supporting nursing in care homes - king's fund · interviews: headlines • broad role,...
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School of somethingFACULTY OF OTHER
School of HealthcareFACULTY OF MEDICINE AND HEALTH
Supporting nursing in care homes
Karen Spilsbury
Barbara Hanratty
Dorothy McCaughan
Project funded by and working in collaboration with
School of HealthcareFACULTY OF MEDICINE AND HEALTH
Presentation of independent work
funded by the RCN Foundation
The views and opinions expressed
are those of the authors
Acknowledgements:
Professor Tony Butterworth,
Emily Cooper, Liz Newbronner,
Jane Maddison, RCN Foundation
Board of Trustees
http://www.rcnfoundation.org.uk/latest_news/2015-news/care-home-research
School of HealthcareFACULTY OF MEDICINE AND HEALTH
Context
UK care homes - more beds than NHS acute
hospitals, majority independent sector
Health of residents – no accessible routine data,
ad hoc surveys suggest increasingly complex needs
Registered nursing workforce – uncertain size,
outside the NHS, no specific training requirements,
no career pathway, limited or no information on:
retention, turnover, continuing professional
development, job satisfaction
School of HealthcareFACULTY OF MEDICINE AND HEALTH
Aim
To map and identify key issues in relation to the care and
professional development needs of nursing staff employed
in care homes
Objectives
Characteristics of the registered nursing workforce
Preparation and development needs of staff
Career opportunities (current or planned)
Nursing innovations/ developments in care homes
Priorities for future research and development
School of HealthcareFACULTY OF MEDICINE AND HEALTH
Who are the nursing
workforce in care homes?
What are the priorities for
front line staff?
What do we
know about care
& development
needs of care
home nurses?
Key issues
Stakeholder perspectives
Existing evidence-base
Realities of context
School of HealthcareFACULTY OF MEDICINE AND HEALTH
Secondary data sources
Who are the
nursing
workforce in
care homes?
School of HealthcareFACULTY OF MEDICINE AND HEALTH
Overall
• Poor understanding about the nursing workforce
• No recommended safe nurse staffing levels
In England
• Estimate 41,700 individual nurses working in care homes
• 54% nurses work full-time
• High vacancy rates
• Annual turnover 32%, 47% employed < 3 years
• Likely considerable variation in staffing levels and turnover
RQIA 2009, RCN 2012, Laing & Buisson 2013, Skills for Care (personal correspondence 2014)
School of HealthcareFACULTY OF MEDICINE AND HEALTH
Rapid literature review
Developing networks
What do we
know about
care and
development
needs of care
home nurses?
School of HealthcareFACULTY OF MEDICINE AND HEALTH
End of life care
Dementia care
Resident safety
Quality of care
Care home relationships
Personal care
Staff well-being and
safety
LT condition management
Tissue viability
Delirium DepressionHospital
admissions
Nurse education/
training
Staff development
Support for care homes
Nursing roles
Rapid review: Themes
School of HealthcareFACULTY OF MEDICINE AND HEALTH
Rapid review: Briefings
School of HealthcareFACULTY OF MEDICINE AND HEALTH
Rapid review: Headlines
RN role broad and multifaceted
Few studies on RNs: ‘care home staff’ and poor quality
Understanding, knowledge and competence - outcomes
Care home staff enthusiastic to engage with training
Resources (staff and time) present challenges
Creative approaches and link nurses
Considerations for training: more than ‘one-off’ event & equity
Organisational culture and environment – residents and staff
Care home manager is key
Opportunities in the care home for nurse education
School of HealthcareFACULTY OF MEDICINE AND HEALTH
Delphi survey
Telephone interviews
What are the
priorities for
frontline staff?
School of HealthcareFACULTY OF MEDICINE AND HEALTH
Delphi survey: Headlines
• The role of the nurse
- Require particular set of skills, knowledge, competence and experience
- Key: promoting dignity, personhood and wellbeing and ensuring resident safety
• Continuing professional development (CPD)
- Priorities: personal care and dementia care
- Main barrier to access: staff shortages.
- Preferred formats: ‘on-the-job’/opportunistic and formal courses (qualification)
• The future workforce
- 30%: undergrad programmes prepare future nursing workforce for care home role
- 35%: care homes provide supportive learning opportunities
- 41%: the care home industry offers challenging and rewarding career pathways
- To secure future nursing workforce in care homes: equity of opportunity
School of HealthcareFACULTY OF MEDICINE AND HEALTH
Interviews: Headlines
• Broad role, overall responsibility, work in isolation
• Full potential of nursing role not always utilised
• Specialist knowledge to manage complex needs
• Post-registration qualification: care for older people
• Focus of nursing education – NHS and acute care
• Overseas nurses employed in care homes
• Difficulties accessing CPD
• Career pathway for care home nurses
• Partnership working, recognition of care home nurse
School of HealthcareFACULTY OF MEDICINE AND HEALTH
Areas for future work
• The care home nurse
• Employment and career pathways
• Creative approaches for learning and development
• Undergraduate pre-registration nursing education
• Partnership working
• Organisational culture and care home leadership
School of HealthcareFACULTY OF MEDICINE AND HEALTH
Thank you
http://nursingincarehomes.blogspot.co.uk/
@SpillersK
@BarbaraHanratty