Moving Your MS Specialist Nursing Service Forward

1. Moving Your MS Specialist Nursing Service Forward Midlands MS Nurse Group Nov 2005

2. This Program is Supported by an Educational Grant from

4. Introduction The role of the multiple sclerosis specialist nurse continues to be an exciting, challenging and ever changing role requiring multi-faceted clinical and professional skills. This CD Rom is a sequel to ‘Setting up a Multiple Sclerosis Specialist Nursing Service”. It is designed as a guide for those MS specialist nurses who have already established their service and are ready to further expand their knowledge, experience and clinical practice. The CD Rom explores some of the more intricate aspects of the specialist nurse role.

5. Introduction The Midlands MS Nurse Group have a wealth of collective experiences in establishing and developing MS nursing services in both hospital and community settings. The ethos of the group continues to be to share and encourage best practice. The topics covered in this CD Rom are issues that we have become more involved with as our services have developed. Our aim as always is to prevent wasted time and energy by ‘reinventing the wheel’.

6. Introduction This CD Rom contains 12 separate sections, each of which details a specific aspect of the MS Nurses role. The sections can be accessed in isolation if desired. Some of the sections also contain examples of sample documentation as appendices, references and a list of suggested further reading. This CD is intended to act as a guide to support your service development, it is not aimed to be a comprehensive tool.

7. Contents Introduction • Section 1: Advancing your Practice • Section 2: Business Planning • Section 3: Writing a Report • Section 4: Undertaking Clinical Audit • Section 5: Developing a Directory of Services • Section 6: Getting Political • Section 7: Organising an Educational Event • Section 8: Writing for Publication • Section 9: Integrated Care Pathways • Section 10: Setting up a Focus Group • Section 11: Stress and Burnout • Appendices All Appendices & Documentation

8. Appendices • Appendix 1: Draft Business Plan • Appendix 2: Organising an Educational Event Documentation • Appendix 3: Stress Documentation

9. Section 1 Advancing Your Practice

10. Knowledge • Knowledge is power and is essential when advancing your role • Read, read and read again. Find a reputable journal and subscribe to it • Ensure you are aware of up to date evidenced based MS practice-the MS Trust send out literature lists with ‘Way Ahead’, before you file it away, email them and ask for articles that are of interest to you

11. Knowledge • There is a need to be aware of professional issues that affect your practice • Be strategically and politically aware-what are the key documents guiding your practice on both a local and national basis • The MS Society have a section on their web site called ‘email alerts’ this is free of charge and is the most up to date service available for MS news. You need to register on line, once you have done this, emails arrive at your chosen address detailing up to the minute information regarding issues that affect the MS community. Knowledge is power!

12. Key strategic papers you need to be aware of (1): 1. NICE Clinical Guideline 8. The management of Multiple Sclerosis in primary and secondary care (NICE 2004). 2. ABN Guidelines for administration of disease modifying treatments (ABN 2001). 3. The UK Multiple Sclerosis Clinical Management Manual. UKMSSNA (no date) 4. The Key Elements for Developing MS Specialist Nurse Services in the UK .(UKMSSNA, MS Trust, RCN 2001)

13. Key strategic papers you need to be aware of (2): 5. Competencies for MS Specialist Nurses. (UKMSSNA, MS Trust, RCN 2003) 6. Developing MS Healthcare Standards . (MS Society and MS Professional Network 2002) 7. National service Framework for Long Term Conditions. (DH 2005)

14. Key strategic papers you need to be aware of (3): 8. Case management competencies framework for the care of people with long term conditions DH 2005 9. Agenda for Change. Knowledge and Skills framework (DH 2004) 10.Supporting people with long term conditions: Liberating the talents of nurses who care for people with long term conditions (DH 2005)

15. Become a reviewer for NICE guidelines • As you are aware NICE is responsible for the development of national guidance on health technologies and clinical practice for the NHS. • One part of the guidance development is the appraisal by various bodies, including nurses. • This is a fantastic opportunity. If you want to get involved you can do so on behalf of the RCN and act as a reviewer. Look at the topics to be reviewed on www.nice.org.uk and if you are interested contact Caroline Rapu, project leader at caroline.rapu@rcn.org.uk indicating your area of speciality.

16. Education for you • Specialist nurses are required to be educated to at least BSc level. Are you? If not investigate at your local university how you can achieve this qualification. Or email Nicki Ward, Lecturer Practitioner in MS on Nicki.Ward@uce.ac.uk She maybe able to provide you with the necessary information • There are lots of educational activities available but be selective, ask yourself what study days/conferences would be most beneficial to you at the current time and identify why

17. Education for you • Ask the MS Trust or MS Society if they need any volunteers to be members of groups that they may run e.g. the MS Trust have an educational committee that informs and supports their educational programme • Speak to the pharmaceutical companies and ask if they are looking for nursing members on their advisory committee • Contact one of the journals and ask them if they need any proof readers for articles that are submitted to them for publication. If you email the editor, they will point you in the right direction

18. Educating others • Run local study days aimed at people with MS. These are really satisfying to organise. Try half days at first to build your confidence (see section7) • Organise study days on MS management for local health care professionals • Run newly diagnosed courses for people with MS • Ask your local university if they need any ‘visiting lecturers’ for their courses. This gives vital exposure to the academic world and provides great experience as well as looking good on your CV

19. Educating others • Be sure to have clear and realistic learning objectives to base your lecture/talk upon. Ensure you evaluate whether these objectives have been achieved • Ensure you have advanced skills in powerpoint presentations, there are lots of courses available • Entertain as well as educate during your presentations. Look at google.org.uk and look at the part marked images. This provides ideal pictures to support your verbal presentation

20. Publishing your work • Disseminate your knowledge by writing publications-you do not have to go to a national journal to do this. Why not write for your local Trust/PCT newsletter to start with. The MS Trust are also always looking for nurses to write for ‘Way Ahead’ • Consider contacting the MS Society or Trust and ask them if they need someone to assist in writing any publications they are working on. • When you are ready to write on a national level, send a brief summary of your ideas to the editor of a reputable journal and await their response (see section 8)

21. Writing a report • Produce an annual report detailing your service provision over the previous 12 month period. • This is the time to really show off and let people know what you are doing/achieving • For more practical advice on this, see section 3 on report writing in this CD • Ensure this report is disseminated to the necessary people, the key players in your organisation.

22. Audit • Visit your Clinical Governance department and ask someone to help you design an audit which will result in you easily obtaining numbers. (i.e. how many patients seen etc) • Audit the effectiveness of your role. What are the key areas of success, what are the areas that you still need to develop? See section 4 • Audit your local MS service-ask patients and their families where they see the gaps as well as the successes • Use the MS Society Standards of care on which to base your audit. This is an ideal way to measure your service against national guidelines

23. SWOT analysis • Following on from your audit use the SWOT analysis to help formulate your annual report and/or your business plan. • SWOT allows a strategic approach to the planning of your MS service and is recognised by management in all sectors as a reliable tool • It will provide you with a vision for your service over the next 12 months. • The SWOT analysis allows you to examine/analyse your service objectively and asks you to look at its strengths, weaknesses, opportunities, threats (SWOT)

24. SWOT • For more details on SWOT analysis use the google resource on your internet and you will find a lot of relevant and helpful information regarding how to do this.

25. Changing practice • Always take time to consider who are the key people that the change will affect and involve them at the earliest time. Involve and value their input • Remember to include service users (see section 10) • Before you introduce change, read up on the principles of effective change management. Change can cause a great deal of unrest! • Use your audit as a basis on which to implement change • Plan how you will audit the effectiveness of the change that has occurred

26. Knowledge and Skills Framework • This is in its early stages of implementation, but it will be a leading strategy in the next few years. It is essential that you are familiar with it • It will, in the future, guide your Individual Performance Review (IPR) or Professional Development Plan (PDRS) • Your manager will use the 6 core dimensions within it and also 4-6 other specific dimensions appropriate to your particular post to guide you in the setting of your personal and professional objectives

27. Knowledge and Skills Framework • You will have to show that you are fully developed in regards to the KSF outline • You will be required to keep a portfolio to show that you are meeting/working towards your specific objectives • (look at the DH website for more details)

28. Maintain a portfolio of evidence Definition of a Portfolio “…A private collection of evidence which demonstrates the continuous acquisition of skills, knowledge, attitude, understanding and achievements. It is both retrospective and prospective, as well as reflecting the current stages of development and activity of the individual” (Brown 1992)

29. Why keep a portfolio? • It acts as a record of professional and personal experience • It contributes to meeting the Nursing & Midwifery Council (NMC) requirements for renewal of registration • For marketing you for potential career opportunities when applying for a job • It helps you identify personal goals and plan how these are to be achieved • It is a tool to provide evidence of your advancing practice toward your KSF annual review • Information from it can be transferred to a profile as a means of achieving accreditation of prior learning • A way to support learning from practice

30. Networking • Set up a MS Interest group inviting local health care professionals interested in MS care. Encourage people to attend by organising influential speakers to present. Allow time for group interaction. • Establish your own data base of healthcare practitioners who care for your patients. This will be invaluable • Understand how to build leadership capability through strategic alliances and networking across disciplines, responsibilities and management levels.

31. Influencing and inspiring others • Ensure you are an active member of your regional MS Nurse group • Put yourself forward to be a UKMSSNA committee member • Speak to the 4 main pharmaceutical companies and ask if they have an advisory group you could join

32. Important websites to advance your practice • Department of Health www.dh.gov.uk • Health Services Journal www.hsj.co.uk • National Electronic Library for Health www.nelh.nhs.uk • Nursing Times www.nursingtimes.net • NHS Health and Social Care Information Centre www.ic.nhs.uk • NHS UK www.nhs.uk • Royal College of Nursing www.rcn.org.uk

33. Vision for the Future • Develop your vision for your professional future as well as that of your service and then make plans of how you are going to get there • Ensure you are aware of the future requirements of your service, how are you going to influence these?

34. Top Tips • Be adventurous, volunteer to teach on study days and to be a member of a key group (the patient council is a popular one at the moment) • Keep an up to date portfolio, ensure you record all the activities you are involved in. Use a recognised template/format to maximise its effectiveness • Seek out the influential people in your organisation, make their acquaintance. Tell them what you do, send them your annual report

35. Top Tips • Keep a notebook to hand and list all your key achievements as they happen. You may want to include: • Groups/committees you are a member of • Documents you have contributed to • Projects you have led/completed • An article you may have written for a local or national venture • Anything else you are proud of • It is easy to forget some of these if you don’t record them

36. Top Tips • The MS Specialist Nurse post provides the individual with great variety and can have huge potential for improving the standards of care within the MS community. • Advancing your practice is not difficult, but it can be very much left up to you to do this. There are fantastic opportunities within the MS world at the moment, so go for it!!!!!!!!

37. References 1. NICE (2004) Multiple Sclerosis. National clinical guideline for diagnosis and management in primary secondary and care. Royal College of Physicians. London • This is the full guideline detailing all the literature that was used during the formation of the document. Although you need to buy this, it is well worth it. • For enquires regarding this, email: ncc-cc@rcplondon.ac.uk

38. References 2. ABN (2001) Guidelines for the use of Beta Interferon’s and glatiramer acetate in multiple sclerosis. London: Association of British Neurologists. 3. Ward, N and Porter, B (no date) (eds) The United Kingdom Multiple Sclerosis Clinical Management Manual. Care across the disease trajectory. Serono Symposia International For details how to obtain this manual please email: admin@ukmssna.org.uk

39. References 4. UKMSSNA, MS Trust, RCN (2001) The Key Elements for Developing MS Specialist Nurse Services in the UK. Multiple Sclerosis (Research) Trust. London 5. UKMSSNA, MS Trust, RCN (2003) Competencies for MS Specialist Nurses. Multiple Sclerosis (Research) Trust. London To obtain a copy of either of these documents phone 01462 476700

40. References 6. MS Society and MS Professional Network (2002) Developing MS Healthcare Standards: evidence-based recommendations for service providers. MS Society: London This document is downloadable from: www.mssociety.org.uk 7. Department of Health (2005) National service Framework for Long Term Conditions. DH: London To obtain a copy of this, visit www.dh.gov.uk

41. References 8. NHS Modernisation Agency (2005) Case management competencies framework for the care of people with long term conditions DH: London For a copy of this document email: office@skillsforhealth.org.uk 9. DH (2004) Agenda for Change. London: DH For guidance surrounding this document please view www.dh.gov.uk The knowledge and skills framework can be viewed on this site also

42. References 10. DH (2005)Supporting people with long term conditions: Liberating the talents of nurses who care for people with long term conditions. DH. London This document can be downloaded on www.dh.org.uk

43. Section 2 Business Planning

44. Business Planning As MS specialist nurses we are continually striving to develop the services we provide. Areas of improvement may be identified through clinical audit (see section 4).To advance and expand services it is necessary to understand and participate in the process of business planning. For a draft business plan see appendix 1.

45. Key Points to the Business Planning Concept Stone (2002) suggests that before conducting a business plan, there are some key points to consider first:-

46. Key Points to the Business Planning Concept • Understanding the business plan concept • Why you need a business plan • Setting basic objectives • Establishing the purpose • Why first impressions matter • Knowing who to involve • Obtaining staff input (Stone 2002)

47. 1.Understanding the Business Planning Concept At the end of this information there is a list of relevant articles and books that may be useful, although this is not an exhaustive list. It is important that you understand the process of business planning before starting or involve people that have had experience. The process will be easier to follow if you understand it first.

48. 2.Why You Need a Business Plan • Planning enables us to be more prepared for changes • Planning enables us to obtain approval and resources required for service development. • It allows us to identify any weaknesses so that we can overcome them and our strengths so we can build upon them. • It allows us to build on the importance of team working. • Planning means we can monitor our progress and learn and plan for the future • Planning will maximise our desired goals and objectives (particularly when looking at the NICE guidelines and the NSF).

49. 2. Why You Need a Business Plan cont’ The York Health Economics Consortium (1993) suggests that business planning is managing change. “This involves thinking ahead; looking at the wider picture; monitoring the progress and being ‘in control’ rather than being overcome by events”

50. 2. Why You Need a Business Plan cont’ For an effective business plan you need to: • Establish the plan • Implement the plan • Control the plan