In early 2023, I fancied a new challenge after 14 years working as a senior nursing lecturer in academia. Only 3 months into the role of Regional Senior Nurse (RSN), for one of the largest social care companies in the UK, it is both challenging and interesting to be doing something very different.
Jack et al (2019) suggested that working in a care home setting is not viewed as an attractive career opportunity for nurses. Many nurses may share that view, but I would like to challenge you to think differently. There is a huge scope to develop and apply skills and knowledge, making a significant positive difference to the quality of care for older people, to live their best life (Cousins et al, 2016).
HC-One has 269 care homes in England, Wales and Scotland, offering residential, nursing, respite, intermediate and specialist care for older people with varying needs. There is also provision for younger residents living with acquired brain injuries, severe learning difficulties or mental health needs. The 5Cs (curious, compassionate, creative, courageous and counted on) are the company's core qualities to be embedded into everyone's practice.
The RSN is a relatively new role, positioned in the Quality and Operational Team. I am one of two RSNs covering the north-east of England.
Aspects of the RSN role include governance and quality, looking at clinical incidents, reviewing and monitoring risks, and the implementation of standards, policies and procedures. We also support home managers, clinical leads, nurses, nursing assistants, senior carers, and carers. This can be through coaching, working alongside colleagues to observe standards of care and developing staff in a supportive, non-judgemental style. We work to develop skills in medication optimisation, effective leadership techniques, and the fundamentals of care.
In addition, the RSN is involved with delivering RESTORE 2 training (West Hampshire CCG and Wessex Patient Safety Collaborative, 2018), which is a national tool used in care and community settings to recognise deterioration through ‘soft’ signs (physical, behavioural, and emotional changes). Training in completing a NEWS 2 assessment (Royal College of Physicians, 2017) will result in an appropriate referral using the SBAR tool (NHS England/NHS Improvement, 2021), depending on the NEWS 2 score. In one care home, a resident had abdominal pain so, under supervision, the carer completed a pain tool and NEWS 2 score, which was 6, and we discussed what action was needed. The carer's sense of achievement in their involvement in an important aspect of a resident's care was rewarding to see.
I have also been an advocate for a resident living with schizophrenia and with capacity, who wanted to make a statement about an event. Supporting, empowering and giving them the voice they deserve, was a positive person-centred outcome.
Part of the RSN role is to support carers and senior carers to progress their careers by studying for the Registered Nurse Degree Apprenticeship and the Nursing Associate qualification. The company also recruits international nurses and the RSNs support one-on-one coaching for the objective structured clinical examination (OSCE) and post-OSCE as the nurses settle into their roles.
The complex needs of residents, including long-term conditions such as dementia, comorbidities, polypharmacy, behavioural challenges and end-of-life care, afford many opportunities for nurses to develop skills in collaborative working, leadership, clinical skills, care planning, and person-centred care (Cousins et al, 2016). There are online learning modules, annual personal development plans and preceptorship is being introduced. This proves that the ever-growing social care environment is worthy of consideration if, like me, you fancy a new challenge and want to make a difference.