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INNOVATION

The transition from staff nurse to ward leader

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To aid the challenging transition from staff nurse to ward leader, a trust developed a training programme to help them acquire leadership and management skills

Abstract

Moving from the staff nurse to ward sister role involves acquiring a range of skills to lead and motivate a team and ensure standards of care are high. Recognising new ward sisters’ need for support, a trust developed a training programme to enable them to develop the necessary skills and provide mutual support. This article discusses the development of the programme and offers the reflections of three ward sisters who participated in it.

Citation: Spencer C et al (2014) The transition from staff nurse to ward leader. Nursing Times; 110: 41, 12-14.

Authors: Caroline Spencer is project nurse, chief nurse’s team; Tara Al-Sadoon is a ward sister; Laura Hemmings is ward sister; Karen Jackson is ward sister; Paul Mulligan is change manager, organisation development; all at Guy’s and St Thomas’ Foundation Trust, London.

Introduction

The role of the ward sister/charge nurse has been highlighted as one of the most important in the NHS (Sprinks, 2010), particularly in relation to change management, vision and role modelling (Firth-Cozens and Mowbray, 2001), and providing developmental opportunities for more junior staff (Stanley, 2006). Bradshaw (2010) identifies the ward sister as the “linchpin”, drawing together patient experience and the coordination of the multidisciplinary team. The role is fundamental to ensuring high standards of care are achieved and maintained, and that patients’ experiences are optimised (Royal College of Nursing, 2009).

Ward sisters are the public face of hospitals and represent a level of management, authority and leadership to patients (RCN, 2011; Lee and Cummings, 2008). They are also role models and advisers to both nursing and multidisciplinary teams (Department of Health, 2008).

Ward sisters are central to achieving high standards, competence and a caring culture (Fenton and Phillips, 2013; Francis, 2013; DH, 2012). However, for years the development of nurses in this vital role has been neglected and many nurses have made the transition to ward sister though a process of trial and error.

Training and development

The organisation development team at Guy’s and St Thomas’ hospital was asked to deliver support and development to all ward sisters with the aim of increasing their ability to be more independent and autonomous (Cheung-Judge and Holbeche, 2011).

To do this, we needed to understand the ward sisters’ current experiences, so we undertook structured interviews and fed back the themes to the chief nurse and the heads of nursing. The intention was to build a development programme that addressed new ward sisters’ needs, building on their aspirations to become effective in their role and develop the necessary management and leadership skills and behaviours. The interviews, with approximately 30 ward sisters, 10 matrons and six heads of nursing, took place in November and December 2011 and covered the following questions:

  • What is your biggest challenge as a ward sister to ensure patients receive excellent care?
  • What culture do you need to meet this challenge?
  • What does the leadership team need to do to create this culture?

It became clear that there was an opportunity to provide experiential learning, create peer support and focus on developing the attitudes and behaviours needed to deliver excellent care.

The programme

We developed Leading an Excellent Service, a programme tailored to meet ward sisters’ needs, aligned with the trust’s values.

The two-day programme was rolled out to groups of ward sisters between January and June 2012, with more than 60 taking part; it is now offered as required. Running it over two consecutive days provides an intense period of development and creates an environment in which participants can develop mutual support networks.

It is based on a four-stage performance management cycle (Fig 1), which we developed to reflect general good management. This approach helps participants make the transition from staff nurse to ward sister by exploring the attitudes, behaviours and practices ward sisters need to be managers and leaders. We aimed to raise awareness of the core elements of leadership and encourage participants to take responsibility for themselves and their service.

We use Argyris’ Ladder of Inference (Senge, 2006) to examine how unconscious processes can get in the way of being an effective leader unless they are uncovered and explored. Understanding the choices we have about our behaviour is essential and the model shown in Fig 2 helps participants to reflect on how they can only lead from “above the line”.

A key intervention on the programme is to develop a culture of feedback. This is practised in the classroom, focusing initially on praise and validation, and acknowledging good work; Studer (2003) identifies this as a key enabler of staff motivation, engagement and responsibility. One practice we encourage is to “hunt out good practice in your staff and validate it”, such as speaking politely to an angry or anxious caller, or going out of the way to help someone who is lost. The aim is to increase participants’ observation of good behaviour in their teams, and encourage them to offer immediate positive feedback to encourage more of this.

The final key skill practised is managing difficult conversations such as those required if a member of the team has not met the standards of behaviour or practice expected.

At the end of the programme, participants commit to what they will continue to work on with each other’s support. Their heads of nursing are invited to hear about their learning experience and draw up a contract to support them to make personal changes and changes at the ward level.

The following case study presents the joint reflections of Tara Al-Sadoon, Laura Hemmings and Karen Jackson before and after they attended the programme and their personal journeys from band 6 staff nurse to ward leader.

Reflections of the ward sisters

Before becoming ward sisters, we were senior staff nurses, bursting with ideas but without the opportunity to put them into practice; we had vision but lacked confidence to make changes. One-year secondment opportunities gave us the opportunity to try out the role of ward sister and gave us more confidence and courage to step out of our comfort zone and think positively and seriously about being able to lead our own teams in substantive ward sister posts.

We did not receive any formal preparation for the role before our secondments, and learnt on the job by observing other ward sisters. In the early days, we felt the weight of responsibility on our shoulders for the reputation of our team, our ward and our trust.

The leadership programme - along with support from our line managers and the chief nurse - enhanced our knowledge and skills in this essential nursing role.

We experienced some difficult, emotional days but have found our way through with the support and empathy of our peers.

During this journey we have compiled a list of tips on being a good ward sister (Box 1); Box 2 summarises our progress over the year from appointment to becoming experienced ward sisters.

Box 1. Dos and dont’s for ward sisters

Dos

  • Plan and prioritise your workload
  • Be realistic about what can and cannot be achieved
  • Take breaks and ask for help and support
  • Reach out and explore the support network (use your peers and support each other)
  • Have a clinical supervisor/ mentor
  • Clarify and review your objectives and skills needed to achieve these
  • Work closely with your line manager and understand their management style, priorities and pressures
  • Delegate to your deputies, ensuring it is a learning opportunity
  • Be proactive and put your ideas forward
  • Challenge in the best interests of your patients and staff
  • Listen to and support staff, giving them the opportunity to share their ideas
  • Give feedback to and motivate your staff
  • Always be fair and consistent
  • Be approachable
  • Have time for staff – always make time to speak to them
  • Empower your staff so they can make informed decisions
  • Trust your instincts
  • Realise you cannot do everything at once
  • Be confident to say no when appropriate
  • Don’t be afraid to have a different opinion
  • Involve everyone in your ward
  • Remember that it is you who makes a difference

Don’t

  • Allow other people’s emergencies to become yours
  • Encourage staff to call you at home
  • Stay late
  • Come in on your day off
  • Take work home
  • Feel guilty

Box 2. The transition to ward sisters

  • Applying to be and being appointed as a ward sister
  • The joy of wearing the sister’s uniform and the reaction of colleagues

Novice ward sister

  • Realising the enormous step from staff nurse to sister
  • Focusing on the role and fulfilling the job description
  • Feeling the weight of expectations – we should know everything
  • Learning on the job, dealing with daily challenges of managing staff
  • Feeling like the “new person” in meetings with “veteran” sisters
  • Finding courage to speak up
  • Establishing networks within nursing and multidisciplinary teams
  • Spending time with experienced sisters to learn the role
  • Finding support from matrons, the head of nursing and the chief nurse

Gaining confidence

  • Establishing a supportive group of sisters in a similar position to share problems, thoughts and ideas and to challenge each other
  • Using this network to prepare rational arguments for meetings
  • Gaining in confidence, finding a voice to speak up

Experienced ward sister

  • Supporting new sisters in their roles
  • Providing input to training for ward sisters including development programmes, human resources and risk management courses

Progress in the role

It has been a challenging journey but our knowledge has grown enormously, both clinically and in our leadership roles. The programme has enabled us to learn techniques to support and develop staff, ensuring we get the best out of our teams by coaching and inspiring them. We also have better insight about how the trust works and our position within it.

After three to four years as ward sisters, we feel more confident in our role, in making decisions and that we will be supported in those decisions. We are more assertive and can approach multidisciplinary team members with confidence. Most importantly, this has resulted in better care and outcomes for patients.

We are now experienced ward sisters who have created cohesive teams and inspired others, and our progress has been acknowledged by our managers and peers. We own our wards and we own our teams.

Ward standards

We run successful wards that provide safe and excellent care; we score highly in the trust’s ward accreditation programme, which measures care quality. We have won internal care awards for offering outstanding care to vulnerable patients and their families and consistently having positive patient experience feedback, and students are keen to return to our areas once they qualify. We have developed staff to be future leaders and can ensure our wards run smoothly when we are not there.

Conclusion

Newly appointed ward sisters often struggle in adapting to their role, which requires management and leadership skills in addition to existing clinical skills.

The Leading an Excellent Service programme, experiential learning and peer support have empowered ward sisters in our trust to grow and develop their teams and wards to ensure high standards of care.

The case study illustrates how ward sisters develop skills over time, moving from novice to expert. The outcome is ward sisters who have the skills to lead teams effectively and provide high-quality care. 

Key points

  • The transition from staff nurse to ward leader involves developing a wide range of skills
  • The ward leader role is crucial in determining the quality of care
  • Development programmes can help new ward leaders develop leadership skills
  • Leadership skills facilitate staff motivation, engagement and responsibility
  • Even with support, new ward leaders need time to become confident in their role
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