ANALYSIS
Fears mount among employers and nurse leaders over the continued churn of nursing directors at trusts across England. Katie Osborne reports
Rapid turnover of nursing directors undermines drive to improve safety Exclusive research by Nursing Standard has revealed more than one quarter of nursing directors – 29 per cent – in 199 trusts across England were appointed in the past 12 months and more than half have been in post for less than three years. Amid the biggest shake-up of the health service in history and unprecedented pressure on senior nurses to steer their organisations into calmer waters following several public enquiries and reviews, including the Francis enquiry into care failings at Stafford Hospital and the Berwick review into patient safety, there are now fears that the NHS may be at tipping point. The director of nursing role is vital to ensure patient safety but the continued high turnover of nursing directors is undermining stability and continuity at board level, warn nurse leaders. RCN England director Tom Sandford says: ‘At a time of such
Movement of nursing directors at 199 trusts in England
29% 18% 55%
were in post a year or less
were in post for two years or less
were in post for three years or less
significant turbulence and pressure in the NHS it is important to have a confident and empowered director of nursing community in England, to provide leadership on the patient safety challenges ahead and consolidate safe staffing. ‘These are difficult challenges given the well-reported shortages
NURSE DIRECTORS NEED THE SUPPORT OF THEIR BOARDS – Tom Sandford
of qualified nurses across England and nurse directors need the full support of their boards and chief executive officers to deliver on these NHS priorities.’ Cheryl Etches has been a nursing director at Royal Wolverhampton Hospitals NHS Trust for nine years. She believes stability at leadership level is vitally important so that effective partnerships can be established. She says working in partnership with the chief operating officer and the medical director is essential and agrees that partnerships cannot be established if there is a continuous ‘churn’ in the system. NHS Employers assistant director of employment services Caroline Waterfield agrees that directors of nursing need support but is not convinced that the high turnover of nursing directors is cause for concern. ‘The figures show that the majority of nurse leaders have been in post for longer than 12 months, indeed many have been in post for considerably longer,’ she says.
‘The post-Francis world has meant that a number of nurse leaders are taking on wider roles within their own trusts, regionally and on the national stage. As a result, there is some movement in the system to backfill and add additional capacity in places. ‘Constant change can be unsettling for staff and organisations, but movement also allows others to take on leadership roles and bring new ways of working to an organisation, which should be encouraged.’ But chair of the Safe Staffing Alliance, a group of leading nurses brought together by Nursing Standard, Susan Osborne says there is a dire shortage of experienced nurses going for senior posts because of a long history of under-investment. ‘Sadly, we have a very junior cadre coming through the ranks so the experience is just not there,’ she says. ‘There has been a gradual dilution of senior nurses over the past 20 years and we have lost more than 4,000 band 7 and band 8 nurses. ‘Because of that insidious cost-cutting we now have the conundrum where quite a number of hospitals have unsafe staffing levels but they are peppered with junior nurses. Chief nurses are struggling because they have not got deputies to help them. We are now hitting tipping point and it is becoming very serious.’ Ms Osborne, who was interim director of nursing at Medway NHS Trust last year, says it is vital the NHS starts to identify nurses early on in their career and prepares them for nurse director posts. However, the current ‘fragmented
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DANIEL MITCHELL
ANALYSIS
‘It is a lot of pressure. These nurses are working long hours and trying to juggle everything. They know they need more resources, but they are unable to get them from the board.’ Ms Etches believes the impact of the Francis report has been twofold. She says: ‘The Francis report put quality and safety central to the board agenda and board members suddenly realised the value of the chief nurse, who in the past was perhaps not perceived as the key executive around the table. ‘The value of the chief nurse has therefore increased and with that so have the demands of the job.’ Ms Etches feels ‘extremely well supported’ by her board, and says: ‘While I might be challenged, and that is right, I think I am able to demonstrate my position quite clearly.’
Criticism
health service’ makes it difficult to spot suitable candidates, she adds. She also believes that nursing directors are not being given enough support at board level since all budgetary responsibility was removed from the role in 1983, following the Griffiths report.
Many bow under the strain because they simply do not have the power or the strength to fight the system for vital resources to make wards safe. ‘The chief nurse is accountable,’ she says, ‘but holds no financial strings. The role is now one of professional advice only.
But not all directors feel similarly valued by their trusts. Unison’s head of nursing Gail Adams says: ‘It is not an easy job and it is not a valued job. Directors of nursing get none of the glory but all of the criticism when things go wrong. ‘If they are not supported and given the resources to do the job, then it is like asking them to do it with their hands tied behind their back.’ She also argues the importance of continuity and stability at board level. ‘Trust and relationships need to be established,’ she says, ‘and that does not happen on day one, it takes time.’ She points to trusts, such as Imperial College London and Guy’s and St Thomas’, where the nurse directors have been in position for lengthy periods of time. ‘The directors of nursing in these trusts have been able to fight their corner for staffing and resourcing at board level and these are very different organisations as a result,’ she says. Ms Osborne agrees: ‘Excellent institutions have visibly stable top tables who work well in partnership with others. Once you have instability at board level you lose trust, the partnership working and, most importantly, an understanding of what is happening on the front line’ NS
NURSING by ${individualUser.displayName} on Nov 21, 2015. For personal use august :: voluses 28 without no 49 ::permission. 2014 15 DownloadedSTANDARD from RCNi.com only. No6other Copyright © 2015 RCNi Ltd. All rights reserved.
Fears mount among employers and nurse leaders over the continued churn of nursing directors at trusts across England. Katie Osborne reports
Rapid turnover of nursing directors undermines drive to improve safety Exclusive research by Nursing Standard has revealed more than one quarter of nursing directors – 29 per cent – in 199 trusts across England were appointed in the past 12 months and more than half have been in post for less than three years. Amid the biggest shake-up of the health service in history and unprecedented pressure on senior nurses to steer their organisations into calmer waters following several public enquiries and reviews, including the Francis enquiry into care failings at Stafford Hospital and the Berwick review into patient safety, there are now fears that the NHS may be at tipping point. The director of nursing role is vital to ensure patient safety but the continued high turnover of nursing directors is undermining stability and continuity at board level, warn nurse leaders. RCN England director Tom Sandford says: ‘At a time of such
Movement of nursing directors at 199 trusts in England
29% 18% 55%
were in post a year or less
were in post for two years or less
were in post for three years or less
significant turbulence and pressure in the NHS it is important to have a confident and empowered director of nursing community in England, to provide leadership on the patient safety challenges ahead and consolidate safe staffing. ‘These are difficult challenges given the well-reported shortages
NURSE DIRECTORS NEED THE SUPPORT OF THEIR BOARDS – Tom Sandford
of qualified nurses across England and nurse directors need the full support of their boards and chief executive officers to deliver on these NHS priorities.’ Cheryl Etches has been a nursing director at Royal Wolverhampton Hospitals NHS Trust for nine years. She believes stability at leadership level is vitally important so that effective partnerships can be established. She says working in partnership with the chief operating officer and the medical director is essential and agrees that partnerships cannot be established if there is a continuous ‘churn’ in the system. NHS Employers assistant director of employment services Caroline Waterfield agrees that directors of nursing need support but is not convinced that the high turnover of nursing directors is cause for concern. ‘The figures show that the majority of nurse leaders have been in post for longer than 12 months, indeed many have been in post for considerably longer,’ she says.
‘The post-Francis world has meant that a number of nurse leaders are taking on wider roles within their own trusts, regionally and on the national stage. As a result, there is some movement in the system to backfill and add additional capacity in places. ‘Constant change can be unsettling for staff and organisations, but movement also allows others to take on leadership roles and bring new ways of working to an organisation, which should be encouraged.’ But chair of the Safe Staffing Alliance, a group of leading nurses brought together by Nursing Standard, Susan Osborne says there is a dire shortage of experienced nurses going for senior posts because of a long history of under-investment. ‘Sadly, we have a very junior cadre coming through the ranks so the experience is just not there,’ she says. ‘There has been a gradual dilution of senior nurses over the past 20 years and we have lost more than 4,000 band 7 and band 8 nurses. ‘Because of that insidious cost-cutting we now have the conundrum where quite a number of hospitals have unsafe staffing levels but they are peppered with junior nurses. Chief nurses are struggling because they have not got deputies to help them. We are now hitting tipping point and it is becoming very serious.’ Ms Osborne, who was interim director of nursing at Medway NHS Trust last year, says it is vital the NHS starts to identify nurses early on in their career and prepares them for nurse director posts. However, the current ‘fragmented
14 august 6 :: vol 28RCNi.com no 49 :: 2014 STANDARD Downloaded from by ${individualUser.displayName} on Nov 21, 2015. For personal use only. NoNURSING other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
DANIEL MITCHELL
ANALYSIS
‘It is a lot of pressure. These nurses are working long hours and trying to juggle everything. They know they need more resources, but they are unable to get them from the board.’ Ms Etches believes the impact of the Francis report has been twofold. She says: ‘The Francis report put quality and safety central to the board agenda and board members suddenly realised the value of the chief nurse, who in the past was perhaps not perceived as the key executive around the table. ‘The value of the chief nurse has therefore increased and with that so have the demands of the job.’ Ms Etches feels ‘extremely well supported’ by her board, and says: ‘While I might be challenged, and that is right, I think I am able to demonstrate my position quite clearly.’
Criticism
health service’ makes it difficult to spot suitable candidates, she adds. She also believes that nursing directors are not being given enough support at board level since all budgetary responsibility was removed from the role in 1983, following the Griffiths report.
Many bow under the strain because they simply do not have the power or the strength to fight the system for vital resources to make wards safe. ‘The chief nurse is accountable,’ she says, ‘but holds no financial strings. The role is now one of professional advice only.
But not all directors feel similarly valued by their trusts. Unison’s head of nursing Gail Adams says: ‘It is not an easy job and it is not a valued job. Directors of nursing get none of the glory but all of the criticism when things go wrong. ‘If they are not supported and given the resources to do the job, then it is like asking them to do it with their hands tied behind their back.’ She also argues the importance of continuity and stability at board level. ‘Trust and relationships need to be established,’ she says, ‘and that does not happen on day one, it takes time.’ She points to trusts, such as Imperial College London and Guy’s and St Thomas’, where the nurse directors have been in position for lengthy periods of time. ‘The directors of nursing in these trusts have been able to fight their corner for staffing and resourcing at board level and these are very different organisations as a result,’ she says. Ms Osborne agrees: ‘Excellent institutions have visibly stable top tables who work well in partnership with others. Once you have instability at board level you lose trust, the partnership working and, most importantly, an understanding of what is happening on the front line’ NS
NURSING by ${individualUser.displayName} on Nov 21, 2015. For personal use august :: voluses 28 without no 49 ::permission. 2014 15 DownloadedSTANDARD from RCNi.com only. No6other Copyright © 2015 RCNi Ltd. All rights reserved.
