Health Education North West Research Articles

Personnel flux and workplace anxiety: Personal and interpersonal consequences of understaffing in UK ultrasound departments

IntroductionBy 2013, the UK government's Migration Advisory Committee had determined sonography to be a formal shortage speciality, and understaffing remains a key concern for research in the domain. This paper, emergent of a qualitative study funded by Health Education North West, explores unit managers' perspectives on the present state of UK ultrasound. The focus herein falls upon the personal and interpersonal consequences of this circumstance for individuals working in specific understaffed departments. MethodsA thematic analysis informed by a Straussian model of Grounded Theory was utilised; N = 20 extended accounts provided by ultrasound department leads in public (n = 18) and private (n = 2) units were collected and analysed accordingly. ResultsThe global themes addressed herein describe (a) how both inter-departmental movement of senior sonographers and early retirement, within a nationally understaffed picture, impacts upon local knowledge economies, and (b) how such staffing instabilities can undermine the day-to-day confidence of managerial staff and practicing sonographers alike. ConclusionsIt is personnel flux, rather than simple short-staffing, that is reported to cause the greatest social-psychological problems for both managers and sonographers. The issues raised herein require further examination from the perspective of sonographers themselves, in order to corroborate the views of the managers interviewed.

To disclose or not to disclose? The workplace experiences of physiotherapists with a specific learning difficulty

Relevance: This is a qualitative study, w hich investigates the experiences of physiotherapists w orking in the NHS in relation to having a specific learning difficulty. Better understanding of the issues faced by the physiotherapist in the w orkplace has the potential to impact on their practice making it relevant to Congress Theme 2. Purpose: To explore the w orkplace experiences of physiotherapists w ith a SpLD, in relation to disclosing their SpLD, their support needs, and the impact on continuous professional development (CPD) and career progression. Methods/Analysis: This w as Phase 2 of a 3-phase evaluation. The study w as underpinned by the social model of disability. An exploratory qualitative design w as undertaken to address the aim of the study. A purposive sample of eight qualified physiotherapists recognised as having a SpLD, w ere recruited. All participants studied on one of tw o programmes at a university in England betw een 2004-2012. Their NHS w orkplace experience w as from across the UK. Participants w ere invited to take part by the investigators via Facebook and email. Ethical approval w as obtained from Manchester Metropolitan University. Eight in-depth interview s w ere undertaken w ith practising physiotherapists w ho had been diagnosed w ith a SpLD. All interview s w ere carried out by the same researcher (GY). Each interview lasted 40-70 minutes and w as digitally recorded. An interview schedule w as used to guide the interview . Interview data w ere transcribed verbatim and analysed using thematic analysis. Results: Four participants w ere female. Participants w ere w orking as a Band 5 (n=3) or Band 6 (n=5) physiotherapist. Four main themes w ere identified: 1) Having dyslexia; 2) Disclosure; 3) Support and strategies; 4) NHS positive and negative responses. Discussion and conclusions: 'Having dyslexia': Participants did not perceive themselves as having a disability; they perceived stigma w as attached to the diagnosis. Participants indicated strengths and w eakness related to their SpLD. 'Disclosure': Disclosure decisions w ere influenced by: perception of their SpLD being a disability; perceived stigma; fear of discrimination; levelling the playing field; support provided follow ing disclosure; the guaranteed interview scheme; w ho they disclosed to, and previous experiences of disclosure/non-disclosure. 'Support and strategies': Some participants benefited from extra time to w rite up clinical notes. There w as a lack of aw areness regarding the UK Access to Work scheme. Their SpLD w as not felt to impact on career progression. Several participants felt their SpLD did impact on CPD, although they had developed strategies to lessen the influence of this. 'NHS positive and negative responses': Positive and negative responses w ere experienced follow ing disclosure. Positive responses, for some, included managerial support in the w orkplace. Negative responses included: failure to disseminate to the w ider team adjustments that had been put into place to support the participant's specific learning needs; and perceptions of being 'bullied' by the line manager. Impact and Implications: Better understanding the issues faced by the physiotherapist in the w orkplace has the potential not only to improve support mechanisms for the employee but also to facilitate the transition of physiotherapists w ith SpLD, from student to employee and back again. Funding Acknowledgement: Health Education Northw est (HENW)

To disclose or not to disclose? Workplace experiences of healthcare professionals with specific learning difficulties: transition from education to employment

Relevance: This survey investigated the experiences of nurses, physiotherapists and a variety of allied health professionals (AHP) employed by the National Health Service (NHS) related to specific learning difficulties (SpLD). Understanding issues faced by those w ith a SpLD in the context of the w orkplace and the impact on access to continuing professional development (CPD) has the potential to impact on practice and career progression making it relevant to Congress Theme 2. Purpose: To explore the experiences of nurses and AHPs w ith a SpLD in the NHS w orkplace. Methods/Analysis: This w as the final phase of a 3-phase evaluation. A questionnaire survey w as used to investigate the experiences of nurses and AHPs, w ith a SpLD, w orking in the NHS and their transitions from education to employment. Questions w ere developed from the qualitative findings of phase 2, w hich investigated these issues in physiotherapy. Participants w ere recruited using social media and email via NHS North West, Higher Education Institution (HEI) and other gatekeepers. Data w ere summarised using tables, histograms and pie charts. Open text comments w ere analysed using thematic analysis. Ethical approval w as gained from Manchester Metropolitan University. Results: As a student, more participants disclosed their SpLD to their HEI than did not disclose. How ever, on clinical placement and on application for an NHS post few er disclosed and there w as an even split betw een disclosure/non-disclosure. Once in employment, the trend w as tow ards disclosure. Non-disclosure w as related to fears of discrimination; of negative perceptions that might be held by others and that the use of assistive technology w ould lessen their w orth in the eyes of others. Participants did not report less favourable treatment compared to non-dyslexic peers, nor did they consider that less w as expected from them. Most had not experienced bullying and enjoyed supportive relationships w ith their co-w orkers. How ever, w hilst students in HEIs benefited from academic support on campus, the same adjustment w as not available on placement in NHS Trusts and once they had made transition to the w orkplace. Over a third of respondents felt their SpLD impacted on their ability to engage w ith CPD. Respondents felt that they had to ask for reasonable adjustment rather than have it provided automatically once the need w as recognised. Discussion and conclusions: Data from the survey suggests that disclosure of SpLD to HEI and to employers is likely, w hilst disclosure on placement and on application for employment is less likely. This seems to be related to fears of discrimination and negative perceptions that might be held by others. Non-disclosure is a barrier to the provision of reasonable adjustment. Impact and Implications: Lack of reasonable adjustment related to non-disclosure or failure to provide reasonable adjustment is a potential issue for those w ith SpLD. It may be that career progression/success in funded CPD opportunities is impeded because some w ith SpLD do not have access to reasonable adjustment/assistive technology. Funding Acknowledgement: Health Education North West

A defining moment for aesthetic nurses

ISSN 2050-3717 Printed by Pensord Press Ltd, Blackwood, NP12 2YA CONSULTANT EDITOR Cheryl Barton Aesthetic Nurse and Managing Director, Aesthetika, Sheffield EDITORIAL BOARD Julie Brackenbury Aesthetic Nurse Consultant, Bristol Susie Byass Aesthetic Nurse Practitioner, Rejuvenating Solutions Ltd, Berwick Upon Tweed Annie Cartwright Advanced Aesthetic Practitioner and Director, Skin & Face Clinics Ltd, Cardiff, Wales Leslie Fletcher Aesthetic Nurse Specialist, USA. Founder of the InjectAbility Institute for Aesthetic Education Trudy Friedman Aesthetic Nurse Practitioner, Aesthetic Skin Centre Sarah Holness Clinic Director, Sarah Holness Aesthetics, Kent Yvonne Senior Advanced Aesthetic Nurse Practitioner, Independent Prescriber and mentor. Trainer and co-founder of PIAPA Nicola Webster Clinical Director and Aesthetic Nurse, Rejuven8, Doncaster Lynn Warren Clinic Director, The Retreat Beauty Clinic and Cosmedical Ltd, Leeds EDITOR: Natasha Devan natasha.devan@markallengroup.com GROUP CLASSIFIED MANAGER: Rachel McElhinney rachel.mcelhinney@markallengroup.com CIRCULATION DIRECTOR: Sally Boettcher PRODUCTION MANAGER: Jon Redmayne PUBLISHER: Anthony Kerr anthony.kerr@markallengroup.com ASSOCIATE PUBLISHER: Julie Smith COMMERCIAL MANAGER: Hanette Ibrahim hanette.ibrahim@markallengroup.com CHIEF EXECUTIVE OFFICER: Ben Allen MANAGING DIRECTOR: Jon Benson O n 5 June 2015, the British Association of Cosmetic Nurses (BACN) and the Private Independent Aesthetic Practices Association (PIAPA) released a joint statement over their shared concern regarding the promotion and marketing of voluntary registers, and questioned whether these registers can claim ‘safer’ clinicians (BACN and PIAPA, 2015). Both the BACN and PIAPA, who hold a ‘register’ of their members, are participating in the Nursing and Midwifery Council (NMC) revalidation pilot group, the new process by which nurses and midwives demonstrate that they practise safely and effectively. They are also contributing to the work of Health Education North West London, which is leading the review of the qualifications required for the provision of non-surgical cosmetic procedures. The publication of a joint statement from BACN and PIAPA was a defining moment for professional aesthetic nurses. To the best of my knowledge, this was the first time that nurses from the two largest professional aesthetic nursing organisations have collectively combined and cooperated as one single voice. We were left in no doubt that the message given by them was both serious and weighty. The statement said: ‘We firmly believe that no nurse, doctor or dentist should feel the need to join a fee-charging voluntary registration body to reassure the general public as to their professional competence’. It continued: ‘Any voluntary register that is offering guarantees of professional practice beyond a premises check could not sustain this position if this is challenged by a patient. Any complaint would always find its way back to the governing councils. The voluntary registers therefore cannot offer any kind of guarantee of patient safety or access to a process for complaints without the approval of the governing councils.’ Although the NMC exists to ‘protect the public’, it remains reluctant to engage or even consult on any guidance for aesthetic nurses. On 8 June, the NMC (@nmcnews) sent a tweet stating ‘we have no plans at present to issue specific guidance on cosmetic nursing’. Meanwhile, the mandatory bodies of our colleagues are acting. The General Medical Council (2015) is now consulting on guidance for doctors offering surgical and non-surgical cosmetic interventions, to promote safe, patient-centred care, by ensuring doctors know what is expected of them. To my relief, I noted that there is an NMC registrant, who is also an aesthetic prescribing nurse, sitting on that group. Likewise, the General Dental Council is actively campaigning and even prosecuting non-compliant therapists who are illegally practising and training others on teeth whitening. It is the deafening silence of the NMC that remains the elephant in the statutory bodies’ room. Patients, the public and our professional colleagues rightly expect that we are delivering care as NMC registrants within agreed ethical, legal and practical standards. Aesthetic nurses are looking to their own mandatory body for leadership on how best to assure patients and consumers that those who carry out cosmetic procedures have the skills to do so. Further delay in addressing the issue of guidance for aesthetic nurses may risk the NMC again being labelled as ‘out of touch’ or ‘not acting in the public interest’. It is now time that the BACN and PIAPA, with their new found symbiosis and collective voice, clear their desks to urgently prepare and issue another joint statement, starting with something like this: Dear NMC...

How important is it to publish during your time at medical school?

Dear Caroline How important is it to publish during your time at medical school? Aaron Dale, second year graduate entry medical student, University of Oxford Caroline replies . . . In professional life—whether as a doctor or a psychologist—it is vital that you are clear about the limits of your knowledge. So when this question landed in my inbox, although I had a few thoughts, I wanted to garner the opinion of an academic clinician who would have a much more nuanced understanding of the key issues. The old adage “if you want to get something done, ask a busy person” came to mind, so I emailed Jeremy Levy, consultant nephrologist, director of clinical academic training for Imperial College Academic Health science centre and clinical lead for Health Education North West London (among many other responsibilities). As expected—he came up …

Safety during night shifts: a cross-sectional survey of junior doctors’ preparation and practice

ObjectivesWe aimed to determine whether junior doctors and trusts in the region make use of published evidence relating to best practice during night shift work that can safeguard alertness, reduce...