A pragmatic cluster randomised controlled trial of a peer shadowing intervention for novice ward sisters/charge nurses in acute NHS hospitals in England

Abstract

Background: It has long been acknowledged that the ward sister/ charge nurse is a pivotal role in health care. However, little is known about how to prepare and support new post holders. A recent study found shadowing a more experienced peer ward sister was associated with adjustment to the role (McKenna 2016). Shadowing is an experiential and pedagogical approach to learning characterised by workplace immersion and direct observation which has been associated with improved confidence, a reduction in medical errors and improved insight and understanding of workplace challenges. Aims: To examine whether a peer shadowing intervention improves self reported confidence, leadership practice, professional environment and reduces prevalence of burnout in novice ward sisters/charge nurses compared to routine support. Methods: A pragmatic, two-arm cluster randomised controlled trial was conducted with 22 acute NHS trusts in England, from September 2018 to March 2019. Participating trusts were stratified by quality and safety rating (SOF score), geographical location (urban/rural), trust size (small/large), and randomised 1:1 to the shadowing intervention arm or routine support arm. 64 novice and experienced ward sisters/charge nurses were recruited to the study. The primary outcome was self-reported confidence in novice ward sisters/charges measured pre and post intervention. Secondary outcomes were changes in leadership practice, professional environment and prevalence of burnout measured by Leadership Practice Inventory (LPI), Revised Professional Practice Environment scale (RPPE), and Massachusetts Burnout Inventory (MBI). Results: Data will be presented for 22 NHS sites. Early analysis, to be completed in July, demonstrates an impact of peer shadowing on ward sister/charge nurse confidence. Discussion and conclusion: Preliminary analysis supports the hypothesis that a peer shadowing intervention improves self-reported confidence in novice wards sisters/ charge nurses, with the potential to provide reciprocal benefit for experienced peers. We will also share findings about the challenges to implementation and suggestions for further refinement.