This weeks EBN blog is from Andrea Stebbings (andrea.stebbings@plymouth.ac.uk), Associate Professor Midwifery (Education), University of Plymouth, https://www.plymouth.ac.uk/staff/andrea-lorien-stebbings

As we approach a new season, this is often a time when we look forward and reflect on changes we want to make; for ourselves and in our work. The lived reality is that we may never quite get there. That is to make the sustained changes, that the line in the sand of the opportunity of a new year might give us; instead we focus on what we have not achieved or where we have “failed”.

What we really need to do is to be comfortable with uncertainty. Over my 30 + years of practice, I have seen how roles, systems, processes, reporting and certain individuals are the hope for change that nurses and midwives and nursing associates want. I recognise why there is a desire for the panacea; that there will be some kind of transformative magic and that an intervention or a person will provide “the fix” and the answer to make difficult things better.

But what if we stopped and reflected on this need for rescuing and transformation. What if we authentically stopped and looked and recognised that we are imperfect people working in imperfect systems. That the “magic bullet” might never appear but as individuals and a collective we can build on what we do well. We can look around us with a new lens and question how the systems and people we work with are there to enable us to blossom, to help us to learn and to protect us. We can do this today.

Rather than seeing ourselves and our workplaces through the language of others such as failing, or, inadequate, or, requiring improvement or even excellent; this different approach of accepting our imperfection may enable us to build on what we do well- today.

Embracing this approach means that we need to be quite brave. If we take a breath (just stop and take 4 deep ones now) and adopt the “dare to dream” lens¹  of appreciative inquiry; we can look at our familiar world differently. Imagine doing this from a position of pride? Imagine building on our strengths, nurturing our curiosity, and meaningfully connect with why things work, or in the alternative, why they do not.

Considering the “why not” is never straightforward or as simplistic as it may seem. However, sometimes through our frustration of navigating imperfect systems as imperfect people it is easy to engage in well-rehearsed tropes. Whilst these may of course be underpinned by evidence and lived experience; we also might not know what else we can really do or how else or think about some of the challenges that we face. Nurses, midwives and nursing associates are intelligent, compassionate people and embracing imperfection with self-compassion can help to remind us of that and enable us to thrive, today.

The recognition of working with imperfection is not new and has been studied by academics who disentangle such philosophy ^{2, 3}. This world and language, regarding, obligations, duty and interpretation are concepts that are recognisable within our code ⁴. How we engage with our narrative of practice and our relationship with those we provide care for, form conversations in every area of practice. Recognising and acknowledging the imperfection in these;  addressing the “what if I can’t question”, is complex. But I don’t think it is one we should ignore.  Finding a way of engaging that imperfection may provide an opportunity to reflect and see the strengths in what surrounds us; and a way to build on these, today.

Working in an AEI I have had the privilege to guide the education of many midwives, nurses and now AHP’s with the A-EQUIP (Advocating and Educating for Quality Improvement) model since 2017 ^{5, 6.}. This model was developed following the demise of statutory midwifery supervision. Built on the strengths and evidence of effective supervision it ensures that there is a genuine commitment to reflect on practice. Using reflective practice as a chance to learn and grow, to see opportunities for quality improvement knowing the context and complexities within the landscape of practice. It is also about recognising that as individuals and as groups we are leaders and have an immediate influence on the provision of contemporary healthcare, the quality and monitoring of this and our own professions standing.

NHSE took a leap of faith in commissioning the education for nurses in A-EQUIP during the pandemic. The model is now secure through embedding in the NHS contract ⁷ and developing standards for PNA education ^8,  .  The driver for this was embracing restorative practice as a means to “work with” the emotional labour of nursing and as such advance UK patient safety ^9.

The AEQUIP model, NHSE 2023

The model since its introduction is being seen as part of everyday business in many organisations. Resulting in a marked change and shift in cultural language for nurses and midwives. By shining a light on and daring to think differently about healthcare this model has been transformative and empowering for nurses ¹⁰ . Building on the success in these early years through embodiment of the model and increasing the numbers of PMAs and PNAs;  it is now the time to meaningfully consider the centre of the model. Our NHS constitution ¹¹ reminds us that the “people that we support” are us too, or at least our friends, family, neighbours and the people in our community.

So, let’s meaningfully reflect on today, and how we can use the opportunities that embracing A-EQUIP can bring us. To think differently and to inform any hopes that we might have for ourselves personally or professionally.  But also remembering that being kind to ourselves, today is essential as we are all just navigating imperfection.

References

1. Cooperrider and Srivastva (1987) Appreciative Inquiry in Organisational Life, research in Organisational Change and Development, 1 129-169
2. Hope (2023) Perfect and Imperfect Duty: Unpacking Kant’s Complex Distinction, Kantian Review, 28, 63-80
3. Rainbolt (2000) Perfect and Imperfect Obligation, Philosophical Studies, 98, 233-56
4. Nursing and Midwifery Council (2018), The Code, Nursing and Midwifery Council- updated from 2015 publication available at: https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf
5. NHS England (2023b) Professional nurse advocate A-EQUIP model: a model of clinical supervision for nurses. NHSE available at: https://www.england.nhs.uk/long-read/pna-equip-model-a-model-of-clinical-supervision-for-nurses/
6. NHS England (2017) A-EQUIP a model of clinical midwifery supervision, NHSE available at: https://www.england.nhs.uk/publication/a-equip-a-model-of-clinical-midwifery-supervision/
7. NHS England (2023c) NHS Standard Contract, NHSE available at: https://www.england.nhs.uk/wp-content/uploads/2023/03/08-nhssc-contract-technical-guidance.pdf
8. Royal College of Nursing (2023) Professional nurse advocate standards for education and training programmes and modules, RCN, available at: https://www.rcn.org.uk/Professional-Development/publications/professional-nurse-advocate-standards-uk-pub-010-854
9. Patient Safety Commissioner (nd) Listening to patients, available at: https://www.patientsafetycommissioner.org.uk/our-work/strategy/
10. Liz Lees-Deutsch, Rosie Kneafsey, Amanda Rodrigues Amorim Adegboye, Natasha Bayes, Shea Palmer, Aiden Chauntry, Mariam Khan (2023) National Evaluation of the Professional Nurse Advocate Programme in England: SUSTAIN – Supervision, Support, Advocacy for Improvement in Nursing, Mixed Methods study, Coventry University available at: https://pureportal.coventry.ac.uk/en/publications/national-evaluation-of-the-professional-nurse-advocate-programme-
11. NHS England (2023a) The NHS Constitution for England. The principles and values of the NHS in England, and information on how to make a complaint about NHS services. NHSE- updated 2012 document available at: https://www.gov.uk/government/publications/the-nhs-constitution-for-england