Recommendation 195

Ward nurse managers responsibilities

Accepted in principle
Ward nurse managers should operate in a supervisory capacity, and not be office-bound or expected to double up, except in emergencies as part of the nursing provision on the ward. They should know about the care plans relating to every patient on his or her ward. They should make themselves visible to patients and staff alike, and be available to discuss concerns with all, including relatives. Critically, they should work alongside staff as a role model and mentor, developing clinical competencies and leadership skills within the team. As a corollary, they would monitor performance and deliver training and /or feedback as appropriate, including a robust annual appraisal.

There needs to be local flexibility in delivering nursing care, so the government are not mandating that ward nurse managers must operate solely in a supervisory capacity.  However, in the initial government response to the inquiry, Patients First and Foremost, the Department of Health gave strong support to supervisory roles for ward managers (including sister, charge nurse and team leader) in delivering oversight to all aspects of care on a ward and in a community, from cleanliness to allocation of staff.  Nurse leadership and visibility at ward level provided by a ward manager is also important to the delivery of safe, high-quality care to patients.

Having sufficient nurses trained and with the capacity to ensure the delivery of safe, patient focused care is currently a core standard requirement of the Care Quality Commission.  Nurse leadership is a core element of Compassion in Practice, the vision and strategy for nursing in England.

Key action areas include:

  • using feedback to improve the reported experiences of patients
  • identifying strong patient experience measures that can be used between settings and sectors
  • a new leadership programme for ward managers, team leaders and nursing directors based on values and behaviours of the ‘6Cs’ of Compassion in Practice
  • providers reviewing options for introducing ward managers, team leaders and nursing directors based on values and behaviours of the ‘6Cs’
  • providers reviewing supervisory status for ward managers and team leaders;
  • strategies to secure meaningful staff engagement, and
  • commissioners to ensure locally agreed targets to deliver high quality appraisals for their staff

Some Directors of Nursing are already achieving this or have plans and timetables in place to deliver it.  Having supervisory leaders should be evaluated locally so that benefits can be demonstrated and shared.

The NHS Leadership Academy ‘offer’ includes leadership programmes for frontline staff – including nurses. We have already taken steps to improve staff performance and appraisal systems as set out in our response to recommendation 7.


The Royal College of Nursing has commissioned the University of Warwick to undertake a review of supervisory status in two acute trusts.  The report of this review is due shortly.

The project seeks to evaluate the change to supervisory ward sisters in two hospitals in the West Midlands. This change means the ward sister is now extra to establishment numbers and crucially has a supervisory role, being visible and accessible in the clinical area; working alongside the team; monitoring and providing feedback on standards and outcomes and creating a culture to enable person centred, safe and effective care .Data has been collected from individual ward sisters through the use of face-to-face interviews to explore how these changes have been perceived by the ward sisters themselves, what they hoped to achieve in moving into a supervisory role, and how they have evaluated whether the change has been successful in terms of patient care.   In addition to collecting information from individual ward sisters the project team has interviewed senior nursing managers and the wider clinical team to explore their perceptions of the move to supervisory ward sister status.

The final report of the study will be disseminated through publications, networking and conferences.

NHS England is considering whether further work to assess the impact of supervisory nurses would be helpful to build on this study.

The Social Partnership Forum produced guidance on staff engagement and partnership working and highlights areas of excellence in NHS organisations where management and trade union representatives work together effectively to identify and resolve issues.  The need for this guidance was indicated in Hard Truths and builds on the six key messages developed by the forum to support the development of the values, culture and working environment in the NHS that would best ensure that patients receive safe, effective and compassionate care.