In the vanguard of teaching care home skills

Caroline Pollington, lead nurse at Sutton Homes of Care vanguard, discusses how it has tried to make information, training and opportunities to acquire skills more widely available to care home nurses and care staff

Caroline Pollington, lead nurse at Sutton Homes of Care vanguard, discusses how it has tried to make information, training and opportunities to acquire skills more widely available to care home nurses and care staff

Vanguard community lead nurse Patricia Franklin (right) delivers training for staff
at Crossways nursing home in Sutton, Surrey.

The NHS in England uses mandatory training to ensure that nurses and other staff are always up to date with the most current information and best practice for the safe and efficient delivery of services. Line managers are responsible for ensuring that their staff are trained at the appropriate level and refreshed on ever-changing practice.

For care homes, the issue is the haphazard nature of mandatory training and limited opportunities for continuing professional development.

The Royal College of Nursing recommends that mandatory training should be undertaken during work hours or that employees should be compensated for attending mandatory training outside of work hours.

Experience and common sense

Team accessibility is important to maintain best practice and support training in hospitals. Nurses in hospital settings work in conjunction with other nurses and care professionals and can access a variety of people for advice and confirmation of best practice.

NHS vanguards

NHS England selected 50 vanguards in 2015 to take a lead in developing new care models that could act as blueprints for the future. NHS Sutton Clinical Commissioning Group in south west London was chosen as one of six care home vanguards. Its vanguard status ended in March this year.

Outside of statutory and mandatory training, care provision is reliant on experience and common sense. Often, a second opinion is vital. In a hospital there is always someone to turn to if you need confirmation that you are doing the right thing.

Mentorship, support and guidance in a team can improve nurses’ confidence and overall patient care. In hospital, upskilling and constant recertification of skills is at the forefront of priorities.

Training, skills and competencies

In my previous role as an educational lead in a hospital setting I was responsible, alongside the ward managers, for ensuring that nurses and carers had the right training, skills and competencies for the varying levels of care they provided.

Where further development was required, a formal plan would be put in place to support the individual to gain these skills, which inevitably included elements of formal study, self-directed study and an assessment of competence. These combined to provide assurance that patients would be cared for safely, effectively and in line with evidence-based guidelines.

Independent of the NHS, care homes can have different approaches to training and education and lack formality and standardisation due to independent ownership. Care home managers can struggle with finding time to release staff for training sessions over and above the statutory requirements.

Complex needs and conditions

This has traditionally made it difficult for care homes to ensure that staff have the right skills to care for residents who increasingly have more complex needs and conditions.

Care homes often experience a high turnover of staff resulting in staffing shortages and financial restraints. Care home staff provide care to a population with far greater needs than ever before, and this population is set to increase in numbers and complexity. According to ambulance call-out data in Sutton, residents with minor issues that could be treated on-site were being sent to hospital.

A review of these issues indicated that perhaps there were some gaps in training.

In care homes, nurses can often work in isolation without access to the formal team that hospital nurses benefit from. There is no doctor, no multidisciplinary team and sometimes no other nurses. Sometimes there are no nurses at all, but carers managing on their own with no clinicians on site.

A poster produced by Sutton Homes of Care vanguard.

Shortage of opportunities

With no other care professionals available to provide a second opinion or build confidence, care home nurses may defer treatment to a hospital so as to ensure that residents are receiving the best care possible.

Infrequency of certain tasks and procedures can also affect care home nurses’ confidence and competence levels. Catheterisation, for example, could be undertaken a few times a year in a care home, whereas it is often a daily requirement in hospital settings. This infrequency may also explain why care home nurses send residents to hospital, because of a fear of not providing the best care possible.

Hospital staff have the benefit of regular, proactive training on new techniques, procedures and innovations that care home staff do not. There is a serious shortage of opportunities for care home nurses in upskilling, recertification and retraining that needs to be addressed.

Guidance on best practice

The Sutton Homes of Care vanguard identified this stark difference in training and education available in care homes compared with hospital settings and the need to do something about it.

With our partners from hospitals, care homes, community nursing, ambulance and social services we agreed that there were gaps in the information available to care home staff and that we would find opportunities to standardise the information available.

We developed with our partners a series of resources to provide care home staff with up-to-date and immediate information about appropriate referrals to services and guidance on best practice in providing care.

More clinical resources

We developed posters and reference cards along with training films to address important issues, such as a signposting resource that outlines which service is appropriate to contact when a resident becomes unwell.

We also developed more clinical resources, such as identifying when a resident is dehydrated to help prevent and manage urinary tract infections, identifying sepsis and falls management pathways.

The resources have been distributed across the care home network in Sutton, and a video has been made that highlights how the vanguard has worked with care homes to train staff.

The resources are fixed in visible locations in the care homes along with credit card-sized reference cards that are attached to staff key rings or lanyards, whichever is preferred. Training films are emailed to care home managers for staff to watch in the home as well as at their convenience.

In partnership with community nursing, we have provided specific study days on clinical issues affecting the older population, such as diabetes, catheter management, wound management, distress behaviours and managing deteriorating residents.

The resources and training opportunities have led to better decision-making by care home staff, which has reduced unnecessary emergency department attendances and admissions and enabled 80% of all residents to die in the care home as their place of choice. These outcomes also provide significant benefits for the wider health economy.

Attention and support

People want to be treated at home. For care home residents, this is their home. In the UK, there are about 10,700 nursing and residential homes providing a total of 421,000 beds.

In contrast, the NHS has about 142,000 hospital beds. Community care outside of the hospital setting is the future of how care will be administered across the country.

We need to offer our workforce in this sector the same support that they would be offered in hospital and other settings. Care home nurses are dealing with some of the most complex patients in the healthcare system, and this sector deserves the same attention and support as the rest of the care system in England.

Caroline Pollington is lead nurse, Sutton Homes of Care vanguard



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