23. Following leaders or leading followers? (matter for discussion)

East Dorset Branch

That this meeting of RCN Congress discusses whether today's nurses are leaders or followers.

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Progress report

Council Committee: NPPC
Committee decision: Covered by exisiting work
Council member/other member/stakeholder involvement: Jane Bovey
Staff contact: geraldine.cunningham@rcn.org.uk , denise.kelly@rcn.org.uk

Nursing is about providing care that is safe and effective and that also meets the needs of the individual. It is also about ensuring that care systems sustain quality and safety and enable innovation, ensuring continuity of care across pathways, boundaries and sectors and working in partnership with patients and their families and other stakeholders to do so.

Nurses and nursing are pivotal to the ability of the NHS to assure the public on all aspects of clinical quality, including patient safety and the patients’ experience, as nurses deliver up to 70% of direct patient care.

Nurses are absolutely best placed to lead clinical teams in a variety of settings. RCN programs such as the Clinical Leadership Programme and Inspire are aimed at developing nurses to be more effective in leadership. Whilst there are challenges for nursing, developing nurse leadership remains a key objective of the RCN.

Debate report

BJ Waltho from East Dorset Branch asked Congress delegates to discuss whether today's nurses are leaders or followers. She said that strong leaders were needed now and expressed concern that the profession was not attracting or retaining the best leaders. The roles of followers and leaders in nursing were both essential, she said, but emphasised the roles were dynamic, can fluctuate and not independent of each other. The actions of leaders rather than the positions or titles or individuals were key, she told Congress delegates.
 
Leaders can be at all levels, Congress delegates heard. Justin McBride told members that nurse managers often have all the responsibility but none of the power. He called for protected time for the management work in his role and told Congress delegates he was worried about the charge nurses and ward sisters of the future as band five nurses are reluctant to step up, having seen the ‘stress, conflict and hassle’ that goes with the role.
 
Gareth Phillips called for ward sisters and charge nurses to be empowered and recommended the Wales Assembly Government paper ‘Free to lead, free to care – empowering ward sisters’ to those present.
 
Cathy Moore and Andy McGovern said that attending Congress gave them the opportunity to see nurse leaders in action.

 

Background

Clinical nurse leadership is an important factor in the provision of good patient care but all too often the ward sister or charge nurse leadership role is compromised by increasing demands which include the delivery of patient care, resource management, limited capacity and a lack of authority.

The findings of the RCN report Breaking down barriers, driving up standards (2009) revealed strong consensus and agreement that the ward sister role remains fundamental to the organisation and delivery of hospital nursing and to the standards of nursing care. However, it highlighted a range of issues relating to the current organisational, professional and employment context of the contemporary ward sister role, including:

One of the key concerns highlighted in the report was an area of conflict relating to the authority of the ward sister to manage the ward and ward staff. In theory ward sisters hold responsibility for the management of the ward, but many ward sisters said they did not actually have the adequate authority to effectively carry this out.

The Productive Ward Initiative – lead by the NHS Institute – has found that ward nurses in acute setting spend an average of 40 per cent of their time on direct patient care and is providing tools that empower ward sisters to deliver change and demonstrate how they can increase productivity and improve infection rates on their wards. This model of working is now being extended into the NHS Productive Community Services Programme and is being used by clinical nurse leaders to improve patient outcomes, enhance patient care and act as advocates for reforming health care delivery.

The structure of clinical leadership varies across the four countries. Scottish Executive nurses work at regional board level; as a result directors of nursing working in hospital and community settings have limited experience of board level engagement which has raised concerns related to succession planning. RCN Scotland is working closely with executive nurse leaders to redress this issue, with a significant input being made into supporting senior charge nurses and the implementation of the Leading better care initiative (National Health Service in Scotland, 2008). In Northern Ireland the RCN is currently working to promote nurse leadership through the establishment of a new senior nurse leaders network, and by convening an inaugural Leadership Challenge programme. In Wales the majority of NHS organisations are delivering the RCN Clinical Leadership Programme. Participants can gain academic accreditation via the BSc in Clinical Leadership at the University of Glamorgan. Moreover the RCN is supporting the Welsh Assembly Government in the development of a ward sister/charge educational programme.  

The RCN will continue to support nurse leadership development through the RCN Clinical Leadership Programme and supports the belief that leadership is as much about having the correct attitude and behaviour as it is about gaining new skills and knowledge.

References and further reading
National Health Service in Scotland (2008) Leading better care: report of the senior charge nurse review and clinical quality indicators project, Edinburgh: Scottish Government.
www.scotland.gov.uk/Publications/2008/05/30104057/11

Royal College of Nursing (2009) Breaking down barriers, driving up standards: the role of the ward sister and charge nurse.London: RCN.
www.rcn.org.uk/development/publications