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Nurses play key role in UK children’s hospital becoming first in Europe to achieve award

Nottingham Children’s Hospital has gained Pathway to Excellence accreditation
Accreditation

Nottingham Childrens Hospital is the first childrens hospital in Europe to achieve the internationally recognised Pathway to Excellence accreditation for nursing excellence

  • Nottingham Childrens Hospital is the first childrens hospital in Europe to win the Pathway to Excellence award
  • Pathway to Excellence is a globally recognised marker of nursing excellence and indicates high job satisfaction
  • Teamwork and dedication were essential in achieving the accreditation in just eight months and during the pandemic

Nottingham Childrens Hospital (NCH) is the first childrens hospital in Europe to gain the coveted Pathway to Excellence accreditation for nursing, achieving it with

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Nottingham Children’s Hospital is the first children’s hospital in Europe to achieve the internationally recognised Pathway to Excellence accreditation for nursing excellence

  • Nottingham Children’s Hospital is the first children’s hospital in Europe to win the Pathway to Excellence award
  • Pathway to Excellence is a globally recognised marker of nursing excellence and indicates high job satisfaction
  • Teamwork and dedication were essential in achieving the accreditation in just eight months and during the pandemic

Nottingham Children’s Hospital (NCH) is the first children’s hospital in Europe to gain the coveted Pathway to Excellence accreditation for nursing, achieving it with flying colours in just eight months – against the backdrop of the COVID-19 pandemic.

The secret of the hospital’s success is an engaged, creative and supported nursing workforce delivering great care.

Pathway to Excellence is a programme run by the American Nurses’ Credentialing Center (ANCC) and is recognised globally as a marker of nursing excellence.

‘The staff wanted some form of recognition for all their hard work – and the excellent nursing care they deliver. We decided Pathway to Excellence was a good fit’

Andrea Cronshaw, clinical nurse specialist and Nottingham Children’s Hospital Pathway to Excellence lead

Awarded on the basis of a mix of evidence of good practice and an anonymous staff survey, the accreditation means that NCH – part of Nottingham University Hospitals NHS Trust – is recognised as an excellent place for nurses to work, with high job satisfaction, professional opportunity and retention.

Impetus to aim for international accreditation came from hospital’s nurses

NCH Pathway to Excellence lead Andrea Cronshaw says the impetus came from the nurses themselves following the development of a nursing strategy at the hospital, which involved staff from all levels.

Nottingham Children’s Hospital Pathway to Excellence lead Andrea Cronshaw
Andrea Cronshaw

‘The overwhelming response was that the staff wanted some form of recognition for all their hard work – and the excellent nursing care they deliver,’ says Ms Cronshaw, a clinical nurse specialist in children’s burns and plastics.

‘We decided Pathway to Excellence was a good fit.’

In the summer of 2019, the hospital made its initial application, then started working to gather the evidence to show it was performing well against all the award standards.

Again, nurses from all levels across the hospital were involved – and enthusiastic, Ms Cronshaw says.

‘There was an element of excitement from the teams that we were going for international recognition.

‘They were powered by going for this accreditation and as soon as the process got started, there was a real snowball effect and it just kept growing until we achieved it.’

What is Pathway to Excellence accreditation?

Pathway to Excellence is internationally respected accreditation from the American Nurses Credentialing Center, which recognises and promotes nursing excellence.

To achieve it, healthcare organisations must provide evidence of excellence in six standards deemed to be essential elements in developing a positive practice environment for nursing:

  1. Shared decision-making
  2. Leadership
  3. Safety
  4. Quality
  5. Well-being
  6. Professional development

Once an organisation’s evidence is accepted, its nurses are surveyed to validate that the standards are embedded – a 60% minimum response rate is required, but taking part is voluntary and confidential.

Source: American Nurses Credentialing Center

Nursing team achieved astonishing 94% survey response rate

The team submitted its evidence – running to 1,000 pages – in January 2020 and was told it could proceed to the next stage. And then COVID-19 hit.

‘We had to make a big decision about whether to continue the application or put it on hold,’ says Ms Cronshaw.

‘We went out to the teams and asked what they wanted to do, and they said they wanted to do it to focus on something that wasn’t COVID-19, because it was engulfing hospitals last year.’

In August 2020, the team heard it had been successful, having achieved an astonishing 94% response rate in the survey stage of the accreditation process, considerably more than the 60% minimum required by the ANCC.

Deputy divisional nurse and lead children’s nurse Rachel Boardman says: ‘The key thing was that the staff were involved in this from the beginning.

Deputy divisional nurse and lead children’s nurse Rachel Boardman
Rachel Boardman

‘It wasn’t as if the leadership team decided we wanted to achieve something – this was about the staff wanting the recognition.’

Accreditation process sparked competition between wards and departments

Ms Boardman says that the evidence the team put forward involved all levels of staff across the children’s hospital: ‘It was evidence of their care, and the quality of care, and how that fits into the system.’

Staff from all levels were part of the steering group driving it forward, she says, and the process also sparked competition between wards and departments.

‘It’s amazing how innovative you can be. Maybe in the children’s hospital we can be a bit more innovative than other people.’

Ms Boardman points to an initiative where they put pictures of leaders in the hospital on a well-known brand of crispy snack tubes for staff to pick out. This was partly to address one of the questions in the process, which was around whether people knew who their leaders were and what they did.

‘The children’s hospital has made this look easy, but actually, it’s a difficult accreditation to achieve. The fact that we did it in eight months I don’t think will ever be beaten’

Lesley Reilly, divisional head nurse at Nottingham Children’s Hospital

Divisional head nurse Lesley Reilly
Lesley Reilly

Divisional head nurse Lesley Reilly says: ‘Children’s nurses are creative and can think of lots of different ways to get key messages out there that engage, enthuse and empower.

‘There were lots of games and in-house competitions. Nurses were competing against each other, and that drove the air of excitement – the passion of nursing shone through.’

Award recognition is validation of nurses’ time and effort

The hospital did not markedly change its practice to achieve the award – rather, the award was a validation of what it was already doing, she adds.

‘The children’s hospital has made this look easy, but actually, it’s a difficult accreditation to achieve. The fact that we did it in eight months I don’t think will ever be beaten.

‘We are the only children’s hospital outside the US to achieve this, but that’s because we’ve invested a lot of time and effort with our nurses.

‘We’ve been on a journey of empowerment, education and training.’

Ms Reilly points to initiatives supporting research, improvement and personal development, including the trust’s well-subscribed chief nurse excellence in care fellowship programme – a competitive scholarship that gives nurses time out of direct patient care to lead an improvement project.

‘We have aspiring academics doing all kinds of work to improve patient care in areas, such as pressure ulcers and mental health assessments, so that we can demonstrate the contribution that nursing care brings to patients.’

Five tips to help you towards Pathway to Excellence accreditation

Five tips to help you towards Pathway to Excellence accreditation icon
Picture: iStock
  1. Involve staff from the start and engage your nursing workforce Get teams excited about the plan to achieve international accreditation
  2. Create a steering group with nursing staff from all levels Getting ideas and input from all parts of the organisation is important
  3. Examine what the organisation is already doing well Gather feedback on what staff say could be improved
  4. Communicate with hospitals that already hold the accreditation Learning from others with experience is helpful
  5. Build on what is already there Nottingham Children’s Hospital involved staff in creating its nursing strategy; the Pathway to Excellence accreditation was just part of that journey of staff empowerment

Patients and families involved in video as part of hospital’s application for funding

NCH clinical academic lead for nursing research Takawira Marufa worked on the hospital’s Pathway to Excellence evidence document and says that it was important that the nurses themselves wanted to achieve the accreditation.

Nottingham Children's Hospital clinical academic lead for nursing research Takawira Marufa
Takawira Marufa

‘This was a way for us to shout about what we’re actually doing.

‘There’s a lot of things that we’ve been doing that have never been publicised –going through the process of accreditation was an opportunity for us to do that.’

Patients and their families were involved in the video that was made as part of the hospital’s application for funding, which came from Nottingham Hospitals Charity.

Since achieving the accreditation, the hospital has been approached many times by other organisations asking how they did it, says Ms Boardman.

Staff engagement with survey was pivotal

While having the evidence of excellent practice was important, for her, the biggest achievement was the staff survey, which proved that staff were engaged with the process.

‘The bit I’m most proud of is the bit we had no control over,’ she says.

‘If I was going to give any advice to anyone wanting to do this, I’d say it’s about the staff. It’s about the culture, the way they work, the way they feel empowered; it comes from them.’


Find out more

American Nurses Credentialing Center – Pathway to Excellence


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