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Brendan Brown: 'Clear roles and uniforms give patients clarity, and staff pride'


Giving staff role clarity will help to will bring improvements to patient care, says Brendan Brown

The nursing profession has been under the spotlight in recent years. I believe most nursing care is excellent - but we know only too well that there have been cases when it has fallen below acceptable standards.

While it is vital that we deliver care that is consistently safe and of a high quality, it is important that we ensure public confidence is fully restored and that services are perceived as being of the highest standard.

So why, with all the complex and challenging issues of life on the frontline of an acute hospital trust to deal with, have I been changing job titles and uniforms?

“Feedback from staff tells us that the traditional dresses and belts make them feel proud of their work and status”

First, I completely agree with those who say that changing job titles and uniforms won’t make any difference unless the culture of an organisation changes. That’s why this decision needs to be seen within the context of a broad range of measures that are transforming the way we work at Queen’s Hospital in Burton and at our two community hospitals in Tamworth and Lichfield.

Achieving effective and compassionate communication has been a key focus for us. We knew that patients and carers sometimes struggled to know who to speak to on the wards when they needed to ask questions and raise issues. So, our matrons now wear distinctive navy uniforms with red piping, which easily identify them as a figure of authority.

Uniforms have to be practical. In addition, they should promote a professional and positive image. Feedback from staff tells us that the traditional dresses and belts make them feel proud of their work and status.

The changes in job title are intended to serve the dual purpose of making the patients and the public clearer about what they do - and also to give the staff a strong sense of identity, self-respect and pride.

Ward managers are now called senior sisters or senior charge nurses, or senior midwives in our midwifery teams. I believe that the change in title emphasises that they are experienced nurses, not someone in an office who looks after administration and stationery supplies. Importantly, they have also been given more time to supervise and support staff through a restructure of responsibilities.

We now have nursing assistants rather than healthcare assistants. This emphasises the central importance of care and compassion for patients to their role. To me, a “healthcare assistant” sounds like a job in retail. This change in job title was also a recommendation that came out of the Cavendish review, carried out in the wake of the Francis inquiry into Mid Staffordshire Foundation Trust.

I disagree with the idea that a return to more traditional job titles and uniforms in any way reinforces old-fashioned notions of a nurse being a doctor’s handmaiden - quite the opposite. I want to empower leadership at ward not just board level. Staff members who have completed the one-year Royal College of Nursing clinical leadership programme have brought tangible improvements to patients and other staff through the skills and confidence they have acquired and this mindset of leadership and ownership is one we seek to foster in all our nursing staff.

We have also been reviewing and re-organising shift patterns in conjunction with staff, and a massive recruitment drive has seen 48 newly qualified nurses join the trust last autumn with additional nurses from Portugal joining us in 2014.

I am very proud of the nursing staff at our trust. By assisting them to have pride and clarity in their roles, and giving them a voice and the opportunity to challenge practice, we are bringing real improvements to patient care and experience.

Brendan Brown is director of nursing at Burton Hospitals Foundation Trust


Readers' comments (10)

  • i know an occupational therapist who became a ward manager, surely "senior sister" or "senior charge nurse" would only have added to the confusion.

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  • that is part of the problem in the UK and so pathetic and militarised with all these ranks, titles and other distinctions such as uniforms which breed envy, nastiness and bullying - for goodness sake! in my environment we were an interdisciplinary team all of equal status and the same uniform whose main aims were to focus on and care for each and every patient and always to strive to give them our very best. We also communicated openly and transparently with one another as mature adults and autonomous professionals and with our patients and explained our care and everything to do with their case so that small errors were quickly noted and addressed without developing into full scale crises which those in the NHS don't even have a clue how to manage effectively.

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  • Every few years this seems to come up. Personally, I think there needs to be some distinction between qualified and unqualified. I've worked somewhere where HCA's and qualifieds wore virtually the same uniform save for a tiny stripe on the arm of the qualifieds dress and it made for lots problems. Doctors would give orders to what they thought were Staff Nurses, basically endless confusion.

    I don't think we need to go back to hats and belts, I'm all for comfort and like the loose-fitting theatre wear that now seems to be all the rage.

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  • Yawn.

    Best practice is to put the entire staff into the same comfortable and laundered scrubs with 'nurse' 'doctor' 'pharmacist' and so on. Any uniform initiative which singles out nurses alone is ridiculous. As is expecting patients to know who and what rank someone is by the colour of the stripe on their tunic.

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  • Anonymous | 9-Apr-2014 7:48 pm

    I agree although I don't find signaling each group of professionals with different colours as I do different ranks of people within the same group. to me they are all the same and as you say how and why should patients be expected to knot what all the different colours and ranks mean. it is not the military services. Doctor, nurse, physio, cleaner, bin man, etc. followed by their name would be just fine.

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  • Wish Australia would follow that path. Make a nurse an nurse and not a "shop assistant' or what ever other concept may be used. Have a uniform which separated nursing staff from every day wear of administrative staff, visitors etc, staff of other business eg banks etc. Be proud to be a nurse

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  • Tosh and conflation. Doctors don't have uniforms and do not rely on dress mode to feel pride or clarity concerning their role

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  • Anonymous | 19-Apr-2014 10:24 am

    frustrating one cannot just tick good comments and those one agrees with here.

    very well said.

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  • sounds more like the instinctive needs and behaviour of our nearest relations, the apes!

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  • what about the men- do they have to wear dresses?

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