One of the largest foundation trusts in England has begun to see significant improvements in basic standards of nursing care after introducing a unique training initiative for its nurses.
The system has led to fewer falls and pressure ulcers, and better use of catheters at the Heart of England Foundation Trust in Birmingham, according to information shared with Nursing Times.
Nurses have also displayed a similar knowledge of basic nursing care regardless of whether they have a degree or a diploma – appearing to quash claims that higher education is leading to the loss of fundamental skills.
The trust’s chief nurse Mandie Sunderland has led the development and roll out of an online skills assessment and training system called VITAL4Care, as reported earlier this year. It was prompted by a series of adverse local media stories, many focusing on basic care failures.
Nurses are assessed on essential knowledge and skills across 14 fundamental areas of care. Where nurses fall short on knowledge the system is intended to help them improve before re-taking the test.
More than 2,000 registered adult nurses have completed assessments since the trust began introducing VITAL around 18 months ago.
Results have been similar irrespective of experience or education level, with staff attaining average scores of 119-120 out of 140. Latest data also suggests it has led to steady improvements in a number of measures for patient outcomes (see below).
Ms Sunderland said: “It does appear that our registered nurses are practising better and generally we are seeing improvements in fundamental basic standards and patient care.
“I feel so much more confident about what my nurses know and I now have the assurance we are doing everything possible to provide excellent standards of care,” she told Nursing Times.
“It can be hard to keep up to date with training and what the latest developments are, but with VITAL we have condensed that information and put it all in one place with different learning mechanisms to keep it interesting.”
She added that the trust had also launched a nursing and midwifery badge, which nurses can only receive if they gain 100% in their VITAL assessment.
“Our culture has improved,” she said. “There is the feeling people are proud to work here and they want to wear their badge because it says they are an excellent nurse.”
The system is currently being adapted and rolled out to midwives, children’s nurses, neonatal nurses and healthcare assistants.
- Overall trust-wide pressure ulcer prevalence has steadily decreased from 3.33% in January 2011 to 2.68% in March 2012
- Percentage of severe hospital acquired pressure ulcers – grade 3 and above – has fallen from 0.72% in January 2011 to 0.21% by March 2012
- Use of hospital inserted urinary catheters has reduced from 12.28% in September 2010 to 11.54% in December 2011
- Compliance with the trust’s nursing care indicator for continence assessments has improved from 86% in April 2011 to 94% in March 2012
- The falls rate for inpatients has decreased from 11.5 during January to March 2011 to 8.6 during January to March 2012
Average VITAL scores:
(out of 140 across 14 areas of care)
- Nurses with diploma – 118.91
- Nurses with degree – 119.94
- Nurses who qualified before 1988 – 119.18
- Nurses who qualified after 2000 – 119.08