Nurses are “unsung heroes” who need to be shown that they are valued, according to an award-winning matron credited with building a cohesive critical care team out of nursing staff from 38 countries.
Listening to her staff and working alongside them on the frontline are key when it comes to building a successful team, according to the winner of the Nurse Leader of the Year category at the 2017 Nursing Times Awards.
“There are lots of nurses who come to work day in, day out and do marvellous things”
Gillan Belfon-Johnson, matron at North Middlesex University Hospital Trust’s critical care unit, was given the accolade for transforming work culture and building a strong sense of team spirit in her multi-national staff team.
Ms Belfon-Johnson, a nurse for 23 years, told Nursing Times she was “humbled” by the award but stressed that she could not have achieved real change without the support of her colleagues.
- Children’s hospice nurse unveiled as ‘nurse of the year’
- Special recognition for nurses who treated terror attack victims
When she first arrived at the unit in 2015, she found a disjointed set-up with nurses working in long-established silos. She had to draw on all her ingenuity and resources to break down barriers and get everyone working as a truly integrated team.
At the time, the department was made up of two separate nursing teams – intensive care and a progressive care unit for high dependency patients. Merging the two into one coherent team proved to be much more challenging than she had initially thought, Ms Belfon-Johnson admitted.
“We had two completely different cultures, with groups of nurses that had worked in each for years,” she said. “I saw the risk the two different environments presented to patient safety, because patients were being managed differently, so what I did was to merge both units. But I did not realise how much of a challenge that would be – it was tough.”
“I saw the risk the two different environments presented to patient safety”
The team currently comprises 98 nurses from 38 different countries. When Ms Belfon-Johnson arrived she found nurses of the same nationality tended to stick together, which could get in the way of teamwork.
“I really needed nurses to support each other, regardless of where in the world they came from, because at the end of the day that patient, that relative is dependent on that teamwork,” she said. “Initially, it did not work and that had a lot to do with assumptions they held about each other.”
Some initiatives were not a great success. For example, sessions designed to improve group dynamics were only attended by senior nursing staff, while band 5 and 6 nurses and support workers did not take part.
However, by focusing on making general safety and quality improvements, Ms Belfon-Johnson said she gradually started to bring people together. This included team study days.
“I built in an hour where teams could speak about general issues they have in the unit and the whole idea was just to get them speaking to each other,” she said. “It was a way to challenge assumptions and see that ‘this person feels the way I do’.”
She worked with nurses to develop a critical care purpose statement setting out common goals in terms of “what brings us to work, what we feel passionate about”.
“I really needed nurses to support each other, regardless of where in the world they came from”
She also supported staff to access critical care training to boost skills and confidence, and fostered a sense of autonomy by identifying champions to take forward work in specific areas, like hand hygiene and pressure ulcers.
Ms Belfon-Johnson said: “We had real problems with pressure ulcers and I had a nurse who was continuously coming to me really upset. I said to her, ‘okay – why don’t you lead a group?’.”
Efforts to boost performance on key quality standards have paid off, resulting in the unit being named the trust’s Clinical Ward of the Year for achieving the best results in weekly audits introduced by the director of nursing and midwifery in autumn last year.
Throughout, Ms Belfon-Johnson said it was important for her to be highly “visible” to staff. “I come to work every day at 7.30am and attend the nurses’ handover and that, to me, is very important,” she said. “The handover itself lasts 10 to 15 minutes and then we have another 10 minutes of general conversation.”
She said that, at this point, she asked staff about their concerns for the shift ahead and also about any other concerns in general. “I take a note of any issues and try my best to resolve then – and I come back to the next meeting and tell them what I have done,” she said. “What I am trying to do is to demonstrate to the staff that I am listening to them.”
“You need to be visible, you need to be with the nurses in the field, going through the good times and the challenging times”
Continuing to practise alongside frontline staff was also vital, she told Nursing Times. At first, the demands of her job meant she was unable to do clinical work. However, she made the case for bringing in an additional matron to free up some of her time.
“You need to be visible, you need to be with the nurses in the field, going through the good times and the challenging times with them,” she said. “I think that makes the staff respect you and follow you as a leader.
She said: “Sometimes staff will say things to me about challenges they are experiencing and. because I have actually worked with them on the floor. I can validate that and reassure them action will be taken.”
She said good nursing leaders also needed to be creative. “Not all the challenges you experience have a policy or a guideline to help you as a manager,” she said, noting that it required learning to “think way outside of the box to try and find the answers, and also be brave enough to try different things.”
When it came to her own team, she came up with ideas including a highly popular “diversity day” that saw staff bring in dishes from their home nations. The first such event was a real turning point, she said. “Staff started comparing food and recipes and talking to each other and that was the day I could see the barriers falling,” she said.
Other initiatives to celebrate diversity and achievement have included displaying the flags of all the nurses’ home countries on a wall at the entrance to the unit, and launching an “employee of the month” award voted for by nurses.
“If people don’t come along with you, then you are not a leader really”
Ms Belfon-Johnson admitted trying to change the culture had been stressful at times. “The buck stops with me, so if I get it wrong there are consequences for the patients, family and the nurses at the bedside,” she said.
“Also, when you are new in a trust, your reputation is on the line,” she said. “I wasn’t sure if what I was doing would work and that was stressful, but it pushed me and made me continue trying to find ways to support the nurses.”
Like other critical care units across the country, the department at North Middlesex is full and very busy. While there are 23 beds in the unit, it is only staffed for 17.
“If I look at how many patients I have physically had in the unit between November to March this year, we had between 17 to 26 patients each day and we mainly stayed above 18,” she said. “The only time intensive care remains in its planned capacity is probably in the summer,” she noted.
She said: “You worry about things like whether we are discharging patients too quickly to clear capacity. Are we bringing patients onto the unit on time? Those are real problems we face here and elsewhere.”
Ms Belfon-Johnson said ensuring the right staffing levels was vital. “It is very important that we increase nurse staffing levels and not force the nurses to work beyond what is safe, basically, and this trust has been really good with supporting that,” she said.
North Middlesex University Hospital
As a nurse from a black and minority ethnic background, who hopes to become a head of nursing in future, she is passionate about ensuring all staff have opportunities to develop and advance their careers.
She said: “I remember my very first matron – when I was thinking of leaving to work at another hospital – taking me to her office and saying to me ‘I don’t want you leaving here until you are marketable. Do this course, get this experience and then move on’.
“I have had that level of support from various people from different backgrounds over the years, and this is why I feel so strongly about it,” she said. However, she told Nursing Times she believed the NHS, as a whole, could do more to support nurses to reach their full potential.
“I have definitely heard stories where people have felt they can only reach so far and can’t get beyond that, and those are not isolated stories,” she said. “This is definitely something the NHS needs to look at, not just for nurses from ethnic minority backgrounds, but in general for everyone – the way people manage and support staff and the opportunities available.”
Given the pressures nurses can be under, she said it was vital they felt “valued”. “Many of the hours nurses put in – not just at this hospital but throughout the UK – they are not actually being paid for,” she said.
Ms Belfon-Johnson highlighted that the autumn budget had promised that additional money would be put aside to fund a pay rise for nurses. “It will be interesting to see what that increase looks like, but I don’t think the NHS can afford to pay nurses and doctors what they are really worth,” she said. “All I can do is try to give them a sense of value by creating an environment where they feel supported and support each other.”
To reward her staff for their efforts, she initiated an Oscars-style ceremony – with award categories such as “best shift leader” and “best team worker” – that was hosted at Tottenham Hotspur Football Club in December 2016. Another red carpet event is planned for this year.
She told Nursing Times she had a lot of pride in her team. “You can come up with so many ideas and different ways of doing things, but if people don’t come along with you then you are not a leader really,” she said. “My staff have supported me and came along on the journey with me. I am really proud of them.”
Ms Belfon-Johnson said she was also proud to be a nurse “despite of all the challenges or maybe because of all the challenges”. “Nurses are – to a large extent – unsung heroes,” she said.
“There are lots of nurses who come to work day in, day out and do marvellous things – they take their lunch late and rarely leave on time when their shift ends. They do it out of concern for patients and that makes me very proud to be a nurse,” she added.
Children’s hospice nurse unveiled as ‘nurse of the year’
Biography – Gillan Belfon-Johnson
- Born in Trinidad, 1968. Met her future husband there and studied for A-levels. Her first part-time job was in a pharmacy
- Came to London in 1990
- 1991: became a full-time student at Essex University, Colchester, Project 2000 nursing qualification (3rd cohort)
- 1994-96: continued to study part–time on the degree course and started at first junior nursing role (D-grade) in the stroke unit at Clayponds Hospital, Ealing (part of Ealing Hospital)
- 1997: moved to UCLH as a junior nurse on a general medical ward
- 1998-2008: joined UCLH’s intensive care unit (ICU) where she remained until 2008 becoming a senior staff nurse. During this time she worked as a practice development nurse in critical care, worked on audit and became a critical care outreach nurse for four years
- 2008-2010: Queens Square Hospital as practice development lead, managing a team of five (her first experience of team leadership).
- 2010-2015: Ealing Hospital as intensive care unit matron – team of 86 nurses
- 2015-present: North Middlesex University Hospital: critical care unit matron – team of 98 nurses