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Role of nursing team leader - interprofessional working

Alistair Carlyle & Chris Nicoll
Staff Nurses
Submitted Date: 06/04/2011
Review Date: 28/01/2011
Exploring the role of nursing team leader, promoting interprofessional working and highlighting the perceived benifits to the service and service user experience.
Local Area
Dumfries and Galloway
Care Setting
In-Patient Setting
Care Group
Evidence Base for Practice
Previously employing a Primary Nursing system the ward faced similar problems as highlighted in many of the national studies into acute wards including those by NHS Education for Scotland (2007, 2008). Accepting admissions from so many community teams also introduced additional difficulties.

·At times Primary Nurses could be allocated patients from all four community based teams resulting in inefficient communication links.
·Variable Admission and Discharge Planning.
·Difficulties with continuity of care within the ward through annual leave, sickness etc.
·Four separate Ward Rounds with no guarantees that nursing staff taking these would be fully conversant with each patient’s progress.
·Follow up for treatment plans at times communicated poorly.

Other Drivers for Change
·Mental Health (Care & Treatment)(Scotland) Act 2003.
·Rights, Relationships and Recovery: The Report of the National Review of Mental Health Nursing in Scotland. (Scottish Executive, 2006)
·Delivering for Mental Health: Acute Inpatient forums and Improving Care (Scottish Executive, 2006)
·A Capability Framework for Working in Acute Mental Health Care. (NHS Education for Scotland, 2008).
·Admissions to adult mental health inpatient services – Best Practice Statement (NHS Quality Improvement Scotland, 2009).
·Ten Essential Shared Capabilities. (NES, 2007).
·Feedback from Users & Carers Involvement.
·Leading Change Program
·Team desire to improve services.

The term interprofessional working appears to be a relatively new term within health and social care. Irvine et al (2002) cited by Barrett et al (2003) state that the nature of health and social care is that, for many the quality of the service received is dependant upon how effectively different professionals work together. This is something we have strived to improve in our ward area.
Quality assurance/impact of practice
Benefits and Improvements
·Strong Focus on User & Carer Involvement.
·Greater knowledge of locality services.
·Better networking with partner agencies.
·Tighter written documentation.
·More robust Admission & Discharge Planning
·Staff ownership and Development opportunities (eKSF, PDP’s, Supervision).
·Appreciation of each other’s roles – clearer understanding of roles and responsibilities.
·Enthusiasm, Vision, Motivation in staff.
·Direction for service improvement & delivery.
·Acknowledgement of what other services can bring to the ward.
·Pilot of appointment times have been a success.
·No increased budgets required for facilitating the change.
·Better verbal communication.

·Regular discussions with stakeholders have been positive.
·Ward Staff presented a Development Day attended by representatives from all partner agencies. Feedback from this has been very encouraging and reinforces the changes that have been introduced.

“ I attended the afternoon session and found if full of enthusiasm, good examples of joint working and people genuinely motivated.”

“Very positive and I hope the intention, motivation and momentum is sustained.”

“Great to see the ward staff so involved”

“It is encouraging to watch and listen to the enthusiasm that staff obviously feel. Good things are happening within Ettrick….”
Practice Summary
The work we are doing allows nurses on the ward the opportunity to lead a nursing team for in patient care. This role is allocated to locality areas and the CMHTs allocated to the area. The role is to work alongside Team Coordinator's (Deputy Charge Nurses), oversee care provided to clients and to improve interprofessional working. This works specifically with one medical team – Consultant Psychiatrist, Registrar, SHO and inpatients allocated to this team.

Teams allocated to locality or specialty
4 team leaders
Work alongside Community Mental Health Team for this area to improve communication between ward and CMHT
Improve admission planning and discharge planning
Improve arrangements for home leave for clients and where applicable arrange visits.
Ensure team diary kept up to date so all members of team are aware of ongoing developments
Practice Detail
The issues faced by the ward led to a project initiative being launched moving away from the concept of Primary Nursing to one of Locality Team Working.

Development of the model:
·Full Nursing Team discussion and initial 6 months pilot agreed.
·Consultant Psychiatrists and Community Mental Health Teams informed of changes and project aims.
·Staff allocated to Teams, headed initially by Deputy Charge Nurses.
·Closer Liaison with Community Mental Health Teams – Ward Staff attend weekly Community Team meetings and Community Staff attend Ward Rounds.
·Introduction of Weekly Nursing Review Sheets.
·Appointment Times for Consultant Ward Rounds introduced following research undertaken by Leading Change Project. This was piloted initially on Ettrick by the Annandale and Eskdale Team. Feedback from patients and staff have been favourable.
·Regular Team Review Meetings.
·Following initial evaluation, need for Team Leader Role identified. Team Leaders identified and appointed via eKSF and Personal Development Plans.

This leads to improved discharge / home leave planning.
Patients given advance notice of appointments prior to discharge.
CPN allocation where appropriate.
Personal development for team leader, developing new skills and leadership qualities.
Work alongside Team Coordinator for developing other members of the team – eKSF.
Morale building in team – regular team meetings with team. Push to get the best performance from the team as a group.
Each team will learn from each other and utilise the positive aspects to improve inter professional working.
Some teething problems
Distance between Ward and CMHTs
Staff availability
Resistance to change
Team re-shuffle,
Team Leaders allocated and some responsibilities disseminated from Team Coordinators.
Additional Comments
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