How do we empower nurses today?

Nursing has long been seen as a challenging profession but viewed by many as a vocation for the dedicated and the selfless, which relies on nurses being professional, self-aware and motivated educators to lead change. Being caring and compassionate were integral to the role, as was the ability to follow instruction, which for some led to ritualistic practice for a number of years.

The development of nurse education led to evidence-based practice through nursing data and research, which has been key to empowering nurses to influence change, resulting in service improvements and better quality of care, and recognition of the need for nursing to be part of a life-long learning process.

Nursing empowerment is a structural process which supports shared team goals and ability. This is  supported by open communication and positive leadership which has the desired outcome of motivating staff to work to the best of their ability which will improve achieving outcomes and  creates the capacity to utilise resources and to provide support, opportunity, and information.

Research shows that empowering nurses allows for better decision making, job satisfaction, reduces stress and improved outcomes for patients. Subsequently when nurses are in a position to influence, they are less likely to suffer from ‘burnout’ as they feel listened to and are empowered to work to the top of their job descriptor.

Within the care sector nurses should not only be empowered but expected to work with a high degree of autonomy, and to act as an advocate for the residents, as they can’t always do this for themselves.

According to the RCN ‘One of the most important principles of safeguarding is that it is everyone’s responsibility ’.This requires strength of character to challenge other professionals, who may often hold more senior roles, to ensure the views of the residents are upheld, and more importantly no harm ensues. The quality of care is reliant on nurses measuring risk and harm and being educated and skilled to act appropriately to ensure safe practice.

This is particularly important within the independent care sector to ensure that despite some residents being frail and having cognitive deterioration, that they are still given the opportunities for improvement and achieve a level of stability through preventative programmes

Research would indicate that a move to an inclusive approach empowers residents through self- determination and autonomy although this does require the nursing staff to think differently and be more innovative.

The World Health Organisation (WHO) defines patient empowerment as “a process through which people gain greater control over decisions and actions affecting their health” and should be seen as both an individual and a community process.

This is evident within interventions such as the Care About Physical Activity (CAPA) programme and meaningful activities used with care home nursing, which show that empowerment initiatives provide both a process and an outcome. Research is limited in this field however if empowerment is present for staff then residents may benefit in a way that promotes an awareness of self-ability that can influence goal setting, with the potential to improve quality of life.

So how do we empower our nurse today?

Education, alongside a determination to provide quality care within a positive culture of change has brought nursing to where it is today, but it is through positive leadership that we will harness our nurses to be empowered today and into the future.

We know that disempowerment can be related to deficient leadership interventions. Some nurses may feel that managers are insensitive to their staffing needs, don’t support employee well-being, and don’t invest enough in training or career or professional advancement. This is fundamental to ensure successful recruitment and to retain staff in this field. Many nurses leave their positions because of negative experiences with heavy or unrealistic workloads, as well as a feeling of being unheard and undervalued.

On the other hand, several studies have indicated that when staff rate their managers then they feel that they’re listened to, and more likely to get, and be involved in the decision-making process. This is an indicator of positive leadership. Therefore if our managers’ behaviours support a team -based approach, then this will ultimately impact on empowering our nurses.

Creating supportive environments where staff have the psychological safety to speak out, to have an opinion and ultimately grow, is also a reflection of positive leadership. This should not be underestimated as highlighted within this recent article: https://t.co/9aHI8UPvsb?amp=1

Creating a positive culture that provides access to appropriate training and development will provide staff with the necessary knowledge and skills to carry out their role efficiently and effectively .This will boost self -awareness, give staff a voice, and the ability to be confident to act as a representative across a variety of arenas. It will continue to challenge staff to find solutions and promote nurse led initiatives.

This needs however to be done as a systemic organisational approach, as even when positive changes are adopted where staff are not consulted about these changes in advance then the changes can still be perceived negatively by staff.

Through this visionary intelligent leadership approach a supportive culture will exist that expects staff to question, to take risks and to have the permission to ensure transformational change.

Ultimately the message to our nurses is one that continues to push the boundaries for excellence, promotes our new nursing standards, ensures advocacy for our most vulnerable adults and doesn’t lose sight of our ability to care.

 

Jacqui Neil

National Workforce Lead for Nursing, Scottish Care

2020 is the ‘International Year of the Nurse and Midwife’ so it seems the right time for my first ever nursing blog. These will continue each month to celebrate the contribution and dedication of our nursing and care staff across Scotland.

This year offers the prime opportunity to hear about the spectacular work that is happening across our care homes in Scotland ,and to showcase this through our Nursing Blogs and to get our talented staff involved by being guest speakers, and take on the Nightingale Challenge.

Our aim at Scottish Care is to provide a topical platform for updates to keep staff informed and to support employers, and through our staff guest speakers to inform the wider care sector that this sector offers fantastic career opportunities for staff at all levels, and delivers quality care to our residents across Scotland.

January’s blog is looking at Workforce Wellbeing, as it’s the start of the year, and it’s important that all our staff take time to think about their own health and wellbeing, to ensure safe and quality care to their clients/residents.

The social care workforce in Scotland is predominantly female and organisations like Scottish Care have long argued that the way in which the workforce is treated in terms of fair work practices, equal pay and other related matters is often one rooted in a discriminatory approach and is evidence of gender segregation. Research indicates that gendered ageism seems to be the cause of many problems women experience whilst working. This will require a change in prevailing values, beliefs and norms within organisations. Viewing the treatment of female staff through a human rights lens would have a significant impact on the retention of staff.

In light of this I have decided to look at Menopause in the Workplace due to the fact that 86% of the workforce are women and to promote awareness of how managing this can improve retention of staff and reduce the days lost to sickness absence.

The average age of the workforce employed and applying for posts in the care sector is 46 years and above. Many are likely to be mothers, grandmothers or informal carers, alongside choosing to work in an extremely physically and emotionally demanding workplace.

Being aware of this and also that staff may also be experiencing issues as a result of bereavement (personally and or/at work), financial pressures, or other health conditions, is important and knowing that all of this could escalate their menopausal symptoms. Beyond the menopause, the lack of certain hormones in women can lead to increased risk of brittle bones and heart disease.

According to the National Statistics Department (NSD) the average age of women experiencing the menopause is 51 years, although this can happen much earlier for some women, with 1 in every 100 being under 40 years. Nationally there are 3.5 million women over 50 in the workplace and this is set to increase due to the increased retirement age.

The Care Inspectorate’s recent report found women workers over 50 years account for 45% of care workers. This therefore means that a significant amount of women working in care are experiencing symptoms in relation to the menopause, and for some these are very significant and impact on their work and personal lives. It is therefore paramount that this issue is recognised and understood so we can ensure that the working environment is supportive, and that staff feel secure and valued.

The true impact of this is under-reported as many women do not seek help, despite experiencing severe physical and psychological symptoms such as anxiety, depression, loss of confidence as well as severe fatigue and difficulty sleeping. At a time when the care sector is in crisis in relation to recruitment and retention of staff, it is key that the staff who are employed take responsibility, and feel empowered to raise this if they are experiencing menopause symptoms that are impacting on their job.

Findings from a new national report revealed that over 370,000 working women in the UK aged between 50 and 64 admitted they have left, or considered leaving their career, because dealing with the symptoms of the menopause in the workplace was too difficult. As in the NHS, staff absence in the independent care sector for short and long-term absences is increasing in this age group, with data suggesting 1 in 4 experiencing menopausal symptoms consider leaving their jobs. Moreover, in a recent study involving a 1000 women, nearly a third of women surveyed (30%) said they had taken sick leave because of their symptoms, but only a quarter of them felt able to tell their manager the real reason for their absence.

Presenteeism is highlighted as a bigger issue than absenteeism in some areas, as staff are fearful of being reprimanded for being off sick. Especially when many are being managed through inappropriate HR policies, with a lack of occupational health support, which not only prevent staff caring for their own health, but also can negatively impact on the quality of care provided to residents/clients.

This can be achieved by developing more support and by introducing mandatory equality and diversity training around age and gender. This may include the implementation of policies around menopause related absence and flexible working arrangements, as well as encouraging informal women’s support networks across the workforce.

The Equality Act (2010) protects women against workplace discrimination on the basis of sex or age, whilst other pieces of legislation place a general duty on employers around Health and Safety and the welfare of workers.

Recent figures have shown that women aged 50 to 64 are the fastest growing economically active group, and therefore have the potential to support the social care recruitment crisis if they are encouraged to join the workforce and managed and supported to be at work.

The employee should adopt a self -management approach and consider ways to ensure that they are looking after their own health and well-being:

• Keeping hydrated in line with the RCN’s ‘Rest Rehydrate Refuel’, which campaigned to ensure staff get nutritional breaks. Ensure breaks are taken, it’s in no one’s benefit to work on.
• Uptake of the flu vaccine remains considerably low, even in the NHS where staff can access free. This needs to be available to all care staff working with vulnerable adults as this prevents unnecessary short-term absences. It’s not too late ……
• You don’t need to join the gym, go for a walk.
• Eat healthier / Drink responsibly
• Seek help with smoking cessation.
• Mental health and wellbeing information guidance.

The following is a list of organisations/websites that offer valuable help and support to women suffering the symptoms of the menopause:

• British Menopause Society: http://thebms.org.uk
• Menopause Matters: www.menopausematters.co.uk
• NHS: www.nhs.uk/conditions/menopause
• Menopause.org.uk: www.menopause.org.uk

Employers should consider positive changes within the working culture and environment to alleviate the difficulties for women to enable attendance at work, and when absent are able to be supported back to work at the earliest opportunity:

• Encourage all managers to undertake a course to deal with this, and to take account of the menopause transition. This would be a positive step to improving retention and days lost through sickness absence. The 2013 TUC report, Supporting working women through the menopause, found that 45% of managers did not recognise the problems associated with the menopause.
• More recently according to the Wellbeing of Women Survey (2016) despite employers requiring an inclusive workforce, around two thirds offered no specific support to women experiencing difficulties related to the menopause.
• Ensure supervision meetings. The Strathclyde’s Scottish Centre for Employment (SCER) research findings and interviews found that care workers valued supervision as a source of support and an opportunity to reflect on practice.
• Managers and colleagues should be more understanding, including education for ALL members of the workforce.
• Option of flexible working hours and time off for appointments.
• Provision of a quiet, cool room with fan to allow staff time out.

Finally in 2019 the Laura Hyde Foundation  launched a well-being badge for nurses to wear  that states ‘Ask me how I am’,  in a bid to allow the public  to consider the staff wellness.

 

Jacqui Neil

National Workforce Lead for Nursing, Scottish Care

It’s now 3 months since I took up my new post with Scottish Care as National Workforce Lead for Nursing , I feel revitalised and reconnected to Nursing,  and so proud to be a nurse in the ‘International Year of the Nurse’. As you will be aware 2020 marks 100 years of nurse registration, and 200 years since Florence Nightingale and a team of nurses improved the unsanitary conditions at a British base hospital, reducing the death count by two-thirds, which led to worldwide health care reform.

Subsequently Care Home nursing has evolved to meet the increasing demands and changing demographics of older people and will require to continue to evolve in light of the numbers of older people predicted to continue to rise up until 2035. Demographic change is complex, with links between the different drivers of demographic change, and a range of social and economic factors which can impact on trends, leaving projections open to uncertainty . Transformational change and leadership is therefore paramount for sustainability of the workforce.

Networking with front line staff who are delivering first class care and compassion within extremely challenging times, alongside working with strategic stakeholders has confirmed the importance of having a shared goal of improving the profile of care home nursing.

Prior to taking up this post I had a 32 year NHS career managing staff groups across acute and predominately community nursing, taking up my first staff nurse post in 1990 , then working as District Sister, Clinical Team Leader and finally as Service (Locality) Manager within  a HSPC.

Despite not having worked within the independent sector I have had strong partnership alliance with the third and independent sector throughout my career.

Working on improving the recruitment and retention of staff within the care sector at a strategic level allows the opportunity to make a difference at service level. Be reassured that I am fully committed to raising and transforming the profile of nursing, and the quality of care provided within the sector through strong leadership.

In September the pre reg nurse training will ensure all students will have a placement within a care home and it’s up to the staff to make it a memorable rewarding experience, that hopefully will see a trend in more newly qualified nurses seeking to work in care home nursing, and see it a positive long-term career opportunity.

Do not hesitate to contact me if there are any workforce or nursing issues concerning you. It’s important that I am focused on areas of concern that are an issue to service delivery, quality and client safety.

My nursing blogs will start this month starting with Workforce Wellbeing and will continue throughout the ‘Year of the Nurse’  to encourage staff to get involved and undertake the Nightingale Challenge. If you have any topics that you would like highlighted please get in touch by email [email protected] or Twitter @TransformNurse.

 

Jacqui Neil

National Workforce Lead for Nursing, Scottish Care

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On a separate but related note, Tom McEwan from UWS will be hosting a webinar on Friday 17 January at 11:30 am to discuss the new pre reg nursing programme, as well as their proposed pilot of care home placements around their 4 campus areas – Ayr, Lanarkshire, Paisley and Dumfries. They are currently looking for care home providers to nominate themselves to take part in this pilot. Please click here to find out more.