Rebecca Anderson, Aimee Matthews and Ewen McColl describe the roles that dental nurses have in relation to leadership and management within Peninsula Dental Social Enterprise CIC.

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Introduction

Whilst leadership and management are closely linked, it is worth differentiating without getting fixated with definitions. Leadership is often described as having a vision and encouraging others to share and work towards this vision; leaders see the path. Management is enabling the processes to achieve this vision; managers navigate the path.1

Peninsula Dental Social Enterprise (PDSE) based in the South West of England employs dental nurses in a wide range of roles and utilises the full scope of dental nurses in order to optimise outcomes for patients. PDSE works closely as the clinical delivery arm of Peninsula Dental School, University of Plymouth. There are four large Dental Education Facilities (DEFs) in Plymouth (Devonport and Derriford), Truro and Exeter under one umbrella where students from the university provide NHS dental treatment to patients under supervision, alongside providing dental outreach services to local communities. Each facility has a Clinic Team Leader who is a dental nurse and CQC registered manager.

Leadership is often described as having a vision and encouraging others to share and work towards this vision; leaders see the path.

As well as leadership roles dental nurses within the organisation contribute to direct support of clinicians, act as Clinic Team Leaders (CTLs), support student clinics, radiography, clinical governance management, support postgraduate teaching and clinical delivery, coordinate clinical research, and lead on outreach teaching and support of the British Antarctic Survey Medical Unit.2

In this paper we describe the role that dental nurses have within the organisation in relation to leadership and management. These roles are essential to the efficient and safe running of large facilities and highlight many of the skills transferable from dental nurse training to senior leadership and management positions.

The Clinic Manager

The Clinic Manager is a dental nurse with leadership and management experience who reports to the Chief Operating Officer (COO) and works alongside the Governance and Operations Manager to oversee the implementation of clinical policies and processes. The role of Clinic Manager is wide spanning across both clinical and non-clinical areas, with the main responsibility lying in working closely with the leads of the relevant operational departments including CTLs, Decontamination Team Leader and Admin Team Leader.

In addition to the clinical aspects of the role, the clinic manager also works alongside the Human Resources department to identify recruitment need and professional development of trainee dental nurses, qualified dental nurses and the dental support teams comprising of decontamination assistants and dental administrators.

The key aim of the Clinic Manager is to ensure that all facilities have the appropriate level of materials, instruments, staff and support to remain consistent with maintaining high levels of patient care. A key area of the Clinic Manager role is also working with groups such as the infection prevention and control nurses to lead and develop policies in line with national guidance and investigate any incidents arising which are related to infection control to prevent repeat occurrences.

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Research dental nurse (centre) working with 3rd year BDS summer research students

When working with the decontamination department and consumables group it is also important not only to maintain clinical activity but also to consider the impact that dentistry has on the environment and to work towards PDSE's commitment to a more sustainable future. Furthermore, the Clinic Manager has an integral role in reviewing both clinical and non-clinical reporting and audit data to identify areas of improvement and areas of excellence within PDSE.

Governance and Operations Manager

The role of Governance and Operations Manager at PDSE is intrinsically linked to the role of clinical manager, with both roles working together to ensure there are adequate mechanisms in place to facilitate high standards of clinical governance cross all four sites. The advantageous benefit to the close overlap of roles and responsibilities is the level of organisational resilience it perpetuates, strengthening governance structures and operational management functions.

Also reporting to the COO, the primary role of the Governance and Operations Manager is to oversee the clinical governance framework, which involves developing policies and procedures, managing clinical incident investigations, overseeing clinical audits, reporting on contractual key performance indicators (KPIs) and overseeing all aspects of risk management. Along with this the Governance and Operations Manager leads a number of key organisational committee groups including radiation, safeguarding and acts as chair of the monthly Clinic Operations group. Incorporated into the Governance Manager role is the role of Data Protection Officer (DPO) which oversees data protection policy and compliance with principles of the General Data Protection Regulation (GDPR).

Clinic Team Leader

The role of the Clinic Team Leader (CTL) is fundamental to ensuring smooth day to day operations and in conjunction with the Clinical Lead forms the cornerstones of each of the four facilities. Fulfilled by an experienced dental nurse, the CTL, assisted by a Deputy CTL, oversees all aspects of clinical operations, patient management, undergraduate clinical experience, and acts as the site CQC Registered Manager. The multi-faceted and fast paced role requires the ability to effectively communicate, prioritise, multi-task and react to change in a positive and determined manner. Evolving from what was previously a more stereotypical lead nurse role, the CTL role encompasses a wide range of responsibilities that include overseeing clinical audits, developing protocols, overseeing staff and student compliance with policies, communicating updates, as well as direct line management of the dental nurse and dental administration teams. The role of CTL is recognised as crucial to the effective running of the DEF and consequentially the knowledge and opinions of the CTL are influential in the development of organisational practices.

Radiation Safety Lead

One of the key roles undertaken by dental nurses at PDSE is the Radiation Safety Lead (RSL). PDSE has a duty as an employer to under Regulation 18 of the Ionising Radiation Regulations 2017 (IRR17) to appoint a Radiation Protection Supervisor (RPS). Within PDSE, the role of the RPS is incorporated into the role of the Radiation Safety Lead (RSL), with each Dental Education Facility having a dedicated RSL.

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A dental nurse (left) assisting an undergraduate dental student

Although PDSE retains the overall legal responsibility for the radiation protection, the RSL has a crucial role to play in helping to ensure compliance with the arrangements made by the radiation employer under IRR17 and supervising the arrangements set out in local rules. Each RSL is an experienced GDC registered dental nurse with post qualification in radiography; undertakes IRMER17 update training five-yearly; attends a formalised RPS training course, as advised by the appointed RPA; and has adequate knowledge and understanding of the requirements of the IRR17, IRMER17 and the Local Rules. The RSL role is to assist in meeting compliance, ensuring radiation exposures are as low as reasonably practicable (ALARP), supervising the work in compliance with local rules and offering local advice and support. This involves undertaking quality assurance audits, leading student induction and remediation sessions and overseeing incident investigations.

Safeguarding Coordinator

Each DEF has a named Safeguarding Coordinator situated on site and who acts as the recognised point of contact for safeguarding matters. This role is again held by an experienced GDC registered dental nurse trained up to Level 3 in safeguarding vulnerable adults and children. This role is crucial to ensuring patient safety by promoting and maintaining an open and inclusive culture in which the importance of effective safeguarding practice is paramount. Along with ensuring compliance with internal policy and procedures and acting as a resource for the wider team, the role involves assessing and identifying safeguarding risks, and working with colleagues to plan and act to prevent or minimise these. The role of Safeguarding Co-ordinator entails being the point of contact for safeguarding incidents, overseeing the process of referral to external bodies from end to end, and overseeing the operational delivery of the Was Not Brought (WNB) protocol. On top of this a crucial part of this role is ensuring that information and updates on safeguarding policies and processes are effectively communicated to the staff and students.

[The role of Safeguarding Coordinator] is again held by an experienced GDC registered dental nurse trained up to Level 3 in safeguarding vulnerable adults and children.

Lead Research Nurse

This role involves coordinating and arranging logistics of a number of clinical research trials. The role requires communicating with research sponsors to ensure that clinical research is carried out in compliance with all regulations and ethical approval. Close coordination with the Governance and Compliance Manager ensures the trials are well recruited and all clinical elements compliant with research protocols and local rules.

Summary and conclusions

Peninsula Dental Social Enterprise employs dental nurses across Devon and Cornwall to use their full scope and extended duties. There are transparent career pathways into leadership and management positions with development opportunities in this area at every stage of a dental nurse's career throughout the organisation.