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EDITOR’S COMMENT

'Develop ward sister role to improve care'

Ward sisters and managers are the individuals who can make the greatest amount of difference to the morale of staff and therefore the quality of care provided in hospitals.
That’s also the view of Jan Sobieraj of the NHS Leadership Academy.

He was voicing his belief in the power and influence of ward sisters at last week’s excellent Finegreen Associates Raising the Bar conference on leadership in Manchester.

Mr Sobieraj recounted a story of how two wards in the same hospital, separated by just a few feet, could be entirely different: one grimy, the other spotless; one calm, the other chaotic and disorganised. The difference, he contended, is always the leader.

Here here. Ward sisters have a tough job - the people left to accept responsibility for anything that may go wrong on the ward, while often left out of the loop on decisions made by senior managers that may directly impact on the care they are providing.

Those who successfully tread the path between managing the expectations of patients and their relatives and those of their superiors do well. But the health service should do more to support people in this challenging role.

Ward sisters don’t just set a standard and ensure staff have the discipline to stick to it, they create a culture that determines the morale of the team

Today’s patients demand a better service than even 10 years ago. They are fuelled by social media and the internet’s ready supply of information - and sometimes misinformation. And all this against a backdrop of scarce resources and financial constraint.

Ward managers, though, along with other clinical leaders, are the most suited to really reassure the patient. The public still trusts people who have an understanding of clinical care, over those they see, rightly or wrongly, as just “the suits”.

It is vital that these managers are supported and developed. Mr Sobieraj spoke at the conference about how some people had recommended that he focus his NHS Leadership Academy efforts and money on training the top stratum of managers. However, he argued that improving the leaders at ward sister level would create the greatest amount of difference - to staff and patients.

Ward sisters don’t just set a standard and ensure staff have the discipline to stick to it, they create a culture that determines the morale of the team. There is a large evidence base that happier staff are more productive and stay longer in their jobs.

The academy is soon to be seeking ward sisters for its training programme. Let’s hope it is successful in producing brave, visionary and supportive sisters, because they are vital to the NHS’s future.

Jenni Middleton, editor

jenni.middleton@emap.com. Follow me on Twitter @nursingtimesed

Readers' comments (16)

  • If they hadn't eroded the role of the Ward Manager in the bloody first place, (leaving them with no power, but all the responsibility), then the blindingly obvious would not have to be stated again!!

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  • I have come across some lazy sisters in nursing, and some just out of touch with patient care.
    Some are so in tune with the paper work they have to do that when they do have the time to help with some physical work on the ward, they hide away from it.
    We were short by a staff nurse the other day and there was an excess of another sister on the ward, we thought that she would do the decent thingh and fill in as there were two sisters on duty, but instead she said to the nurse who already had her maximum amount of patients, to take on the other patients and she will help out. It so happen that she assisted a little on the easier side, did jobs that were quite light and shy away from direct patient care.
    I will like to see sisters and charge nurses having direct patients care just as the grade 5 for a portion of their working pattern.There is a massive problem with them wanting to fill in when the ward is short staff and there is no cover to be found.
    I can give many examples, another time on another ward I witness a patient ask the sister who was in the bay for a drink of water, the sister turn to the carer and told her to give the patient a drink. It was just a matter of pouring the water from the jug to the glass for the patient. This sister had become so used to just telling others to do all the time that she had felt it was not her job anymore to do.

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  • I meant there is a massive problem with them not wanting to fill in when the ward is short staff

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  • Anonymous | 21-Nov-2012 9:12 pm

    When I was a ward sister, I had the sleeves rolled up and worked on the ward daily, as did my fellow ward managers in other wards.

    Almost overnight a few years ago, the administration quadrupled, our budgetary control was taken away from us, staff levels were cut and more and more impossible targets were set. I fought our corner and listened to the moans of my staff and fought against the detached indifference of our 'seniors'. But I finally got fed up trying to please everyone but myself, chucked it about 4 years ago and went into research.

    It is a real shame to hear about managers who don't think that it's their job to help their staff by helping out when they can. However, I'm sure that there are many who sorely miss nursing their patients and working with their colleagues out in the ward.

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  • We hear and see this statement about how key the ward sister is to patient care and staff morale all the time, yet we do nothing to support them, develop them or even make sure the right person is doing the job.
    When I was a ward sister I used to dedicate saturdays and sundays to the days when I would definetly take a case load of patients. During the week was impossible with the demands of the manangers who weren't in at weekends, paperwork to be completed, unit cover to be provided, ward rounds to be undertaken as consultants would not go round on thier own or with a junior nurse.
    I used to give my staff the opportunity to spend a day with me so that they could see all the reasons why I couldn't commit to taking a caseload during the week.
    In this way I hoped my team would understand why I couldn't be relied on to help out during the week at best all I could do would be to help with drugs and meal rounds.
    Everyone wants to talk to the sister.

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  • my ward sister is very hands-off, will not help out at all, belittles the staff, comes in when she feels like it and actually creates more stress for everyone. she has no idea how to manage staff, the ward, the shift and has no interest in the patients.

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  • tinkerbell

    ' and has no interest in the patients'
    Anonymous | 22-Nov-2012 6:01 pm

    Any nurse who has no interest in their patients should be sacked and a ward sister who has no interest in her patients also.

    It is so hard to get rid of the loafers, they're just getting in the way of everyone else who is trying to provide quality care.

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  • The senior sisters has a major role to play in keeping patients and staff in a comfortable and safe environment.
    I hope that the academy will address the following as I have seen a lot of sisters having weakness in the following areas:

    -- bullying issuses, not compenent enough
    to deal with it
    -- allocation of staff, will need support on
    this as there should be a proper
    national template, also to
    understand dynamics of allocation
    throughout the whole shift
    ---Duty Rota, done so that there is not
    two or more sisters or seniors on
    same shift.
    Senior sisters to also do late,
    weekend and night shifts to ensure
    they are aware of patients and staff
    needs over a 24 hour period, also to
    enable supervision and support over
    24 hour period
    ---A Part of their working week to be on
    the floor with patients allocated
    to them so they do not lose the
    ability give hands on care and to
    use this opportunity to work directly
    with carers
    ---Interviews, how to ask
    questions,(closed, open &
    prompts)

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  • My ward sister has only been here for 12 months and has completely destroyed the ward. She never goes in to the patients and is a total bully to certain staff.Her language is foul and she is a disgrace as a ward sister.Whoever gives people like this a jib as a manager. Her skills at managing staff are nil.Shes pally with members of staff who are gossips and staff that keep themselves to themselves and get on with their work ,shes not interested in and they get the crap off duty. If you confront he she just says shes not changing it.This ward was a pleasure to work on with excellent caring staff that had been there for years and shes split the ward down the middle making it a horrendously uncomfortable and stressfull place to work

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  • anon 10.46 - I fully understand what you are saying, the ward sister can have a tremendous effect on the whole ward, not always a positive one.

    there are many ward sisters/managers who are put into that position for reasons no-one understands.

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  • tinkerbell

    some people are promoted beyond their competence level.

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  • I will like to give an example of a good ward sister, I am sorry to say I have not met any like her.
    This sister was so pleasant to deal with always willing to help when she can.
    There was a queue of nurses wanting to get on this ward. When I work there I look forward to my shifts. I do not work there any more I now look forward to my off shifts.
    She was very knowledgeable, if you had problems eg putting in an NG tube and you told her she was ready and able, not only did it but teaching as she did it, then saying if you have more problems let her know.
    When we could not get cover she would allocate herself to the patients and have the same support that a grade 5 would have if she/he had to be in charge.
    She worked late shifts as well and used her time wisley to allow patients relatives to make appointment to see her during afternoon visiting hours. This was very popular with the friends and relatives of patients, and also the staff nurses as they were not kept back from their work to spend a lot of time with patients families. She never felt that she had to get all the best days off. There was a fair system in place. Work one christmas and/or new year and you are sure to get the next off.
    She would not waste time listening to gossip to know what was going on in the ward as she worked with all her staff and she knew their strenght and weakness.
    She would use opportunity to teach one if she finds weakess, and was strong enough to discipline anyone that fall short time and time again.
    The ward was well run on every level even the doctors love coming on the ward.
    After all these years after leaving that hospital I still wish she was on my present ward.

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  • Oh my goodness,how times have changed and unfortunately not for the better. A ward sister was once the back bone of the ward. Yes there were some who were useless but on the whole the sisters that I have worked with in the past were excellent nurses,good managers and commanded the respect of the rest of the ward staff.This was back in the sixties and seventies before the middle management ideas came into force. I am afraid that the position has been eroded over the past few years because of all the increased bureaucracy that ward sisters have to attend to. Its time to make a stand for the sake of the patient and tell the managers where to go.

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  • in my trust ward sisters are only allowed to work 9-5 monday to saturday

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  • I mean monday to friday!

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  • But all these examples are based on stories not what role ought to be.
    Ward sisters already had power and status but it was eroded by the pointless matron and non clinical managers. Seizing power back is what is necessary.

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