VOL: 97, ISSUE: 35, PAGE NO: 34
Anne Buchanan, RN, CQSW, is deputy director of nursing, West Middlesex University Hospital NHS Trust, London
Grace Gibbs, MBA, RN, RM, is director of nursing and midwifery, West Middlesex University Hospital NHS Trust, LondonThe need to improve the basics of patient care, including the cleanliness of clinical areas, patient catering and the empowerment of senior nurses to directly influence these crucial aspects of care, has been made explicit in The NHS Plan, a policy document that sets out the government's agenda for change in the health service, and in Health Service Circular HSC 2001/010.
The need to improve the basics of patient care, including the cleanliness of clinical areas, patient catering and the empowerment of senior nurses to directly influence these crucial aspects of care, has been made explicit in The NHS Plan, a policy document that sets out the government's agenda for change in the health service, and in Health Service Circular HSC 2001/010.
Expansion of the scope of nursing practice, as outlined in the 10 key roles for nurses in The NHS Plan, will have to be led by senior clinical nurses. They will also be responsible for ensuring that nurses have the appropriate skills and clinical competencies to carry out these expanded roles safely.
Like many organisations working in devolved management structures, West Middlesex University Hospital NHS Trust had senior nurses working at directorate level. They were responsible to the assistant directors of operations in each directorate and were involved to a varying degree in the operational business of the directorate.
This often compromised their ability to concentrate on nursing issues and there was often conflict in terms of where their accountability lay or whose priorities should be addressed, especially when it came to the use of resources.
Another area of concern was that the trust had several vacancies at G-grade ward sister/charge nurse level. These vacancies were mainly a consequence of retirement and staff turnover and the trust had been unable to fill them because the nursing job market in and around London is a highly competitive one.
For this reason it did not have strong nursing leadership in some clinical areas. This resulted in the attendant problems of poor staff retention, an increasing number of complaints and a general lowering of staff morale in the affected areas.
Last year we decided to use the 'modern matron' concept to support key changes we wanted to make to existing ward sister/charge nurse and senior nurse roles.
We reviewed the current responsibilities, accountability and reporting relationships of senior nurses and proposed the following changes:
- Job descriptions were rewritten to enhance the leadership role and take account of responsibilities for delivering the strategic nursing component of the NHS modernisation agenda;
- Lines of responsibility and accountability to the director of nursing were reinforced to emphasise the senior nurses' contribution to the corporate nursing agenda;
- Reporting relationships were clarified;
- Job titles were changed to reflect the new relationship with the director of nursing and midwifery and to bring about professional parity with other assistant directors: for example, assistant director for nursing and patient care (emergency and older people's services);
- Remuneration was increased to reflect changes in responsibilities and to bring it into line with the new four-phase career structure for nurses outlined in Making a Difference.
We took the opportunity to redefine the skills, competencies and experience required of ward-based clinical leaders. Because the trust had been unable to recruit to G-grade posts, we decided to appoint ward-based senior nurses at H grade, using Whitley grading criteria.
We valued the role and wanted to appoint nurses with enhanced clinical and people-management skills. This was reflected in the person specification.
With the support of the trust board, senior management team and staff-side representatives, we have filled these new posts.
However, the issue of how we achieve parity for staff who are already in post remains. We have an agreed process for managing this and applicants will be assessed against the competencies of the new person specification. Where shortfalls are identified, we will work with applicants for a specified period of time to help them achieve these competencies.
Our aim is to give incumbent post-holders an opportunity to develop their skills and expertise to meet the competencies required for the new roles. Some may not meet the competencies within the time frame or may be reluctant to change their roles and remit. We will use the trust's procedure for managing organisational change to resolve such issues if and when they arise.
Delivering The NHS Plan's radical programme for change will require first-class leaders at all levels in the NHS. It advocates the return of 'matron' to NHS hospitals, not to reintroduce an outdated hierarchy but to provide a strong professional nursing focus and visible clinical leadership. We think this is the way to achieve these changes and to enhance the nursing contribution at West Middlesex University Hospital NHS Trust.