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Pay ward managers more to improve patient care


Sisters and charge nurses must be given higher status and more pay if the NHS’s current problems surrounding the care of older patients are to be successfully addressed, according to senior clinicians.

Speakers at two high profile inquiries into NHS quality standards last week both identified the loss of good ward managers as a key area in need of improvement, highlighting an ongoing problem in nursing.

The ongoing Mid Staffordshire Foundation Trust public inquiry and the newly established Dignity Commission were told that good ward managers should be paid more and encouraged to stay at the bedside rather than move into more senior management roles in order to raise standards of care.

Last week also saw two more reports expose shocking examples of poor care of the older patients, this time in the community. The reports, from the Queen’s Nursing Institute and the Equality and Human Rights Commission, follow the cases highlighted over the past 12 months by the Care Quality Commission, health service ombudsman and the Patients Association.  

In his closing submissions to the Mid Staffs public inquiry, the FT’s chair Sir Stephen Moss said junior nursing staff needed role models on the wards.

“Ward sisters who’ll not accept anything less than the best standards of care should be rewarded and encouraged to stay at that level, without moving into more senior or managerial roles,” he said.

Sir Stephen, who was director of nursing at Queen’s Medical Centre in Nottingham for more than 20 years, told Nursing Times that staying at the bedside should be seen as an “attractive career choice”, and nurses should not feel they had to move into management or education to progress.

Sisters and charge nurses are usually paid an Agenda for Change band seven salary – ranging from £30,460 to £40,157 – although in some places they can be on a band six, which starts at just £25,528 per year.

Meanwhile, at the Dignity Commission’s third evidence session last Thursday, Royal College of Physicians clinical vice president Linda Patterson said a sister or a charge nurse working with a senior doctor could be a “very powerful” team.

“The ward manager is the leader for quality on a ward. They need to have higher status, they need to be higher paid and be seen as an absolutely key role,” said Dr Patterson.

The Commission, which is examining why some organisations fail to treat older people with dignity, was set up by Age UK, the NHS Confederation and the Local Government Association, and began hearing evidence earlier this month.

Royal College of Nursing director of nursing and service delivery Janet Davies told the hearing it was also important that ward managers were only responsible for one ward. Additionally, she said there was a need to recognise nursing older people as a specialist area, and “not something you do because you can’t get a job elsewhere”.

Both the commission and the inquiry will produce reports including recommendations for improving standards of care next year.

Adviser to the commission Dame Elisabeth Fradd told Nursing Times nurses on the frontline had been “blamed enough” for the problems surrounding older patients.

“It’s a much bigger issue. It’s about the culture inside the organisation that either does or doesn’t support nurses,” she said.

Dame Elizabeth is a member of an informal group of senior nurses, which also includes Sir Stephen Moss, that have come together to call for a change in the culture of the NHS. All of whom are acting as advisers to the Dignity Commission.

She said it was “not surprising” people came into healthcare with poor attitudes towards older people, as it reflected in society’s tendency to marginalise them.

She added: “When that’s coupled with an organisation that isn’t compassionate [towards staff] how can you expect people to be compassionate when they’re delivering care?”

  • The Royal College of Nursing in Wales last week launched a campaign, “Time to Care”, to highlight the importance of nurses having enough time to carry out their work duties to the highest possible standard.

RCN Wales director Tina Donnelly said: “Nurses need time to provide a high standard of nursing in the health care, and this is vital to ensure that the fundamentals of care; such as nutrition and hydration, privacy, dignity, respect and meeting hygiene and toilet needs are fully met.”


Readers' comments (12)

  • michael stone

    Ward managers probably do need more 'power' to prevent more senior 'general' managers from ignoring their input regarding staffing, practices, etc. But that is a 'who gets the final word about what' question, and such issues are always contentious.

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  • John Howes

    Absolute nonsense. If many of the Ward Managers(formerly the Ward Sister) were doing their jobs we would not be witnessing the appalling failure to care which is not just featured in the tabloids, but reported albeit slowly by the CQC. It is the failure of all public services, that if you pay more (MOD etc) you improve the service. If this country hasn't grasped that simple fact yet then our handcart is well and truly hell bound. If we have learned anything at all about more pay as an incentive is that people believe they are paid more for their worth and have no incentive to do anything about the mess they are party to.

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  • tinkerbell

    Absobloominlutely! At last! Why do we have to go all around the houses to get back to square one. The basics of nursing, hands on. Good, multi experienced nurses shouldn't be stuffed away in an office inundated with paperwork, going around in ever decreasing circles, they should be out there on the frontline with their patients and staff getting stuck in, sleeves rolled up. Leading by example, being a good role model. Looking after both their staff and their patients, witnessing/observing the care that is being provided, particpating in the care that is being provided, questioning what is going on, discussing what is happening and why, bringing it to the attention of upper management, speaking up, educating and changing things for the better, encouraging a good team spirit, boosting morale, allowing for a good moan so staff can get things off their chest that doesn't last the whole shift but then getting back out there to do the job. Promoting positive attitudes that promote a positive culture regardless of patient group, treating others as you would like to be treated with respect. Leading the way, being an agent for positive change. I don't think we come into nursing for the fantastic pay, it's not about the money, but i wouldn't turn my nose up at a pay rise. A good charge nurse/ward sister combined with a good, caring ward doctor are a powerful force for ensuring that patients receive quality care, with enough staff to provide that care and can make all the difference to an individuals care because they know what is happening on a day to day basis. Whenever i have been promoted to a post that has taken me away from the frontline of nursing i haven't stayed there long because i enjoy being where i want to be, which is why i came into nursing, with the patients. It's a hard job and staying positive isn't always easy but it is also about realising when we are burnt out and need a rest ourselves, a lot of irritability and low morale amongst staff is borne out of tiredness & frustration about not being able to get the job done, feeling unheard, being pulled in too many directions like a 'push me pull me' & because we don't always have the resources to do the job as well as we would like to but lets also celebrate the good days too and acknowledge one another for a job well done, under difficult circumstances, so that we can support one another when things aren't all they should be knowing that we've done the best we can with what we've got, where we are. Promote staff nurses who display these qualities and you will have a good ward sister/charge nurse and let upper management shuffle and nurse the paperwork and attend unending meetings that appear to achieve nothing at all, or get them all down on the ground floor level too when you are short staffed. They would probably achieve much more if they did it at least one day a week/month/year. Bit cheeky but when you are really up against it ask them if they can give you a hand. Hopefully they were all nurses once and will realise where you are coming from. The only way to do it is to do it! All the knowledge in the world is useless if it cannot be put into practice.

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  • I think we need more staff and properly trained staff for the Ward managers to work with to improve the care of ALL patients not just care of the elderly. I am therefore presuming that the supplement paid to care of the elderly and psychiatric nurses was abolished with Agenda for change. Yes, folks those of you old enough (and experienced enough having been trained the good old fashioned way), will remember that and also how dignity, fluid balance, nutrition was an automatic part of every day nursing care. Have no problem with nurses being paid more generally whether lower band nurses or ward managers or Sister/ charge nurse level. How does paying someone more improve standards? Do they think nurses and other people only work according to how much they get paid? If that was so, then surely these bankers should be paragons of virtue and ALL MP's would be upstanding member of society and would not dream of fiddling their expenses. They get paid a whole heap more than Ward Managers and Charge nurses. This is rubbish. More staff and well trained staff and yes, payment for responsibility should be considered. We are already experiencing a pay CUT!!

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  • Psychiatric Lead was worth £425 pa the last time I received it and that was less than the mufti allowance I got for working in my own clothes rather than becoming "a man in a white coat".

    To suggest that raising the pay for ward managers is tantamount to suggesting that personal financial reward should be the biggest driver around standards when in reality it should be a blend of altruism, high personal standards, professionalism and excellent leadership skills. Perhaps ensuring that similar characteristics are assessed during the recruitment of staff to all middle and senior management positions across the NHS might be a useful exercise?

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  • What a rubbish statement. What you need is to gatekeep these wards by ensuring that staff who apply for post on them or are moved into them really want to work with older people. Standards of care start from the top, ward manager level, and they dictate the care provided by their team. More money wont bring this about, its about the individual manager and their own professionalism.
    Another issue across the board is the style of training given to all nurses, get back to basics ie total patient care.
    Good care is not always about the money. I know, I have provided good care during the 80's and 90's even when older persons care was seen as the cinderella service of the nhs. Its hard work and requires the best staff, selected because they are able to look after the most vulnerable and to a high standard.

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  • michael stone

    'Sisters and charge nurses must be given higher status ....'

    Surprisingly, to me, most of the nurses who have posted, don't seem to think that just paying people more will improve care.

    But if bad care standards, are because the situation on wards is being controlled too much by 'higher management', isn't higher 'status' (which might not simply equal more pay) for the staff on the wards, necessary ?

    The link between 'wanting to behave better' and having the power to ensure 'that we can behave better' ? Is that, a problem with current NHS systems ?

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  • yes ten years ago when I came into post as a ward manager,I did manage the ward alone,and what I wanted to say or do was respected.ward managers dont manage these days,you are given the impression that you are,but at the end of the day its the accountant and general manager that overule us,and the matrons half of whom in my trust have never been ward managers and have not got the same experience,as myself-just people who wanted to get off the wards.Get rid of the matrons,and general managers,stop treating us like rubbish,and give me my ward back!

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  • tinkerbell

    John Howes | 28-Nov-2011 11:34 am
    Anonymous | 28-Nov-2011 12:13 pm
    Anonymous | 28-Nov-2011 12:24 pm
    Phil Luff | 28-Nov-2011 12:25 pm
    Anonymous | 28-Nov-2011 7:14 pm

    Way to go guys, government want to know what nursing needs, ASK a hands on, hard working nurse:)

    Of course it's not about the money or we'd all have been long gone. Do they think we are all just doing this job for 20, 30 years or more because we are bored or until a better paid one comes along.

    Governments TRUST what we say, give us back our wards, give us the staff to do the job,(Coping's not the same as Caring) get rid of the passengers who don't want to do the job (caring for the patients) and then let us frontline staff get on with it. We are the only ones capable of turning the NHS round and as an added bonus will be saving the NHS money by getting rid of the myriad of unneccessary bureaucracy/upper management. Why wasn't this ever thought of before? An NHS led by those who are actually doing it and in the 'know'.

    This governments 'knowing the price of everything and the value of nothing' has to stop if we are to save OUR NHS. The fundamental principles of our NHS are priceless, 'for everything else there's mastercard'.

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  • Who on earth truly believes that 'higher status and more pay ....' will improve patient care?

    The only thing that will 'improve' the care of patients is..... the staffs attitude towards their patients, and applying all their basic nursing care skills.AT ALL times!

    Paying people vast sums of money for theur, 'status', wouldn't change a thing... just take a look at our current crowd of elected MPs, and you'll get the idea.

    By all means improve NHS nurses pay scales, but, primarily, ensure they fully understand the concept of...'Nursing Care'' before they are permitted to work with the sick, old and vulnerable.

    Having had the privilege of working in the 'field of nursing' for some 30+ years, I have, sadly, had to witness,
    numerous, 'highly paid' nursing staff use their 'status' to meet their own ends, and do precious little to improve the care of their patients.

    When I was at work, I was made to feel stupid and inferior to those , so called 'colleagues', for showing a genuine interest in the well being of the patients in my care.

    Subsequently, I was forced into taking 'early retirement', in order to maintain my own sanity, and well being.
    Not much of an advertisement for promoting our grossly, under-valued, NHS, am I?

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