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Summary
This article investigates the factors that have shaped the role and work experiences of ward sisters and charge nurses. The article considers how ward sisters make sense of the tensions between their clinical and managerial responsibilities and the contradictions inherent in different aspects of their role. It offers suggestions on how these tensions might be alleviated.
Keywords
Charge nurses, nursing management, professional development, professional responsibility, ward sisters
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THIS ARTICLE ADDRESSES a growing tension in the role of the ward sister. The terms 'ward sister' and 'charge nurse' can be used interchangeably. The term ward sister is used in this article for purposes of brevity. Practitioners and policy makers have recognised that the ward sister is 'the backbone of the NHS and the hub of the wider clinical team' (Department of Health (DH) 1999). As practitioner-managers with 24-hour responsibility for care, ward sisters are at the interface between management and clinical staff; thus they are at the 'point of care delivery', where policy aspirations meet operational realities.
The position of ward sister includes both clinical and managerial responsibilities. While they are professionally accountable for standards, co-ordination and delivery of care (DH 2001a), ward sisters also have a pivotal role in decisions affecting the implementation of governmental and organisational policy. For example, although policies such as single sex wards may seem straightforward to politicians and the public, the complex realities at ward level require careful negotiation of the competing interests of patients (Dixon-Woods et al 2009). The direct relationship ward sisters have with patients means that they, unlike more senior managers, witness the consequences of competing policy objectives and operational realities and may be blamed when things go wrong.
Against this, as a Royal College of Nursing (RCN) (2009) report titled Breaking down Barriers, Driving up Standards concluded, ward sisters find it difficult to delineate their role given an absence of agreed definitions and of clarity about its aims, purpose and...