Nurse Appraisal Training Day

1. Nurse Appraisal Training Day Taunton Sept 2012 Please do not circulate this document without the authors agreement

2. Those present Lisa Horman, Blackbrook Surgery Caroline Samuel, St James Marion Baker, Blackbrook Sue Johnstone, Redgate Penny Mabley, Crown Denise Orton, Blackbrook Jill Hellens, Somerset LMC Please do not circulate this document without the authors agreement

3. Tasks for the day(s) – starting point • Establish the purpose of nurse appraisals • Create a framework and the relevant forms • Consider what the appraisal meeting should include • Identify and practice appropriate communication skills • Consider the challenges and ethical issues that might arise • Know how to produce SMART PDPs Please do not circulate this document without the authors agreement

4. Hopes (before & after scores/10) • Understand more about appraisal 4->8 • Feel equipped for the job 2->7 • Roll out across the UK! • Develop an acceptable framework 0->9 • More info about the role of appraiser 2->9 • How it will work and fit in 2->5 • Non-threatening, positive experience -10! • GPs leading by example? • Doing it properly, constructively Please do not circulate this document without the authors agreement

5. Skills brought by the group • Nursing experience (lots of it) • Mentor in A&E / other / primary care • Lead practice nurse • Appraisal experience – primary and secondary care • Teaching qualifications /experience • Previous appraisal course • Re-developed nurse appraisal process • Clinical supervision (funding problems) • Enthusiasm • Reflective discussions with colleagues • Cytology module development / teaching / assessment • Assessment experience – NVQs etc • Communication skills • Nurse advisor / pastoral role • GP appraiser • Doctor in difficulty work Please do not circulate this document without the authors agreement

6. Fears and concerns • Fitness to practice issues • Positivity in the face of adversity • Lack of peer appraisal support • Time and work-life balance • Working in other practices • Fitting in with practice development needs • Duration • Resources • Not doing a good enough job • How much to take on – boundaries in the appraisal • Practice nurse views / acceptance • Lack of knowledge / expertise in specialist areas • Personal investment / reputations Please do not circulate this document without the authors agreement

7. What should appraisal include? • Description of PN’s role(s) • Educational needs assessment • A healthy dose of reality • Stepping stones to longterm goals • CPD evidence and reflection • Thoughts and feelings about job / role • Personal attributes and skills • Challenges, barriers and constraints • Agreed and clear aims • Clear information about confidentiality Please do not circulate this document without the authors agreement

8. It should not include... • Pay, rewards and conditions • Counselling • Disciplinary matters Please do not circulate this document without the authors agreement

9. Practicalities and Decisions • Clarify numbers (at least 20?) • Covering letter • Appraisal forms – appraisee form, summary of appraisal, feedback from appraisees, reflection by appraisers • Funding and duration (1.5-2 hrs?) • Allocation / selection of appraisers • Location • Overview of forms, PDPs, collation • How much detail to go into • Writing it up / publishing it Please do not circulate this document without the authors agreement

10. The appraisee’s form • Name, job title, workplace, contact details, qualifications • Description of roles: clinical; admin / managerial; teaching / research; teamwork and communication; any other aspects • CPD records from the last year • Career development plans • P38 self-assessments • Achievements; SEAs / complaints • Optional evidence eg PDP, in-house appraisal, audits, reflections etc etc etc Please do not circulate this document without the authors agreement

11. Other forms • Summary of appraisal discussion; based on GP Form 4 with our own categories • PDP form – use GP form • Appraisee feedback – use GP form • Appraiser evaluation – we need to think about this Please do not circulate this document without the authors agreement

12. Communication Skills • Active listening, encouraging contribution • Body language • Open questions • Terminology • Tone of voice • Keeping a positive approach (a la NLP) • Non-judgemental, avoiding assumptions • Checking understanding and agreement • Picking up cues • Feeding back and reflecting Please do not circulate this document without the authors agreement

13. Active Listening / Body language • Utterances • Relevent comments / encouragements • Eye contact • Nodding • Expression – matching • Layout of room Please do not circulate this document without the authors agreement

14. Open questions • What do you mean by? • Have you thought about trying? • How is this going to affect you? • How do you feel about? • Could you tell me more about? • You mentioned... • Avoid “Open-close” questions – immediately narrowing the options before reply Please do not circulate this document without the authors agreement

15. Moving things on... • Summarise / check • Ideas and expectations • Sign-posting change of tack • Linking things • CBT – thoughts, feeings, behaviour • Thought cascades and hot thoughts • Not taking things personally Please do not circulate this document without the authors agreement

16. Empathy (not sympathy) • Acknowledging but not catching feelings • Allowing emotions – giving permission • Normalising feelings • My friend, John... (avoiding assumptions) Please do not circulate this document without the authors agreement

17. Cues • Lack of content / evidence / reflection – MAY mean; lack of confidence, inexperience, anxiety, lack of opportunity, time / payment / work-life balance, lack of motivation, new to the job, fear of the process / confidentiality • TMI – MAY mean; over-documentation, ambitious, high-flyer, work-life balance, perfectionism, obsessional streak, irrelevance, lack of confidence, secondary care experience / prior learning • Emotional reactions – Upset; (acknowledge and offer discussion), blank walls / defensiveness (reassurance?), deflection / denial (careful!). Matching but not mimicking Please do not circulate this document without the authors agreement

18. What might we want to use the appraisal process for ourselves? • Advice, support, guidance • Clinical supervision – prescribing • Triage and minor illness • Research (reservations) • Workload / pressure • Time / meeting expectations / admin • Lack of control / influence / voice • Fairness of allocation of work / time • Other interests and challenges • Co-morbidities and complex disease • Working in different places Please do not circulate this document without the authors agreement

19. More of our needs... • Pressure of work • Isolation / all eggs in one basket • Not feeling listened to / being solely responsible for a role • Lack of support / patient safety implications • Outside / non-NHS opportunities • Work-related stress and anxieties • Role development for the future • Tackling repeated frustrations / usual stuff • Changing stuff or changing your feelings Please do not circulate this document without the authors agreement

20. And the rest... • Time – finishing on time • Delegation and lack of personnel • Things that don’t happen • Intractability • Lack of meetings • Communication • Working towards retirement • Catharsis! Please do not circulate this document without the authors agreement

21. Elements of the appraisal meeting • Opening / scene-setting • Discussion related to form • Ideas, concerns and expectations • Summarising / overview • Compiling the ENA • Create an agreed PDP • Close meeting • Write up forms Please do not circulate this document without the authors agreement

22. Opening • Introduction – check times / protected etc • Appreciation for their involvement • Their thoughts / feelings / expectations / agenda • Reassurance / explanation as appropriate • Confidentiality and caveats – “significant cause for concern” Please do not circulate this document without the authors agreement

23. Opening – what worked well? • Putting at ease – tone, manner, informal • Felt on equal footing • Appraisee-centred • “We” phrases • Suggestions: • Rehearsal / crib sheet • Practice Please do not circulate this document without the authors agreement

24. Prompting / starting discussion • Let the appraisee talk initially • Can work through the form (highlighter?) • Take cues from opening discussion • Prompt using their own language Please do not circulate this document without the authors agreement

25. Exploring issues • Active listening • Empathy and undertanding • Confidence in the appraiser • Summarising / re-capping • Asking questions to clarify • Avoiding judgement Please do not circulate this document without the authors agreement

26. Being Solution-focused • Allow appraisee to lead if possible • Reflect / summarising / checking • Making suggestions (NB “yes, but”) • Offer own / others’ experiences (with care) • Prior experience and solutions • Personal attributes • Signpost to other resources • Talking yourself into solutions • Change, fixing things – knowing when not to • Permission for acceptance / in ability to resolve • Challenging entrenched positions Please do not circulate this document without the authors agreement

27. PDP items – some examples • Increase pension • Mandatory updates and training • Supervision for prescribing • Overall aims / smaller objectives • Consolidating learning from courses • JBDI – putting it into practice • Patient education group work • Succession planning / sharing skills Please do not circulate this document without the authors agreement

28. SMART objectives • Specific • Measurable • Achievable – stepping stones • Realistic • Timed / trackable • Outcomes, resources, constraints • Personal, not practice • Why, what, who, how, when Please do not circulate this document without the authors agreement

29. Next / next time... • Review forms / finalise – and try them out before next meeting • Keep in touch – email and face-to-face • Get started – keep momentum • Fitness to practice issues • Allocation of appraisees (Jill) • Organise another date – Fri 12th Oct am • “Social” meeting – Thurs 18th October • Educational needs assesment • PDP Please do not circulate this document without the authors agreement