The change in role from ward sister to ward manager has caused significant recruitment problems, as nurses want to provide expert care, not balance books, says Janet Scott
The ambition of most of my generation of student nurses was to be a ward sister. Specialist and consultant nurses did not exist and there was only one matron in a hospital.
The sister was the ward expert, an advanced practitioner who ensured that patients received excellent care from ‘her nurses’. She – there were few male charge nurses in general hospitals at the time – set the standard of care on her ward.
With the introduction of general management in the NHS in the 1990s, sisters have become ward mangers. Consultant and specialist nurses – rarely part of the ward staff – have been introduced along with matrons.
This has led to not only a name change for sisters but also arguably a dramatic role change that has been little researched.
The role has also been influenced by changes in medical education and working practices. Ward managers’ function has become a combination of managerial tasks with a clinical role. This can and does lead to divided loyalties.
In practical terms, ward managers’ jobs are not popular. Anecdotally, staff nurses are reluctant to apply. Evidence suggests that trusts are having increasing difficulty in recruiting to these posts, and Wise (2007) found that only 10% of nurses and midwives wanted line managers’ jobs.
In a qualitative study to examine ward managers’ roles in 2006–2007, I interviewed 16 ward managers, and two chief nurses in two district general hospitals. I presented the findings at the RCN research conference earlier this year. All ward managers took pride in their clinical expertise, and considered themselves role models for both nursing and junior medical staff.
Of the 16 interviewed, none were supernumerary. Fourteen said they still undertook clinical practice; the amount of this varied and was influenced by their area of work and their time in post. Of the other two, one saw herself as teaching and giving advice, and the other as a provider of expert advice.
The amount of time spent in the clinical area appeared to be influenced by the type of ward in which they worked and their length of time in post. Those who had recently been promoted tended to do more clinical practice than the experienced managers, with the exception of the two theatre-ward managers and a midwife. To cope with their administrative responsibilities, they worked on average an extra 7.5 hours per week.
These ward mangers found the job a challenge and felt they could make a difference. Their priority was to ensure quality of care according to their professional standards, rather than accounting proficiency. However, this could lead to conflict with other members of their organisations and their corporate objectives.
Little research has been done to examine the consequences of the role changes. If we want to provide clinical expertise in ward areas, and improve quality of care, it is essential that ward managers can share their expertise with staff in a supernumerary capacity.
The ward manager’s role has to be reviewed, as suitable candidates are not being attracted to the job as it stands. This is unsurprising, as nurses are recruited to nursing to work with patients and make a difference, not with a desire to balance a budget.
Janet Scott is independent nurse researcher and was associate senior lecturer, School of Health and Social Care, University of Greenwich. She was seconded to the Centre for Health Services Studies at the University of Kent to do the research reported here
Wise, S. (2007) Wanted: the next generation of nurse and midwifery managers. International Journal of Public Sector Management; 20: 6, 473-483.