First time in charge of a ward: the support every newly qualified nurse needs
COVID-19 has made ward manager duties even more challenging and more likely for junior staff. Heres how to help team members succeed
I remember my first day in charge of a ward as if it were yesterday, even though it was 30 years ago.
I had qualified four months earlier and was working on a 28-bed surgical ward. When I arrived for my shift, I was told that the ward sister was off sick and that I would be in charge and I would be fine.
A role that calls for experience and resilient leadership
But I didnt feel fine; I felt anxious, out of my depth and desperate for the shift to be over. I was not
COVID-19 has made ward manager duties even more challenging – and more likely for junior staff. Here’s how to help team members succeed
I remember my first day in charge of a ward as if it were yesterday, even though it was 30 years ago.
I had qualified four months earlier and was working on a 28-bed surgical ward. When I arrived for my shift, I was told that the ward sister was off sick and that I would be in charge and I would be fine.
A role that calls for experience and resilient leadership
But I didn’t feel fine; I felt anxious, out of my depth and desperate for the shift to be over. I was not an aspiring ward leader or someone on a fast track leadership programme, and was unprepared to be ‘in charge’.
I knew two of the other five members of staff on duty, both of whom were experienced enrolled nurses. There were also two nursing students and a nurse from the temporary staffing pool who had not worked on the ward before.
‘Many junior nurses will experience being in charge for the first time when senior colleagues are not there, stepping in to fill the role at short notice with no time to practise or gain confidence’
I remember this shift so well because I was frightened – scared that something might go wrong, that someone might die and I would be accountable.
When I did my PhD 20 years later, my research reinforced to me how tough and challenging it is to be in charge of a ward. A ward manager is one of the hardest roles to recruit to in the NHS, with few people aspiring to be one.
Why? Because running a ward is a really difficult job. Add in COVID-19, an exhausted and under-resourced workforce and anxious and frightened relatives, and it is easy to see why this is such a tough role that requires experience and expert and resilient leadership.
Stepping in at short notice to run a ward
For an unprepared junior staff nurse, the role is a scary step up. Many junior nurses will only experience being in charge for the first time when their senior colleagues are not there, stepping in to fill the role on a single shift at short notice with no time to practise, gain confidence or learn from mistakes in a safe and reflective environment.
There is no course that tells a newly qualified nurse how to run a ward for a day when no-one else turns up.
They will arrive for handover, get the ward keys, orientate the temporary staff to the ward and start their day unscripted and stressed. It is unlikely they will have a meal break or go home on time.
It is days like this that can make our valuable junior nursing staff feel scared and anxious. Feeling out of your depth at work is a negative and destructive emotion. It causes stress and self-doubt and has a negative effect on a person’s mental health.
Time and again, we put junior nurses in charge of wards when they are not confident to take on the responsibilities the role requires, putting the welfare of our patients and our precious workforce at risk.
How to support junior nursing staff
- Training Focus, where possible, on supervising junior staff to manage a shift when senior support and backup is available. Find time to teach, run short simulation exercises, and support staff to practise, and shadow and learn from good role models
- Confidence As a profession, develop first-level manager and leader competencies, and give these national recognition so that nurses know they have reached specific levels of leadership and are capable of doing the job
- Trust Ensure j
unior staff feel confident that they will not be asked to take on management and leadership roles they are not trained to do without the support of senior staff - Communicate Listen to your staff so you can understand what support they need and help them get it
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Taking on responsibility without the right training and support
With the COVID-19 pandemic, more than 30,000 nurses are off sick or self-isolating, many of whom will be ward based. While this presents huge challenges for those responsible for safe staffing levels, it also means that junior nursing staff are being put in positions of responsibility without the support or training required.
‘It is not good governance to put people in charge who do not have adequate training… and it is not acceptable to allow junior nurses to be frightened when they come to work’
Whether this is for a single shift or a short period of time, or is increasingly normal practice, as a profession we need to work hard and quickly to ensure we provide all nurses – whatever their band or level of experience – with the tools and resources to do their jobs competently, safely and with confidence.
Without this support, the people we rely on to deliver front-line nursing care in our hospitals will likely become casualties of our profession.
How we can invest in our junior workforce
We have a chance to change this. The COVID-19 pandemic has created unprecedented challenges for front-line nurses. It has raised the profile of nursing globally, yet the workforce feels increasingly vulnerable.
We have a responsibility to invest in our front-line junior staff. It is not good governance to put people in charge who do not have adequate training, it is not safe to put people in charge who do not have the skills to lead, and it is not acceptable to allow junior nurses to be frightened when they come to work.
As a profession, we need to increase the support and development of our junior workforce by effective supervision, mentorship and leadership training. But we also need to ensure they learn their skills in a learning environment from great teachers– not on the job when all other staff are absent.
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