Business Clinic
Teaching Care Homes – Raising the status of nursing

A new pilot has been launched to set up teaching care homes for training nursing students. It is hoped that it will raise the profile of long-term care nursing and encourage more nurses into the profession. Is it just what is needed to challenge outmoded perceptions?

A recent report from Skills for Care on the National Minimum Data Set for Social Care (NMDS-SC) looked at the situation of registered nurses in adult social care. It found that the average age of a registered nurse in adult social care was 47 years old, and almost a third are aged over 55, so may retire within the next 10 years.

In the same report, Skills for Care estimated that 9% of the registered nurse roles in the adult social care sector were vacant – approximately 4,500 vacancies at any one time.

It highlighted the significant pressures on the adult social care nursing workforce. Pressures that, it concluded, will continue in the short- to medium-term. This makes it imperative that adult social care can attract and retain nurses with the right skills and values, to raise and deliver quality and standards for people using social care services.

Teaching care homes

Given that the pressures on adult social care nursing are unlikely to ease soon, to address these and to advance care home nursing, a ground-breaking new nurse-led pilot has been launched. It aims to improve the learning environment for staff working in homes, undergraduate nurse apprenticeships and all learning placements in care homes.

‘Care home nursing is seen as the last bastion career by many nurses, these much-maligned and out-dated perceptions need to change if we are to make long-term care nursing an attractive option for the nursing workforce of both today and tomorrow,’ explained Deborah Sturdy, Visiting Professor at Buckinghamshire New University, who is the Programme Lead for the new Teaching Care Home pilot.

The pilot is a partnership between Care England, the International Longevity Centre – UK, Manchester Metropolitan University’s Department of Nursing, Psychology and Social Care and the Foundation of Nursing Studies. Care England was awarded a grant from the Department of Health to set up five pilot Teaching Care Homes for a one-year programme.

Manchester Metropolitan University’s Department of Nursing, Psychology and Social Care will be working with the teams to develop a framework for a Teaching Care Home. The Foundation of Nursing Studies will then lead a bespoke Caring Cultures programme, that all homes involved in the pilot will participate in. It will have both learning sets and workplace development and homes will be supported by an expert executive coach. The executive coach will assist the home leaders to make changes within their environments to support a culture of learning for all.

Finally, the International Longevity Centre – UK will bring together the findings to evaluate the work and write a final report.

Role of care homes

The homes participating in the pilot are Lady Sarah Cohen House, run by Jewish Care; Millbrook Lodge operated by The Orders of St John Care Trust; MHA’s Berwick Lodge; Chester Court which is operated by Barchester Healthcare and HC-One’s Rose Court Care. The homes will develop best practice and learning opportunities that can be rolled out to other organisations that deliver long-term care nursing.

Each participating home will undertake a home-based development project. Ideas being explored include: tapping into the hidden workforce talent to aid the development and transition of non-UK registered nurses working in care homes; enhanced nursing roles to enable nurse prescribing and avoidance of admission; and multidisciplinary team partnerships with the NHS to create shared care and proactive case management.

Why it’s needed

Deborah explained the need for the pilot, ‘We are facing unprecedented difficulties in both recruiting and retaining the workforce. As a result, we need to be actively encouraging undergraduate students to work in long-term care settings. It’s important that we create and support a workforce, who embrace the clinical complexity, diversity of skill and expertise needed to work in a long-term care setting. We need to develop new roles, which support the registered nursing workforce, as well as develop a framework for good undergraduate health learning. By creating a positive, learning, environment for all, we should be able to sustain, retain and develop the current workforce.

‘The sector must demonstrate the potential that long-term nursing has, to be a partner in preparing the future workforce and build a new narrative, which describes the contribution of this part of the profession. Long-term care nurses have unique skills and knowledge; developing these will help to build a robust foundation for the future.

‘This pilot aims to create real centres of excellence in practice development and learning for nursing students. The Teaching Care Home programme can also provide undergraduate learning for medicine and therapists which is something we will want to explore in the future.’

Care home nursing is not held in the highest regard. However, the role offers a lot of autonomy for a nurse. They lead on their own cases without the distractions that come with acute settings. As such, they offer student nurses and other medical professionals a perfect setting in which to learn, apply their knowledge and take control. This is what the pilot aims to achieve: to create positive learning environments for undergraduate nurses, medical students and therapists to learn, apply that learning and lead with interesting and complex patients.

Over to the experts

Will the pilot contribute to raising the profile of long-term care nursing as a proactive career choice? Will it challenge outmoded perceptions? Will it re-energise the workforce and create an environment for learning for all, positive role models and professional sector leaders? What does the panel think?

Can only have a positive impact on care staff

In its report Managing the supply of NHS clinical staff in England earlier this year, the National Audit Office estimated that there was a shortfall of some 50,000 clinical staff in the NHS. Of this total, the largest shortage – approaching 30,000 – was in nursing staff. So hospitals, community trusts and primary care are all going to be on the look-out to bolster their nursing numbers, especially as patient safety continues to be a key issue.

It follows that anything social care can do to demonstrate its attractiveness as a sector, not only for current nurses, but for those returning to the profession and for people thinking of making it their career, has to be a good thing. And Teaching Care Homes is a very good thing. It’s nurse-led; it’s developmental; and it raises the profile of care homes as an alternative to clinical settings.

Also, we know that wherever possible, people prefer to be treated in their homes, rather than going into hospital, so this new initiative is very much in-line with the focus on person-centred care at the heart of the Five Year Forward View. Above and beyond the benefits for nursing staff, having this emphasis on learning in care homes can only have a positive impact on care staff, and how they see themselves and their careers.

There are a number of places around the country where lead nurses are funded through the NHS to go into care homes and train staff, so they become more skilled, they can do more for their residents and they start to recognise their own abilities.

Wouldn’t it be great if Teaching Care Homes enabled this to become the norm?

Debbie Sorkin National
Director of Systems Leadership
The Leadership Centre

Care homes as centres of practice development

The Teaching Care Homes programme and its pilot certainly have the potential to establish care homes as centres of practice development. The pilots should also showcase care homes as a really worthwhile place to work, for a range of professionals, in both health and social care. Care homes are an essential part of an integrated health and social care system and they have an important role to play in training and developing an integrated workforce.

The biggest challenge to the effectiveness of the project will be a cultural one. Health services have traditionally ignored social care and, worse than that, they have often treated the people who work in social care as second class professionals. This is not helpful given the inter-relating roles of health and social care, and the need to drive integrated ways of working.

Whatever the evidence that comes from the pilots within the Teaching Care Home Programme, the challenge to its effectiveness will be to make sure it is respected, acknowledged and responded to by the whole system – health and social care.

Care homes and care homes with nursing deal with, and support, people who have very complex needs. This means that in these settings, health and care professionals can have a real opportunity to develop skills and to use their professional judgement to make a difference to people’s lives.

I hope the Teaching Care Homes Programme will graphically show this and herald a new era of mutual respect and truly integrated working. I hope the programme, becomes an important part of developing 21st century services that cross the continuum between health and social care.

Professor Martin Green OBE
Chief Executive
Care England

An important pilot study

This is an important pilot study. The value and contribution of nurses working in adult social care has long been overlooked and under-estimated.

People residing in care homes live with multiple long-term conditions requiring skill and expertise. Nurses in care homes have to demonstrate a breadth and depth of clinical skills set in the context of relationship-centred care. The person who lives in the care home and their families are central to all that takes place.

These pilots have the potential to contribute to changing the perceptions and image of what happens in a care home. It is a myth that student nurses do not care for older people, as they form the largest group of people needing acute hospital care.

The care home provides an ideal place to gain important skills and knowledge in the care of older people and in long-term conditions. The care sector has many excellent role models.

This pilot study has the potential to contribute significantly to how nurses working in care homes are perceived. It will also contribute to new ways of working and new roles for nurses.

Nurses working in a care home are part of a nursing and care team providing 24-hour care. They are the lead clinician. They do not have other medical or clinical support immediately to hand. The opportunity to manage and co-ordinate care is immense. The long-term conditions of people living in care settings are not always stable and predictable, meaning that the scope for nurses to learn to manage this complexity is immense and will underpin their future career development.

Sharon Blackburn CBE RGN RMN
Policy and Communications Director
National Care Forum

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