A few years ago one of my friends had feedback after a job interview where she was unsuccessful. She was told she wasn’t demonstrating the capacity to think strategically in the way that the role required. We unpicked this a bit, she was upset and had really wanted the challenge of the new role, the change of pace and position that the role would bring but also the progression and opportunities. Neither of us felt that we really understood what that feedback meant. It feels like a bland, throw away comment that excludes the recipient from the discussion and I’ve been thinking about this after some helpful conversations last week about how I do my job.

What does strategic thinking really mean and how do you know if you are doing it?

Most people reading this know that I am a behaviourist at heart. I love working with people who’s behaviour is/was described as challenging, seeking to understand what drives their behaviour and always asking ‘why does X need to do that?’ I don’t need to hit my head to get a cup of coffee, so why does X? The training and mentoring I had which allowed me to put those puzzles together, triangulating data and undertaking a functional analysis used all of my key skills as an introverted, reflective, analytical, intuitive thinker (I know who I am!). I have always been lucky to have worked with role models and leaders who thoroughly valued an evidence-based, person-centred approach. Going on to do an M.Sc in positive approaches to challenging behaviour helped me hone those skills and I continue to be a reader, a deep thinker and a keener (a new word I learned last week).

Understanding the key drivers

As a nurse consultant it is essential to read widely, keep up to date with the evidence base and be able to input into policy from a practice based perspective. That ability to source and select evidence that is credible, reliable and synthesise this into a workable position, in accessible language is essential, having an academic background helps. As an undergrad our nursing programme was built on reflection and critical analysis. For me, this means seeking to understand information, the evidence and also the thoughts and feelings associated with the issues that are raised. Walking in someone else’s shoes helps to understand why they think and feel the way they do, but it is essential to also step that to one side to see what these things mean more broadly and why that matters.

strategic thinking

Macro thinking

Reflecting on the discussions and the feedback my friend had. I think after years of working with, knowing and being supported by this fantastic person it’s likely that the responses that she gave to the interview questions would have been heavily embedded in clinical practice and service user experience, values laden and cemented with passion, compassion and doing the right thing, always. Those are hugely inspirational values and attitudes to demonstrate in nursing and particularly when working with the most valuable members of society, those who are precious and important to so many and need to have their voices raised and heard above others to have their needs, wants and rights achieved and fulfilled. However, I’m not sure that this demonstrates strategic thinking. It demonstrates an ability to think in a very person-centred, individualised, focused and deep rooted way. It is focused on the individual clinical situation. It says: ‘I have my strengths, skills, I know what works and what others need to do and that’s my position’.

It is not that people who think strategically do not think about the person and what is right for them, but they can also demonstrate an openness to thinking about other perspectives, experiences and opportunities that broaden out one persons experience to the value of others and not just in a human way. Strategic thinkers still need to fully understand the person and what is important to them, knowing what people with learning disabilities and their families want from your service is essential in being able to deliver the experience that makes their lives better and increases their opportunities for health, well being, fulfilment and active participation in society. Co-producing and collaborating underpins this, thinking strategically is about knowing how to make this happen. Knowing who to work in partnership with, building those networks and joining up with people who do not always think like you, that is a fundamental.

long term strategic thinking

Understanding the challenge

This relies on being pro-active and intuitive, understanding the direction of change and travel across different levels of the system including policy and organisational drivers so we can see what is coming and prepare to meet that challenge. In any situation it is important to ask how much of it we understand, in the last couple of years I have been able to say to my colleagues, ‘I’m not sure if I fully understand what’s going on here’, their broader knowledge of some of the historical, relational or cultural factors have supported my ability to see the bigger picture and make that link back to the drivers that are building that long term perspective.

The Novid day

A really helpful exercise I was involved in recently was in partnership with the service managers in our community teams to collect in the moment information on how our community teams were adapting to the challenges of supporting people during our Covid 19 response. We have been working on developing our community learning disability teams because ultimately we want to provide the best service we can for people with learning disabilities and their families. The Improving lives programme has helped guide this, as well as the work from the learning disability professional senate and of course our own commissioned review. Understandably Covid 19 had overtaken some of this and so an opportunity to engage with the professions who make up the CLDT and appreciate their perspectives on how they are delivering an essential and valuable service during such a challenging time has created a new dynamic to the work done.

This rich information about how people with learning disabilities are being supporting in creative, innovative ways focused on access to health and maintenance of mental health and well being has allowed us to further understand that ‘core element’ of what a CLDT looks like and plan for going forward in line with the wider review of the community team model. A couple of us Skyped this week, my colleague suggested that we give ourselves a ‘Novid’ space to reflect on some of this and reflect on what it means, looking at the opportunities and threats from these new ways of working and visualising a future operation of the CLDT model.

That’s strategic thinking. Bringing the persons experience into a model for future planning.

I have seen a colleague doing this expertly throughout the COVID 19 response, I listen to him summarise the (almost daily) ethical debates and dilemmas that the clinicians bring, often the things we are finding most challenging based on policy change or updated guidance and new evidence and he asks us: ‘if I was admitted to ward X what would I see, what would this mean for me?’ It brings the focus of our policy and practice right back to where it needs to be, the person’s experience. We are able to work together, from different perspectives to think through how that person and their needs fit with the wider health and social care system. In this process there is a clear balance of logical and creative thinking.

Where do nurses talk about this?

After discussing this idea for a blog with a friend we wondered about the confidence of colleagues to describe themselves as strategic thinkers, particularly early career nurses. Is there a need for this in the curriculum and in supervision or the coaching relationships that we develop?

Do we need to provide space for unpicking some of the things that we do that allows us to draw together the evidence base, understand the drivers and policy to see the bigger picture?

Many nurses have the capacity to do this without even realising that’s what we do. Being passionate, values based and person centred can be harnessed into being confident, pro-active, forward-focused and with the open mindedness for making evidence based decisions with insight and gut feeling. Strategic thinking is essentially about knowing that a change or decision is not about what it means for you, it is about looking up and out and knowing there are far reaching consequences which meet the overall organisational drivers and position going forward.

In thinking about taking this forward how we might develop our ability to take a strategic view there are a few questions we can think about:

How well do you understand the situation, how safe does it feel or how confident are you to say that you don’t? Who can help you develop that knowledge and appreciate the broader context, interface issues and implications of decision making?
What are the issues and events that we choose to focus our energy on? Is this because we are concerned about the implications for self or for the service? How important are these things?
Most importantly are you taking a long-term perspective, do you recognise that the decisions you make today have consequences for the future? Will this lead to the provision of better services for those who want and need them?

knowing me knowing you

I was going to use an image of ABBA to complement the title of todays blog but who doesn’t love the cheesy awkwardness of Alan Partridge? The shameless self-promotion and capitalising on opportunities that come his way, despite his lack of skill, integrity and capability.

A-ha!

When I first started teaching a colleague told me it would take a couple of years before I really felt like I knew what I was doing.

A couple of years! They were not wrong!

At that time the University had two intakes of learning disability student nurses which meant running the curriculum twice a year. There was a lot to learn as a new academic, interviewing and recruiting to the programme, inducting and supporting new students and continuing the links with practice as well as designing and delivering teaching, assessment, marking and preparing feedback (which I’m not convinced is always valued as much by the student as it should be) attending board, mitigating circumstances panel and learning and development committee amongst other things. At the same time, I was studying for the PGC, learning how to facilitate learning and finding ways of engaging in research.

I linked into and learned about a couple of things that helped me feel I was connecting with others, contributing to the wider profession and maintaining clinical currency. I was working in a small team with colleagues who had been known to me all of my professional life, Marie, Karen and Dave had taught me when I trained at Teesside and Rob and Pam had been colleagues, managers and senior leaders in the children’s learning disability service I’d had placements and then worked in.

As a team we maintained strong links with practice, with regular tripartite meetings. At the beginning and end of every placement period (and sometimes in the middle) the student, practice mentor and academic mentor would meet, where the terms of the placement were set, the learning contract was agreed and at the end reviewed, learning assessed against outcomes and competencies signed off, or not.

I have experienced these meetings in all three roles. I think as an academic it helped in maintain a clinical presence, understanding developments in practice and the challenges faced by colleagues who worked hard to support a meaningful placement experience and deliver quality learning opportunities to the students while also delivering care and managing the responsibilities of their daily role. It also felt supportive as I was learning to be an academic I still felt the support and presence of clinical practice, linking regualarly back to the areas I had worked in.

Becoming part of LIDNAN (The Learning Disability Nursing Academic Network) was really helpful in understanding what was happening across all universities with nursing programmes and how other learning disability academics were addressing the issues relating to recruitment, opportunities for other fields of practice to know about meeting the needs of people with learning disabilities and to keep up to date with national programmes such as Strengthening The Commitment (2012) and events like Positive Choices. If you don’t know about these things they are a good place to feel the power and nurturing of learning disability nursing as a profession.

At this time I started to blog for learning disability elf writing reviews of research in under 1,000 words to help disseminate new ideas and make research more accessible to a wider audience, providing a ‘coffee break read’. I really enjoyed doing this, the research was allocated based on the reviewers interests, mine being: death and dying, challenging behaviour, nurse education among other things. Online supervision was provided to sense check and ensure that the key themes were easily translated and understood. I used the experience of blogging in teaching to support students to see the value in being succinct and the skills needed to be critically analytical. The way the website is set up it allows you to look at the critique and then the original article and this is a helpful resource for students to learn the value of these skills. Also the messgae that these are skills for life and that there are different routes into publishing and delivering research or scholarly activity.

I also began to use social media in a more professional way and develop an online profile, networking with colleagues from a wide range of areas and linking with some of the key leaders in our profession, other nurses, nurse academics, student nurses and self-advocacy groups, parents, carers and people with learning disabilities. It took me a while to get confident with social media, I wasn’t always comfortable with posting on face book which I saw as a more personal space and I didn’t really understand how to use twitter! When I discovered we learning disability nurses (@weldnurses) I saw the power of coming together in a network and sharing ideas, celebrating success and disseminating research in an interactive way. I learned how to use twitter as a resource, how to develop and nurture relationships, connect others and network with others. I hosted my first twitter chat on 4^th October 2016, working with the whole person: behaviours that challenge. It was a fantastic experience (good for CPD & revalidation) and I enjoyed pulling together the summary afterwards which helped me draw out themes and areas for further learning.

I’ve gone on to host other chats and co-hosted with a former student nurse @lauldn4 after we went to Cambodia together and talked about the value of international placements for learning disability nursing students and with a speech and language colleague Helen Cunliffe @helenglais sharing ideas on the importance of accessible communication. It was great to support Liz Fair, Community lead nurse host a chat recently on palliative care a great way for her to disseminate findings from her M.Sc. and encourage a conversation about the role of a learning disability nurse working to ensure best practice for people with learning disabilities.

These are all examples of activities that have contributed to my personal and professional development. I’ve developed a network of online and off line colleagues, champions and ‘check-ins’ that keep me connected with various elements of practice and research, helping me bounce thoughts around, share ideas about the things that are important in our profession and to the people who use our services. I’ve learned lots, connected with my learning disability nursing heroes and many opportunities have come my way because I have been active in these forums.

Everyone’s journey to achieving their ambition will be different, my aspirations for the future will need a different level of engagement, in wider platforms and with evidence of leadership, research and practice developments. There will need to be a focus on impact and measurable outcomes. This will take time and investment in my own professional development, the mentoring, coaching and leadership I receive will hopefully support me in working towards those goals. Equally, I see my role as very important in furthering the opportunities, potential and aspirations of others.

Thanks for the Feedback on the blog so far

It’s been really good to hear feedback about how this blog is being received, lots of people have shared thoughts about the concept of imposter syndrome and the impact this has on them in practice. I was really happy to have contact from former students and a colleague who told me that student nurses are talking about the blog and it’s having influence in practice. I hope that giving an outline of some of the activities I have undertaken in steps to becoming a nurse consultant is going to encourage other learning disability nurses to engage in a way that suits their role and meets their needs to be visible, vocal and valued as a professional who is leading the way in their way, with the work they do.

Tag: #Networking

Joining up the dots: Strategic thinking clinicians .-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.