During my nursing career of 28 years within the NHS, I worked with only three exceptional leaders of people. Two of those leaders worked together in the same unit. One was senior to the other and both worked in harmony together. It was some of the golden days of my NHS life.
When you have a good boss, it shows through and through. You feel valued, invested in and your opinions matter. There is a fairness and compassion within that person. They are interested in people, usually are highly skilled and experienced in their field and have a humane and caring character. They have disciple within themselves and enhance and encourage that in the workplace. The atmosphere in the place of work is happy, standards are high and efficiency prevails. When you are asked to perhaps stay late, or to help in a crisis of staffing, you will come forward because you invest in your workplace, in return for how you are treated. Well, that was how it was for me anyway.
Sadly, overall leadership within the NHS is poor in my opinion. There are good leaders in the NHS of course and these ones stand out. However, a good leader is often challenged by higher management, if they are not a “yes man” and not always popular with that seniority. In the end these people leave and go on to other positions, leaving the vacuum and the loss behind. Poorer management often comes in as a result and then staff leaves and recruitment/retention gets harder. Moral goes down: stress goes up.
I think one of the problems for nursing is a lack of experience in leadership. Historically, to become a ward sister, at one time, you needed to be qualified for five years.
This is now a dreadful statement to make but I have heard someone say once, that nurses are like “painters and decorators”, you climb the ladder so fast that you scarcely come into contact with any patients. This is a simplistic and rather brash view, but the point here is that, I personally feel that the quality of those in charge, in terms of interpersonal skills with people, CAN be lacking. There just isn’t that core backbone of personal standards, discipline and integrity that there once was.
Then at the heart of the matter, combine these factors with nurses who do not feel listened to by higher management. They feel dis-empowered, that no-one really cares and that they are just a number, easily dispensed with and easy to replace. Challenge anything with anyone who is in a higher position than you and you will often come out worse. Employees can easily feel start to feel vulnerable. Conflicts and bullying are present in the NHS, just as they can be in any large employing organisation. Staff feel threatened and gagged if they dare to speak out. Confidentiality clauses are cited as a means of fear to shut people up for fear of losing their jobs or being frog-marched up to the NMC ( Nursing, Midwifery Council) professional conduct committe. Nurses are in a terrible dilemma if they feel standards are being compromised, yet have no confidence in any leader to talk to or simply feel too afraid. They trust no one. Both the Royal College of Nursing and the NMC have issued guidelines on how to whistle-blow professionally but too few are still prepared to blow that whistle at a local level with a mortgage to pay.
Finally, it is in my view that the NHS also operate within a very rigid and hierarchical structure. Everyone knows their place in the pecking order from cleaner, to porter, from nurses to doctor and consultants. There is less snobbery now between those at the top of the management tree to those at the bottom; and nurses are no longer seen merely as doctor’s hand-maidens due to their increased technical and skilled roles. Thankfully, there has been this shift ( enhanced by our increasing number of graduate nurses) but both leadership qualities and this persistent hierarchy remains an issue……
On Monday: Management decisions at the very top- Government policy. How PFI’s and the obsession for targets and figures are critically wounding our NHS.