Nursing and Midwifery Excellence

Here at Bradford Teaching Hospitals NHS Foundation Trust (BTHFT) we want to give our patients, families and communities the best nursing and midwifery care that we possibly can. That is why we have begun an exciting journey to Nursing & Midwifery Excellence. You can follow us on X (formerly Twitter) using @BTHFTM4E.

The Covid-19 pandemic brought many challenges for nurses, midwives, their patients and their families. It also showed us that doing things differently can make all the difference to excellent care. There are some fantastic examples of brilliant care in Bradford since the start of the pandemic, and we want to draw on those successes and ensure that all nurses and midwives at BTHFT are involved in our journey to excellence. Below are some of the things we have been working on.

The Nursing & Midwifery Strategy was collaboratively developed by Nurses and Midwives in BTHFT, highlighting six key areas vital to providing the very best care. The strategy was launched in May 2022.

The strategy means that we now have a strong focus on our staff and our patients as the strategy sets out our ambition to be outstanding in all aspects of nursing & midwifery care.

You can read the complete strategy here.

The areas of focus in the strategy are:

One of the key principles of the Magnet® model is empowerment of clinical staff, identified as structural empowerment in the model. Shared Governance is a framework that ensures nurses and midwives are involved in shared professional decision-making. Sometimes known as professional governance or shared professional decision-making, it empowers nurses and midwives at all stages of their careers to be involved in decisions affecting wards, departments or the whole Trust. It does not replace or change the shared decision-making that we undertake with patients.

Shared governance supports staff who provide direct patient care to make changes that benefit their patients. Shared Governance is essential to achieving our Nursing & Midwifery strategy aims. We have set up Shared Governance Councils that allow nurses and midwives to have a voice and either contribute to or lead change. It means that decisions that impact on clinical care are not being made at senior level without involvement of the people delivering that care. Each council is responsible for one or more objectives within the  Nursing and Midwifery Strategy. This is an important and exciting change at BTHFT.

Our seven Trust shared governance councils are:

• Advancing Practice
• Nursing & Midwifery Quality and Safety
• Achieving Nursing & Midwifery Excellence
• New Knowledge, Information and Technology
• Professional Development & Practice Education
• Recruitment, Retention and Recognition
• Leadership

We have also started a pilot of ‘Unit Councils’. These councils focus on ward or department-level change. The pilot started in the Emergency Department in July 2022 and other teams have now started their own unit councils. The councils are looking at a variety of projects which will improve patient care and experience.

We have developed a professional practice model called the Bradford Model of Nursing & Midwifery Care. This is a BTHFT-specific model of nursing and midwifery care, and it demonstrates what we work to achieve as nursing and midwifery teams.

In 2022, the Achieving Nursing & Midwifery Excellence Council created and approved a process for clinical staff to develop the professional practice model.

In the first stage, members of all Trust Councils were asked to contribute to word clouds to identify what good care in BTHFT meant to them.

The words were analysed until a list of keywords and phrases was established. In February 2023, the Professional Practice Model competition was launched. NMC registrants were invited to submit designs. The designs were voted for by NMC registrants working in the Trust, and the most voted-for design was developed for Trust-wide use. Task & finish groups have helped us to decide how the winning design should be used. The winning design will be used throughout the Trust to support recruitment, education & development, career progression and recognition. It includes our Trust values and objectives.

Since 2020 we have been involved in the Magnet4Europe project [LINK to MAGNET4EUROPE – Home]. Magnet ® is an American nursing accreditation scheme (developed by the American Nursing Credentialing Centre). Many studies have shown that Magnet®-recognized hospitals have lower health professional burnout, better recruitment and retention rates and safer patient care, suggesting that the Magnet® journey is an intervention that results in positive changes, ones which the Magnet4Europe study seeks to achieve.

Participating hospitals from 6 European Countries (including our Trust), have started work to replicate the US model over the four years of the project; we are aiming to cultivate a climate with a focus on excellence in staff well-being and ensure our individual organisational goals identify closely with our colleagues, and patients’ needs. We are one of 11 UK hospitals taking part in the project.

The study seeks to test whether the same benefits are seen in European hospitals when Magnet® principles are adopted. The Magnet® model has a strong focus on leadership, empowerment, innovation, and excellent practice. The principles also ensure that nursing & midwifery outcomes are measured effectively so we can highlight best practice and are well informed when changes need to be made. The components of the Magnet® model as set out in the illustration below.

Research has shown many positive outcomes for patients and nurses when Magnet® principles are used within a hospital environment. Much of the research to date has been undertaken in the United States of America. The Magnet4Europe study has the following aims:

• To test the feasibility and sustainability of the Magnet Model® for organizational redesign in the context of health care in Europe.
• To redesign hospital workplaces to improve the mental health and well-being of nurses and physicians and to improve patient safety.
• For participating hospitals to receive a full-blown redesign of their workplaces– supported by one-to-one twinning with an experienced Magnet® recognized hospital and regular learning collaboratives.

Previous research points to specific features of complex organizations that if modified can significantly improve the wellbeing of health professionals and patients alike. Magnet4Europe will translate these research findings into practice to expedite workplace redesign in hospitals and other healthcare settings.

BTHFT have been partnered with  a US Magnet® designated hospital for the duration of the Magnet4Europe project. Mather Hospital in Long Island, New York, has a long and successful history of implementing Magnet® principles in their hospital. We are privileged to have the support of Mather hospital, and their parent company Northwell Health, as we embed the Magnet® principles within BTHFT through the Nursing & Midwifery strategy.

As a Trust, we have strong links with other health and social care providers. We are a key provider in Act as One and an integral member of the West Yorkshire and Harrogate Health & Care Partnership. We have strong relationships with local Universities through our research at the Bradford Institute of Health Research and through our Education team. However, there is more we can do more to support clinical nurses and midwives to become involved with our partnerships. We are working on several initiatives to further develop these links and highlight the opportunities available to our nursing and midwifery staff.

The Professional Nurse Advocate (PNA) role was developed in response to the Covid-19 pandemic. PNAs are registered nurses who support other nurses in a confidential setting. There are four main responsibilities of the PNA. They give restorative clinical supervision; this means that they give nurses an opportunity to reflect on their practice and speak about challenges. They support nurses to think about their careers, signposting to new opportunities and areas for development. They can support quality improvement initiatives, helping nurses to make change. They also have to monitor and evaluate their impact, and support other nurses to evaluate their work. We are implementing PNAs within the Trust so that by 2025 all Registered Nurses should have access to a PNA.

Professional Nurse Midwifery Advocates (PMAs) were implemented in 2017 and replaced a clinical supervision model that existed in midwifery for a number of years. PMAs use the same support model as Professional Nurse Advocates, but the reporting element is different.

The PMA and PNA roles are essential in helping us meet our strategy’s aims and invest time in nurses and midwives, providing opportunity for individuals to focus on their professional practice away from their usual place of work.