Nurse directors can be heroes, but need more support

More support is needed to retain nurse directors in their posts and avoid them becoming scapegoats, an RCN congress fringe event in Liverpool heard

Nurse directors need more support to encourage them to stay in their posts and avoid becoming scapegoats, an RCN congress fringe event in Liverpool heard on Monday.

The debate, Nursing directors: Heroes or modern-day scapegoats, highlights long-held concerns about the historically high turnover rates for chief nurses in trusts and health boards.

More than half of directors of nursing in England, Scotland and Wales have only been in their post for three years, a 2016 investigation by Nursing Standard revealed.

Better mentoring

In an attempt to address the issues, congress heard how better mentoring and more time spent helping directors of nursing to ‘find their feet’ was needed to improve retention rates.

Panel member and Ashford and St Peter’s NHS Foundation Trust chief nurse Heather Caudle, who is about to take up a new role at NHS England, said she would have added to the statistics on nurse director turnover but for ‘pull factors’.

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

Demanding posts

RCN executive nurse network chair Irene Gray, who coaches nurse directors and has held the role herself, said ‘step-up experience’ is important. She said nurse directors could appear like swans, seemingly floating along smoothly but ‘paddling like mad underneath’.

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

Chris Butler, who has been a chief executive of trusts for 14 years, said: ‘I am getting increasingly concerned about the hard-to-fill director jobs… In my last but one trust, which was a very stable organisation, I couldn’t fill the director of nursing job the first time around.’

Vacancy rates

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 aims to train a select group of nurses for the director roles in 12-18 months.

The event also heard about the impact of ethnicity on being a nurse director.

Ms Caudle spoke of the risks of being ‘different’ as a nursing director from a black and minority ethnic (BME) background. She said being seen as different could bring a risk of being scapegoated if things go wrong.

It is ‘a risk, an occupational hazard, if you are visibly different to your board,’ she said.

She said when going through stressful times individually ‘sometimes that feels like isolation’.

‘If you are visibly different you have to rely on the commonality, which are your human characteristics and connections, in your trust.’

Board understanding

Others suggested time was needed for nurse directors to ‘find their feet’ in roles in smaller trusts, and boards needed to be convinced of the importance of the role.

Kath McCourt, a non-executive director in northeast England and former chair of RCN council, said nurse director issues were often the final item on the agenda at trust board meetings.

'There is something about how you educate your board, which is about the things that are really relevant to them and make sure they understand the things clearly,’ she said.

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.'

Confidence and experience

But she added: ‘I think it’s very 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 was important to help them in a new role.

A nursing student said there was not enough support or encouragement for students to go on to become strong leaders in the NHS.

Another speaker said being the first director of a nursing post was difficult and it was good to start at a smaller trust to ‘find your feet’.

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