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'How do we prepare our rising stars to deal with inflexibility?'

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Liz Charalambous reflects on some of the challenges that await new recruits to the nursing profession, including top-down and inflexible management

I was invited to speak to undergraduate nurses this week to promote postgraduate studies - an enjoyable task, as they were very keen. They took time out of their dissertation-writing to hear about how to advance their careers. How exciting to be among bright, enthusiastic people entering our profession, with a career of nursing ahead of them. Yet part of me felt sad that they will have to fit their ideas and altruistic intentions into what can often be a hierarchy of autocratic, inflexible management.

How do we prepare our rising stars to navigate their way through a minefield of gatekeepers with hidden agendas? Not to mention surviving the toxic bullying cultures that exist in some nursing teams.

Historically, nursing has been a hierarchical profession. And having to work 24 hours a day means nurses must decide between family time and work. But why should it be like this? Surely a 24/7 service can lend itself to flexibility and the offering of set hours to those needing to accommodate childcare (and often older-parent care) alongside their working life.

Nurses also need time away from the bedside to pursue knowledge. Encouraging further study requires managers to be flexible, otherwise how will we promote nursing and clinical academic careers, as well as embedding evidence into practice?

It appears that those in positions of power - from government to managers, matrons and ward sisters - who so often slip into the role of gatekeepers, have the keys to the kingdom. They are in a position to set the tone of organisational culture. They can demand certain ways of working, enforce rigid work patterns, demand flexibility and total commitment to the service, or choose to nurture that most transient, immeasurable and fragile of worker qualities: goodwill. I suspect that nurses who feel physically and emotionally supported give better care.

Top-down management and rigid rules do not always create the desired response. Staff will leave or find creative ways to survive the crushing effects of control.

Bullying occurs in all professions, even nursing. We must find ways to address these issues and support each other if we’re to improve patient care and promote nursing, especially among the newcomers to our profession, who need support and kindness. After all, who would want to institutionalise them into poor habits and insidious unspoken rules, based not on evidence, but on sinister agendas? Thankfully, new ways forward are emerging - clinical academic careers in nursing, shared governance and frontline leadership strategies, to name but a few.

Balancing different agendas can be a challenge – managers are pressured to deliver services under exceptionally difficult circumstances for long periods, amid unprecedented demands on healthcare.

We need to stop, look up and see the horizon. We can, as a profession, control our own agenda if we stick together. But first, and for the sake of our patients and ourselves, we must discover what that agenda is. So who controls your agenda?

Liz Charalambous is staff nurse, Nottingham University Hospitals Trust, and a PhD student at the University of Nottingham.

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Readers' comments (1)

  • In reference to the debate on working 12 hour shifts, I have worked a mixture of both 12 and 7.5 hour shifts.

    As a ward sister I have allowed staff who have requested 12 hour shift patterns to try them to allow both myself and the individual to evaluate the value.

    Personally I worked them to provide clinical cover and universally the hours have been in excess of my WTE contracted hours. On the positive side, working a long day allows me to plan and deliver my clinical workload effectively and provides the patient with continuity of care. On the negative side, long days are tiring if worked in long sequences or as additional to contracted hours. This can obviously have a concerning impact on patient and staff safety.

    However the impact on safety can be mitigated by effective rostering which ensures adequate rest days and has filters which to ensure thresholds to prevent too many shifts being rostered. This is easily achieved if using electronic rostering systems, which many organisations now use.

    However, in most organisations, I believe the adoption of these shift patterns has largely been as a measure to manage chronic staffing issues and an effort to retain staff. Work-life balance has become such a big issue because of the vast rise in pressure and role expectation on nurses as all healthcare roles evolve.

    I believe questions regarding shift patterns are more complex and definitely require British research as overseas systems are very different and are not directly comparable

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