VOL: 96, ISSUE: 43, PAGE NO: 37
Chris Caldwell, BSc, MSc, RGN, RSCN, PGDipEd, is principal lecturer (practice development), RCN Development Centre, South Bank University and lead nurse (clinical leadership and supervision), Barnet and Chase Farm Hospitals NHS Trust, Enfield
Wilma MacPherson, CBE, MSc, RGN, DipN, is director of quality and nursing, Guy's and St Thomas' Hospital NHS Trust, LondonThe erosion of the ward sister's role in leading, teaching, and monitoring the quality of patient care has been well documented (Girvin, 1998; Malby, 1998). However, the current nursing strategy for England, Making a Difference, demonstrates a clear recognition of, and commitment to, the leadership role of the ward sister: 'They are sometimes undervalued and do not attract the recognition they deserve. Yet they are the backbone of the NHS, and the hub of the wider clinical team' (Department of Health, 1999).
The erosion of the ward sister's role in leading, teaching, and monitoring the quality of patient care has been well documented (Girvin, 1998; Malby, 1998). However, the current nursing strategy for England, Making a Difference, demonstrates a clear recognition of, and commitment to, the leadership role of the ward sister: 'They are sometimes undervalued and do not attract the recognition they deserve. Yet they are the backbone of the NHS, and the hub of the wider clinical team' (Department of Health, 1999).
Thus, in 1997 an open learning resource pack was developed in collaboration with experienced ward sisters and senior nurses (Guy's and St. Thomas' Hospital NHS Trust, 1997). It aimed to enable ward managers to evaluate their strengths and identify areas for development. In order to gain maximum benefit from the initiative, they set up work-based learning groups where they could develop together, sharing experiences and learning from their peers.
Programme aims and outcomes
The programme runs over a six-month period and aims to:
- Enable participants to achieve a critical understanding of their leadership and management style and the effect that this has on their colleagues and patients;
- Develop confident and skilled clinical leaders who are creative, flexible risk-takers who are able to work well both within and across professional teams;
- Develop nurse leaders who are able to promote the value of nursing to enhance patient care;
- Provide peer networking;
- Enable participants to identify and achieve individual development goals that have an impact on both themselves and the organisation.
Learning processes and tools
The programme content is based on the individual needs of the participants. They are expected to explore their learning needs honestly and take responsibility for addressing them. This process begins with a 360-degree review where participants ask their colleagues (manager, peers and subordinates) to evaluate their leadership ability using the Leadership Practices Inventory (Kouzes and Posner, 1987).
The programme is work-based with participants learning from their own and their peers' experiences in practice (McCormack and Manley, 2000). Peer-group learning also facilitates collaborative working, sharing of expertise and the development of powerful, supportive internal networks.
Self-awareness is developed through structured reflection using diaries, group-action learning (Weinstein, 1999) and individual coaching. Participants are also encouraged to find a mentor (from within or outside the organisation) who can continue this process and enable them to widen their networks further. A challenging yet supportive environment is created where participants can systematically review their practice and experiment with new ways of working.
While the focus is entirely work based, the participants felt that they would learn most effectively if the action learning sets took place in an environment away from the hospitals. To this end we used the training centre of a large business organisation, with which the trust has links.
Who can participate?
The programme is open to all G-grade nurses and midwives across the trust. Potential participants are self-selecting, which is essential since the philosophy of the programme requires participants to be responsible for their own development. Additionally, potential applicants are asked to discuss their involvement with colleagues and gain formal support from their manager.
It is notable that following the first programme, participants have frequently commented that they were attracted either as a consequence of hearing sisters talk about the benefits of the programme, or as a result of observing the impact that the programme has had on their colleagues' leadership skills.
Outcomes to date
Informal evaluative feedback from managers, colleagues, team members, the trust board and participants' families have been extremely favourable. A formal evaluation related to intended learning outcomes is routinely undertaken with participants and facilitators at the end of each leadership programme. A flavour of the feedback obtained is presented in Box 1. The positive experiences of some of the participants are outlined in Box 2.
Taking the programme forward
While initial feedback has been positive, the trust has several hundred sisters and charge nurses in post. Existing resources have only enabled the facilitation of two action-learning sets within a six-month period, thus limiting the extent to which the programme can be rolled out.
A number of senior nurses and past participants have expressed an interest in further developing their knowledge and skills in relation to leadership development, particularly the action learning process.
As a result of this interest, facilitator training has taken place and, as a result, the number of staff moving through the programme has been considerably increased. We are beginning to cement a culture of peer learning through reflection, challenge and support.
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