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Senior nurse blames ward sister rotas for poor standards


Ward sisters at a hospital criticised by the Care Quality Commission are forced to spend 40% of their time on bureaucracy, an independent review has found.

CQC inspectors reported “major” concerns about standards of nutrition when they visited Worcestershire Acute Hospitals Trust as part of a programme of dignity and nutrition spot checks at 100 hospitals earlier this year. It described patients being prescribed water to make sure they had regular drinks.

An independent review of the trust by Professor Janice Stevens, nurse and former Department of Health director of healthcare acquired infections and mixed sex accommodation, found it was now compliant with the nutrition standard.

But she was critical of the trust’s rota system, which means sisters spend only three days a week on the ward. Of the remaining two days, they are expected to spend on-call helping co-ordinate bed management across the trust’s two hospitals and one day in the office dealing with admin tasks such as recruitment and audit.

Professor Stevens said: “It is genuinely hard to see how they can effectively fulfil their role as leaders when they are unable to be ‘in-charge’ of their ward on a daily basis.”

She recommended the trust review who should be responsible for the admin tasks that are currently left to sisters and matrons.

Speaking at the NHS Confederation annual conference last week, CQC chief executive Cynthia Bowyer gave an update on the inspection programme, which is carried out by teams including a senior nurse.

Results are in for 68 of the 100 trusts, but only 57 have been found to fully comply with both dignity and nutrition standards. At least 11 hospitals have failed to meet both standards, of which two have “quite serious issues”, Ms Bower said.

She said the biggest difference between trusts failing and passing was “simply people being kind”.

Last week the CQC revealed Sandwell and West Birmingham Hospitals Trust and East Sussex Healthcare Trust were the latest two trusts not complying with its standards.


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Readers' comments (18)

  • Rotas and admin are often the bane of many of our jobs, and someone needs to come out and seriously tackle it before we are buried under its weight.

    And I'm not even going to reply to that stupid and insulting comment “simply people being kind” again!

    But when are the CQC going to grow a pair and actually tackle the problems they find instead of just mentioning them?

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  • "...director of healthcare acquired infections and mixed sex accommodation"

    what a strange job title! Is there some sort of link between what seems like two different areas of specialization?

    Maybe it is just me but I find this whole article disjointed and confusing, not to mention the strange rota system for sisters and as for

    "...the biggest difference between trusts failing and passing was “simply people being kind”."

    Is this all that the CQC are being paid to investigate? what recommendations are they making and what action are they taking in the trusts where they find that people are not kind and what percentage of 'kind' people does it need in each trust to pass their test?

    Is the assurance that sick people are receiving adequate hydration and nutrition merely an act of kindness in a trust as the last paragraph leads us to believe?

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  • Staffing and rotas could be done by admin given training and guidelines - releasing our senior experienced nurses to share their knowledge and skills with their teams. In other Public Services, they have non-professional 'duties officers'!

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  • tinkerbell

    As a ward sister i am on the frontline every shift i work, on the ward with my colleagues and patients. I might get one management day per month to catch up on audits and supervision since my employers have decreased my management days. Guess what, i like it that way. At least i know what my patients are eating and drinking and how often. I know most things about what is going on. As a nosey parker and a hands on nurse i make it my job to know what is going on.

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  • In these modern times, duty rotas have to take into account 'children and family' friendly issues, which can restrict some options for covering shifts. I am not saying this concept is wrong, but that it is something that has an influence on duty rostas. I know many sisters and other staff responsible for duty rotas, often do this task at home in their own time. Another thing I have found in my experience is that senior management, not only nurses, do not always negotiate with each other to cover each other. Again it seems that problems are devolved to the people on the ground that have to deal with real patients and people.

    I found this article jumping from dignity and nutrition to sisters being allocated bed management tasks. I believe the latter is down to the decisions of senior management and not what the ward sister would rather be doing. In that case one can't blame the ward staff for not addressing ward issues when ward staff are delegated elsewhere. The reason that ward staff are delegated elsewhere is to cover for gaps in that service, be it bed managers, matrons or more senior staff.

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  • tinkerbell

    just an update, when i mentioned to one of my senior managers yesterday that i hoped to retire next year he said 'good that will save us some money'. Hmmm! I hope he meant this tongue in cheek but as everything is about saving money now i guess i may be an expensive luxury.

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  • boots4daisy | 14-Jul-2011 10:12 am

    even though tongue in cheek, which one seriously hopes it was, it just goes to show what is foremost in manager's minds instead of focusing on patient care which is presumably central to any healthcare organisation! A very unhealthy culture pervading our society which has probably evolved from attitudes at the top level of government!

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  • Perhaps these Sisters ought to check their job descriptions. Since when have senior nurses been bed managers? What do the unions have to say about this? Surely if the nurses in question say no, our job is to oversee our wards then who can argue with that? The NMC? I don't think so.

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  • tinkerbell

    Anonymous | 14-Jul-2011 10o:34 am
    of course you are absolutely correct. There needs to be a new way of translating manager speak e.g., save money means frontline nursing cuts, patient centred care means if you have enough staff.
    Caring means coping. Patients means pawns in a game. Sadly it is all very devious terminology designed to hoodwink us into believing that upper management actually care, I am sure there are some managers that do care but they are drowned out and worn out and too exhausted to make any difference. It just comes down to jobs for the boys and they are hardly going to sack themselves are they?

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  • Lets just face it,its all a bloody mess, just crisis management every day and all day,all over the country.
    If management really want to know whats going on..??? do they??? then they should all go do an "auxiliary" shift on a ward,get in the thick of it,see the truth!!! Ive never seen my director of nursing anywhere near a nurse or patient at ward level.
    The matron couldnt even help on an acute ward when they were short because she, had not bothered to keep updated on new equipment!!! that was her excuse not to help a desperate staff nurse in tears,so she couldnt do obs,or iv drugs or a drug round,best she could offer was doing a tea round!!!!! so left the ward!! What the hell is wrong with you woman,MAKE it your job to update youre supposed to be the top clinical nurse,the one we go to for guidance,isnt that what the matron role came back for...a very visible!! (what in a office at endless meetings) expert for patients,visitors and nurses.Just another name for manager puppets as i see it.

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