Setting the bar high: nurses in Wales deliver improvements for patients
As part of Nursing Standards series celebrating modern nursing roles in the UK, three nurses in Wales explain how they improved continence services, ensured consistency of care by diabetes specialist nurses, and created a Hygge-style environment for people with schizophrenia
These are three very personal accounts of how front line nurses view their roles, says RCN Wales director Tina Donnelly. At the heart of each account is the compassion to deliver better services that meet their patients needs.
Clare Eaton is senior nurse, continence service, Aneurin Bevan University Health Board. In the past five years she has transformed the service, which she is proud to lead....
As part of Nursing Standard’s series celebrating modern nursing roles in the UK, three nurses in Wales explain how they improved continence services, ensured consistency of care by diabetes specialist nurses, and created a Hygge-style environment for people with schizophrenia
‘These are three very personal accounts of how front line nurses view their roles,’ says RCN Wales director Tina Donnelly. ‘At the heart of each account is the compassion to deliver better services that meet their patients’ needs.’
Clare Eaton is senior nurse, continence service, Aneurin Bevan University Health Board. In the past five years she has transformed the service, which she is proud to lead.
‘Incontinence is an isolating condition that has a negative impact on quality of life. Sadly, there is still too much focus on incontinence pads. Robust continence assessment requires time, but time is a scarce resource.
‘We have developed excellent education programmes for catheter skills and continence promotion, and have undertaken three huge initiatives. The first was providing a nurse-led urodynamic service for gynaecology. This reduced the waiting list for urodynamic investigation from over a year to just four weeks and released consultant time, enabling them to provide more clinics.
‘If we get the quality right, patients will get what they need, costs will be reduced and waste will be eliminated.’
‘In the second initiative, Spend to Save, we moved continence assessment of patients in residential homes to the continence service. We employed a band 6 specialist nurse to assess and reassess these patients and saw outcomes improve within a year. Waiting times for assessment were reduced from six to eight weeks to a maximum of two, and ending the over-prescription of incontinence pads reduced costs by £83,000.
‘The third initiative, in partnership with primary care, involved moving the prescribing of all bladder and bowel appliances from GPs to the nurse continence service. In one year, we saved the GPs 460 hours in prescribing time, and reduced admissions to emergency departments for patients with catheter-related problems.
Adapting to needs
‘Patients contact us for prescriptions and we highlight those who haven’t been recently reviewed. Some may have dropped off the radar, possibly for years. Some need to return to urology, while others are reviewed in the community.
‘If we get the quality right, patients will get what they need, costs will be reduced and waste eliminated. There will always be a small number of patients whose needs cannot be met within the formulary, but our team can prescribe outside the formulary if necessary.
‘We are adapting to the needs of an evolving health service. We see a little niche and think "we could run with that".
‘I wish I had a pound for everyone who says "I couldn’t do your job", but I’m proud of what I do and what we deliver here. I am especially proud of my team whose expertise has enabled us to achieve all this.’
Gaynor Harrison is lead diabetes specialist nurse, Cwm Taf University Health Board. She has developed a programme that ensures all specialist diabetes nurses work to a set standard.
‘Diabetes nurses are involved at every stage of life, from seeing the impact of the disease on the unborn child through to patients with complex conditions who are dying. The fact that diabetes takes so many forms keeps my interest alive.
‘Our patients can be assured that when they see a diabetes specialist nurse, they see a rounded individual who is highly skilled and qualified to deliver the care they need.’
‘We need to ensure that people with all forms of diabetes are getting the best possible care from highly skilled and trained diabetes specialist nurses (DSNs).
‘DSNs have no clear pathway to follow to work at an advanced level. Even those with postgraduate degrees may lack the required skills because diabetes is so complex.
‘In the past, you relied on having people in the team who were keen to mentor new nurses. I was fortunate in having fantastic mentors who led me through a pathway.
‘When I joined the team in 2015, several people were about to retire and we needed to recruit new nurses. I wanted to make sure that all DSNs have the same knowledge, skills and approach to mentoring DSNs who are new in post.
‘I decided to develop a working programme capturing the core competency framework devised by TREND UK. The programme, launched 14 months ago, enables the DSN to develop critical thinking skills, carry out effective assessments and prioritise service needs. Nurses who have been through the programme have gained key skills regarding therapies, diagnostic testing and multidisciplinary working.
‘For the first time we have a specialist diabetes team working across primary and secondary care. Our secondary care nurses spent time in the community seeing how patients cope with the disease in their own environment, and the community nurses came in to hospital to develop competencies in areas they may not have encountered outside.
‘All our nurses now work to a set standard and work is in progress to ensure standardisation in additional specialisms, such as insulin pump therapy. Our patients can be assured that when they see a DSN, they see a rounded individual who is highly skilled in every area and qualified to deliver the care they need.’
Penny Phillips is a staff nurse at Marine Court, a private, long-stay nursing home in Colwyn Bay. She aims to make the environment 'comfy and safe' with plenty of creative opportunities.
‘Most of our clients have long-term schizophrenia, and this is their home. My aim is to create a Hygge-style environment that is comfy and safe. It’s a festival-style atmosphere without the drink and drugs.
‘My style of nursing is about patients and staff working together to integrate therapeutic interventions into activities to enhance quality of life.’
‘My style of nursing has come back in fashion through user-led movements such as star wards and safe wards. It’s about patients and staff working together to improve things, integrating therapeutic interventions with activities to enhance quality of life.
‘I worked as a mental health nurse in the NHS for many years, but never wanted to be a manager. NHS nurses are bogged down in paperwork and have too little time to spend with patients.
‘Long-term clients say the worst thing about being an inpatient is the boredom. When patients are bored, they are angry, and it all becomes very negative. There’s a lot of evidence that there is less aggression when patients are doing something constructive.
‘That’s why I look for lots of things for clients to do, and it’s best if the activity is seen as a hobby rather than work. For example, using simple craft equipment, we make Christmas and birthday cards. There is porcelain painting and cross-stitch work, and one person is doing an NVQ in cookery. We recently started a poetry writing group, where people can express emotion through sharing poems they have written.
Quality of life
‘While we are engaged in these activities, I can assess motor skills, communication and cognitive potential.
‘I believe that green space is important to people who are ill. It isn’t about facilitating patients’ health or ensuring they get adequate exercise; sitting on the grass can be just as valuable as gardening or walking. My attitude is ‘let’s go out, amble around and enjoy the sun’.
‘I take patients out for walks, individually or in groups. We are near the town so can go shopping together, which meets many different therapeutic needs.
‘My emphasis is on quality of life and the development of life skills. The managers here are brilliant, I can spend as much time engaging with the patients as I like, and for the first time I am paid for what I do without red tape restricting my professional practice.’
Alison Whyte is a health journalist
More in this series
Nursing Standard is marking the RCN’s centenary year by celebrating the astonishing range of modern nursing roles and the often unheralded great work by nurses across the regions.
- The changing face of modern nursing in the south west
- Great achievements by dedicated nurses in the south east of England
- The inspiring nurses in the north of England who make a difference in their modern roles
- Inspirational, meaningful care: quality nursing across Scotland
- Nurse pioneers transforming care in the eastern region
- Improving patient care and staff satisfaction in north west England
- From nutrition to co-production: celebrating nursing innovation in London
- Innovation in action: transforming patient care in Northern Ireland
- Celebrating nursing innovation across Yorkshire and the Humber
- Nurse-led initiatives transforming patient care across the East Midlands
- A new approach: celebrating nurse innovation in the West Midlands
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