Many ward managers are struggling to cope because they lack essential training in key areas like rostering, warn safe staffing experts.
In particular, a lack of training on new electronic rostering systems may mean ward sisters are left floundering, while opportunities to improve staffing and make the best use of resources are missed, a conference of senior nurses heard.
“I don’t think anyone should go to work on the verge of tears every day”
Maria Nicholson, head of workforce insight at the health service’s staff bank NHS Professionals, said some trusts invested in sizeable teams to introduce e-rostering but then expected the system to “run itself”.
Ward managers were being given “virtually no training” on how to get the best out of the system, yet were blamed when things went wrong, she added.
“Too often you see ward managers being held to account when they have had no training and support,” she said. “They may only have been in post for a few months and it may be their first ward sister job.”
Meanwhile, ward managers also felt “disempowered” because of bureaucracy around ordering bank and agency staff, she told the Safe Staffing Summit run by Healthcare Conferences UK.
Management consultant Eve Mitchell, who works with trusts to review nursing establishments and staffing, described the lack of support for ward managers as “ludicrous”.
She said that when she discussed staffing issues with ward managers, it was not unusual for them to burst into tears.
“I don’t think anyone should go to work on the verge of tears every day,” she said. “From a patient safety point of view, it’s not good because you can’t make good decisions when you are so upset.
The NHS is frequently called on to have a workforce that reflects the population it serves
“We need to invest in these people, otherwise who will want to step up to these roles only to get shot down,” she asked.
Ms Nicholson said investing in training and support “paid dividends”. A review by her team found trusts could save between £150,000 to £1m by eliminating poor practice and implementing robust rostering policies.
This included having a dedicated rostering support teams to audit practice on the wards and provide ongoing training and advice.
A trust employing 1,500 to 2,000 nursing staff would need a team of three “as an absolute minimum”, ideally consisting of a band 8, band 5 and a support worker, while larger organisations would need “much bigger” teams, she said.
She said sometimes the best solution was to hand over day-to-day rostering tasks from ward managers to admin staff such as ward clerks.
However, she also stressed the need to give responsibility and accountability back to ward managers, including the freedom to get in extra staff where needed without having to “fill out a form”.
Where wards were struggling, she suggested centralised rostering could be a temporary solution while extra support and training were put in place.
It was also vital rostering data and issues were reported to the trust board, otherwise “the whole thing becomes meaningless to the staff”.
“Too often you see ward managers being held to account when they have had no training and support”
Problems identified by the review included rosters not being published on time, such as several days after they were supposed to be up and running. Ms Nicholson said she had seen one example of a roster being published two weeks after it had gone live.
Other issues included details of vacant shifts not being sent to the bank on time. “If you only tell them on the day or the day before there is a 75% chance they won’t be able to do it,” she said.
The review also uncovered a significant problem with unused contracted hours, with some individual nurses owing between 30 and 60 hours they had already been paid for. There were some departments where about half the nursing staff owed at least 7.5 hours – one whole shift.
At one trust, where eight areas were reviewed, the total cost of unused contracted hours was £314,988 over 12 months – based on rostering data being 100% accurate. Even if the data was only 25% correct, then the cost was still £78,747.
Ms Nicholson also urged managers to look again at shift patterns and consider moving away from traditional four-week cycles to eight weeks or more.
In addition, there was a need to review flexible working arrangements regularly. She said there were many examples where flexible working had been agreed with individual nurses to help them cope with responsibilities, such as caring for young children, yet never looked at again.
She said flexible working arrangements should be reviewed every six months to a year, but that doing it every three months was even better.
Pauline Milne, head of clinical workforce development and planning at Health Education England, acknowledged there were training gaps, with ward managers often expected to learn about issues like safe staffing “on the job”.
She revealed Health Education England was working with NHS Employers to develop new training aimed at ward sisters, charge nurses and team leaders that would cover core skills including rostering, setting establishments and staffing levels and wider workforce planning and development.
The creation of the e-learning package, consisting of four modules, is being overseen by a working group that also includes the Royal College of Nursing, Royal College of Midwives, NHS England and the Shelford Group of leading trusts.