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Power to the people

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If you want a say in how your organisation is run, better opportunities and a chance to improve your clinical skills, consider a career at Nottingham University Hospitals where the decisions are shared.

If you want to work for a trust that listens to you and acts on what you say, then Nottingham University Hospitals could be the place for you. As one of the biggest acute teaching trusts in the UK, it has introduced shared governance, which gives all nurses and midwives the chance to say how their hospital is run.

The trust introduced the concept in 2012 and now has the most advanced shared governance set-up of any UK trust.

Shared governance creates councils for each ward or department, which staff at any level can join, including healthcare assistants, clerks, domestics and nurses. There are usually six per council. They meet for six hours a month to discuss issues on their wards and then work with senior management to make changes. The idea is that frontline staff are best placed to pick up on the issues that really affect patients, and can make changes quickly.

“The councils work on four key areas,” says Anna-Marie Edwards, one of two shared governance facilitators at the trust. “These are patient care, patient safety, staff engagement and ward environment.”

A quarter of all wards (25) have shared governance, involving more than 200 staff, and Ms Edwards says her work with her colleague involves recruiting people to council, coaching them in change management and service improvement, and then leaving them to it.

The process can have massive benefits for patients, staff and managers. Shared governance facilitator Kerry Taylor says one ward sister reflected on the process and said it had enthused her about her job because the council “was tackling the most challenging issues in nursing”. Staff have also said they’ve had more development than before and, in a recent survey, 88% of council members said they feel more able to speak up and be assertive, while 73% are more aware of the responsibilities and skills needed to be a leader.

“This has opened council members’ eyes to the opportunities here because they understand more how it is run,” says Ms Taylor. “It isn’t just linear career development. One council member is shadowing the chief of operations while there are lots of scholarships, secondments and access to senior people. For example, as a band 5, I got the chance to be mentored by the former chief nurse Jenny Leggott.”

Examples of initiatives arising from the councils are a ward changing continence pads and providing training. This led to no further avoidable moisture lesions on the ward and a cost saving of £2,000 in just three months. Another ward successfully introduced new medicine timers to avoid missing drug doses.

“Council members are constantly asking patients and colleagues about what they want to see improve,” says Ms Taylor. “What makes it different to other trusts’ service improvement programmes is that we get an hour and a half with the chief nurse every month. In this Leadership council, our chief nurse is face to face with frontline staff who are bringing up issues and asking for help. Councils are honest – and this is a genuine, fresh-faced approach to how wards are run.”

Chief nurse Mandie Sunderland says: “It shows all our staff that we value their ideas and input, and are listening and learning to those on the front line. It ensures that everyone’s voice is heard and we are proud of what we have achieved.”

It’s a culture that provides noticeable differences for staff. Ms Taylor says: “Colleagues who trained with me but are working elsewhere are regularly shocked by how much more we are doing and the opportunities I have had. They tell their ward sisters something and six to eight months later, it’s still not progressed.”

“It’s no longer a project,” says Ms Edwards. “One of our senior nurses described it as not just a piece of work – it’s the way we do things around here.”

“We had a call last week from a maternity support worker who told us part of the reason she took the job at NUH was shared governance,” says Ms Taylor. “She wanted to join the council – that made us feel proud. Shared governance makes a real difference to people who work here.”

Nurses and midwives have many opportunities to learn and develop at Nottingham University Hospitals NHS Trust. We’re now recruiting band 5 nurses and midwives across all specialties.

To find out where your career could lead with NUH come and meet our team on Thursday 24 or Friday 25 September (9am–5pm) at Nottingham Forest Football Club, City Ground, Trent Bridge.

To interview on the day register online at or send your CV to

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Readers' comments (1)

  • As a matron at NUH, it works! All my wards have shared governance councils, I just leave them to get on with it as they have a good framework to get on & facilitate changes & staff inclusion. The staff know where to find me if they need support or additional information to make something happen. It's not scary, no one loses control its empowering. I am so proud!

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