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'Give sisters the freedom to be ward leaders and innovators'


Vicki Leah and Katherine Fenton explain why effective clinical leadership is vital to ensure dignified care

The Commission on Improving Dignity in Care issued a consultation report following last years’ stream of damning accounts of shocking standards of nursing received in particular by older people. These were painful to read on personal and professional levels. The accounts of appalling care described by patients and carers recounted practices and attitudes from nurses that completely contradict everything the profession stands for.

While we welcome the commission’s report and agree with its recommendations, we feel frustrated and extremely saddened that it has taken an independent commission to show us the way forward.

We cannot help but ask: “How did it come to this?” And: “Why did the nursing profession not step up to the challenge presented to us so vividly in these reports and react immediately and decisively?” We are the guardians of quality and we must uphold the traditional values of nursing in a modern and ever-changing NHS.

The obstacles to dignified care include complacency, a lack of urgency, denial, averting the gaze and arrogance. Are we waking up from a slumber to find a workforce that is disengaged, demotivated, “going through the motions” and always “too busy”?

“It is the ward sisters and charge nurses who will be the key in influencing the behaviours and values of their teams”

The commission recommended recruiting staff on their values as well as their technical skills. Values-based recruitment needs to start at entry level as part of university selection. Assessing candidates’ values, motives and attitudes to work in a patient-centred environment may be the best method to sort out the personality from the CV and lend some credence to the traits of compassion and thoughtfulness. Those good at talking about care practices need to be filtered out from those with the instinct to apply good practices. Recruitment around values rather than capabilities will identify those who do not fit with the model of nursing we all want to be proud to be associated with.

At University College London Hospitals Foundation Trust, we launched a multi-year campaign, Making a Difference Together, to support our team to consistently deliver the highest-quality patient experience, moving from “good” to “great”.

Authentic patient and family involvement is at the heart of this campaign. Four hundred employees attended workshops where five members of staff were paired with patients or carers to listen to the “story of the patient”. These powerful “in your shoes” sessions are just one example of a whole set of work streams aimed at defining and embedding a new way of working with the patient always at the centre.

Effective clinical leadership is essential in translating the outputs from Making a Difference into practice, and it is the ward sisters and charge nurses who will be the key in influencing the behaviours and values of their teams.
Organisations must give ward sisters and charge nurses the freedom to express themselves, to challenge, to innovate, to take risks and try out new ways of doing things if they are to transform services. Sisters and charge nurses must be allowed to lead their teams, not just manage them.

We are moving towards value-based recruitment at all levels and for all professional groups. We need to genuinely integrate patients’ and carers’ opinions into core business, and allow sisters and charge nurses to lead from the front, taking the responsibility, accountability and authority to drive through sustainable changes to deliver the dignified care we all expect.

Vicki Leah is consultant nurse for elderly care, London City and London South Bank Universities; and Katherine Fenton is chief nurse and professor of nursing leadership, University College London Hospitals Foundation Trust


Readers' comments (7)

  • From my observations within the NHS most sisters are chosen because they are the more compliant, robotic members of staff who will do without question what is asked of them. The NHS does not promote innovators and has very little power or incentive to remove ineffective staff members or those who are constantly off sick.
    It needs to have managers to manage effectively not promoted healthcare staff.

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  • How true.I am recently retired from NHS after 50 years My daughter works as an AP working 20 hrs a week three and a half days,and she is so stressed through bullying by management its untrue.First she was told that she couldnt finish at 3pm anymore ,had to have a half hour break therefore finishing at 3.30pm Cant pick son up from school now so relying on family.Last week she was told she coulndt finish at 12.30 anymore due to having a half hour break and now has to finish at 1 pm.Yesterday she was told she cant have her half day anymore and hours will be adjusted over the month She has committments to her grandaughter who will have to be paid for an extra afternoon at nursery.She was put down for a full days overtime tomorrow without being asked.When she asked could she finish at 2pm instead of 3.30pm as she had something on she was told NO.She ws then told she will not be paid overtime for this as it will now be taken as normal hours and she will work i day less in the future.Where do we go with these bullying tactics Perople do have lives and committments.If you retaliate which is not my daughters nature you are told to get out.Her union rep is a waste of time as she is more management side than employee.Has anyone any advise please as i am so worried about her Iknow its digressed from the topic but good fair leaders are very hard to find these days and are feathering their own career nests with bullying tactics fed to them by management with total disregard for well being of staff

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  • Is there more than one Union rep where she work? or actual go higher and call the union head office, Surely any change in work conditions should be negotiated and not presumed. Is she contracted hours or does her contract have any noting of shifts types or/and number.

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  • Shes rung head office but was told she had to ring local union which is a waste of time as she is for management!So youve nowhere to go

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  • She is contracted hours 20 hours per week

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  • I think it has to be pointed out that ward sisters generally are just corporate enforcers. What's the point of giving more power to people who hardly question their orders. Nothing will improve for patients or staff. A ward sister should be the beating ethical, legal and innovative heart of a ward. Instead, what do we get? A bunch of yes men. We need effective leaders, people who will challenge the status quo.

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  • I am a ward manager/sister and do not toe the line to anyone!
    I work hard,and ensure that standards are met on the ward by various leadership styles to impress on staff the benefit to the ward of being a "Good safe area for patients" As a result of this I do not have to work in a defensive/sucking up way with management but actually find they leave me alone because we achieve.I stick up for my staff if anyone tries to undermine them but equally they get a "Telling off" in an appropriate manner if old school so the job gets done. We are a happy team and all support each other through good and bad times.Please dont tar us all with the same brush.

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