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Incentivise nurses to stay at the bedside, says former tsar


Ward managers should be incentivised to stay at the bedside rather than being forced to choose administrative roles if they want to progress their careers, according to the government’s former older people’s tsar.

In an interview to mark the end of his three-years in post, Professor David Oliver told Nursing Times that good sisters and charge nurses were “vital” to delivering patient care and, along with the consultant, set the “tone” on the ward.

“If you think about it a ward sister is managing 24 to 28 staff and a £2m budget. What preparation do they have for that role?” he said.

“Worst of all we then send them the message that if you want your career to progress – and you want to earn more money – the only way to do it is to stop being a ward sister and become an operations manager or [go into] an administrative role.”

Professor Oliver, who is now president-elect of the British Geriatric Society, decided to stand down as national clinical director for older people because the role is moving from the DH into the new NHS Commissioning Board, and changing substantially in nature.

He continued to work part-time as a consultant in geriatric medicine while holding his national role and suggested it would be good if more senior nurses continued to practice regularly.

“I do find it very interesting that very senior medical managers, divisional directors in hospitals, national clinical directors by and large, maintain their clinical practice [while most senior nurses do not],” he said.

“I know it’s easier for a doctor to do a four hour clinic than for a nurse to do a Saturday night shift, but it can be done.”

Professor Oliver said improved pay and incentives could help to encourage senior nurses to continue with frontline work.

“You can become a nurse specialist but by and large, if you want to progress your career, you have to stop being at the bedside. We should send a message out that being a ward sister is such an important job that we get the best people in there and reward them properly for it.”

Last month’s Mid Staffordshire Public Inquiry report recommended that ward managers “should ensure and develop a clinical aspect to their role, working alongside staff as a role model and mentor”.


Readers' comments (18)

  • The real question is do you need to be a registered nurse to undertake administration roles? What qualities, knowledge or skills does an RN bring to the role that are unique to being an RN and thus prevent someone else fulfilling the role? Why should a person be restricted to being a Band 5, for example, because they don't necessarily have the aptitude or the wish to undertake the 'management' type role associated with the higher bands? There is a culture inherent in the NHS (and other bodies) that seem to see progression as only being applicable for 'management' roles, clinical/technical roles are restricted to the lower bands, and it means that people with vast experience and knowledge are not being utilised properly. Not everyone is a good manager so why promote to the point of incompetence? Allow those of us who know that they don't want to or can't manage to progress along a parallel career path.

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  • there was a time when ward sisters were promoted because they were experts in their chosen field, nowadays it seems a ward sister is chosen because they can manage staff and a budget, they are moved around from ward to ward and therefore have less knowledge and experience of their particular group of patients.

    there should be 'admin' ward managers and 'clinical' ward managers - at the moment ward managers are not effective in many areas. they rely more and more on the band 5's knowledge which is all well and good but at the end of the day a ward manager is a nurse and they must look after patients.

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  • Most Sisters where I work are purely managers - many have lost their skills and knowledge is past a sell by date. Why do people believe sisters are at the bedside? Most are in their office full time and much of the admin they do could be done by a decent secretary...

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  • I am a District Nurse and team leader and have been fighting hard to maintain my clinical role and have often been belittled by management for "doing non band 7 work". I said patient care was the most important thing a nurse could do and nothing is beneath me. My team know I won't ask them to do anything I won't do and it means I know what its like. I am so glad that this is now beginning to be recognized. I just fear it will take our managers too long to change their attitude. I have already been given the chance to apply for redundancy as they don't like clinicians to be above band five - what does that say to all the degree level trained nurses?

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  • maybe we should give ward managers a bonus for looking after a patient? what do you think, a pound for a bedbath, fifty pence for a commode. ward managers are nurses, I have no problem at all asking mine to help with patient care, that is their job.

    How does a ward manager, or any other nurse, keep their registration if they don't do any clinical work?

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  • I do agree with this article.
    Why do we waste experience nurses talents to paper work that as above noted a decent secretary could do.
    On a daily basis I see senior sisters walking around the hospital, finding out when a bed will be empty so a patient can be transferred into it.
    These nurses should be on the wards teaching, supervising, talking to patients and their relatives.

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  • I always get very depressed reading these threads.

    Communication is key. I am a ward manager in a very busy acute setting, managing over 30 staff and having clinical and operational responsibility for my area. I don't need "a pound for a bedbath" or "fifty pence for a commode", because I have always been a hands on, involved nurse. I work with a terrific bunch of nurses and HCAs whose skill, enthusiasm and aspiration mean that I enjoy going to work every day. I know that they will do their best for our patients. They know that I will support them, to the best of my ability, in their job. I work incredibly hard to fulfill all the roles that are required of me, be they clinical, managerial or administrative. But my staff are not daft enough to think that these things just magically happen somewhere in the background. They are realistic and knowledgeable about the roles of all staff in our unit. Regular clinical supervision and staff development, the necessary evils of management admin, audits, duty rota, etc, etc, come at a price. A ward manager is generally one person who finds that the buck (from all directions) lands at his/her door.

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  • Anonymous | 13-Mar-2013 11:25 am

    You have absolutely no idea of what being a ward manager entails. Typical then, that your solution involves introducing yet another layer of management! Utterly clueless!

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  • Anonymous | 14-Mar-2013 8:13 am

    so which of the intelligent comments have you added to the thread? one is also entitled to be clueless. Admitting it and showing curiosity is part of the discussion process and shows how people can learn and move forwards. it seems the NHS would benefit from a bit more of this open mindedness. If everybody knew all the answers care would be excellent and there would be no need for such articles or these threads at all.

    Sad you can't have an adult discussion here without being criticised and getting your head bitten off for any ideas of suggestions, no matter how silly they may appear to some.

    some members of the public also have the right to be very concerned and inquisitive about what is happening in their health services and what to expect if they have the misfortune to be admitted to hospital of which many of the elderly live in fear and dread.

    Many of the attitudes of disdain, arrogance and intolerance expressed here in response to others' concerns and queries are not what one would expect from the nursing profession and those entrusted to looking after the health of others as they are a reflection to the public of what happens in the NHS.

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  • anon 8.13 - I was interviewed by an Administrative Sister in a private hospital, they do exist. What do you think makes a good ward manager?

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