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Government misses opportunity to redefine ward sister role

  • Comments (9)

The government’s failure to make mandatory the recommendation by Robert Francis to get ward sisters out of the office and back with patients and staff is a missed opportunity.

Instead the government response has left it open to “local flexibility” and also open to it not happening.

For many years the role of the ward sister has been undermined. Their critical role as leaders of clinical care side-lined in favour of an office-based existence revolving around ticking boxes.

Is it any wonder that so few nurses now aspire to be ward sisters and those who take up the challenge end up frustrated in their roles?

Over many years the critical role of the sister has been downgraded and their position in the hierarchy means that no one listens to their concerns.

In February in his landmark report Robert Francis highlighted what many nurses already knew; that ward sisters are pivotal to providing effective care. His recommendation for supervisory roles for ward sister which would allow them to get out of the office and lead their teams was widely welcomed.

My concern is that failing to make this recommendation mandatory and leaving this to local decision makers will perpetuate the status quo. Trusts with vision will develop supervisory roles and others will take the risk and continue to use their ward leaders as a flexible workforce.

For many years there has been a lack of investment in clinical nursing and clinical leadership. Senior nurses took their eye off the ball and as a profession we have obsessed about what nurses could become rather than the how nurses could continue to provide compassionate care in a changing health economy.

Robert Francis has shone a light on the immense pressures nurses are under and the need for clinical leadership has never been so great.

I sincerely hope trusts have at last woken up to the value of the ward sister role and will invest in it so nurses can proactively lead clinical care rather than react to it.

It is happening in some trusts. Let’s hope good practice spreads to all.  

  • Comments (9)

Readers' comments (9)

  • Anonymous

    Ward sisters in my place of work are totally clinically based, and band 7 nurses spend most of their time with the patients, included in the established numbers. Where are these trusts that keep band 6 and 7 nurses away from clinical areas. What we need is band 8s out of the office working on the front line to lead by example

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  • Anonymous

    As a Band 7 who spends most of her time in a clinical setting, I really do get fed up with the lack of awareness about just what is involved in our job. The amount of admin required to function is absolutely crushing. The answer is not to tell people to get out of the office. It is to remove the very real obstacles which keep most ward managers in the office. Give them back control of their ward/unit budgets and a much bigger say in staffing (levels and who is recruited). Stop issuing them with impossible targets and mountains of paperwork, endless audits and data input.
    In our Trust the specialist nurses and Band 8s have to achieve a minimum of one shift per week in wards/units. I think that's a pretty good idea.
    But any more would frankly be ridiculous. We need effective nurse managers doing the job in management. I can't sign up to this idea that every nurse should be "on the frontline". We need nurses to be managers, specialists, researchers, etc., if we are going to advance our profession and improve patient care. My Band 5s and Band 6s are extremely capable, well trained and experienced nurses. They don't need a Band 8 leading by example in the frontline. They need a Band 8, at senior level, fighting their corner for more staff, better resources and listening to what we on the frontline tell him/her we need. That is their job.

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  • Anonymous

    I too am a Band 7 in nursing numbers on every shift- that means on the ward nursing. I regularly miss breaks to ensure the other staff get theirs and this is my choice I know.
    Yes I do have an office but it is locked and dusty.
    The managerial aspects of my role are undertaken in my own time, by either coming in to work an hour early or after my shift is over and often from the nurses station on the ward. The office is used to do appraisals which I also do in my own time because we cannot take two nurses of the ward who are on shift and for private discussion.
    I believe that I am not unique in doing all this and that Senior Management are fully aware and actually state that this comes with the job. Where are these Band 7 ward managers who are office bound?

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  • Anonymous

    Anonymous | 22-Nov-2013 8:32 am

    The powers that be must love all these idiots who work for nothing in their own time. It is actually poor management because you are not doing your job in the time and fashion you should be. It doesn't come with the job and you are doing a huge amount of damage tolerating and perpetuating this culture. How can senior management ever be forced look at appropriate and adequate staffing levels when the true picture is being actively and deliberately hidden by those who portray themselves as martyrs to the cause? Stop it. You are doing a great deal of harm.

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  • Anonymous

    My office is most definitely NOT locked and dusty. It is necessary for my job and to keep my ward running smoothly. The door is always open to all. I spend most of my time working in the ward with my staff. However, I am a ward manager and there are duties which are my responsibilty and an absolute must to ensure that the ward is run properly and efficiently. So I have to allocate office time for that purpose. I go home on time as do my staff and we all take proper breaks. I did not come into this job to work myself into a bitter state of slavish ineffectiveness. The best care is given by nurses who are well trained and educated, who are not exhausted and who are provided with the environment which fosters these things. I want the nurses in my ward to have the opportunities to achieve the best they can and to see how it can be done. No manager should be hiding in offices, neither should they be constantly at the patients bedsides. In both cases, there is no management happening.
    This was a wasted government opportunity. I agree with an earlier poster about returning budget control and the power to effect change to the ward manager. I have been doing this job for 30 years, so I know how much eaiser it used to be, but it is not impossible even now.

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  • Interesting read from the above (Anonymous 10:41 am) seems to have an excellent leadership approach with a team that functions. You find such teams being focused, supportive and the multidisciplinary team engages with ease. But at times even with a 'well trained and educated' staff the external pressure and expectation is too high and challenging to a point of being brutal. Unfortunately its not unusual for managers to looses direction and fail to represent staff effectively. Even so, a team that works together is able to support each other excel and collectively able to says NO to unpaid work. I choose not to use 'idiots' (like the above entry) for nurses who give up their free time and work without breaks, but may urge those nurses to reconsider and work as required. Nurses do not set presidency (working without pay) because other nurses and members of staff will find hard to sustain making them fall into a culture of ritualistic practice. I agree, for nurses to have control and move in the right direction the government should sincerely reconsider returning budget control to the ward managers, its never too late.

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  • Anonymous

    I completely agree with the poster who talks about 'idiots'. Worse than being an idiot, any nurse who works for free is dangerous. Setting a precedent for the continued understaffing and devaluing of the role of nurse is definitely dangerous, but it is also very very stupid. All the while we concern ourselves with semantics.

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  • Hi! guys my apologies for the error (the above to read Precedent) Thanks to entry (Anonymous 4:12). What many nurses don't realise is how their conduct, is or may affect lives of staff members with dire consequences. The nurses in question may be clever in performing duties but not wise. Let us be honest in pointing out the wrongs and may just save a life/lives. I may seem soft for not calling them outright 'idiots' as they may seem to be, but I hope individually we get a chance to humanly speak, truly and openly discuss the issues we have in our wards. If there is a change in one, then we shall consider ourselves winners. The battle starts here and with frontline nurses (sounds more like an infantry battalion) actually some may be that challenging now.

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  • Anonymous

    Why can't people just call a spade a spade? There are idiots in the nursing profession who do idiotic things which damage and hurt. They exist from the frontline all the way up to Chief Nurse Idiot.

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