Making care homes great places to work and learn
After a successful pilot stage, the Teaching Care Home programme is recruiting more homes to challenge perceptions of the sector, develops its workforce and boost recruitment.
After a successful pilot stage, the Teaching Care Home programme is recruiting more homes to challenge negative perceptions of the sector, develop its workforce and boost recruitment
Kate Sanders is the first to admit the perceived image of care homes is not always of vibrant learning environments at the forefront of developing best practice. ‘Care home nursing is sometimes not seen as a career choice, but somewhere nurses work because it's closer to home or has flexible hours,’ says Ms Sanders, practice development facilitator at the Foundation of Nursing Studies (FoNS).
To combat this, FoNS joined Care England, Manchester Metropolitan University and the International Longevity Centre in a Department of Health-funded project to champion the sector and empower its workforce. Working with five care homes run by prominent organisations across England, the Teaching Care Home pilot set out to challenge ingrained attitudes through their development as centres of learning.
‘We’re keen to change the views people hold about care homes and nursing here,’ says Ms Sanders. ‘We’re trying to promote the idea that they’re interesting places to work, with a lot to offer.’
FoNS created a bespoke development and support programme for each of the five homes: Berwick Grange in Harrogate, Chester Court in Northumbria, Millbrook Lodge in Gloucester, Rose Court in Manchester and Lady Sarah Cohen House in London.
This encompassed six learning and development workshops, three or four site visits and ongoing mentorship, with each of the homes identifying an improvement project they wanted to lead. These ranged from improving residents’ nutrition, helping non-UK nurses gain their registration and achieving better hospital admission and discharge for older people.
‘The first thing we did was explore what a teaching care home might look like,’ says Ms Sanders. ‘We wanted to give it a definable form.’ Through workshops, conversations on social media and round table discussions, a draft vision was created. It highlights the commitment to person-centred care and discusses ways of working for ‘all who live, die, work and visit in the home’.
'Homes should be honest and talk about what they would like to be different, and about the importance of learning for staff'
To help raise the profile of care home nursing as a positive career choice, the programme aims to increase the number of nursing students who opt to do placements in the sector. However, a lack of mentors remains an obstacle. ‘It’s a chicken and egg situation,’ says Ms Sanders. ‘They can’t have students because they don’t have enough trained mentors, but providers are reluctant to fund training because they feel the universities should pay.’ To improve the situation, care homes are actively seeking out and strengthening relationships with local universities – for example, Chester Court has provided its first placement for a third-year student from Northumbria University.
The project has been such a success, FoNS is recruiting five more homes to join a new cohort – which starts work next spring – and a third group of five will take part from 2019. Participants will continue as peer supporters, gradually building an expanding network of homes that work towards making the Teaching Care Home vision a reality.
Applications are invited from nursing homes in England that provide care to all ages, including older people, those with a long-term condition or a learning disability. Prospective applicants must identify three members of staff to lead the work – the manager, a registered nurse and a care worker – and there should be an organisational sponsor at chief executive level. The closing date is 14 November.
‘We’re looking for potential,’ says Ms Sanders. ‘Homes should be honest and talk about what they would like to be different, and about the importance of learning for staff. They should also be able to create a welcoming and supportive environment for students, who can ask questions and challenge, knowing that it will be appreciated.’
The Burdett Trust for Nursing is funding the programme for the next two years, and provides a small bursary for practice improvement.
‘By having lots of positive stories to talk about, we’re trying to contribute to a different narrative about nursing in care homes,’ says Ms Sanders.
Making mealtimes a pleasure
Weight loss was becoming an issue for some residents at Chester Court care home in Northumberland, and staff were increasingly concerned.
‘We decided to find out about their mealtime experiences and what we could change to make it better,’ says Maureen Atkinson, who is one of nine nurses at the 41-bed home, which provides care for older people and those with long-term conditions, including Parkinson’s and multiple sclerosis.
There was a long list of things the residents disliked, ranging from the menu itself to the ‘dull and boring’ colour scheme of the dining room and the bibs. ‘They didn’t want to wear them, so we bought butcher’s aprons for the men and pinnies for the women,’ says Ms Atkinson. ‘They liked them so much, they didn’t want to take them off between meals.’
Residents also complained about the heavy three-course meals in the evening. ‘They didn’t want à la carte,’ says Ms Atkinson. ‘They wanted something simple – soup and a sandwich. They’d eat this, whereas they’d just fiddle with larger meals.’
Now there are flexible mealtimes as well as alternative menus, which are available all day. There’s also an emphasis on making food as appealing as possible, including for those on a pureed diet. As a result, residents have put on weight.
Staff have also benefited, says the home’s manager, registered nurse Pam Towers. ‘Our ethos is person-centred care, but that’s now been emphasised across the board,’ she says. ‘It’s helped us to look at our staff individually and value them. If your staff aren’t on board and don’t feel valued, you won’t get the best from them.’
Embedding daily reflection in practice
While reflection is an established aspect of clinical practice, care home manager Karen Davies was keen to harness its benefits for every staff member at Rose Court in Manchester, which has 100 beds and offers dementia, nursing and residential care.
‘We recognised a gap,’ says Ms Davies, a registered nurse. ‘My ambition is to embed ten minutes of daily reflection into everyone’s work. I want them to feel they have something to say that’s worth listening to, that will have an impact on residents or their own practice.’
Following training in coaching and facilitation skills, staff undertake reflective sessions in pairs. One person asks the other three questions: What went well today? What didn’t go as planned? What will you do differently tomorrow. ‘Speaking out loud is powerful,’ says Ms Davies. ‘It makes people focus. When you hear yourself say those words, it makes it real.’
Although staff were nervous initially, feedback has been positive and the process has allowed them to recognise when things have not gone well and try to find solutions.
‘They’ve been able to problem solve, adding to care plans that enrich someone’s life,’ says Ms Davies. ‘It has improved staff skills, helping them to develop the vocabulary to articulate what goes well, and what doesn’t, and be confident in their communication.’
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Lynne Pearce is a freelance journalist