The nursing accessory role was created to abode a abilities gap and accommodated workforce needs. This commodity describes a table-top simulation advised to advice bury the role in absolute teams.
The nursing accessory role was created to arch the gap amid healthcare abutment workers and registered nurses, and formalised by the Nursing and Midwifery Council in 2018. Embedding the role into the analytic ambience requires a absolute compassionate of the ambit of convenance and allowances to the nursing workforce. This commodity discusses the use of workforce redesign and tabletop simulation to appoint and advance bounded compassionate and buying in inpatient wards. This admission fostered the chief nursing abutment bare to bury the nursing accessory role in a financially applicable model, and gave nurses a abundant greater compassionate of the role and how it would fit in their analytic teams.
Citation: Cox S (2021) Application workforce transformation to bury the nursing accessory role. Nursing Times [online]; 117: 9, 32-34.
Author: Sue Cox is arch of nursing for workforce transformation and education, Guy’s and St Thomas’ NHS Foundation Trust.
The Shape of Caring assay (Willis, 2015) was commissioned by Health Apprenticeship England to assay the apprenticeship and training of registered nurses (RNs) and affliction agents accouterment affliction for circuitous patients. It articular a gap in abilities and ability amid healthcare administration and RNs. To arch this gap, the nursing accessory (NA) role was created and became adapted by the Nursing and Midwifery Council (NMC) in 2018. The NA role was advised to:
The Interim NHS People Plan (NHS, 2019) answer the NA role as a way to admission access into nursing. This commodity explores how a ample astute and association assurance acclimated workforce transformation to apparatus the NA role alongside the development of RNs to accommodated the Nursing and Midwifery Council’s (2018) standards for approaching nurses.
The assurance has formed adamantine over the years to bout NMC requirements to the needs of the accommodating citizenry and has a able-bodied admission in bandage with the standards and expectations for safe staffing set out by the National Quality Board (NQB, 2016). Despite year-on-year advance and accepting added nursing agents in post, the trust’s abstraction amount remained changeless at 12-14%. It was accustomed that a altered way of alive was bare to accommodated the growing needs of our accommodating citizenry and to redesign our nursing workforce.
In January 2020, there were 123 amateur NA posts beyond bristles analytic areas in the trust. The posts are actuality formed out, advisers by directorate, to ensure they are anchored and the role is valued. However, all-embracing change was bare to abutment accretion accommodating action and acuity, so a bristles -year workforce plan was created.
Each advisers completed a programme of workforce redesign and assay as allotment of the anniversary enactment review. The safer nursing affliction apparatus created by the Shelford Group and accustomed by the National Institute for Health and Affliction Excellence (2014) was acclimated to adviser staffing numbers. It is important that this apparatus is acclimated alongside able judgement, accommodating acuity and account action plans, to abutment the controlling process.
The assay acclimated approaching about-face assay at set timeframes (2019, 2021 and 2024) to map the circadian enactment adapted in bristles years’ time, admiration the cardinal of altered bandage nurses and abutment workers adapted on anniversary about-face (Table 1). The aim of approaching about-face assay was to bury the NA role in the nursing aggregation with the abutment of chief nurses, while affair the adapted accomplishment mix for the accommodating population. We fabricated it bright that this was not about abbreviating the cardinal of RNs, but about embedding the NA role and accouterment chief assistant leadership.
The workforce plan predictions included an admission in bandage 6 requirements, a change in bandage 3 and 5 requirements and the accession of the NA role, breadth adapted and safe. Consideration of account and banking constraints were key to ensure this was amount aloof or reflected acuity and action changes.
The constant five-year workforce plan rebuilt the nursing establishments to accomplish them fit for purpose and congenital the NA role, analogous accommodating acuity and ensuring the adapted staff, with the adapted skills, at the adapted time. Once it had been agreed that it was adapted for the NA role to be allotment of the nursing establishment, acceptable numbers of NAs were bare in anniversary enactment to bear and advance a constant workforce model. This helps to abutment greater compassionate and use of the role, and improves the acquaintance of all agents and patients involved.
Following a assay of all directorates’ five-year workforce plans, a arrangement enactment was created for a archetypal 28-bedded breadth application the aggregation nursing admission and accumulation the new NA role. This arrangement guided analytic teams on how the new role could be anchored in analytic areas, while actuality alert of the charge for variation, depending on the admeasurement of breadth and accommodating acuity.
Tabletop simulation (Box 1) was alleged to abutment the directorates in testing these new establishments and embedding the NA role in their analytic teams. Simulation allows nurses to practise analytic and controlling abilities and claiming basal assumptions through real-life situational experiences, afterwards compromising accommodating affliction (Kim et al, 2016).
Box 1. Tabletop simulation: how it works
Tabletop simulation has been acclimated to abutment directorates to analysis and affirm approaching establishments through skill-mix optimisation and re-profiling how anniversary aggregation affiliate works. The aims and objectives of the tabletop simulation are to:
The apish about-face is followed by a debriefing session, application an admission such as the Plus/Delta model. This is a simple archetypal that does not charge a accomplished debriefer; it allows participants to analyze what went able-bodied (plus) and what could be done abnormally (delta), thereby allowance individuals to amateur how they can assignment bigger as allotment of a aggregation (Gardener, 2013). This debriefing adjustment was additionally acclimated during ‘time outs’ or pauses throughout the simulation action to analyze the account abaft accomplishments or decisions.
Ten simulation sessions accept taken abode to date, involving 31 altered breadth settings and 90 participants. For the purpose of the sessions, the directorates aggregate calm agents from three to six wards with similarities in blueprint and accommodating speciality. Two wards completed alone sessions due to their altered accommodating populations. Anniversary affair had an boilerplate of nine participants (range: three to 14 per session) and included nursing assistants, agents nurses, breadth managers, matrons and active of nursing.
Questionnaires were completed afore and afterwards the tabletop sessions to appraise how they added understanding. The pre-session analysis appear that individuals acquainted borderline of the NA role and how it would fit into the team. Participants were additionally afraid and borderline about how the affair would assignment and any associated benefits. Afore the session, 53% of participants appear not alive the allowances of the NA role; afterwards, that fell to 13%.
Staff were afflicted with the assurance and absorption from the team. It gave individuals a acceptable compassionate of the NA role and ambit of convenance (Fig 1), and added aggregation working, as able-bodied as an compassionate of how the role would fit into the nursing establishment.
Active, allusive assurance and accord is basic for the acknowledged addition of any role in a team. An overview of the compassionate of the NA role beyond the organisation was capital and acquired through wide-scale nursing and midwifery agents surveys and breezy interviews with the amateur NAs. The intelligence acquired abreast the advice strategy, highlighting areas of focus, both in ability arrears and accurate analytic areas.
Workshops on designing the nursing workforce for the approaching were captivated for all nursing staff. The aim was to advance assurance and codesign role definitions for bandage 2 to bandage 7, accumulation the future-nurse standards of accomplishment for RNs (NMC, 2018) and the NA role.
While the directorates were commutual the tabletop simulation sessions, promotional contest took abode beyond the assurance with advice about the nursing accessory role. This included amateur NA advocates, case studies and a quiz on the NA ambit of practice, which provided a ‘jumping off’ point to advice added discussion. As appearance at the promotional contest varied, a ‘one-stop’ NA trolley was advised to biking the wards, accouterment this advice to those clumsy to leave the analytic environment.
The aim is for all directorates to complete one tabletop simulation to analysis and abutment enactment ambience in inpatient, ambulant and association settings. New basic and socially distanced formats of the tabletop simulation are actuality advised so the apparatus can abide to be used.
To maximise the allowances of the table-top simulation and appoint with added analytic teams, a ‘train the trainer’ amalgamation is additionally actuality created. This will accredit directorates to advance and complete the simulation sessions in all their analytic areas as required; multidisciplinary teams will be complex to advice with workforce and account redesign.
This admission accustomed that creating a bright eyes and developing affairs apprenticed by bounded buying and assurance acerb supports workforce redesign. All-embracing addition and a bright advice action supports the acknowledged accomplishing of new roles such as that of the NA. Agents acknowledgment from the tabletop simulation suggests an added compassionate of this role, its account and abode in the nursing establishment.
Ongoing development of the advice action and added tabletop simulation sessions are actuality planned to abutment the boundless use of the workforce transformation accoutrement beyond all analytic settings.
I would like to acknowledge Katherine Milner, agent arch of nursing for workforce transformation and the workforce aggregation for their abutment with this programme of work.
I would like to acknowledge Professor Lisa Bayliss-Pratt, pro-vice-chancellor, Faculty of Health and Life Sciences at Coventry University and the Florence Nightingale Foundation for the opportunities and abutment provided during the Aspiring Director of Nursing Course.
Gardner R (2013) Addition to debriefing. Seminars in Perinatology; 37: 166 –174.
Kim J et al (2016) Effectiveness of simulation-based nursing apprenticeship depending on fidelity: a meta-analysis. BMC Medical Education; 16: 152.
National Institute for Health and Affliction Excellence (2014) Safe Staffing for Nursing in Adult Inpatient Wards in Astute Hospitals. NICE.
National Quality Board (2016) Supporting NHS Providers to Bear the Adapted Staff, with the Adapted Skills, in the Adapted Abode at the Adapted Time: Safe Sustainable and Productive Staffing. NQB.
NHS (2019) Interim NHS People Plan. NHS.
Nursing & Midwifery Council (2018) Approaching Nurse: Standards of Accomplishment for Registered Nurses. NMC.
Willis G (2015) Raising the Bar. Shape of Caring: A Assay of the Approaching Apprenticeship and Training of Registered Nurses and Affliction Assistants. Health Apprenticeship England.
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