MHA Nursing Workforce Strategy

Our Mission

As acharity,our mission is to enable people to live later life well.

Our Values

Inspired by our Methodist roots, we: Respect every person, treating them with dignity

Nurture mind, body and spirit

Inspire the best in each other

Our Vision

By 2024 we will have increased the quality,impact and reach of our services by connecting our communities and realising our potential as One MHA. In line with the MHA Purpose, the nursing strategy is particularly focussed on ‘enhancing later life’ and ensuring that MHA is ‘fit for the future’

Introduction

Our purpose

MHA launched afive year strategy in April 2019. Following the impact of aglobal pandemic the strategy was refreshed in 2022 to focus on recovery,and to position MHA to respond positively to the future.

Thereare nowfive strategicpillars:

• MHA Reshaping Careand Later Living

• MHA Connections

• MHA Enhancing Later Life

• MHA Fit for the Future

• MHA People

The nursing workforce strategy is designed to support MHA to be fit for the future, to value our nurses by realising their potential and to enhance later life. We want to mirror the strategic aim of the NMC by aiming for a workforce that is ‘safe, effective and kind’ This strategy provides the backbone for the CareHome blue print project which will define and deliver our futureapproach to care home provision.

Within the context of this strategy ‘best’ is defined as ‘safe, effective, kind and compassionate’.People receiving care expect it to be right for them, consistently, throughout every stage of their life. Kindness and compassion is how careisgiven through relationships based on empathy,respect and dignity.Itiscrucial that MHA nurses have these qualities. It is also imperative that we improve our services not only through reference to clinical evidence but also with reference to what the people who use our services tell us.

Overarching strategic statement of intent

MHA aims to be the place wherethe best nurses want to work and wherethe best nurses want to stay.Inthe words of one of our nurses ‘Weneedto make being an MHAnurse special’.

Context

According to the Nursing and Midwifery Council (NMC), the adult social care workforce employs 42,000 registered nurses in England alone. Registered nurses are however in decline across adult social care, down 17,000 (33%) since 2012/13.

The appointment of afirst-ever Chief Nurse for Adult Social CareinDecember 2020 set out the Chief Nursing Officer’sintention to recognise and acknowledge the importance of nurses who deliver clinical carefor people living in carehomes, ‘helping them to stay healthy,happy and independent for longer’. Nursing in social caresettings has now been acknowledged as an immensely skilled and complex area of practice…‘these nurses areactually practicing advanced clinical decision making, autonomy, carecoordination and leadership in very challenging circumstances.’

In 2023 MHA will have been delivering services for 80 years and areproud to be the largest charity provider of adult social care. MHA deliver nursing services across 33 nursing homes and have the potential to be delivering nursing services to 1,601 people when full occupancy is achieved. MHA acknowledge the immense contribution that the nursing workforce has made during the COVID-19 pandemic.

MHA dementia nursing homes offer support for people living with dementia and who may also live with along-term illness or disability wheremorecomplex nursing and medical support is required. MHA general nursing homes provide carefor those with long-term illness or disability wheremorecomplex nursing and medical support is needed.

Background information

The MHA Nursing Profile:

MHA have atotal of 1,601 nursing places over 33 nursing homes. The distribution of places is set out in table 1and 2below.

Type of nursing service

Number of places

General Nursing, England 940

General Nursing, Scotland 65

General Nursing, Wales 44 (TyGwyn)

Total 1049

Table 2: Number of places for people living with dementia and with nursing needs

Type of nursing service

Number of places

Nursing Dementia, England 534 Nursing Dementia, Scotland 18 Nursing Dementia, Wales 0

Total 552

Skills for Carefigures showed a5%fallinthe number of registered nurses working in adult social careinEngland in 2020. MHA is currently carrying avariable nursing vacancy rate approximated at 13%. This results in costly nursing agency use with continuity of careand support adversely impacted.

Strategy development and implementation

ANursing Strategy Steering Group (NSSG) was set up to develop and implement this strategy.

The group decided it was critical to shape the strategy by connecting with the nursing workforce thereforea number of focus groups wereset up andviews sought.

At the start of the development of this strategy the NSSG identified drivers for action as follows:

• Competition to recruit nurses because of Brexit, the impact of the COVID Pandemic and mandatory vaccination as acondition of employment

• NHS terms and conditions seen by many to be moreattractive than MHA (particularly relating to the pension, annual leave entitlement, benefit scheme, access to personal development and career development opportunities)

• The NHS has morepositive coverage in the media than adult social care

• No clear career progression routeinMHA for post holders such as carers, seniors and nurses

• Nurses feeling aheavy responsibility as often working as the only healthcare professional on duty

• Competition with other providers over agency nurses

• Therecan be alackofunderstanding and appreciation of the nursing role and the level of complexity of the role

• Morerecently thereisoften an expectation that nursing colleagues take on the roles of other external healthcareprofessionals

• Therehave been asmall number of concerning cases of nurse misconduct across the Charity

• The interview process for nurses is not standardised

We askedour nurses what made them want to work for MHA. Hereare examples of what they said:

“The fact MHA is acharity; it’s nice to be working for acharity that is reinvesting its money in supporting older people.”

“Encouragement from management to succeed and improve.”

“It’sraretosee anursing home that is so well set up with equipment and that is so well organised.”

“MHA arecertainly the most caring company Ihave worked for.”

We askednurseswhat had made them most proud over the last two years. Hereare examples of what was said:

“Most of all how we supported each other through such a traumatic time, how we helped each other,the residentsand the families and how strong we were.”

“Being able to remain supportive to staff and families and loving our residents as they went through atraumatictime.”

“Complex nursing. Strong team. Skilled colleagues. Teamwork we supported each other.”

We want to build on the positivity that our nursing workforce have expressed through the focus groups that we held.

Our four commitments

Four commitments form the structureofthis Nursing Workforce Strategy:

Commitment one

We will provide aframework for the recruitment and induction of nurses and nurse associates with the aim of attracting those who have compassion, high standards,and theright skills and with leadership potential.

Commitment two

We will support, develop and provide acareer pathway for our nursing workforce with the aim of the retention of high performing compassionate nurses across MHA. This will include the development of special skills such as Infection, Prevention and Control, Palliative Care, Dementia, Tissue Viability, Prescribing.

Commitment three

We will support the futureof nursing in adult social careby seeking to work closely with universities to provide nurse placements and to provide a pathway for those wanting to become assistant practitioners/ nurse associates and nurses.

Commitment four

We will celebrate the value of our nursing workforce by the celebration of International Nurses’ Day,through events such as an MHA Nurses Conference, by encouraging nominations for recognition such as the Chief Nursing Adult Social CareGold and Silver awards and the RCN nursing awards and by providing appropriate levels of support.

Commitment one

Our plan

• We will improve the way that we advertise nursing roles, using success stories from nurses within MHA and demonstrating the opportunities that are available within the Charity as we make these available, advertising that we are aprogressive organisation with a clear strategy for nursing

• Therewill be astructurefor the recruitment of nurses which will be values based and will be with reference to the NMC Code and to the Chief Nursing Officers ‘6 Cs’ (Care, Compassion, Competence, Communication, Courage and Commitment)

• The job description for nurses will be reviewed and will include essential elements based on the NMC Code, MHA values and the 6Csprinciples –therewill be a requirement to have IT skills or awillingness to develop

• Therewill be aframework for induction that will be used across the organisation with essential elements and also elements that can be adapted based on anurse/nurse associates background and experience

Our nurses said: “It’snotaboutencouragingnursesto stayastheyseemtodoso,it’sabout howtoattractthemintoMHAinthe firstinstance.”

“Weshould‘advertisetheopportunities moreeffectively’and‘providemore developmentandtrainingprospects andadvertisethese’.”

“Weshouldchangethegeneral perceptionofnursingincarehomes anddispelthemyththatthisiswhere nursesendupiftheycan’tdo anythingelse.”

• Each newly appointed nurse will have a ‘supporter’ who is aregistered nurse and who will provide this support for the first six months in role

• We will accept and encourage the recruitment of newly qualified nurses and therewill be aperiodofpreceptorship when commencing employment to support the nurse to develop the confidence to practise competently as anurse

• We will recruit from oversees and do this in away that aligns to the framework provided by the NMC. We will identify the homes wherethereis thepotential to recruit nurse associates and work with those homes to put in the necessary support to make that happen

• We will look to collaborate with Universities that offer the nursing degree and meet with 3rdyear nursing students to talk about MHA and the opportunities that the Charity offers

In the CQC ‘State of Care’ report for 2020/2021 therewereserious concerns that the sector werelosing social care staff to other industries. The same report cited examples of carehomes having to cancel their registration to provide nursing carebecause their attempts at recruitment had failed, leaving residents needing to be found new homes in local areas. Often those new homes were equally struggling for nursing staff and had little capacity left because of this.

Commitment two

Our plan

• We will grow our understanding of our nursing workforce to better understand why nurses become dissatisfied and choose to leave; we will do this by developing amodel of consultation through focus groups

• We will acknowledge the current skills of our nursing workforce and make more use of them

• We will look at practical ways of releasing nurses to learn

• We will find more opportunities to develop our nursing workforce in different ways, for example through secondments, role swaps and shadowing colleagues, providing a nursing skills pathway

• We will strengthen therole of clinical supervision/reflective practice, using different approaches such as journal clubs, critical incident analysis

• We will strengthen the leadership skills of our nursing workforce with aparticular focus on the importance of compassionate leadership both from nurses and from those who lead them

• We will securea policy around competency assessment, deciding what aspects of the nursing role requirecompetency assessment annually and deciding whose competent to assess anurse as competent

• We will find new ways of ensuring that our nursing workforce feel stimulated to learn even if they have no ambition to progress other than within their current role

• To progress our nurse led services and provide to moreresponsive services we will commission the training of anumber of nurse prescribers

• We will work towards having three MHA Specialist Dementia Nurses.They would provide expert advice and support to residents, their families and those who support them across all MHA services.

• We will work collaboratively with national end of life careorganisations and we will grow our links with local hospices to improve end of life careprovision

• We will carry out nurse led exit interviews to understand why nurses have chosen to leave MHA –themeswill be established in order to learn

Our nurses said:

“Wewanttotakemorecomplex residents,developclinicalskillsand beauniquehome.”

“Wewouldliketobecomementors forstudentplacementsanddevelop clinicalleadershipskills.”

“Wewouldliketheopportunitytovisit otherhomestoseewhatwecanlearn anddodifferentlyandtobringnew ideasback.”

The NMC, in setting out their five year strategy,state that their regulatory standards, education and process of revalidation support nursing professionals to better meet and adapt to the changing needs of people using health and social careservices. The RCN make the observation that ‘with services under pressure, tighter budgets and astruggle for resources, nurses often report feeling neglected or stunted when it comes to their professional development’ and they encourage nurses to be proactive in seeking career development opportunities.

Commitment three

Our plan

• We will maintain and grow our involvement in the development of student nurses at all levels of training, creating atalentpipeline through internal and external sources

• We will only agree to take student nurses whereweare able to confidently retain their supernumerary status, release nurses to mentor and thereforeensurethat they are given the support to actively learn and aiming for consistent mentorship

• We will identify talent within the context of our residential, retirement living and community services, in terms of those who might have potential to take up anursingor anurse associate role

• We will make opportunities to ‘grow our own’ by working with universities to make available the assistant practitioner pathway’, apathway into the nurse associate role or a pathway into nursing, exploring possibilities regarding use of the apprenticeship levy

• As we build ourcapacity,wewill look at morewidespread use of Nursing Homes as astep down from secondary care

Our nurses said:

“Itwillbegoodfornursestobeable toworkasmentors.”

“Itwillbegoodforseniorsandcarers asitoffersaprogressionroute.”

Some MHA nursing homes already support local universities in providing placements for student nurses however this is not something that all nursing homes across the Charity currently do. Wherewehave nursing homes with astable workforce we arewell placed to support the futureofnursing by providing meaningful places to learnfor nursing students.

Our nurses weregenerally positive about taking nursing students however therewas some confusion about the Nursing Associate role and some concernregarding where accountability for their actions would sit.

What the experts say...

The Chief Nurse for Adult Social Care said, ‘Undertaking aplacement in social carebringsabroad range of learning opportunities. As well as enabling them to experience health and careprovision across adiverse range of settings, students build an understanding of the work of the sector and the crucial role in supporting people to live their lives the way they want to and be cared for in surroundings wherethey arecomfortable’.

Commitment four

Our plan

• We will acknowledge the value and complexity of anurseled service, looking into ways that MHA can award outstanding contributions to the profession and to those who areserved, and encouraging nominations for nursing awards

• We will work towards anetwork of support through peers and nurses in managerial positions with the aim of developing role autonomy whilst supporting clinical decision making andreflective practice

• We will link into the MHA programme of digital transformation to ensurethat systems that areintroduced enhance safe and effective care whilstreleasing time to be with the people that we serve

• We will look at the scope of the nursing role and consider how we use or build expertise and experience to lead and promote certain elements of clinical practice, for example end of life care, dementia, infection control, fall prevention, tissue injury prevention

• We will look at new ways to bring nurses together to shareand learn,looking at the possibility of asponsored national conference with external speakers

• We will use good news stories to celebrate how MHA nurses have progressed their career within MHA, detailed what inspired and motivated them

• We will celebrate International Nurses Day in May each year following on from 2020 which was the 200th anniversary of Florence Nightingale’sbirth and celebration of the International Year of the Nurse and Midwife

• We will encourage the nursing workforce to sign up to the Skills for Carenewsletter for social carenurses

• We will use external opportunities such as the Nightingale frontline leade support service who offer safe and confidential spaces for nurses to come together to ‘decompress and reflect on leadership challenges’

ership d

Our nurses said:

“MHAneedstoinvestinthequality andskillsofnurses.”

“WewouldlikeMHAtoruna conferencejustfornursesandinclude anursingaward.”

“Supportafterinitialinduction isessential.”

“Ifwecouldhaveclinicalskillsor traininghubsdedicatedtotheMHA Nurse,wecouldalsooffercoursesfor otherprovidersifweinvested.”

“Thereshouldbe‘recognitionofthe levelofskillcarehomenurseshave.”

We want to ensurethat MHA nurses have asense of how important they a as leaders and as members of awide team and to acknowledge the vital contribution that they make to the overall purpose of MHA.

What the experts say...

According to Kings Fund (2020) Nurse and midwives have three coreworkneeds that must be met to ensurewellbeing and motivation at work, and to minimis work place stress: autonomy, belonging and contribution.

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ABC framework of nurses’ coreworkneeds (Kings Fund)

Autonomy

The need to have control over one’swork life,and to be able to act consistently with one’svalues

Belonging

The need to be connected to, cared for by,and caring of colleagues, and to feel valued, respected and supported

Contribution

The need to experience effectiveness in work and deliver valued outcomes

•Authority,empowerment and influence

Influence over decisions about how careisstructured and delivered, ways of working and organisational culture

•Justice and fairness

Equity,psychological safety,positive diversity and universal inclusion

•Work conditions and working schedules

Resources, time and asense of the right and necessity to properly rest, and to work safely,flexibly and effectively

•Teamworking

Effectively functioning teams with role clarity and shared objectives, one of which is team member wellbeing

•Cultureand leadership

Nurturing cultures and compassionate leadership enabling high-quality, continually improving and compassionate careand staff support

•Workload

Work demand levels that enable the sustainable leadership and diversity of safe, compassionate care

•Management and supervision

The support, professional reflection, mentorship and supervision to enable staff to thrive in their work

•Education, learning and development

Fl c

exible, high-quality development opportunities that promote ontinuing growth and development for all

References

• CareQuality Commission –State of Care2020/21 https://www.cqc.org.uk/sites/default/files/20211021_stateofcare2021_print.pdf

• Dementia UK (2022) What do Admiral Nurses do? https://www.dementiauk.org/for professionals/how-to-become-an-admiral-nurse/what-do-admiral-nurses-do/

• Department of Health (2014) Compassion in practice Nursing, Midwifery and CareStaff Our Vision and Strategy (introducing the 6Cs) https://www.england.nhs.uk/wp-content/ uploads/2012/12/compassion-inpractice.pdf

• Florence Nightingale Foundation (2022) Frontline leadership support service https://florence-nightingalefoundation.org.uk/nightingale-frontline-leadership-support-service/

• International Council of Nurses (2020) Nurses: Avoice to lead nursing the world to health https://2020.icnvoicetolead.com/wp-content/uploads/2020/03/IND_Toolkit_120320.pdf

• NHS (2019) Long Term Plan https://www.longtermplan.nhs.uk/wp-content/uploads/2019/08/ nhs-long-termplan-version-1.2.pdf

• NMC ‘Good nursing and midwifery care–What our professional Code means for you’ https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code-patientpublic-leaflet

• NMC (2020) Leavers Survey https://www.nmc.org.uk/globalassets/sitedocuments/councilpapersanddocuments/leaverssurvey-2021.pdf

• NMC The Code (2015) https://www.nmc.org.uk/standards/code/ Updated to reflect the regulation of nursing associates: 10 October 2018

• NMC (2020) Regulate, Support Influence Strategy 2020 –2025 https://www.nmc.org.uk/globalassets/sitedocuments/strategy/nmc-strategy-2020-2025.pdf

• Nursing in practice (Jan 2022) https://www.nursinginpractice.com/community-nursing/ deborah-sturdy-appointed-as-permanent-social-care-chief-nurse/

• Royal College of Nursing (RCN) Nursing Awards 2022 https://www.rcn.org.uk/news-andevents/events/uknursing-awards-2022-250322

• Royal College of Nursing (RCN) (2021) Nursing Workforce Standards; Supporting asafeand effective nursing workforce file://mha-vm-fs01/users$/hpress/Downloads/009-681.pdf

• Royal College of Nursing (RCN) (2017) Safe and Effective Staffing: Nursing against the odds

• RoyalCollege of Nursing (RCN) (2016) The contribution of registered nurses in Scotland’s CareHomeTeams file://mha-vm-fs01/users$/hpress/Downloads/SCO-POL-Nursing-In-CareHomes.pdf

References

• Skills for Care(2021) The size and structureofthe adult social caresectorand workforce in England https://www.skillsforcare.org.uk/adult-social-care-workforce-data/ Workforceintelligence/publications/national-information/The-size-and-structure-of-the-adultsocial-care-sector-and-workforce-in-England.aspx#:~:text=Key%20findings,%2F20%20 and%202020%2F21.

• Skills for Care(2021) How to make the most of student nurse placements in social care settings –for the person who needs careand support, employer,studentand education provider https://www.skillsforcare.org.uk/resources/documents/Regulated-professions/ Nursing/How-to-make-the-most-of-student-nurse-placements/How-to-make-the-most-ofstudent-nurse-placements-in-social-caresettings.pdf

• Skills for Care(2019) Registered nurses; Recognising the responsibilities and contribution of registered nurses within social carehttps://www.skillsforcare.org.uk/Documents/Learning-anddevelopment/Regulatedprofessionals/Registered-nurses-recognising-the-responsibilities-andcontribution-of-registered-nurses-withinsocial-care.pdf

• The Kings Fund (2020) The courage of compassion: Supporting nurses and midwives to deliver high-quality carehttps://www.kingsfund.org.uk/publications/courage-compassionsupporting-nurses-midwives?utm_source=linkedin&utm_medium=social&utm_ term=thekingsfund

©2022. MHA is the trading name of agroup of companies. Methodist Homes is aregistered Charity in England &Wales (No.1083995) and Company limited by Guarantee (No. 4043124) with registered office:MHA, Epworth House, Stuart Street, Derby DE1 2EQ

Auchlochan is aregistered Scottish Charity (No. SC040155) and Company limited by Guarantee (No. SC352117) with registered office:Auchlochan House, New Trows Road, Lesmahagow,LanarkshireML11 0JS.