Looking Back to Move Forward: Transforming Perceptions of Nursing and Midwifery

Wow, what a year! A thriving community of activist nursing and midwifery Ambassadors, challenging the status quo and creating a different future, has emerged!

I want to take this opportunity to reflect and celebrate our collective achievements. This blog outlines the work to date and shows what has been achieved, with an infographic of the highlights.

The Nursing Directorate in NHS England engaged Horizons to help transform perceptions of nursing and midwifery for this new era. Led by Helen Bevan, we have co-created and supported delivery of the originally titled Transforming Perceptions of Nursing and Midwifery programme as an urgent ‘call to action’ within the nursing and midwifery professions. We have built a rapidly growing community of 2,200 ambassadors with reach into more than 500 organisations since the work started 16 months ago. We have created a strong platform of connections, activist leaders, resources and support networks, built on social movement principles, ready to be further accelerated and amplified for 2019/20.

Our driving aim is to build on the passion and creativity within the profession, to build confidence and to create the conditions that enable our current and future workforce to deliver the NHS’ mission of high quality care for people and communities.

 The Challenge 

If we are to meet the ambitions of the Long Term Plan, the NHS must recruit and retain more staff, working in rewarding jobs as part of a more supportive culture. Our staff are feeling the strain. While this is due, in part, to a recurrent ‘background’ number of vacancies, the current number is unsustainable.

At the heart of it is the principle of building the ‘agency’ of nurses and midwives; the power to make a positive difference both individually and collectively, fuelled by pride in the professions.

 The Role of NHS Horizons 

Transforming Perceptions of Nursing and Midwifery programme was conceived as part of a wider set of responses to this challenging context, led and co-ordinated through the NHS England Nursing Directorate. The Directorate, led then by Professor Jane Cummings, recognised that relying solely on programmatic approaches to change (such as more effective workforce planning) or ‘helicopter’ strategies (such as corporate marketing campaigns) would not, on their own, achieve the cultural shift in nursing and midwifery required for transformation.

Horizons was commissioned to catalyse a movement of leaders within nursing and midwifery who would feel confident and skilled to:

• Develop new narratives around their professions, to challenge current perceptions which hinder recruitment and retention.
• Use their individual and collective agency to exert greater influence, both within their professions and in relationship with decision-makers.
• Work within their professional and place-based communities both to develop their own leadership skills and inspire future generations into nursing and midwifery.

Our brief aligns closely with a key underlying theme of the Long Term Plan: the need for patients and our workforce to build their own agency, taking more power and control in their own lives, activating their health and self-caring. Our commission was to co-create and then support the delivery of a range of initiatives that would help frontline staff to lead this shift day to day.

Our contribution to date has been split into two phases:

• Phase 1, delivered in 2017/18, co-created the approach with leaders of the professions. We then used crowdsourcing and mobilisation approaches to co-design a campaign strategy, through which a network of hundreds of potential change agents was established.
• Phase 2, delivered in 2018/19, used accelerated design approaches to deliver a series of actions (30-Day Challenges) to drive change ‘on the ground’, while developing a more sustainable network of nursing and midwifery Ambassadors.

Phase 1 (2017/18) 

Using a series of design meetings and workshops, we led the creation of a campaign strategy for transforming perceptions of nursing and midwifery, centred on the three main demographics with potential to lead current and future transformation in the professions:

• Future generations: Increasing the number of young people who consider nursing as a top career choice by growing networks to skill up Ambassadors to go into schools and information-sharing with key influencers in education, including parents, teachers, peers and other advisors.
• Current workforce: Building the individual and collective capabilities of current nurses and midwives to use their voice, exerting influence on their own behalf and on behalf of their professions.
• Decision-makers: Engaging with policy makers, politicians and the media to better understand and value the contributions of nurses and midwives, so as to involve them in strategic and policy decisions.

The design process was supported by rapid crowdsourcing actions, both online and through a series of face-to-face co-production events led by a nursing and midwifery advisory group.

A bespoke crowdsourcing platform was designed, curated and managed over the course of six weeks, captured ideas on how to transform perceptions of nursing and midwifery for the better. More than 250 actionable ideas, distilled from 25,000 interactions, including 6,000 contributions via social media, were made by more than 1,900 participants, including a tweetchat hosted by WeNurses

Through the designed and delivery of a convergent design process, hundreds of ideas were distilled into “Ten Enemies”:

and “Ten Building Blocks” for change:

These formed the basis of the main campaign strategy. By Easter 2018, NHS Horizons’ crowdsourcing and mobilisation approach had led to: 

• Broad engagement at all levels of the nursing and midwifery professions, linking senior leaders (including Chief Nurses, Heads of Midwifery and Directors of Nursing) in unfiltered, robust and constructive conversations with hundreds of frontline staff.
• A clear campaigning mandate for change, based around nurse and midwives’ own ideas, around which a national movement for transforming perceptions could be shaped.
• The identification of a nascent informal network of potential change agents in nursing and midwifery, connected for the first time around a shared purpose to transform perceptions of the professions.

We led the development of a ‘theory of change’ for the programme in partnership with leaders from the Nursing Directorate. 

This was created on the basis that leaders who want wide scale and rapid change are more likely to be successful in their efforts if they work with an explicit model or theory of large scale change.

 Phase 2 (2018/19) 

The actionable ideas, campaigning mandate and informal network created in Phase 1 formed the basis of NHS Horizons’ contribution in Phase 2. In 2018, we:

• Led the design and delivery of a series of 30-Day Challenges on themes related to the crowdsourced ideas.
• Catalysed, grew and then managed a community of nurses and midwives, formalising their network into a recognised constituency under the header ‘Ambassadors’.
• Began work to embed the fresh ideas, community-based actions and new narratives emerging from work with the Ambassadors into the wider efforts to improve recruitment and retention in nursing and midwifery.
• Used innovative and engaging approaches such as a virtual and face-to-face hackathon, social media campaigns, virtual facilitation and hosting.
• Aligning the programme in preparation for becoming Nursing Now England and shaping the delivery framework for Transforming Perceptions of Midwifery
• Additional activity included delivered Accelerated Design Events for special areas of focus that emerged during Phase 2. These include the Launch of Transforming Perceptions of Midwifery, Learning Disability Nursing, and RCN Activists.

Through this activity, we were able to engage thousands of nurses and midwives throughout 2018/19.

The 30-Day Challenges

Based on the crowdsourced ideas, NHS Horizons designed, publicised and led the delivery of 10 30-Day Challenges through 2018/19. Two further challenges are planned for April and May 2019.

More than 400 people, including Ambassadors, critical friends and patients contributed to refining the 12 30-Day Challenges for 2018/19. The challenges are based on time-bound campaigning methods, each ‘sprint’ forming a mini-campaign in its own right while the cumulative impact expands the overall programme’s aims:

The 30-Day Challenges:

sketchnote by Scriberia via NHS Horizons

A resource pack was produced for each of the 30 day challenges, alongside virtual training sessions and mentoring opportunities for ambassadors, supporting them to take part and to share their experiences.

Participation in the 30 day sprints, both by Ambassadors and by an increasingly diverse group of self-organising frontline staff, has generated national energy and pride in the professions while producing new, actionable ideas for future campaigns.

As a representative sample of our work through the 30-Day Challenges to date:

• As part of the 30-Day Challenges, Ambassadors have created and published more than 600 blogs, articulating their pride in their professions and shaping a new narrative for their future. A selection of the blogs were designed and developed into a Collection. This work is currently subject to a collective impact assessment, which NHS Horizons will deliver as part of its Phase 2 work.

Sample tweet from an Ambassador

• Several hundred nursing and midwifery leaders held team conversations attributed to the 30-Day Challenges, both as part of the Student Nurse Project initiative for experienced nurses to nominate students and newly-qualified nurses for their work in building positive perceptions, and more widely.
• A group of Ambassadors, ranging from students, lecturers and registered nurses came together on the programme’s Slack platform to focus on the variation in application and selection processes. This variation is creating confusion for teachers and career advisors on what to advise young adults. This work is now being developed further in partnership with the Council of Deans.
• On average, the Ambassadors who responded to a request for information stated that they had participated in four of the Challenges (Qualitative Benchmarking Survey disseminated to Ambassador network Feb 19)

Sample tweets from an Ambassador

The Ambassadors community

Horizons has led the management and expansion of a community of change agents known as ‘Ambassadors’.  In Phase 2 of our work, this network of nurses and midwives who committed to growing their individual and collective influence for change, grew tenfold from 215 to more than 2,200. We know that there are many more joining in on Twitter, taking part in the 30 Day Challenges and role modelling the transforming perceptions programme values.

The Ambassadors network provides, for the first time, a national community of active change agents, and has the potential to form a sustainable infrastructure of activists taking the lead in transforming perceptions of nursing and midwifery.

The Ambassadors network is sustained through a series of virtual and face-to-face communities managed by NHS Horizons. Each community provides social learning opportunities, peer-to-peer support, ideas exchanges and promotion for the individual and collective work of its members to transform perceptions of nursing and midwifery. Facilitation of the networks is based on evidence-based methods which have been shown to create the conditions for large-scale change (including accelerated design, facilitation processes, virtual hosting methods, social media expertise and collaborative workspaces).

To date, active Ambassadors participating in Horizons’ nursing and midwifery communities have been drawn from more than 500 organisations across health and care:

Demographic spread of Ambassadors, as at February 2019

Here is a representative sample of Horizons’ impact through the Ambassadors’ network to date:

• Nearly 100 Ambassadors have been supported with the skills and resources to deliver sessions in schools across the country, in partnership with Inspiring the Future. There have been several different approaches, including attending careers fairs, classroom activities (reaching approx. 2,000 children in more than 30 schools). Ongoing schools-based sessions are planned across England, and Ambassadors continue to develop their skills with both primary and secondary schools.
• Co-design and facilitation of eight major Accelerated Design Events, focused on themes related to transforming perceptions to impact on recruitment and retention in nursing and midwifery. These brought together more than 1,200 Ambassadors and senior leaders for joint learning and action planning. Through these intensive approaches we have been able to:
  • Build the capacity and skills of leaders to deliver ambitious plans
  • Help leaders to role-model the values and behaviours that build positive perceptions
  • Identify ways to tackle and address long-standing issues and problems
  • Support the implementation of early wins that create momentum and belief
  • Enable a shift in gear from planning to leading change
  • Allow decisions about complex challenges to be made quickly yet in a way that creates the ownership by nurses and midwives that makes change happen
  • Enhance the capacity for change across the professions, building the capability of nurses and midwives as leaders and change agents so that the approaches, or elements of them, can be replicated and delivered locally.
  • Monthly Ambassadors Virtual Networks with participation from up to 200 Ambassadors joining and more engaging offline, shaping the resources for each 30 Day Challenge whilst sharing and learning together.
  • An additional four regional workshops have been delivered to more than 300 participants, many of whom have joined the Ambassador network (and recruited others in turn) as a result.

Wider work to support Transforming Perceptions of Nursing and Midwifery

Throughout 2018, Horizons leveraged the energy and narratives of the Ambassadors network to enhance wider corporate programmes designed to address recruitment and retention in nursing and midwifery.

Work delivered ‘on the ground’ included (but was not limited to):

• Leading sessions at NHS Expo which promoted positive messages and which created investment from NHS senior leadership into the programme.
• Delivering high-profile presentations using case studies derived from the work of Ambassadors, including flagship masterclasses on large-scale change for NHS Improvements national Falls and Enhanced Care Collaboratives.
• Facilitated Facebook Live session with #150Leaders about the key elements for reverse mentoring and the impact on the mentor in developing their leadership skills.
• Designing the activities and driving the social media campaign for the soft launch of the gender-neutral mini uniforms at Percy Shumer Primary School with 60 Year 5 children and Ruth May, Chief Nursing Officer for England.

Work delivered virtually, to augment the corporate communications strategy of the #WeAreTheNHS recruitment programmes will have contributed to the 4.3% in applications for nursing degrees and 9% increase in young male adults applying (UCAS).

These included (but are not limited to):

• Using the re-purposed crowdsourcing platform as a space for Ambassadors to share positive stories of the profession (70,000 interactions).
• Driving social media engagement through the well-recognised hashtags #NursingNowEngland (formerly #FutureNursing), #FutureMidwifery and @NN_England (more than 150,000 interactions).
• Establishing a new programme specific Twitter account @NN_England (3,500 interactions).
• Designing and maintaining a public facing Facebook Page to enable professionals beyond nursing and midwifery professionals to engage and contribute to the programme (15,700 interactions).
• Creating and then growing two Facebook groups (Nursing Now England and Transforming Perceptions of Midwifery) to share wider communications around positive perceptions of nursing and midwifery. These groups are ‘closed’ to better enable discussion and mutual support between Ambassadors. (3,500 interactions in last 3 months).
• Live tweeting from all events to include and involve people from ‘beyond the walls’, gathering contributions and interactions wider than the attendees present (more than 30,000 interactions).
• Using Livestream via YouTube and Facebook to engage a wide online audience in the launch of key milestones in the programme. These included the launch of Nursing Now England (December 2018) and Transforming Perceptions of Midwifery (January 2019) (3,900 interactions).
• Dedicated pages on the NHS Horizons website (3,800 interactions)
• Publication of blogs via Passle from NHS Horizons to stimulate discussion, engage nurses and midwives with the programme, as well as build confidence and skills with Ambassadors (11,400 interactions).
• Designing, developing and maintaining engagement channels on the Slack platform for Ambassadors to work together solving problems and finding solutions. There are currently 10 active channels, and further will be developed in response to need. (800 interactions since launching on 1st February).
• Providing design input and clinical guidance to the development of the #WeAreTheNHS Secondary Schools pack (258 downloads via PHE resource hub in one month and 5,478* engagements on a tweet post from @BevMatthews_ including the poster.). * included in #NursingNowEngland interactions).

To date this year, the virtual communication channels used to support the programme show a total of 292,858 known direct interactions with the programme. 

Responses from the representative sample of active Ambassadors tells us that these interactions, through engagement with the programme, have:

• Increased confidence, 
• Developed leadership skills, 
• Improved digital abilities 
• Expanded network of connections

(Qualitative Benchmarking Survey disseminated to Ambassador Network February 2019). 

NOTE: The total interactions will be significantly higher as not included are: tweets about the campaigns that do not contain the hashtag, and engagement interactions for the Horizons Tweets of the Week which always contains a broad range of Ambassadors tweets and activities.

The NHS Long Term Plan recognises that to create a healthy, high-performing system ultimately depends on our people. The scale and pervasiveness of change required to deliver the Long Term Plan are unprecedented. As the biggest group of staff in the health and care workforce, nurses and midwives have a significant contribution to make. 

Much depends on our ability to mobilise and activate nurses and midwives to play a key role in shaping the future and to create a workforce that is fit for purpose for the future. These professions need to be regarded as high-status, high-value careers; with nurses and midwives having a powerful voice at the decision-making table.