The increasing pressures placed on nurses to meet government targets, reduce waiting times and improve infection control requires a lot of support from senior staff, particularly directors of nursing services (DNSs).
Yet an NT survey has revealed that almost 40% of nurses do not actually know their DNS at all. One in five say they do not know their DNS well, while more than half of the 2,757 respondents say their DNS does not know who they are either.
‘I have never seen my DNS in my three years of employment,’ says one respondent. ‘I have worked for my trust for two-and-a-half years and I don’t know who our director of nursing is,’ says another. And a third responds: ‘I do not think that the director of nursing knows any of the nursing staff on the shop floor.’
These are just a few of thousands of comments received in response to the survey which reveals that, although some nurses have high praise for their DNS, others feel they do not do enough to support nurses on the wards.
‘Directors of nursing will say there is a real issue about getting out and about,’ says Janet Davies, RCN director of nursing and service delivery.
‘Some work at enormous trusts with many sites and it can be a real challenge. But nothing replaces actually being able to see things for yourself and meet staff, so this has to be a priority.’
DNSs have to work hard in order to get to know their staff, says Eileen Sills, chief nurse and chief operating officer at Guy’s and St Thomas’ NHS Foundation Trust in London, which employs over 2,500 nurses and midwives.
‘You have to work in a visible and engaging way,’ she says. ‘I meet all students and new starters at induction
and have an “open door” policy so that staff can come and see me any time. It is important to make staff feel supported.
‘But shift patterns and staff turnover mean there will be staff you don’t get to meet,’ she adds.
The NT survey revealed that almost 70% of nurses do not think their DNS makes it their business to visit every nursing department, and only 35% think their DNS is knowledgeable enough about their area of practice in order to make good decisions about it.
‘There needs to be tangible evidence of good nursing leadership,’ says Lesley Doherty, director of nursing and performance improvement at Bolton Hospitals NHS Trust in Manchester.
Ms Doherty conducts regular ‘go and see’ rounds of all nursing departments. As well as checking that nursing policies and practices are being adhered to, she speaks to patients and staff and is accompanied on her rounds by nursing students. She also does clinical practice when needed.
‘I have always visited the wards to see what staff are doing,’ says Ms Doherty. ‘Having a visible presence suits my leadership style. But it is about visual management, I don’t interfere.
‘It is also important for nurses to understand you are still a nurse and are prepared to do shifts,’ she adds.
Ms Sills also does regular ward rounds and the whole of the senior nursing workforce at Guy’s and St Thomas’ do clinical shifts every Friday. ‘We go wherever the support is needed, from care of the elderly to oncology,’ she says. ‘And if I
want to see someone, I’ll go to their area of practice. Working outside the office raises visibility.’
Many nurses who took the NT survey said that although they were receiving feedback from senior nurses, they did not feel they were getting enough from their DNS.
‘Directors of nursing have to make themselves available so that nurses can raise any concerns or issues,’ says Ms Davies. ‘But they can’t possibly have in-depth knowledge of every clinical area, so they have to be able to rely on their advisers on the ground.’
Ms Doherty has monthly ‘grapevine’ meetings with her ward managers where they review audits, assess ward performances and set targets.
‘I get feedback from the wards and it is also a myth-busting session to dispel any fears or concerns nurses have. The key aim is for staff to be involved in any decision-making,’ she says.
At Guy’s and St Thomas’, the ward within the trust with the best performance receives a monthly £1,000 prize, and there are also awards for areas that have made good improvements.
‘Information is collected from the wards and presented by matrons at a weekly meeting,’ says Ms Sills. ‘You have to be able to rely on your senior team to enable you to make informed decisions so you can recognise areas of best practice. It is not just about the bad news,’ she adds.
Although many nurses who responded to the NT survey were critical of their DNS, more than 70% say their director of nursing is focused on improving patient care, and 64% say they do have the support they need to make changes to improve care in their area of practice.
However, three out of five respondents say they feel that their DNS’ obsession with targets and waiting times is detrimental to patient care.
‘We are currently being expected to see more and more patients in order to meet targets, despite nursing staff not being replaced when they leave the unit,’ says one respondent. ‘Targets tend to relate to new patients – therefore existing patients get pushed back and their care is compromised,’ says another.
But both Ms Sills and Ms Doherty dismiss the notion that their actions are purely target-driven.
‘All nurses have a responsibility and an obligation to meet national targets but that does not mean it is done to the detriment of patient safety and quality of care,’ says Ms Sills.
‘Targets are important but everything is patient-centred,’ adds Ms Doherty. ‘Ward managers set handwashing targets and do hygiene audits which are there to improve care, not undermine it.’
Many respondents to the NT survey revealed they do not fully understand what a DNS actually does. So what can DNSs do to raise their profile and dispel some of the negative myths surrounding their role?
One answer is to adopt an ‘open door’ policy so that they can get to know the priorities and concerns of their nurses
and make their role abundantly clear, says Ms Doherty.
‘There needs to be a mechanism in place to raise concerns,’ she says. ‘Nurses can contact me directly at any time, I always reply personally to any emails and am always available if I am needed.
‘Directors of nursing also need to make sure their role is explained,’ she adds. ‘If not personally, then through matrons or ward managers. You have to be prepared for criticism if people do not understand what you do.’
What nurses said about their directors of nursing