Nursing Workforce Standards - case studies

Amrevbeatefa (Efa) Akinjise-Ferdinand is a senior sister in critical care at Luton and Dunstable Hospital, where she’s also an RCN Learning Rep. She became a standards champion in 2023. 

When I first looked at the RCN standards I found a lot of similarities with the professional competences created by the Critical Care National Network Nurse Leads Forum (CC3N). As I went through the standards to see how our unit compared, I found myself ticking, yes, yes, yes. 

Staffing within critical care is crucial and the RCN standards reflect how important this is in all healthcare settings. My unit has 12 beds, but we try always to have 11 nursing staff, never going lower than eight, with no one ever having to look after more than two patients. 

If we ever have any staffing issues, we will always escalate, sometimes to the general manager. This is in line with the RCN’s standard’s checklist on clinical leadership and safety, which also talks about mitigation planning and sharing concerns with senior managers. 

The standards also show we’re doing well with how we treat any agency staff who come to work with us and our rostering of staff, who know their rota up to 12 weeks in advance – the standards suggest six to eight weeks. Our shifts are flexible and take into account people’s needs and responsibilities outside work. On standard 12, which talks about dignity, respect and feeling valued, I’ve ticked yes for everything. 

Although our performance is good, it wouldn’t be fair to say we haven’t changed anything as a result of the RCN standards. Most of us worked through the pandemic and it was very hard. But it also emphasised the need to look after staff, prioritising their health and wellbeing. The standards have highlighted this even more. 

Staff who are working very hard can become quite stressed. When I’m managing I actively encourage everyone to take their breaks, and if they need to finish something first, I’ll help them, or ask someone else to give them a hand. It’s really important they step away from the patient for a short time, so they can come back feeling refreshed. We also regularly provide talks, seminars, or some extra training and even if it’s just for 30 minutes, it gives staff a lift. Happy staff makes for happy patients. 

I found standard 8 slightly challenging and I wanted to try to understand it better. This talks about when calculating the nursing workforce whole-time equivalent, an uplift will be applied that allows for management of planned and unplanned leave and absences. I’ve now discussed it with the relevant staff and this is something I’m going to be briefed more about, so I know exactly how it works in practice. 

I’m delighted to have been chosen as a standards champion. Looking ahead, I’d like to have a team on our unit making sure we continue to meet all of the standards, auditing each on a regular basis, so we can see what we’ve achieved. I think they have multiple uses and can work for every setting. 

I’ve just got a secondment to be a senior sister and the standards checklist even helped with my interview, enabling me to demonstrate my understanding of best practice in several different areas, including patient safety and infection control. The standards are encouraging nurses to be the best we can be. 

Which Standards has Efa found especially useful?

• Standard 7: The time needed for all elements of practice development must be taken into consideration when defining the nursing workforce and calculating the nursing requirements and skill mix within the team. 

• Standard 8: When calculating the nursing workforce whole-time equivalent (WTE) an uplift will be applied that allows for the management of planned and unplanned leave and absence.

• Standard 9: If the substantive nursing workforce falls below 80% for a department/team this should be an exception and should be escalated and reported to the board/ senior management.

• Standard 12: The nursing workforce should be treated with dignity, respect, and enabled to raise concerns without fear of detriment, and to have these concerns responded to.

 • Standard 14: The nursing workforce is supported to practice self-care and given opportunities at work to look after themselves. 

Cathy 

I first heard about the RCN’s Nursing Workforce Standards and how to become a champion at an RCN Board meeting earlier this year. I thought this would be a good exercise to do with our company, as it provides evidence of where we are now and where improvements could happen. We are Care Quality Commission (CQC) registered, with our last inspection rating us as ‘Good’. Evidence gained through the standard will help us on our journey towards ‘Outstanding’.

I asked staff, including nurses and senior carers, to look at the standards and complete the audit forms. This process has generated some immediate and tangible changes. For example, in one of our offices we’ve provided staff with benches, where they can sit outside on the lawn and enjoy their lunch. It’s great - but what happens in winter or when it rains? We didn’t have a staff room. Now we’ve created a beautiful indoor space, which has plants and is very calm and quiet, with no work allowed. Previously, staff had ticked ‘no’ to the question of whether they had a safe space, with some saying they weren’t taking breaks - but now they’re using the room and it’s very popular. 

What surprised me were the gaps in what I’d assumed our staff would know. For example, we have specialist welfare officers and trained mental health first aiders throughout Ocean Healthcare, but some staff reported they wouldn’t know who to approach or where to go if they needed this kind of support. I think it’s something newcomers may not have been told about, so we’ve made sure we include it in everyone’s induction and our monthly staff information, ‘Tide Times’. 

While we have company values that staff have helped to create, it’s important they make a difference to people’s working lives. Doing the audit has given me a tool I can use to measure against my assumptions. It’s opened a lot of conversations, helping us hear staff suggestions and their positivity, alongside identifying any gaps in their knowledge. 

It’s given us a framework where we can look at issues such as personal safety and dynamic risk assessment, which may be needed when you’re confronted by the unexpected in a client’s home. It’s something we’d not offered training in before, but now we’ve added it to our staff induction programme, looking at when you might need to escalate and what underpins that decision.

Diary management is another challenge the audit clearly highlighted, with some staff not feeling as empowered as we’d thought to carry this out for themselves. Now we’re providing development training where we invest time in improving these kinds of skills, including leadership and accountability. We’ve also revisited our appraisal documentation to make it more focused on the individual. Encouraging self-management is a key longer-term goal in our mission to ‘Live happy, care well’. 

Additionally, senior managers have a day each week when they concentrate on their own priorities, rather than firefighting on everyone else’s behalf. This is something I’d not thought about before. But we need to stop pouring into the jug, because it doesn’t get any bigger and can leave some staff struggling. Looking ahead, evidence of the standards working will include its impact on the retention of staff and we’ll be collecting data. 

Having these standards reinforces the RCN’s role in driving quality and professionalism. Ultimately, they have endorsed what we know is going well, and then given us a project plan, based on staff feedback, for those few but important areas where we need to improve.  

Jade 

Ocean Healthcare’s philosophy is ‘Live happy, care well’. Everything we do here has relationships at its heart. Our aim is to make a real difference in healthcare, affecting people in a positive way. If people are happy and feel supported in their work, they’ll be able to provide the best quality services for our clients.  

The RCN standards tie in very well with our overall ethos and becoming champions has given everyone something to celebrate. It recognises what we’re doing well, cementing our core values. It’s a badge of honour - for all our staff.

Which standards has the company found particularly helpful?  

Ocean Healthcare found the standards on clinical leadership and safety; and health safety and wellbeing useful.

These include:

Standard 6:  A registered nurse lead must receive sufficient dedicated time and resources to undertake activities to ensure the delivery of safe and effective care.

Standard 13:  The nursing workforce is entitled to work in healthy and safe environments. 

Standard 14: The nursing workforce is supported to practice self-care and given opportunities at work to look after themselves.

If you would like to know more about our success in becoming work force champions please contact nursingworkforcestandards@rcn.org.uk.

Standards Champion, Hayley Ingleson is a senior practice learning facilitator with Leeds Community Healthcare NHS Trust, where she has been using the RCN’s Nursing Workforce Standards to support nursing students to flourish in their placements.

A lot of my work is with those who are new recruits to the nursing profession, working with hundreds of nursing students, including those on nursing apprenticeships and trainee nursing associates.

It’s really important we get things right from the beginning. We have a real job to do to make sure we set those standards from the outset, so that students know they’re very well supported, can thrive and become registered.

We provide placements in a variety of community-based settings, including social care and some independent care providers. We’re drawing upon the standards to make sure what we’re developing is high quality, so students can benefit from a really safe and effective learning experience. With every placement I bring to the circuit, I look at whether it will meet these standards and if not, how we can make sure it does. The standards give us a blueprint to develop our placements, helping us bridge the gap between pre-registration and becoming a registered nurse.

For me, all of the standards are relevant and form a benchmark for good practice in developing individuals to reach their full potential. In particular, I was pleased to see some standards relating to recruitment and retainment of nurses. It’s good to see a collaborative approach to how we support them - and especially how we keep them.

If I had to single out a couple of standards they would include Standard 7. This has been particularly useful, as it talks about considering the time needed to develop practice, when defining the nursing workforce. This translates into regular supervision and support for nursing students, with time set aside to be assessed, supervised in practice, and taught the different skills and knowledge they need.

Standard 10, which references being appropriately prepared and working within your scope of practice, is also important. While this standard mentions registered nurses and nursing support workers, it’s vital this is recognised for students too. A lot of my work centres on helping students understand the diversity and health needs of those communities where they’re working, so they really understand the local demographics.

We’re also passionate about encouraging our nursing students to look after themselves and practise self-care, which is reflected in Standard 14. Among our initiatives is a network enabling students to share any worries or anxieties they have on their placements, gaining peer support. It resulted from a student survey, when they said they wanted somewhere to come together with fellow students. Now they can meet virtually once a month, with input from me and others, including colleagues from the university and the freedom to speak up guardian. It means students can escalate any concerns in a timely manner.

Overall, the standards really reflect my own ethos, supporting everything I’m trying to do. They also provide a rationale for what I’m developing, including very structured placements, with the standards adding weight to my approach. It’s in our interests to draw on the standards to improve placements, as if we get it right, we’re much more likely to recruit those students, once they’re registered. For example, we’ve recently appointed five newly qualified general practice nurses. In the past, we’ve struggled to attract new registrants into this key role, but now they have the confidence to make the most of these career opportunities.

We have a responsibility to make sure students are placed within safe and high-quality learning environments, with the time to learn and thrive - and the standards support that framework. They are a positive step forward, recognising the value of nursing.

Which standards has Hayley found particularly helpful?  

Standard 7:  The time needed for all elements of practice development must be taken into consideration when defining the nursing workforce and calculating the nursing requirements and skill mix within the team.

Standard 10:  Registered nurses and nursing support workers must be appropriately prepared and work within their scope of practice for the people who use services, their families and the population they are working with.
 
Standard 14: The nursing workforce is supported to practice self-care and given opportunities at work to look after themselves.

If you would like to know more about our success in becoming work force champions please contact nursingworkforcestandards@rcn.org.uk 

Janine Compston is a full time RCN steward for the Belfast branch. She’s using the RCN’s Nursing Workforce Standards in settings ranging from nursing homes, the community and hospital wards - to improve members’ working lives and the quality of care they’re able to deliver. She is Northern Ireland’s first standards champion.

When we’re advocating on our members’ behalf, being able to present evidence that shows why something isn’t safe makes a huge difference. These standards help nursing staff clarify the issues they’re facing at work, often helping them to pinpoint why they feel so under pressure.

Managers are becoming more curious about the RCN’s standards, especially when I quote them during our discussions, and I either give them a copy or direct them to the website. From my perspective, the standards help us look closely at what can change and be upgraded for everyone’s benefit, so we’re bringing along solutions rather than just highlighting problems.

One example I’m dealing with at the moment involves a nursing home, which has just two nurses to look after 40 plus residents, day and night. According to their framework it appears to be properly staffed, but on closer inspection the model they are using dates back to the 50s. It’s clearly no longer fit for purpose, particularly when you think about nurses’ responsibilities today, given the increasingly complex needs of residents who are living longer, with more comorbidities. I’m finding standard 2 useful here, as it talks about nursing establishments being based on service demand and the patients’ needs.

Another case involves a member who works in the community, via an agency, delivering highly complex care to patients in their home. Although she is experienced and knowledgeable, she was asked to attend a patient for the first time, who was very unwell when she arrived. She felt overwhelmed and unable to provide the safe level of care he needed on her own, especially after she discovered that previous nurses had been given more preparation, including shadowing and buddying. This was an inappropriate allocation of work and I’ll be asking the agency about their business continuity plans, especially what happens when their nursing workforce is compromised, understaffed or redeployed.

A third case involves a difficult working environment, with a severely overloaded nurse who was trying to do the work of several staff because of problems with retention and recruitment. She’d also had a limited induction and no further training. By the time I met her, she was completely exhausted. Several standards have been useful here, including the first, which talks about setting staffing levels, while standard 9 says that a fall below 80% for the substantive nursing workforce should be an exception requiring escalation, yet here it had become the norm.

The RCN standards are helping to structure important conversations. When members are looking for advice on a particular issue, I suggest they check the standards first to see if there’s something relevant to their situation. They can help someone explain exactly where the difficulties lie - and what needs to change. My view is if your organisation meets all the standards, everything will be better – happier staff, a better quality of patient care and less incidents.

 

Which standards has Janine found especially useful?

• Standard 1: Executive nurses are responsible for setting nursing workforce establishment and staffing levels. All members of the corporate board of any organisation are accountable for the decisions they make and the action they do or do not take to ensure the safety and effectiveness of service provision.

• Standard 2: Registered nurse and nursing support workers establishments should be set based on service demand and the needs of people using services. This should be reviewed and reported regularly and at least annually. This requires corporate board level accountability.

• Standard 3: Up-to-date business continuity plans must be in place to enable staffing for safe and effective care during critical incidents or events.

• Standard 9: If the substantive nursing workforce falls below 80% for a department/team this should be an exception and should be escalated and reported to the board/ senior management.

• Standard 10: Registered nurses and nursing support workers must be appropriately prepared and work within their scope of practice for the people who use services, their families and the population they are working with.

• Standard 13: The nursing workforce is entitled to work in healthy and safe environments.Standard 11: Standard 11: Rostering patterns for the nursing workforce will take into account best practice on safe shift working. Rostering patterns should be agreed in consultation with staff and their representatives.

Lena Johnson manages a respiratory ward, where she has been caring for patients with COVID-19 since the pandemic began. 

I first heard about the RCN’s Nursing Workforce Standards when I was invited to a conference about safer staffing. For my nursing team, who have gone through two very difficult and demanding years, the section that talks about wellbeing is really important. I’m using these standards to help support staff, thinking about what we can offer to help them. 

Staff have been through a great deal of trauma that stays with them. At one point during the worst of one of the waves, we had 20 patients who were ventilated on our ward. I’ve never seen so many ill patients in one place. I still remember coming into work one day and losing six patients, one after another. On a ward like ours, you would usually have one patient die every couple of weeks. We need to acknowledge the impact all of this continues to have on the 50 nursing staff I manage. It has been very tough - but at least we can see a big contrast now, with vaccination driving down the numbers of those who become really sick.

I’ve always been passionate about staff wellbeing and seen it as highly important. But during the pandemic it became very obvious to me that, as ward manager, I needed to work on it from day one. At the beginning, every member of staff was in action mode, but I knew as soon as there was a lull, we would see a lot of cracks appearing, with staff starting to struggle. 

Over the last couple of years, people have become much more used to opening up about mental health, although in some cultures it can still be a taboo subject, with talking about it seen as a sign of failure. With their clear recommendations and focus on good practice, the RCN standards have really helped me to address this issue with my staff, who come from a variety of international backgrounds, validating what I’m trying to achieve. 

On our ward, we have a clinical psychologist providing face-to-face support once a week, with staff able to book time directly or via occupational health. We also offer care spaces, where four or five staff come together to discuss whatever might be worrying or stressing them, working towards finding solutions. In addition, professional coaching is helping small groups of staff manage their stress and learn from difficult experiences. Discussions around mental health and wellbeing have now become part of the norm and something we do every week. Knowing that you are not alone, and what you’re feeling is completely normal, is reassuring. 

Standard 11 talks about making sure rostering patterns take into account best practice. As I want as many people as possible to be able to come to our ‘Wellbeing Tuesday’ sessions, I enable staff to work half shifts, so they can attend either at the beginning or the end of their work. There is senior buy-in for this, including from the chief nurse. 

The standards give me ideas for things I can do better or begin to introduce. It also reassures me that I’m doing the right thing for my staff, which in turn has a positive impact on the care we can give to our patients. These standards are providing a blueprint of what we all need to be aspiring towards.

 

Which standards are helping Lena support her staff's wellbeing?

• Standard 11: Rostering patterns for the nursing workforce will take into account best practice on safe shift working. Rostering patterns should be agreed in consultation with staff and their representatives.

• Standard 14: The nursing workforce is supported to practice self-care and given opportunities at work to look after themselves. This says: “The health and wellbeing of nurses is fundamental to the quality of care they can provide.” 

An RCN member for about 30 years, Lorraine Gallier is a nurse manager for a London-based recruitment agency, which supplies nursing staff to NHS organisations around the UK. She has been using the RCN’s Nursing Workforce Standards Checklists since July, helping her gain a fuller picture of the experiences – both good and bad – of agency nurses on the ground.

"In the summer, I attended an RCN webinar looking at how we can help agency nurses have better experiences, by changing some of our practices. It’s the first time I’d heard about these RCN checklists and I decided to start using them, asking our staff to fill them out, especially if they’ve had any issues on their shift.

I’m finding the checklists very easy to use and it’s also helping to trigger some important conversations. For me, a key question is whether our agency staff feel welcomed and valued as part of their new temporary team. This is part of a whole set of questions on the Clinical Leadership and Safety Checklist, which really explore the experiences of bank and agency workers, helping us to understand much more about what’s happening on the ground, so we can work towards improvements.

The way someone is met when they first arrive on a ward is so important. Asking someone’s name sounds very basic, but our staff tell us that sometimes no one will ask what they’re called for a whole 12-hour shift. It’s important wards know when they are unwelcoming, and agency staff are unhappy, because word will spread and they will find it harder and harder to attract the staff they need.

Generally speaking, many bank and agency staff feel like the permanent newcomer until they’ve proved themselves. It takes so much longer for them to feel welcome when they’re working through an agency. I’ve had personal experience of this, when I was a senior nurse but doing some agency work to keep up my clinical practice skills. At one point, I was referred to as “only a bank nurse”. If you talk to nurses, many of whom are highly qualified and very experienced, in that dismissive way, they won’t come back. There are no winners here.

Unfortunately there is still a lot of stigma attached to agency nurses, with a perception they’re paid a fortune, but contribute the bare minimum. It’s very unfair, as many nurses join agencies purely for the flexibility they can’t achieve with a permanent post. It’s also important to remember that agency staff don’t get many of the financial benefits of salaried staff, such as enhanced annual leave.

Sometimes agency staff can be placed in impossible situations, with unrealistic expectations. In one incidence, we had a nurse who was moved four times during her night shift. The last move was after midnight, with no proper handover, to a ward she’d never worked on before, with some very unwell patients. Luckily she was a highly experienced nurse, with a background in both A&E and intensive care. But would you treat a permanent member of staff in that way?

It can be very difficult to raise issues like this, because staff worry it could jeopardise future bookings. I will always try to discuss it, to see if anything can be done. Where possible, we fill out incident forms, sending them back to the organisation and asking for a response – which is not always forthcoming. But slowly, and with a lot of encouragement, I feel things are beginning to change, as we’re understanding much more about the barriers faced by agency nurses.

And it’s far from all bad, with the RCN checklists also helping us to see lots of positives. Many staff are reporting they feel able to escalate concerns and report any incidences that might happen during a shift. Filling out the checklist can also be a reminder of something that’s happened, helping to pinpoint why an experience has been especially good or poor.

It’s great that the RCN is taking a lead on this because agency nurses feel someone is on their side and taking notice. At the end of the year, I’m going to audit all the responses we’ve had and produce a paper looking at quality assurance.

My hope is that these checklists guide organisations on how to treat their agency staff, including giving them a proper induction and access to technology, so they can perform at their best, are supported and welcomed. Everyone needs to feel their contribution is appreciated and above all, they’re recognised as a valued member of the team."

Which checklist questions have been the most useful?

On the Clinical Leadership and Safety Checklist, Standard 9 has been particularly useful. This includes questions such as:

• Do you feel welcomed and valued as part of your new temporary team?
• Are you treated with respect, dignity and your rights protected?
• Are you oriented to every new area with information on how to report incidences and raise concerns?

On the Health, Safety and Well Being Checklist, Standard 14 has proved useful, with questions such as:

• Are you supported with debriefs after difficult and challenging situations at work?
• Do you have access to hot and cold healthy food options in your workplace?
• Are you able to talk about your mental health and wellbeing comfortably with your manager?

Mark Butler is RCN West Midlands Regional Board Chair and has been a steward for more than 20 years.

"The RCN’s Nursing Workforce Standards are proving to be a fantastic resource and I’ve been able to use many of them in my work representing members. I recommend them to all RCN reps as part of their toolkit, as I think it’s one of the best documents we’ve ever produced.

I had one case involving a member who was a very experienced and dynamic ward sister. In the middle of the pandemic, she moved from a hospital setting to a very busy community-based team, where she was given a case load, but no support or help to settle in. In her new role, she followed a policy that applied in hospitals, but there was no equivalent in the community setting. This resulted in a complaint and my needing to represent her.

As her health was being adversely affected, I was able to cite Standard 13 which talks about how the nursing workforce is entitled to work in healthy and safe environments. Standard 10 was also useful, as it talks about how more senior staff, who are taking on additional or different roles, need a period of preceptorship until their competence and confidence are achieved. As a result of my intervention, managers decided there was no case to answer and she returned to work, receiving her back pay and a formal apology.

Another case involved a healthcare support worker, who worked night shifts on an acute mental health admissions unit. There was an incident where a fire alarm was activated as a prank, during a very busy time. She was disciplined over a complaint that she shouted at a patient, but it was to make herself heard above the noise of the alarm. The consequences of facing a disciplinary included losing such a large amount of her wages she was forced to start using food banks.

In my role representing her, I was able to talk about the qualities of good leadership, referring to the introduction in the standards document, which says: “Nursing leadership must embody compassion both in style and behaviour towards the staff they lead.” I also cited Standard 12, which talks about how leadership should support and nurture psychological safety and Standard 10, with its focus on staff working within their scope of practice. Eventually the case was dismissed and she returned to work, with the opportunity to have more training, helping her career pathway.

When I’m delivering preceptorship training, I also use Standard 8. We talk about how you manage a ward using staffing; how you judge that staffing; and how ward managers should build in enough practice time for mentors, preceptors, learners and students.

These standards are helping to create lasting change, with my trust working towards a new and improved system that is altering how we deal with a range of issues, including absence management, disciplinaries and performance. This has come about through my repeatedly asking managers to show how they are complying with these standards. We know they are studying them closely, especially those elements around responsibility, accountability, staffing and leadership.

I think it’s demonstrated to managers that the RCN’s approach is more robust than ever. This says: these are the standards we expect as a minimum. And as an employer, if you’re not meeting them, you need to be prepared to be challenged."

Which Nursing Workforce Standards did Mark use to help members?

• Standard 8: When calculating the nursing workforce whole-time equivalent (WTE), an uplift will be applied that allows for the management of planned and unplanned leave and absence. “Underestimation of either or both planned and unplanned leave will result in an establishment that cannot meet day to day staffing requirements,” says the standard. “…over reliance on supplementary staffing, such as bank and agency staff, will impact on overall costs and quality of care.”

• Standard 10: Registered nurses and nursing support workers must be appropriately prepared and work within their scope of practice for the people who use services, their families and the population they are working with.

• Standard 12: The nursing workforce should be treated with dignity, respect, and enabled to raise concerns without fear of detriment, and to have these concerns responded to.

• Standard 13: The nursing workforce is entitled to work in healthy and safe environments. “Health, safety and wellbeing is more than just the absence of work-related disease or injury rather, an emphasis on achieving good physical and mental health amongst the nursing workforce,” says the standard.

RCN member Nicki Hockly has been general manager at Bryn Celyn care home in Maesteg, Wales, since 2020. The home provides nursing and residential care for 56 people. Her nursing staff reflects a variety of different backgrounds, including mental health, learning disability, older people’s care and the community. 

When I was invited to hear more about the RCN’s Nursing Workforce Standards, I did some research first to find out what it was all about and how it might help us. I thought all the standards were good and although they are quite ward-based, they could also apply to what we’re trying to do here. 

As I was working my way through the standards checklist, I was able to tick ‘yes’ to so much. It made me realise how well we’re doing. It’s one thing to think it, but the audit gives you the evidence to back that up. 

It especially highlighted our success in nursing retention and recruitment. Several people have asked me how we manage to retain our nursing staff, given the current climate. We put a lot in place to support our staff and it’s interesting to see how what we’re doing here is mirrored in these national standards for good practice. We’ve never had to do big recruitment drives or even use agencies to plug gaps, because our staff are happy and they stay.

As a manager, I try to remember how things felt when I was a nurse, thinking about the barriers I faced and the support I needed to overcome them. I recall very clearly trying to juggle work with my home life and what the children were doing. It’s key to find out what’s important to individual staff and do your best to accommodate their needs when you’re drawing up rotas, also giving them as much advance notice of when they’re working as you can, and making it as fair as possible for everyone. This reflects Standard 11, which talks about agreeing rosters with staff, with individuals able to request days off or preferred shifts.

Doing the audit also encouraged me to think about some of the smaller things. In the past I’ve always thought big, looking at how we reward nursing staff and how I can support them even more, as their nurse manager. But this process has also made me step back and realise there’s actually a lot of job satisfaction in what we do. I’ve tried to foster a team spirit here, where we all look out for each other, and that’s become the culture.

The audit has also helped to initiate some positive changes. For me, one of the more surprising realisations was that staff needed a safe space, where they could talk to each other without managers listening in. As a registered nurse, I’d always thought of myself as one of them. But now I can see there is always going to be a line, because although it’s very important to me that I don’t lose my core values as a nurse, I’m also the care home manager.

Recognising all of this, I’ve just introduced a new and informal clinical supervision group, which is open to anyone who would like to attend, except me. The aim is to prevent little issues from building up, with safe conversations where staff can air anything that’s happened during their shifts, including any challenges. There’s an opportunity to engage in reflective practice, but they can also confide in each other and seek one another’s support. Of 10 staff, seven have signed up to attend the first one. This responds to standard 14, which talks about providing an area where staff can have restorative time.

Becoming a champion feels very rewarding. Sometimes it’s hard to recognise what you’ve achieved, but this helps you to see it much more clearly. I feel proud. 

Which standards has Nicki found especially useful?

• Standard 11: Rostering patterns for the nursing workforce will take into account best practice on safe shift working. Rostering patterns should be agreed in consultation with staff and their representatives.

• Standard 14: The nursing workforce is supported to practice self-care and given opportunities at work to look after themselves. 

For learning disability and autism specialist nurses, Tara Webster and Fiona Springall, mapping their service against the RCN’s Nursing Workforce Standards is generating tangible improvements.

Tara Webster

Working with adults who have learning disabilities or autism, a large part of my role is managing emergency admissions, ensuring care is good quality, accessible, equitable and people feel included in decision-making. I also help to train other staff, so they understand their responsibilities in relation to providing good care for our patients. A third aspect of my role involves carrying out audits and helping to implement improvement projects, so our service is continually improving.

We decided to map our service against the RCN’s Nursing Workforce Standards so we could gain a detailed view of where we were doing well and where any challenges might lie. In practice, we put each of the RCN standards on a spreadsheet, marking ourselves as green if we were doing well, amber if we were partially there, and red if we felt we weren’t meeting that standard.

It proved to be a real eye-opener. Although it showed some areas where we already knew there were gaps, some were new to us. The structure incorporates issues you may not have previously ever considered, giving you the questions to ask to help you see the bigger picture. It gives you an excellent place to begin your analysis, especially for those nurses who’ve never considered their role in this level of detail before.

What it really highlighted for us was what happens when we’re not here. There have been times when our help has been really needed in the middle of the night or at the weekend, but we’re not working. Incidents can arise when things don’t go as well as we’d like. Typically, in the UK there is only one specialist learning disability liaison nurse per trust, so it’s a challenge facing every organisation.

Although we plan to do strategic work, such as audits and projects, we know that we’re often called away because of clinical pressures, and this time isn’t protected. Until we did this benchmarking exercise, we hadn’t thought about whether there was a solution and what it might be. It gave us the evidence to understand that what we needed was an extra person, demonstrating the difference they could make. Based on the information we’ve gathered, we were able to present a fully formed request, rather than simply an idea, and the person is now being recruited.

Fiona Springall

 I work with children and young people, with a focus on outpatient care, supporting them to come to hospital and have treatment.

We were asked to take a look at the RCN’s Nursing Workforce Standards by the RCN’s Professional Lead for Learning Disability Nursing, Jonathan Beebee, who wanted us to explore how we might apply them to our roles. Carrying out this exercise, and seeing how we could implement the standards in our own service, has led us to creating a new extra post - so it’s a success story really.

The new band 5 learning disability and autism nursing post is for an initial two years and will be specifically for the 0- to 25-year-old age group. In effect, it will support both mine and Tara’s roles, freeing up some time spent on clinical work, so we have some dedicated and protected time to spend on improving the service for our patients. It will also help to improve continuity, as patients transition from children’s into adult services.

Benchmarking our service has encouraged us to consider different avenues, giving us the confidence to say we need more support. I think it will be really helpful to do the exercise again, once the new person is in post, perhaps on an annual basis so we can continue to track progress and collect evidence.

Of course you can collate your own inhouse statistics, such as the numbers of patients you’re managing and any incidents. But having this overarching set of standards from the RCN can really underpin your analysis, adding weight to presentations and your business case.

Jonathan Beebee, RCN Professional Lead for Learning Disability Nursing

As learning disability nurses, sometimes we can feel slightly detached from what other nursing colleagues do, so we see things like these standards and think they probably don’t apply to us.

I encouraged Tara and Fiona to give them a go and see what they thought. As a result, they’ve flourished. It’s helped them look at the strengths of their service, alongside potential challenges. It’s also empowered them to position their case for an extra staff member, providing evidence they wouldn’t have had otherwise. I’d urge other learning disability nurses to grasp this opportunity with both hands, as the standards can be such a useful tool.

Which nursing workforce standards were especially useful?
Standard 9 - If the substantive nursing workforce falls below 80% for a department/team this should be an exception and should be escalated and reported to the board/ senior management.

‘This has given us the recognition that we’re unable to meet this standard and we still have a long way to go,’ says Fiona. ‘It’s been eye-opening to see that so clearly.’

Head of practice development Tracey Gilchrist, practice development nurse Liam Campbell, and practice development facilitator Hayley Shields all are learning disability (LD) nurses working for Enable, a third sector social care provider in Scotland.

They have become RCN Nursing Workforce Standards champions, carrying out a successful audit in April 2023 that’s highlighted both what they do well and where they could improve. 

Tracey

Initially I was approached by Jonathan Beebee, the RCN’s Professional Lead for LD nursing, as we’re both members of the Scottish LD nurse leads group. I was keen to explore this opportunity to see how the standards and audit could apply to LD nurses working within social care.

Even from the beginning we could see the opportunities the standards could give us. We’re all working in challenging circumstances and sometimes your kneejerk reaction can be, we don’t have the capacity for this, we’re just too busy. I’m so glad we invested some time into it. It’s been a fulfilling process, bringing a good balance against the current demands of our role, while helping to direct the development of our internal governance structures.

We started by using the standards to audit what we do. This has really helped us recognise what we already do well here – sometimes that’s not acknowledged, but it should be. Next we’ve developed action plans where we feel we can make improvements. Some have led to immediate changes, while others are slightly longer term and focused on things we’re working towards.

Both as a team and individually, we’ve felt engaged and well supported in every part of this process, even if it’s exposed something we need to work on. The audit gave us a safe space for reflection, allowing us to move forwards in a planned way, rather than action planning in a crisis or emergency.

Personally, this work has really helped me to recognise the gaps in support I have as a senior learning disability nurse working within social care, holding up a mirror to something I’d felt for a while but hadn’t really addressed. It’s given me clarity and helped me act, guiding me in the right directions towards a more formal structure, involving clinical supervision alongside mentoring with someone I’ve known since I was a nursing student.

Although the standards might be associated with working in a more traditional NHS hospital environment, as learning disability nurses it’s in our nature to adapt what exists already to suit our specific needs. We’ve applied those skills here, interpreting the standards to fit our circumstances.   

As a nursing team, this has helped to ground us. It’s been a good journey and will continue to benefit us.

Liam

When we first heard about the standards, I wasn’t at all sure about how they might translate into working in social care. It seemed to me it was more of a hospital-based tool, where you were looking at issues such as staff numbers. I didn’t have a good understanding of how it might work for us. But in practice, it’s really made sense.

Among the tool’s benefits is helping to create structures for some of the conversations we’ve had on specific topics, such as how we assess the risks of lone working. It’s been really useful for promoting these kinds of discussions.

It’s also been instrumental in highlighting the importance of professional development. Our organisation has always been committed to it, but this has put a greater emphasis on setting up regular times, ensuring I take responsibility for making it happen. You feel the benefit because it helps refresh your practice, and undoubtedly that improves the care we’re able to provide for the people we support and their families.

Having these conversations has helped us come together even more as a team. The next audit will highlight how things have changed, as well as setting some new priorities. It will also encourage us to carry on with what we’re already getting right, not letting any of that slip, through complacency.

Hayley

For me, the audit has really pointed out how well supported we are as a team and how there is always someone there to turn to if you need help. There were lots of sections where I was ticking yes, that’s what we’re doing, which felt good. It’s really important to highlight what works well, alongside those areas where you can improve.

During the process we involved a student who was here on placement. We got very honest feedback from her and some great ideas, which we’re taking forwards. This includes a student welcome pack, which I’m involved in creating. We quite often have students, so this is something that will be very helpful for them.

Which standards did the team find particularly helpful?

• Standard 1: executive nurses are responsible for setting nursing workforce establishment and staffing levels. All members of the corporate board of any organisation are accountable for the decisions they make and the action they do or do not take to ensure the safety and effectiveness of service provision.

• Standard 6: a registered nurse lead must receive sufficient dedicated time and resources to undertake activities to ensure the delivery of safe and effective care.

• Standard 7: the time needed for all elements of practice development must be taken into consideration when defining the nursing workforce and calculating the nursing requirements and skill mix within the team.

• Standard 13: the nursing workforce is entitled to work in healthy and safe environments.

• Standard 14: the nursing workforce is supported to practice self-care and given opportunities at work to look after themselves.

Wendy Preston is the RCN’s Head of Nursing Practice. She is also an honorary consultant nurse at George Eliot Hospital in Warwickshire and an advanced nurse practitioner in 111/out-of-hours care for the independent sector.

Making sure that the RCN’s Nursing Workforce Standards are grounded in reality has been important to me from the very beginning. In my honorary role - as a consultant nurse in a district general hospital - I’m able to check in with nursing leaders and colleagues, explaining what we’re trying to do and seeking their views about what they think will work in practice.

From my first-hand experience, I can see the huge pressures that nursing staff are still facing, as the pandemic’s impact continues. The last thing we want to do is make that worse, by setting goals that feel unattainable. But it’s important the RCN sets standards based on what is needed, rather than what’s currently available.

For me, one of the crucial standards is the first one, which says that every organisation’s chief nurse should be at executive level, with any exceptions seen as outside the norm and documented. If organisations want to see real nurse leadership in action, with all the benefits that brings, this has to be what happens.

We’re the largest profession in the health and social care workforce. An organisation’s lead nurse must be sitting at the top table, so nursing is always on the agenda and their voice has equity and can be heard in vital discussions about the nursing workforce. How can you campaign and influence on behalf of nursing staff, if you’re not representing them at the highest level?

Another key standard is 6, which talks about how nurse leads should be supervisory, rather than rostered. I’ve witnessed examples of vast variation across countries, regions and settings. From nursing establishments that allow 100% supervisory nurse leadership, to nurses being expected to lead teams, while rostered as a registered nurse for the majority of their shifts.

While we know that good practice in leadership comes from having the time to do it properly, we also understand what a challenge this can be, especially on busy wards that face almost constant difficulties with staffing. But just because it’s hard to achieve, doesn’t mean it’s not right to aim for it.

Our standards must be both aspirational and realistic. Sometimes that means working towards a goal, a few steps forward at a time. In practice, what we’ve seen is nurse leaders - including ward managers - creating a business case towards achieving 50% of their time being spent as supervisory, eventually building towards 75% and then the whole time, enabling them to achieve standard 6.

So far, feedback has been very positive, with nursing staff understanding that these standards can drive real and positive changes locally, in all settings, using national standards and guidance. They support achieving staffing for safe and effective care.

For me, it’s like splashing a pebble into a pool of water, with the ripples slowly getting bigger. It’s a long journey, but we need to keep going, constantly sharing our progress.

Which Nursing Workforce Standards did Wendy use to help members?

• Standard 1: Executive nurses are responsible for setting nursing workforce establishment and staffing levels. All members of the corporate board of any organisation are accountable for the decisions they make and the action they do or do not take to ensure the safety and effectiveness of service provision. It says: “Leaders responsible for contracting or commissioning services have a duty to ensure there is a nurse at executive level within an organisation’s governance structure.”

• Standard 6: A registered nurse lead must receive sufficient dedicated time and resources to undertake activities to ensure the delivery of safe and effective care. “In the majority of large organisations this registered nurse lead will be supervisory and not rostered as part of the nursing workforce allocation,” says the guidance.