1. Implementation of the Nursing Strategy Sheena Vernon
18th January 2019

2. 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

3. 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

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

5. Link nurse / CHD nurse job description- approved!

6. 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

7. 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

8. 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

9. 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 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.

10. 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

11. 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

12. 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

13. 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. 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.

15. 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.

16. 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.

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

18. 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??

19. Thank you & Questions