DISAPPOINTMENT AT LACK OF MANDATE TO MAKE WARD SISTERS SUPERVISORY Chair of the prime minister’s nursing and care quality forum Sally Brearley agrees: ‘It is a very difficult role, so we do need to make it more attractive and better supported.’ This week, examples of best practice and advice gathered by the forum on how best to bolster ward sisters’ time will be published on NHS England’s 6Cs Live website. ‘It will explain where people have been able to introduce supernumerary status, how they achieved it and the benefits derived from it,’ said Ms Brearley. Of 50 NHS organisations in the UK surveyed by Nursing Standard last year, just ten employed all their ward sisters on a fully supervisory basis. At three organisations, none of the ward sisters received any allocated supervisory time, while at the other organisations the amount of time given varied widely. Nursing Standard called for ward sisters to be supervisory in its Power to Care campaign, launched in 2011. The campaign aimed to boost the status of ward sisters and also give them administrative support. Colin Baker, ward manager on a 14-bed acute assessment ward at Gloucestershire mental health trust 2gether, has been fully supervisory since he began working for the trust 13 years ago. He says that without mandating a supervisory the financial pressures A NURSE CONSIDERING role, on trusts could lead to ward PROMOTION WILL sisters being included in THINK LONG AND HARD the staffing numbers to savings. ABOUT IT – Howard Catton make ‘If I were not supervisory, I would not have the time to do all the things expected of me. We ‘If there had been a clear signal would not have time to train staff or about the importance of the role being offer supervision. supervisory and it was not included in ‘We would not have time to audit the day-to-day numbers, it could have patients’ notes properly or be able to had a positive impact on nurses at the provide assurance that things had been start of their careers thinking about done correctly on the wards. We would whether or not they should aspire to operate in a much more reactive way.’ a leadership role.’ Nurses have expressed disappointment over the government’s decision not to make it mandatory for ward sisters and charge nurses to be employed on a fully supervisory basis. Last month, the Department of Health (DH) stopped short of accepting Robert Francis’ recommendation that trusts should be compelled to employ ward sisters on a supervisory basis, meaning they are excluded from ward staffing numbers. The government was responding to the Francis report into care failings at Stafford Hospital, which in February said that supervisory status would enable ward sisters to mentor junior staff, act as role models, develop staff competencies and leadership skills, and monitor performance on the ward. But the DH argues that, while it supports supervisory roles for ward sisters, employers should have flexibility over the way they are deployed. RCN head of policy Howard Catton says ward sisters may become increasingly difficult to recruit unless the role is made more attractive and is properly supported. ‘A nurse who is considering promotion to a ward sister role will think long and hard about it because he or she knows that significant hours, workload and responsibility come with that role,’ he explains.

14 december 4 :: vol 28 no 14 :: 2013

SCIENCE PHOTO LIBRARY

ANALYSIS

In response to the Francis report, the government wants there to be an assigned nurse for each patient. Sally Gillen reports

The named have been Health secretary Jeremy Hunt’s announcement that every hospital patient is to have the name of their nurse placed above their bed came as a surprise to many especially those who for years have been doing just that. Guy’s and St Thomas’ NHS Foundation Trust older people’s nurse Mark Boothroyd is one of them. ‘On my ward, and every ward I have worked on, nurses are always assigned a group of patients for whom they are responsible,’ he says. He adds that while names are not always placed above the beds, they are often displayed on a main board next to a section or bay, as is the case at his current place of work. ‘For me and my colleagues this initiative already exists, so Jeremy

NURSING STANDARD

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ANALYSIS

How it works in practice One of England’s largest NHS trusts, University College London Hospitals NHS Foundation Trust, which has 1,107 beds, introduced named nurses in June. It works as follows:  The name of the patient’s nurse and consultant, the patient’s preferred name and their expected date of discharge is written on the headboard.  There is also a box for any special details, such as if they need help eating.  Deputy chief nurse Sue Beatson says: ‘The boards are great because the patient knows who is responsible for their care. It also means that when you are at someone’s bed, you can see what they like to be called and a consultant can see which nurse is looking after the patient.’

nurse concept: ‘But we doing this for years’ Hunt’s announcement will make absolutely no difference’ he says. ‘Maybe there are some hospitals where nurses work across the ward as part of a pool, sharing responsibility for all patients. I have not worked in that way and it would probably be extremely stressful trying to keep knowledge of between 20 and 30 patients in your head all day.’

Consistency

As a concept and way of organising care, the named nurse system has existed for years. But Mr Hunt’s announcement, part of the government’s response to the Francis report into failings at Mid Staffordshire NHS Foundation Trust, is arguably designed to provide a

NURSING STANDARD

consistent approach to organising care across England’s hospitals. Having the name of a nurse written down can provide reassurance to patients and their families. In his report, published in February, Robert Francis recommended that each patient should have a named nurse responsible for co-ordinating their care and, wherever possible, the nurse should be present at every interaction between the patient and a doctor. The concept of the named nurse is likely to have been proposed by Mr Francis after frustrated relatives complained that they were never able to locate the nurse responsible for their loved one’s care at Stafford Hospital.

RCN assistant head of nursing Tim Curry says: ‘It is a good idea because it can improve communication between relatives and nurses, but it is dependent on staff capacity.’ At one time, patients had a named nurse who was responsible for their care throughout their entire hospital stay, rather than on a shift-by-shift basis, says Mr Curry. But the use of named nurses in this way petered out, partly because the high turnover and number of patients made it impractical. Sometimes decisions would need to be made about patients, but the named nurse was not on shift. ‘They were not doing what they were designed to do,’ Mr Curry adds. Some disquiet has arisen following remarks made by Mr Hunt at the launch of the government’s response. He said that having the names of a nurse and doctor above a patient’s bed would ensure ‘everyone knows where the buck stops’. ‘That is an unfortunate phrase,’ says Mr Curry. ‘The buck does not stop just with nurses – lots of people are involved in patient care and things happen outside of a nurse’s control’ NS december 4 :: vol 28 no 14 :: 2013 15

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The named nurse concept: 'But we have been doing this for years'.

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