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Nurses already have the right skills to run trusts

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Julie Burgess on how being a chief executive uses similar skills to a ward sister’s.

As a nurse who has become a chief executive, I am frequently asked by nurses about my job and whether I worry about the responsibilities that come with it.

I don’t particularly worry about these because I have had to take responsibility throughout my clinical career.

While I carry a lot of responsibility, some decisions I have to make or conversations I have are not as difficult as those in clinical practice. Being a chief executive is like being a ward sister - I use the same set of skills.

I never thought I would end up as a chief executive. I only came to the post after being asked to become the acting chief executive in a large acute trust. What surprised me was that the role was one where I could make a difference and set the tone and culture of the organisation.

Throughout my career as a nurse, I had always wanted to make a difference. Maybe arrogantly, I had believed that no-one could do this better than frontline clinical staff.

I stopped clinical practice because I wanted to carry on influencing the agenda so I could make a difference at a more strategic level. I also recognised that I had spent too long in a critical care environment and was probably burning out.

As a chief executive I am responsible for everything that goes on in the organisation. As the chief executive of a foundation trust, I am also the accounting officer and responsible to Parliament for the resources under my control.

This is quite scary in some ways. However, as a nurse I have worked within the NMC code of conduct and, having reviewed the latest version, every single one of those headings can be applied equally to the role of accounting officer.

As a ward sister of a critical care unit, I had a number of very sick patients under my care. The mix of patients changed daily, as did the issues and problems. Looking after these patients were a variety of nurses of differing abilities; some were very experienced and some were new to critical care nursing. However, they all needed to be effectively supervised, led and managed to ensure the right outcome for each patient.

As nurses, I often think we are bilingual. We relate clinical practice to everyday life and translate what people say to us back into clinical practice. Nurses who are ward managers and above also learn ‘management speak’ and are therefore trilingual. They are able to not only communicate at a clinical level with patients and the public but also to translate messages into management speak. These skills should not be underestimated.

It is the very same set of skills that I used as a ward sister that I now use as a chief executive. The ward sister’s patients in beds become the chief executive’s issues and agendas that need to be addressed. The ‘patients’ in the chief executive’s ‘ward’ are: issues around clinical strategy; financial issues; governance issues; legal cases; difficult complaints; and handling the press.

All these patients in the chief executive’s ward have teams looking after them, who might be directors, directorate teams, or people in corporate roles. They are all working to achieve the best for the patient and I, as chief executive, need to have an overview of everything to ensure we achieve the right outcomes on each issue.

If we look at the staff who are looking after the patients in the chief executive’s ward, they all have different levels of experience and different learning needs. My role is to ensure that they are all encouraged, supported and developed so they are able to deliver the level of service that is required.

‘People ask me how I cope with the finance. As a nurse, I used to analyse large amounts of data. Imagine those big intensive care charts standing at the end of beds’

I don’t do all this by myself - I have a team of directors to support me in delivering the trust’s overall agenda. However, as a chief executive, I need to set the tone, pace and priorities - exactly what I was doing as a ward sister.

The second question people ask is: ‘How do you cope with the finance?’ As a nurse, I used to analyse large amounts of data.

Imagine those big intensive care charts that are about half a metre square and stand at the end of beds. To begin with, the amount of information on those charts can be overwhelming. However, you soon develop the skills to identify what is right, or wrong, and what further questions you need to ask.

This is analysing data and is exactly how I approach finance. In my head, those financial papers are translated into big, intensive care charts. I have had no formal financial training. However, I have made sure that I have underpinned my experience with theory.

The Darzi report stressed there was a need for more clinicians to become chief executives and that means the door is open for nurses, midwives and allied health professionals.

Do not be put off if you have not had formal management or financial training. Look at all your transferable skills. Think of your glass as half full and fill the remaining part with mentoring, coaching, broader work portfolios or informal training.

The opportunities are out there for you - and I would urge you to grasp them because being a chief executive means you can make a big difference to patient care and the wider health agenda.

Julie Burgess is chief executive, Birmingham Women’s NHS Foundation Trust

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