the position and the benefit of link nurses in the
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The position and the benefit of link
nurses in the prevention of
infection
Rose Gallagher
Nurse Advisor Infection Prevention
and Control
My presentation
Introduction to the RCN and my role
Background to Link nurse work –
personal and professional
UK experience
Using concept analysis to transform
workplace culture
Framework and competences
Summary
2
Role of the Royal College
Represents nurses
and nursing
Promotes
excellence in clinical
practice
Shapes health
policies
Nursing Dept
‘working to
influence, develop
and support nursing
practice’
The RCN and Infection Prevention
What’s it all about? Key drivers for work:
What does it mean to nurses and
Nursing?
Where can the RCN add value?
4
Why link practitioners?
Personal and professional drivers
Desire from members
Need to support Infection Control
Teams and to help embed ownership at
the clinical level
Grow future infection prevention nurses
Recognition that education alone is
insufficient
5
Challenges for UK
Link practitioners are widely used
Variation in what they are called, how they
are used and the support they receive
Expectations of the role and purpose vary
Programmes are rarely evaluated
Need to avoid ‘improvement evaporation’
Creating a post that is desirable rather than
onerous
Looking deeper at some of the
challenges
Need to develop a flexible workforce
Change in focus to ‘outcomes’ which bring with it an emphasis on measurement (includes assurance audit and surveillance)
Change in social and nursing culture – vocational assumptions are no longer valid
Focus on fundamentals of care, not necessarily technical skills
Need to bring incentive and performance ‘partnership’ to the clinical level e.g. CQIN
Cleanliness champions (CC)
Scotland
A Cleanliness Champion is an individual who, on a
day-to-day basis, works with patients, in the
healthcare setting.
Cleanliness Champions will be good role models
and as a result, should influence the culture in their
workplace to bring about behaviour change in the
prevention and control of infection.
Cleanliness Champions are individuals who can, and
will, recognise infection risks and take appropriate
actions.
9
Programme development and
structure
National policy to reduce HAI’s
2002 – need for 3,500 CC’s to support
ICT’s
1 CC to each clinical area
11 learning units with content managed
nationally
Mentor in practice
Evaluation in 2009 10
A good start but:
Heavy emphasis on education not
culture
Value of CC education in addition to
mandatory education not clear
Why develop programme for all staff?
How much improvement was down to
education as opposed to attributes of
the CC?
12
Knights (1997)
It is not experts representing problems at
a distance that are needed, but
practitioners actively participating in
producing context related and localised
responses to a set of political, economic
and social conditions with which they
are confronted…………
13
What did I want to achieve?
To develop a generic role framework for a link
practitioner that could be used in any area of
practice
To apply the role profile to infection
prevention and publish as a resource
To develop simple competences to support
those in that role
To work with stakeholders to evaluate the
work
14
Part 1 - May 2010
Annual event for general nurses
Opportunity to gain something from the
day
Series of workshops
Link nurse workshop full – twice!
Analysis of themes from the discussion
16
Part 2
Use a concept analysis approach to the
outcomes from the May meeting
Draft a document summarising the
findings and context for the role profile
Send out for comments
Discuss at the RCN European event to
determine suitability for wider adoption
17
Enabling factors
The factors that need to be in place for the
link role to be implemented successfully
Can be related to the:
Individual
Workplace
Employer organisation
19
Attributes How would you recognise a link practitioner role?
What would the link role do?
Acting as a role model and visible advocate
Enabling individuals and teams to learn and
develop their infection prevention practice
Communicating and networking around infection
prevention practice
Supporting individuals and teams in local
audit/surveillance
20
Outcomes or consequences
Can be:
Individual
Workplace
Organisational – this may vary depending
on the institution e.g. community or acute,
small or large
21
22
Enabling factors
The factors that need to be in place for the link role to be implemented successfully
The essential recognisable characteristics of a link role system
The Link nurse…
Outcomes
Or consequences of having a link role
INDIVIDUAL: Role Clarity e.g. role profile in place
Up to date knowledge, skills & understanding about IPC best practice
Knowledge and skills to facilitate learning in and from practice
WORKPLACE: Inter-disciplinary team recognise the role & value of the link worker role
Active support with engagement from clinical leaders, managers, senior nurses & all members of interdisciplinary team
Access to best practice guidelines & evidence-based practice. Local opportunities to regularly review IPC measures, indicators and practice
ORGANISATIONAL: Organisational and senior management endorsement, support and active commitment to the role Governance systems in place for monitoring infection control/prevention practice and outcomes
Regular Board reporting and discussion
1. Acts as role model and is a visible advocate for infection Prevention/Control (IPC) e.g.
Role models best practice
Is visible in the clinical area
Actively promotes IPC issues
Celebrates achievements and best practice
Challenges others when standards are not met 2. Enables individuals and teams to learn and develop their infection control/prevention practice e.g.
Uses opportunities to learn in and from practice
Creates a culture for learning from incidents/complaints
Provides creative opportunities for learning
Acts as a local resource for IPC
Works with students and practice facilitators on IPC
Sets up and sustains Link nurse meetings
Reviews collaboratively local IPC measures, indicators & IPC practice
3. Communicates and networks around infection control/prevention practice e.g.
Develops and creates methods for communication such as; IPC Notice Boards. Newsletters, blogs
Provides regular 2-way communication with the Infection control team
Provides & receives reports to & from Ward/Dept manager Promotes and establishes local networks Signposts best practice and relevant resources
4. Supports individuals and teams in local review/ audit/Surveillance e.g.
Supports completion of local review/audit/surveillance
Facilitates ownership of local review/audit/surveillance
Reports regularly and systematically to governance systems
For Link Nurse (LN): LN role is recognised and supported by the wider MDT
Role satisfaction, continued commitment and motivation
Role enhances professional development For the workplace
Best practice standards and guidelines implemented
Link Nurse Role is actively used by the wider MDT
Infection prevention/control learning is identified and implemented
Reduced IPC related complaints & incidents
A culture for networking and mutual support is created
Success is celebrated
Sustainable body of local expertise around IPC
For the Organisation: ICP practice is standardised across organisation Findings from reviews/surveillance and audit are implemented
Corporate objectives are met including those around learning and development IPC is considered everyone’s business
Increased uptake and interest in IPC link nurse role enabling sustainability Positive media messages are developed
Part 3 - Thinking about
competences
Need to match levels of skills to need
Need to create simple, usable competences that support professional development and the Link Nurse role
Identifying what is needed beyond the core competence and career framework (for nurses)
Match to the UK KSF
Provide clarity on attitudes and behaviours
Core behaviours
Person-centred
Inclusive
Reflective
Passionate about infection control
Visible in practice area
Welcomes feedback
Good communicator
Proactive
24
In summary
It is a start, not the solution
We have started to explore some of the
complexities of the link nurse role
It has been well received by link nurses,
interesting feedback from ICN’s!!
We welcome your feedback and
contribution
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