My job

‘Never be a friend of complacency’

Clinical lead for nursing and care services Caroline Betts on the opportunities and challenges of leadership

Clinical lead for nursing and care services Caroline Betts on the opportunities and challenges of leadership


What is your job?

As a matron, I am clinical lead for nursing and care services in a St Raphael’s Hospice, North Cheam, Surrey.

What are your main responsibilities?

Caring for patients and their families at end of life, multi-disciplinary collaboration in and out of hospice, organising daily workflow, overseeing referrals to the hospice, managing community and inpatient clinical teams, clinical governance, leading on safeguarding, medicines management, and maintaining Care Quality Commission requirements and standards.

Why did you become a nurse?

Seeing the difference we can make to people’s lives is satisfying. Nursing has changed since I trained, and there are now opportunities to specialise, learn, educate and lead.

What do you enjoy most about your job?

I enjoy the variety every day brings and working in a team. When multi-disciplinary team working is at its best, patients receive a better service and, ultimately, this is the outcome we all should strive for.

I also enjoy leading a team of professionals who embrace change with a ‘can do’ attitude. I feel privileged to work in an environment that supports people physically, socially, psychologically and spiritually.

But I particularly enjoy teaching and mentoring, watching people flourish in their roles, and trying where possible to promote a team approach to all changes and decisions.

How and where have you developed leadership skills?

I have been a nurse for more than 25 years, and I learned many of my skills from role models who I respected and valued.

It can be easy to learn management skills, but leading can be more of a challenge. Everyone in a team has something to offer, and has strengths that should be appreciated and nurtured. It is important for people to feel valued.

Clinical supervision while in my leadership role has helped me to focus on important tasks, while giving me time to reflect on things that worked well or did not go to plan.

It is important to recognise when something does not work and implement change when it is needed, not for the sake of it. Regular review and modification are essential to ensure changes are embedded and become accepted practice.

How does your job make use of your skills?

Since starting at the hospice three years ago, I have introduced many changes, including those to inter-departmental communications. I have also sought to ensure that incidents and complaints are examined, and that learning from them is disseminated to all team members.

For every team meeting, we now have a clinical agenda that incorporates clinical governance, information governance, incidents and complaints, recruitment, education, competencies and audit, so everyone is informed.

I was clinical lead for the introduction of a patient electronic record system, and continue to review and modify it. With a team established from the beginning of the project, I have delivered yearly training programmes to embed the new system and, with this great team, we have maintained the momentum of the project.

Most importantly, I have undertaken service reviews and, to this end, have re-organised the working hours of the inpatient and the community teams to allow for flexible working and a better work-life balance. In end of life care, we have teams of highly specialised people who are passionate about the patients we see and it is humbling and rewarding to be a part of this.

What is the greatest challenge?

Changing culture is the most challenging aspect of leadership because it involves getting teams on board with change when they cannot see where change is needed. But I have learned that change starts with compromise on both sides.

What inspires you?

Teamwork, respect for each other and good humour.

What do you do in your free time?

What free time? I love spending time with my family: walking, eating and holidaying. I also love going out with friends and reading.

What achievement makes your most proud?

Moving from one specialty to another: intensive care to palliative care. After ten years in intensive care, it would have been easier for me to remain in my comfort zone but, after three years of study and clinical work with colleagues, I have found a new comfort zone. It is important not to become complacent and embrace new challenges.

What makes a good nurse leader?

Someone who listens, who is never removed from patient contact and clinical practice, who can role model all aspects of the job, who respects all individuals in the team, who is not afraid to manage performance, who knows when they are wrong, who knows when they are right and, most importantly, someone who puts patients and their families at the forefront of what they lead.

What advice would you like to pass onto students and junior staff?

Always maintain your professional integrity. If in doubt, don’t do it: ask. But never be afraid to learn from mistakes; we have all made them. Take pride in your role and always consider how you would like a family member to be treated in the same situation. Maintain a voice throughout your career and challenge that with which you disagree. Never be a friend of complacency.

This article is for subscribers only