Date Published: 2 March 2009

Nurses call for more support for nurse leadership on wards

The Royal College of Nursing (RCN) will today publish a new report, Breaking Down Barriers, Driving up Standards: The Role of the Ward Sister and Charge Nurse. The report is based on research with nurses across England and looks at their current roles, best practice and areas where more support is needed.

This research is timely because quality leadership is crucial to delivering quality patient care. The RCN has welcomed Lord Darzi’s commitment to high quality care, and this report outlines the changes which need be made to ensure that nurses are able to deliver that care in every part of the NHS. The report demonstrates that some ward sisters are prevented from offering the leadership their role requires because they have a high clinical load of their own, they have to do too much paperwork and they are not given enough authority over the ward environment.

The difference made where ward sisters are able to supervise patient care and oversee the ward environment is clear both in the report and by the ward sisters who are attending today’s launch.

Dr Peter Carter, RCN Chief Executive & General Secretary said:

Ward sisters are at the heart of delivering high quality care. As part of their role, they must manage a team of nurses, oversee the care patients are getting and make sure that the ward environment is clean and safe. This report shows what can be achieved where their expertise is used to manage wards properly, and where they have appropriate support to carry out their duties.

One example featured in the report shows the problems which arise when nurses are not given the necessary authority to lead on their ward. Nurses on one ward had to go and buy their own batteries for medical equipment because they did not have the authority to get them delivered through the hospital system. This is not an effective way for a ward to be run, and there are few other industries where this would be tolerated. Talented nurses should be free to lead and to nurse, and good nurses should be encouraged to take a career route where they can lead, educate and oversee care as ward sisters.

Lord Darzi knows this, and he recognises the vital contribution made by ward sisters to delivering high quality treatment. Where the ward sisters are nurse leaders, who can educate staff and oversee patient care, wards run more effectively, and this should happen across the country. Talented nurses should be able to benefit more patients than those they treat directly.”

Louise Boden, Chief Nurse at UCLH Foundation Trust, said:

Ward sisters are the key to delivering the best possible care. We know that when a patient comes into hospital, they need to know who is in charge. They also want to know that that person has all the necessary skills, resources and authority to produce a good care environment, appropriately trained staff and well organised care. At UCLH we are committed to supporting ward sisters and charge nurses to be able to supervise care delivery, and deliver results for patients.”

The main headlines of the report are:

1. Ward sisters have a huge breadth of responsibilities, encompassing leadership and management, clinical practice and education and teaching. To carry out all of these roles they must supervise nursing on all shifts, rather than taking on heavy clinical loads themselves. One ward sister said -

If the patients are to receive good care I have a big role to work in a supportive and supervisory way with staff and students.”

2. The roles ward sisters actually fulfil are often unclear, and the aims, purpose and function of a ward sister vary in different settings. Patients want to know who is in charge and that that person has the necessary authority to deliver high quality care. More clarity in this area would encourage more talented nurses to take this route. One ward sister said -

One of the purposes of the role is to make sure everybody knows what is going on…that is the patient, the nurses, the doctors and others like the occupational therapist and physio, dietician…you have to be able to co-ordinate the activities of everyone working in the ward, so that each patient gets the best possible individualised care…”

3. Ward sisters are constantly balancing roles as professional nurses and the front line of management for the largest group of NHS staff. The report found that ward sisters were motivated to manage their ward team by a passion for nursing, rather than an aspiration or desire to be a manager per se. They should be supported in delivering their managerial responsibilities while keeping nursing central to their job. One ward sister said -

We have to lead the whole recruitment process…writing the letters, sending them out, doing the interviews, everything…it takes a long time…I would rather be supporting my staff on the wards, giving patient care…I don’t think I am using my skills as a clinical expert when I am planning interviews.”

4. Ward sisters have reported a lack of formal preparation and skills development for ward sisters and aspiring ward sisters, despite some excellent examples of training in some trusts. These programmes, such as the one at Imperial College Healthcare NHS Trust, should be made available to ward sisters across all trusts. One ward sister said -

I don’t really feel confident managing long-term sickness on my own…but nobody really helps you…I find it difficult to get the support I need…and it takes forever…I think we should be supported more with certain aspects of the role..”

5. Ward sisters are theoretically responsible for key factors affecting nursing standards, such as cleanliness and nutrition, but often in practice they are unable to control them. Trusts should ensure that clinical staff are able to deliver care in an appropriate environment with all the necessary resources.

We don’t have any [weighing] scales that work at the moment…each day we ring facilities. They just say it will get sorted but it isn’t…meantime the nurses are trawling the other wards to borrow beg or steal some scales…why can’t I just ring up the company and get them to come and repair them?

The report also includes evidence that effective ward leadership correlates with patient outcomes and staff performance in terms of lower rates of medication errors, higher levels of patient satisfaction and lower ward absence and sickness rates

Source: Royal College of Nursing (RCN), UK.
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