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Interview - A fortunate wind blew me here

Alison Moore spoke with Zena Moore following her appointment as the new head of the RCSI School of Nursing and Midwifery

“My 17tH birthday was my first day on the wards. I was put on the children’s ward and, looking back, I’m not surprised as I was only a child myself.”

The new head of the School of Nursing and Midwifery at the Royal College of Surgeons in Ireland (RCSI), Prof Zena Moore, in an interview with WIN, thus describes her very first day of nurse training in the 1980s at St Michael’s Hospital in Dun Laoghaire, Co Dublin.

Zena officially took up her new position this spring, following her previous position as acting head of the Faculty. She brings more than 12 years of academic experience at the College to the role. A registered nurse, Zena joined RCSI as a lecturer in 2002, and has since been academic director and deputy head of the Faculty before commencing her new role.

Speaking on her early career she explains how soon enough after her training in St Michael’s, and after a brief stint in St James’s Hospital, she was fortunate to get a permanent post in the Meath Hospital at a time when they were hard to come by.

“I was really lucky to get one in the 80s. The assistant director of nursing interviewed me and gave me that chance. I stayed in the Meath Hospital up to the move to Tallaght,” she said.

Throughout this period, Zena worked in medical wards and the emergency department, but on suffering the bereavement of a stillbirth on her first baby she sought more regular hours. It was this that led her to her eventual specialty in wound care.

“The hospital couldn’t have done more for me. They really took care of me. It was like being in a family. They gave me the regular hours and it happened to be in a wound clinic.

Wound care
“There was no established way of taking care of wounds, not just in that department but anywhere in Ireland, or anywhere at all really. At that time the European Wound Management Association (EWMA) was born so it was serendipitous that I landed in there as I started working with the EWMA and my whole interest in the area grew from there.”

Zena’s work with the EWMA was initially on the “outside of things” until the consultant she was working with at the time nominated her to fill his position in the Association on his departure.

When the Meath Hospital moved to the new facility in Tallaght, the post of a tissue viability nurse was advertised and Zena was appointed.

She explained that up to this point, she had been running the wound clinic but not in an official post, and in the interim had studied at the University of Wales in Cardiff for a postgraduate diploma in wound healing and tissue repair. This involved going over and back to Cardiff every eight weeks for two years and she gives special mention to the support of her husband (Bud) during this period.

“I had three small children but my husband is an absolutely amazing man and would look after all of them. It was a really brilliant, multidisciplinary programme and it opened up my whole way of looking at things and gave me confidence in my practice so that when the tissue viability post came up I got it,” she said.

Zena then continued her study, taking on a masters programme at the Wound Healing and Research Centre at the College of Medicine at the University of Wales. It was at this point that a lecturing position came up in the RCSI.

Royal College of Surgeons in Ireland
“It was an opportunity to bring education into a wider arena in terms of wound management. It started with a module and then we had a small programme which grew, and now people do a PhD in the area. So I came to the RCSI as a clinical person with no experience of academia per se, and Seamus Cowman, who was head of nursing, gave me that opportunity to grow as an academic,” she said.

Zena referred to the nurturing environment of the RCSI and the “fantastic colleagues” who supported her.

“I always describe it as a hand in a glove; even though I didn’t have a lot of experience of academia, they provided the structure so that I could operate and become competent in what I was doing, in a very supportive manner.

“Pauline Joyce was one of those colleagues and she is still at the RCSI working in the Institute of Leadership, and she has a really fantastic way about her, in terms of being able to support you in a way that is very safe and so that you are able to learn and grow as a result of your mistakes.”

Prof Zena Moore

A registered nurse, Zena Moore joined RCSI as a lecturer in 2002. Since then she has been academic director and deputy head of the Faculty of Nursing and Midwifery. Her area of clinical research interest is wound healing and tissue repair. She is actively involved in research in this field and has undertaken 10 systematic reviews with the Cochrane Wounds Group and the Cochrane Renal Group. She has published more than 100 articles and book chapters. Currently she is principal investigator on a best evidence in medical education systematic review, exploring the impact of peer observation of teaching.

Zena is the chairperson and clinical lead for the HSE/RCPI National Pressure Ulcer Collaborative Project and chair of the repositioning group of the European Pressure Ulcer Advisory Panel guideline development project. She is an honorary senior tutor at the University of Wales and a visiting lecturer at the Faculty of Health Sciences, Hogskolen i Buskerud, Drammen, Norway. She was President of the European Wound Management Association (EWMA) 2009- 2011. She remains an active member of the association, and is the chair of the EWMA Multidisciplinary Project.

A native of Cork, she holds a postgraduate diploma, with distinction, in wound healing and tissue repair and an MSc in wound healing and tissue repair from the University of Wales. In 2002 she received a Fellowship of the Faculty of Nursing and Midwifery, RCSI and in 2009 she completed her PhD. She also holds an MSc in Leadership in Health Professionals Education from RCSI. In her spare time Zena likes to “chill and listen to music”.

Cochrane fellowship
The next step for Zena was a Cochrane fellowship with the Health Research Board (HRB). “That funding gave me time out and I focused on a systematic review of wound cleansing for pressure ulcers. Now I’m doing my 11th Cochrane review so the HRB really gave me a great opportunity to develop that skill and enabled me to teach others how to do it.”

Zena subsequently received funding from the HRB to undertake a PhD in pressure ulcers at the RCSI, which she completed in three years. “I really, really enjoyed it. There were stress points up and down but I had a great network of people supporting me,” she said.

On completion of her PhD, Zena returned to work at the RCSI where she was deputy to the head of faculty. “This time last year I was a lecturer. There was an opportunity to do a masters in leadership in health professional’s education, with Pauline and her team over in the Institute of Leadership, and I really enjoyed that,” she said.

As part of this course, Zena and a colleague, Anne Weadick, did a project on peer observation in teaching, where peers would observe and support each other’s classes and help to inform better teaching outcomes in a supportive manner. “Because it is formative, you should enable systems to be put in place for training that benefits teaching. It is part of the quality agenda and RCSI has a new strategy to 2017 in place and excellence in education is one of them, so competence and quality in a supportive environment are at the forefront” Zena explained.

The opportunity to take over as the head of the nursing school at the RCSI arose when the former head of the school, Prof Seamus Cowman moved to a new role with the RCSI’s campus in Bahrain, leaving the vacancy.

“I applied for the job and was lucky enough to get it. I’m really happy. It’s a lovely team here, it is small but very supportive in all our endeavours,” she said.

While very much ensconced in the world of academia these days, Zena determinedly keeps her “feet in clinical practice”. “Prevention of pressure ulcers is a key priority for the HSE this year. I am leading out on the Pressure Ulcer Collaborative, which is about getting people to work together as teams within their individual organisations, be that community or hospital,” she told WIN.

Zena explained that the Collaborative is following a model from the Institute of Healthcare Improvement in the US whereby the staff on a ward would know how many pressure ulcers they have, how many are hospital-acquired and would explore the causes for them, with the aim of getting them to zero.

“I’ve kept my feet well in clinical practice in terms of pressure ulcer research and prevention. It is very important in here as a lot of our programmes are clinically based, we need to have that clinical credibility. If I was just taking everything from a book I would have no believability. As a leader, people need to believe that you do know what you are talking about,” she said.

According to Zena, the RCSI wants to be the leading provider of post graduate nursing and midwifery education in Ireland and as such, their key focus is ensuring that it meets the clinical, academic, and professional scholarship needs of individuals within the health service.

“In plain English, it means that we want to demonstrate the impact that nursing and midwifery have on patient outcomes, and that by undertaking education and being involved in evidence-based practice that the staff are generating evidence for what it is they are doing.

“We want to empower people to be able to demonstrate the difference that they make to practice and be able to respond accordingly to the leadership and professional challenges that they face everyday,” she explained.

Discussing the recent Lancet study, which demonstrated the value of university education in nursing, Zena stressed that both education and clinical practice must be valued.

“If you don’t have clinical experience you can’t apply education as you don’t know how to synthesize it or make it applicable for the particular situation that you find yourself in.

“What we would stress is making sure that the evidence that you are making your decision on is based on best practice, and one way that you can enhance that is by being actively involved in education and being able to demonstrate your competency.

“Yes, it could be okay to continue doing something we have ‘done for years’ as long as we know that there is no new evidence to suggest that we should be doing it differently. Being actively involved in education empowers people, because it enables you to be a more active part of a team,” she said.

The fundamental aim of nursing and midwifery is to enhance the lives of the patients that they take care of and in order to do this, according to Zena you need to be able to respond to ever-changing demands.

“For example, if you are working in an acute hospital setting it is completely different than it was 15 years ago. Your focus remains the same, on the patient, the expectant mother, the neonate in intensive care; the needs of the patient influence the requirements you have for that nurse or midwife. Expanding our scope of practice is related to the patient, or client group, that we have.

“As such it is not so much that more is expected of you, but that the acuity has changed, and that the profile of patients has changed. Patients are much more informed, so therefore they have expectations that we have to address,” she said.

The RCSI is offering postgraduate training to newly graduated nurses and midwives with the aim of developing their skills and competencies early in their careers so they are actively able to respond to the leadership and professional challenges of the health service.

“It facilitates, very early on in the person’s career, the expansion of skills in terms of leadership, teamwork and communication. So they can look at the whole concept of patient safety and clinical risk right from the outset of their careers and respond as required,” she said.

Their very freshness can be an advantage in such situations according to Zena: “When new people come into practice they are able to see things that the rest of us don’t see, and therefore by giving them the skills to know what to do when they are challenged by situations like that, it enables them to respond more effectively and empowers them to lead from the outset of their careers.

“I just feel lucky that I’ve been able to work in an area that I love. I love wound care and being in an organisation like the RCSI, having a clinical focus is fundamentally important and the fact that I am able to share that with so many people, while being given the opportunity to learn so many other skills, like leadership and evidence-based practice, and to interact with people from a wide variety of clinical areas, has been fantastic.

“The fact that you always feel like you are driving towards a goal that you can see, and that your goals change, is great. You get to develop different skills and I feel very lucky to be in the position to be doing that.

“Your credibility lies in who you are as a person. That was one of the things that I was able to explore in the leadership programme in the Institute of Leadership here in RCSI. Really looking at leadership skills, how you see yourself as a person, and living your espoused values, for me is really important. It’s about being credible, believable and trustworthy. For my students here, if I promise to do something I will do it,” she said.

Referring to her recent appointment, Zena told WIN how she felt really lucky to be where she was at this point in her career.

“It’s a great team here. I feel very comfortable. I know the organisation well. It is a great opportunity and I feel really lucky that I’m in this position. I am very grateful to my family, friends and colleagues for supporting me all the way along my journey.

What was it that Seamus Heaney said? ‘It was a fortunate wind that blew me here’.“

We wish Zena the best of luck in her new position.

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