Implementation of the Nursing Strategy Sheena Vernon 18th January 2019

The Standards Section A: The network approach Section B: Staffing and skills Section C: Facilities Section D: Interdependencies Section E: Training and education Section F: Organisation, governance and audit Section G: Research Section H: Communication with patients Section I: Transition Section J: Pregnancy and contraception Section K: Fetal diagnosis Section L: Palliative care and bereavement Section M: Dental

Update Nursing strategy- approved Network Board 27th November CHD nurse/link nurse job description- approved Network Board 27th November Established joint nursing meetings- Level 1 and 2CHD CNS, biannual to6 to offer support, share clinical practice and for education, Network Link nurse meeting BRHC link nurse meetings, monthly Link Nurse activity survey Next steps

Nursing Strategy – approved! Where to access? CHD Network website!

Link nurse / CHD nurse job description- approved!

Link Nurse activity across the network- survey results Survey monkey- 90 people Purpose: To understand what is happening with the Link Nurse role across the network 15 responses (16%) Results useful but incomplete

2. Please state your place of work (Hospital and Clinical area) Virgin Care BaNES Gloucester Royal Hospital Community nurse Childrens Community Nursing Team, Torbay Hospital BRHC - Cardiac Team Children's Community Plymouth Royal Gwent Hospital Gloucestershire Royal Hospital - paediatric assessment Musgrove Park Hospital, Cardiology Cardiology out-patients UHW NDDH Community Children's Nursing University Hospitals Plymouth Trust CHDU Cardiff Great Western Hospital, Swindon. Generic Community Children's Nurse Comments: Childrens In a very adhoc way as there is no dedicated time to support this role Outpatients and home visits Weekly Both –Daily Daily Adults Bi-monthly joint clinics, inpatients as and when they are admitted, advice line set up Weekly for clinic, couple of times/week for toe procedure

Comments: Childrens We seek advice and obtain as needed for cardiac nurses specialists in Bristol British Heart Foundation info The information is usually supplied by the lead centre and we are a DGH Always provide the most up to date information. Use various web sites to get this information and the cardiac nurses in Southampton and Bristol for information. Adults Teaching boards Comments: Childrens Unsure. I will check

Comments: Childrens However it be useful to have a named clinical nurse specialist. If you have 2 different consultants visiting, who work with different specialist nurses, it can be difficult. Is there a generic email address?? As with previous comment it is supplied by the lead centre Adults But know where to access from CNS team in Cardiff Comments: Childrens Yes and no Its obvious if they need a procedure, but we are not specialists I am part of the CNS team Have a good link to both Southampton and Bristol Nurses.

Comments: Childrens Having now added this meeting I will sign post here in the future But I can. Please can you send some colour posters about this? I haven't yet as I was not aware of this until the previous network meeting I attended but I will in the future

But perhaps unrealistic expectations in a non paid role Comments: Childrens But perhaps unrealistic expectations in a non paid role The lead centres offer support but we mainly access the nurses We can liase with local paediatricians if the patient has direct discussion with the local children's ward. We work as an MDT We have two consultants in Plymouth who have an interest in Cardiac children. They are very supportive and helpful. Comments: Childrens But its a link role, so the expectations and the demand don't always match Not really applicable to us as we are community nurses not dedicated cardiac nurse, our manager is supportive Adults But know where to access from CNS team in Cardiff

Comments: Childrens Time resource Not really applicable to us as we are not dedicated cardiac nurses but general community nurses who support a variety of families in the home The time allocated to the cardiac service is very limited at 0.2 and this was to be taken out of existing establishment. We no longer have a local cardiologist at Torbay to support patients, due to this workload has increased, although both visiting consultants are very helpful and approachable as are the cardiac nurse team. It can be difficult sometimes when you are visiting a child at home. However there is always an option of open access to Derriford Hospital. Support from the nurses in Bristol and Southampton is also helpful. Time to focus on the cardiac link role is very limited as I have taken it on extra to my own band 5 role and don't get separate link nurse shifts or admin time to complete anything. The manager who also acts as a link nurse sees the role as one to help educate staff. I would like more time to help parents/families/children. Adults I feel well supported by the network and my manager. The only challenges have been the normal ones in setting up a new role from scratch. Current challenges include change of local consultant and succession planning. Often rostered to not work on CHD specific days

Comments: Childrens Although more knowledge is always helpful! And we can easily access courses based in Bristol which are very informative and Southampton Hi I have attended study days in the past but feel that it would be very helpful to keep skills knowledge up to date to be able to access /participate in on going sessions ie once every 2 years as we always have complex cardiac patients on our caseload. As a community nurse we are expected to retain knowledge and skills on a wide range of conditions and diseases . 13. Where did you receive your cardiac education and what was it? (Courses, study days, in-house training, cardiac courses in Bristol) Childrens Advanced Cardiac Nursing Bristol In house 20 years nursing Bristol study day at the BCH education centre. Cardiac nursing course, Bristol Liverpool and attending up dates, courses and training in Bristol. Cardiac study days in bristol since qualifying, university teaching during degree, and cardiac ward placement during degree. Adults Study Days (Bristol) On the job training from Steph, Sheena and Bristol nurses 28 years experience in Cardiology ,in-house courses , 10 month secondment ACHD CNS,study days in Bristol.

14. Is there any specific education which you would like the Congenital Heart Disease network to provide for you?  Childrens Shadowing specialist nurses Basic overviews of common conditions is always really useful yes general day on more common conditions and care in the community/monitoring / complications ect. Regular up dates. How to best support families/children. Comments: Childrens I work as part of the CNS service Have found it very helpful. Adults I think it's excellent and have encouraged local staff to access it.

Comments: Childrens But its planned for the future Not yet This is not a regular teaching session however I teach as necessary to support other nurses who are looking after cardiac children. Adults 15 minute teachings on lesions, provide teaching boards, teach student nurse during TOE sessions aswell as members of own nursing team Comments: Childrens It is easy for us to go to Bristol and it is good for networking If this could be opened up to ward staff in the local DGH children's ward this would be shared knowledge and skills . I believe that it is imperative that there is education provision in the peripheries for nursing staff who are caring for a large cohort of CHD patients That would be something that I feel would benefit the team in the future.

Taunton- CHD nurse up-date Adults- nurse with allocated time developing service, participating in clinics, seeing occasional in-patients and telephone support Children's-increasing involvement from clinic staff Transition discussions taking place between children's and adult services.

Challenges Time for nurse to support clinics or in-patients Education for nurse Support for nurse Management support

Plan moving forward Six monthly meetings with Level 1 and 2 CNS- invite Level 3 link nurses Visit centres Exeter We need manager support- how can you help us with this??

Thank you & Questions