Analysis

Addressing the issues of high turnover rates in senior nurse roles

A departing nurse director has spoken of the ‘anxiety of individuality’ sometimes felt in senior roles such as hers

A departing nurse director has spoken of the anxiety of individuality sometimes felt in senior roles such as hers

Heather Caudle is leaving her position as chief nurse at Ashford and St Peters NHS Foundation Trust, Surrey, to take up a new post with NHS England.

Heather Caudle Picture: Barney Newman

But she told a fringe event at this years RCN congress that roles such as hers can be isolating due to a combination of factors including being a decision maker and being different.

Ms Caudle has a mental health nurse background, but in 2014 went on to become chief nurse at Ashford and St Peters, which she joined in 2011 as associate director of quality.

This month (July), she takes up the role of director of nursing for improvement at NHS England.

During the congress session, called Nursing directors: heroes or

...

A departing nurse director has spoken of the ‘anxiety of individuality’ sometimes felt in senior roles such as hers

Heather Caudle is leaving her position as chief nurse at Ashford and St Peter’s NHS Foundation Trust, Surrey, to take up a new post with NHS England.


Heather Caudle 
Picture: Barney Newman

But she told a fringe event at this year’s RCN congress that roles such as hers can be isolating due to a combination of factors including being a decision maker and being ‘different’.

Ms Caudle has a mental health nurse background, but in 2014 went on to become chief nurse at Ashford and St Peter’s, which she joined in 2011 as associate director of quality.

This month (July), she takes up the role of director of nursing for improvement at NHS England.

During the congress session, called Nursing directors: heroes or modern-day scapegoats?, Ms Caudle said there can be a temptation for chief nurses to be either a ‘superhero or scapegoat’ because they make decisions in trusts that are by nature ‘risky organisations’.

Support needs

The debate heard how nurse directors need more support to encourage them to stay in their posts.

Comments came in response to long-held concerns about the historically high turnover rates for chief nurses in trusts and health boards.

‘These jobs are hard. It’s about being able to deliver high-quality healthcare'

Last year, for example, an investigation by Nursing Standard revealed that more than half of directors of nursing in England, Scotland and Wales have been in post for only three years.

To address the issues, those attending the event heard how better mentoring and more time spent helping nursing directors ‘find their feet’ were needed to improve retention rates.

Chief executive turnover can be around 18 months, said Ms Caudle, who is on the RCNi editorial advisory board.

Speaking about nursing directors, she added: ‘These jobs are hard. It’s about being able to deliver high-quality healthcare and leaving people feeling looked after in a context that’s very difficult.’

Many members of the audience and panellists at the event in Liverpool spoke of the need to help those who are ‘stepping up’ into the role of nurse director.

Lacking resources

London senior nursing director Cynthia Davis, who has been a deputy and interim director of nursing, said what has struck her is the lack of preparation and support available to those in these ‘demanding posts’.

Last year, an aspiring nursing directors programme was launched by NHS Improvement and Health Education England in recognition of the high vacancy rates for these senior roles.

It is aimed at training a select group of nurses for director roles, which will take between 12 and 18 months.

'Without the right support, I don’t know how you are going to move forward… It breaks my heart.’

Consultant nurse Jackie Green

Others suggested that time is needed for nurse directors to ‘find their feet’ in smaller trusts and that executive boards need to be convinced of the importance of the role.

Consultant nurse Jackie Green told the meeting: ‘I have been a nurse for 30 years and I have seen a large number of directors of nursing who are absolute heroes. They have achieved that through their relationships with their directors or chief executives.'

But she added: ‘It’s sad to hear people cannot fill director of nursing posts. Without the right support, I don’t know how you are going to move forward… It breaks my heart when I hear it makes them leave nursing.’

Other nursing directors said confidence and experience are important to help them in a new role.

A nursing student said there is too little support or encouragement for students to go on to become strong leaders in the NHS.

Panel member Nursing and Midwifery Council chief executive Jackie Smith summed up the ‘challenging’ role of a nursing director by saying it is meant to be ‘everything to everyone – and that’s not at all easy’.

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