1. how to support our night staff.
Schwartz after dark -
how to support our night staff.
Facilitators: Geoff Coyne and Sarah Crawford
Clinical Lead: Andrew Hanrahan
Administrator: Virginia Caalaman
Main Contact: Sophie Duport
Royal Hospital for Neuro-disability, West Hill, Putney SW15 3SW
In the poster we present our reflections after one year of night Schwartz rounds.
We compare the first year of night Schwartz rounds with the first year of day Schwartz rounds
Night rounds
Day rounds
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The stories presented by the panel were relevant to my daily work
When comparing the feedback summary from the first year of night rounds with the first year of day rounds we were struck by how similar they actually are.
Because of the homogeneity of the participants (all clinical and all nursing staff) the stories and discussions during the night rounds are more directly relevant to their daily/nightly work and to patient care.
It is worth noting that despite the diversity of the day participants the rounds are found valuable and relevant to their work. The stories may have less direct impact on patient care (46% day vs 65% night) but they support understanding and working together (55% day vs 51% night).
Both night and day rounds received positive feedback, staff are planning on attending again and would recommend the rounds to a colleague.
Because of the logistics of the day rounds and the fact that several meetings and events may clash with the day rounds, staff are more conscious of the need to plan to attend (82% day vs 75 % night).
They equally are more willing to spread the word (84% day vs 75% night).
Background
The Royal Hospital for Neuro-disability (RHN) has been running Schwartz rounds since April It all started with the support of the Health Innovation Network and the Point of Care Foundation.
A typical round will be scheduled during the day at lunchtime.
The rounds have been well attended and received good feedback. However we had some queries by our night staff about the rounds.
We have two different teams on night shift. Staff on nights do not rotate between teams or between day and night shift. So there was no way for them to be part of a round as scheduled.
Our chaplain, Geoff Coyne, has supported the Schwartz rounds from the beginning. He proposed to facilitate a Schwartz round during one of his monthly night tour. This meant that each night team will have a round every two months.
We decided to follow the same format as a day Schwartz round but have a shorter one:
45 minutes per round,
2 panel members and
one facilitator.
Refreshments served before the round around midnight.
The first night Schwartz round started in November The night rounds have been running for a year now. 0%
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Today’s Round will help me work better with my colleagues 0%
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I gained knowledge that will help me to care for patients
Logistics
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The group discussion was helpful to me.
Format:
Despite being shorter, the night rounds offer a very positive support to staff.
As this format worked well we will maintain it.
Attendance:
The staff are keen to attend but we will continue to monitor attendance closely.
Themes:
The night staff represent a smaller, tighter community than the day staff which means that confidentiality and anonymity are difficult to maintain: stories dealing with speaking up or feeling undervalued did not trigger the same vibrant discussions as during the day. Some staff were reluctant to participate.
It is hence really important to give staff a choice of themes and be mindful that some themes may not be appropriate.
Frequency:
As the pool of potential panel members is rather small it was felt that one round every two months was a bit too frequent. We have now changed the frequency to one round every three months. 0%
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I have gained insight into how others care for patients
Themes
The night teams selected their own themes:
The feeling I tried to hide: “Encountering Severe disability at RHN”.
Feeling Undervalued: But what makes me want to come back the next day.
Looking after a patient that didn’t like me.
The patient I will never forget.
Breaking Bad News.
When a patient dies.
When we had to speak up no matter what. 0%
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I plan to attend Schwartz Rounds again
Attendance
Adapting the format for the rounds has enabled us to reach a small community within our organisation whilst maintaining the beneficial support that the rounds offer.
The average attendance is 19 for the night rounds compared to 37 for the day rounds.
The night rounds are attended by nurses and health care assistants only whereas the day rounds are attended by therapists, doctors and non-clinical staff but rather few nurses.
There is a greater homogeneity of participants in the night rounds. It is also a much smaller community.
The feedback form completion and return is almost 100% for both day and night rounds. 0%
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I would recommend Schwartz Rounds to colleagues
The RHN Schwartz round Steering group (P Allen, F Low, G Coyne, S Crawford, A Hanrahan, L Rose, V Caalaman and S Duport) would like to thank all the brave RHN staff who have volunteered to be on the Schwartz round panels. We are very grateful to the Point of Care Foundation for their support and guidance.