Blog: The Nightingale Challenge; ‘Key learning in the midst of a global pandemic’.

2nd July 2021
The Nightingale Challenge; ‘Key learning in the midst of a global pandemic’.

Nathan Tate – RN, Specialist Practitioner Adult Nursing, Independent Prescriber, Lead Nurse Major Trauma Service and Critical Care Outreach Team

I was delighted to be selected in late November 2019 to join a cohort of thirty young nursing and midwifery leaders from across Northern Ireland to participate in the Nightingale Challenge Northern Ireland Global Leadership Development Programme (NCNI GLDP), launched in January 2020 alongside the 2020 International Year of the Nurse and the Midwife. I have always been very committed to my own continuing professional development as well as that of my nurse colleagues. In late 2019 at the time of being selected for the NCNI GLDP programme I was working as a senior nurse in a very busy emergency department. I rarely had the headroom to think about the bigger picture and challenges facing nurses across Northern Ireland or worldwide. The NCNI GLDP provided the perfect platform to immerse myself in the latest strategic challenges facing nurses around the world and to stimulate my thinking around not only ‘What’ needs to be different in nursing, but also the ‘How’ emerging young nurse leaders could play their part as positive role models to transform nursing practice. Having the opportunity to link more closely with senior leaders such as Charlotte McArdle Chief Nursing Officer Northern Ireland and to be part of a leadership programme of such quality with global reach was very exciting.

In January 2020 we commenced the NCNI GLDP aimed particularly at improving leadership skills, policymaking, advocacy and our understanding of global health. As a group of young nursing and midwifery leaders on the NCNI GLDP we were fortunate to have two face-to-face workshops (in January and March 2020) before it became necessary to link virtually via Zoom, email and social media, due to Covid-19 restrictions. During each workshop I was encouraged and motivated by the role-modelling of the leaders who contributed as speakers such as Charlotte McArdle (Chief Nursing Officer, for NI), Mary Frances McManus (Director of Nursing Public Health, NI) Howard Catton (CEO, ICN) and Dr Catherine Hannaway (Global Health Consultant). Much of our theoretical learning was by e-learning modules and I managed to complete four Quality Improvement modules facilitated by the Institute for Healthcare Improvement (IHI, USA). I had some knowledge of Improvement tools and approaches already but doing these modules in a systematic way as part of the NCNI GLDP programme refreshed my knowledge and maintained my enthusiasm for undertaking further improvement work in my own clinical area of major trauma which I moved role mid-year in 2020 following a successful interview. I am currently undertaking the United Nations ‘Primer Certificate on the Sustainable Development Goals’ which is interesting and insightful – something I hadn’t really thought too much about before joining this programme.

During the NCNI GLDP I had opportunity to undertake the NHS 360° Leadership Appraisal, with Dr Catherine Hannaway as my facilitator. The process skilfully facilitated, provided me with an increased understanding of the importance of self and an improved understanding of how I could use the feedback to further develop as a young nurse leader. In particular, having feedback from the colleagues I work alongside demonstrated to me that I was valued by my team and gave me increased self-awareness and confidence as a result. I believe this impacted positively on my leadership style and my ability to role-model the best leadership behaviours to motivate my team.

In March 2020 we experienced the first wave of Covid-19 and national lockdown restrictions. I was initially in a role in the Emergency Department very much on the frontline, working as part of a multi-disciplinary team meeting the challenges of the pandemic on a daily basis. It was an apprehensive time as you can imagine, as we had never experienced anything like it before. There were daily challenges including how to find extra space and staff capacity to deal with the new restrictions and guidance, including ensuring social distancing amongst patients attending the department. Covid-19 was a high priority for the media, particularly national news and we experienced similar situations being a busy hospital, as those reported from other health and care organisations across the UK. Having to familiarise yourself with all the constantly changing guidance and using Personal Protective Equipment (PPE) meant we really had to adapt quickly to working in a new way for the safety of both patients and staff. We were working in a ‘new world’ of constant change that required working at pace, and communicating very differently wearing PPE so our patients could both understand and be reassured.

In the first wave of Covid-19 everyone was working to their limit and the only thing we all knew for certain was each day would bring more change as we all worked nationally and locally to contain the virus and provide the very best care and treatment. The Emergency Department staff, including myself, needed to ensure we had robust segregated work areas if patients attending were potentially suspected of having Covid-19 symptoms. Additional risk-assessments were also necessary as part of the emergency triage process. The NCNI GLDP helped me greatly in those early days as I needed to respond to a fast-changing environment and to think on my feet using all my knowledge and experience. I became very adept at change management and supporting my wider team through difficult times.

At the end of the first wave of Covid-19, as healthcare professionals we were all suffering from change fatigue to be quite honest. Belfast Health and Social Care Trust (BHSCT) actively encouraged us to seek support for our own wellbeing and a number of mechanisms and resources were in place to support staff to stay safe and well. The NCNI GLDP also encouraged me to draw on a number of resources to build up my own personal resilience. In particular I appreciated the support from the other NCNI GLDP participants especially those from within my own organisation. My other passion which also helped me de-stress would have been singing socially outside of work, but unfortunately that was curtailed because of Covid-19 restrictions so I was very appreciative of the support from my colleagues at the BHSCT and the NCNI GLDP at that particular time. Thankfully my singing group began using Zoom to bring us all together weekly. I also managed to take a week’s annual leave and this helped me re-charge my personal batteries before the anticipated second wave of Covid-19 hit.

In September 2020 I had successfully applied for a senior lead nurse role in Major Trauma Service and Critical Care Outreach Team. This role was aligned closely with Intensive Care services and involved caring for very seriously ill patients with major complex injuries. The role required a steep learning curve for me with the Covid-19 pandemic being an added complexity. I joined a new team who were working across Major Trauma and Intensive Care at the same time. Good team working and flexible working was absolutely vital at this time. The NCNI GLDP helped me have the competence and confidence to work outside my comfort zone. It also helped me maintain my momentum to deliver the best care I could for the patients. The regular structured on-line learning sessions of the NCNI GLDP kept me re-invigorated in these very challenging times, both personally and professionally.

Given the improving national situation of the Covid-19 pandemic, I am beginning to have the opportunity to implement some of the learning from the NCNI GLDP programme with my new team. My focus for my Quality Improvement project, as part of the NCNI GLDP is contributing to improved ward safety and patient experience. I have completed the preparatory work to ensure staff are actively involved in the project, especially where they have ideas on how we can continually improve the safety and effectiveness of what we do. I am using the IHI (USA) Model for Improvement as part of my project approach. I am looking forward to sharing the learning from my improvement project more widely by the end of June 2021.

I am so appreciative of having this opportunity to participate in the NCNI GLDP. It has given me a better understanding of where I fit globally and locally as a young nurse leader and how I can make a real difference to the nursing profession. I intend to apply my enhanced skills and knowledge to improve services for patients and local people as well as ensuring I become the best nurse leader I can be.

Critical Care Outreach Team