As the first group director of nursing and midwifery in the country, Colette Cowan has a challenging road ahead. But just three months into the job, she has already managed some impressive achievements and has a strong vision for the future of nursing in Ireland. 

Ms Cowan was appointed to the newly created post of group director of nursing at the Galway-Roscommon University Hospital Group in October 2012. She is responsible for the nursing agenda of the entire hospital group – which includes Galway University Hospital, Merlin Park University Hospital, Portiuncula Hospital and Roscommon Hospital – at a strategic level. She also sits on the hospital group board as an executive director, and as such, is accountable for the workings of the whole nursing division of the organisation.

“I am the single line of accountability from bed to board,“ she said. 

Background

Ms Cowan completed her nursing training at St Vincent’s University Hospital, Dublin, and worked there for five years as an intensive care staff nurse before moving to the Mid Western Regional Hospital in Nenagh, where she was director of nursing for four years.

“I worked, centrally, in the Mid West on the reconfiguration board when we had to close emergency departments in the smaller hospitals and change acute surgery and centralise it. That was a great learning curve; it was very interesting to be part of a high level strategic group. This experience has assisted in my understanding of the unique and important role of model 2 and 3 hospitals and the value they add to communities.”

After working in Nenagh, Ms Cowan became the nurse advisor on the executive management team for nursing for the Mid West Integrated Service Area of the HSE. She then took up the director of nursing position at Galway University Hospital before applying successfully for the role of group director of nursing and midwifery.

“As part of the small hospitals framework, I am now working with my colleagues at Roscommon Hospital on continuing their excellent work in building on the services and safe care they are delivering,” she said. 

“Equally, Portiuncula as a model 3 hospital is providing services to a large catchment area, and we plan to develop a medical assessment unit and expansion of specialist surgeries. These sites enhance the role of Galway University hospitals as a major tertiary centre. Nursing is at the core of these changes, so it is an exciting time to be based on these sites.”

Ms Cowan is responsible for patient experiences and staff safety in all four hospitals of the Galway-Roscommon University Hospital Group. “I report directly to Bill Maher, CEO of the group. We have strong governance structure and excellent working relationships with the clinical directors who provide leadership and support to nursing at directorate level.” 

“Dr Pat Nash is the group clinical director and has an excellent clinical understanding of the challenges and the need to ensure patient safety and quality is our first priority. Having this collaborative team is key to my role as the voice for the patient and staff. “

“On an operational level, I work closely with the directors of nursing, assisting them in resource issues, quality and safety,“ said Ms Cowan. “I look at the nursing resource, key performance indicators, how I can cost contain, and where nursing fits in the directorate models. I engage with the directors of nursing at our professional council meetings weekly on the delivery of key priorities for 2013. “

Hospital board

Ms Cowan is one of four executive directors on the board of the hospital group. The others include the chief executive officer, chief financial officer, and group clinical director. The chairperson of the board is Noel Daly, a former chief executive of An Bord Altranais who has served in senior management posts in the health service in Ireland and the UK. Also on the board are several non-executive directors.

“My job on the board is to provide a report, monthly, on patient quality and safety, patient experience and patient stories. I assure the board that the organisation is providing a high level of care, that the service is being delivered. I ensure that the non-executive directors understand and can interpret what we’re trying to deliver.“

Colette Gowan, new group director of nursing and midwifery for the Galway-Roscommon University Hospital Group(click to enlarge)

In touch with the frontline

Ms Cowan also oversees a ‘strategic nursing forum’, which is a monthly meeting of the directors of nursing and assistant directors of nursing of the hospital group. The forum reports to the executive council. To keep abreast of what is happening on the wards, she consults the directors of nursing who have direct links with the frontline. She takes a ‘hands-on’ approach in obtaining knowledge about the daily workings of the hospital.

“I meet with staff regularly, I walk the wards, I even help out in the emergency department when we have a crisis. It’s in those times that you learn the real facts because it’s a very challenging time for nursing and midwifery in the sense that we’re short staffed and it’s difficult to cover sick leave at ward level. The staff are working extremely hard, and in particular, this winter was difficult for them with the flu virus and norovirus. 

Ms Cowan obtains much information about the operating of the wards through what she calls “soft intelligence”. She also uses key performance indicators every month to measure staff efficiency. 

Achievements

Ms Cowan highlighted the large amount of core work that staff have carried out at ward level to improve patient flow. The hospital group has reduced patient trolley numbers in its emergency departments and recently came second for an Irish Healthcare Award for improvements in patient flow. “We have led out on the whole structure around bed management and patient flow with new leader appointments – we have patient flow managers at CNM3 grade that are working very closely with the clinical directorate model so that’s a big success,“ said Ms Cowan.

“We’ve managed to get more advanced nurse practitioners: One started in September in the emergency department and we’ve more coming on stream in April, so we’re proud of that as well.“

In her role as group director, she has helped to establish a succession development management programme to grow more staff into succession roles and to assist them with management experience. This programme was kicked off recently by the Office of Nursing and Midwifery Services Director (ONMSD) under Michael Shannon.

Ms Cowan has also helped to develop a nurse leadership development programme for CNM2s. ”The work that they have done on that programme has empowered them,” she said. “They’re doing an awful lot of initiatives at ward level and that gives me faith in the system.“

Group nursing and midwives’ strategy

The Group Nursing and Midwives Strategy 2013-2018 is set to be launched imminently. The five-year strategic plan is based on the hospital group’s standards for better, safer health care. 

“It also encapsulates the clinical governance model that delivers on patient care and experience. Our whole plan is pitched around that,“ explained Ms Cowan. “My vision is that the strategy will develop nursing and midwifery to be at the heart of patient care and at the heart of the hospital group because we are the core people that can deliver on the change process.

“My aim is to have the best trained, most flexible, dedicated workforce across the group, and that we become an employer of choice across the west of Ireland and that people will want to come and work for us. I’m ambitious!“ 

Higgins Report

The Higgins Report, commissioned by the Department of Health, was drafted by Prof John Higgins, who analysed hospitals around the country to determine how they should be geographically grouped. It is envisioned that there will be six to seven hospital groups nationwide in total, which will form a hospital trust. There are plans to appoint a group director of nursing in each of these hospital groups. 

“There will be six or seven group directors of nursing and midwifery in the acute sector, which will make a very cohesive, tight group that will work on future strategies, nationally, and be able to work on the national policy agenda with the Department of Health. I think that’s very important and very exciting for directors of nursing to be able to combine as a group with core vision and drive the agenda.“

Group director skills

Ms Cowan says that good communication skills are essential for her job. “You definitely need to be resilient in the role and you have to be a good communicator with staff so that they understand what’s happening. I think that’s very important.“

“It’s very important to be able to communicate at all levels with your team, and not only your team, but externally, with the unions. We have a good working relationship with the industrial relations officers. They’re honest and I respect honesty.”

According to Ms Cowan, group directors of nursing and midwifery should be enablers of change, as well as being proficient in developing political intelligence. 

“You have to balance your operational aspects with the strategic plan. I like to be able to identify good practice, because that influences what I do. There’s some  great practice going on in the Galway-Roscommon University Hospital Group and I want to showcase that at many levels of nursing and midwifery. I want us to be at the forefront, and that shift has happened despite the challenges with the lack of workforce. All those challenges are there but people are still motivated, they still want to deliver and I’m very proud of the service here.“

Ms Cowan is currently studying for a diploma in leadership and quality at the RCPI, a qualification that will no doubt enhance her capability for carrying out her role successfully. 

“This is a new programme that’s being delivered for senior managers at a multidisciplinary level,“ she explained. “It gives people the tools to embed quality, to lead and to achieve quality improvements, which is very exciting for the country.“

Ms Cowan describes her job as “very challenging but very interesting“.

“I’ve always enjoyed working in a challenging environment,” she said. “I have a five year plan. I see the vision for the development for the future for nursing, but more importantly, I love being able to influence patient experience.“

Ms Cowan has a strong sense of the direction she would like to see nursing and midwifery take in the future.

“My vision for nursing is that we need to become one unified group, where a number of hospitals work together as one,” she said. “We must develop advance nurse practices and nurse-led services, but that should happen across the hospitals, so that an advanced nurse practitioner wouldn’t be just appointed to one site, they would work across sites. They would provide an enhanced service to a bigger patient population, which would improve patient experience,“ she said.