Katherine Fenton, Chief Nurse of UCLH, talks about why the nursing world needs clinical leadership.
The essence of clinical leadership can be summed up in the vision provided by Florence Nightingale when she said “Let whoever is in charge keep this simple question in her head … how can I provide for the right thing to be always done?”
The best clinical leaders strive to do the right thing, to ensure their staff and support services always do the right thing for patients, but go further and look for a better way.
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I have seen and experienced the impact of clinical leadership – both good and bad. If you get it right you have wards where patient experience and outcomes are excellent, but staff strive for greater. Clinical leadership that falls short results in low staff morale, higher rates of incidents and a poor patient experience.
When I reflect on clinical leadership in nursing and midwifery, two roles stand out to me as key to the success or failure of patient experience - ward sister/charge nurse and matron.
Whilst many will look at these roles with historical rhetoric, we have got to get to a place where we move away from this and deal with these roles as they are, taking the best from the past and ensuring the individuals in these roles are right for now and the future.
Anyone who has undertaken either will know they are tough, they require exceptional individuals with caring values, intelligence, and physical and emotional resilience and dexterity. In taking what was best from the past – the confidence that patients and visitors have visibly seeing someone in control, we must ensure ward sisters and matrons also have the skills to mobilise change, seek and deliver new ways of improving care pathways and have an unending quest to do better.
At University College London Hospitals NHS Foundation Trust (UCLH) we are undertaking major programmes of work focused on these two groups of staff. Our ambition is for ward sisters to spend 75% of their time undertaking clinical leadership. From monitoring the activity of ward sisters we know on average just 40% of time is spent in clinical leadership.
Many of the non clinical leadership activities are essential to their role such as budget & staff management and development, but they are not streamlined to minimise the time away from clinical leadership. Add in all of the audit and reporting requirements and it is apparent that ward sister roles have become undoable. This balance has to be redressed. To redress the balance the entire organisations functions both clinical and non clinical have to be focused on getting it right for these individuals and reducing the essential but time-consuming non-clincial workloads.
Taking Florence Nightingales words further ‘back office’ departments must keep this question in their heads ‘how can I provide for the right thing to be always done…for the ward sister’. If they support sisters to be clinically leading – they will get it get it right for patients.
This is the focus of a major change programme for us at UCLH. It requires organisational commitment to these roles and investment in developing them and supporting them to do what they excel at – clinical leadership.