One-to-one: listening, learning, leading

18 March 2022

Almost six months into her role as Wales’ top nurse, Sue Tranka talks about her journey so far and her key priorities for the future, including for the CP workforce.

Sue Tranka was appointed chief nursing officer (CNO) for Wales in August. It is a role she describes as ‘an honour’ following her near 30-year career in nursing – a journey she has ‘absolutely relished’.

Born into a long line of nurses and nursing professors, her interest in the profession was piqued at a young age, but she adds: ‘I had no idea then I would embark on a long, enriching and fulfilling career.’

For Sue nursing has remained ‘the most rewarding profession’. She adds: ‘There is no greater privilege than being able to provide the physical care and emotional and spiritual support to others when they most need it.’

Tireless efforts

Arriving in the role in the middle of a pandemic, the impact of Covid-19 has been at the forefront of Sue’s mind. ‘I have spent the past few months speaking to staff on the frontline – the workforce that has been working so hard, so tirelessly, during the pandemic – to check in with them to get a sense of whether what I’m hearing is exactly what they’re experiencing,’ says Sue.

‘What I have learned is that the key priorities for the community practitioner [CP] workforce are recruitment, retention and health and wellbeing, particularly for a workforce that has been through such a difficult period. I also want support a systematic approach to leadership development, building capacity and capability in the system, and improving patient outcomes, including tackling inequalities – something the pandemic laid bare.’

With staff under such pressure, stepping up recruitment is among Sue’s first priorities for 2022. ‘In the short term we have to close the vacancy gap,’ says Sue, citing a new NHS international recruitment scheme to support 400 nurses joining the Welsh workforce. She adds: ‘In the longer term, our workforce planning needs to be robust: we’re working with Health Education and Improvement Wales on strengthening the planning.’

She adds: ‘We have already made huge increases – since 2016, nurse training places have increased by 69% and midwifery training places by 97% – but I would really like do some granular work in terms of the number of CPs we need, and discuss with the professions the potential for accelerated pathways into those roles.’

Given the workforce challenges facing health visiting and school nursing services specifically, Sue says: ‘We need to build the capacity of those teams and have the right workforce in place. By that I mean not only having adequate numbers, but the right workforce, including the registered component.’

'There is no greater privilege than being able to provide physical care and emotional and spiritual support to others'

She says current work on developing an acuity tool for health visiting and formulating a universal programme of delivery contacts for school-age children ‘is predicated on identifying the workforce numbers required, including associated skills mix’ with the aim of proving a ‘team around the family’ approach and highly skilled teams. It is also important to ‘think about how health visitors and CPs can be supported in the long term’, adds Sue. ‘Their career framework and the need for parity across community practice and acute workforce in terms of banding and the level at which they work.’

Sue’s CV

  • Sue came to the UK from South Africa in 1999. She trained as a midwife, registered general nurse, and mental health and community nurse, with leadership experience across operational and clinical roles.
  • Before her current role she was deputy CNO in England, taking on the key role of director of infection prevention and control just months before Covid-19 hit.
  • Prior to that she was deputy CNO for patient safety and innovation at NHS England and Improvement.
  • She has had a career-long passion for patient safety and quality improvement, and has held a role of honorary visiting professor at the University of Surrey.
  • In October 2020, she was voted one of Health Service Journal’s 50 most influential BME people in health.

Skills concerns

Having met with health visiting teams during her fact-finding first few months, Sue is aware of concerns raised about the skills mix. She says: ‘I want to hear their concerns about the skills mix and understand what’s driving it,’ she says. ‘It’s not about diluting or devaluing professional roles – that’s something that is really important to me as a nurse, and nor has the government set out to do that – quite the opposite.

‘We want to enable the workforce to work at the top of their licences, using the skills and knowledge they have worked so hard to gain doing the most appropriate tasks, while being able to delegate appropriate tasks to members of the team. We have started work on preceptorship and clinical supervision which is important for the workforce health and wellbeing,’ says Sue.

One of her ambitions is to see good practices like debriefing and clinical supervision being enshrined in policy. She adds: ‘I have an NHS secondee coming to work in my office to support the development of a policy around clinical supervision, because it is so important to allow the workforce time to reflect and discuss difficult and challenging experiences and to create a safe space in which to do that.’ And while the pandemic has meant the importance and value of nurses has never been better understood, and that has already ‘translated into investment and training numbers’, says Sue, the question remains: ‘Have we done enough?’

While there is plenty going on behind the scenes, Sue’s first major public-facing step in her new post was the launch in late January of the Maternity and Neonatal Safety Support Programme in Wales, ‘a significant piece of work in maternal and neonatal services, supporting the Welsh Government’s ambition to improve outcome and quality of care’.

This £1.15m plan, which includes the appointment of maternity and neonatal champions to every health board in Wales, reporting back to Sue, aims to ensure a consistent approach and improve the safety, experience and outcomes for mothers and babies in Wales.

A milestone for all

Taking on the role of CNO for Wales is not only a major milestone in her own career, but also an important step forward in a wider context, says Sue: ‘I am the first CNO in the UK to come from an ethnic minority background, which shows how far we’ve come in breaking down barriers, and is fantastic for Wales – I think it’s clear that promoting equality is a priority in Wales, evident from the Race Equality Action Plan.

‘But I also want to say I am so much more than my ethnicity; I am in this role because I have worked incredibly hard, I am good at what

I do. I have come up through the ranks and put in the time and effort – and I am also from an ethnic minority background.

‘I don’t go around thinking of myself as a role model, but at the same time I am acutely aware that my appointment to a very senior role signifies change, and sends out a signal to other women and girls from ethnic minority backgrounds that it is possible to break through those barriers, and what is achievable if you work hard, and are invested in and supported to grow.

‘It is so important to me that we do all we can to support the development of other women from black and minority ethnic backgrounds seeking senior roles in our NHS. Mentoring is something I have always done in my career, and outside of it through my work with the charity Bridge Builders; I want to help all young women and girls see that they can achieve what they set their hearts to.’

Frontline heroes

With children and families at the heart of the Welsh Government agenda, Sue is quick to recognise the role of those staff on the frontline. She says: ‘As we enter the third year of this pandemic, I would like to say a heartfelt thank-you to CPs for the care and support you have given and continue to give to the families and children in our communities, and for your professionalism, compassion and your dedication.’

Sue adds: ‘We need to build on that best practice we already have and look forward to an exciting future delivering our plans and strategies for the wellbeing of our future generations, allowing children in Wales to fulfil their potential.’

On women’s healthcare

Sue says: ‘I believe strongly that advice and support must be provided to girls and women across their life course to enable them to remain healthy throughout their lives, thus moving away from providing an intervention purely when problems are experienced.’ 

Life lessons

What drives you?

Witnessing injustice and inequality. Growing up among profound inequalities in South Africa has spurred me on to ensure I do better for others. My career in patient safety over many years has made the pursuit for excellence stronger.

How do you unwind?

Spending time with my family. Many of our activities are centred around food, so naturally I love eating it – not so much cooking it!

Any pearls of wisdom in aiming for senior roles?

Remember to be kind: first to yourself, then to others. Don’t ever let this compassion leave you – it is what makes you a nurse first and a great leader second. Also remember, there is no single road map to success.

Final word…

Nursing was my professional beginning; it has been my ticket to the world. The profession has shaped me into the person I am today.

Image credit | Shutterstock


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