Harnessing our collective nursing power
In this interview with Helen Balsdon, Interim Chief Nursing Information Officer at NHS England, she talks to us about her journey from frontline cancer care to harnessing the power of nursing in the digital evolution in healthcare.
We're delighted to share an interview with Helen Balsdon, Interim Chief Nursing Officer (CNIO) at NHS England, carried out by FCI member Emily Burch. Helen is passionate about using technology to support the delivery of high quality, evidence-based care, empowering patients in managing their own health record and supporting the development and mentoring of the future digital nursing workforce.
As acting CNIO for NHS England, Helen’s work seeks to ensure that nursing practice is supported by digital technology and data science and that nurses are equipped to work and lead in a digitally enabled environment.
Prior to her current role, Helen was CNIO/Head of Nursing at Cambridge University Hospitals working across the organisation to provide clinical leadership for all aspects of informatics including adoption and use of new ways of working using technology.
A Florence Nightingale Digital Leadership Scholar Alumni, Helen is a strong and vocal advocate for developing future digital nurse leaders, building the digital nursing network and actively participates in nursing mentorship.
We all have a story about why and how we became a nurse
Emily asks, How did your nursing journey start? What drew you into the profession initially?
Helen explains, "I've wanted to be a nurse since I was about 11 and I don't know where that came from; nobody else in my family was a nurse. I apparently always wanted to do that, and I was quite single minded about it. I entered my training and never looked back; it was the right thing for me.
My training was continuous assessment, we were the last course before they introduced Project 2000. I started in the community, the training was designed so you could understand and be immersed in healthy communities. We learnt about how people live their daily lives in their own homes, it was such an insight. That experience in community over 30 years ago, now seems so far away from my current practice, but it sticks with you, and I always remember it.
I remember a lovely slide from my community training; it showed 365 people all on one slide, half of one person was turned red; that showed you how much interaction a person had with a hospital over the course of a year."
People live their lives in the community, they spend far longer living their life without hospitals, that's important to remember. In my nursing journey I have looked to take that forward and think how we, as nurses, support people and enable them to live their best lives in that community setting and technology's got a great role to play in that. But of course, I'm quite biased.
That digital spark
Emily asks, With all the knowledge and understanding you gained from your training, you career took you into cancer care, where you worked for much of your career. What sparked your journey into digital? How did that happen?'
Helen describes, "I was implementing electronic prescribing for chemotherapy, I realised how good it was in reducing that unwarranted variation we had experienced in prescribing regimes and supported standardising practise.
With that standardisation, we were able to schedule chemotherapy slots for patients in advance, supporting them to plan and live their lives while receiving treatment. I think it gave nurses a louder voice, and empowered people differently, I really loved that.
Six months after this initial project they restructured the hospital. My role would have been changing within cancer care and I thought, is now the time to move on? Should I do something different?
One of the corporate jobs in the restructure was in informatics because there were plans for a full EPR across the Trust. I had got a history transformational change within cancer care, I'd also done quite a lot with patient user engagement groups and had clearly done that digital project. I thought I could bring a lot to this job, so I went for it, and I got it. And that was me."
Managing transformational change
Emily ask, Digital brings with it a lot of opportunity and challenge of transformational change; how do you manage that in your first digital role?
Helen explains that in her first informatics role the experience of a tricky EPR go live.
"It was all over the press, and we had to try and make sense of what had happened at Cambridge. We had to ask people to work differently and that’s hard, but within three days nurses began seeing the benefits of what we were trying to achieve. They reported being able to read the doctors' writing, see all the patients charts and not have to search out information and that was really from the nurses being open to change and seeing how the systems would help them do a better job.
But it doesn't mean to say had any easy ride. What I learned very quickly was the need to have the nurses and midwives at your side.
We had 56 clinical areas to roll the EPR out to and none of the floor layouts, ways in which medications were administered, such as drug cupboards, trolleys etc were the same. It showed me that one size doesn't fit all. You need to take nurses on a journey, but you also need to listen and understand what they do.
Map all those processes and have robust conversations about what is safe and effective.
Our digital journey supported great open conversations on how do we reduce the nursing unwarranted variation. The digital processes helped us ask ourselves important questions:
What is safe?
What are we trying to do?
How is the best way to do it using the technology we've got?
What do we need to enable that?
How do we engage people?
Are we being open minded to new ideas?
Lastly being a visible leader was key; because sometimes the reported challenges to IT was not the challenges reported on the ground. Any assumption that clinicians are just using the technology wrong or just not engaging with it may not be the whole story. Just because we've built and deployed technology in one way doesn't mean to say that's how end users will see or use the technology, understanding this and seeing it first-hand meant being able to translate issue between the digital teams and clinicians and resolve problems quickly.”
A journey from frontline to acting Interim CNIO
Emily asks, How have you seen your role in nursing and digital change as you've gone from frontline and now through into a national role?
Helen describes how she has seen an evolution. “My role as CNIO in Cambridge evolved as digital maturity increased. Delivering an EPR project involves preparation, go live, stabilization and optimization and I don't think any organization moves beyond optimization because things actually always continue to change.
As service needs changed, as national policy changed, I realised my job was less about the technology and more about how we practise and work within healthcare. It became about building my network, ensuing no nurse in this space felt that they were doing this work alone.
I had huge imposter syndrome going into my first digital role because I thought I'm not a digital nurse, I don't know that a lot about technology. But what I did know was a lot about people and supporting change. I had to work through that imposter syndrome, I grew in confidence and was able to deliver and take our organization to higher degrees of maturity,
Now in a national context, I can see that same journey and experiences in lots of other people and my role allows focus on building that same network and support for others, using a similar approach that I had in my role in Cambridge but on an England-wide scale.
I'm really passionate about this vibrant digital nursing community, building it and sharing what we do. By supporting and enabling each other we can go smarter and faster as a collective."
Liberating creativity; perfection is the enemy of good
Having discussed the power of networks and building a vibrant community within digital nursing throughout Helen’s career, Emily wants to know, Who has influenced you the most in your journey so far?
Helen explains that there isn't one singular influence.
"I've had different people influence me at different times of my career and not all nurses; but I couldn't be a Florence Nightingale scholar and not mention her impact on me. Her use of data and analytics was before her time, it was revolutionary, and you can see that legacy across healthcare today looking at how we strive to make data-driven decisions.
My influences have not all been nursing leaders. I had a fabulous CEO in my previous organisation. His leadership approach was different to what I had experienced before, he focused on how you liberate the creativity within people. He would challenge us to think of how do we liberate the talent in the organisation so that people weren't always seeking permission.
He also showed me the power in influencing culture, bringing people together and putting people on a change journey.
He had a saying that resonated with me which was perfection is the enemy of good. He recognised that people have got a lot of the answers inside of them, they just need to be empowered to crack on and see how far they can go. It was changing cultural norms. People like this have been my influences.”
My biggest challenge is me
As the current acting CNIO for NHS England, Helen is the second person to have held this role. Emily asks, What challenges have you faced across your nursing to journey to reach your current goals?
Helen describes how “you always think about things that challenge you rather than what challenges you; and I think I have probably been my biggest challenge, how I am inside. I have doubted my abilities, believing at times that I’ve not been ready for the opportunities presented to me. I'm very much a fatalist in the fact that I think opportunities will come along at the right time. That mindset can at times, prevent us from seizing or seeing an opportunity.
I have found the best way to support development in yourself is through mentorship and coaching. It can help you:
understand yourself better
learn about how to be the best you can be,
be more confident in carving out and seizing opportunities for yourself
That career crating piece which is so important for development.
It's not always about that next promotional step or job change, but how to challenge yourself productively to stretch your learning and bring joy to that work piece. We spend so many hours at work. You've got to be happy, and if you're not, you're in the wrong job.”
Future leaders in digital nursing
With the recent merging of NHS Digital and NHS England, there has been a lot of change across digital and digital nursing. With the presence of CNIO and the role of the digital nurse ever expanding Emily asks, What does the future look like for digital nursing?
Helen explains, “I am really excited about the future. When I came into digital nursing nearly 10 years ago, there weren't many digital nurse voices, and we were all quite disparate. Now there is this ever-growing vibrant community.
I am seeing the way our future digital nurse leaders think and how they are moving improvement forward, that growth mindset; it blows me away. I am watching these new digital nurses coming into our community and seeing their potential as the future CNIO for NHS England and it’s exciting to think that this is the legacy that we leave.
We will inevitably go through huge amount more digitisation. Across England we have 40 hospitals that haven't yet got an EPR that will go on this digital journey. We will increase in digital maturity, and with that, new opportunities will emerge.
Our role in NHS England is about making sure we're ready to harness and test those opportunities and really help people through that journey. It won’t always be smooth and there will always be things to challenge us, but with the creation and support of shared decision-making councils, building and growing the talent of our nurses at the early stages that their career and setting those bright sparks alight, the future opportunities within this community are just truly amazing”.
Using your FCI voice to influence the broader digital nursing agenda
As members of FCI's NAMPIG, Emily asks “How can we be harnessing our voice and supporting those in our faculty. What would be three key pieces of advice you would give our fellow FCI members looking to support embracing the digital space in their organisation?”
Helen starts with the importance of community. “It’s about being active in your community within the FCI or any other organisation, rather than passive. Active in a way that allows us to get to surface of what the real issues are for digital nursing and midwifery in this space. How are we able to work together to solve them? And using our shared learning and shared engagement to overcome them.
It's also important that anybody in a in a formal group such as the FCI, use their power and their voice to lobby people like Natasha Phillips and Ruth May in their roles to influence that broader digital nursing and midwifery agenda; its helpful for us to know at the centre what our clinicians want, and how do they want it landing. Don’t be afraid to use your voice.
I would also push our nurses and midwives to publish. Within our profession we are good at getting on, managing, and solving a problem, we do the doing. At NHS England we have just done a huge piece of work, led by one of our Florence Nightingale fellows that demonstrates that within the digital nursing and midwifery profession we rarely do any research, and we certainly don't publish a great deal. We need to get better at that, because if people are all hiding their bushels and the amazing work, they are doing we are never going to find them and those great practices.
Let's raise the digital nursing and midwifery voice. Let's get it down on paper so that other people can see the incredible work being done and use our knowledge to improve the lives of our patients."
We are in this together
Finally, Emily asks, With such a diverse nursing and midwifery profession, there are areas that may not be as digitally mature or have had limited funding within digital. How do we ensure their voice is at the table and opportunities within digital available to them?
Helen replies “It's a case of getting involved, any contribution it doesn't matter how big or small. Embrace it. If you're really interested, find somebody that can help you and ask if you can meet with them, shadow and learn from them. We are in it together, but the only way we're really going to be able to harness the collective power is if we understand more about how we all work in the different sectors and how we might think about working differently.
So, let's embrace the technology to help us have better conversations. Those important next step questions are about bringing the different care settings together and understanding more about how we can collectively work to have a positive impact on patient’s lives, supporting them to live their life the best that they can out in their world.”