VOL: 100, ISSUE: 44, PAGE NO: 28
Oliver Shanley, MSc, RMN, director of clinical governance, nursing and forensic mental health services, South Essex Partnership NHS TrustWith the The NHS Plan (Department of Health, 2000) the government made it clear there was a need to reintroduce the...
With the The NHS Plan (Department of Health, 2000) the government made it clear there was a need to reintroduce the role of matron to establish a clear responsibility for standards in the ward setting. The role of modern matron is now considered to be a fundamental part of clinical governance, ensuring the quality of the care provided is of the highest standard. Staff at South Essex Partnership NHS Trust instituted an audit to provide an accurate picture of the impact of modern matrons.
Chris Beasley, the new chief nursing officer, has high-lighted the latest role of modern matrons in infection control with the launch of the new Matron's Charter (O'Dowd, 2004). This article looks at how successful the implementation of modern matrons has been since they were first introduced.
The NHS Plan (DoH, 2000) and the subsequent Implementing the NHS Plan (DoH, 2001) outlined the basic principles for the establishment of modern matrons. The guidance identifies how matrons would be 'accountable for a group of wards, would be easily identified to service users, highly visible, accessible and authoritative figures to whom service users and their families can turn to for assistance, advice and support, and upon whom they can rely to ensure that the fundamentals of care are right'.
The plan makes it clear that demand for modern matrons would be met 'by making sure ward sisters and charge nurses have the authority and support they need to resolve clinical issues, such as discharge delays, and environmental problems such as poor cleanliness'.
The government also developed a range of other policy initiatives that were designed to support the objectives (Box 1). Also, there was a commitment to enhancing clinical leadership development, which was evidenced through such programmes as the NHS Modernisation Agency's 'Leading an Empowered Organisation' course.
The role of the modern matron is considered to be a fundamental part of clinical governance - ensuring the quality of care is of the highest possible standard.
The government clearly identified the attributes required for modern matrons:
- They should be well-qualified clinicians with substantial experience of care management at ward and unit level;
- They should be well-respected professionals and experienced clinical managers with a reputation for setting and delivering standards, and have the ability to lead by example to motivate and empower others;
- They must have demonstrated, and continue to demonstrate, that they place the needs of the service user as central to all that they do and that they are committed to pursuing and resolving patient concerns.
In 2003 the chief nursing officer for England published an evaluation of the implementation of the modern matron role across England and Wales (Department of Health, 2003). It reaffirmed that the new role 'positions nursing at the very heart of the NHS modernisation agenda and identified that this role is critical in facilitating a profound cultural change which puts the patient first'.
This evaluation identified 10 key responsibilities for modern matrons, which included improving the cleanliness of hospitals.
South Essex Partnership NHS Trust responded to the plan by implementing modern matrons across the organisation. There are seven posts: two each for older people's and adult services; one in forensic (the only male matron); one in rehabilitation services; and one in services for people with a learning disability.
Our matrons' tasks include:
- Providing clinical leadership;
- Responsibility for standards of clinical practice;
- Ensuring there is an effective working relationship with ward managers, directors and support service managers;
- Responsibility for the development and delivery of local clinical governance frameworks and clinical audit;
- Facilitating local research;
- Organising student placements, education and training;
- Balancing the skill mix in teams and ensuring wards utilise their resources effectively;
- Cleanliness and control of hospital-acquired infection;
- Organising the appropriate training in medical equipment/devices.
A fundamental part of the modern matron role is to provide clear, visible and strong nursing leadership. In order to provide an accurate picture of the impact of modern matrons the author decided to conduct a survey of the trust.
This involved sending out a postal questionnaire to clinicians, managers, support services staff, the service user network manager and the modern matrons themselves. The author set up meetings with staff and conducted a literature review.
A consistent theme in the comments received was that the amount of meetings matrons are required to attend affected their accessibility and visibility.
The importance that the organisation has placed on the modern matrons has meant they are often asked to attend meetings. The modern matrons report that they attend over 30 meetings each, of which many require all matrons to attend. There are plans for this situation to be streamlined.
The survey found leadership is paramount, but that modern matrons have no formal direct management responsibilities. Operationally they must report to their relevant director and professionally to the director of clinical governance. The problem with this process is that matrons can be seen to not possess the authority to change things.
Any managerial role must be balanced with the need for modern matrons to focus on quality, standards and best practice. Therefore, the trust is to reorganise line-management responsibilities so ward managers are accountable to the modern matron.
A further core feature of the modern matron's role is to ensure that both the standards of care and also clinical practice are enhanced - partly through developing and implementing policies and also through ensuring the implementation of contemporary nursing practice.
Respondents recognised that this is an essential part of their role. They equally identified that competing demands did not always enable them to focus on these issues as much as they would have liked to.
One of the common criticisms about the provision of health services is how basic standards of cleanliness, hygiene and the importance of nutrition are overlooked. These areas would seem to be an essential part of the modern matron's role in raising standards.
Should an infection occur, modern matrons provide clinical expertise to the ward and, if necessary, liaise with infection control nurses to develop action plans. They also ensure that any infection control lessons are communicated to staff across the relevant areas.
Modern matrons work closely with ward housekeepers and receive all copies of monitoring sheets on cleanliness, quality of food, linen provision and repairs and estate issues. They work collaboratively to respond to all housekeepers in addressing any problem areas.
Respondents felt that the modern matrons are definitely raising standards.
Respondents felt that an important part of the modern matron's role should be ensuring that ward areas have the appropriate skill mix. They seek to achieve this by working closely with ward managers in the monitoring of duty rotas and budgets.
At times when wards are experiencing difficulties, matrons have worked shifts to maintain service standards. While some progress has been made in this area, again it is made more complex by the lack of direct line management accountability. This lack of clarity can potentially lead to uncertainty about the authority that is attached to the role.
The trust has recommended that matrons should work more collaboratively with the assistant directors. The assistant directors will focus on budget and resource management, while modern matrons will focus on quality and standard-setting issues. While a natural blurring between the two will occur, it is imperative that matrons retain their clinical focus.
- 'Our matron has been accessible, helpful and supportive. Since her appointment I feel her input has enabled me to progress professionally and she has stabilised my ward's affairs.'
- 'We now have another point of access to utilise in times of need.'
- 'Staff feel supported, less stressed, there is improved staff morale and an improved standard of service.'
- 'Our modern matron is always around. It is nice to see him on the wards.'
The audit suggests the role of the modern matron is having a positive impact and there is evidence that further improvements can be made. The role remains in its infancy and expectations must be balanced with the need for the post to become established.
- This article has been double-blind peer-reviewed.
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