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>> You can join us on Twitter. We’ve got a Twitter handle here. We got hashtag. Edge talks or

you can use handle @the edge NHS. We would love to hear your views on Talent Management

in nursing. Please join us or join us on the WebEx and tell us what you think about the subject in

the chat room or introduce yourself, what's your interest in this area? So we're going to start in a

couple more minutes but we'd love to hear from you and say good morning and see how you're

doing.

[Pause].

>> You're looking lovely, Sue.

>> Oh, thank you very much, Sue.

[Pause].

>> Okay. It's 9:30 I'm going to give it for what's minute people who want to join in this

conversation to come online. Just a couple more minutes and then we're going to make a start.

[Pause].

>> Okay, it looks like we can start now. I'm hoping everybody's ready to go. We got a very, very

interesting area. One that I'm very passionate about on the subject here we're going to be talking

about is talent management in nursing. Why does it matter to frontline staff and managers in the

NHS and the presenter is Sue Haines from Nottingham University Hospital. I'm going to

introduce her more formally but before I do so some housekeeping. So in terms of joining today

we got a twitter and a hashtag that we'd like you to start using the hashtag is hash edge talks

and the handle is at school for radical. Join our Facebook group. Tool school for health and care

radicals. Please join us on Facebook and we'd love to hear your comments about this session

today. So my name the Janet I work as an associate with NHS England and I'm going to be

chairing the session today. If you have any questions for me, please raise them in

the chat room.

And Dominic is going to be leading on the chat room today so he's going to be monitoring the

conversation there and needing at that point in the presentation and also looking at twitter so if

you got questions raise them in the chat room or through our twitter hashtag. I'd like to go onto

just introduce sue HANS and she's got a very impressive background and it's worth me just

quickly saying that Sue started qualifying at around 1985 as she was on a medical unit at NHS,

at the Nottingham general hospital before moving into specialized and intensive care nursing.

She worked at units at Queens medical centre and Nottingham in a period of sixteen years as a

staff nurse and onto an educator and lead. She has an interest in education and software report

and this is very evident in the presentation she's making today. She looked to become a TANT

director of nursing at Nottingham city hospital and also onto become an assistant director in

Nottingham university hospital NHS trust within the new nursing development team.

Within her current role she has a specific interest and responsibil ity for nursing, education

practice learning and loads of other really important areas of this -- of talent management. She

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has a research interest and currently studying a doctorate so hey to all those doctorate students

like myself studying part-time and holding everything down. And, again, her interest is around

talent management. We'll hear a lot more from her today so I don't want to take up too much

time. I want to hand over to her and I'll be coming back later onto help with the conversation and

the questions. So over to you, Sue. Look forward to hearing this wonderful presentation.

>> Thank you very much, Janet, thank you very much for the introduction. So today I think that

there's some information on the slides about the edge have provided. And I'll go through those

first and obviously Dom doing the twitter and the chat room. It's new for us this method of

teaching across the web. So I'm here today. I was invited and thank you very much, to share,

and it's the findings of my doctoral research which I have just passed and I'm feeling very

relieved and empathise with everyone studying out there. So the initial feedback was to give

some ideas on the work of the research and also what we've been doing about the findings

within our organisation here. So I'm really delighted I got colleagues here to share with people

today. Some of the key ideas, so some examples of work we've been doing over the past three

years here at Nottingham to help with the discussion and hear what others are doing too.

So I go to Dr Joanne Cooper and Ted and they'll be taking part in the discussions as we

progress through. So the aim of this webinar from our point of view is to report on the findings of

some of the research that we've been doing here.

Particularly my research around talent management and nursing but what I found through my

networking across the country and with different professional groups is some of the themes are

very, very similar and my particular interest is frontline staff. I'll share some of those findings and

then go into some of the examples. So that's the plan for the session and we'd really like to

facilitate some wider debate and discussion because we feel this is such an important topic and

our approach is about inclusive talent management and we welcome all discussion debate about

how we might do that within nursing and within health care. So I'm going to start with some of the

basic background of some of the work I've done through doing my research.

I looked into it as a health care professional who didn't know much about it as a concept that was

more familiar with business and HR management. I was very conscience that I was very

interested in retention of staff. How do we develop our very, very able that are newly qualified

when they come into our organisations? The other challenge we know is the aging population.

We got a global health demand for care workers and registered nurses as well particularly. And

we also know now with the changes to nursing workforces and these national shortages that

actually nurses have got to compete attracting people into nursing who now can go and choose

any other career. Particularly now fees are going to be included for undergraduate nursing

courses so we got to make nursing attractive profession. We got to make sure we got the right

skills and people coming into nursing.

So one of the thoughts, the feedback we got through our staff here is when you're newly qualified

you come out to nursing particularly and you don't know the career pathways to go down. The

fact that there are so many routes you can go down in nursing and actually what newly qualified

staff will say to us is we don't know what's there and we don't know what we don't know. When

you look at talent management as a concept it's much more widely referenced in health care

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probably today but when this research started it was very underwritten about health care. So I

was looking about what the business was saying about it and there was many definitions of talent

management and the one thing I've learned from this study is that the whole concept of talent

management is there's an agreement in literature that it is under-researched and it's poorly

evaluated and there are very different models of talent management when you

look at the literature.

So one of the most key definitions I looked at in terms of my research was at the time one

identified from CIPD they said talent management was a systematic attraction, identification of

individuals, I won't repeat the whole quote but it was about having value either because your high

potential or because you're business critical and how organisations and businesses define

business critical is quite an interesting point. But when I looked into it much deeper what I found

was that the literature was in a way on a continuum so when you talk about talent management

people often automatically assume you're going to talk about exclusive models and talk about

talent pools and the literature particularly in the NHS about high leadership. People aspiring to be

directors rather than frontline staff. So on the other end of the spectrum a much more emerging

over the last four years was an inclusive model of talent management where there's opportunities

for all.

This is based around staff engagement models where there are open and transparent processes

and shared governances which we'll talk about. So with an inclusive model of talent management

individuals nominate themselves for opportunities rather than being selected by senior

managers. And that's now the model that the NHS leadership academy and their sort of 2014

quote about inclusive time management was around everybody should be considered talent and

the value is the diversity of talent and in a way if you look at the breadth you have of talent

survey and of nursing from our point of view it's the inclusive approach which is recognised in

diversity rather than selective niche talents that is the optimum approach to take.

What I want to show you some of the findings of the study I actually did. The core components

we have to find within our talent management include a continuous process of recognising what

you want talent is for your organisation. So how are you defining what talent is. For us in nursing

that might be such a diversity of things and what outcomes are we expected so what does

talented nurses do for patients? What are the outcomes we can expect? How do we track talent

and manage and evaluate? Something the literature shows there's a lack of evaluation overall in

processes that are used. There's a lot of opportunity for us to inform the literature and the

evidence base for practice. So my research study aimed to gain new insights and knowledge in

how tall ENT management was emerging in nursing.

And to look at what our frontline clinical nurses were saying and these are a brief summary. How

do people define what talent was in nursing, define the challenges and what are senior level staff

thinking? So I've undertaken an exploratory case study and it included a range of data collection

including document resources to engage and this diagram just shows a sort of a representation

of the data sources used. And the wider consultation that we had involved 229 staff nurses from

across our organisation so this was to make sure we were really engaging with our frontline staff

to understand what talent meant to them and what they felt was important for us to be

recognising in the organisation.

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So the results of the study, are clustered thematically under key core themes. The first one is

talent. The second one is leadership and culture and the third one is career development and I'll

just outline the core aspects of each theme.

So how is talent defined in nursing? The main finding was there was such a diversity in skills and

attracts that the participates raised as talent in nursing. Nurses valued what they did but what

they were concerned about was that talent in nursing was not recognised or valued Widener

nursing or in organisations. Whilst there was diversity there was something about nursing feeling

understated about what talents were that they had and they were recognised as everyday skills

and not realising the positive impact they had.

There were issues around people identifying the poor areas, leadership, skills interpersonal

skills, patient-centred skills and professional knowledge and skills. Nurses were very much

unaware of the diverse talents of clinical nurses were not thinking of talents required to be a

nurse researcher or educator. They were thinking around talents to be a clinical nurse and

valuing the roles that they did. Interestingly, executives involved in the study were very, very

positive about nursing talents whereas what the participants were saying is there's a negative

media image of nursing and that's something we've heard talked about in social media over the

past couple of years. Particularly since the Francis report which rightly recognised failings in

nursing. So these participants said people don't know what nurses do.

And they wanted to have a reclaimed pride in nursing as a profession. They said excellence

wasn't recognised. Only what hasn't been achieved so there was a performance culture where

people were expected to deliver on targets but weren't recognised when they did well.

Recognition of talent was important in nursing and this was about those who shouted the loudest

and those people wider than the people who shout the loudest. The other key identifying was

career pathways so the invisibility of nursing careers we don't know what we don't know. What

career pathways? And one of the most interesting points was a lack of clinically focused career

pathways in nursing which is referenced to other literature and previous studies including

governmental policies and reviews such as the prime minister commission on nursing.

Nurses want to move laterally not just up hierarchy and this is critical for improvement and

retention. They need to recognise and value the band five staff nurse role was absolutely pivotal

because it was valued by many of the participants and it was what they wanted to be fulfilled and

valued for that role rather than the theory they had to move onto get recognition. So the most

familiar pathway was managerial and I'm sure people won't be surprised to hear that so the ward

sister or charge nurse was not seen as an attractive role and I think we have seen this

throughout the literature in nursing. The participants identified was only one pathway you'll see

here from one participant. You see, you become a staff nurse, a sister and a matron and not

everyone wants to go on that route.

But one thing that was clear was that there was real lack of knowledge about what career

pathways and it links now into the shape of care and findings and also from the reports of a

couple years ago. So the invisibility of careers was identified and the academic careers were

misunderstood. They were described as boring, there was a lack of understanding about what a

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clinical academic career may look like within nursing. Now if we're attracting and wanting to

attract and retain people from diverse backgrounds into nursing now, we need to be cheer --

clear about the diversity.

Specialist nursing was the correct route but people didn't know how to get to them. Nurses out

there will know if you want to be a specialist, the role is different in every single organisation.

Every single specialty sometimes there are different routes and that is now being addressed and

identified as a key area of improvement but it's something that's really, really important for our

career I think and our future. Other routes in nursing were described by our participants as taking

this away from patient contact and that was regarded as really, really important because actuall y

what nurses were saying we came into nursing to have patient contact and career routes were a

problem. So nursing education, there was limited awareness of education roles.

And for community in other, in light of the view, nurses from this setting were not talk about

careers in community so there's something there about the visibility of nursing careers. Ward

leadership and culture. The sister charge nurse T line manager was seen as the key talent

developer. The key individual that could enable opportunities or provide opportunities. They were

seen as the gatekeeper and the qualities and skills of the sister charge nurse or line manager are

in so critical for the development of talent at frontline level. The appraisal was seen as key and

effective appraisal is key to talent development. And so often these could be rushed, and

something that people are not adequately prepared to do. So whilst within my research there

were excellent examples of appraisals what it identified was there was significant areas for

improvement and I think that's also reflected now in the NHS staff survey.

The other interesting point is the need for independent careers advice for nurses because the

diversity of careers. Now the other really important point that was identified and furthermore

we've gone on to do research in the organisation was the importance of diversity as a priority

within an inclusive approach to talent management. Now here you can see a great photo of

Pamela who from our organisation a staff nurse from the cardiac area who has done an award

and her focus was on leadership for BME staff.

Her study has gone onto inform wider feedback within the organisation and we have a BME

leadership group which are taking forward her ideas from the findings and these include the need

for mentorship and reverse mentoring for BME staff and senior managers. We need to have

better quality appraisals and that's something certainly our wider talent management strategy is

focusing on and access to support for our BME colleagues it's certainly in nursing periphery and

wider. There needs to be clarity around recruitment and improved transparency and that's the

key focus of our organisational talent management strategy within our nursing which this nursing

periphery approach is leading into and our trust is formalizing talent management processes

through development such as people forums over the next six months.

Talent can be sometimes be seen as a disruption. From a nursing point of view it's so imperative

that we can identify talent not as necessarily what we would normally expect but how do we

embrace and welcome diverse skills and innovations that nurses bring? So what would help?

Valuing and involving staff nurses, developing managers, clearer pathways, more specialty

clinical education and clinical career ladders for our band five staff nurses with key findings

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from my study.

And this is informed our inclusive talent management approach within the organisation which is

illustrated here which we have fed into from 2014 to 2016-17. So that's the key findings of my

study. And the work that has informed future planning and practice here within the case study.

So I'm interested to see if there are any particular thoughts from others before we move onto the

three examples from practice that I wanted to use to illustrate some of the work that we've been

doing over the past four years and the results of these study findings. Over to you, Janet.

>> Hi, hi. I wondered whether or not in terms of the -- I think the findings have been fantastic. I

wonder whether or not you built upon any best practice from other sectors around some of these

really important things around include shift and diverse in management and I'm interested in the

skills for managers in terms of picking up on talent of staff and the issue around career

progression there particular.

>> I think from the BME diversity, that, the research was done 2012-13 so in a way that has now

in formed further discussion.

When I was originally looking at the literature there was not much evidence within other sectors

that I could find and actually the work that Pamela has now been doing and needing into our

organisation has been absolutely invaluable. From a point of view of the career development,

there are other researchers which I have looked into in terms of inclusivity so professor is writing

more about talent management and the leadership academy is producing far more.

And I've gained loads through going to the BMO advisory group and listening to the conferences

and what the staff are saying about what needs to happen. So this is a really key area of priority

in terms of talent management for nursing. And we want to learn from others to, certainly through

our organisation. Our starting point has been the work of Pamela and her very interesting survey

of our nursing staff on their feelings about career progression and leadership, opportunities for

our BME nurses and midwives and that's forming the basis at the moment of our work to take

forward. In terms of the career development, sorry, can you remind me what the second question

was, Janet?

>> Can you hear me now?

>> Yes, I can.

>> I was thinking more around the career progression. I think one of the key things you

mentioned is not having a route in knowing what the career options are. So tell us in the

development side what is your place on that front?

>> Yeah, so this is really, we fed our findings into the shape of caring review. That was key that

this has to become clearer in nursing. We're developing more career resources for our nurses

but interestingly with our allied professional health colleagues there was a lack there. There are

challenges with other professional groups in health care we're doing careers resource macro

site.

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So a career resource directly for our staff to access and the strands of work fall around clinical

academic careers so how do you start that? The other thing is education careers. How do you

get into education development? We're developing an advanced practice strategy. So how do we

make it clear the routes into advanced practice and also man -- managerial routes how do we

make sure those roles are developed effectively. That's the approach we're taking and needing it

to the agenda as well.

>> Thank you I'm going to go over to Dom to find out what 's happening in twitter and the chat

room. So onto you, Dom.

>> So my voice is croaking, sorry. Everybody at the moment is currently just listening to what is

being said. Resonating this is a really interesting conversation and I think people are really loving

these slides as well.

>> Okay. Thank you, Dom, over to you, Sue.

>> Okay. One of the things we wanted to do is to share was the fact although students weren't

included within the research that I undertook, students are very much integral stem now as our

future work. We have a task group. We have -- we very much engage and involve our students

because obviously they are the future of the workforce and it's going to be important to connect

and see careers and aspirations the younger nurses and the new nurses coming through nurses

aspiring to. So what we'll move onto look at then is the piece of work we looked at in terms of

excellence so, one of findings was very clear that there was no aspirational standards for

excellence in nursing available at the time when we were looking at this during 2012-13 and then

we'll talk about shared governance and a career option we got implemented here so reiterating

about the aims of the webinar and move on now to the case examples.

For nursing as talent there's felt to be a lack of vision or standards of excellence in nursing play

over the last three years. And what the one thing we chose within our organisation was the

magnet recognition program so when we looked outwards the only frame we could find was the

magnet recognition program. So now what we've done is utilise that had framework as a map.

Whilst not actively pursuing at this stage the credential model we used the model as a map

because the model is based on what is excellence in nursing. And I won't obviously go into the

details of that but it was just to let -- to share that we'd use it as a mapping for excellence. It's

formed the basis of you are a strategy and integral to why we progressed with shared

governance. So we wanted to set clear aspirational reward and recognition and power our nurse

to realise the excellence of what they were doing and say we are aspiring to

be nationally excellent.

The pictures demonstrate the initiatives working with the education department very formally in a

strategic way over the last three years how we promote positive images of nursing to connect

with our community to, develop a professional practice model and implement shared governance

across our organisation. Now this journey to excellence using a framework to map on, here's just

a picture of our leadership council which Carrie will talk about more. This is showing a long

journey, it involves taking our nurses out, to talk to our chief nurse to learn at conferences and

events and to understand what does create nursing excellence? And the things we've learnt from

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the magnet model. The things we learned around developing talent. They are the outcomes

required to achieve magnet status and looking or driving improvements in patient care. And one

of the things we like about it is the international benchmarking. So it's just not enough to say you

are good, you are excellent in nursing. You have to prove that through benchmarking events

from the organize nations. We have registered nurse satisfaction level and that is down to ward

and unit level.

This is another addition on top of staff surveys. But what are our nurses feeling at ward and unit

level and this is a requirement for magnet and the detail is a requirement. So you can show

impact and actions that you are taking. The other thing that's key for magnet is that shared

governance is foundation for magnet. Now this is devolved management structure which Kate is

going to chat about but it's a clear model, inclusive and opens up and recognises individuals and

the other thing is clear career ladders. So within the magnet framework, clear career ladders are

really, really important. And education and valuing nurses and midwives. So the components of

magnet, whether you commit to a program of credentialing or not the components provide a

framework with which to benchmark yourself against in terms of driving towards

nursing excellence.

So at that point, what I want to do is now hand over to carry Taylor and she's also a leadership

fellow at health education England and has a wealth of experience I'm going to hand other to

Carrie and she will share with you how to influence leadership and culture to help develop talent

here.

>> I hope you found this all very useful so far. So thank you very much, Sue, I'd like to start by

kind of talking a little bit about what shared governance is and then how we go onto utilise that to

form a culture of inclusive talent management and I think one of the first things to say is that

although our story is about nurses and mid WOOIFs the principles can be applied across all

disciplines and I mean any member of staff that works here at any wage or in forms our culture.

That includes our students, our patients and that's about saying everybody is important and,

again, just to reiterate what Sue said it's about inclusive talent management and how can we

make sure that everybody feels involved in the patient journey and in change essentially.

So we really strongly believe Tim's philosophy that 90% of decisions made about patient care

should be made by those who deliver that care at the point of care or those should inform the

change moving forward. What we think about here to do that is essentially shared governance.

Now the term shared governance can be used in different ways so it's also known as shared

decision-making or shared leadership and business participatory management or devolved

leadership. There's lots of different phrases that are used but here we do shared governance.

So we, back in 2012, we kind of brought together some staff members on one of our units and

asked them to look at what changes they felt needed to be made in their area. And one of the

first things they did amongst a lot of other staff around the organisation was to come up with a

definition for what they felt shared governance really meant to them and this is it as you can see

on the screen. It was about saying, you know, actually our patients at the centre of our journey

and the people, again, who deliver the care should be informing how that journey the formulating,

the policies and procedures that kind of come along with that patient as well and it's about

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bringing decision-making closer to the frontline and connecting with the wider organisation with

the frontline staff. So as I've said before, shared governance can be known as other things but

encompass shared leadership, shared decision-making, innovation and a really important

component and in fact you can't do shared governance without it is shared research.

So it's making sure our evidence base practice is the heart of everything we do and that's

knowing why we do what we do on a daily basis and stamping out terms such as we do it our

way because we've always done it that way and in natural fact that's not necessarily a good

culture to be in. Yes, it's great to be doing things that are kind of always done and if it's cone --

done in the right way but are we up-to-date otherwise we'd be putting oxygen and egg white on

pressure ulcers. So that's how we inform the practice moving forward.

We get the staff themselves who look after those patient to recognise that and to make that

change. So this is our model here. We employ participation methods. Going back to that

inclusive strategy of talent management so what we're saying is actually anybody can be

involved in these councils. We call them ward based councils at the frontline. Each area is

entitled to have a council within their ward and we also have a community council because we do

have a community team but for the purposes I'll just talk about wards for now so, again, all about

voluntary participation. So what we do is we put posters up on the wall in the area when they've

made contact with the team. Maybe one will come and say we want shared governance in our

area. It's something we really feel will enhance our patient journey

and enhance staff satisfaction.

And we ask them are you passionate about patient care? Do you want to have a voice? Do you

want to develop your leadership skills? And I leave the posters up for a couple of weeks and I go

over in the morning to catch the day and night staff and talk about what we can give to staff

members through doing this and then we wait for them to come to us. It's saying is this

something you want. This isn't a promotion. This is about linear career development so actual ly I

feel at this moment in time in my career I want something extra but I don't want to go up that

managerial pathway. That's not for me. I just feel I would rather develop further skills around

leadership, around understanding the wider organisation.

So the largest number of themes we've had for a seven-person council was 47 names so as you

can imagine really, really kind of key and exciting opportunities for people to have protected time.

And that's the crux of this. So we're giving our staff six and a half hours a month protected time to

come together in a room and to say, what are our issues? What are our problems and our

concerns and our ward area that affect patient safety and staff satisfaction? So it's not just about

saying you have to discuss everything to the safety. It's about what affects the whole journey as

a staff member or a patient and how can we affect the whole organisation? Each one of these

councils elects their own chairperson. What we do have in a couple of our areas now is a couple

people who would like to be chairs of these councils do anonymous manifesto s and they have

all the staff in that state of recovery actually in that kind of team nominating who they wanted to

represent them in the wider organisation. And it was actually a non-registered member of staff

that was elected as the chairperson for the council.

A really, really key opportunity to develop skills because we know she would like to go onto

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access for nursing and complete her degree. And that's a real great opportunity for career

pathway and for her to network throughout the wider organisation. So to do that and to

operationalize that all the chairpersons of the councils and the wards attend our monthly

leadership council so that is with our chief nurse. Chaired by our chief nurse. There's other

stakeholders around the table as well. People from procurement, finance, Joanne Cooper,

learning and organisational development colleagues.

Lots of different people who are there to help make change for the staff members so it's not a

meeting where people come and they expect to be told what to do. So the format of the meeting

is very much we have a 20-minute key speaker at the beginning which is chosen by the

chairperson of the councils so we've had the chairman of our board, we've had the chief exec

talk about complex change. When we had our CQC visit we had someone come and talk about

the myth so to speak about what our CQC visit was going to look like. That was the first twenty

minutes and the rest of the meeting is about them. It's about them saying this is what we are

working on at the moment directly in our area. This is what is going well and this is what we need

help with and it's the job of other people around the table to help them make the change. So

rather than that them with top down approach we're saying what's key in your area and how can

we help you make that change?

Throughout that whole process we're continuously developing staff members and giving them the

tool to understand how to write a business case or to be a more assertive leader. The continuum

is absolutely huge so what was really key through that is now with 34 councils and we're in the

process of setting up one evidence based practice council which is to form the evidence based

practice agenda throughout the organisation.

It was really important that we understood the feedback from staff was so back in 2014 we

surveyed, 3, 732 of our 4,500 nurses. They said, that nurses on my ward take an active role in

contributing to decision-making. Only 12.5% agreed with that and actually that's really worrying.

That's saying is it because they feel they can or they don't have the confidence or no mechanism

to allow them to do so? They don't have time? Moving onto 2015 they did an interim survey of all

the council members that sit on the 32 councils so in total we have approximately 200 staff

members on those councils ranging from students and with other M.D.t colleagues that sit there

as well. We survey them. Important to emphasise that is a representation of the rest of

their ward areas.

They've been chosen or elected to be there in first instance and this is what they said. 200 staff

members said I feel more able to develop and improve practice and 81% of those said I've had

the opportunity to develop leadership skills. That's massive. That's absolutely huge and, again,

that's completely relying on voluntary participation with this. So that's them putting themselves

forward and saying, yeah, I'm ready for something else and the quotes at the top as you can see

that's only two quotes of 200 because we asked for some free text as well so really, really key

agenda moving forward and I won't go into too much detail but as you can see on the screen,

this is some examples of some of the work that has been achieved by our council members and,

again, it's on a really vast continuum. Each council we have 34, works on probably up to about 8

projects as they call them at a time.

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So they get support from all their management teams to make these changes and to do these

projects but they're working on some really key organisational strategies and it's actually how

they, again, get that support from around them to develop them and also to make the change.

Now what we seen really clearly is people who have started to develop these skills who they be

would have at one time thought I judgment to be SH -- I just want to be a staff nurse for the

whole of my career and that's okay but once they have asked to be involved in this they start to

see there are other opportunities for their careers and so it's allowing us to say, okay, so what is

it you want to do. How can we make that happen for you? How can we signpost you to different

places or to different opportunities that will give you further development?

In particular lots of the national scholarships and opportunities through Health Education England

or through the organisation itself were able to send those to the staff directors. Usually if you

send out to the nurses that are struggling with staff levels they don't send it out because they'd

rather the staff don't leave but we should be saying everybody has the opportunity to apply for

this secondment not just because you're well staffed at the time. So directly sending it to our

councils and saying can you disseminate this through your wider staff group.

It's a key element of this. So my input from this was at six months qualified the chaired the first

part of the organisation. I'm now five years qualified and had amazing opportunities just by being

involved and in the last six months have also had the opportunity to work with the health

education of England and I know without the shared governance opportunity I wouldn't be a

place that I am now. I am seeing lots of other people being able to do that as well and kind of

really coming through the system now. So really key area of work for us as time management.

Any questions? Sorry Joann I can't hear you.

>> Can you hear me now? That was fantastic and it's great to share your personal experience of

what's worked for you.

I have a couple of questions and then hand it over to Dom in the chat room. I just wanted to find

out, in terms of measuring the impacts of your work, it feels like there's lots of people involved in

lots of different strategies of how they actually get their voices heard around really bringing their

personal interests into their work interests and using this, the council to actually experience work

in a different way. I wondered, have you thought about how you're going to measure the impacts

of that? Because you mentioned something around how it links into the work strategies. I was

interested to find out if you were to compare your process with another trust or another -- two

trusts, how do you compare yourself in terms of organisations that don't have the same appetite

for this sort of work.

>> Absolutely. That's a really key area for us. So part of the start of that was to do that

engagement survey to see where we were at the time and that one question they showed you

was actually a part of much larger range of questions. Part of the magnet framework that Sue

just talked about was measuring unit level staff satisfaction data. That was one of the key areas

of saying where are we now and benchmarking ourselves internationally against other

organisations. As part of magnet shared governance is integral so it's saying how is our start -up

doing at a unit level and not a lot of the current staff satisfaction surveys that we do and you do.

We're able to say there's far more in the medical centre there like X. And then on another ward

12

without shared governance potentially because we do have wards and over 34 councils are

feeling that. So it's how we utilise that. And then the further piece of research that we're doing is

how do staff feel connected into the organisation and utilis ing some people. The IBMG

(feedback).

>> We're having a little bit of problems hearing you. Yeah.

>> Can you hear me now?

>> Yeah, can I hear you now.

>> Sorry, utilising, to see who is connected in the wider organisation. Whether they feel in control

of their practice or contribute to change, how autonomous they are or what authority they got with

that so we're in the process of doing that. With councils who are just in the new stage of setting

up their council.

>> That's fantastic work. Can I just hand over to Dom to find out what's happening in the chat

room and on twitter?

>> Yeah. There's been lot of agreement that there's absolute love for the shared governance and

one of the things that really stood out is the idea of protected time for staff to be involved in this

type of work and that really resonated with a lot of people online.

>> Yeah. I think -- that's just to interject, that's the difference between the themes of how we

operationalize that and are making sure that we have the award and run this with us. It's not

they're telling us to do this. They're right on our side (feedback).

>> How did you get your senior management on board with this? How did they -- how do they

feel about this? It's almost like a cultural shift as well within an organisation. So in order to be

sustainable you also got to have that sort of top down bottom up support. How did that happen?

>> It's a long process, it's still ongoing.

>> Okay.

>> We needed our director of nursing at the time was really key in making that happen. You

need that top down to encourage that bottom up. We've always had board engagement really.

They were really keen to get this going and a kind of divisional nurse and a director nursing of

management. Once we piloted that first council, you'll hear shortly there was a pilot council and

there were a lot of outcomes that came from that with a huge reduction from (feedback) in one

area, that real change, that tangible example put a lot of people on board. Thinking about that

change care of those people that are still (feedback).

>> We're having a little problem with the sound quality but I think we got the message from you

there. Thank you.

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>> Thank you very much, I'm going to hand over now to Dr. Joanne Cooper who is going to talk

to you a little bit more.

>> Thank you.

>> Hi, good morning, everybody.

>> Hi.

>> All right. So I'm just going to start here. So just spruce myself, I'm head of research at the

trust and it's my pleasure this morning to share with you another initiative that we've started to

develop and it's in its early stages but we're working on it going forward. And it really links to the

work that's been showcased nationally but in particularly in relation to Sue's research around

some of the challenges that people have in terms of perception of clinical academic careers.

Head of nursing and research, clearly it was a concern that people thought that research careers

were boring office jobs and not something you wanted to do so I certainly have a vested interest

in moving this forward and the best bit will come when you hear from someone who has

undertaken one of these roles. Ted will talk to you about his experience.

So returning to some of the key things that Sue's research identified. The inclusiveness of it, the

visibility, the opportunity to try something, to learn right from the frontline from being a band five

staff nurse, a band six midwife early on in your career, or an allied health professional. If you

don't know what you don't know, how can we create opportunities to get that insight right at the

early stage? So at the bottom of the slide here, it talks about a clinical career ladder or as Sue

referred to as frame. That's what these chief roles are about in a nutshell. So just before we go

onto look at the role in more depth I thought it would be useful to put this into context. We heard

a lot about culture this morning and what we do fits within culture. So a bit of insight into the

culture that has helped facilitate this. Clearly we have a research active culture.

Dominantly more and more so within nursing. We worked for allied health professionals and a

very supportive discipline routine going forward. We had opportunity to support research and

innovation scholars. Those undertaking new careers such as the Francis Nightingale and the

HEM. We are very grateful to have that opportunity.

We have three, four years of a process in evidence practice course you get staff nurses to

appraise that literature for the first time in many years or to understand and take a small project

forward. So they're keeping those skills right from qualification and it's proven really valuable for

those who been qualified a short time to those who have been qualified longer. We have a group

that is facilitated by a Ph.D. student and she's great at connecting people.

We have the council that is how we learn, not just how we do policies and guidelines but how do

we share the showcase knowledge of dissertations and so on. We provide regular academic

membership and we engage the research in action. But new initiative we're going to talk about

now are the chief nurse, excellence in care junior fellows so if you remember the junior fellows

we put that in intentionally because this is the beginning of a journey and we would like to have

them as we develop what this might look like. Here's a picture of some of our fellows. There's

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couple that are missing. One that is going to be newly starting from Scotland and another that's

undertaken her master in research. But you'll see here from the left we got Frankie who is with

children. Sharon who is looking at nurse discharge. And there's Ted that you'll see shortly around

scheduled governance. Particularly patient focused issue and we have our chief nurse in the

middle. You have Kimberly who is an ODP so it's not just nurses. It's ODPs and they can take

model. And then there's Rose who is going to be looking at care in the area of which they work.

There's Helena who is looking at dementia care and on the right is one of the mentors as part of

the structure that we have.

So you'll see that there is a diverse group here but also diverse topics and things that are

relevant to the critical area. That was absolutely vital to engage. And it's pivotal and absolutely

extremely important. So what are the roles about? This is a list of some of the key things here so

band five or band six. They go and think about that in the first instance. That's really important.

Essentially they have 0.2 or that equivalent to work on the project and their development. So this

is as much about developing the fellows leadership insight and their own confidence as it is

about the project itself. But the two are mutual and they are hand in hand. We English formal

mentorship and networking. If some of us think about career or lack of insight of opportunities,

how do you understand how decisions are made in the NHS as a junior member of staff?

By the time we get to senior positions we don't have those opportunities so it's about visiting

those areas and learning from them right at the outset. There is leadership development and we

work with them to look at the clinical and academic CV building. They might want to be clinical

academics or ward sisters. This is about looking at what their opportunities might be or may be

very happy to be those key evidence base translational leaders at the frontline. So they are all

assigned chief nurse fellow mentor. That would be a critical and academic mentor. We use the

VEET framework to map against their strengths.

The photo that you saw was from a quarterly leadership meeting that they have with the chief

nurse and already I've been given tips and some requests for next quarterly meeting as to who

else they would also like to hear from in terms of leadership going forward. Just that opportunity

to hear Mandy's story really gave some insights and to share their projects and ask questions.

We have great support from our divisions and it's how they engage with the division activity to

understand how the challenges are managed and resolved and each of the projects will be

evidence for the magnet journey and the excellence and the time is 12-24 months. The majority

of funding is taken from vacancy. So this is funded in the sense that we have roles we can't fill.

Why wouldn't we use some of that funding to both recruit new TAF staff but also retain those we

wish to keep in the organisation.

I just provided a diagram here to show an illustration of how that mentorship support might work.

So we have a clinical support both from an academic side from that side but then also really

showing the important role of the lead nurse within the division and also whoever is in working

with the sister or someone that is in the practice development of the division but corporate

support from both myself and Mandy going forward so each of the fellows will have one of these

populated themselves and it's important to show. And then as my final slide it's really about how

we're going to see what difference they make and that impact is very important to show. So we

have some thoughts we're going to develop. This is what's going on but really, so my questions

15

are, did we recruit and select the right people or the criteria we use for development . Is it

suitable. What about the supporting developments that we proposed? What about the division

related opportunities and how useful are they? What these fellows learned from them and how

can we build for the next ones coming round? Then in terms of the project.

The quarterly leadership meetings and the mentorship and how we can capture going forward

the project related outcomes and also the outcomes and the achievements for the individuals

themselves and how that's impacted on them as an aspiring leader for the future and we're

looking to get independent analysis using quantitative and qualitative outcomes. And here's Ted,

so we're also using his picture of the retention strategies. I'm sure he'll be all over Nottingham

and each of the fellows are blogging. This is a copy of his blog so keep your eyes peeled for that

and I'm going to stop now and hand over to Ted and you can share your experience. Thank you.

>> Good morning. My name's Ted, I'm a staff nurse that works on one of the contribution boards

but obviously for the (inaudible) I do the chief nurse fellow position. I've been in the role now

since about April time of this year so I've been one of the longest standing chief nurse fellows. It's

a mix of a personal development role for myself allowing me to sort of develop as part of my

continued development and some lifelong learning that is going through the very start of my

career because I'm only three years down the line before becoming qualified and having been

part of the journey through the student task force group which is a running engaging as Sue

mentioned in the beginning it's something I was brought in to maintain the retention here that I'm

trying to engage from the very beginning.

This role is inevitable. It's quite a new role but the trust is developing and there are eight currently

in post. Ourselves we are still finding our feet fall. We haven't got any criteria which is helpful for

us to develop our role and to improve it going forward but it's hindrance in the fact that we don't

really know what we're doing and we don't know what we're finding out, therefore, we are literally

seeing what doors are opened and going head first and jumping on through which I guess is the

benefit I enjoyed from my role. I've been looking at the safety element as part of what I work on

just by e-mailing people in the trust to see how engaged everyone seems to be in order to help

improve the whole for the better and it's great to see and something that's quite surprising

actually that they're willing to listen to someone so -- from the bottom effectively on the front line

that wouldn't necessarily be talking to people. Something that has really made me think is the

way that they got me on board with it.

And obviously the allowance to go ahead with this kind of program from the top down and allow

us the bottom up to flourish which was mentioned a lot from this morning. Within the role, we

obviously have open opportunities to develop for clinical academic careers, develop people with

PhDs and any of that sort of futuristic project work that these are obviously opportunities that

allow us to gain skills, knowledge, and leadership that we can use for the rest of our nursing

careers. And something that is sort of -- something at the going of our careers that gives root to

build the foundations of what we hopefully are amazing future nursing careers and see what

opportunities open up from the future really.

It kind of allows us to work within our own ward areas or our own department area to improve the

day-to-day activities that we do within these wards. And it allows us to be fully informed of the

16

political standings of the NHS and kind of where we see ourselves in the future and allow this

culture that I think is helping this staff to keep on this frontline work and engaging through shared

governance as well as part of my project at the moment is allowing us to power on forward. The

position is also allowing us to network with different people as I mentioned earlier allowing us to

network with a chief nurse and I think that's my perspective of the role for the time being. I don't

know if there's any questions from anyone while I'm sat here.

>> Thank you very much for that. That is really, really helpful. That's given us a real insight into

your work. I think people are talking about how developmental your work is. A lot of jobs are very

defined, very specific, I really -- I am really enjoying hearing about how you can explore and use

your own imagination to develop your role. I think that's the way of the future is using

imagination, using all the skills that you have to develop your role. How are you feeling about

that? Is it quite scary or something that you're welcoming?

>> Like I was saying it's been one of the hindrances as well as one of the help of the role. It's

quite difficult when I first started trying out one of the chief nurses commented on at the

beginning is kind of the lack of where you start. What do I need to do now in order to try and work

out the plan for my project or my intervention that I want to try to introduce? I mean, linking in

with the coaching that we are having through the educational leadership that I'm having sort of

with Dr. Cooper liaising within my individual leadership structure has allowed me to network with

these people who have opened these doors for me and allowed me to try to engage with people

that I would really never speak to within my band five role normally.

But I mean obviously as there is no sort of tight strings attached to this role it allows me to use

my imagination, to use my skills, thinking outside of the box. Effectively, sort of seeing my

horizons and engaging in areas that obviously link to people I haven't met before and try to push

forward in this change of culture and this dynamic diversity of improving knowledge and

leadership for the future really.

>> Thanks, that's really helpful. I wonder if Dom's got any comments in the chat room.

>> Nothing at this. I think, Hayley talked about coaching. That's one of the things there.

>> That's one of the things I saw from the feeds. Like we saw from Dr. Cooper earlier the

structure that he has. I don't know if you can or not -- I can. It was to do with the structure. My

ward manager is really on board to allow me to find my wings and to find the people who help me

to be flexible and I, although, some of the chief nurses have set days on Monday because I try to

engage with people around the trust I try to be flexible with my hours although I stick with the

hours I'm given I try to move them around to liaise with people I can speak to and also my

divisional nurse for any input and that's been really helpful and with the help we've been liaising

with the educational roles through coaching and leadership with that. Furthermore, the nurse I've

been liaising with the presentation skills, so I'm going to go in a few months’ time in order

to develop myself.

To present myself. Better for these kind of conferences and try to sort of develop myself further

like I said earlier for my future nursing career and stuff that I can use now and build upon for the

17

rest of my career.

>> I wanted to ask you, did you ever envisage that when you came into nursing, that you'd be

doing this now?

>> No. Not at all. Kind of, a bit like what was mentioned earlier about this, you come into nursing

and you don't necessarily have tunnel vision for the nursing pathway and the nurs ing career

pathway and I don't think when I thought -- when I first started, I didn't see it from the

opportunities and the framework and the ladder that nursing hopes up to you and you kind of, I

think because if you were ever a patient or a visitor to a hospital you see the frontline staff of sort

of that identifies with the band six that works on the ward or the deputy charge nurses. You then

see the ward manager and you are focused in that kind of mechanism for that's the only route

within nursing. And I think once you come into nursing, you can kind of see that there are other

opportunities, other people within the organisation that don't necessarily have a patient or like a

visitor visualization that you can see when you walk into a hospital

.

That's obviously the key stakeholders that empower the hospital to run as it does and to allow

the people across the organisation to keep it going day after day. Because people you don't

necessarily see and obviously, yeah, this role has obviously opened my eyes to many other

people within the trust and other key stakeholders that are trying to push forward for allowing the

NHS as a whole to have this culture shift to improve this talent management and to engage with

the future nursing workforce.

>> Thank you, that's been really helpful.

>> If there's no further questions I'll pass you back to Sue who will conclude the session. Thank

you very much.

>> Hi. Thanks ever so much to Ted I think that was a really fantastic illustration of the

experiences in this very, very new role and opportunity and a great effort to be here with us and

supporting us today. So thanks to Ted. So I just wanted to summarize some of the points really,

Janet, if that's okay for colleagues. I think what you've heard from both Carrie, Jo, and Ted are

the absolute critical nature of us appointing nursing particularly in light of these shortages. We

need to talk about nursing as a talent, a profession with opportunities. We need to promote

inclusive strategies for talent management across the NHS because we are really -- it's

imperative, particularly for the public to understand what nurses do and it's really key in terms of

our professional image and people's understanding of roles and the diversity of careers that are

open to nurses.

When they've qualified which is so diverse. The slide that is in front of you. This is how we are

getting talent management and inclusive talent management on the agenda at nursing meetings.

It's developing our strategy. So we want to talk about inclusive talent management at every level

of the organisation. So people can start to connect and understand that nursing is -- offers talents

and it's an integral component of the workforce that needs to be valued and recognised. So this

is our model that is emerging and you'll see at the centre shared governance is the core of that.

So that's the inclusive model that is embracing diversity and culture change but it's a cyclical

18

process so it has to be talked about and managed and we need to consider this because of

staff retention.

It's so critical moving forward. So implications for practice. We just got some couple of points and

it'll be great for people, you know, needing back after this event. We'd love to hear from other

people about what they're doing too. We are saying implications for practice. Both from the

research findings. It's about inclusivity and diversity. It's about increasing the staff development

opportunities and representation in key roles within nursing and wider. The headers certainly in

nursing and the wider health care need to consider health care management more than in their

own organisations.

What we also find I think and I don't include the research I've done is people may consider their

own ward, their own department, their own organisation but certainly in light of five-year forward

view, how we are developing nurses with talents to work across health care boundaries and

shifting context of health and social care, that requires chief nurses, and other leaders to be

coming together to talk about these shared opportunities. And it's certainly one thing we're

looking at here with more rotational posts across our health care community with chief nurse

colleagues in primary and care sectors. We need to be looking at how we evidence nursing

excellence. So it's all right to say we are excellent. But how do we actually prove that? What are

the patients expecting? What is staff satisfaction and recruitment and retention of our staff? And

there's opportunity to learn across our professional groups.

Because it's about recognising and valuing diversity and that's one of the things that I think we

really want to fully embrace for nursing here. So just moving on then clear career pathways are

essential for nursing. Particularly in nursing where we are recognising nationally as well as within

our own organisation and need for this. The other point is the recognition and value of the staff

nurse role as a career choice in its own right. People who do not wish to progress to other roles,

who do not wish to progress into managerial roles need to recognise the staff nurse role in their

own right and what we're learning from for example within some of the states and magnet

hospitals they have career ladders for staff nurses where nurses can get a level of paid

progression for doing exceptional pieces of work and contribution but they stay as staff nurses.

So there's opportunities to explore that we think within the UK, within the NHS. So mentorship,

appraisal and recognising and rewarding those two develop others. People who develop talented

individuals. We need to ensure these people are recognised.

And we need to work hard on developing a positive image of nursing and the diversity of roles

and that's been the region and our local area and also wider within nursing. And then for

research, because obviously my original starting point that we started at the going was a

research study. And one thing that is really clear is talent management with frontline health care

staff is a really under-researched area and does require further study there is research. It's

emerging and there's research for leadership roles and executive roles.

But how we retain and develop frontline staff who are the foundation of NHS is really key for

further research and that will include longitudinal studies into the impact of the strategies we're

doing and what retained staff. We're here specifically as you heard from Jo Cooper wanting to

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look at shared governance and how that is developing. And also a more evidence based

approach for career guidance for nursing because there's limited information available about how

to provide career advice in nursing and what makes a really good appraisal. So is it about how

you are coaching and enabling somebody to look to develop their full strengths and poems? And

further study to identify what is the excellence in nursing the UK.

So we talked about the magnet model you saw from the United States. That's one model and I

know now following shape of caring there's another further look at what does that mean in the

UK? What does excellent mean? Because we need these standards to retain our nursing

colleagues. So I think really that is the summary. That's some of the pictures of our staff taken

from the work we've done to promote positive images across our community and down on the left

you'll see who was the winner of our nurse of the year award this year who was voted for by the

Nottinghamshire public this May. That was a fantastic opportunity to connect with our community

for them to say what they value in nursing. And I think, yeah, so there's our twitter handles.

That's all I have to say and our colleagues here today. So we would welcome connection

and communication.

We'd love to hear from people. It's something we feel really passionate about here.

>> Sue, thanks for that, that was incredibly informative, challenging, it's really challenged me in

terms of my own practice around this area. Around diversity, inclusion, really looking at how we

define our role and also the power dynamics in terms of that whole process. And you've covered

such a broad remit around cultural change, values, thinking about our own learning model in an

organisation and that's something we're thinking about within horizon and there's some key

messages in terms of really evidencing what they're doing. So, yes, they're learning in the

context of being fluid and dynamic but we have to show that this approach works and that it is

actually making a difference if it's going to be available.

>> Yeah, evidence base. Absolutely key.

>> Thanks for that. And I'm going to just hand over to -- just for a couple more minutes I'm going

to hand over to Dom to see if there's anything coming up in the chat room.

>> I think once again everyone is really grateful for you guys taking the t ime and explaining

through a number of those ideas and concepts and the way those things work. It's clear the

comradery you have and people had been watching this afterwards on YouTube and will be

getting in touch and having more conversations with you as and when they do so so thank you

very much for today.

>> Thank you, thank you, Dom.

>> I wondered, Paul, if you could introduce the next edition of edge talks for us before we close

out? Are you there, Paul?

>> I'm here, Janet. I believe the next edge talk is actually going to be run by yourself talking

about the school for health and care radicals evaluation survey that's been released recently.

20

>> Okay, that's fantastic. Thank you for reminding me, Paul, thanks, thanks for that.

>> And that will be on the first Friday in September and at the same time.

>> Lovely. Thank you, Paul. I just wanted to say, again, to Sue and her team, thank you so

much. We really appreciate the time that you've taken, your patience in talking us through a very

detailed presentation today. I have learned a lot. I'm sure everyone has as well so thank you for

talking, you and your team, have a great weekend. It looks like it's going to be really sunny and

hot here in London. We hope to stay in touch with you and have you involved in other areas of

our work. I think there's a lot of connectivity between what you do and what we do in horizon. So

thank you to the teams supporting this presentation, to Dom, who is looking after the twitter chat

and to all the people in the background for making this happen and to Kate for arranging Sue to -

- her and her team to talk to us today. So thank you to everybody. And have a wonderful

weekend. Thank you and good-bye.

>> Thank you. Bye.

>> Bye-bye.

>> Bye.