Clinical director: a suitable job for a nurse

Lisa Skinner is one of the first nurses to lead a diabetes department in an acute hospital. As clinical director she has overall responsibility for the service and oversees consultants’ job plans

Clinical directors are not normally known for being quiet and unassuming – or for being nurses. But at the Queen Alexandra Hospital in Portsmouth a small piece of history is being made.

Lisa Skinner, a nurse with 30 years’ experience, has led the diabetes and endocrine department for the last two and a half years. She is not the first nurse to work as a clinical director at the trust but there are relatively few nationally, particularly in acute trusts.

But her move into the role was almost by accident. When the former clinical director – a doctor – decided to step down, she was suggested as a replacement. ‘It was not something which ever entered my head when I started my career,’ says Ms Skinner, who was then the senior nurse in the department.

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Suitability

‘I thought the clinical director job was for doctors. Then I stopped to think about the role and what sort of skills were needed. There was an application process – I had to apply formally and do a presentation to our senior management team.’

The job has several elements, she says. ‘The first one is making sure that my service delivers what it is meant to deliver, that it delivers the right level of service to patients and works well with other people,’ she says. She has to represent the diabetes and endocrine service in various different settings in the trust.

Pushing herself forward is not something which comes naturally to her, she is quick to admit. ‘I am not overly confident. Every move I had made in my career I have thought "what am I doing?"' she says. As she had worked in the service for a long time, some of the role was not too daunting but she did find the idea of having to represent the team in the wider environment a little unnerving initially.

‘I thought the clinical director job was for doctors. Then I stopped to think about the role and what sort of skills were needed’

Lisa Skinner

It’s easy to imagine that some doctors might resent having a nurse in the role but Ms Skinner insists that was not the case in Portsmouth. There are a wide range of personalities in the team, she says, but they have had no problems accepting her, even though she has to oversee the consultants’ job plans.

Support from consultants

She wanted to make certain there was support among the consultants for her taking on the role before she accepted it, she says. ‘If there had been consultants who were opposed to it, it would have been difficult,’ she says. While her role works well within the team, she can see that it might not in all teams and in all settings. Other nurses generally ‘think it is great that I have been given this opportunity,’ she says.

Ms Skinner is dubious that the way she does the job can be directly linked to being a nurse – it is more about her as a human being than her profession, she says. And she is reluctant to use stereotypes to categorise doctors or nurses.

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‘I am quite a calm, thoughtful person. I can offer a level of balance,’ she says. ‘I do have a slightly different perspective and experience. All of this has helped me grow as a nurse and as a human.’

Challenges have included understanding some aspects of how doctors organise themselves as a group and their viewpoint. The way doctors’ rotas are run, for example, was a bit of an eye-opener for her. ‘It was a steep learning curve,’ she says. So far she has managed to combine her clinical director role with her role as senior nurse in the service.

Celebrating success

It is a reasonably small team – between 20 and 30 in total with five diabetes consultants, a similar number of whole time equivalent nurses, two research nurses and a small number of endocrine specialists, all supported by a four-strong admin team. 

‘I am the first port of call for most of the team on a day-to-day basis,’ she says. ‘I may not be the line manager for the admin team but it is normally me they come to.’

‘I am quite a calm thoughtful person. I can offer a level of balance’

Lisa Skinner

Associate national clinical director for diabetes Partha Kar – who was clinical director in Portsmouth before Ms Skinner – says: ‘Lisa took over the reins of the diabetes centre as the clinical director nearly three years ago and since then has been a quiet yet driving force in pushing for improvements in diabetes care. Continued success of the local super six model, (which ensures better, more co-ordinated treatment for diabetes patients), recruitment of new consultants, an increase in podiatry workforce as well as access to mental health provision for patients with diabetes, have been some of her achievements.’

She has done it all, Dr Kar adds, ‘while carrying on in her understated manner as a leader – and as one of the first nurses to lead a hospital diabetes department in the NHS’.

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Opportunities

He points out that as well as leading the department and representing it in the wider hospital, a clinical director will have to set policy, oversee the department workforce and take on governance responsibilities.

Clinical directors tend to do the role for between three to six years so Ms Skinner does not expect to do it forever. ‘This is a great job but being a nurse is also a great job,’ she says. ‘It has allowed me to think that there are other opportunities out there and to keep an eye open for them.’

Alison Moore is a freelance health journalist