“Leading with small acts of kindness improved communication and made space for engaging with each other.”

Eleni Mc Crea is a community midwife based at Whiteabbey Hospital. She is new to the role – and new to leadership, as she develops and implements her skills much more quickly than she had envisioned due to Covid-19.

In our series of Nightingale Blogs, Eleni describes new ways of working and how care is provided to women who are understandably worried about the risk of Covid-19.

She also reflects on strong female leadership, stress, morale, compassion and kindness.

Hugely diverse field of midwifery

I have been qualified for less than two years and work within the Newtownabbey Community Midwifery Team. I am a direct-entry midwife, having studied a midwifery degree in Yorkshire and coming into midwifery later in life, from a background of occupational therapy and health promotion. Now based in Whiteabbey Hospital; I work out in the community and from GP surgeries across the locality.

The community midwifery role is hugely diverse which makes this field of midwifery incredibly rewarding. We provide antenatal care, which encompasses health promotion; screening, clinical care, and home births. This means we have frequent training for emergency management and a professional requirement to keep our clinical skills up to date. We then provide postnatal care for newborns up to 28 days of age if required. We holistically support women and their families from pre-conception to the transition to family life. This means we build strong relationships with the women we care for through ‘continuity of care and carer’ – a model which provides care from the same midwife or team of midwives during the pregnancy, birth and the early parenting period.

At the start of the Nightingale Challenge, I reflected on my own thoughts about leadership. I was interested in how these pre-conceived ideas manifest in my own practice. I recognise that I lack confidence in my leadership skills. My own understanding of leadership was rooted within an autocratic perspective. This style of leadership has its place however evidence suggests that quality of care is improved when a collective leadership style is implemented in health care. My goals included improving my confidence in my leadership skills, in line with enabling professionalism, to improve my midwifery practice. Covid-19 has caused me to develop and implement these leadership skills much more quickly than I had envisioned.

Strong female leadership

As part of the Northern Nightingale Challenge, I attended a collective leadership workshop just prior to the pandemic where nine dimensions of behaviour in leadership were analysed. Alongside confidence-building, I feel this workshop shaped my response to the challenges I have faced in my role as a midwife during this unprecedented time.

I have reflected on the strong female leadership I have observed within the community midwifery team. This leadership has continued to shape my own practice in a positive way. I recognised that the leaders within our service were ‘leading with care’. This compassionate care involved being visible and available to the team. This set the example within our team to spread a caring environment from which to work. We talk to women about the physiological impact of environment to birthing, and the effect of stress on wellbeing. It is imperative that we are using the same narrative to each other in times of high stress. This inspired me to raise morale, mainly with plenty of tea! (I am from Yorkshire). Leading with small acts of kindness improved communication and made space for engaging with each other. In line with ‘Prioritise People’, an element of the Nursing and Midwifery Council’s code, small acts of kindness in leadership should not be underestimated.

Midwifery-led hubs

With a ‘shared vision’ from the Healthcare Leadership Model between community midwifery management and ourselves, we brought midwifery-led hubs into fruition.

The Healthcare Leadership Model (developed by the NHS Leadership Academy) is useful for everyone because it describes the things you can see leaders doing at work and demonstrates how you can develop as a leader – even if you’re not in a formal leadership role.

We did not have midwifery-led hubs before Covid; we saw women in GP surgeries – and we are now devising the clinics themselves.

Moving caseloads from GP practices into our clinical space at Whiteabbey Hospital was only possible due to sharing this vision with Midwifery management and working together. This gave us autonomy and flexibility to see women within a safe space. We had to identify the risk factors of any logistical issues and work within the Trust and public health Covid-19 guidelines. Women were understandably worried about the risk of Covid. With little evidence available at the start of the pandemic, they were concerned about what Covid-19 might mean for their unborn babies over the long term. Having our own environment meant we could provide women with individualised care as required. We have a very committed team of domestic staff, who were instrumental in providing a sanitised clinical space.

We also opened up daily postnatal clinics alongside the option of home visits – to provide further opportunities for breastfeeding support, in light of the positive effects of breastfeeding on newborns’ immune system during a pandemic (NHS, 2020). This was also to ensure we reduced the risk of readmission to the paediatric ward for weight problems. We utilised Zoom for large multi-disciplinary meetings and held extra telephone consultations for parenting education for vulnerable mums.

We are particularly committed to continuity of care and carer, which can improve outcomes (Sandall et al 2016), led by our co-ordinator who engaged our team and encouraged us along the way with her inclusive leadership style.

Care for families during distressing times

Community midwifery can be diverse, and due to this, we work with a large number of the multidisciplinary team. We frequently work alongside GPs, social workers, hospital based midwives, health visitors, mental health professionals, our Family Nurse Partnership, obstetric medical team and paediatricians among many others. This collaborative approach is essential to ensure the very best outcomes for maternal and child health.

During this time, I was able to strengthen the relationship I had with the GP practice through bereavement care. Bereavement care is very much part of being a community midwife and a privileged role albeit difficult, especially during Covid-19. Through work in ‘connecting our service’, (DoH, 2018), we were able to develop holistic, individualised care for families during very distressing times. The relationships I have built up with the GP practice will have a positive impact on my practice going forward and preserve safety. This new creative way of working has pushed me to work outside of my comfort zone, developing confidence in my leadership abilities.

Buddying new staff

There is no doubt my confidence has increased during this pandemic. I had the confidence to be filmed by the BBC and talk about community midwifery. I co-ordinated the team and actually enjoyed it! I have had the confidence to buddy new staff and those redeployed to our service during the Covid-19 pandemic from other specialisms. I have new confidence to liaise with a huge range of professionals after being required to do so to facilitate care for women and babies.

I like to run and during this pandemic I have continued to do this. It has allowed me to have some reflective time and an outlet for the stress generated whilst working in the health service during a pandemic. Self-care has never been more essential.

Eleni Mc Crea
Community Midwife, Newtownabbey Community Midwifery Team, Whiteabbey Hospital

Eleni is one of 27 nurses and midwives in the Northern Trust taking part in the Nightingale Challenge.

The Nightingale Challenge asks for every health employer to provide leadership and development training for a group of young nurses and midwives during 2020, the International Year of the Nurse and the Midwife.

@nhsctrust #NorthernNightingales
@NursingNow2020 #NursingNowNI #NightingaleChallenge
#InternationalYearoftheNurseandMidwife

Other Northern Trust Nightingale Blogs

Gemma McClean, Hospital Diversion Nursing Sister
Judith Shevlin, Community Mental Health Nurse
Denise O’Donnell, Acting Ward Manager, Covid-19 assessment ward

9th July 2020