Author Topic: Management in Nursing  (Read 11384 times)

Charlie Harden

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Management in Nursing
« on: November 13, 2007, 10:42:31 AM »
Its interesting how the management of nurses has evolved over time. Historically nursing as a profession is unique in that it is usually centered around teams and team working. How these teams are managed has had a significant impact on the influence nursing has had in recent times. I remember the fall out when the Salmon Roles were created during the 70s resulted in the Nursing Officer structure being created which placed nurses at every level within the NHS. Despite general opposition particularly from doctors this appeared to be the golden time for nurse managers. My view is that the structure was good but the appointed nurses were not prepared properly for the new roles. I similar thing happened later in the 1980s when General Management was introduced. Senior Nurses were squeezed out because of a similar lack of preparation.  Any comments?

backman

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Re: Management in Nursing
« Reply #1 on: November 13, 2007, 12:30:00 PM »
  I think is a common misconception that if someone is a good nurse that they should make a good nurse manager,hence all the hype about bring back Matrons.We have been lucky in that in the history of nursing as a profession that there have been some dynamic characters who have been both good clinicians and good managers.I would recommend the book When Matron Ruled as giving examples of some pretty impressive characters;  http://www.amazon.co.uk/When-Matron-Ruled-Peter-Ardern/dp/0709068581

 However like many things in healthcare today,the concept may be one thing but the application in reality may be something else altogether. In management in the modern NHS you need to be grounded in the financial,political and organisational basics as well as grasping the clinical implications of healthcare delivery.In my experience we focus on the later to the detriment of the big picture and thus dip out in our ability to become effective senior managers.Do students today really understand the commissioning process and know about effective equipment procurement,and in fact do they need to?

Charlie Harden

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Re: Management in Nursing
« Reply #2 on: November 13, 2007, 01:08:40 PM »
Yes I know this book well. It's often quoted by politicians as proof of how rubbish managers are today compared to the 'good old days' The facts are that the old matrons had no clout above their hospital level. Often not even members of  the old Hospital Management Committees which I guess were the forerunners of todays Trust Boards.  That nurses have been unable to use their muscle over the years may be gender related?

backman

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Re: Management in Nursing
« Reply #3 on: November 13, 2007, 03:26:49 PM »
 But then the matron didn't really need to have clout at anything other than Hospital level.The role often evolved out of the Workhouse Matron and Masters responsibilities for enforcing Institutions rules and managing provisions and staff on a day to day basis and didn't develop to much more until much more recently.Historically the Matron was always accountable to the hospital board,usually led by the Medical Officers and there were certainly cases where troublesome Matons were dismissed and disagreements about management styles are certainly nothing new.As far as gender is concerned,are the comparisons between General Hospitals and Asylums,and the management of these affected by the much higher incidence of Male staff? One might argue that the development of Asylum nursing and RMPA training and certification led the way for other nurse registration in the 1920s.

Bored Hat

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Re: Management in Nursing
« Reply #4 on: November 13, 2007, 04:29:17 PM »
Interesting subject. Ironic really as I am just putting together a short piece on the "rise and fall of the Nursing Officer".
I know it is perhaps an over simplification - but I think the problem is that there are not enough Managers who can nurse - that is they lack the fundamental skills. Students today appear to embrace the computer terminal more than the "bedpan".
Is it the Management IN Nursing or the Management OF Nursing?

Bored Hat

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Re: Management in Nursing
« Reply #5 on: November 13, 2007, 07:52:26 PM »
I do not mean to "hog" this but (and I think this fits in with this topic) one of the NHS initiatives which bemused me was the introduction of the "Modern Matron".
It's a hoot!!! I have a friend who wears that title but it was 'imposed' upon her and she sees no real value in it.
The Department of Health definition or justification is as follows:

"When patients and the public were consulted about how the NHS could be improved, one of the messages that came through loud and clear was a call for the return of a matron figure, a strong clinical leader with clear authority at ward level.

That is why the Government made a commitment in 'The NHS Plan' to introduce modern matrons - senior sisters and charge nurses who are easily identifiable to patients and who have the authority and support they need to make sure the fundamentals of care are right.

Many NHS Trusts have recognised the potential of the modern matron concept and have been swift to establish the new posts. In April 2002 there are nearly 1900 nurses in modern matron posts across the NHS in England, nearly four times as many as originally envisaged."

With respect and deference to the relevant individuals - it is just eye-candy and window dressing!

backman

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Re: Management in Nursing
« Reply #6 on: November 13, 2007, 09:08:06 PM »
 I agree that this is yet another cosmetic exercise that the public wanted.I can't help thinking that we should perhaps dress nurses like a cross between a victorian parlour maid with  starched apron and Barbara Windsor or Hatti Jacques from the Carry on films,after all it might reassure the public?

Odysseus

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Re: Management in Nursing
« Reply #7 on: November 13, 2007, 09:46:47 PM »
I wonder what a male 'modern Matron' would think of that uniform?  But to be serious, I agree that all these name changes are 'eye candy' and window dressing. Could someone perhaps enlighten me as to how changing names makes (the same) nurses better clinicians, or indeed managers?

A rose remains a rose by any other name - but I can't help finding that modern managers (who seem to implement whatever policy the government of the day hands out with a verve) have little to do with improving the quality of care.

Managing care needs a thorough understanding of the care required and how it is best delivered. In my experience care is best prescribed by one best fitted, usually a consultant, and deliverd on the same principle by a nurse.

Interference is best provided by one with little practical understanding of the situation but with administratve goals to achieve - what's in a name? I can't help wondering how much money (and achievable higher standards of care) are squandered on hireing (and even 'retiring') many of todays managers.

Bring back real (Hospital) Matrons; real sisters; real charge nurses; real nurses. Watch standards of care rise. Or am I being too simple?

Bored Hat

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Re: Management in Nursing
« Reply #8 on: November 13, 2007, 10:32:55 PM »
Amen Odysseus! I am all for progress and making things better - but I'm still waiting!

Charlie Harden

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Re: Management in Nursing
« Reply #9 on: November 14, 2007, 01:39:18 PM »
Don't assume that a consultant is better at managing care than anyone else but I see what you're getting at. I was a Charge Nurse in the 80s - then was promoted to Nursing Officer and I can honestly say that the first 2 years as a manager were the best of times. I still had clinical cred & I felt really in touch with bedside care. When general management was introduced we were all re-organised so much so that some of us didnt really know what our job was any more.  Many senior nurses took early retirement and some like me just left. What a waste

Odysseus

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Re: Management in Nursing
« Reply #10 on: November 17, 2007, 08:05:53 AM »
Yes, I can relate to that.

But a long-standing issue was always what do you do about promotion after becoming a sister or charge nurse? One either sat still and stayed with the patients, or sought promotion because of pay and prospects.  The (deplorable) distancing from patient care was inevitable. Even those who went into teaching met the same fate.

Many clinical teachers whose objective was maintaining hands-on care ended up in the classroom finding gaps in teacher numbers. Or actively persued (or were pushed into) further carreer development and ended up as tutors - many of whom, in spite of taking up teaching in the hope of retaining some direct contact with care, were never seen again outside the School. Many were very highly trained and yet the system sucked them away from patients too.

Long live Lycette Green (the report that is) which is where, I think, General Managers came from! A lot to answer for.

backman

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Re: Management in Nursing
« Reply #11 on: November 17, 2007, 12:55:10 PM »
 I certainly remember that when I started my training the ward sisters had usually trained as a student & worked as a staff nurse in the same hospital or area and occupied the post for many years. Role mobility with new sisters coming in from outside only came about several years later,it had always been "Dead mens shoes" but general management seemed to encourage all nurses (myself included)to expect a management post within a few years of qualifying? 

Odysseus

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Re: Management in Nursing
« Reply #12 on: November 20, 2007, 08:37:24 AM »
And I can certainly relate to that, backman.

I remember well the 'almost 20 year rule' relating to promotion from staff nurse to sister/charge nurse. It ran to 'about' 20 years in quite a few hospitals in the late '50s early '60s. Newly qualified staff nurses (without a blotted copy book) were all interviewed by Matron/CMN and added to the 'Secondment list'.  Secondment for further registration training that is... That could involve a five year queue!

I remember to that we all knew the name of the next sister/charge nurse, as did the person in question immediately the current one was filled.  The alternative was to leave and take your chances elsewhere, not an encouraging prospect at that time.

backman

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Re: Management in Nursing
« Reply #13 on: November 20, 2007, 08:46:57 AM »
 Yes,I can still remember several "Sisters in Waiting",some of whom never achieved the role due to 30 or 40 year tenure of the previous incumbant.It was really only the high flyers who flitted from one management position to another in different hospitals.I remember I was amazed to see my first sister aged in her 20s,progress eh!

Charlie Harden

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Re: Management in Nursing
« Reply #14 on: November 21, 2007, 03:41:26 PM »
Does anyone seriously  believe that  Modern Matrons have any real power? Clinical groups are usually managed by a general managers who will report  to an operational director. These are the budget holders and therefore have the real power. They can just say 'Well thank you for your input Matron now go away' Since the Grifffiths report in the late 80s and the introduction of general instead of hierarchical management a one eyed man could see that the lack of clinical management skills at operational level was bound to affect standards of patient care.  Modern Matrons just aren't the answer.

 

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