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

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

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

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

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)

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)

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

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

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

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

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.

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.

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.

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

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

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

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

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