Coming back to what we know

- A Strategic Direction for Irish Association of Directors of Nursing & Midwifery 2016 - 20120

‘Coming back to what we know – a Strategic Direction for IADNAM’ is a publication that sets out a map for the work of Irish Association of Directors of Nursing and Midwifery between 2016 and 2020. The Association has invested energy, time and resources in co-designing this strategy with members, the wider healthcare community and importantly service users and their advocates. This engagement and other work of the Association collectively enables us to provide the wider community and healthcare colleagues with confidence in our capacity and capability to act in the best interests of people who want a different and more improved health wellbeing and service for themselves and their families.

Our profession with its roots in health and its varied specialities e.g. physiology, sociology, psychology and social care has extensive technical, medical and tacit knowledge of the holistic system and expertise that is critical to people’s health and wellbeing. Our Association represents a proud legacy and practice of championing the needs and rights of patients and communities, continuously committing to professional development, delivering expert care and expanding our frames of knowledge. As nursing and midwifery leaders, we depend on the mutual support of our IADNAM members to lead change and challenge when the quality of care and treatment of patients is compromised.

“Coming back to what we know’ our strategic direction document, is not about a sentimental longing for tradition or assuming we have lost an integral part of our professional identity that needs to be reclaimed. It is about strengthening our resolve when faced with the challenges of leading our profession. It is about daring to be as proactive and determined as our predecessors, as we take up a much more transparent visible and inclusive leadership stance. We remain committed to keeping the person who needs our care and support at the centre of all we do and confidently claim our insight, knowledge and clinical expertise in a wide variety of domains and contexts. This provides us with a platform of legitimacy that is vital for nurses and midwives to be acknowledged as full partners in patient care within the multidisciplinary team and with policy influencers.

Many of us contribute to and decide on strategic directions in our day-to-day roles as managers and leaders in the wider health, mental health and social care arena. We have brought all that experience and knowledge of the wider system and used it to influence and direct the further development of the Association. We are standing on the shoulders of a legacy of creative thinkers, visionaries, dynamic nurse leaders and previous presidents of IADNAM. We have collectively taken that responsibility of nurturing and further developing that legacy to meet current and future opportunities. We are so appreciative of all the time, energy and insight that the current Executive and Membership have brought to creating this strategy.

We look forward to working with the Membership to enact these shared priorities and ambitions. IADNAM’s strength comes from a culture that never under-estimates our role as practitioners, organisers and creative thinkers. We are proud to place that strength of purpose in the service of our passion for Nursing and Midwifery professions and providing better health and care for the people of Ireland.

Our Strategic Profile
  • An independent Association that is a powerful and influential contributor to the development of nursing and midwifery. It represents a determination to get beyond its traditional comfort zone and be a champion for sustaining care, compassion and kindliness in the wider development of health and care
  • Members of IADNAM are currently involved in implementing key strategic priorities across the Irish heath service. Therefore, when members meet, they create a coherent overview of where health is positioned and how it is delivering on its commitments to patients and their families and the wider community
  • Nursing and Midwifery leaders are encouraged to meet and discuss matters that impact on their individual and collective capacity to lead their teams and develop a vibrant and forward thinking profession
  • The needs of patients are paramount in the practice of care while also acknowledging that attitudes and cultural norms are shifting towards a greater demand for partnership, autonomy and transparency in how health services are organised
  • The preferred leadership approach is about promoting inclusivity and solidarity while also acknowledging and addressing the many challenges that arise for the profession
Our Strategic Principles

Belonging

  • Being part of creating a voice for nursing and midwifery
  • Belonging to an Association that is making a critical contribution to health and social care in Ireland
  • Sharing experiences of being in the role of a senior Nursing and Midwifery Director/leader

Professional Development

  • Communicating leadership perspectives and practices that are best
    suited to what’s needed in the current context
  • Getting beyond ‘siloed’ mentalities and ‘siloed’ organising
  • Calling on support and back-up when needed

Identity

  • Holding the vision and values of nursing and midwifery with pride and integrity
  • Offering to contribute views and expertise in the design and delivery of health and social care services
  • Taking a courageous stance when championing values and opinions
Our Strategic Analysis
  • In the midst of competing demands and resource constraints, the nursing and midwifery workforce is not stable, sufficient or completely ‘fit for purpose.’ This limits our potential to develop inter-disciplinary practices in diverse locations and beyond the dominance of traditional hospital-based environments.
  • With multiple interests and competing agendas; healthcare in Ireland struggles to implement ‘whole system reform’ and is therefore stressed, over extended and prone to controversy. This presents key challenges around governance and safety and requires proactive nursing and midwifery leadership.
  • The predominant focus on measurement – even to the extent of measuring what cannot be held in a matrix – without critically examining the consequences of such a ‘rule-bound’ obsession needs to be further researched.
  • There is an urgent need to develop care practices that are about ‘doing things’ with people as opposed to ‘for people’ as part of their wellness journey.
  • There is greater scope to expand the role of nursing and midwifery and ensure that we contribute the full spectrum of our knowledge, expertise and influence in promoting a culture of person-centeredness in all aspects of our work.
  • We must review the role of nursing and midwifery in the context of being full partners in patient care, clinical decisions, the multidisciplinary team and policy influencers.
Our Strategic Resolve
  • The membership criteria of the Association changed in recent years and the consequent expansion of membership is an untapped but vital resource to implementing this strategy
  • The Association’s positive reputation as a source of expertise, representation, clinical and organisational knowledge will continue to be valued by a wide spectrum of health policy making interests
  • The voluntary commitment of the Association’s executive and membership permits the creation of independent voices that can champion the needs of people who require support with care and achieving better health
    outcomes
  • The leadership of IADNAM has the capacity to convene networks of different perspectives and unleash new energy for the further evolution of nursing and midwifery
  • IADNAM is prepared to influence with courage and creativity and knows how to make sense of the complexity of demands and different agendas at play in a health and social care context
  • The membership is committed to becoming an all island association that models more contemporary forms of inclusive organising and leadership
  • will continue to form global networks with international colleagues to share experiences and knowledge
Strategic Priority 1 - Identity

Mandate: Enable intra-nursing dialogue in the service of re-generating and expanding the core of nursing and midwifery principles and practice

Motivation: The demands on health services and compartmentalised models of care have led to protectionism and defensiveness within the profession. The potential to champion more holistic approaches to the continuum to care and take up a leadership role in developing more collaborative ‘care’ partnerships is currently limited.

Map of intended action:

a) Create and publish narratives of nursing and midwifery practice that demonstrate the profession’s ability to act as convenors of care in partnership with individuals and their families

b) Develop an info-graphic of diverse nursing roles and the locations in which they happen for fellow health professionals and users of health services

c) Champion and explore alternative service and collaborative delivery models by further developing our networks, social media collaborations convening creative forums to address “ wicked problems”

Strategic Priority 2 - Attitude

Mandate: Promote a non-paternalistic attitude to care that acknowledges the depth of emotional connection that is required in the cycle of 24/7 nursing and midwifery practice

Motivation: The current focus on delivering compassionate and high quality care within nursing and midwifery is an important reminder of what really matters to the profession. In spite of the dynamic tension between the desire for evidence-based scientific practice, the centrality of relational caring must be better articulated and remain integral to nursing and midwifery practice.

Map of intended action:

a) Revisit the work on ‘Care in an Irish Cultural Context’ (1980) published by Ms Meabh Dwyer and use it as a starting point for articulating ‘The characteristics of care in Nursing and Midwifery in 21st Century Ireland’

b) Continue inter-professional dialogues started in the series of World Cafes in 2015 to enable shared perspectives on care in shaping interdisciplinary dialogue and practice

c) Create discussion and thinking around how the new models of rapid turn around care and self-care effect our current held values around time bound relationship development focused care.

d) Convene dialogues with our Academic partners regarding changing models of service delivery and the effects to undergraduate and postgraduate education

e) Enhance collaboration with the Regulatory bodies, both the Nursing and Midwifery Board of Ireland and the Health Information Quality Authority. Seek to create alliances with other Professional Regulatory Bodies.

Strategic Priority 3 - Advocacy

Mandate: Interrogate the impact of increased regulation to establish independent measures of care quality in/on nursing and midwifery practice

Motivation: Leaders in nursing and midwifery can no longer depend on authority engendered by traditional hierarchy and public trust in their professional practice. This creates genuine concern around how best to champion care quality as integral to the profession. At the same time, quality and patient safety standards are more regulated and measured via an expanding and specialist care quality infrastructure.

Map of intended action:

a) Assist the profession to acknowledge that nursing and midwifery and organisational culture have the greatest impact on patient experience

b) Promote the development of staff engagement processes that build awareness and provide staff with greater ‘permission’ to make small changes and take greater ownership of their work

c) Explore the impact of increasing regulation on care practices in nursing and midwifery through a Big Conversation at the World Café

d) Role model an inclusive partnership approach that will further enhance mutual learning and respect in the development of a more nuanced approach to care in older age

e) Influence the shape and direction of quality and safety as an agenda that must address improvements and accountability across the healthcare workforce in Ireland

f) Collaborate with external regulators to design frameworks of quality and measurement that are culturally and professionally appropriate for nursing and midwifery

Strategic Priority 4 - Leadership

Mandate: Instigate more contemporary approaches to governance, leadership and culture for both the current and future leadership of nursing and midwifery

Motivation: Since 2014, a dedicated work portfolio – Big Conversations @ The Nursing and Midwifery World Café – has worked in partnership across different nursing and midwifery organisations to strengthen the voice and identity of the profession. At a time of health service crisis and continued fiscal constraint this work is an iterative endeavour that is building new networks both within and beyond the profession.

Map of intended action:

a) Complete the current programme of big conversations by reflecting on outcomes and deciding on dissemination strategies. This includes the design and development of work programmes that address each of the themes addressed to date

b) Agree on the next phase to further build nursing and midwifery voices and dialogue in key areas of influence and professional development

c) Investigate the potential and create the rationale for a full-time resource to enable shared leadership and action across the different nursing and midwifery institutes and organisations

d) Produce an IADNAM set of publications that are aligned with priorities addressed in this strategy

e) Take the Annual conference in three year cycles and build on inputs and ideas generated

f) “Leadership narratives in different times” – explore through safe creative dialogue the hierarchical nature of Irish Nursing Culture

g) Expand our International Network in a focused and meaningful way.

Strategic Priority 5 - Sustainability

Mandate: Sustain an independent and dynamic association of nursing and midwifery leaders

Motivation: The Irish Association of Directors of Nursing and Midwifery has grown its membership by 10% in the last five years. Its structures and organising methods need to change and develop further. This will maximise the potential to foster constructive dialogue and become the visible thought leader for the profession of nursing and midwifery.

Map of intended action:

a) Maximise the member contribution by reviewing member participation and creating the conditions for further member engagement

b) Modernise the Association’s governance and Articles of Association by ensuring that the promotion of mutual support, networking and professional camaraderie remains central to the current generation of
leaders in nursing and midwifery

c) Continue to network and collaborate with colleagues in Mental Health Nursing and in Northern Ireland so that we can best support each other’s work to influence the wider health system

d) Encourage a membership attitude that shares knowledge and expertise from a place of interdependency and reciprocity and extends to key collaborators seeking to address some of the toughest issues now facing the wider health system

e) Increase the Association’s public visibility by aligning its online presence with this new strategic framing and visual identity

f) Reflect on the pros and cons of a name change in light of this more outward focus and the need to strengthen the Association’s advocacy and visibility

g) Create capacity for openness and transparency in our Association by strengthening governance structures and procedures.

In conclusion, this Strategy ‘Coming back to what we know’ is designed to equip nurse and midwife leaders to take up a visible and inclusive leadership voice and identity to influence health policy to ensure the people we care for are at the centre of its design and delivery.

Acknowledgements:

I would like to thank Dr Liz Hayes and collegues in Corporate Community for their input into the creation of this Strategy. Their experience, determination and skill has been invaluable to its success. I would also like to thank the officers, executive and wider membership of the Association for their contribution to the design of our inaugural Strategy.

If you have any questions please contact us