participation.

� Sharing good practice both internally withinthe organisation and externally with ourstakeholders, including national and localgovernment.

� Encouraging nurses and midwives to activelyseek research scholarships and apply forresearch grants.

� Encouraging nurses to demonstrate howthey are contributing to the research agendathrough annual appraisals and developmentreviews.

� Supporting staff to publish research papersand present at conferences.

� Proactively seeking programmes andinitiatives that enhance and expandopportunities for multidisciplinary and nurseled research programmes.

� Developing research capacity within allteams to strengthen focus on evidencebased service.

� Undertaking regular audits, as part of astructured work plan, to identify anddemonstrate good practice and helpimprove the quality of services.

� Identifying within appraisal systems howaudit is evidenced within individual practice.

Definition of Clinical Audit: A quality improvement process that seeks to improve patient care andoutcomes through systematic review of care against explicit criteria. Health Research Authority(2)

The Public Health Wales nursing strategy is:

“The vision and direction for nurses working in Public Health Wales.”

Anne McGowan, Nurse ConsultantVaccine Preventable Disease Programme


References

Appendix One

American Dental Education Association. (2014).Public health nurse. [Online]. Available at:http://explorehealthcareers.org/en/Career/149/Public_Health_Nurse [Accessed: 10th Mar 2014]

Boyle D and Harris M. (2009). The challenge ofco-production. How equal partnerships betweenprofessionals and the public are crucial to improvingpublic services. Nesta. Available at: http://s.bsd.net/nefoundation/default/page/file/312ac8ce93a00d5973_3im6i6t0e.pdf [Accessed: 10th Mar 2014]

Faugier J and Butterworth T. (1994). Clinicalsupervision: a position paper. Manchester: Universityof Manchester.

Institute of Medicine. (1990). Consensusdevelopment at the NIH. Improving the program.Washington DC: National Academy Press.

King’s Fund. (2013). Revalidation: opportunity orchallenge? Weblog 23 January. Available at:http://www.kingsfund.org.uk/blog/2013/01/revalidation-opportunity-or-challenge [Accessed 10th Mar2014]

NHS Employers. (2014). Appraisal and simplified KSF.[Online]. Available at:http://www.nhsemployers.org/PayAndContracts/AgendaForChange/KSF/Pages/Appraisal-and-simplified-KSF.aspx [Accessed: 10th Mar 2014]

NHS Health Research Authority. (n.d.). Determinewhether your study is research. [Online]. Availableat: http://www.hra.nhs.uk/research-community/before-you-apply/determine-whether-your-study-is-research/ [Accessed: 10th Mar 2014]

NHS Health Research Authority. (n.d.)http://www.hradecisiontools.org.uk/research/glossary.html#H [Accessed: 10th Mar 2014]

Nursing and Midwifery Council. (2014). Regulation inpractice. [Online]. Available at: http://www.nmc-uk.org/Nurses-and-midwives/Regulation-in-practice/[Accessed: 10th Mar 2014]

Nursing and Midwifery Council. (2014). Revalidation.[Online]. Available at: http://www.nmc-uk.org/Documents/Revalidation/Revalidation%20factsheet.pdf [Accessed: 10th Mar 2014]

Nursing and Midwifery Council. (2008). The code.Standards of conduct, performance and ethics fornurses and midwives. [Online]. Available at:http://www.nmc-uk.org/Documents/Standards/nmcTheCodeStandardsofConductPerformanceAndEthicsForNursesAndMidwives_TextVersion.pdf[Accessed: 10th Mar 2014]

Sully P and Dallas J. (2010). Communication skills fornursing and midwifery. London: Elsevier HealthSciences.

United Kingdom Central Council for Nursing,Midwifery and Health Visiting. (1996). Positionstatement on clinical supervision for nursing andhealth visiting. London: UKCC.

Weihrich H and Koontz H. (2005). Management.A global perspective. 11th ed. Singapore: McGrawHill. Chpt 5.

Welsh Assembly Government. (2011). Code ofconduct for health care support workers in Wales.Cardiff: WAG. Available at:http://www.qni.org.uk/uploaded/Final%20-%20NHS%20HSW%20Booklet%20ENG.pdf[Accessed: 10th Mar 2014]

Welsh Assembly Government. (2010). Doing well,doing better. Standards for health services in Wales.Cardiff: WAG. Available at:http://www.wales.nhs.uk/sites3/documents/919/english%20web%20version.pdf [Accessed: 10th Mar2014]

Welsh Assembly Government. (2009). Researchgovernance framework for health and social care inWales. Cardiff: WAG. Available at:http://nww2.nphs.wales.nhs.uk:8080/PHWRandDDocs.nsf/($all)/4602A12262FF565880257AB10050A467/$file/Research%20Governance%20Framework%20Wales%202009.pdf [Accessed: 10th Mar 2014]

Welsh Assembly Government. (2008). Designed torealise our potential. A beliefs and action statementfor nurses, midwives and specialist community publichealth nurses in Wales for 2007 and beyond. Cardiff:WAG. Available at:http://wales.gov.uk/topics/health/cmo/professionals/officechiefnursing/cnopublictions/realise/?lang=en[Accessed: 10th Mar 2014]

Welsh Assembly Government. (2003). Fundamentalsof care. Guidance for health and social care staff.Cardiff: WAG. Available at:http://www.wales.nhs.uk/documents/booklet-e.pdf[Accessed: 10th Mar 2014]

Welsh Government. (2013). Delivering safe care,compassionate care. Learning for Wales from Thereport of the Mid Staffordshire NHS FoundationTrust Public inquiry. Cardiff: WG. Available at:http://wales.gov.uk/docs/dhss/report/130710safecarefen.pdf [Accessed:10th Mar 2014]