The Heart of England NHS Foundation Trust recently (October 2007) piloted a new role, the Senior Nurse Personal Assistant. Since the introduction of four Senior Nurse Personal Assistants 12 months ago, there have been demonstrable benefits:
• Senior sister more clinical, able to influence care
• Improved quality of ward administration, documentation and quality audit results
• Professional service development
These have been measured using the trust’s annual audit of ward administration, Nursing Annual Audit Review (NAAR) with an overall improvement of 14.3% seen in the pilot area. Senior Nurses on these wards are now spending an average of only 6 hours a week on administration tasks.
Nationally, there is published evidence that nursing staff are spending increasing time undertaking paperwork and additional duties. A study commissioned by the Department of Health took place in October 2005, aimed at discovering the amount of time Senior Nurses spent on clerical and administrative tasks.
The results demonstrated that they were spending more time on administration and the resulting reduction on time spent on delivering patient care was shown to reduce job satisfaction.
The need to provide nursing teams with support
With the increasing emphasis and importance the trust has placed on structured systems and processes, there is need to provide nursing teams with the support to develop, collate and report performance data. Results from the annual nursing review and HR personal file checks demonstrated that some areas did not have an information infrastructure to easily demonstrate how the area was being managed.
The Senior Nurse PA role was to provide a first-point contact for all non-clinical activities and assist with the reporting and the analysis of performance data. Senior Nurses have been able to increase their presence on the ward to focus on delivery of high quality care. The post was advertised at band 4, Agenda for Change, in order to ensure that suitably experienced and professional persons were attracted into the post.
Aspects of the Senior Sister’s role
Aspects of the Senior Sister’s role, which are now managed by the PA, are listed below in the order of the greatest importance and impact on the Senior Nurse role
• Diary Management
• Personal Files
• Creation and maintenance of a staff database
• Authorisation of annual leave, within set guidelines
• Staff sickness monitoring, booking review meetings and generating the appropriate documentation
• PIN Registration monitoring and reminders
• Incident report analysis
• Establish Audit programme and reporting system
• Administrative tasks, such as redesign of documents and development of electronic versions
• Organisation of office space with correct accessible archiving
The immediate effect of the Senior Nurse PA role has been the Senior Nurse’s ability to have more clinical time and be available in the ward. This has given a more visible form of leadership for both staff and patients. Quality of care has improved as the Senior Nurse is able to lead by example, tackling complex discharges and improving length-of-stay statistics.
The Senior Nurse is more able to act as a role model to junior staff, sharing her knowledge and skills. Senior Nurses have been able to recommence local training plans and clinical supervision sessions, resulting in the team feeling more valued.
Improving patient confidence
There have been more opportunities for face-to-face discussions to identify and to resolve issues as they arise, thus preventing complaints. The patient’s confidence in the service has also been enhanced with the most senior nurse caring for them, and this has been reflected in this reduction in patient complaints and comments in a questionnaire regarding the service.
The quality of documentation, such as reports and letters, has greatly improved and these 0are now done in a timely fashion. The new staff database set up and maintained by the PAs gives easily accessible, up-to-date information ranging from the department’s training needs to the individual’s sickness record. This has allowed for better planning and service development.
The success of the pilot has been disseminated to the rest of the trust. Improvements seen in standards of administration, annual audits, the clinical time regained by the Senior Nurses and the benefits to the service delivery have enabled other Senior Nurses to have business cases approved to recruit Senior Nurse PAs.
For further information, please contact:
Karen Bowley at Heart of England Foundation Trust
Telephone 0121 424 1345
Acknowledgements – Liz Lees and Sue Winwood