Examples of how the Principles are being used
Since their launch in November 2010 the Principles of Nursing Practice (PNP) have been used by a range of trusts and organisations. The examples presented here are organised under four broad themes:
If you have examples of how you are using the Principles of Nursing Practice you would like to share, please contact Chris Watts (firstname.lastname@example.org), RCN Project Manager, Quality, Standards and Innovation Unit.
The Principles are a useful tool for reporting on quality nursing care. For example, they have been used to support the Welsh Assembly response to the report compiled by the Older People’s Commissioner for Wales: Dignified care? The experience of older people in hospital in Wales.
This is an important demonstration of the dual use of the Principles: acting as a structure for developing and presenting reports of this nature, and at the same time acting as a set of descriptors that offer a positive articulation of good nursing practice.
Patient and public involvement
The Principles have been developed in partnership with patients and the public and, as such, they are a shared understanding of what all people can expect from nursing. This has led to them being endorsed by a range of patient and service user groups as well as being directly promoted to patients. For example, the Queen’s Nursing Institute (QNI) are promoting the Principles through their website telling patients what they should expect "from all members of the nursing team, including health care assistants, who come to your home or care for you in the community" – see Principles of Nursing.
Elsewhere, the Principles are being directly promoted to patients, their families and carers. Aneurin Bevan Health Board, as part of their response to the report Dignified care? The experience of older people in hospital in Wales, are displaying a copy of the Principles on patient/public information boards on all wards.
Northumbria Healthcare NHS Trust are putting posters up across hospital sites and obtaining feedback from patients based on the patient survey.
A further example of how the Principles are being used to present a positive articulation of good nursing practice is the PRIDE initiative developed by Dudley and Walsall Mental Health Partnership NHS Trust and launched on Nurses Day "as a way of recognising and valuing the key role played by nurses every day in offering high quality services. PRIDE stands for: Professional, Respect, Innovation, Dignity and Effectiveness, all key elements of the nursing role" - see Pride at the Heart of nursing in Dudley and Walsall. A PRIDE Pack has been issued to all nurses in the trust and contains a description of best practice nursing tools including the Principles of Nursing Practice. Alison Gleeson, Head of Nursing, has written an article in the Nursing Times - see Are you proud of yourself?
The Principles can support staff development in a variety of ways. This may be through launching and promoting them to all staff as has been done by Luton Community Children’s Services and Northumbria Healthcare NHS Trust.
At Northumbria the Board of Directors has approved the use of the Principles and they are being distributed to all nursing staff. Northumbria are also linking the Principles to a ward accreditation scheme where they will provide a clear framework of expectations of nursing care for all ward staff.
The Principles are also being embedded in nursing strategies. Nuffield Health Bristol Hospital are using the Principles in the development of their nursing strategy and recently held a workshop to launch the Principles to senior nurses.
The RCN Orthopaedic and Trauma Nursing Forum is also promoting the PNP at a workshop, to explore with delegates and forum members how the PNP can be used within orthopaedic nursing. The forum is also linking the Principles to its competency framework which is currently under review.
Similarly, Eastern and Coastal Kent Community NHS Trust are planning to embed and cross-reference the Principles in their clinical competencies which also inform appraisal and personal development for staff in the organisation.
Basildon and Thurrock University Hospitals NHS Foundation Trust are launching a nursing and midwifery journal for the Trust, utilising the Principles as an underlying framework. The aim is to improve communication and share best practice as well as patient and staff stories. The first issue accompanies the Trust’s Nursing Strategy launch in mid-September, and the aim is to produce an issue every two months.
The Principles have been used by the RCN in Scotland in the ‘Supporting Better Care’ Programme (SBC). As part of the new pilot for evaluating the SBC programme for health care assistants (HCAs), participants from the pilot dementia and diabetes sessions were emailed three months after attending the programme to obtain feedback. The feedback from the pilot evaluations was very positive and stated that the Principles of Nursing Practice have been incorporated and used within the programme and help as a part of reflection tool. The Principles have helped participants to identify how they personally deliver patient centred care and their comments include:
“I now feel that I can suggest things that will make a difference to my patients and that I am more aware of the issues that they may be facing”; “I feel it gives a good, well rounded education for HCA's. Makes us feel like valued members of the team.”
As well as supporting staff development, the Principles can be linked to recruitment. In the Eastern and Coastal Kent Community NHS Trust the Principles are being embedded into the recruitment and selection process. As Sue Baldwin and Jane Bromwich from the Trust explain:
"Quality nursing needs quality people to deliver the service, whatever the core business of the respective services and wherever it is delivered. We are starting the process of embedding the eight Principles with the recruitment and selection of those newly qualified nurses who upon appointment will commence on our preceptorship programme. At the recruitment events the prospective applicants are met and advised that the Principles are being embedded in nursing practice in this organisation and that they need to embrace them and make them ‘real’ for patients.
"Our selection processes will include a group interview where the Principles are used throughout the conversation and discussion that the shortlisted candidates have, to help identify those people with the aptitude and motivation to deliver a quality (and quality improving) safe service.
"After group interviews we will hold individual interviews which include scenarios that are based on the Principles. Interviewers will be prepared for their role prior to selection days to ensure that they are all conversant with the Principles and are confident and competent in facilitating a selection process based around them."
Elsewhere the Principles are being used to emphasise the patient care values expected from staff. In the nursing recruitment section of Derby Hospitals Foundation Trust website, Director of Nursing and Midwifery Brigid Stacey says: "Our values reflect those in the Royal College of Nursing’s Principles of Nursing Practice. These describe what everyone can expect from nursing practice, whether colleagues, patients, their families and carers. They are also what we expect all our nurses to follow" - see Welcome from the Director of Nursing and Midwifery.
Facilitating a preceptorship programme
As well as embedding the Principles in their recruitment and selection process, Eastern and Coastal Kent Community NHS Trust aim to use the Principles within their preceptorship programme. Sue Baldwin, Interim Director of Nursing and Jane Bromwich, Head of Practice Standards for the trust said:
"The internal preceptorship programme supports nurses through their early days as a registrant when they are being socialised into their role. In the longer term we are currently in dialogue with the local higher education institution, who are considering the potential to commence a preceptorship module in the last months of their pre registration degree programme. If this is agreed as a way forward, the Principles would provide a common language to facilitate and guide our new registrants during the transition from university to accountable practice."
1000 Lives Plus in Wales have issued a nursing version of their quality improvement guide in which they map each of the Principles of Nursing Practice to 1000 Lives Plus work areas, illustrating how the Principles relate to quality improvement activities. The guide describes a useful set of techniques that nurses and nursing at all levels can use in different settings and explores how nurses can use these techniques in their work. For further details and to download the guide see Launch of nursing version of quality improvement guide.
Framework for care and continuous improvement
The Principles can act as an overarching framework for care standards and continuous improvement. In the Eastern and Coastal Kent Community NHS Trust, the Nurse Leadership Group made a successful request of the trust Board that the Principles were formally endorsed by the organisation. Sue Baldwin, Interim Director of Nursing, and Jane Bromwich, Head of Practice Standards, explain:
"In Eastern and Coastal Kent Community NHS Trust we are keen to make the Principles for practice ‘live’ – and to use them in our ‘quest’ to continuously improve practice and support nurses in the delivery of safe quality patient care. The Principles rest comfortably with the organisations strategic objectives and pledges. They also give a platform for our personalised care programme as the framework clearly articulates a person-centred approach.
The Principles should not be perceived as a bolt on to existing standards and quality drivers but as a framework that can guide a nurse and their team whatever their role and at whatever stage they are at in their development and career. They can be measured in our organisation through our existing processes i.e. complaints; incidents; patient experience and audit.
The Nursing Standards Group under the leadership of the director of nursing will be involved in designing a programme around how we embed the Principles of Nursing Practice further to ensure that they do not become mere rhetoric, but a living aspirational framework for the standard of everyday nursing practice in Eastern and Coastal Kent Community NHS Trust."
Measuring and benchmarking
The Principles are a useful tool for mapping and developing measures. For example, Luton Community Children’s Services are using the Principles as a framework for mapping their existing measurement processes (e.g. CQC outcomes, DH indicators, patient safety and clinical risk processes, local performance management and staff surveys) and developing measures where gaps exist. The Principles can also be used to identify where gaps exist in current measurement processes.
Similarly, the Principles can be used as a benchmarking tool. The Steering Group of the King’s College Trust 2020 Project, an initiative to improve the quality of nursing care, are exploring the use of the Principles as a benchmarking tool for the pre- and post-evaluation of this project.
The Principles can support practice development initiatives such as the work Macmillan Cancer Care are doing around the development of a human rights framework in cancer care. As part of this work Macmillan are in the process of developing behavioural quality standards capable of reflecting and upholding human rights principles at key points of intervention across care pathways, and are working with the RCN to align these to the PNP. Future opportunities include a joint development programme around human rights working with regional PNP champions and service users.
The Principles are being used as a practice development tool in an academic programme run by Canterbury Christ Church University, Department of Nursing and Applied Clinical Studies. A series of masterclasses at the university includes a session which addresses why the Principles of Nursing Practice are needed in addition to existing standards and expectations, and explores the difference they can make to patient experience and practice. The masterclass will use the Principles to illustrate and explore the potential of practice development in creating a workplace culture of effectiveness and providing of safe and effective care.
The School of Nursing and Midwifery at Keele University has integrated the Principles into its pre-registration programme. See below for details of how the Principles are being used in the pre-registration and post-registration programmes.
- Case work is undertaken on the course for all branches, with a patient case accompanied by a series of questions to be addressed by first years and new starters. Students discuss the content of the case studies and consider how they have actively demonstrated some of these elements from the Principles (along with other policy and guidance) in their patient care.
- Students are also encouraged to use the Principles alongside the NMC Code of Conduct and guidance on professional conduct for nursing and midwifery students, and look at these documents for similarities and distinctive aspects.
- Students have been successfully encouraged to use the Principles both to demonstrate their working in an anti-discriminatory way and when considering nursing care and implications for practice.
- It is intended that first year students will produce a reflection written piece whereby the student actively demonstrates their nursing practice using the eight Principles as the focus.
- Qualifying students are being encouraged to use the Principles to support both their dissertations and job applications.
- The Principles are to also be used by post-registrants in an upcoming evidence based practice module as a framework for considering value base and implications for practice. Students will be encouraged to use the Principles alongside other models such as Benner’s Stages of Clinical Competence and consider how the Principles permeate from novice to expert.
The RCN in Scotland held a college engagement event in August. Thirteen delegates attended the event from a range of nine Scottish Colleges. Topics for the evening included the Principles of Nursing Practice as well as accountability and delegation, and discussions were held as to how to integrate the Principles into teaching sessions.