Staff focus

This section introduces the staff focus theme. Resources to support this theme are: 

Introduction

An educated, trained and developed workforce is an integral part of clinical governance. Valuing the contribution that staff make to quality health care and continuing improvement,  and the provision in workplaces of a learning and supportive culture are important to achieving better patient care (Scottish Government 2010).

Health care practitioners in turn need to take individual responsibility for their own development and updating of skills. This is an essential element within professional accountability, and is reflected in the RCN Principles of Nursing Practice (Royal College of Nursing 2010a). Individual accountability is explicitly reinforced in Principle B of the RCN Principles of Nursing Practice and this includes a responsibility to continuously update nursing skills and competences. Evidence of competence contributes to the demonstration of accountability in practice (Scrivener 2011).

The RCN Principles of Nursing Practice clearly articulate what patients, families, carers and health care colleagues can expect from nurses and nursing practice. Principle B focuses on ethical and legal integrity, accountability and responsibility for the actions taken by individuals in delivering safe and effective care to patients. Principle F focuses on evidence-based practice, technical skills, education, training and clinical reasoning – see Principle B and Principle F.

A focus on evidence-based practice is a cornerstone of clinical governance. This involves not just an ability to display awareness of best available evidence but also recognises the importance of implementing best practice. Such implementation is supported through up-to-date training and skills combined with the use of clinical reasoning – the ability to apply evidence both according to the needs of individual patients and the context in which care is delivered (Gordon and Watts 2011).

Structures enabling appropriate professional development include appraisals, clinical supervision and use of competence frameworks. A competence 'describes the performance criteria, knowledge and understanding needed for an individual to carry out a work function effectively' (Skills for Health 2011). Appraisal objectives and competence development can be linked to the NHS Knowledge and Skills Framework and Skills for Health competences (Department of Health 2004; NHS Employers 2010; Royal College of Nursing 2006).

Clinical supervision provides a formal process for reflection on experience and problem-solving and both supports individuals in assuming responsibility for their own practice and fosters developmental and evaluative practice for safe and effective care. One description of clinical supervision is that it is "regular, protected time for facilitated, in-depth reflection on complex issues influencing clinical practice" (Bond and Holland 2010, p.15).

Other mechanisms supporting staff to deliver safe and effective care also include a focus on health and wellbeing at work. The correlation between staff experience and staff wellness with productivity, the patient experience and patient outcomes is acknowledged (Scottish Government 2010, p.6). The Boorman Review (2009) made clearer the links between the  health and wellbeing of staff and productivity, efficiency and better patient experience and patient outcomes. The recommendations made in the Boorman Review have been recognised and promoted by the Government (Department of Health 2010; Department of Health 2011).

Workforce planning and decisions around staffing levels and skill-mix can also impact on the delivery of safe and effective care and these are subject to a number of challenges. A report from the Royal College of Nursing written in the aftermath of a global financial crisis 'shows just how vulnerable NHS nursing staff numbers are to changes in policy' (Royal College of Nursing 2011a). Cuts in staffing are taking place (Royal College of Nursing 2011b) despite the 'growing body of research evidence which shows that nurse staffing levels make a difference to patient outcomes, mortality and adverse events' (Royal College of Nursing 2010b).

However, the provision of a learning and supportive culture which is such an important element of effective clinical governance also includes supporting staff in working in different ways and managing continual change. Often this is through role development as nurses and health care assistants take on tasks traditionally performed by others. Equally the constantly changing demands of health care in the 21st century require that roles are revisited.

In every role the ability to work well as part of a team is essential, and effective teamwork is integral to clinical governance (McSherry and Pearce 2010). Effective teamwork has been described as 'team working and interdependency through integrated working with and between health and social care both public and independent' (McSherry and Pearce 2010, p.29).

The RCN Principles of Nursing Practice make clear the importance of good team working to the quality and safety of care: “Nurses and nursing staff work closely with their own team and with other professionals, making sure patients’ care and treatment is co-ordinated, is of a high standard and has the best possible outcome” - see Principle G. In addition good team work must be underpinned by ensuring 'communication within, across and between teams is coherent, consistent and comprehensible' (Platt 2011, p.31).

References

Most of the items in this reference list can be accessed online. They were last accessed on 25 February 2013. Some of them are in PDF format - see how to access PDF files.

Bond M and Holland S (2010) Skills of clinical supervision for nurses: a practical guide for supervisees, clinical supervisiors and managers. 2nd ed. Maidenhead: Open University Press.

Boorman S (2009) NHS Health and Well-being: final report. London: DH.

Department of Health (2004) NHS Knowledge and Skills Framework. London: DH.

Department of Health (2010) Equity and excellence: Liberating the NHS. London: DH.

Department of Health (2011) Healthy staff, better care for patients: realignment of occupational health services to the NHS in England. London: DH.

Gordon J and Watts C (2011) Applying skills and knowledge: Principles of Nursing Practice F. Nursing Standard 25(33)  pp.35-37 (PDF 559KB).

McSherry R and Pearce P (2011) Clinical governance: a guide to implementation for healthcare professionals. Chichester: Wiley-Blackwell.

NHS Employers (2010) Appraisals and KSF made simple – a practical guide. Leeds: NHS Employers.

Platt M et al (2011) Continuous care across teams: Principles of Nursing Practice G. Nursing Standard 25(34) 27 April pp. 31-33 (PDF 84KB).

Royal College of Nursing (2006) Discussing and preparing evidence at your first personal development review: guidance for RCN members on the NHS Knowledge and Skills Framework (PDF 312.4KB). London: RCN.

Royal College of Nursing (2010a) RCN Principles of Nursing Practice. RCN website.

Royal College of Nursing (2010b) Guidance on safe nurse staffing levels (PDF  1.70MB). London: RCN.

Royal College of Nursing (2011a) A decisive decade – mapping the future NHS workforce (PDF 741.44KB). London: RCN.

Royal College of Nursing (2011b) Frontline First website.

Scottish Government (2010) The healthcare quality strategy for NHSScotland. Edinburgh: Scottish Government.

Scrivener R et al (2011) Accountability and responsibility: Principles of Nursing Practice B. Nursing Standard 25(29) pp.35-36 (PDF 554KB).

Skills for Health (2011) Glossary: competences. Skills for Health website.