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Charge nurses are vital to personal care on wards


It’s the sister who dictates care standards, says Katherine Fenton. So ensure patients get better care on your watch

The day sisters put on their navy blue uniform is the day their lives change. The charge nurse has more impact on patient experience than anyone else. Where there is a good sister, there will be good care.

My dad had almost perfect care from his cancer diagnosis to death. Care should be like that for everyone

Many nurses aspire to become that ward sister - the person who everyone looks to for guidance and leadership.

Yet sisters may not realise the huge impact they will have. Every word they utter, every action they take and every measure of behaviour will be noted, commented upon, copied and archived.

So it’s important that sisters know it and have strategies to manage all those impressions and expectations.

Patients need to feel safe, cared for and in good hands; staff need to know what the sister expects and where they are being taken; teams need to know who is in control.

To enable this, sisters should start with remembering why they came into the profession; they should think about what motivates them, and their vision for patients and staff. If staff are happy and well led, the evidence tells us, patients will get better care.

My dad had almost perfect care from his cancer diagnosis to death. Care should be like that for everyone.

They must focus on keeping care personal and this should be checked daily. “Intentional rounding” should be introduced, which means talking to patients regularly and making sure they are OK.

The nurse’s role can got lost in the demands of busy environments. Much more is now done technically - but we joined the profession to care for patients, and make sure they get a good deal from us. Sisters are central to that.

Keep care personal with “intentional rounding”

Businesses such as John Lewis can guarantee customers they will get the same service in whichever store they go in. It is not the same in the NHS. The only way you can ensure consistency is by carrying out intentional rounding and asking patients what they think of their care. Here are my top five tips for implementing this service:

  1. Make sure you attract senior endorsement of this process.
  2. Offer a consistent approach - same message, delivered same way by all involved; both in relation to the initiative and actual rounding practice.
  3. Engage the whole team - make sure frontline staff are involved.
  4. Demonstrate the benefits for patients and staff by measuring relevant metrics and displaying results.
  5. Get staff training right with simple and speedy delivery, perhaps using slides/video, scripts and easy role-play.

Readers' comments (10)

  • I always thought that was what my role was! - I became a sister in 1987 and hope that many nurses have gone on and used me as a role model as I did with the ward sisters I met as a student and staff nurse.
    Why once again does it take an article in the nursing times to state the obvious in good practice.

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  • what an incredibly antiquated and out-moded attitude. all qualified nurses are 'sisters' and accountable for the care they deliver

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  • with such quaint ideas it is high time the government gave the nhs a shake up in order to move with the times and improve the quality of patient care which should be the same for all and everywhere

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  • The problem is that nurses do not aspire to be ward sisters any more. Its a very rewarding role but very stressful and all consuming if done well. We need our best nurses in this role but in so many hospitals grading does not reflect responsibilities that the role entails and role dilution has occured with matrons taking over functions across a numbe rof wards in a bid to save money.

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  • I do not think this is antiquated, out-moded or quaint. I think someone on the ward who has expert knowledge, expectation of high standards and a certain amount of gravitas is necessary. I think a better example than John Lewis is that of a school - look how crucial a Head is to a school, a Head Teacher can make or break a school, in the same way a sister is crucial to the ethos of a ward.

    I don't agree with anon 12.33 that all trained staff are 'sisters' they are at different stages of post registration education and experience. Someone has to lead.

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  • 'I don't agree with anon 12.33 that all trained staff are 'sisters' they are at different stages of post registration education and experience. Someone has to lead.'

    then open your eyes and go and work in other countries ssuch as those in western Europe where they have a more enlightened, modern, mature and sensible approach to nursing and to their patients and high and professional standards of care.

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  • Ward Sisters and Charge Nurses are central to the delivery of high quality patient care. As Katherine says, where there is good ward leadership there is good care; we need to give much more support to Ward Sisters and Charge Nurses and value what they do. Katherine also mentioned the value of 'intentional rounding', to find out more about how this can make a difference read about a project FoNS supported as part of our Patients First Programme; activities like this can make a difference. The project - Proactive Patient Rounding: Developing Nursing Practice to Improve the Quality of Patient Care can be accessed via this web-link:

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  • Anon 27/1 10.42

    I won't have the opportunity to do that, but I would be interested for you to explain further. They may all have the title 'sister', but does no-one take ultimate responsibility for a ward? Perhaps you could share your experience?

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  • the new government are providing the hs with golden opportunities for reforms which should wake people up and motivate them to eliminate stuffy old fashioned attitudes and ideas of superiority. management is not about putting individuals on pedestals and following them like sheep, kowtowing to them or 'awarding' them with symbols such a dark blue frock, frilly cap, cuffs or different coloured belts, in an attempt to distinguish them from the rest (we are already all unique individuals with our own precious distinctions and need to show who we are - we do not need external symbols to demonstrate this unless something is lacking - nursing isn't a fashion parade!) it is about real leadership, a genuine interest in other people in sickness and health, modern working practices and the needs of patients and the staff looking after them, professional hands on experience, keeping up to date and knowing how to employ the latest knowledge of and developments in medicine and nursing, management, technology which includes information technology and skills in using these for excellent communications, and adopting management practices from the latest business models which are constantly evolving.
    New and up to date ideas and attitudes more appropriate for the 21st century motivate and unleash creativity in employees and encourage the professional growth required to provide excellent service to patients and provide greater job satisfaction than the old-fashioned, dictatorial, bullying culture which stiffles all the qualities that were initially sought by organisations on employment of their staff. Is there any point in providing advanced training if this is not utilised? All qualified nurses in hs employment should possess all these qualities which they should feel free to engage in their professional practice.

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  • i agree with the above posters.
    I love my two ward sisters, but on the other hand the most rude, the most politically weak and the most socially inept nurses are of the senior variety.
    Their weakness and apathy about the corruptness of trust management, the ridiculousness of pointless and ineffectual management decisions and the following of inferior ideas is to blame for the weakness of nursing as a profession.

    Too many Sisters and Charge Nurses lack actual power and are really bullied by matrons, consultants and relatives. most want a quiet life really. but many stay in positions of authority despite this. they don't move on they stay and rot the post to the very core.

    But of course maybe i'm biased becaue my managers are great and others are really crap at their job.

    As a senior staff nurse i have to deputize for them but the standards remain the same - though to be honest, everyone says the shift is quieter, calmer and better organized when i'm in charge.

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