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Learning and practicing QI skills during the COVID-19 pandemic can enable young nursing leaders to provide better care, now and in the future.
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Using QI to Improve Community Nursing Services During COVID-19

By IHI Team | Wednesday, June 9, 2021
Using QI to Improve Nursing Services During COVID-19

During my time as a student nurse, I was drawn to placements that were based in community nursing. The idea of caring for someone in their own home and preventing an unnecessary admission to hospital was something I was very passionate about during my training and is still very much my priority today. 

I believe that the Ivybrook Community Nursing Team has grown stronger throughout the COVID-19 pandemic, as we have worked tirelessly to overcome many challenges. I am particularly proud of how we have worked together to make sure our patients continue to be at the center of all we do. We have adapted the way we work to ensure their needs are fully met, yet they remain as safe as possible within their own homes.

I was thrilled to be selected to join a cohort of 30 young nursing and midwifery leaders from across Northern Ireland to participate in the Nightingale Challenge Northern Ireland Global Leadership Development Programme (NCNI GLDP). The NCNI GLDP provided the perfect platform to immerse myself in the latest strategic challenges facing nursing and health care today, and to stimulate my thinking about my own leadership abilities and practice.

In January 2020 we commenced the NCNI GLDP, aimed at improving leadership skills, policymaking, advocacy, and our understanding of global health. We were fortunate to have two face-to-face workshops before it became necessary to link virtually via video, email, and social media, due to COVID-19 restrictions. During each workshop I was encouraged and motivated by the role-modeling of the leaders who contributed as speakers.

During the NCNI GLDP I had opportunity to undertake a range of leadership assessments and personal development tools. I found the NHS 360° Leadership Appraisal extremely valuable. I gained useful insights into my current leadership skills and increased my awareness of the impact of effective leadership and teamwork. We need nurses and midwives everywhere to have a voice to lead and tools like these will help us along that journey.

I also further enhanced my understanding of the challenges and opportunities facing nursing and health care around the world. We all need to play a role in ensuring “no one is left behind.” That has certainly been highlighted through the COVID-19 pandemic, from the supply of personal protective equipment to the availability of vaccines.

During the first wave of the COVID-19 pandemic, the NCNI GLDP helped me have the confidence to adapt to a fast-changing environment. I learned to be flexible and creative to deliver district nursing services in new ways. I drew on resources from the program and from my own organization to build my personal resilience during this time. As you can imagine, it was necessary to totally rethink many aspects of how to respond to referrals for new patients and existing patients. The priority was to provide a quality service that kept patients, families, and staff safe from transmission of COVID-19 while meeting patient’s needs that would keep them well for longer and avoid unnecessary hospital admission.  

Given the additional service pressures due to the pandemic, I realized it would be even more important for my improvement project to have its focus on ensuring that all referrals to the services were appropriate, so that patients received timely access to the right service, at the right time. By seeking to reduce the number of inappropriate referrals, I hoped to contribute to ensuring all patients referred had their needs met.

I set about using the learning from IHI Open School courses in quality improvement which I completed as part of the NCNI GLDP. With support from my team and the quality improvement team in my Trust [regional health system], using the Model for Improvement and Plan-Do-Study-Act (PDSA) cycle, I scoped out the initial phase of my improvement project. I tailored my project to be at a small scale to keep it at a manageable level.

As part of the initial plan phase, I collaborated with a small group of colleagues and patients to develop my thinking around how to reduce the number of inappropriate referrals and ensure district nursing resources were targeted at the right patients, at the right level, and at the right time. Understanding the referral data at the outset of the improvement project provided a baseline against which I could measure any service improvement in this initial test phase. I also sought to ensure my improvement project was aligned to the overall Department of Health strategic framework. The next phase involved creating a draft visual poster to raise awareness of the services district nurses provide, the referral criteria, and practical information on how to contact the service.

The learning from the initial phase will be utilized to develop a larger test once COVID-19 restrictions are lifted. The next phase will be taken forward with a wider group of stakeholders and expertise from service improvement and communications colleagues. I am looking forward to working with a wider group of colleagues so that the district nursing service and the patients using it can have an improved experience.

Despite being in the middle of a COVID-19 pandemic, it is still possible to participate in learning (and in fact even more important than when things are calmer) that can equip you to better do the role you are doing today, as well as build your knowledge and skills for the future. I have gained rich learning from developing my leadership knowledge and skills. I was able to deploy much of my newly acquired knowledge in real time during the COVID-19 pandemic, including utilising the learning for my improvement project. There have been many challenges over the past 18 months that we could never have foreseen or planned for, but I believe I am now better equipped as a role model for nurses and nursing. During my nursing career I will always reflect back on what I have learned from this program, the remarkable, knowledgeable, courageous and resilient people that I have met from Northern Ireland and all around the world and will continue to strive to make a positive difference in nursing and to those I care for going forward.

Christine Oliver is a community nurse on the Ivybrook Community Nursing Team, Southern Health and Social Care Trust, Northern Ireland.

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