APPENDIX 4 PART OF NTW(c)22 A Complete NTW Nursing Strategy 2014-2019 Delivering Compassion in Practice Assistant Practitioner Guidance Document
Introduction. In March 2014 the Trust launched its five year Nursing Strategy Delivering Compassion in Practice. A key aim of the strategy is to enable the Trust to set the future direction of our nursing and care workforce. In the nursing strategy we made a commitment to develop comprehensive career and development pathways for the whole of our nursing workforce and create workforce capacity, capability and flexibility to take on new and extended roles. We believe by determining suitable staff skill mix of competency, experience and education we will best improve the experiences of service users and staff. The development of the Assistant Practitioner post is a key element in delivering our Nursing Strategy; this new role provides opportunities to extend traditional roles and allows skilled trained staff to make a greater contribution to the development and implementation of collaborative, needs based care. To support you to make the transition into this new role we will provide you with a twelve month period of preceptorship. During this period you will be supported by a work based mentor who is an experienced Registered Nurse who will guide and support you in achieving the competencies set out in this portfolio. You will also be supported through tripartite meetings with your mentor and Ward Manager. Following your period of preceptorship you will continue to use the competency framework set out in this portfolio to demonstrate your competence in practice on an ongoing basis; taken from the Assistant Practitioner job description, the framework is integrally linked to Trust Values; Skills for Health Code of Conduct for Healthcare Support Workers and our Nursing Strategy: Call to Action and will be used as the foundation for appraisal and continuous development whilst in this post. Gary O Hare Executive Director of Nursing and Operations V02 2
Contents Page What is Preceptorship Page 4 Responsibilities Page 5-7 Monitoring Progress Page 8 Support Mechanism Page 9 Reflective Practice Page 9-10 Portfolio of Evidence Page 10-11 Competency Page 12 Assessment of Competence Page 12 Appendix Page 13-16 V02 3
What is Preceptorship? Preceptorship is about providing you with the support and guidance you will need to make the transition to becoming a competent Assistant Practitioner. It is a structured process of induction and development that will help you to address some of the challenges of this new role and improve your transitional experience. It will help you to develop your confidence as an Assistant Practitioner and by promoting the development of a more able and confident practitioner improve patient care. How long will it last? NTW recognise that this is a new role not only to you; but to the team in which you work and we have therefore agreed to provide a period of preceptorship of twelve months. This allows you to develop your knowledge and skills and demonstrate your competency over a sustained period of time. Why is it important? The preceptorship and competency document is underpinned by :- Trust Values. Caring and Compassionate Respectful Honest and Transparent Code of Conduct for Healthcare Support Workers As an Assistant Practitioner you make a valuable and important contribution to the delivery of high quality healthcare, care and support. The Code is based on the principles of protecting the public by promoting best practice and the Trust considers it good practice and supports its implementation. Nursing Strategy Call to Action You should use the Call to Action when reflecting on your practice and when completing your evidence portfolio to reference the way in which you have demonstrated them against your competency framework; Skills for Health Code of Conduct for Healthcare and Support workers, Trust values and the Code. The most relevant sections are:- Strategic Aim 4 Building and Strengthening Leadership in which we commit to; Identifying career and development pathways for our nursing workforce designed to build the knowledge and skills needed to future proof the nursing workforce Strategic Aim 5: Ensuring we have the right staff, with the right values and skills, in the right place in which we commit to Support the development of a refreshed competency based induction and appraisal system which incorporates the values and behaviours of compassion in practice Strategic Aim 6: Supporting positive staff experience in which we commit to; Implementing a nursing portfolio for all nursing and care staff which will be aligned to competency frameworks linked to annual appraisal V02 4
Responsibilities You will Practice in accordance with your job description and operating procedures and protocols Adhere to all Trust policies and procedures Identify and meet with your mentor as soon as possible after you have taken up post Prepare for your regular meetings with your mentor Be flexible in meeting the requirement to work a minimum of one day per week with your mentor Work with your mentor to develop learning goals and agree SMART (specific, measurable, attainable, relevant and timely) objectives and achieve these by using your personal development plan in line with the NTW ( HR) 09 Staff Appraisal Policy (Non Medical) Prepare for clinical supervision sessions Maintain a reflective practice journal Attend any training deemed appropriate Ensure that you understand the competency framework set by the Trust Take responsibility for providing evidence to demonstrate your competence as an Assistant Practitioner Be open and willing to discuss any limitations or problems you may have; accept constructive criticism and where required work with your mentor to develop further action plans Attend peer support / reflective practice days Accept accountability for your practice and the care you give your patients adhering to the Code of Conduct for Healthcare Support Workers V02 5
Responsibilities Your Mentor will - Be an experienced Registered Nurse and qualified mentor Work a minimum of one day per week with you Meet with you on a regular basis to evaluate your progress towards fulfilling the objectives set Provide clinical supervision Provide positive feedback on those aspects of your performance that are being undertaken well Provide honest and objective feedback on those aspects of performance that require further development or are a cause of concern and assist you to develop a plan of action to remedy these Facilitate you to meet the knowledge and skills of the competency framework in line with NTW ( HR) 09 Staff Appraisal Policy (Non Medical) by; - assessing your past experience to determine your development needs - agreeing a personal development plan including any training - setting specific, measurable, attainable, relevant and timely objectives (SMART) - identifying the type and range of evidence you will need to demonstrate competence - assisting in the reflection and review process at the quarterly formal stages of the review process Facilitate your transition to an Assistant Practitioner who is; - confident in her/his practice - sensitive to the needs of patients / service users - an effective team member and up to date with her/his knowledge and practice V02 6
Responsibilities Your Manager will Identify an appropriate mentor Meet with yourself and your mentor during the induction phase Ensure that you work a minimum of one day per week with mentor Monitor implementation of preceptorship to ensure personal development plans are in place and that you are achieving required role competency in line with NTW ( HR) 09 Staff Appraisal Policy (Non Medical) Ensure the clinical area provides a high quality learning environment Ensure you are provided with clinical supervision Be an active participant in tripartite meetings Monitor the preceptorship process to ensure it is appropriate and equitable Ensure action plans are implemented Problem solve any issues as they arise Contribute to the Trust evaluation of the role of Assistant Practitioner V02 7
Monitoring Progress Informal meetings should take place once a month Your mentor will arrange the meeting with you; the initial meeting should take place within the first week in post. Prior to this meeting you should familiarise yourself with this guidance, complete the form which outlines your previous experience and learning and consider you development needs and any issues you wish to discuss. During this meeting you should commence your personal development plan with your mentor Each meeting will be recorded on the documentation provided in the competency document. After one month in post you should agree objectives (Trust, service and role ) as outlined in NTW ( HR) 09 Staff Appraisal Policy (Non Medical) There will be a quarterly formal review of progress (tripartite meeting) with your mentor and manager. You will be responsible for preparing for this meeting which will be recorded on the forms provided Attendance at the peer support / reflective practice days should be planned with your mentor /manager Tripartite Meetings Tripartite meetings should involve you, your mentor and ward / team manager. There should be an initial meeting at the outset of your preceptorship and then quarterly. Additional meetings may be held at the request of any party. The expectations should be clear to all and will include the following; Clarification of current level of functioning Agree support needed Review progress against the framework Professional and practice development issues Personal development plan Training requirements Work performance issues Any concerns or disputes should be raised within the tripartite meetings, and /or following Trust procedures The purpose of the Tripartite meetings is to support you; provide guidance and constructive feedback and where appropriate highlight areas for development and actions required. It will be the responsibility of your mentor and manager, where required to formally identify any issues of concern and agree a development and monitoring process to support you. V02 8
Support Mechanisms 1. Clinical Supervision Clinical supervision is a term used to describe the formal process of professional support and learning which enables individual practitioners to develop knowledge and competence, assume responsibility for their own practice and enhance consumer protection and safety in complex clinical situations. It is central to the process of learning and to the expansion of the scope of practice and should be seen as a means of encouraging self-assessment and analytical skills. (DH 1993) Through the development of competence (including appropriate values, relevant knowledge and high quality care) clinical supervision aims to facilitate the delivery of consistently high standards of care enabling the practitioner to reflect on practice, clarify goals, identify appropriate clinical interventions and to accept appropriate individual responsibilities (i.e. duties of post; tasks agreed with supervisors) and the related personal accountability (e.g. by setting and monitoring acceptable standards of practice: Clinical Governance: DH, 1998). Your mentor will provide you with monthly clinical supervision in line with NTW (C) 31 Clinical Supervision and Peer Review Policy. It is important that you come to this meeting prepared; your reflective journal will be of particular use to you during these sessions. You will document these sessions as per NTW (HR) 09 Staff Appraisal Policy (Non-Medical). 2. Peer support / reflective practice days During your preceptorship period you will be invited to attend peer support/reflective practice days on a quarterly basis. These sessions offer you an opportunity to share your experience and reflect on your practice in a safe environment supported by experienced senior nurses. Your reflective journal will help you to prepare for these sessions. 3. Reflective Practice: What do we mean? Reflective practice centers on the idea of lifelong learning; it is a way of analyzing our experiences in order to learn from them and improve the way we work; increasing confidence and creating a proactive approach to practice. Engaging in reflective practice improves the quality of care and closes the gap between theory and practice. V02 9
Reflective practice can be defined as; the process for making sense of events, situations and actions that occur in the workplace ( Oelofsen, 2012; Boros, 2009) What is important about reflection throughout your practice is that you are not just looking back on past actions and events, but taking a conscious look at your emotions, experiences, actions, and responses, and using that to add to your existing knowledge base to draw out new knowledge, meaning and have gain a higher level of understanding, all of which can be recorded in a reflective journal. Benefits to Reflective Practice include:- Increased learning from an experience Identification of personal and professional strengths and areas for improvement Identification of educational needs Acquisition of new knowledge and skills Further understanding of own beliefs, attitudes and values Encouragement of self-motivation and self-directed learning Could act as a source of feedback Possible improvements of personal and clinical confidence Models of Reflective Practice include Kolb 1984, Gibbs 1988 and Rolfe 2001. See Appendix for further information Portfolio of Evidence It s important that as you progress you collect evidence that demonstrates practice and professional development in line with the defined competencies and achievement of your appraisal objectives ; in line with Trust Values ; Nursing Strategy Call to Action and your Code of Conduct for Healthcare Support Workers. Remember you are not required to provide a piece of evidence for each; rather you should reflect holistically how the evidence reflects the component parts. The portfolio of evidence should be used during reviews (both in your preceptorship period and in ongoing reviews for appraisal) and will help both you and your mentor to identify your learning and development needs. The portfolio provides assurance that you can deliver on a practical level as well as the theoretical rationale for delivery of care. Evidence provides objective information on the level of your competence and your competency in your role. It is important that you discuss with your mentor the type of evidence that will be required and gathered. You must ensure that you clearly link the evidence to the appropriate indicator and may include; Research articles V02 10
Reflective journal Witness testimonies Examples of records Service user and carer feedback Care plans Risk assessments Record of attendance at meetings Ward guidelines Relevant policies ( and the way in which they have been applied) Please note in developing evidence confidentiality must be maintained Evidence should be; Valid/Relevant: does it meet the needs of the indicators of the competency framework. Relevant to any training and development needs that have been jointly identified Sufficient: there must be enough evidence to match work against all of the indicators. One piece of evidence can be used for more than one indicator and core practice area. Current: it must be up to date and must demonstrate that knowledge and skills are being currently and consistently demonstrated and used. Reliable: it needs to be appropriate and reflect the standards required. Authentic: can the evidence be attributed to the individual.. V02 11
Competence and competency. Competence is made up of four inter linked components; Knowledge: you must first acquire the knowledge to know how to do your work and why you do it Skills : you must learn the skills required for your role Behaviour : you must demonstrate the behaviour that is required to effectively manage every situation you will encounter Judgement : you must finally develop and use your judgement to appropriately address situations Competency can be defined as the application and demonstration of appropriate knowledge, skill, behaviour and judgement in a practice setting. It can t be attained simply by attending a course and you can t measure it simply by passing a test; it can only be confirmed when; Knowledge and skills are consistently applied in practice Assessment of Competence Your mentor is required to assess your competence against the core practice areas and the indicators in the competency framework. This is not a one off assessment rather as you progress your mentor will work with you to monitor your progress and identify any areas in which you need to develop. They will assess your ability against the indicators to; consistently apply knowledge and skills in practice consistently display appropriate behaviours and judgements in practice practice in a safe and confident manner Through monthly meetings; clinical supervision and tripartite meetings your mentor, manager and yourself will review your progress and provide advice and guidance on any actions you need to take (utilising the competency assessment form provided) and where required formally identify any issues of concern and agree a development and monitoring process to support you. V02 12
Appendix V02 13
Appendix 1 Caring and Compassionate Put yourself in other peoples shoes Listen and offer hope Focus on recovery Be approachable Be sensitive and considerate Be helpful Go the extra mile Trust Values Respectful Value the skill and contribution of others Give respect to all people Respect and embrace difference Encourage innovation and be open to new ideas Work together and value our partners Honest and Transparent Have no secrets Be open and truthful Accept what is wrong and strive to put it right Share information Be accountable for our actions Corporate Appraisal Objectives 2014/2015 For all Staff ( not line managers) For all Staff To work with your line manager and colleagues to develop your team objectives for the next year To understand and contribute proactively to transformation in your local area and understand how your work, in your team, helps to deliver high quality patient care Skills for Health Code of Conduct for Healthcare Support Workers Be accountable by making sure you can answer for your actions or omissions Communicate in an open, and effective way to promote the health, safety and wellbeing of people who use health and care services and their carers Uphold and promote equality, diversity and inclusion Work in collaboration with your colleagues to ensure the delivery of high quality, safe and compassionate healthcare, care and support Promote and uphold the privacy,dignity,rights,health and wellbeing of people who use health and care services and their carers at all times Respect a person s right to privacy Strive to improve the quality of healthcare, care and support through continuing professional development V02 14
Strategic Aim 1 Call to Action: Helping people to stay independent, maximising well-being and improving health outcomes Develop your skills as a health promoting practitioner making every contact count Ensure you use clear principles of recovery /living well in all interventions; working within broad agreed care pathways Build meaningful relationships increasing time spent with patients and service users by utilising appropriate technology Reduce the impact of health inequalities for people with a learning disability Maximise your contribution to the dementia challenge Nursing Strategy Strategic Aim 2 Call To Action: Working with people to provide a positive experience of care Recognise rights and aspirations of patients; service users; carers and their families Embed the 6C s in your daily practice and use these to evaluate the standards of care and support received Listen to; seek out and act on patient, carer feedback ensuring the patient and carer voice is heard Strategic Aim 3 Call to Action : Delivering high quality care and measuring the impact of care Use measures of care to help you learn improve and highlight the positive impact on the people you care for Develop knowledge and skills to interpret data and research findings Commit to supporting the development of a culture of continuous improvement Ensure you and your team use evidence and information available to continually improve the standard of care delivered every day Strategic Aim 4 Call to Action : Building and strengthening Leadership Put yourself in patients shoes and ensure your actions are always in their best interest Include examples of how you have delivered the 6C s in appraisals with your line manager Act as a role model at all times setting and maintaining high standards of care and treatment Utilise available staff effectively within the team to maximise delivery of 6 C s Raise concerns and challenge practice if it is not contributing to wards delivery of compassionate care Strategic Aim 5 Call to Action: Ensuring we have the right staff, with the right values and skills, in the right place Incorporate values and behaviours of Compassion in Practice into recruitment and appraisals Strategic Aim 6 Call to Action : Supporting positive staff experience Engage fully in the appraisal system taking joint responsibility for a positive personal development plan Engage in clinical supervision and where appropriate skills based supervision Personally be responsible for applying the 6 C s every day in your work in line with statutory duty of candour Acknowledge your own lived experience of using health care services : creating a culture where your experience is valued Collect, share and further review evidence based good practice V02 15
Appendix 2 Models of Reflective Practice There are a number of models of reflective practice which can be used to develop ourselves as reflective practitioners but here are three which are commonly used discuss them with your mentor and using these examples select one and retain a reflective journal. In all of your reflections consider how they may impact on your agreed objectives. Kolb 1984: this model highlights the concept of experiential learning cycle and is centered on the transformation of information into knowledge. This takes place after the situation has occurred and entails a practitioner; reflecting on the experience gaining a general understanding of the concepts encountered during the experience then testing these general understandings on a new situation In this way the knowledge that is gained from a situation is continuously applied and reapplied building on a practitioner s prior experiences and knowledge. Gibbs 1988: describes the use of structured debriefing to facilitate the reflection involved in Kolb s "experiential learning cycle". Gibbs describes the stages as; Description: What happened Feelings: What were your reactions and feelings Evaluation: What was good or bad about the experience Analysis: What sense can you make of the situation; what was really going on; were different people's experiences similar or different in important ways; do you need to bring in any ideas from outside the experience to help you." Conclusions (general): What can be concluded, in a general sense, from these experiences and the analysis you have undertaken Conclusions (specific): What can be concluded about your own specific, unique, personal situation or way of working Personal action plans: What are you going to do differently in this type of situation next time; what steps are you going to take on the basis of what you have learnt It is a 'cycle' because the action you take in the final stage will feed back into the first stage, beginning the process again. Rolfe 2001: this model is a cycle composed of three questions; What is the problem...was my role...happened...were the consequences So what...was going through my mind...should I have done...do I know about what happened now Now what...do I need to do...broader issues have been raised...might happen now V02 16