Be Clear About the Role of the Ward Manager

Chapter 1 Be Clear About the Role of the Ward Manager

Be clear about what 24-hour responsibility means 

Be clear about what makes a good leader 

Make sure your decisions are informed ones 

Clarify your objectives 

Understand your legal responsibilities 

Be clear about your matron/line manager’s role 

Remember you are the patients’ overall advocate 

Don’t take on other people’s pressures 

Balance your clinical work with administrative duties 

Be aware of the impact of your role on others 

When you become a nurse manager your responsibilities change. Most of your education and experience to date will have been focused on clinical practice, but the manager’s role requires a very different set of skills. You are required to manage a team of staff with a set budget and are responsible for maintaining an environment in which people can work well.

Being a good nurse does not necessarily mean that you are naturally a good nurse manager. The two roles are very distinct. As a nurse, you are responsible for providing patients with a high standard of care. As a nurse manager, you are responsible for providing patients with a high standard of care through others. It takes time and experience to learn the art of being a good manager. Clarifying exactly what is expected of you in your role is the first major step.

Be clear about what 24-hour responsibility means

Ward managers carry 24-hour responsibility for the ward. This means you are required to ensure that systems and processes are in place for patients to receive a high standard of care from your team, day and night, irrespective of whether you are there or not. It also means that you could be liable for poor patient care when you are not there if it is evident that you did not do everything to ensure that those systems and processes were in place. This includes:

The individual nurses in your team are registered professionals and therefore responsible and accountable for their own actions or inactions, under the terms of their registration. However, as their manager, you may be liable if you do not provide the right working conditions for your team to provide good care.

Being called at home is unacceptable

The term ‘24-hour responsibility’ does not mean that you should be accessible out-of-hours. It is a common misconception that the ward manager should be available at all times. There have been instances when on-call or site managers have called ward managers at home or on their mobile phones to sort out issues. You do not receive any payment for this, so it is unwise to encourage it. Home distractions or tiredness could also impair your response.

It is different if you have not done your job properly. For example, if some staff do not turn up for work on your ward one day and it is not clear on the roster who should be working that shift, then that is your responsibility. It means that you did not ensure adequate cover in your absence, and therefore need to be contacted to clarify matters. However, if members of your staff call in sick when you are not there, leaving shifts uncovered, it is the responsibility of the shift leader, matron or site manager to deal with the problem.

It is also not appropriate for members of your own team to be calling you at home. Your role is to enable them to make their own decisions and not to have to call you out-of-hours for advice. It is the responsibility of both you and your organisation to ensure that other senior managers are there to turn to for advice and support in emergencies when you are not there. This is usually the matron during office hours and some sort of on-call or site manager out-of-hours. If there is no such system properly in place, you could be liable for failing to address this omission.

Raising concerns

If you are working under extreme pressure or there are staffing shortages out of your control, you must report it to the appropriate senior manager and be able to demonstrate that you have made every effort to remedy the situation. Again, this is made clear in the NMC code which also adds that ‘you must report your concerns in writing if problems in the environment of care are putting people at risk’ (NMC 2008).

You should also be alert to pressures being felt by your staff, since overworked staff may act inappropriately. In 2011, the NMC found ‘basically a good nurse’ with ‘no evidence of general incompetence’ who was ‘dedicated to a career in nursing’ guilty of misconduct when she failed to summon assistance or commence resuscitation on a pulseless patient and completed the patient’s fluid charts retrospectively. In another case, the High Court held that the NMC had been unduly lenient in not finding unfitness to practise on the part of a midwife who failed to provide support to a junior colleague undergoing preceptorship and subsequently spoke in a bullying and intimidatory manner towards the person who had reported her. It is important to raise concerns over staff pressures rather than raise your voice to staff.

The NMC has produced clear guidelines for raising concerns to help all nurses and midwives (NMC 2010) and the Royal College of Nursing (RCN) in Northern Ireland has produced some good guidelines which are particularly relevant for ward managers and shift nurses-in-charge (RCN 2010). These guidelines also detail what you should include when raising your concerns in writing, such as:

If your line manager fails to address your concern, then you should raise it with your organisation’s designated person. Every organisation is required to have a designated person with specific training and responsibility for dealing with escalated concerns. For nurses and midwives, it’s usually (but not always) the director of nursing. Only ever consider taking your concerns further (e.g. regulatory organisation, MP or media) once you have exhausted these routes within your own organisation, and never do so until you have sought advice from the NMC, RCN or other trade union. Public Concern at Work is an independent charity which also offers free advice in such situations (

Be clear about what makes a good leader

OK, so your job title is a ‘manager’. This does not automatically make you a good leader. Your job is to manage staff and resources to ensure that patients on your ward receive a good standard of care. If you lead well, your job as a manager will be made far easier. The job of a manager is to ensure people get things done, whereas a leader guides and inspires people and asks them how we can get things done. A good leader also enables their team to question whether the things need doing in the first place.

There are various leadership models being promoted within health care. The main ones at the moment are transformational and shared or distributed leadership.

Transformational leadership

Transformational leadership is about influencing others to do things. The transformational leader is charismatic and inspirational. They are more considerate towards individuals. They stimulate people to be more creative and to challenge the system if necessary. The opposite of transformational is transactional. Transactional leadership applies to the older managerial style of setting tasks, giving rewards to those who achieve them and ‘punishing’ those who do not.

It is debatable as to whether transformational leadership is the model that is actually being used throughout practice at the moment, or whether it is entirely appropriate, since the current emphasis on meeting performance indicators can be viewed as largely transactional. However, a transformational leader will not only ask their team how indicators can be met, they will also question them and look at alternative solutions if they are detrimental to the overall patient care. So even in a transactional organisation, you can be transformational in your approach.

To become more transformational in your style, it would be worth considering the five practices of good leadership based on 30 years of research by Kouzes and Posner (2011). These are to:

Make sure your decisions are informed ones

If you make decisions that affect your staff or patients based on the advice of one person alone, you cannot blame them if your decision was the wrong one. If there is a serious incident, for example, and you take a course of action that your manager advised, you may remain fully responsible for the outcome of that decision. So get advice from others as well before you make that decision. Make sure all your decisions are informed ones.

Jun 15, 2016 | Posted by in NURSING | Comments Off on Be Clear About the Role of the Ward Manager

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