PTH-120 Nursing Challenges of Implementing the Three Session Day

Abstract

Introduction Introduction: Three session working day in endoscopy was implemented at the Royal Liverpool hospital (RLH) in October 2009: in order to increase capacity as there was no room for estate expansion. The main drivers for this were increased projected activity from Bowel Cancer Screening and the increased waiting times. Methods Aim To discuss the nursing challenges when implementing three session days. Results Initial steps: The three session day provides 18 extra lists per week. The business case provided a comprehensive breakdown of what would be achieved by the three session day, why it was necessary, what this would mean for the patients and what it would mean financially for the trust. Workforce Challenges As nursing establishment increased, 10 WTE nursing staff/HCA, including one band seven Deputy Manager/ Trainer. It is important that new staff are flexible. Workforce redesign, skill mix reviews, and altered contracts required careful negotiation and planning. Changing nursing rotas was a challenge as the new template did not marry well with traditional Monday - Friday 9-5pm nursing rotas. A creative and flexible approach to shift patterns was necessary, this allows maximum flexibility in rostering shifts but staff benefit from more time away from the department. Each staff member should be individually considered for each type of flexible working plan. It is important to robustly manage staff absence. Training Challenges A culture developed of staff only feeling confident to do certain procedures, thus limiting the skill mix across the department. It was realised that so many new starters and an expanded workforce required further investment in training. It is essential to have a senior nurse to focus on training. Since then a full training programme has been implemented providing clear guidance and structure to all staff. Support is also provided in weekly training sessions and cascade training. Leadership Steering a team through any organisational change required strong medical, managerial and nursing leadership, with key skills of problem solving, organisation, negotiation, and the ability to communicate the right messages to the team. Communication strategies include weekly activity meetings with the managers, senior nurses, admin manager and endoscopy leads. Monthly staff meetings, quarterly user group meetings, Glitch board, communication board and daily team brief were introduced to facilitate feedback and communication. Conclusions The three session day benefitted the department greatly by increasing much needed capacity when there was no room for expansion. It has been challenging and has only been successful through effective communication, a team approach and a commitment to achieving a common goal.