Most nurse line managers are struggling to find the time to provide meaningful support and advice to staff and are under increasing pressure as they try to juggle conflicting demands of their role, a survey by Nursing Times has revealed.
The survey was carried out jointly with Unison and Managers in Partnership and involved nearly 300 nurses and other healthcare staff – most with some form of line management responsibility.
“Until we invest in line management, we won’t be able to tackle priority issues”
It found nearly 80% said they did not have the time to carry out their management role to their satisfaction with tasks like staff development most likely to be left undone. In addition, 52% revealed they had never received any training for their line management role.
The survey, carried out in September, paints a picture of line managers under increasing strain due to staffing shortages and other issues, with about 80% reporting they were under more pressure now than a year ago and nearly 60% facing “significantly more” pressure.
Most also report having less time to devote to their management responsibilities, as they strive to get everything done and that is negatively affecting the quality of support they give to staff.
“I am finding it difficult if not impossible to complete any management work and have to complete the rota at home,” said one ward manager who reported days dedicated to management tasks had been vastly reduced and were often cancelled.
“My staff are also feeling the strain as I am unable to provide them with the support they need/want,” they said. Another stated: “Instead of carrying out management duties, I am busy covering staff where areas are short.”
“Many organisations are casting them adrift to sink or swim in the daily tide of staffing shortages and operational targets”
The survey encompasses the views of those in charge of small and medium-sized teams to those tasked with line managing 50 staff or more. Around half of participants identified themselves as a line manager with responsibility for one or more staff, while most said they had at least one member of staff reporting directly to them.
The findings suggest nurse line managers are often juggling responsibilities such as signing off staff rotas, ensuring safe staffing levels, carrying out staff appraisals, tackling performance issues and managing changes in their service or team with the day-to-day demands of nursing practice – with not enough protected time to complete their duties and limited training or support.
Nearly 70% said they did not have supervisory or supernumerary status, with many reporting management tasks had to be abandoned when wards were busy or short-staffed. In all, 78% said they did not have enough time to carry out their management role in the way they would wish.
When it came to tasks left undone, more than 40% said personal development was most likely to fall by the wayside. Meanwhile, a quarter said staff development or appraisals were most likely not to get done, followed by mentoring at 14%.
Only about a third of respondents said they had either helped with career planning and staff development or received help from a manager with career advancement within the past two years.
“Instead of carrying out management duties, I am busy covering staff where areas are short”
The results suggest lack of time, training and support are resulting in poor experiences of line management. More than half – 54% – of those who took part in the survey said they had asked for help from a line manager to solve a work problem within the past 12 months.
Similarly, 52% had sought help with resolving or coping with workload issues, while 46% had sought help from their line manager to access training and development.
Other requests for help included making changes to work patterns, coping with home or family issues, thinking about career planning and bullying. However, around 56% said the issue in question had not been handled well.
The survey, which included nurses working in a range of settings, suggests a worrying picture of management culture overall. More than 40% viewed the management culture in their organisation as “bad” or “very bad”. Only about one in five said it was “good” or “very good”.
Good practice appears to be patchy, with just 16% saying managers in their organisation acted consistently and less than half that it supported managers to tackle problems and have difficult conversations.
A common theme to emerge from respondents was a lack of support from senior management, with middle managers highlighting a lack of autonomy, consultation and involvement in key decisions.
“The role of the ward manager is often misunderstood and often not respected by more senior managers,” said one respondent. “I am rarely consulted on matters that affect my ward and staff but am often informed after decisions are made.”
“The role of the ward manager is often misunderstood and often not respected”
When it came to specific issues where managers needed more support, tackling bullying and negative behaviour came out on top, with nearly 80% saying this was an area where help was lacking.
Meanwhile, 73% said they felt managers needed more support in dealing with performance issues and giving feedback. More than half cited flexible working and sickness absence management as issues where managers needed more help.
The survey suggested two thirds of managers were clear about their roles and responsibilities and the standards they were expected to meet. But about a quarter did not have the time or resources to do everything they were supposed to and any only had time to focus on the most pressing issues.
It also revealed many managers felt torn and under pressure from conflicting demands, with 55% feeling there was conflict between their responsibilities as a professional registrant and financial responsibility to the board.
sara gorton for index
“Our direct line managers are very approachable and sympathetic but are often powerless to make changes that are uncomfortable for their line managers, so are trapped,” said one respondent.
When it came to the pressure managers faced, more than 80% said they felt they were under more now than 12 months ago. Around 60% said they were under “significantly more” pressure, while 22% said pressure had increased a bit and 16% that it had stayed the same.
More than half said they had less time to devote to management responsibilities than they did a year ago with 38% reporting they had “significantly less” time.
“I and many of the staff I work with feel under massive stress,” said one ward manager. “I have sleepless nights worrying about safety issues on my ward.”
Significantly, more than half said they had not received any training for their line management role and those who had received some said it had not been updated that often.
More than 77% did not receive regular updates on training. More than half did not feel they had received appropriate levels of management training while less than a third said they had received appropriate training.
Only half said they had received training on policies and the line management role before they had undertaken any line management tasks.
When asked what one thing would be most useful to improve their performance as a line manager, 31% said “more time”, 23% said “more support” would help, 18% said “more staff”, and 16% “more training”.
When asked to rate staffing levels in their ward, team or setting, 54% said they were always short-staffed. Most reported difficulties recruiting new staff.
Unison head of health Sara Gorton said: “Healthcare staff want to work in well-managed teams that are fair, supportive and able to respond to their needs.
“This report suggests that rather than supporting nurses to become good managers, many organisations are casting them adrift to sink or swim in the daily tide of staffing shortages and operational targets,” she said. “If the NHS is serious about improving workforce culture, this has to change.”
Managers in Partnership chief executive Jon Restell said: “Line managers are under more pressure than they were a year ago, with less time to devote to anything other than firefighting. Some have too many staff to manage.”
He added: “There is a long way to go before we say that nurse managers are getting the support and training in their role that they need. Until we invest in line management we won’t be able to tackle priority issues such as discrimination, bullying, performance, flexible working and sickness absence.”
Unison line management survey
Unison line management survey
Unison line management survey
What survey respondents said on line management:
“I feel very equipped to deal with my role but I don’t have the time to do what I want. I am regularly told what my responsibilities are but not consulted or involved in the decisions made about my ward such as extra beds or staff being moved.”
“In my workplace I see no evidence that my managers have received any specific training for their role in terms of behaviour and correct management of staff.”
“I have just resigned from a managerial role due to stress and being unable to spend time caring for my family due to workload.”
“My line manager sees me once or twice a year with most communication being done via email. The only reason my appraisal has been done this year is because we are due a CQC visit.”
“I am an experienced leader and motivator of all members of a team towards a common goal and improving practice. My managers are aware of these skills but lack the skills to make the most of mine.”
“I raised some concerns with my line manager. I didn’t receive the standard of support, advice or guidance I had been expecting and my working situation became so difficult I had to request a ward transfer.”
“I enjoy being a ward manager but feel unable to support staff in the way I would like. I just feel helpless at the moment to improve things and worry about my staff and what the future holds.”
“I feel there is a cultural shift towards negative practice in leadership and management. This has been catalysed by more pressure from both our patients/service users and our leadership to do significantly more with significantly less.”
“People are promoted to positions in management when they do not have the skills, experience or, most importantly, the personality.”
“As a manager I get very frustrated by the way that staff are treated by senior management above ward level – there is no respect and staff are not cared about. When I raise this issue I am told very loudly that at my stage in my career I need to learn to be more political and that my role is to support senior managers rather than my team. This is something I will never agree with but it gets me into trouble.”