the ward sisters role
DESCRIPTION
The ward sisters roleTRANSCRIPT
Facing the Care Challenge Leadership – The Ward Sisters Role
“ Having been an employee at the hospital I feel very embarrassed and ashamed to have worked there… there was not a day went by that I didn’t go home in tears.”
The patient, whose daughter in law was an employee at Stafford Hospital, was admitted to hospital following bowel surgery for unexplained bleeding.
His condition began to deteriorate and he was admitted for minor surgery. Hours later his family were asked to identify him as he had been operated on without any wrist identification or notes. The nurse told the family, who were extremely upset, ‘don’t worry, he is not dead’.
On the ward the patient was not cleaned or dressed. Often he was left exposed in view of other patients and nursing staff talked of his low chance of survival in front of him.
Five days after being admitted to hospital the patient died.
Source: Direct contact
When the patient stayed at the Emergency Assessment Unit at Stafford Hospital for three days he received excellent nursing and medical care. Despite the negative reports he continues to have the ‘highest regard’ for the hospital.
Source: Direct contact
The RCN’s Definition of SupervisoryBreakings Down Barriers, Driving up standards (RCN, 2009) recommends that all ward sisters and Team leaders become supervisory for the purpose of maintaining and improving the quality and consistency of health care experienced by patients and service users.
The RCN has subsequently defined supervisory[1] in the context of the ward sister/team leader role in all settings as the presence of the following attributes;
[1] Supervisory is used in preference to ‘supernumerary’ as ‘supernumerary’ implies being ‘extra’ to the establishment numbers within a clinical team. Whereas ‘supervisory’ encompasses the purpose for which this time would be used; acknowledgement that time is required to undertake supervision over and above the provision of direct care; and a range of strategies for achieving supervision that may involve the provision of direct care with other team members.
The RCN’s Definition of Supervisory Being visible and accessible in the clinical area to the clinical team, patients and
service users e.g. being approachable to visitors; enabling team members to ask questions
Working alongside the team in different ways e.g. supporting junior colleagues in the provision of direct care; facilitating learning in and from practice at the same time as working alongside; undertaking a care plan review
Monitoring and evaluating standards of care provided by the clinical team e.g. enabling reflective review at staff handover; bringing staff together to review clinical and workforce data for example balanced score cards
Providing regular feedback to the clinical team on standards of nursing care provided to, and experienced by, patients and service users e.g. providing feedback at the end of each interaction with staff members, at the end of the shift or in staff handover
Creating a culture for learning and development that will sustain person-centred, safe and effective care e.g. through ensuring there are systems in place to ensure evaluation of practice, clinical supervision and shared governance/decision-making, as well as a focus on patterns of behaviour and the provision of high challenge and high support
Breaking down barriers – Breaking down barriers –
Driving up standards:Driving up standards:
Supervisory ward sistersSupervisory ward sisters
The Dartford and Gravesham The Dartford and Gravesham NHS Trust experienceNHS Trust experience
ContextContext
New PFI 460 bed DGH New PFI 460 bed DGH ‘‘Good’ CQC ratings for quality, Good’ CQC ratings for quality,
‘excellent’ for finance‘excellent’ for finance Very ‘flat’ nursing hierarchyVery ‘flat’ nursing hierarchy Top ten Nursing Times rating for Top ten Nursing Times rating for
nursing satisfactionnursing satisfaction But…. below average staffing levels But…. below average staffing levels
(Audit Commission benchmarking / Dr (Audit Commission benchmarking / Dr
Foster).Foster).
RCN ‘ Breaking Down RCN ‘ Breaking Down Barriers’Barriers’ Resonated for us…. Resonated for us….
Ward sisters felt disempoweredWard sisters felt disempowered Part of ‘rostered’ numbersPart of ‘rostered’ numbers Crisis management – not proactive Crisis management – not proactive
leadershipleadership PDR rate low… PDR rate low… Role confusion and conflictRole confusion and conflict Matrons ‘acted down’ to Band 7 roleMatrons ‘acted down’ to Band 7 role Difficult to recruit Band 7s. Difficult to recruit Band 7s. Complaints showed lack of ward leadershipComplaints showed lack of ward leadership Quality wasn’t being monitoredQuality wasn’t being monitored
Business caseBusiness case
Phase 1 – (09/10) release ward sisters 2 days Phase 1 – (09/10) release ward sisters 2 days a weeka week
Some investment in ward numbers (small)Some investment in ward numbers (small) Phase 2 – (10/11) release ward sisters full Phase 2 – (10/11) release ward sisters full
timetime Phase 3 – increase ward staffing levels to Phase 3 – increase ward staffing levels to
average for ‘peer’ group (?2011)average for ‘peer’ group (?2011) Total investment c £1.5 millionTotal investment c £1.5 million
Why was business case Why was business case
accepted?accepted? Clinicians as decision makers – business case sub-Clinicians as decision makers – business case sub-group of the Clinical Directors’ Board – chaired by a group of the Clinical Directors’ Board – chaired by a CD. CD.
Supportive Exec and Board teamsSupportive Exec and Board teams The ‘case’ made itself: The ‘case’ made itself:
Maidstone and Tunbridge Wells is next doorMaidstone and Tunbridge Wells is next door Mid StaffsMid Staffs Foundation Trust application – Monitor focus on Foundation Trust application – Monitor focus on
qualityquality Realisation that ward nursing care wasn’t all it Realisation that ward nursing care wasn’t all it
should beshould be Realisation that ward sisters had a complex Realisation that ward sisters had a complex
management and leadership task… management and leadership task… Recognition of below average staffing levelsRecognition of below average staffing levels Context of financial and activity growthContext of financial and activity growth
Nursing strategyNursing strategy
Focus on wards – not other areasFocus on wards – not other areas Focus on accountability of ward sisterFocus on accountability of ward sister
Clinical Fridays – metricsClinical Fridays – metrics Agreed Trust wide job descriptionAgreed Trust wide job description Formal delegation of ward budgetsFormal delegation of ward budgets E-rosteringE-rostering Delegation of people managementDelegation of people management Need for personal developmentNeed for personal development
Role of ward sister:Role of ward sister: ‘‘The Ward Sister/Charge Nurse remains the The Ward Sister/Charge Nurse remains the
key nurse in negotiating the care of the key nurse in negotiating the care of the patient because she/he is the only person in patient because she/he is the only person in the nursing structure who actually and the nursing structure who actually and symbolically represents continuity of care to symbolically represents continuity of care to the patient. She/he is also the only nurse the patient. She/he is also the only nurse who has managerial responsibilities for both who has managerial responsibilities for both patients and nurses. It is this combination of patients and nurses. It is this combination of continuity in a patient area together with continuity in a patient area together with direct authority in relation to patients and direct authority in relation to patients and nurses which makes the role so unique and nurses which makes the role so unique and so important in nursing’ (Susan Pembrey, so important in nursing’ (Susan Pembrey, 1980) 1980)
What has improved?What has improved? Fewer nursing complaintsFewer nursing complaints Better ‘collegiate’ team of ward Better ‘collegiate’ team of ward
sisters sisters Fewer in hospital fractured Fewer in hospital fractured
femurs and pressure ulcers femurs and pressure ulcers Better MRSA and C Diff ratesBetter MRSA and C Diff rates Fewer Band 7 vacanciesFewer Band 7 vacancies ?? Summer effect?? ?? Summer effect??
Learning pointsLearning points
Matrons roles have to changeMatrons roles have to change Awaydays for both matrons and ward sistersAwaydays for both matrons and ward sisters Formal ‘performance management’ of ward Formal ‘performance management’ of ward
sisterssisters Not all ward sisters will ‘get it’ – some will Not all ward sisters will ‘get it’ – some will
grasp the new opportunities, some won’t.. grasp the new opportunities, some won’t.. Must stay in uniform and be visibleMust stay in uniform and be visible Challenges of staffing problems, vacancies Challenges of staffing problems, vacancies
and agency ban – ‘supervisory role’ can get and agency ban – ‘supervisory role’ can get lost…lost…
FinallyFinally
‘‘Get off the dance-floor – Get off the dance-floor –
onto the balcony’onto the balcony’
Thank you to the RCNThank you to the RCN
Group work
1. What should Ward Managers be called?
2. Should Ward Managers undergo compulsory management training?
3. Do you believe Ward Managers have the right level of authority to go with their level of responsibility?
4. Is it time to make all Ward Managers clinical supervisors/supervisory?
5. Consensus Statement
Our views have increased the mark of the 10,000Thank you viewers Looking forward to franchise,
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