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Call to support sisters and regulate advanced roles


“Immediate steps” must be taken to strengthen and recognise the “linchpin” role of ward sisters and charge nurses, the Prime Minister’s Commission on the Future of Nursing and Midwifery recommends.

It says local reviews need to ensure the role is properly paid and banded and given “optimum” support from managers and senior clinicians – including access to management training and mentoring.

The urgency of the recommendation reflects the commission’s concern that the status of the role has been downgraded, leading many relatively inexperienced nurses to be promoted into the role without sufficient clinical or managerial experience.

Sources close to the commission told Nursing Times the downgrading was partly due to the sister’s loss of control over functions such as cleaning, but also because of the elevated status now given to specialist nurses - who are often paid more than ward sisters for what are regarded as more interesting jobs with a lighter workload.

Among the draft recommendations, the commission says the Nursing and Midwifery Council should regulate advanced nursing practitioners to ensure each the up to date skills to merit their title.

The recommendation follows discussions between commissioners, NHS employers and the Department of Health that too many advanced and specialist nurses have been promoted into their posts – many paid at band 8 and above - with no ongoing evidence they continue to work at an advanced level. Commission members have visited Australia where advance nurses are regulated – a system that results in fewer but more consistently experienced advanced nurses.

Nursing Times has been told the regulation of these staff groups could lead to a significant number being stripped of their “advanced” or “specialist” title, with knock-on effects for pay and grading. But a source close to the commission said: ”Pay is really not the motivation; it’s about safety”.

However, a director of nursing involved in the discussions told Nursing Times that nurse leaders saw it differently. She said her trust planned to cut its “specialist” and “advanced” nurses and use some of the money saved to increase pay and training opportunities for ward sisters.


Readers' comments (5)

  • I absolutley aggree ward sisters have a tough job. But to suggest most advanced nurse practitioners are paid more and have a lighter work load is ridiculous. I'm an advancved nurse practitioner and an independent prescriber with clinical responsibility. I'm paid at band 7 and most certainly do not have a lighter workload.

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  • I'm working towards an MSc AP and expect to be paid for the responsilibilty and training accordingly. I'm wondering if the previous comments are from people with BSc's in NP or AP as the titles we all use are far from clearcut. I'm surprised ward sisters/charge nurses are still only paid as band 6's but that fits with my general amazement, and anger, that the government is still comfortable paying us all so little considering what we actually do and in the quantities we do.

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  • Please nursing press explore your facts and get them correct. The ward Sisters lost the control of hospital domestic services over 20 years ago so please do not report on this nonsense. This is an excuse! The ward sister has the overall patient care responsibility in an ever increasing safety and health aware society, the overall responsibility of utilisation of funds, skill mix and staff resources, the overall accountability for ensuring the staff are educationally and skill responsibile among many other responsibilities. The ward sister salary has not increased since I held my last position 26 years ago although the banding and grading system has camouflaged pay stagnation. Most ward sister have continued their education at their own expense are equally as qualified as any advanced practice nurse or clinical nurse specialist and they have gained on the job all round clinical and managerial experience. However let it not be forgotten that the advanced practice roles also carry with them extensive sole responsibility for patient care, recovery and survival and yet amongst those roles are many differences in salary and grading. The role is the same with the same responsibilities whether it be in a city position or in a country area. Advanced roles and I am including ward sisters and clinical nurse specialist, should be rewared for the expertise that comes with the role and responsibilities. Once again the government must take responsibility for the division in nursing. We don't hear of the same issues in medicine and yet the nursing profession is expected to step up to the mark and take on what was previously medical responsibility and care. Not to discredit the work of our medical colleagues, I understand that our medical colleagues have fared very well over the years as they progressed in their careers.
    Advanced roles should be armed with advanced experience as well as advanced qualifications. Experience would limit the flood gates from opening and permitting inexperienced staff from flowing into the advanced roles without background experience to sustain them in the role.

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  • I am in a position of having been employed in the role of specialist nurse for 7 years and more recently as a ward manager (2 years). Both posts were at band 7.

    My personal experience is that the report is a true reflection of the disparity between the nurse specialist and ward managers levels of work load and responsibility. As a nurse specialist I had specialist knowledge and qualifications. I ran clinics, developed and managed a service. I had respect, status, few concerns of staff management issues (I had two team members) and imense job satisfaction. As a ward manager there is role ambiguity, never enough time, I feel like I am juggling many plates at the same time, I manage 30 members of staff. I rarely have time for a lunch break and work in my own time frequently. (something that never happened as NS).
    I have never exerienced such stress or workload than I do now as a ward manager. I only changed roles due to re-location and am actively seeking to get back to nurse specialism.

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  • I have been a ward manager for two years having worked as a nurse practitioner in three different settings incuding the role of Community Matron for the previous 9 years during which time I completed the nurse practitioner MSc.
    Both posts were graded at 7 and I defended my banding vehemently as a nurse practitioner and therefore understand and sympathise with the similar defensive comments above.
    However my move to the ward manager role was self motivated as I had moved from a F grade senior staff nurse role into a G grade NP role and felt that a piece of the jigsaw was missing from my 30+ year career.
    I am well qualified to compare and contrast the two roles and consider the role of ward manager to be by far the more challenging due to the extremely wide remit off the role as already discussed in earlier comments.
    This is not to decry the practitioner role as will undoubtably be seen by some, there are highly qualified, motivated and innovative nurses in both roles as well those who don't step up to the mark. However a degree of honesty and realism should be adopted and the essence of both roles is to take ownership and demonstrate our worth to our employers, colleagues and most of all our patients.
    As with the gradings etc, the process of re-evaluation will undoubtably be divisive and nurses will be drawn into a self preservation mind set, don't let this happen, stand together for what we believe in and if each of us aspire to meet the requirements of our roles and beyond then we should have nothing to fear

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