Friday 7th September 2012
How collective learning is helping clinical nurse specialists improve their confidence in the workplace
Life as a clinical nurse specialist (CNS) can be challenging. You may not have the leadership experience you want. You’re stuck in the middle and everyone expects something different from you. You’re trying to influence change without necessarily having power.
That was the situation Lead Cancer Nurse Tracey Goldsbrough set out to change at York Teaching Hospitals NHS Foundation Trust. Last year, Tracey approached life coach Tilla Brook to see if she could help her CNSs improve their confidence and credibility so they could drive improved care.
Some of the issues they were struggling with included:
- feeling that they weren’t being listened to and taken seriously, sometimes because of other staff making assumptions about age, gender and experience
- having such high expectations of themselves that they were unable to meet them, so were constantly struggling with self-doubt and guilt
- not feeling that it was okay to ask for help for fear of looking weak or incompetent
- feeling unable to overcome their fears so that they could take risks to drive change.
The overall impact was frustration, poor motivation and low job satisfaction. Tracey’s aim was to help them to overcome these barriers and to see themselves as leaders in their field.
Macmillan agreed to fund a short programme of two, half-day workshops, followed by a facilitated learning set meeting where the CNSs could reflect on work issues with their peers. It was hoped that the two groups would want to continue to meet to support their collective learning.
Tilla developed a programme that offered opportunities to talk about the day-to-day realities of life as a CNS in a safe, yet challenging environment. She used a variety of interactive exercises to explore negative thoughts that stop us moving forward; unhelpful behaviour patterns; poor communication skills; and difficult relationships at work.
The groups developed a high level of trust, and individuals were open to making changes in themselves.
Each participant identified a specific challenge to overcome after the workshop. These included having tough conversations with consultants (see case study), challenging processes at multidisciplinary team meetings, renegotiating relationships with ward staff and negotiating patient expectations. The idea was to put new skills into immediate action to address something that was causing them discomfort. Each was ultimately about delivering improved patient care.
Feedback from all the participants was very positive, despite several being apprehensive at the beginning because the programme was so different from a ‘sit and listen’ style course.
The delegates’ outcomes are best summed up in a selection of answers to the question, ‘What’s the biggest impact for you from attending the programme?’:
- ‘I’m more aware of what I’m feeling. When I’m conscious of it I can better choose what to tackle, and when’.
- ‘I realise that I can change my behaviour so I get more of the responses I want/need’.
- ‘I can now put things [that trouble me] in a box, put the lid down and get on with what’s important’.
- ‘I have the confidence to stand my ground’
- ‘She [Tilla] left something with us that we can draw upon’.
Tracey says, ‘The course has had a profound effect on the participants. The CNSs that I manage have come out of each session with renewed energy and a clear plan of action. I have heard several individuals, when faced with a difficult situation, asking themselves, “what would Tilla say?”. They have then used the thoughts, words or tools to look at new ways of tackling a challenge.
‘I have worked with many staff over the years in the NHS and I have never heard such a positive response to a course, nor have I witnessed participants actively utilising new tools and techniques on such a regular and practical level.
‘This has proved an excellent way of supporting a group of staff who provide a high-quality service.’
Both groups have agreed to maintain the self-directed learning sets, meeting every few weeks to review progress and support each other to move forward.
Case study- Victoria Coates, Palliative Care Clinical Nurse Specialist
‘Part of my role involves advising medical colleagues on prescribing medications for symptom control. I have been in post for just over 18 months. Young, relatively inexperienced and advising both junior and senior doctors – oh, the fear! This has been a huge challenge for me.
‘Recently, after considering what Tilla might say, I did something that was completely out of character for me – I confronted a consultant the morning after he had been rude and dismissive. After going home and having a sleepless night feeling angry for not sticking up for myself, I decided to explain to the consultant how the situation left me feeling. Does he think I am a jumped-up nurse who doesn’t know what she’s talking about?
‘Did any of the awful things happen that were running through my head before I approached him? Quite the opposite – I was faced by a humble, embarrassed and apologetic consultant who appreciates my support and advice. “Will I avoid him in future,” he asked? Definitely not.
‘I hope that with a little insight and some tools to help manage challenging interactions I can continue to grow. I am starting to understand that I cannot always tell what people think of me without asking them.’
Email Tilla. www.tillabrookcoaching.com