One of Ruth May's key priorities as chief nursing officer for England (CNO) is to empower nurses, midwives and care staff to be involved in shared decision-making, and collective leadership. As part of this strategy, NHS England (2019) and NHS Improvement (NHSI) are supporting the first national cohort of organisations to apply to join the global Pathway to Excellence® accreditation.
The American Nurses Credentialing Centre (ANCC) Pathway to Excellence programme is a ‘nursing excellence’ framework, aiming to create a positive practice environment for nursing staff that improves nurse satisfaction and retention (ANCC, 2019). The programme aligns closely with the CNO's national vision to establish an England-wide collective leadership model with a focus on transformational leadership, research and innovation.
The Pathway to Excellence programme was developed into a national scheme in 2007, having started out as a US regional scheme to improve nurse retention. Against the backdrop of the UK's recruitment and retention needs, many nurse leaders, including myself, have put ourselves forward to join the NHSI collaborative to experience the benefits of a real focus on our practice environments. The ANCC describe the Pathway standards as strongly associated with the following:
With a focus on patient outcomes, engaging with communities to drive forward population-based change, as well shared decision-making through local accreditation programmes, Ruth May recognised that there are many synergies with other key NHS programmes.
Harris et al (2018) recognised the global challenges for nursing, and cited numerous studies that demonstrate the global consensus that enabling the right practice environment is essential to improving patient care, quality and safety, and how the ANCC Pathway to Excellence framework is applicable and attainable in international settings. At the core of the Pathway is the promotion of positive practice environments, characterised by shared governance and the ability to exercise autonomy, and decision-making. To become designated, organisations must demonstrate that the six Pathway standards are incorporated into their daily operations: shared decision-making, leadership, safety, quality, wellbeing and professional development.
The presence of these essential elements of a positive practice environment is also validated by nursing staff through a confidential and voluntary survey, giving all nurses in the organisation a voice in the designation process. The survey reflects a real-time snapshot of the current state of the organisation. To make the journey successful and more meaningful, organisations are encouraged to conduct an internal self-assessment involving frontline staff and leaders to identify opportunities for improvement as an initial step. This process engages frontline staff members early in the development, implementation, and integration of processes to close the identified gaps.
The Pathway to Excellence programme supports their efforts to become global leaders for nursing and healthcare. Because the Pathway designation must be renewed every 4 years, nurses know that Pathway organisations must sustain the foundational elements they have developed and implemented to build a positive environment that helps nurses provide safe patient care and achieve their personal best.
Northampton General Hospital NHS Trust was the first in the UK to achieve Pathway to Excellence accreditation from the ANCC (Mitchell, 2018). The hospital worked over a 2-year period to meet 12 practice standards that are deemed essential to creating an ‘ideal practice environment’:
I am excited to be part of this collaborative and see the potential for Pathway to Excellence designation as a huge opportunity to both systematically embed excellence across a whole organisation and to achieve recognition for the leadership and compassion delivered to colleagues and patients alike across the NHS.