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The role of the modern matron in a urology department

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Katie Cooper, BSc Nursing and Human Sciences, RN.

Matron, Urology, St George's Healthcare NHS Trust, Tooting, London.

The public consultation for the development of The NHS Plan 'provoked a strong call for a matron figure, a strong clinical leader with clear authority at ward level' (DoH, 2001). This matron figure was to be easily identifiable and accessible. The ultimate aim of the new modern matron was to ensure that 'the basics of care are right' and that the quality of the patient's experience was improved (DoH, 2001). In reality, the role involves comprehensive leadership, team building and service development.
The public consultation for the development of The NHS Plan 'provoked a strong call for a matron figure, a strong clinical leader with clear authority at ward level' (DoH, 2001). This matron figure was to be easily identifiable and accessible. The ultimate aim of the new modern matron was to ensure that 'the basics of care are right' and that the quality of the patient's experience was improved (DoH, 2001). In reality, the role involves comprehensive leadership, team building and service development.


The role of urology matron at St George's Healthcare NHS Trust, London, is very varied with many challenges. The greatest challenge is maintaining a balance between clinical and non-clinical work. It is all too easy to spend excessive time at meetings or performing administrative tasks. The first six to 12 months in post were extremely challenging due to the lack of senior support in the ward and it often felt like I was performing the role of senior sister and matron at the same time.


The key objectives set for the modern matron are shown in Box 1. This paper will discuss each of these in turn, describing the reality of putting these into practice in a urology department.


Maintaining high standards of cleanliness
At St George's Hospital we have a contract cleaning service. The service level agreements for this service are set between the matron and the cleaning company. A weekly timetable is prepared so that the domestics are able to cover all aspects of ward cleaning and a weekly quality control audit is performed to ensure that the cleaning standards are maintained. Our ward domestics are part of the ward team. If there are problems with the cleaning, it is the responsibility of the matron to discuss this with the domestics. Serious issues are referred to the domestic supervisor. The St George's matrons have a monthly meeting with the facilities department to discuss issues and problems. However, as matron I do not have the authority to instruct that payment is withheld.


Prevention/control of hospital-acquired infection
It is the matron's responsibility to prevent hospital-acquired infections. For urology, the biggest infection risk is from indwelling catheters. Infection control is always on the agenda of the monthly staff meetings. An infection control link nurse is in place who is responsible for monitoring the ward and providing up-to-date information.


Improving the quality and delivery of food
The delivery of high-quality hospital food is quite difficult with an allocated sum of only £1.60 per patient, per day. Matrons attend the Better Hospital Food group within St George's. The group's main aim is to find a way to ensure the 24-hour availability of food for patients. One key achievement has been to set up a sandwich delivery to urology departments for patients in the trial without catheter clinic.


Involving patients in planning services
The urology department is a pilot site for patient and public involvement, one of the 'seven pillars' of clinical governance. The aim is to involve patients in service delivery, using their ideas and feedback.


Work has taken place with the patient advice and liaison service (PALS) to set up patient focus groups. Posters have been put up around the department and cards are to be handed out to patients asking them to join the group.


Resolving patients' complaints
It is the matron's responsibility to reply to patient complaints. This can be a way of changing practice for the better. In the urology ward, for example, visiting times have been changed in response to a patient complaint about noise late at night.


Ensuring high-quality care
Matrons can ensure high-quality clinical care and lead by example by performing patient care themselves. This is essential for maintaining 'professional competence, authority and credibility' (DoH, 2001). Patients like to be looked after by 'the matron'. I work at least one day a week in the ward, making beds, performing hygiene care and dressings and organising social discharges.


Auditing the quality of the care given is essential for clinical governance. Our nursing teams perform audits on issues such as documentation, tissue viability, environmental conditions and health and safety. All the staff are involved in the auditing process. Clinical governance is a key part of the matron's role. I chair monthly meetings and follow an agenda based on the 'seven pillars' of clinical governance. At these meetings issues such as clinical risk, clinical effectiveness and patient involvement are discussed.


Improving the ward environment
A great deal of time has been spent improving the urology ward environment with funding from the ward improvement fund. Lockers have been put in the staff room and new equipment, including a second drug trolley, was purchased for the ward. This enables two drug rounds to take place at the same time, which ensures that patients receive their medications on time.


Investing in clinical leadership
Investing in clinical leadership is essential. Courses such as 'Leading Empowered Organisations' and the St George's Healthcare Trust 'Leadership Programme for Senior Staff' are instrumental in changing or reviewing one's management style.


Empowering nurses
As matron I have overseen the integration of the outpatients' team into the urology department. Several nurses from the ward work in outpatients to provide cover and a rotational programme is planned to enable staff to obtain a broader experience. The outpatient sister and staff nurse have set up nurse-led clinics for intermittent self-catheterisation (ISC), prostate assessment and a urology 'SOS' emergency clinic. The work of two specialist nurses is described in Box 2.


I and the senior urology nurses meet monthly to discuss issues and support each other.


As part of the remit for service development, I am working with the urology consultants to create a urology nurse practitioner and pre-admission post. A nurse-led pre-admission service is planned to ensure a smooth patient journey from admission to discharge. The urology nurse practitioner will run nurse-led clinics such as ISC teaching, renal stone disease, continence promotion and urodynamics.


Recruitment and retention is always a challenge. The key is to create a professional but enjoyable atmosphere with plenty of professional development opportunities. There can be problems with bank and agency nurse overspends, which are monitored weekly. It can be difficult to keep within the budget because the staffing establishment for our ward and outpatients is below the actual required nursing numbers. Budgetary constraints such as these can impede service development plans.


We have worked extremely hard to build up a dynamic and cohesive team in the ward. When I started this job, there were no ward sisters. We now have three excellent sisters who were all promoted from staff nurse positions. All our health-care assistants are studying for NVQ 'Care skills' courses. Several nurses have attended the urology course and most are able to perform male urethral catheterisation and ISC teaching. At present we have only five vacant posts.


Conclusion
I believe that the role of matron can make a difference to a ward or outpatient environment. The authority and leadership attributed to the post enables decisions and plans to be carried out. There is a risk that the matron becomes a 'Jack of all trades, master of none' due to the NHS challenges and demands. Some days it is difficult to see the role as the one the Government and the public intended - although I do tend to be 'chief problem solver'. As matrons we still have a way to go to inform the public that we are service developers and budget controllers, as well as ensuring that the bedpans are polished and the floors are sparkling. It is up to us to dispel the myth of the old battle-axe matrons, although we can learn from their ability 'to get things done'.


Further reading
Middleton, C. (2003) Guiding lights. Guardian (Society supplement), April 16.


Department of Health. (2001) Implementing the NHS Plan: Modern matrons - strengthening the role of ward sisters and introducing senior sisters (Health Service Circular 2001/010). London: DoH.

Cole, A. (2002) Modern matrons: take me to your leader. Health Service Journal 112: 5833, 24-29. Further reading
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