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Training gap leaves ward managers at risk of blame for rostering problems


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”

Eve Mitchell

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.

Blurred hospital corridor with three figures in it

The NHS is frequently called on to have a workforce that reflects the population it serves

The review uncovered a significant problem with unused contracted hours

“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”

Maria Nicholson

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.


Readers' comments (13)

  • michael stone

    'Meanwhile, ward managers also felt “disempowered”'

    I think that one is 'a big club' as well.

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  • When are we going to promote Sister's being out on the ward emonstrating best practice, supporting learners, advocating for patients etc. Not hunched over a computer in the office, or trawling personal records to ensure we keep up with 3 monthly reviews!

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  • E-rostering leaves staff to work for 5 long days,I am thinking what is this,Is it possible, for example, 2long days 3 nights will the e-rostering know what skill mix is

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  • 'Twas ever thus.

    Back in the day when I was doing the ward management thing did I get any training or support around what I was supposed to do? Not a bit of it.

    This has been endemic in the NHS for ever and it is not like HR departments and higher managers don't know, as they have been told by many people. Their attitude, as ever, seems to be "Oh, it's only nurses, they don't matter."

    Even when this lack of training and support in managing a ward was highlighted and documented via the trust appraisal mechanism the response from HR was "No. We are not planning on offering any relevant training!" This was in the mid-'90s...

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  • It is nice that those in the report got virtually no training this is better than th NO training many recieve.

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  • I consider myself very lucky having got 2 full days training & several site visits afterwards from ER team member. The system is hopeless mind you, absolutely no concept of team dynamics or fair & equitable and much more time consuming than using a pencil & rubber

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  • michael stone

    ANONYMOUS 16 APRIL, 2016 2:16 PM

    I loved your comment !

    Mind you, these days I think I'm quite likely to read (and to be somewhat perplexed by):

    '... they received no virtual training'

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  • I agree with basket press in that ,I did the rotas back in the 80's 90's and it worked perfectly well. I was managing a busy acute ward with 30 odd staff day and night shifts to accommodate, I devised my own system and once I had cracked it ,it worked very well. We had people in those days whom had say thurs evenings off to accommodate being brown owl! There was also a personal preference sheet I referred to such as one person preferred 3 lates ,2 earlys Another whom wanting to save up for something big , all weekends till further notice It makes a huge difference to staff morale if they feel senior staff care about their personal lives. Our sickness rates were low too. Interestingly my ex sister in law was paid a HUGE amount of money as a systems analyst to bring in e rostering to the south of the country. And clearly it has rolled out across the country since. I have many friends/ex colleagues whom still work in the NHS whom inform me the new system is a shambles. One area they can only put in 2 requests a month!! If only the DOH had asked me I could have explained my system for free! As usual the people devising the 'systems' have no understanding of the multi complexities and variables of devising a 'ROTA' because as usual they have never worked on a ward. A bit like many of the department managers now a days.

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  • I work in mental health. I used to be full-time, but chose to have a sessional (bank) contract instead. One of the many reasons was the off-duty. I have never known anything quite so ridiculous! It is not done by the ward manager, but by Band 6s, who are already run ragged. Overheard the other day, after a new HCA had said she was unhappy with her off duty: "people just don't realise how difficult it is to give them 2 days off together. If she wants a job like that, she should work in an office".

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  • Laha78

    But 2 days off in a row really isn't asking for much in the grand scheme of things, especially on a busy ward of whatever area of nursing you work in. When I did the rota for a busy acute admissions ward I used to always give the staff at least one week on the rota where they had 2 or more days off together. It makes for a happier and less exhausted workforce.

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