Creating a Congenial Hospital Space

Janene Lawrence is a seasoned professional in the healthcare sector. Throughout her career she has worked as a nurse educator and charge nurse manager (medicine), working at many of the foremost hospitals in New Zealand including Auckland, Middlemore, and Wellington. Currently, Janene is acting Regional Screening Operations Manager for BreastScreen Central based out of Hutt Hospital.

Could you briefly overview your journey in the industry and your key roles and responsibilities as the clinical nurse manager?

My first role was as a registered nurse in the medical ward at Auckland Hospital where I worked for 18 months. Following this, I moved to a role within a general practice at Mangere Health Centre in South Auckland. My experience within the general practice setting assisted me in realising the importance of patient education, especially in light of the economic and health inequities for many of the people who were accessing the service.

Following that, I held various roles at Middlemore Hospital from staff nurse to nurse educator, and then charge nurse for 17 years across a number of wards. During this time I found myself working in the challenging environment wherein a national shortage of nurses meant that – despite extensive recruiting campaigns around the country – left many providers short-staffed. As a result, the hospital became reliant staff recruited internationally.

This led me to quickly realise the need to engage with my colleagues and ensure that we made our overseas staff members feel valued and that their contributions were recognised, in order to build cohesiveness in the team. We found this not only benefited the team, but also the level of service we provided to our patients. We found engagement and inclusiveness with new overseas staff was an opportunity to tap into their skills, and use their experiences to help grow and develop the workforce.

After Auckland I relocated to Wellington where I took the role of nursing services manager at ABI Rehabilitation Service for 12 months, after which I became charge nurse at Capital & Coast DHB (outpatients – Wellington and Kenepuru) and, for the past four years, prior to my recent secondment to BreastScreen Central, I have been working at Hutt Valley DHB as a clinical nurse manager (medical).

When I started, we faced the same nursing shortage issues being seen across the country and the need to access talent from overseas. Working together to make a difference in the lives of staff and the patients we care for is our primary objective which, I believe, we can achieve by putting ‘kindness’ at the centre of everything we do. Accordingly, I encourage my staff to develop a positive attitude and focus that can assist in influencing everyone in the hospital ecosystem.

The numerous changes in the workplace, such as the mental health reforms, have proved to be a significant challenge. Another challenge facing many hospitals is that of ageing facilities that do not have state-of-the-art amenities and services. This compounds the other issues we need to manage. In order to mitigate this, I have created and developed leadership teams who work alongside me and who are empowered to take charge in the day-to-day care of patients.

I really value my role as it provides me with the opportunity to make a difference by ensuring all staff are listened to, have a voice, are encouraged to share and try new ideas, and can actively be part of any changes that are implemented. Staff know they are valued and, as such, remain motivated – which is vital for employee retention and aids us in providing the best care for patients. Furthermore, I was greatly inspired by exemplary people from the Struder Group after attending a conference in 2003, reminding me that the emphasis must be on patient experience and staff engagement to be able to implement and sustain transformational change. The foundation in my thinking is to be agile and trusting of a system where the culture is adaptable, especially during challenging times.

Have you adopted any specific strategies or technologies to improve patient experience?

Since COVID-19 we have started using Zoom / Teams, which has greatly benefited us – particularly considering we focus on staff education and communication. It has enabled us to meet with patients’ families worldwide, greatly improving our engagement levels. The technology has also given us opportunities to become more active in any collective discussions rather than working in siloes.

Different groups of employees formulate a sizeable portion of the innovative ideas and strategies. These groups develop methods and tactics that help us perform simple tasks more efficiently. One of the more pressing challenges is dealing with time pressure to carry out care in conjunction with the shortage of beds, which is consistently looming over staff heads. Dealing with such constant pressure can lead to error and potential injuries. Staff have been encouraged to develop their own solutions, and simple changes such as  ward based training (CPR – rolling the training so staff are able to attend ),  the accessibility of equipment i.e. sliding sheets for each patient located at the bedside, has led to improved access and a decrease in risk of harm to both staff and patients.

Another initiative taken when responding to staff challenges – particularly in nursing – was re-evaluating our entire work model to optimise workflow. Conducting ward activities with a reduced workforce and trying to roster adequate breaks for staff was extremely challenging – largely due to patients, many of whom were non-acute, not being discharged as privately-owned care facilities were refusing admissions. This led to an increasing number of patients waiting in hospital to go to residential care.

To address this, we reviewed the roles and responsibilities of the registered nurses and healthcare assistants etc. By looking at our model, recognising the limitations, and adopting changes inspired by the residential care model we could provide appropriate care for the patients with the staff we had as we were waiting for new staff to start.

What would be your advice to fellow peers and colleagues in the industry?

First and foremost, we need to cultivate a kind and considerate attitude and approach in the workplace – focussing on our strengths and abilities – rather than our limitations and perceived weaknesses. We must revisit strategies and programmes that may not have worked in the past, assess their effectiveness, and utilise the human and material resources available now to make the necessary changes. Ultimately, the success of these programmes and initiatives relies on the efforts of the people implementing them.

To this end, I want to ensure that nurses working under me can acknowledge and achieve their full potential and have ample choices and access to opportunities.

As nurses, we need to focus on why we are nurses. We provide services to the people and to deliver our best. We must demonstrate a culture of kindness within ourselves and have the courage to move in directions that will allow opportunities to grow our own health professionals and always put the people first.