Building stronger teams: Nurse leadership in social care
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Building stronger teams: Nurse leadership in social care

Jennifer Trueland Health journalist

The pandemic highlighted the complex role of social care nursing. Now, it is hoped that career pathways and peer support will help to boost its image and attract people to the sector

Social care nurses often work in isolation from their registered peers, but more than ever need support from across the profession to carry out their roles.

Nursing Standard. 37, 9, 19-22. doi: 10.7748/ns.37.9.19.s12

Published: 31 August 2022

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Picture credit: iStock

Experienced nurse leaders who are working to change the image and culture of the specialism say this will help create stronger nurse-led teams, attract new nurses and boost nurse leadership in the sector.

Under the spotlight

Many nurses working in the field feel that their skills and expertise are not properly appreciated, even by their nursing peers. If the pandemic has shone a light on social care across the UK, is has also shown the dangers of a lack of proper collaborative working across sectors and understanding of what care homes do.

It has been a difficult and often distressing time for nurses working in care homes, which were expected to accept people discharged from hospital with COVID-19, or whose COVID status was unknown.

But it also highlighted the complex and valuable work that nurses do in care homes – and led to the appointment of England’s first chief nurse for social care, Deborah Sturdy.

She commissioned a rapid evidence review of adult social care nursing, published this year, which outlines what nurses bring to care home settings and calls for further research on these and other areas of social care.

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During the pandemic, strong leadership made a real difference to care home staff and residents

Picture credit: iStock

‘Nurses benefit from being supported by other nurses’

Leadership from nurses helps to promote professionalism within the team, says a new report from Scottish Care, which focuses on the experience of nurses working in social care.

It found that nurses benefited from being supported by nurse leaders and other nurses.

‘Nurses felt vulnerable where strong leadership was absent, and this contributed to them leaving their roles,’ it says. ‘It is important that leadership models are developed around the people who live and work in care homes.’

Scottish Care transforming workforce lead for nursing Jane Douglas says that nurses working in care homes need professional support, and this can be difficult if they are the only nurse working in a home. ‘A lot of nurses in smaller care homes will be working on their own, and some won’t even see each other at a handover, so they’re not getting that professional support.

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‘However long you’ve been qualified, you need professional support from another nurse’

Jane Douglas, Scottish Care transforming workforce lead for nursing

‘However long you’ve been qualified, you need professional support from another nurse. But if you’re the only nurse, where are you getting that clinical leadership and advice – how can you have those clinical conversations with another nurse? You can feel isolated.’

Scottish Care (2022) Hearing the Nursing Voice: Listening to Independent Sector Social Care Nurses tinyurl.com/scottish-nursing-voice

Revising the image of social care nursing

Nurses working in social care often supervise and lead the care assistant workforce and carry out clinical, administrative and regulatory duties, in addition to the managerial demands – it is a broad and complex role.

The research also describes the shortage of registered nurses in the social care sector – and highlights that there is some evidence that a higher number of nurses employed in care homes is associated with better outcomes for residents.

Scottish Care transforming workforce lead for nursing Jane Douglas says nurse leadership and professional peer support are vitally important in care homes.

She conducted research, published in May, that involved interviewing registered nurses to find out their perceptions and experience in the sector (see box). It found that too often care home nurses still feel that their experience and skills are not properly valued.

Dr Douglas, who is a former care home manager and chief executive, wants to see a change in culture. ‘Social care nursing should be seen as a specialism. If we can change the image so that working in social care nursing is a specialist role, then I think we’ll see more people making a positive career choice.’

‘The COVID pandemic highlighted that social care is short of staff and we do need to do more work to make social care and nursing homes a desirable place to work’

Karen Rennie, programme lead and lecturer, Queen Margaret University, Edinburgh

During the pandemic, strong leadership made a real difference to care home staff and residents, says Anikó Szücs.

In early 2020, she was unit manager in the dementia unit of a care home near Manchester and one of a team that included three registered nurses during the day.

‘When it all started, no one knew how to react – the World Health Organization was communicating different things so every country was changing direction, regulations and advice on a daily basis. It affected everyone, but it really affected care assistants.

‘It was important for me to give clear advice to the care assistants because everyone was fearful for their lives, as well as the lives of the residents.’

She was ‘lucky’, Ms Szücs says, because she had a good team in place.

Communication was vital. ‘We had handover before every shift started, and we informed them about everything we knew. But, importantly, they could ask us any questions they liked and if we didn’t know the answer, we could go and find out.’

The care assistants knew their jobs well, she says, but had to be guided through the challenges of the pandemic, such as how to use personal protective equipment correctly, and how to isolate residents where required.

‘With dementia, it’s hard to keep people in their rooms so we had to be creative about isolation.’

Within higher education, there have been moves to promote social care nursing as a specialism and to provide education and training opportunities to upskill and support nurses so that they in turn can support their colleagues.

Since last year, Queen Margaret University, Edinburgh (QMU) has offered an innovative programme on advancing care home practice, which can lead to a postgraduate certificate, diploma or master’s degree.

Tips on creating strong nurse-led teams in care homes

Advice from Scottish Care transforming workforce lead nursing Jane Douglas:

  • » Embed a culture of leadership with a non-hierarchical structure so everyone feels they have a voice and can come up with ideas and lead on their implementation

  • » Encourage self-reflective learning in all staff members, including managers. Have a real, appreciative view of yourself and acknowledge that you can always learn from your mistakes, no matter how senior you are

  • » Managers should be open and be their authentic selves with their teams because that helps to instil trust

  • » Have regular huddles where nurses get together on site, not just for talking through safety or other concerns, but to chat about other professional issues and share ideas

  • » Ensure there is a network of support for those who are the only nurses in a home, whether it is with other nurses in a care home group or by working together across an area

  • » Clusters of care homes can come together to offer training, which also helps to build networks and support

  • » Celebrate good practice Become attuned to when members of the team are doing something exceptionally well, for example finding creative ways to help a resident eat or relax, and tell them how well they are doing

Fast facts

34,000 registered nurses worked in adult social care in 2020-21

33% fewer registered nurse jobs were available in social care in 2020-21 than there were in 2012-13, following a year on year decrease

2 in 5 registered nurses in the adult social care sector (38.2%) had left their role in the previous 12 months, according to figures from 2020-21

Source: Skills for Care tinyurl.com/social-care-data

Advanced practice

Programme lead and lecturer Karen Rennie says: ‘The COVID pandemic highlighted that social care is short of staff and we do need to do more work to make social care and nursing homes a desirable place to work.

‘It’s important to think about what it’s like to live in a care home for residents and that’s always the number one priority.

‘But there does need to be more emphasis on care home or nursing home careers – how do you make it a desirable place to work and a fulfilling job?’

QMU developed the care home programme – which is aimed at all clinicians, including senior carers and care home managers who might or might not have a nursing background – because it wanted to enable staff to undertake advanced practice and flourish in that environment.

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Ensuring nursing in social care is viewed as a specialism will help attract recruits, experts say

‘We know that resources are tight and we’re not going to magic up a massive workforce,’ says Dr Rennie. ‘But we do need to help the people who are already in care home environments to become more skilled and be able to make positive change in their care home and in their practice, and to become leaders in their own discipline.’

Dr Rennie, who was attracted to care home nursing having done a placement as a student and still does nursing shifts in an Edinburgh care home to keep up her skills, believes that all staff can make a difference.

‘You don’t need to be in a managerial or chief executive position to be a leader for care home practice.

‘This course enables learners to think about their own values and beliefs about care home practice, what would be a person-centred environment and how they can make a difference.

Berkley Care Group clinical governance and training manager Louise Atherton has worked in social care nursing, including in care homes, for about 25 years and is keen to promote the role as a career and showcase its value.

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Care home staff can be supported to become leaders in their own discipline

Attracting nurses into the sector early in their career

Leadership and management skills are a key component of the Berkley Nurse Programme and Quality Standards, launched by the luxury care home group this year. Aligned to the Queen’s Nursing Institute Standards of Education and Practice Standards for Care Home Nurses, the 12-15 month programme takes nurses working in its group through four key areas.

The programme covers accountability and professionalism; clinical care skills; leadership and management; and ability to take research and apply it to practice.

Ms Atherton says she was keen to build a programme to attract nurses to come into the sector early in their career and the course is aimed at nurses at all stages of their career – from newly qualified to those with many years’ experience.

It also highlights that there is a career pathway in care home nursing.

She says: ‘I will remain actively involved in the training and coaching on the programme because it is good for nurses to have links to people working at a higher level within the group because it helps to develop career aspirations.

‘Over the next few years we’ll be looking for nurses to join me on the quality side, but also potentially to become general managers, or come into the operational team. We’re also looking at an advanced practitioner pathway.’

Clear progression

While the pandemic brought more attention to the need for strong leadership in care homes, Ms Atherton thinks that change had already begun.

‘People were starting to realise before the pandemic that we expect an awful lot from care home nurses and that we have to support them to deliver.’

There’s a sector-wide shortage of nurses, she adds. ‘That’s why it was important for me to develop something that attracts good nurses and is nurse-led, and also offers them something back, such as career progression.

‘Our nurses are experienced and they’re expensive because we pay them well, so they’re a premium resource. It’s my job to make sure we get the best out of them every day they come to work.’

Find out more

QNI (2020) The Experience of Care Home Staff During COVID-19 tinyurl.com/care-home-staff-QNI

Cornes M, Manthorpe J (2022) The role and contribution of registered nurses in social care: a rapid evidence review tinyurl.com/RN-insocialcare

Scottish Care (2022) Hearing the Nursing Voice: Listening to Independent Sector Social Care Nurses tinyurl.com/scottish-nursing-voice

QNI (2021) Standards of Education and Practice for Nurses New to Care Home Nursing tinyurl.com/standards-care-home-QNI

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