Working collaboratively with Pacific Nations

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Working collaboratively with Pacific Nations. Jo Conaglen AUT New Zealand Mary MacManus AUT New Zealand Michael Larui MOHMS Solomon Island Verzilyn Isom SICHE Solomon Islands. Working with consultants O ur experience. Solomon Island nursing issues that required a consultant - PowerPoint PPT Presentation

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Working collaboratively with Pacific NationsJo Conaglen AUT New ZealandMary MacManus AUT New ZealandMichael Larui MOHMS Solomon IslandVerzilyn Isom SICHE Solomon Islands

1Working with consultantsOur experienceSolomon Island nursing issues that required a consultantNursing training programNursing staff development

What we learned in the processWorking togetherShared Goal: to improve the standard of SI nursingConfidence to do what we knew we had to do

Overview the situation that created the need for a consultantNational concern re the need to improve the standard of nursingMary completed a review in 2009.The report helped us understand where we were at that point. I have to know where I am before i can think about how to move forward. The report summarised the concerns in a way that made it clear we had to do something now and we needed help to do it.The recommendations made us confident that Mary understood our issues. We met her and knew she was the person to help us put these recommendations into action.We will talk about what we wanted to achieve and how working with M&J helped to get there.

Shared Goal ; to improve the standard of nursing

In the beginning it was clear that to improve the standard of nursing 2 things needed to be addressed;the nursing training in the college needed to be more appropriate AND we had to have a more organised approach to the development of the nursing staff. But how were we going to do it?

In the beginning Michael thought nursing staff development was his concern and Verzilyn thought improving the nursing training program was her concern.

In the beginning we couldnt see how the two were connected therefore we hadnt seen the need to work together 2Phase one:InvolvementComing together

Shared goal: improve the standard of SI nursing

Trust developed

Process of coming togetherMary & Jo held many meetings and brought many different groups of people together. We hadnt met in this way to discuss these problems in this way before. Helped us to become clearer

Explain the following points

how M&J encouraged you both to discover you shared similar concerns egthe nurses and teachers initially blamed each other for the quality of the new graduate but M&J encouraged them to talk and gradually they cold see they were both responsible for teaching the students. We could see we needed to find a way to work together and not against each other

how nurses and teachers were beginning to trust each other

how trust and confidence in Mary & Jo was developing

M&J were able to say things to the group we couldnt say ourselves eg can you think of an example?Being outsiders helped us to say things we couldnt say

3Relationship is fundamentalTalk-talkIssues become clearDirection begins to emerge

Our expertise was valued

Confidence to work with the emerging bigger picture

The Pacific way is to sit together and talk-talk.

Mary & Jo came to SI regularly they were there with us and listened.

Explain how you were confident we had understood your issuesGive an example of how M&J would pull together the discussions in a way that helped you understand your issues clearer eg teacher responsibilities for student clinical learning and nurse preceptor responsibilities for student learning. If we wanted graduates performing at the level of a beginning RN they needed to be assessed against the competenciesExplain how Mary & Jo knowledge of nursing education and use of nursing competencies in practice and education helped you see how you could use competencies to improve nursing practice (Micahel) & develop standards for year 1,2,3 nursing students to be assessed against (Verzilyn)

Explain how Mary & Jo acknowledged your expertise ( didnt make you feel inferior or inadequate).

Could see how the competencies needed to be developed and used to assess the probationer as competent to be registered. Briefly explain the probation program is one year and during this time the nurse is rotated regularly through a number of wards. At the end of this year they apply to become registered. However the nurse wasnt being assessed as competent. Everyone could see there needed to be some mechanism of assessment for registration.

Nursing Council now included in discussions. Started askingwhat do you expect of a registered nurse?How do you know a probationer is ready to be registered?

In the process a bigger picture was emerging. Confidence to work with the bigger picture that was emergingeg Could see the importance of making the competencies workable:SINC could use them to improve the credentialing processes. Michael could use them as a guide to nursing development. Verzilyn could develop expected practice standards for nursing students when they are in clinical practice these could be developed over the 3 years to reach the competencies on graduation.

4Phase 2:Collaboration Clear vision: All nurse leaders and nurses in senior positions will have a post graduate qualification

With the competencies and probationer program addressed it was becoming clearer that the ongoing development of the nurses needed to be focused on improving competence.Overview briefly how staff development was fragmented Scholarships were awarded to nurses to attend overseas courses .these were often inappropriate for SI needs and wasnt necessarily improving the standard of nursing practice. It made sense to develop something in country. Mary and Jo presented a range of options

In the process you developed a vision for a post graduate level course offered in country for all nurse leaders and nurses in senior positions. This was a very exciting time.Could SICHE offer a degree? We explored this with the college directors and the answer was yes. Marys expertise with education regulations was invaluable in discussion with SICHE they were willing to listen. We mapped out an educational structure for RNs to gain a BN.. Mary and Verzilyn worked to develop the pathway and the papersMichael worked on a policy for awarding & prioritising scholarships for nurses around the country.

SI began offering its first degree program - Bachelor Nursing in 2012.

5Phase 3:Empowerment Competency confirmed

Sustainable planCountry ownershipIts good/ its right/ its oursIn-country skills and expertise to keep it goingCommitment to keep developing

Country ownershipTalk about how initially M&J were the experts but now you are telling us what you want us to do

Convey the message that what is happening is right for nursing in SI That you have the incountry skills and expertise to keep it goingThere is commitment to keep it developing

6Consultant brings:New perspective

begins conversations that critiques long held beliefs

Be a new voice

Able to see beyond the here and now

A long held belief that wont be questioned even if it gets in the way of progress.

You have heard that Mary & I have worked with Verzilyn & Michael for 4 years. Heard from V&M how we have learned to work together over this timeWe helped them to look at old problems and see new solutionsIn the beginning V&M looked to us for answers. Now when we arrive in the country they tell us what they want us to do.

How did this transition happen? ANSWER: many things as you have heard

First lots of listening while key people talked.Second questioning those taken for granted beliefs

Just as the Hindu would not question the sacredness of the cow nor do we question long held beliefs even when they no longer serve us well. We end up doing things out of habit without questioning them eg only the nurses can teach the students in clinical that there is no place for the nursing teachers in clinical

Why dont we question these beliefs & ways of doing things? Because we dont think to question it its the way we do things hereBecause we are afraid to question it afraid of being criticised, thought of as unworthy somehow

One of the most difficult aspects of health/health education reform is to confront senior staff with the idea that what they have been doing for many years may be inappropriate in the light of current knowledge

At these times it is helpful to be an outsider. Because we are outside the system we can ask the questions that havent been thought about. We dont get caught up in the internal politics the struggles and tensions between different groups

We have a kind of diplomatic immunity to say things that you might not be able say for fear of causing offence. Michael and Verzilyn have taken advantage of this to convey messages best said by an outsider.

We can question things because we are not part of the system. This helps free up thinking and envision a different future. A bit like looking into a crystal ball where the image slowly becomes clear.

McLean, a health change manager said we cant assume that policy makers can necessarily identify the most appropriate way ahead (McLean 1998). 7Will Paciific people understand this?CollaborationRepeated visits Review, & revise Skill preparation for next phaseKeep up momentum

Strengths focused

Relationship Within and between

You see Verzilyn all alone here leadership can be lonely. I like to think she looked forward to our visits.I know our visits meant lots of hard work for everyone but they were important.They were the burst of energy that kept things moving forward.

Repeated visits gave us a chance toReview whats been achieved since the last visit. Revise what wasnt working - Discover what wasnt done and why -may have been it wasnt well understood or not confidentPlan for the next phase next 5mths included some skill development of the teaching staff

Im sure everyone breathes a sigh of relief as our departure day drew near. Now they could catch up on the daily work that was building up. And this is just the point - Without these visits there is a real danger of getting busy with the everyday work that robs us of time and energy to focus on the changes.

Strengths focusedIf we are to work collaboratively we need to focus on strengths Very easy to focus on the difficulties and problems. There is a Natural tendency to see what we dont have. The lack of resources become the excuse for not finding new ways - We are focused on working with what you have and finding creative ways to change NOT finding fault and problems

I was reminded of this after a long day of working with staff Verzilyn quietly commented to me I dont want the problems. While quietly said I heard it loud and clear of course she doesnt need to hear me say the things she knows only too well. She wants help to find solutions.

Need to be reminded of what is good and working we are in a good position to do this.

Our relationship with SI nursing important as V&M told youAbility to move forward is very much due to V&M ability to work together. As they said in the beginning they didnt see that their work issues were connected. Now they work together and established a close connection between nurse education and nursing standards.

Ross more than 20 years ago proposed that a collaborative approach was likely to result in a greater degree of mutual understanding of the problem and solutions that are most appropriate for the local setting8Working in a Foreign CultureRecognising the blindness of our own cultural views

Ensuring that understanding of situations is correct

Partnership essential for solutions that are culturally appropriate

We have to remind ourselves that the cultural differences can lead to misunderstandings and confusionHave to keep checking that we have understood correctly easy to assume that everyone thinks the same as I do. Eg

I just expect all teachers will write a report at the end of each semester to summarise the delivery of their course. Its a quality assurance thing. I have been asking the SICHE teachers for 2 years now but they still havent done it. Still dont understand what stops this. there is something Im just missing.

M&V talked about SI solutions to SI problems.

We can help them to think about possible solutions but the final decision must your own & not a western solution imposedFinal decision must rest with the country and be fit for purpose i.e. fits the countrys plans - have the skills and resources to work the plan and keep it going

9Shared VisionMeaningful CommunicationMutual RespectNo Shared VisionPerception GapAssist not runAdvise not controlI expect you can see that a vision gives direction : Michael and Verzilyn have a vision for a well educated nursing workforce - where all nurse leaders and senior nurses have a post graduate qualification

It has taken trust and commitment to work through the challenges to achieve the changes in SI

Its true that Change takes a lot of work.

I wonder if we asked V&M would they have started if they had known the hard work ahead10Conclusions Relationship: from araikwao to wantok

Collaboration partnership based on respect for each others strengths

Empowered to act and keep on developingMichael & Verzilyn summary of the key points about what worked. Perhaps 1-2 sentences for each of these points Relationship from araikwao to wantok MAYBE???Collaboration working together as partners acknowledging & respecting each others strengthsEmpowered to put the plan into action and keep it going well after the consultants have gone

Recommendations for successful working with consultants11

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