St Gemma’s Hospice in Leeds is the largest hospice in Yorkshire. They deliver specialist palliative care to patients with life-threatening or terminal illnesses via their in-patient unit, a day hospice, and a community team.

The challenge

The hospice employs approximately 60 registered nursing staff in Agenda for Change Bands 5, 6 and 7 posts across their three specialist nursing environments. However, they lacked a suitable measure of competence for this important part of the workforce and were therefore unable to assess nursing knowledge and skills. Consequently, they were not able to fully address gaps in staff training and development. The challenge was to create a competence framework against which they could assess current gaps in staff training, train new members of staff, and demonstrate to patients and relatives that they had a specialist workforce who were compliant with the specialist skills required for excellent palliative care delivery.

Image: Development of Competence Framework.

How they did it

Skills for Health helped to set out an action plan with a clear timeframe (Oct 2014 – June 2015) and began by engaging staff with an awareness event for senior nurses who could champion the scheme. Volunteers from each band and nursing environment were invited to talk about their daily duties and skills, and the purpose of the scheme was made clear so staff felt supported rather than judged by the assessment of their competence.

Awareness raising was followed by two workshops examining case studies of patient scenarios that encompassed the entire patient experience, from admittance to bereavement support. Facilitated discussions of the competences demonstrated during the case study scenarios were distilled into competence lists for different nursing bands and environments.

Competences were mapped against National Occupational Standards (NOS) and these were honed with the help of senior nursing staff to create a usable competence framework.

The outcomes

  • Nursing staff have a clear appreciation of what they do and the skills they currently use.
  • A clear list of band-specific competences was created for Bands 5, 6 and 7 specialist palliative care nursing staff.
  • Staff advancement through the bands can be mapped against clear skills and knowledge requirements using the competence framework.
  • The competence framework was amalgamated with a national End of Life Care framework study, to create an in-depth document that will be launched nationally in Oct 2015.
  • The pilot work has positioned St Gemma’s in readiness for revalidation of nurses from March 2016.
  • Skills for Health has enabled the replacement of reactive training with a proactive approach to equipping the workforce.

Differences in clinical competences were minimal across bands. However, as expected, Band 7 nurses were identified as having more management and strategic responsibilities. The exercise found little difference in competences between nursing environments.

"The workshops were particularly good. Skills for Health’s team had a huge amount of respect for the staff and what we do, and were very facilitative – they got a lot from them. It was hard for the nurses to do, but I think they really gained lot. They researched a huge amount out there around what is happening in palliative care at the moment. Skills for Health really understand specialist palliative care and really understood us... they made it organisation-specific to our patient needs and came on board with us."

The future

The competence framework will be used to inform staff training and development needs and help manage the budgets for these activities. Nurse in Charge roles will be first to use the competence framework to assess their training needs, a group of 10-12 staff who are well positioned to champion the scheme amongst junior colleagues. The competence framework will ensure the hospice has the right skills to enable the workforce to to do their jobs, and has identified the resources that need to be put in place.

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