Sisters must be closer to nursing directors in NHS hierarchy

The commission’s final report, Front Line Care, says it supports urgent calls from the nursing, midwifery and medical royal colleges, and other stakeholders to strengthen the role of the ward sister, charge nurse and equivalent in community and midwifery settings.

The commission noted significant concern at the erosion of these “linchpin” roles by the growing popularity of specialist and advanced practice posts, workload pressures and loss of control over areas like cleaning and catering.

It states: “These roles should be restored through re-established and enhanced posts, properly graded and rewarded, and continued development and investment in education and training. Their responsibility and accountability for budgets and health outcomes should be explicit.

“Organisational hierarchies must be designed to ensure there are no more than two levels between these roles and the director of nursing. Heads of midwifery should report to the board directly or via the director of nursing.”

It adds: “Post-holders and those aspiring to these roles should be better prepared and supported to acquire managerial and leadership competencies as well as being expert clinicians and supervisors of practice.”

The commission said it also backed the fast-track development of nursing leadership, and that regional schemes should be established to bring on potential leaders.

It says: “They will identify talent, offer training and mentorship, and ensure that successful candidates who reflect the diversity of the workforce are fast-tracked to roles with significant impact on care delivery.”

The report also says said barriers to nurse led services should be removed, as putting nurses and midwives in the forefront of leading and managing services “brings many benefits”.

For example it notes: “A major barrier to change concerns public uncertainty or ignorance about the qualifications and competence of nursing and midwifery leaders.”

Additionally the commission says the “social enterprise philosophy is ripe for nursing and midwifery leadership” because of its ability to engage and empower staff.

But it adds: “The lessons apply to all organisations, not only those formally labelled as social enterprises.”   

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