Exclusive: Half of chief nurses in England, Scotland and Wales have been in post for less than three years

More than half of all directors of nursing in England, Scotland and Wales have been in post for less than three years, exclusive research by Nursing Standard reveals.

More than half of all directors of nursing in England, Scotland and Wales have been in post for less than three years, exclusive research by Nursing Standard reveals.

nurse turnover
English NHS trusts and Scottish and Welsh health boards have seen a high turnover of chief nurses. Photo: Dan Mitchell

An analysis of 230 English NHS trusts, 14 Scottish and seven Welsh health boards found 132 (53%) chief nurses had only been in post since 2014. Of this figure, 33 nurse directors took up their new positions this year.

The only exception to this theme was in Northern Ireland, where all of its five health and social care trusts have chief nurses in the posts since at least 2013.

Worringly high 

RCN director of nursing, policy and practice Dame Professor Donna Kinnair says: ‘While there are many reasons for people moving posts, this is a worryingly high rate of turnover at a senior level.

Donna Kinnair
Dame Professor Donna Kinnair says senior staff
turnover is too high. Photo: Nathan Clarke 

‘It seems to be another sign of the pressures that are affecting all areas of the health service.

‘We are particularly concerned many chief nurses struggle to get the front-line needs of their organisation heard at board level. 

‘Their advice is often undermined by NHS leaders who are distant from the impact of inappropriate staffing levels on patients.’

Professor Kinnair adds that chief nurse posts can be targeted or blamed for corporate organisational quality failures, even when those roles do not have budgetary or line management responsibility to improve care in organisations.

‘When staff turnover is too high, it can create a lack of stability and increases recruitment costs for already cash-strapped trusts,’ she says. ‘At a time of growing uncertainty for the health service, it is more important than ever that trusts have steady leadership and continuity.’

Coaching key

Claire Johnston has spent 12 years as director of nursing at Camden and Islington NHS Foundation Trust, making her part of the UK’s small minority (3%) of long-serving directors. She too is surprised by Nursing Standard’s findings.

‘I find it shocking that so many directors of nursing, particularly in their first board-level role, tumble so quickly,’ says Ms Johnston. ‘The turnover rate rightly needs the attention it is being given by leaders like NHS Improvement director of nursing Ruth May.


Nursing directors in post less than one year

‘Dr May has asked established directors to offer coaching and mentoring to neophyte and aspirant directors. I’ve volunteered: I’m a firm believer in the power of coaching.’

Ms Johnston says those new to the role of chief nurse need to know how to influence and work closely with the rest of the executive team.


‘As a director of nursing, you may not have the operational clout or the budgetary control, but working effectively through the power of influence is your art,’ she explains.

‘Together we can get it right and take best decisions by pooling our talent and respecting one another’s contribution.’

She adds that sharing the load by picking deputies with different skills and approaches is crucial.

In 2013, NHS England medical director Bruce Keogh published a review of 14 English trusts with high mortality rates, and raised concerns about the capability of nursing directors at a number of the trusts.

Concerns raised

Professor Keogh also commented on the relative inexperience of several trust chief executives, which averaged 18 months. NHS Employers director of development and employment Sue Covill acknowledges the chief nurse role has its challenges.

Bruce Keogh
Professor Bruce Keogh published a review of 14 English trusts with high mortality rates, raising concerns about staff competency. Photo: Tim George 

Ms Covill says: ‘Stability within the senior leadership team is important, and so understanding why people may be leaving is key to being aware of any issues that need addressing.

‘We also need to ensure there are opportunities for current nurse leaders to move to other organisations across health or social care. 

This allows them to share their expertise in other parts of the system and to create opportunities for aspiring deputy directors to take on their first director post.’


In post less than two years

Ms Johnston says she wishes more young women and men would see mental health and learning difficulty nursing as a ‘wonderful, lifelong career choice.

Mental health nursing 

She says: ‘It is more difficult to stay on top than it is to get there – but if you focus on the right things with conviction, you will make a good deal of difference.’

Workforce expert Jim Buchan, who is professor in the faculty of health and social sciences at Queen Margaret University, Edinburgh, says turnover is not in itself a bad thing.

‘Any organisation needs fresh ideas and new blood.'

‘But constant high levels of turnover in senior positions are likely to contribute to organisational instability, and at NHS level it may point to a loss of leadership skills and institutional memory.’

Dr May says the high turnover was a real concern.

Early retirement an issue

‘I believe it reflects the increased complexity and scrutiny of the role,’ she says. ‘I am also concerned that the number of directors of nursing opting to retire early at the age of 55 is exacerbating this situation.’

She adds that NHS Improvement has a programme to support first-time directors of nursing, including individual meetings to plan for the first 100 days in post and ongoing support through the transition.

Ruth May
NHS Improvement director of nursing Ruth May says early retirement among directors is an issue. Photo: Tim George 

It has also launched a new programme where more experienced directors of nursing buddy up with first-time directors of nursing, and those in particularly difficult circumstances.


In post less than three years

Dr May says the move will counteract the loss of experience when some directors of nursing take early retirement.

‘NHS Improvement is keenly aware that the NHS is at risk of losing a huge amount of expertise when directors of nursing take early retirement,’ she adds.


'The role is broader than its ever been'

Beverley Tabernacle took up the post of Robert Jones and Agnes Hunt Orthopaedic Hospital nursing director in January.

‘Being a nurse director was something I’d aimed for throughout my career,’ she explains.

Her appointment follows a stint as Bolton NHS Foundation Trust acting director of nursing.

‘I felt it was a real opportunity to inspire the workforce,’ she adds.

‘When you go through the career ladder as a nurse, you either go through the operational or clinical side.

‘You don’t [normally] get to be exposed to the financial or clinical engagement elements that you get as a nurse director. The role is  broader than it’s ever been.’ 


Additional reporting by Layla Haidrani

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