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

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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?

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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

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Council Recommendation 2009

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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Change in social and nursing culture – vocational assumptions are no longer valid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.

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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

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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?

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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…………

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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

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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

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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

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Key themes from the analysis

Enabling factors

Attributes

Outcomes or consequences

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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

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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

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Outcomes or consequences

Can be:

Individual

Workplace

Organisational – this may vary depending

on the institution e.g. community or acute,

small or large

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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

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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

Thank you for listening

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