Getting the balance right- Nursing leadership in a digital age.

As we move into the winter months in a year that has presented challenges beyond anything ever faced, we must refocus and ensure that we learn from what has happened. Challenges are also opportunities to do things differently and collaboratively and can result in positive change.

In this last month when we have been informed of an investigative review alongside the push for a national care service. There is undoubtedly real concerns on how this will impact the sector, especially when sustainability is already fragile for many providers. Some may dispute that the timing of this review is not best placed and will not serve to support the future stability of the social care sector.  The real hope for such reviews is that they allow a collaborative approach which provides choice and control for the people of Scotland and to ensure the future of health and social care integration.

We understand the care sector is extremely complex and tightly regulated to ensure that care is delivered in a way that edifies the safety of all residents and that the care delivered within a framework through real professionalism by meeting all standards around personal outcomes. Ensuring personalisation is central to realistic care and is something the care home sector prides itself on, and rightly so.

For a mutual agreement to happen it is key to ensure mutual respect and understanding exists. Many of the frustrations the sector has felt have been as a result of not working in sync, making changes at one end with little regard on how this may impact across the care sector.

The mutual aid and care assurance provided by NHS boards and HSCP’s was initially viewed by some  with skepticism, however in the main this has now been shown to be supportive in nature and also provides a recognition of the professional care being delivered across our care at home and care home services. Despite the inequalities that have existed in relation to accessing PPE, testing for staff and residents, alongside visiting restrictions there is a real desire to get problems resolved as quickly as possible to reduce the risks to residents and staff, especially round stress and distress.

 It is completely understandable that we must be stringent and inspected to protect against the risks of spreading infections as we care for the most vulnerable groups and have come through the greatest loss of life. The care sector requires prompt and workable guidance, and this has not been the case over the last several months, often being left in a state of limbo, spinning plates until the next piece of guidance or legislation is advised, which often conflicted with the previous guidance.

So, it’s important to concentrate therefore on what we can control.

It is people that make things happen and therefore we must ensure that there is leadership that will be strong and appropriate to take our staff through and out the other side. Staff are without question our greatest asset and as such we must ensure we prepare them to work to the top of their roles and that they are fully supported to understand their responsibilities alongside promoting a creative environment to enhance change to best fit the needs of our older people, who make care homes their homes, either through need or choice.

One thing that has been paramount during these last few months is that our care homes are our residents’ homes, their homely settings, not a hospital ward and as a sector it is important that this continues to be raised in relation to impractical, unworkable guidance and to protect people’s human based rights.

This is reliant on our professional care home managers feeling empowered and ensuring the needs of residents and families remain the key priority. This requires resilience demonstrated through leadership and professional integrity.We fully understand that transformational leadership in care homes can improve staff job satisfaction and retention and enhance the delivery of effective care for residents but this needs to be future proofed including in the context of the new digital age in order to succeed. Leadership needs to be promoted at all staff levels as part of ensuring the development of healthy work cultures and behaviours. Throughout this pandemic the words all in it together have been mentioned often and are truly the way to promote true compassionate leadership.

As we understand and learn from the effects of unhealthy work environments and the detrimental impact these can ultimately have on care outcomes then we must focus on leadership that is compassionate, is empathetic and supportive. This style of leadership is what provides trust and safety for staff to develop and to feel motivated and valued and ultimately drives service improvements and best value.

The wellbeing of staff therefore needs to be at the fore-front and this is as important for managers just as it should for all other staff. Managers can often feel isolated and pressured to feel like they are coping when they may be struggling. The need for self -care therefore needs to be recognised as a key determinant to ensure stability during a time of uncertainty.

Leadership historically is viewed through a lens of a ranges of styles, which may be interchangeable to enhance and ensure safe practice, and should promote access to information resulting in a motivated high performing efficient and effective team.

Over the years we have seen a leaning towards a more empathic style of leadership (humanity based) which ensure the manager and the staff are integrated in the aims and ambitions of the team through a mutual trust and open culture. Gone are the days of traditional bureaucratic leadership of command and control within a hierarchical approach. As we develop a transformational approach to service redesign so does the leadership style transform. Therefore, based on this it seems natural that our leadership style requires to be mindful of the gains that leadership could have by the use of e-health, social media and digital progression.

There has been a real push for the development of digital platforms to ensure live information around care and the conversion from paper-based processes to digital. This has been escalated during the pandemic to ensure tighter safeguards. An example of such is the introduction of the daily digital safety huddle management tool, rolled out to care homes in line with the platforms used by NHS nursing staff. The purpose being to be able to deliver excellent care and take appropriate escalation procedures around staff and patient safety and monitoring. During the last few months we have witnessed visually and in practice the real benefits in the use of digital platform to access information and deliver services through virtual technology such as Near Me. Although for some scenarios the preference would still be to be a face to face conversation, it definitely allows for a speedier decision making process and ensures better time management.

So, to lead into the future it is important our staff embrace the technology and make it intrinsic to their working practice whether this is through teaching, providing clinical supervision or promoting e-care planning, or rostering to ensure a capable workforce. This will require financial support and time invested to rectify digital poverty across the sector to ensure national equitable approaches which do not put our residents at risk. It also requires enhanced knowledge and skills to be developed around data analysis and quality improvement processes. The sector has innovative staff but requires this collaborative consideration to achieve a meaningful vision for care home nursing.

When I took up the post of transforming workforce lead for nursing, I didn’t envisage how the term transforming would truly be brought to life, during this exceptional year of the nurse. What a year indeed. The speed and pace of work has been exceptional and has managed to move nursing to the forefront of the future integration plans, with the true value of nurses recognised through their resilience and compassionate care. On a personal level until last year I had never written a blog nor was I an active participant on social media however the professional benefits gained by keeping updated and reflective practice are priceless and I would recommend all nurses to let your voice be heard.

I truly believe all nurses are transformers and leaders, we all have a journey, some just starting off and others nearing the end of their professional careers with a legacy to leave and be taken forward. Lead by example, be true to yourself and your patients/residents and ensure you advocate to ensure care is never compromised and our communities have the opportunities to thrive and our vulnerable receive the best care possible through leading from the heart.

Jacqui Neil

Transforming Workforce Lead 

@TransformNurse

Last Updated on 21st September 2020 by Shanice