1. A Competent Workforce: The ACAD Experience
Sir Graham Morgan
Director of Nursing
NWLH NHS Trust

2. Facilities 4 General Theatres 2 Ophthalmic Theatres 2 Endoscopy Suites
Interventional Radiology Suite & MRI
22 Bedded Recovery Area
19 Stepdown Beds (max 48hr stay)
6 Bedded Paediatric Area

3. Specialities and Case Mix
ENT, General Surgery, Urology, Orthopaedics, Ophthalmology, Gynaecology, Oral Surgery, Interventional Radiology and Cardiology
Day case to Intermediate Surgery
BMI upper limit 35-40
ASA I-III

4. “Jack of all trades………master of none?”
The ACAD Nurse
“Jack of all trades………master of none?”

5. ACAD Nursing Pay Structure
Band 1: ACAD Nurse (Salary range D- mid E)
Band 2: Senior ACAD Nurse (Salary range mid E – top G)
Band 3: Clinical Nurse Manager (H grade equivalent)

6. The Nursing Structure Clinical Lead for Nursing
4 Clinical Nurse Managers (do not rotate)
1. Theatres & Pre Op
2. Pre Assessment
3. Recovery and Step Down
4. Paediatrics
Band 2 nurses (rotate every 12 weeks)
Band 1 nurses (rotate every 4 weeks)

7. Specialist areas
The nurses in theatres and Paediatrics do not rotate as these areas need specially trained and skilled nurses

8. Core Skills: The ACAD Nurse
Pre-operative Assessment
Anaesthetics
Theatre Circulation
Post Anaesthetic Recovery

9. Training The Workforce
Collaboration with Thames Valley University
Level 3 Courses
Competency Based Courses:
theoretical knowledge
practical skills
Accredited Clinical Education Manager
Lecturer Practitioner & Clinical Educator
Following collaboration with Thames Valley University, competency-based courses were established that encompassed theoretical knowledge and the development of clinical practical skills within each core area. The courses were managed by an accredited educator

10. Competency Based Courses
1 week
4 weeks
Each course consisted of one week of lectures followed by a negatively marked exam for pre-operative assessment only. After two weeks of supervised clinical practice, skills were consolidated during a three-month apprenticeship. Within this period candidates were expected to complete a clinical portfolio in the form of a competency-based logbook together with an evidence-based theoretical assignment. A certificate was awarded upon successful completion of the course.
3 months

11. Benefits to Nurses Development of New Skills
Academic and Professional Recognition
Increased Job Satisfaction
Nurses develop new clinical skills that are recognised academically and professionally and have the potential for increasing job satisfaction.

12. Benefits to Patients High Standards of Nursing Practice
Continuity of Care
Enhanced Patient Satisfaction – every ACAD patient is contacted by telephone at 24 / 48 hours
Patients benefit from high standards of nursing practise and continuity of care. An 18-month prospective telephone audit has shown that 98% of patients treated in our facility were generally pleased with the service they received.

13. Benefits to the Organisation
Multi-skilled flexible workforce
Improved Recruitment and Retention
Easy cross-cover of work:
increased surgical activity
staff annual leave
The organisation benefits from a multiskilled, flexible workforce that provides an economic, efficient, and effective health service, with easy cross-cover of work during periods of increased surgical activity and staff annual leave.

14. Lessons Learnt: 4 Years On
No Course = No Money
Slow Rotation = Slow Money
‘Grow Your Own’ v Recruiting to Band 2/3 Posts

15. Our Next Steps Scrub Technicians accreditation
Patient Group Directions
Structured Career Path

16. Changing the Workforce / New Roles
Healthcare Assistants doing dressings
Housekeeper
Clinical Governance Support Nurse
Quality Support nurse –variance monitoring of protocols
ACAD Co-ordinator
New Ways of Working Pilot – Minor Ops.
Surgical Practitioner

17. Summary Multi-skilling Works Well Long and Difficult Process
It’s Worth It
So in summary, we have shown how innovative ideas in nursing practise are facilitated within a new ambulatory centre. To ensure the maintenance of high standards that are recognised nationally; our training programme is undergoing external accredited validation.
THANK YOU VERY MUCH FOR YOUR ATTENTION

18. Any questions?