As a nurse leader, you don’t have to be a hero
Dame Eileen Sills, known for strong leadership, is focusing on staff well-being – including her own
Dame Eileen Sills’ strong and visible leadership style has been hugely influential. Now she is focusing on staff well-being - and admitting her own vulnerability
Back in April, Nursing Standard started working with NHS England on a project to celebrate the NHS’s 70th anniversary in July: we would identify and publish a list of 70 of the most influential nurses in the NHS’s history, from its inception in 1948 to the present day. The shortlisting and judging process, which involved the UK's four chief nursing officers, was not easy; some brilliant nurses didn’t make the list. One who did was Eileen Sills.
As chief nurse at Guy’s and St Thomas’ NHS Foundation Trust, Dame Eileen Sills’ style of clinical leadership has had influence nationally. If you work in an organisation where the director of nursing ‘walks the floor’ on a regular basis, or if you are a very senior nurse who continues to work clinically one day a week, then that may well be due, at least in part, to the trailblazing example set by Dame Eileen.
A balanced workplace culture
We meet at St Thomas’ in early August, on a day that even by this summer’s standards is almost freakishly hot. On the way into the building I’m struck by the number of staff who are braving the heat to take their breaks outside, not far from the gaze of the Mary Seacole statue. It crosses my mind that their chief nurse (she is also director of patient experience and infection control) would approve, the encouragement of a ‘take a break’ culture being one of her more recent initiatives.
‘I learned very early on that if you want to be able to make a difference, you couldn’t do that from your office, you needed to be where that impact was going to be’
But I begin by asking her about that style of leadership. It is often described as ‘strong and visible’ but what does that really mean, and why is visibility so important?
‘I learned very early on in my first reasonably senior position before becoming a director that if you want to be able to make a difference, if you wanted to make changes, you couldn’t do that from your office and you couldn’t do that via email or in a meeting,’ she says. ‘You needed to be there where it mattered, where that impact was going to be.
‘I got my first director’s post when the Burdett Trust produced the Who Cares Wins report, which was very much about connecting with the front line, and that resonated with me. I had taken a decision that I would always be out and about and that I would always be in uniform.’
An authentic nursing voice
She qualified in 1983, and continues to work clinically, (she describes her clinical skills as ‘basic’) because it is much easier to ‘articulate an issue and find a solution if you have that personal experience. You can talk to the board with some gravitas.’
In her early days at Guy’s and St Thomas’ her ‘out and about’ leadership was ‘a challenge for the organisation because they were used to something more traditional. I broke the mould – I was working very differently to the rest of my peer group across the country. Now there is an expectation that if you are in a senior leadership role you will be visible in your clinical service.’
‘If somebody wants to see me on a Friday they walk the floor with me’
When she introduced ‘Clinical Fridays’ to the organisation’s senior nurses in 2006, a year after joining the trust, some were concerned they were being asked to do their job in four days not five. In fact, says Dame Eileen, it is about working in a different, more effective way. She says she doesn’t put the business of being chief nurse on hold every Friday, she takes it with her. ‘We live in a world of emails, people have lost the art of talking to one another.
‘If somebody wants to see me on a Friday they walk the floor with me. It’s amazing – people look for an hour in your diary, but you can do so much with five minutes.’ She believes the benefits of drawing on her Clinical Fridays' experience to represent patients and staff more convincingly at board level are immeasurable.
The risk of becoming the 'fix-it' person
There is, she concedes, a ‘slight downside’ to being so visible and involved in clinical services – the risk of becoming ‘the fix-it person’ in the organisation. She has found a balance, where she only fixes something if it is a staff or patient issue that requires immediate attention. If it’s not, she will leave it to someone else and only become involved if it is not resolved. She has no desire to be the cavalry riding to the rescue. ‘As a leader you are not a hero. You have failed if you are the person who is always going to be there to save the day. I’ve learned to work differently.’
‘I didn’t do very well in my first director’s job… it was the loneliest job in the world’
Being accessible to staff has always been an important feature of her leadership but now, at this late stage in her career (‘this is the job I will retire from’) she often asks people who approach her if they would like to see a member of her team. ‘I will stand behind them [the team], it’s their time, not my time.’
If leadership is not heroism for Dame Eileen, then neither is a successful career about never making a mistake. She admits, very cheerfully, to almost being sacked from her first nurse director post. ‘I had to come to mutual agreement to leave. I didn’t do very well in my first director’s job. When I left I was quite angry but six months later I realised it was half my problem and half theirs. I went into it thinking it was the next career step, but it was massive and the loneliest job in the world.
‘I couldn’t see how people perceived me. I walked on to wards and people would hide behind curtains. I was totally focused on the job – I hadn’t put enough thought into the politics and understanding the totality of the organisation.’
‘If you make mistakes, it’s very public, you get flack but then people move’
With the support of the then chief nursing officer for England, Chris Beasley, she got a second chance, moving on to Whipps Cross Hospital in east London. The pressure to succeed, she recalls ruefully, was immense. ‘I remember Chris Beasley saying you can make one mistake, but you can’t make two.’
Anyone who wants a career at nurse director level needs to be prepared for how exposed they will be when things go wrong. ‘If you make mistakes, it’s very public,’ says Dame Eileen. ‘It’s like when I stepped away from the national guardian’s job. You get flack – but then people move on to something else.’
She was appointed national guardian for speaking up safely in January 2016, a high-profile role designed to support whistleblowers in the NHS. However, she resigned after only two months when it proved too difficult to combine with her responsibilities at Guy’s and St Thomas’. ‘I had to get out of the bed in the morning and I had to do what was right for the welfare of my family,’ she says.
Support in testing times
The support of her family is a big part of why she has managed to stay in such a demanding role at Guy’s and St Thomas’ for so long. They are, she says, ‘a health orientated family’: her husband is a retired GP, her elder daughter a ward sister at UCLH, her younger daughter a student physio. ‘They understand if I have to be here.’
Dame Eileen says the trust is her ‘second family’ – and sometimes, in exceptional circumstances, the second family comes first. This was the case when staff found themselves responding to two terrorist attacks last year, one of which took the life of Kirsty Boden, a nurse at Guy’s who died after going to help people injured in the London Bridge atrocity. ‘I moved my bed in here because the organisation needed me to be here – especially when we lost one of our own.’
But most of the time, the message she tries to send as a leader is that you can be good at your job and have balance in your life. A campaign she has introduced to the trust encourages staff to take their breaks, stay hydrated and leave on time. She admits that she struggles to take her own advice sometimes: ‘I’m very bad at it, therefore I do everything I can to take breaks because it is habit, complete habit. I know I have to be a role model – “if I can do, so can you”. We are telling people you are not a hero by working through your break and then making a mistake.’
The expectation that nurses should sacrifice their quality of life for the job is particularly unhelpful as they get older or when illness strikes, she suggests. This was brought home to her when she was diagnosed with a long-term chronic condition. ‘Last year I got sick and I remain sick. I can’t work those long hours anymore.’ Though she says her illness was not related to her workload, it was still ‘a massive wake-up call – I use my personal experience to try and improve how people work. I was fit as a fiddle and all of a sudden got sick. It can happen to anyone.’
It is up to employers, she says, to support nurses and midwives to continue to work and ‘add value’ as they get older, and an important part of this is being willing to adapt to individuals' changing health and circumstances. She adds that if her boss had not been supportive, she would have taken early retirement and ‘grieved’ for her job.
The importance of a can-do attitude
As a nurse leader you have to love the job, says Dame Eileen. ‘You have to come across with enthusiasm and a smile on your face because that is what your staff need – that optimism all of the time.’
Tight constraints on NHS funding, rising demand, and increasing pressure on the nursing workforce have given nurse directors plenty of reasons to complain in recent years, but she says the place to do it is, usually, behind closed doors. ‘If you moan a lot publicly you are sending those vibes out into your organisation. You have to have a can-do attitude.’
She is concerned that the axing of the bursary is depriving the profession of older recruits who bring valuable life experience and transferrable skills. But instead of agitating for its reinstatement, she is exploring alternative ways to support students financially, for example by giving them the option of taking a nursing associate award after their second year, enabling them to work part-time and complete their courses in two years, instead of one.
‘We’ve no idea whether we can do this, but it is our responsibility [as leaders] to look creatively at the art of the possible. That’s what these jobs are all about.’
‘Our goal is to have a waiting list of people wanting to come into the organisation. It’s a big goal… but it makes you do big things’
At a time when many trusts are struggling to fill nurse vacancies Dame Eileen has set a target for her organisation to have a waiting list of potential recruits by 2020. The current vacancy rate at Guy’s and St Thomas’ is 11% (it would be 7-8%, she points out, were it not for growth in services such as critical care which means new beds keep being opened). Isn’t she setting the bar rather high? ‘You could create an average goal but where’s the aspiration?’ she replies.
‘Our goal is to have a waiting list of people wanting to come into the organisation. It’s a big goal and some would say “that’s daft”. But what it does is really force people to think about what to do to attract and retain people. It makes you do big things. In the end we may not achieve the 2020 goal [across the organisation] but we will do in a number of areas.’
Areas that already have waiting lists of nurses include oncology and haematology. How have they managed this? By creating services that are rewarding places to work. ‘It’s about vibrant leadership from top to bottom – a cadre of ward leaders who we can be incredibly proud of.
‘When a nurse gets out of bed they want to do a good job, they want to work in a supportive team with a leader they respect. They also want to feel that they matter – our staff want us to invest in their development. And they want to have fun when they come to work. If they are happy your patients will get good care.’
Unlocking kindness towards patients and between colleagues
Dame Eileen Sills' proudest career achievement is Barbara’s Story. The extraordinarily moving video, launched in 2012, tells the story of how an older woman with dementia experiences the hospital and care system.
A drama, rather than a conventional training video, it places the viewer in Barbara’s position and makes you see the world, with all its terrors, through her eyes. ‘Within six weeks of Barbara’s Story being launched, she became the most important person in the organisation,’ says Dame Eileen.
‘It unlocked passion in the organisation that had always been there. We had been so used to talking about hard metrics but people wanted to talk about kindness, which is very difficult to measure.’ She believes everyone who sees it – the video is a cornerstone of staff induction – wants to do the right thing by Barbara.
Dame Eileen is hoping to have similar success with the latest video in development, but this time the focus will be on staff. Several characters will be shown at work and dealing with issues in their personal lives. ‘We want people to see the person behind the name badge: see me, not my job title.’
The campaign linked to the video, due to be launched next year, will aim to make staff feel valued and encourage them to support one another.
The Nightingale Project she introduced to the trust in 2016 has done much to foster supportive teamwork by staff from different clinical backgrounds and encourage consistent care across shifts. It looks at the key factors affecting staff and patient experiences and standardises how nursing staff are deployed. The focus is on arrangements in the first and last hour of the shift, but Dame Eileen says the mid-shift huddle also makes a big difference to staff. ‘It is a check-in where staff get to say, “I’m really worried” or “I’ve been shouted at today”. People come together as a team.’
Another important outlet for staff is the ‘safe in our hands’ weekly briefings that happen every Friday in Guy’s and St Thomas’s. The open access meetings on both sites are a forum to consider key indicators and talk about harm events.
Everyone at the trust was ‘very disappointed’, says Dame Eileen, when CQC inspectors in 2015 decided that patient safety was an area requiring improvement (the trust was ‘outstanding’ for caring and received an overall rating of ‘good’). ‘But that was three years ago. The things they highlighted have been addressed. It hurts – and it continues to hurt, but we are not arrogant and we are not complacent.’
‘I’ve had a fab career, I’ve enjoyed every minute’
She says health organisations need to care about their staff as much as they care about the patients, and will be launching a campaign next year, focusing on staff well-being (see box). Nursing is a ‘hard, complex job’ and nurses cannot give good care when their own well-being is neglected. ‘It really matters to be mental-health aware,’ she says.
After almost an hour and a half in Dame Eileen's company, I’m convinced she is not only coping with the pressures of her hard, complex job but actively enjoying it. When she says ‘I’ve had a fab career – I’ve enjoyed very minute of it,’ it doesn’t sound trite, just a simple statement of fact.
A lot of this enjoyment is due to Guy’s and St Thomas’, an organisation that seems to fit her like a glove, where she has enjoyed the backing of a like-minded board and, she says, has never had to fight her corner. ‘This organisation has allowed me to do the job the way I wanted to do it – completely.
‘This place keeps me here. There is something about Guy’s and St Thomas’ that gets under your skin.’
Thelma Agnew is commissioning editor, Nursing Standard