Greater management role for nurses

The role of nurses in middle management should be clearly defined and they should be given wider responsibility

The day-to-day management of nurses and midwives was severely criticised during the Commission's consultative process. The Commission recommends a framework for the greater inclusion of nurses and midwives in the strategic planning process, the strengthening of their management, and development of nurses and midwives for management roles within the wider health service.


More effective communication systems need to be implemented in hospitals, tailored to the specific requirements of each discipline of nursing. The Commission recommends all health service providers put in place mechanisms for ensuring effective internal communication systems with nurses and midwives. These will be audited on an ongoing basis.

A culture which encourages the full disclosure of information is needed among the providers of the health services. Management needs to foster an open system where information is discussed openly and frankly with nurses and midwives involved in the delivery of services.

Management training

Training is needed for management to develop their oral communication skills, as this is the primary and most effective means of communication. Management must also be open and willing to listen to information from staff.

Health service providers are to systematically facilitate the development of personal career planning amongst nurses and midwives. Training is to be provided to management and staff on the aims and objectives of personal career planning. The Commission recommends the development of the post of chief nursing officer at the Department of Health.

The Nursing and Midwifery Planning and Development Units in each health board will have a strategic planning and policy development role for services within the board's region. The units will co-ordinate the delivery of services, oversee the provision of continuing nursing education, and assist with improving internal communication with nurses and midwives within their regions.

The director of each unit, who will be a senior nurse on a fixed term contract, will report directly to the health board CEO.

Management role

Nurses and midwives require strong professional leadership. The responsibility of senior nursing and midwifery management should include: providing clinical leadership for nurses and midwives; ensuring appropriate in-service education programmes are met by all the assigned staff; and ensuring modern standards of clinical care are in operation.

All matrons in large acute hospitals and psychiatric services should be entitled 'director of nursing'. Matrons in Bands 3, 4 and 5 are to be given more explicit input to the determination of the budget.

Middle management: Middle nursing and midwifery management must have their role clearly defined in the interests of the delivery of more effective quality patient care. Middle management should have the authority to manage their area of responsibility without constant reference to more senior management. They should be given explicit delegation of responsibility from the director of nursing.

Where appropriate and when agreed with the clinical team, consideration should be given to the appointment of nurse/midwife managers as 'clinical directors'. There should be greater nursing and midwifery management input in areas such as catering and laundering which impact on the quality of patient care.

First line management: Clerical and IT support should be available to first line managers to assist them in their managerial functions and they should be given greater budgetary responsibility.

Hospitals are to invest in MIS to allow for the greater devolution of budgetary responsibility resulting in significant improvements in the effective and efficient utilisation of resources.

Training programmes are to be offered to first-line managers to assist them with their increased management and budgetary responsibilities. As first-line managers have an enormous impact on the culture of care and hence on the impact on the quality of patient care, their role is to be developed to include professional/clinical leadership; resource management and facilitating communication.

Furthermore, they are to be given management training before commencing their position and supported in the continuing development of management skills.

There should be three grades of first-line management in the health service. These would rarely be in a single unit at one time and only one person would be designated as being in overall charge. The three grades of clinical nurse managers (CNM) are:

Nurse and midwife managers at each level in the health service should have appropriate management qualifications or experience.


Vacant/acting-up management posts are to be filled without delay. The Local Appointments Commission is no longer to be involved in administering the selection and recruitment of middle nurse and midwife managers.

The Office for Health Management is to approve appropriate management courses for each level of nursing and midwifery management.

Greater flexibility

The HSEA and nursing organisations are to agree a framework for the provision of permanent part-time contracts to allow for closer correlation between service needs and personal circumstances. They are also to examine the arrangements for those seeking to transfer between health boards or hospitals.

The high level of long term temporary nurses has seriously impacted on the morale of the profession and although this is currently being dealt with, there may be scope for the process to move at a quicker pace. Vacant permanent posts are to be filled without delay and a framework is to be put in place to ensure the problem does not recur.

Decisions on compassionate leave are to be delegated to local management to allow for greater flexibility in exceptional circumstances.

Occupational health

Under the Health and Safety Act 1989 every employer is obliged to put in place appropriate safeguards to ensure the safety of employees within the workplace.

The Commission recommends the on-going development of occupational health programmes.

A scheme similar to the sick doctors scheme should be established for nurses and midwives by the nursing organisations, ie. the INO. Critical incident de-briefing systems are to be developed as a matter of urgency. A professional, confidential counselling system for nurses and midwives should be made available in their places of employment.

Nurse and midwife managers should be entitled to use their discretion to a greater extent, allowing for increased flexibility in the provision of sick leave. Details of the allowance scheme for employees absent as a result of an attack at work should be circulated. Employers should provide adequate rest/changing facilities .

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