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How to restore pride in nursing


Mentor your staff through change to deliver sustainable turnarounds, says Tina Cookson

When you are delivering turnarounds, expectations are for a quick result, but to deliver real and sustainable change, clinical staff need to understand and accept the challenges and own the recovery process.

Coaching and mentoring staff through change can take longer, but is more sustainable.

At our trust, most of the clinical staff felt demoralised by poor media coverage. Self-esteem was low and they needed and wanted action and to be part of bringing back pride for nursing and the hospital’s previously good reputation.

My approach was a combination of being visible as a director of nursing, having one to ones with all the matrons and ward managers so I could understand their personal and professional challenges, and asking nurses what decisions were needed. It was about leading and learning, rather than over-auditing and criticising.

Through high visibility and role-modelling behaviours, showing the decisions I would make and what I would do, I then got them used to taking back control and making their own decisions. Keeping central control is not good for sustainability. A clear accountability framework with both support and challenge is evidenced to work well.

To boost self-esteem, create the idea of the wards or whatever environment nurses work in as “centres of excellence”. Enthuse nursing leaders to feel like there will be no mistakes “on their watch”.

Sometimes I see people auditing and measuring but to no real end, so watch for that. Agree with your team that something needs to change, and check back in with them if it doesn’t happen to find out why or if they need additional support. Make sure they know they must be both responsible and accountable.

Focus your effort on where care delivery happens – and engage staff to ensure they feel able to challenge managers.

Make sure staff see nursing and medical leaders working together. Role model the importance of multidisciplinary working at executive level.

Don’t forget to take examples of good practice back to your team, not just the bad. It’s easy to forget to be visible and provide support in the well-performing areas as well – it’s a trap I fell into until staff told me off.

The impact of doing this at James Paget is that we are now compliant for all previous major and warning notice concerns. We have more to do, but staff have regained their pride.

Tina Cookson is interim director of nursing at James Paget University Hospitals Foundation Trust , which she is in the process of turning around following poor Care Quality Commission reports. She has worked in the NHS for over 30 years, holding senior posts in PCTs, community and acute NHS trusts.

What you can do to improve communication

  • Organise one-to-one meetings with all your team regularly
  • Value appraisal – it’s quality time with your team
  • Ask your team what three things they would like you to focus on to support them
  • Agree an action point, and check back to ensure it is happening or if you can offer more support if it isn’t
  • Encourage communication across disciplines and prioritise patient safety
  • Role model the organisation’s values



Readers' comments (9)

  • Tina

    Bad press results from poor Managerial decision making /action (or non decision making/action).

    It is of course the patients and clinical staff who suffer!

    The MANAGEMENT failings of James Paget (JP) are well documented in the public domain, I have no intention of repeating those FAILURES here.

    I do have a few questions

    1. Why was it necessary for the CQC to expose MANAGEMENT FAILINGS at JP and issue WARNING NOTICES ?

    Who amongst the MANAGEMENT was failing and who has been disciplined ,resigned or been sacked.

    2. Why did the CQC have to require, on more than one occasion that action be taken ? Was this yet more evidence of managerial sloth ?

    3 "When you are delivering turnarounds, expectations are for a quick result, but to deliver real and sustainable change, clinical staff need to understand and accept the challenges and own the recovery process".

    I apologise but, this is typical "management speak" which attempts to imply that the clinical staff are somehow to blame for any shortcomings in managerial performance.

    If I was a member of the clinical staff at JP I would definitely be "demoralised" by managements failure. Clearly that failure was related to unrealistic workloads, and whilst I have no direct evidence of this a poor skill mix and a relative lack of qualified staff.

    Staff need to be valued and listened to, their legitimate concerns need addressing.

    I wonder how many incident reports lie hidden which mention "staff shortages"?

    Does JP have a "turnaround" program especially for MANAGEMENT, if not then the obvious question is WHY not!?

    Did MANAGEMENT offer a full and wholesome apology to the staff in respect of the MANAGEMENTS failing of them?

    Finally I sincerely hope tJP spokespersons have given up using the mantra "lessons have been learnt" the public no longer believes this vacuous statement.

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  • could be a very long and slow process restoring confidence and pride in nursing

    first there needs to be sustainable and positive change in the whole infrastructure of the NHS and all other nursing organisations in order to change negative attitudes, many of which have sadly become deeply ingrained and will not change overnight.

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  • Too much management speak which is meaningless. This is used as a barrier.

    This sentence...

    "When you are delivering turnarounds, expectations are for a quick result, but to deliver real and sustainable change, clinical staff need to understand and accept the challenges and own the recovery process."


    "When you want to improve, the clinical staff must take responsibility for making the improvements"

    To really improve, you need to speak to the managers who control budgets and who are in charge of the nurses and convince them.

    They care for the patients and managers take advantage of this. Nurses work extremely long hours, like 10 hour shifts without paid breaks. A lot of nurses don't have a proper lunchtime or a break. Nurses can, but they won't if it puts patients at risk.

    What's the most important thing of the NHS?
    Cuts. Cuts and more cuts. How many nurses and doctors have lost their jobs?
    Obviously, no one has told the patients as they continue to fall ill.

    Nurses need nursing as well. They need to be respected and cared for as well. Nurses are amazing, wonderful human beings who care and care and care.
    They need nursing as well

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  • the role of managers is to provide management and administrative support for nursing services and provide nurses and other healthcare workers with the resources they need to do their job of providing the best possible quality of care. management is organisation in the workplace but it is not to be in charge of nurses, coercing them, harassing them or hampering them in this work.

    nurses are autonomous professionals who must be in charge of their own work. t

    there is a power struggle between the position power bestowed upon managers by their employing organisation and the knowledge power of nurses but why is this power not being put to work effectively in parallel to strengthen the services provided to patients?

    what is it that is preventing managers from working alongside nurses to achieve their common goal which is the care of their patients?

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  • tinkerbell

    Anonymous | 10-Aug-2012 10:41 pm
    'what is it that is preventing managers from working alongside nurses to achieve their common goal which is the care of their patients?'

    I have often wondered. Why are nurses just left to get on with it by colleagues who have risen up through the ranks, know the pressure we are under but leave us to struggle regardless.

    I don't doubt there are some leader managers who do their best to make sure that staff on the ground floor are represented in the boardroom meetings, but i fear they are in the minority.

    With all the cutbacks that are being made to frontline services i wonder if the managers are finally realising that they too may be surplus to requirements as they have very little left to manage now that nursing posts are being decimated nationwide.

    Bizarre that they are now only realising they may need to be more visible.

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  • Ms Tinkerbell

    Have you noticed how these arrogant "managers" stick their nasty truth avoiding nonsense in the NT but never have the courage to respond to comment(s) ?

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  • tinkerbell

    Jenny Jones | 12-Aug-2012 5:52 pm

    Yes but on this 'turnaround' thingy will tea and biscuits be provided as we come round yet again and again on the merrygoround, turnaround thingy, whatever that is. I for one would like some carousel music to be played to allieviate the boredom and prevent dizziness.

    I am struggling for my sanity today whilst i read the latest load of old tosh that keeps getting regurgitated as news. Must stop reading this website as i think it is now bordering on masochism.

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  • Yesterday I worked a long day on a ward that was short staffed for the whole day, care assistant short in the morning and staff nurse short in the late shift.
    The ward sister or ward manager as they are called now was on late duty. I had to take on more work on the late shift on top of my already most difficult part of the ward.
    The ward manager decided to send both myself and the carer I was working with on break together . During our break the bay was not supervised as it should as the patients there were at great risk of falls.
    One patient had a fall and hit his head, there was another patient who was not well. Even though the ward manager was supposed to be working with her two care assistants and there were doctors on the ward , as soon as she knew that one of my patient was unwell she came to tell me while I was having my half hour unpaid break. Then 3 minutes later sent her carer to get us as a patient had fall. I did not have a break that late shift, but the ward manager had hers as she was no where to be seen when she went on her break.
    When the ward manager came on duty she said that she would not admit any more patients as we were one nurse down however while I was running around on adrenaline only the manager admitted two more patients.
    When I left last night later than my finishing time, all ward manager said to me was when are you back again. I never get even words of thank you , that is not uncommon from ward managers on the wards I have worked.
    I was sure to thank the Carer who worked with me as she was brilliant.
    I am a pair of hands.

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  • 8.40

    should be published in the national press and management named and shamed so that these problems can be addressed otherwise they will just continue and only get worse. A copy should also be sent to Cameron,DoH Sec. of Health, DoH Chief Nurses, RCN, NMC and CQC and their regulatory body whose name i have forgotten.

    It could remain anon. if you wish and want to protect yourself and your job. if this is not an issue and you wish to protect present and future patients a letter should be sent to your ward manager, group manager and hospital management, legal department and complaints department.

    there is a lot that can be done to address such problems.

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