Caroline Shuldham: The nurse director role is tougher than ever

The responsibilities of leadership in today's NHS are vast, but in the right organisation the top job can still be immensely rewarding.

The responsibilities of leadership in today's NHS are vast, but in the right organisation the top job can still be immensely rewarding

The average tenure for a nurse director is about three years. Picture: Daniel Mitchell

I was a nurse director for over 20 years, initially at Royal Brompton, then at Royal Brompton and Harefield NHS Foundation Trust. It was a complex role and an overwhelmingly positive experience. Over the years, however, much has changed, and today the average tenure is about three years. 

Vacant positions can be difficult to fill, and there are risks and vulnerability when things go wrong that were not so prevalent previously. This can lead to negative views of the role that influence nurses when making career decisions.

The responsibilities and demands on individual nurse directors are huge. As a board member, nurse directors carry wide-ranging corporate accountability and are the professional lead for nursing. Portfolios frequently include responsibility for areas such as clinical governance, quality improvement, risk, patient engagement and experience, and patient safety.

I started because I was asked to ‘act up’, but there are preparation schemes such as the Leadership and Aspiring Nurse Director programmes. 

Able to engage

The nurse director has to be able to engage throughout the organisation, from the clinical interface with patients and their families to the board and across disciplines. Colleagues often look to the nurse director to make patient care central. They influence staff at all levels but also listen, assimilate evidence from a variety of sources, analyse, make changes and help others to do so too.

A strong team and a focus on priorities help make the nurse director role possible. I found it interesting, stimulating and challenging, and was conscious of the importance of working effectively with staff.   

At its best, you know you have had a positive impact, but the role also comes with big worries, serious problems to tackle and difficult decisions. You have to think, consult, work things out, negotiate and collaborate with others. 

The many positive aspects include working with teams, ensuring high standards for patients and managing resources intelligently. In the right organisation for you, it is a fantastic, rewarding leadership role.

shuldhamCaroline Shuldham is chair of the RCNi editorial advisory board. A former nursing director, she is an independent adviser on research, teaching and mentoring.


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