Editorial

We have to understand why it’s tough at the top

Nurses know all about resilience, and most possess it in abundance. Coping with the pressure of caring for high numbers of dependent patients is an achievement in itself, especially when set in the context of inadequate resources in a healthcare system that can seem designed to make nurses’ lives more difficult.

Nurses know all about resilience, and most possess it in abundance. Coping with the pressure of caring for high numbers of dependent patients is an achievement in itself, especially when set in the context of inadequate resources in a healthcare system that can seem designed to make nurses’ lives more difficult.

Survival in this high-pressure environment is often only possible with the help of colleagues who share the daily experience of modern nursing, who appreciate how tough it is to get to the end of each shift unscathed. But for one group of nurses – those in the most senior leadership positions – such peer support may not be on hand. Many are struggling to cope.

Nurse directors need more support. Many are struggling to cope

Nurse directors rarely attract much sympathy, partly because they are relatively well paid, are seen as being able to enjoy the trappings of high office and do not have to get their hands dirty unless they choose to do so. But research reported in Nursing Standard this week demonstrates that their day-to-day working lives are proving increasingly challenging.

The study authors – who include Daniel Kelly, RCN chair of nursing research at Cardiff University and an adviser to this magazine – interviewed 40 nurse directors to explore how the post-Francis world of greater scrutiny from healthcare inspectors, financial austerity, nurse shortages and ever-increasing public expectations affected their ability to provide professional leadership.

The findings may not be surprising but they shed light on why recent Nursing Standard surveys have revealed such a high level of turnover among the country’s most senior nurse managers. It will be interesting to gauge the mood among them when they convene for the chief nursing officer for England’s annual summit in Birmingham in a fortnight.

There is no question that nurse directors need more support. Despite repeated calls for action, too little is being done to prepare middle managers for these highly challenging roles. And nurse directors are still paid less than others in trust boardrooms, which is a mini-scandal all of its own.

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