'We're creating the nursing roles of the future,' says long term plan lead
As a trust chief nurse, Carolyn Morrice is a pioneer of integrated care and new nursing roles
As a trust chief nurse, Carolyn Morrice is a pioneer of integrated care and new nursing roles
At the start of her nursing career, Carolyn Morrice was called in to the surgical sister’s room and given some advice that has stayed with her to this day.
‘She told me that I’d never make it as a surgical nurse because I spent too much time talking to patients,’ she recalls. ‘I was devastated, because I loved surgery. Then I thought that if talking to patients wasn’t part of my role, then I didn’t want to do it.
‘Talking to patients is, and has always been, critical to my role, and I’m glad she didn’t put me off. It does show, however, that negative role models can also sometimes be helpful, because they motivate you to do something different.’
More than three decades later, communicating, whether it be with patients and their families, colleagues or members of the public, remains at the heart of Ms Morrice’s practice. As chief nurse for Buckinghamshire Healthcare NHS Trust she never underestimates the value of building relationships and makes good use of those conversational skills honed on the wards.
At the heart of shaping services
Both are attributes that stand her in good stead as she helps her local healthcare system move to a new way of working. She has been instrumental in setting up the Buckinghamshire Integrated Care System (ICS), which brings together local trusts, clinical commissioners, the county council, and the FedBucks GP federation.
The ICS was one of the first in the country. The aim is to have an integrated health and care system for the area’s population of more than half a million people. Nurses are at the heart of this, says Ms Morrice, not just in providing the services, but in shaping them. They are also crucial in determining how their own jobs will look in the new landscape.
‘I see myself as a conduit for pulling together nursing staff from all settings – getting nurses in trusts and GP practices and the community meeting and talking about their work’
‘We’re looking at how we build and create the roles of the future – at what skills and expertise will be needed across the system,' she says.
'Nurses have always been involved in transformation in their own organisations, whether that’s in an acute trust, community services, or GP practices. What we have now is the chance to influence how we care for people across a whole community, and nurses are keen to take that on.’
The Buckinghamshire approach includes a clinical senate where clinicians, including nurses, meet regularly to offer independent, practice-based advice for the ICS board.
‘The senate has had three meetings so far, so we’re still finding our way,’ Ms Morrice says. ‘There’s not a roadmap for how you do this, but there’s a lot of enthusiasm, and we have an ambition to include strong patient and user involvement as well.
‘I see myself as a conduit for pulling together nursing staff from all settings – it’s getting nurses in trusts and GP practices and the community meeting and talking together about their work and the challenges they face – and working together to find solutions.’
Integrated care in action
In Buckinghamshire, nurses are leading care for people aged over 75. The community nursing project aims to deliver appropriate care interventions before patients reach crisis point, preventing unnecessary hospital admissions and supporting them to maintain their independence.
Its nurses are well versed in the normal ageing process and disease progression, and act as the first point of contact to reassure patients and link with other services. They identify areas of concern, including physical, psychological, social, environmental and financial aspects of patients’ health and well-being.
The nurses are supported to work with other service providers, including health, social and voluntary care, family and carers. The team’s achievements include:
- Increased referrals to memory clinic services
- 54% reduction in emergency department attendances
- Average length of stay of nine and a half days, compared with the national average of ten days
In a recent blog for NHS England, Ms Morrice called the service ‘a perfect example of how nurses are leading the way in developing new and integrated services for the benefit of vulnerable groups within our population’.
‘You have to trust your team’
Ms Morrice finds facilitating this kind of transformation exciting and worthwhile – but how does she balance it with the day-to-day work of being chief nurse for a large NHS trust?
‘Having a good team around you, with people who complement your style, is important,’ she says. ‘But as well as having the right people with the right skills, it’s important to be smart with your time, and to be able to trust your team to get on with the day-to-day business of caring and providing a high quality service.’
During our interview, one thing that stands out is the value she places on nurses helping each other and showing the way, whether that’s about the next step on the career ladder, or encouraging different ways of working.
This shines through when she is talking about her own career, as well as the women who inspired and supported her, and her current role, where she sees staff development as an important priority.
‘I feel it’s important to help people develop as nurses,’ she says. ‘It might sound a small thing, but I’m pleased that my previous deputy chief nurse is now a chief nurse elsewhere. I knew when we appointed her that this was likely to happen and I do miss her dreadfully, but I wanted to bring her skills and expertise to the trust and also help support her to get to the next step.’
New challenges for nursing staff
She also cites the career development of two healthcare assistants, one of whom has trained as a registered nurse and the other who has taken the step of training as a nursing associate.
‘I’m just as proud of that,’ she says. ‘We want Buckinghamshire to be a place of choice for the workforce. I want people to see that they can start with us as a band 2 or band 3 and work all the way up. They can have one employer but so many roles across a long and rewarding career.’
'We want to create different roles, such as shared roles in health and social care, without diluting nursing’
She is pleased that the trust is providing opportunities for those nurses who want new challenges, but don’t necessarily want to take a corporate nursing route. ‘There was one nurse consultant here when I joined the trust – now there are nine,’ she says.
Moving towards integrated care offers an opportunity to look at different sorts of nursing roles, she adds.
‘Of course we have workforce challenges like everywhere else, but we are looking at how we can provide different models of care that don’t necessarily depend on registered nurses,’ Morrice says.
‘We want to create different roles, such as shared roles in health and social care, without diluting nursing, which is a given. For example, we could have a nurse working 50% on a ward and 50% in the community.
‘We also know that 30% of nurses are expected to retire soon – we want to explore ways of not losing that expertise.’
Steps to a senior leadership position
Carolyn Morrice decided as a child that she wanted to be a nurse. ‘My parents weren’t medical, they were in education. But my friend’s mum was a nurse and I loved hearing the stories that she told, so that was that,’ she laughs.
She began training in 1984 at the then Glasgow Eastern School of Nursing, where she took ‘the traditional route’ to qualify as a registered general nurse. ‘I did the BSc later, and it took a long time because by then I was working, and had a three-year-old child. It was tough, but the advantage was that I appreciated the academic side because I was a bit older and had some experience. And I loved my training at Glasgow Royal Infirmary.’
Working for a short time in Glasgow after registration, Ms Morrice then headed south – not as part of any great career plan, but because her husband joined the Metropolitan Police. She quickly found her niche in vascular nursing, a specialty she still adores.
‘I was mentored and coached by some amazing nurses and have always been supported to take the next step’
‘I did it for 15 years and I absolutely loved it,’ she says. ‘I liked the fact that there were challenging patients with co-morbidities and high levels of complexity, and also that there was a combination of patients we’d just see once and others who we’d get to know over a longer period of time.’
Working as part of a multidisciplinary team was also a seminal experience for her. ‘We were one team, and I learned the value of the nurse leadership role. The team was fabulous, and we delivered a high standard of care.’
By this time, Ms Morrice was looking at how she could develop her career and was attracted by corporate nursing. ‘I had been a matron for a while and had naturally taken a lead,’ she explains. ‘I influenced and led as a clinical nurse. I was also mentored and coached by some amazing nurses and have always been supported to take the next step.’
In 2008, she took on the role of head of practice and innovation at West Hertfordshire Hospitals NHS Trust, then moved to Mid Essex Hospitals as deputy director of nursing in 2010. She joined her current organisation in 2013, first as associate chief nurse for surgery and critical care, and was then invited to apply for the chief nurse role a year later.
However, even when she stepped on the corporate ladder, she was still uncertain about whether that was the way she wanted to go. ‘I was looking at a nurse consultant role. Vascular surgery is still my love – if I’m out and about and a patient has vascular problems I want to get in there and get involved.
‘But that’s the thing about nursing – there are so many paths you can take. It’s a fantastic career.’
Sharing what works
I ask Ms Morrice what, if anything, keeps her awake at night. ‘Variability in care and how to get rid of that,’ she says instantly. Consistency of care is one of her top four priorities (see box): ‘How do we ensure that we know that everybody is getting the same high quality of care?’
My four priorities
Succession planning: ‘Building the chief nurses and directors of nursing of the future’
Workforce: ‘It’s our biggest challenge and opportunity’
Sustainability: ‘How do we build it into systems and people’
Consistency: 'Getting it right for everyone, every time’
She then answers her own question, by outlining the steps taken at her trust ensure quality of care using the Perfect Ward app, which is now in operation across 63 clinical areas, in the community as well as in hospitals (despite the name). This allows teams to audit their performance on a range of measures and benchmark and compare it with others. ‘It means we can share what’s good and what could improve,’ she says.
- RELATED: App review – Perfect Ward
The next step will involve including patients in the teams that review the performance of individual areas.
‘We should definitely include patients – they are our eyes and ears on the ground,’ she says, adding that nurses do not feel threatened by it.
‘It’s taken a long time to build it up and nurses have been involved in shaping it, so they own it.’
As well as being intimately involved in developments at a trust and county level, Ms Morrice also keeps an eye on the big picture. She admits that when the NHS Long Term Plan was published, she approached it with some trepidation, fearful that it would mean a significant change of tack. In the event, however, she was pleased.
‘It was reassuring,’ she says. ‘It was an endorsement of what we were already doing. I was relieved that it didn’t signal a change of direction but that it reinforced what we know is the right thing to do, such as care closer to home.’
The best outcomes
As a nurse leader, Ms Morrice has a vital role to play in implementing national policy on the ground and making the aspirations of the plan a reality.
It’s a role she clearly relishes. But, strikingly, she suggests the standout experience of her nursing career dates from her time as a ward sister in a vascular unit, when she spent 12 hours with a patient who was nearing the end of his life.
‘I feel it was the best nursing I have ever done – we had to adapt from “rescue” to “end of life”, which involved conversations with him and his family and the rest of the team. It married the technical skills and knowledge and emotional skills to work with the medical staff and the family to get the best outcome for the patient.’
Jennifer Trueland is a health journalist