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Why should ward sisters be supervisory to practice?

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4 March, 2013

Article

Fenton K, Phillips N (2013) Developing skills in clinical leadership for ward sisters. Nursing Times; 109; 9, 12-15

 

5 Key Points

  1. The ward sister role is vital for consistent, high-quality care
  2. Lack of clinical leadership is a factor in poor care
  3. The Francis report has called for a strengthening of the ward sister role
  4. A critical analysis of healthcare organisations and a whole-systems approach to change is required to modernise this role
  5. The role needs to be clearly defined and sisters need ongoing development

 

Let’s discuss

  • “The ward sister is the key nurse in negotiating the care………She is the only person who has direct managerial responsibilities for both the patients and nurses. It is the combination of continuity in a patient area together with direct authority in relation to patients and nurses that makes the role unique and so important to nursing.” Do you agree with this statement? Explain your answer.
  • What are the three main components of the ward sisters role?
  • The authors of this article describe the ways in which healthcare is becoming increasingly complex. Outline how these challenges and pressures impact on ward sisters?
  • How would you define a whole-systems approach to change? How does this approach support ward sisters in their leadership role?
  • Explain why ward sisters should be supervisory to practice?
  • What do organisations need to do to enable this to happen?

Readers' comments (7)

  • rovergirl6@hotmail.com

    The ward sister has the opportunity to encourage her staff to give good care to the patients in their care ,staff should be able to look up to her as their role model. We should be able to trust her to ensure all care is the best the staff can give . patients are people and who knows any one of the nurses who give care to our patients may one day become a patient and lets see how they feel. I will say that not all nursing staff are giving poor care but the majority are.

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  • What is a ward sisters role? I know what I want, a leader for starters. Not some henchman who got the position because they happened to smoke with the matron. This leader has to have a good grounding in ethics, if not, then make it a priority for the post. He/she must be innovative, not afraid to try out knew methods of clinical care. Must be legally minded, when a trust or management is wrong they have to stand their ground. They must be technically adept, they need to teach. Be of high moral standards, leading by example. Leaders need to set the bar high, and stand by their principles. Be good communicators, empower their trained staff, listen, and know when to take a step back. A leader has to be of high quality, sorry it's not a job for any Tom dick or Harry.

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  • totally agree with these comments, too many get the post through who they know not what they know.I disagree with making the ward sister 'the voice of the expert' all RGN have good training and develope expertise, we can't all be ward sisters but we can all be good nurses.By making the ward sister role 'expert' the public will believe that todays highly trained RGN's are not competent.The goverment should move to promote all RGN's are seen as competent professionals.

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  • Anonymous | 6-Mar-2013 11:20 pm

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  • rovergirl6@hotmail.com | 6-Mar-2013 6:56 pm
    Anonymous | 6-Mar-2013 11:20 pm
    Anonymous | 10-Mar-2013 5:17 am

    I assume then, that you are all ward sisters, fully competent and living up to all the attributes that you advocate. If you are not? Then, why not? You seem to be experts.

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  • I was a ward sister for many years. My first sister's post was in the days when we did the same shift patterns as our staff and were able to spend a lot of time on the ward.

    I earned my posts through merit and not because I was anyones 'henchman' or because I 'smoked with the matron'. It was never an easy job. The buck stopped with me and I took full responsibilty. I worked harder than anyone on my ward. I had budgetary control and recruited the staff for my team. The framework existed for me to do my job and be accountable for it.

    Then the management structure of the NHS began to change. The paperwork and administrative work increased 20-fold virtually overnight. Audits, evaluations, targets, etc, became the order of the day. We were not allowed to work normal shift patterns, because it was cheaper to pay us 9-5 Mon-Fri. Ward managers lost control of their budgets. We then had to accept whatever Tom, Dick or Harry were sent to us by HR, as staff, no matter how incompetent and unsuited they were. Staff numbers were reduced and many of the decisions we had been responsible for were taken out of our hands and given to the mushrooming number of middle managers. I went from being responsible to one person, to answering to five, who all had different briefs.

    I was always happy to accept responsibility for my ward as long as I had to ability to have a decent measure of control over changing things which were wrong. Towards the end, I had just become the person that everyone blamed. Managers blamed me if their individual, impossible targets weren't met and the staff blamed me for not 'fixing' the new NHS for them. So I finally threw in the towel after 20 years.

    Here's the thing. If you want effective ward managers, then you need to look at (a) What you want them to do, and then (b) Give them the resources to do it. It is easy to be critical when you haven't done the job, and I agree with
    Anonymous | 10-Mar-2013 1:13 pm. If you think you can do better, then have a go.

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  • Hmm. Its theory without the ability to change much. Hospital management prefer neutered Ward Sisters and Charge Nurses because they cannot allow them any real power now. Seeing as they have usurped the structure to promote their own personal and group power there isn't really much of a strategy if Nurses lack power. Short of a revolution, how do they reassert themselves when clearly the profession from the top down seems totally unwilling to be assertive, direct or even pushy.

    Whether Ward managers operate in a supervisory capacity or not is largely neither here nor there. He/she is but one professional amongst a sea of professionals.
    It will take more than simply supervising. Many nurses such as myself work with no direct supervision, as is expected by myself and my job description.

    The real role is to control and determine the environment and the selection of patients that keeps the ward workable and productive. Acute Surgical wards should NEVER have a random assortment of frail dependent medical patients dumped there because of bed shortages. But that happens. Of course we don't expect cardiologists to treat rheumatology patients on a semi regular basis despite the fact that they are physicians. Yet as a surgical nurse I am expected to use a bunch of plausible fundamentals to.do both things at once.

    This is the issue of Ward Sisters; control. Without it a Sister or Charge Nurse is nothing.

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