A day in the life of a nurse team leader
Kiran Jhanzaib, RMN, works as a Team Leader on Tamar Ward, a general adolescent unit in Maidenhead. She tells us what it’s like to walk a day in her shoes at Huntercombe.
An interest in psychology
I’ve always been interested in psychology; my brother’s a doctor and I originally planned to become a psychiatrist. However, somewhere between my degree in psychology and MSc in occupational and organisational psychology, life intervened. I got married and then had a baby so needed to re-adjust my lifeplan. I ploughed on with my MSc regardless, determined to complete it and juggling courseworks around a new baby.
Whilst family life is, of course, important, I was determined to fulfil my potential professionally. For me it was important to make a difference to people’s lives; I wanted to be able to go home after work knowing that I’d made a difference. So I applied to complete my registered mental health nurse qualification. Having an MSc already meant that only a further two years study were needed – though with a young family to care for this continued to be a challenge.
Qualified Mental Health Nurse (RMN)
I qualified in 2014 and started at Huntercombe Hospital Maidenhead shortly afterwards. I chose Huntercombe as I believed that they offered the best continued professional development (CPD) and training possibilities; something that has been proven by my experience with the company.
The transition from RMN to CAMHS (Children and Adolescent Mental Health Services) was challenging. There was much to learn but with the support of the team and my manager I was able to develop into a competent CAMHS nurse. These days there are far better inductions and CAMHS-specific training programmes at Huntercombe for everybody working in CAMHS, so somebody coming in without specific experience will find the transition much easier.
Having nursed for a number of years I was ready to take the next step up and with the support and encouragement of my manager I decided to apply for a team leader role. However , I applied twice unsuccessfully before finally succeeding at my third attempt. Each rejection was upsetting, but it only made me more determined. After each rejection I sat with my manager and worked out areas of weakness and elements that I needed to work on in order to be successful. With hindsight, this journey was critical in my personal development and ability to now do my job; I needed to learn to accept criticism and learn from this. With the development plan formulated by my manager and I, I was able to learn where my strengths and weaknesses lie and where I needed to develop.
The role of team leader requires an array of skills; nursing knowledge obviously but also the ability to lead and motivate a team in an environment that can be challenging and pressured but that ultimately must be kept calm and positive for the welfare of staff and the wellbeing and recovery of patients. It also requires the ability to multi-task and prioritise as the shifting needs of the patients and ward change. There is no such thing as an ‘average day’ as every day is different.
There are some consistent tasks that help to give routine to the day. The day begins and ends with handovers with the preceding and following shift team. This handover is vital to the continuity of care and safety of patients and staff. I take notes during handover and then allocate priorities and tasks in light of this.
This is where my extensive knowledge of team members’ capabilities and personalities, aligned with patient needs is vital. I need to ensure that appropriately qualified staff are allocated to relevant tasks but also that there is the right mix of skills attending to patients. For example, if there is an outing planned I have to ensure that the staff escorting the patients have the competencies and skills to manage this, but also that those left on the ward with patients also have the appropriate skillset.
Communication is key
There is always a board in the nursing station that is continually updated with the status and needs of patients and I add my own notes about who in the team is responsible for what during the shift as well as any outings or external visitors that are expected. There is also a board on the ward for patients that I update with this same information.
Communication and the management of expectations is critical, so every day, before the team go onto the ward, I bring them all together and brief them with any updates on patient status and what is expected of them during the shift. The same briefing is held at the end of the day so that I can manage the handover to the next shift and deal with any issues that staff want to raise about things that may have happened during their day.
At 9am every day there is a multi-disciplinary team (MDT) meeting, where clinicians, therapists and representatives from the entire team come together to ensure everybody is aligned on patient status, progress and next steps. Any incidents and responses are reviewed at this point as are medication and enhanced observations prescriptions. One of the nursing team always attends and I like to rotate attendance so that all of the nurses are given the opportunity to take part.
The next task is to then carry out any unallocated tasks or changes from the handover and MDT meeting. This can be anything from attending meetings – CPA, formulation, community (patient lead), psycho-education, reflective practice for staff or patient groups, to standard checks and audits such as clinical audits or checking resuscitation equipment. As Team Leader it is also my job to audit the audits to ensure they are always done to the appropriate standard – with daily, weekly, monthly and quarterly audits to attend to, this is a significant volume of work.
Adaptable and flexible
However, the hospital environment is constantly changing. If an incident occurs, then we all drop everything to prioritise the management of the incident and ensure patient welfare. All incidents must be documented within 15mins of taking place to ensure that all details are fresh and accurately recorded. Once the immediate situation is dealt with I have to update Carenotes (patient record) and attend to all other formalities whilst also ensuring that the remainder of the team on the ward are able to re-settle patients and return the ward to the calm state that is needed.
Equally, I may need to attend to a patient not feeling well, staff concerns or helping out with another unit. It is vital that I’m open, ready and flexible because things can change at any time and patient welfare always comes first.
After lunch I start to get the day’s clinical notes onto the system – day shift summaries, documenting patient mood and mental state, diet and additional notes about incidents. Clearly, it only takes one or two incidents to throw the day off and lose momentum but with lots of people looking to you for leadership it is vital that I juggle my priorities whilst remaining calm and projecting confidence.
Whilst incidents are not necessarily a daily occurrence, knowing how much of an impact they can have on the shift, the team plan their day to prepare for what are known to be peak times for incidents to occur. Often this is around 5pm as the MDT prepares to leave. Knowing this, the team ensure that all breaks are taken prior to this so that the full team are available on the ward to manage any incidents should they occur. This is also the time when I do a daily debrief with the team, ensuring that any patient updates are noted and that team members are able to discuss any issues, challenges or successes.
The evening medication round takes place at 6pm and by this time the shift are preparing to handover to the night shift. Much of this time is spent preparing the ward for the next team; ensuring patients are settled, the ward is calm and that all handover notes are ready.
The ability to remain calm and thrive under pressure are clearly vital to the role and also to the ability of the team to provide great care.
Not only do the team need to feel confident that those leading them are calm and competent but also that they are valued as individuals. All staff attend supervision, including team leaders but team leaders also have their own allocated staff members to supervise. This support structure ensures that everybody feels confident, motivated and happy in their work – all of this is reflected in the standard of patient care they are then able to provide.
The ability to thrive under pressure depends on a great many other facets of a well-functioning team. For me, this comes back to having a good relationship with my team and knowing their capabilities; this means that I’m able to delegate quickly and comfortably knowing where people’s strengths lie.
Time with patients
Even though I love the leadership role, I’m still keen to spend time with patients. I plan my month so that I spend at least a day every month with every single patient on the ward (there are ten). I think it’s vital to be able to divide myself between clinical and patient time as I’m far better able to react to patient needs and issues if I know the patients. I didn’t become a nurse to sit at a desk all day and whilst this is a necessary part of the role, so is patient contact. Every week I sit with patients and document this, sharing my notes with my manager. As team leader you need to be approachable to patients and staff and build therapeutic relationships with both. To enable you to juggle all of this it’s vital to plan monthly, weekly and daily tasks.
I’ve now been team leader for two and a half years and feel ready to look to the future. I see my next step as moving on to become a ward manager. I haven’t discarded the idea of doing my PhD but for now, I believe that I can still progress in my journey with Huntercombe, growing and developing as I go.
Having only ever worked for Huntercombe, I see no reason to go elsewhere. As far as I’m concerned Huntercombe have provided the building blocks to enable me to continually progress, along with any training needed; I’m currently attending Huntercombe’s iCoach Academy and Train the Trainer courses. My managers have always been hugely supportive and encouraging and I in turn aim to be the same kind of manager. It’s amazing to work in such a supportive culture, it makes a massive difference to the working environment.
What would I say to somebody considering a role with Huntercombe?
“Huntercombe are passionate about staff and patients. They know that staff thrive on training and development and that supporting them in this enables them to provide great care to patients. I’ve grown as a person as well as a professional at Huntercombe and feel strong and supported. Working at Huntercombe not only develops your career but enables you to develop as an individual with transferable skills that can be used in the future. However, once you start with Huntercombe you won’t want to leave.”