Enabling Professionalism in Nursing and Midwifery Practice at UCLH

In May 2017 the Chief Nursing Officers for the UK and the Nursing and Midwifery Council (NMC) launched a new framework: Enabling Professionalism in Nursing and Midwifery Practice. The aim of the framework is to describe what nursing and midwifery professionalism looks like. It supports the application of the NMC Code to practice environments and day to day life as a registered professional.

Professionalism is ‘characterised by the autonomous evidence-based decision- making by an occupation who share the same values and education’. Arguably, now more than ever, nursing and midwifery need to articulate their unique contribution to safe, effective person-centred outcomes.

Why the urgency? The NHS is under increasing operational, financial and workforce pressures, giving way to a dominant culture of performance management that can negatively impact on the professional identity of nurses and midwives. It is the relational element of our roles that defines us and when eroded, our professional identity gets lost, leading to high levels of stress and disillusionment. This is reflected nationally where we see attrition rates from the profession at an all-time high. Paying attention to our professional identity, proudly recognising and celebrating our unique contribution is critical to retaining nurses and midwives.

UCLH has a strong historical culture of nursing pride that pervades through today’s nursing and midwifery community. At UCLH we were the first to embrace the Enabling Professionalism in Nursing and Midwifery Practice framework. Our Nurses Day 2018 event was a celebration of our unique contribution, illuminating stories from individuals, recognising their role in practice, leadership, education and research in today’s healthcare.

The Enabling Professionalism framework has been shared widely across UCLH nursing and midwifery groups and as you would expect, it resonated, energised and sparked ideas and initiatives aimed at recognising the contribution of our profession. More than this, it generated peer to peer discussion and exploration of what it means to be a professional nurse or midwife and how we actively enable this day to day. By creating the conversations, we started to change the language we use and ‘call-out’ what is a professional discussion and how it is distinct from is operational concerns. This distinction led us to challenge how we create time and space for professional dialogue and debate. We have started to examine our forums and committees and readdress the balance between professional and operational responsibilities.

I believe the Enabling Professionalism framework resonates with UCLH nurses and midwives because of our strong commitment to education and training. At UCLH we believe highly educated nurses with personalised continuous professional education are key to ensuring patients are safe and at the heart of everything we do. This culture of valuing and investing in nursing education has enabled us to be at the cutting edge of new role development in the profession, thus protecting our professional identity and promoting autonomous practice.

The enabling professionalism framework emphasises the importance of the practice environment to support and encourage professional behaviours – effective leadership, from board to ward, is vital to fostering a positive environment. The UCLH Nursing, Midwifery, AHP and Pharmacy Strategy (2016-2021) reflects the ethos of ‘Enabling professionalism’ in the five strategic aims to:

provide the highest quality care within our resources
listen and respond to our patients and improve their pathways
value and develop nurses and midwives to deliver their potential
practise in ways which manage our resources and promote financial stability
inspire, innovate and generate world-class research.

The strategy is brought to life through the annual priorities and the recently published second annual report celebrates the year-on-year achievements. These promote professional pride and demonstrate that UCLH nursing and midwifery practice is leading the way in achieving high standards of care, education and research.

Exemplar Ward is one such example. The UCLH ward accreditation programme is an evidence-based, quality improvement programme that aims to reduce unwarranted variation across UCLH wards and departments. The UCLH research team combined operational research and ethnographic methods to develop a formative process evaluation of Exemplar Ward. Exemplar Ward has generated evidence that demonstrates the importance of maintaining Exemplar accreditation in assuring local compliance with fundamental standards, as well as building our capacity for quality improvement. The second year of Exemplar Ward has seen more than twice as many wards achieve accreditation status with many more wards making significant improvement. Now in year three, Exemplar Ward is expanding beyond the ward environment with the first accreditation model being developed for the Outpatients Department.

Exemplar Ward reflects what is important to the profession and through the constructive conversations, enables nurses and midwives to articulate their value as professionals and to challenge and celebrate their practice and behaviours to uphold professional standards. This is demonstrated by the fact that UCLH has one of the lowest rates of hospital-acquired pressure ulcers (HAPU) in the country. The incidences of HAPU are recorded in the Exemplar Ward monthly data set and contribute to the annual accreditation status. The standards for monitoring and responding to a pressure ulcer were revised in line with Enabling Professionalism in 2017 and this led to a change in approach, placing greater emphasis on reflective practice, critical thinking and shared learning.

Our centre for nursing and midwifery led research (CNMR) plays a key role in ensuring that UCLH contributes to the evidence base for nursing and midwifery locally, nationally and internationally. We have focussed on generating not only developing nurses’ research skills but also interest in the findings via our quarterly journal ‘Connect’ and our annual fellowship scheme. Whilst there is much to celebrate at UCLH, we are not complacent and know there is more to do to support our profession locally and nationally. Over the coming year we will continue to focus on bringing to life the Enabling Professionalism framework to ensure nurses and midwives thrive at UCLH and retain their unique identity.

Vanessa Sweeney MSc RN DipHE Deputy Chief Nurse – UCLH