Nursing two-sided
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-------'--------.;~ __ 'Anthony (orr _ MY TASK is to present a possible. nftw structure which would separate clinical supervision from the management of staff which I mentioned last month ("Let 'adaptable' be the key word", NM, Jcly24~ ~ First, it is necessary to identify the highest level of clinical co-ordination which a department or group of wards needs. The question to ask is: "Should wards and/or departments be brought together so nursing policies can be planned and should a senior member of staff be appointed?" The person appointed should be an expert in the specialty if necessary and should have some direct patient contact. The senior nurse would direct care programmes and prescribe their content. .In a 600~bedded hospital, for ' example, senior nurses might be appointed to full-time positions in medicine, surgery, psychiatry, and part-time in geriatrics, paediatrics, orthopaedics and gynaecology. A full-time co-ordinator may also be needed to co-ordinate the theatres, accident and emergency and out-patient departments. The management aspects could be brought together in a different way. One nurse manager could cover surgery, orthopaedics, gynaecology, the accident and emergency department and the theatres. A second could be responsible for medicine, paediatrics, geriatrics, psychiatry and the out-patient department. A trainee nurse manager would be a helpful addition to this team. The career structure, designations and salary scales could be: Grade Scale Ward Sister 0-5 Senior Sister 3-10 Unit Director (Nursing) Area Director (Nursing) Divisional Director (Nursing) Director of Nursing Salary (£) 7,000-9,500 8,500-12,000 8~15 11,000-14,500 13-20 13,500-17,000 18-25 16,000-19,500 23-30 18,500-22,000 This system would have 31 scales Nursing • ssa two-sided • com Anthony Carr, Area Nursing Officer for Newcastle upon Tyne, suggests an entirely new structure for senior nurses in which the clinical and management sides are separated. which could be applied to both management and clinical positions. Each grade, except the first, has eight scales and the grades overlap by three scales at each end. The scale which staff would be put on would depend on a number of factors. These might include the number of staff, dependency of . patients, throughput of patients, design of ward, number of consultants, input of nursing care required and so on. This overlapping would allow titles to be separated from salary. The system would allow closer financial integration between grades, and flexibility to differentiate between jobs in the same grade. It would allow, for instance, a divisional director (nursing) of a very large division to be on Scale 25 (£19,500) while the director of nursing (district nursing officer) of a small district would be on Scale 23 (£18,500). In a 600-bedded hospital, the divisional director (nursing) might have eight senior clinical nurses and two nurse managers reporting to her. This system would mean the senior nurse would be much nearer to the clinical scene and therefore have a closer understanding of both the developments and difficulties at patient level. The nurse manager's job, on the other hand, would be more difficult to define and even more difficult to put into practice . But if this type of organisation could be made to work, it would mean that two distinct careers would be possible in addition to teaching. In larger divisions, the area director position could be used in management and clinical positions. In a 1,000-bedded hospital, for instance, it would be difficult to have 20 or more staff reporting to the divisional director. Some of the clinical and/or management unit directors and senior sisters could report to an area director who would be , the co-ordinator. Some unit directors could report direct to the divisional director. The area director (nursing) with clinical responsibility would have to have daily clinical sessions or undertake research at district level. I have given the title "Director of Nursing" to the district nursing officer. It is a more appropriate title. The director's staff, apart from divisional directors in charge of service, would be . other divisional, area, unit directors and senior sisters. These posts could incorporate planning, personnel, research, child health and so on. The system I have proposed would allow nurses to continue in clinical nursing up to Scale 20. Exceptionally, a district health authority might promote a clinical nurse to divisional director (nursing) (Scale 18-25) if it could prove a need for such a post, particularly in a clinical research situation. The attraction to the clinical nurse would be that Scale 20 is two-thirds to the top of the system (66 per cent), while most clinical posts now stop at n.;..sing officer level, which is only about 39 per cent of an area nursing officer's salary. Nul-sing management, on the other hand, 'would be a good choice for those who enjoy managing people and systems. . The professional may well reject this system, but if this is rejected, what will we put in its place? 0 Nursing Mirror, August 21 1980 12
Transcript of Nursing two-sided
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__ 'Anthony (orr _
MY TASK is to present a possible. nftwstructure which would separate clinicalsupervision from the management ofstaff which Imentioned last month ("Let'adaptable' be the key word", NM,Jcly24~ ~
First, it is necessary to identify thehighest level of clinical co-ordinationwhich a department or group of wardsneeds. The question to ask is:"Should wards and/or departments bebrought together so nursing policies canbe planned and should a senior memberof staff be appointed?"The person appointed should be an
expert in the specialty if necessary andshould have some direct patient contact.The senior nurse would direct careprogrammes and prescribe their content.. In a 600~bedded hospital, for '
example, senior nurses might beappointed to full-time positions inmedicine, surgery, psychiatry, andpart-time in geriatrics, paediatrics,orthopaedics and gynaecology. Afull-time co-ordinator may also beneeded to co-ordinate the theatres,accident and emergency and out-patientdepartments.The management aspects could be
brought together in a different way. Onenurse manager could cover surgery,orthopaedics, gynaecology, the accidentand emergency department and thetheatres.A second could be responsible for
medicine, paediatrics, geriatrics,psychiatry and the out-patientdepartment. A trainee nurse managerwould be a helpful addition to this team.The career structure, designations
and salary scales could be:
Grade ScaleWard Sister 0-5Senior Sister 3-10Unit Director(Nursing)
Area Director(Nursing)DivisionalDirector(Nursing)Director ofNursing
Salary (£)7,000-9,5008,500-12,000
8~15 11,000-14,500
13-20 13,500-17,000
18-25 16,000-19,500
23-30 18,500-22,000
This system would have 31 scales
Nursing•ss atwo-sided
•comAnthony Carr, Area NursingOfficer for Newcastle uponTyne, suggests an entirelynew structure for seniornurses in which the clinicaland management sides areseparated.
which could be applied to bothmanagement and clinical positions.Each grade, except the first, has eightscales and the grades overlap by threescales at each end. The scale which staffwould be put on would depend on anumber of factors. These might includethe number of staff, dependency of. patients, throughput of patients, designof ward, number of consultants, input ofnursing care required and so on. Thisoverlapping would allow titles to beseparated from salary.The system would allow closer
financial integration between grades,and flexibility to differentiate betweenjobs in the same grade. It would allow,for instance, a divisional director(nursing) of a very large division to beon Scale 25 (£19,500) while the directorof nursing (district nursing officer) of asmall district would be on Scale 23(£18,500).
In a 600-bedded hospital, thedivisional director (nursing) might haveeight senior clinical nurses and twonurse managers reporting to her.
This system would mean the seniornurse would be much nearer to theclinical scene and therefore have a closerunderstanding of both the developments
and difficulties at patient level. Thenurse manager's job, on the other hand,would be more difficult to define andeven more difficult to put into practice .But if this type of organisation could bemade to work, it would mean that twodistinct careers would be possible inaddition to teaching.In larger divisions, the area director
position could be used in managementand clinical positions. In a 1,000-beddedhospital, for instance, it would bedifficult to have 20 or more staffreporting to the divisional director.Some of the clinical and/or managementunit directors and senior sisters couldreport to an area director who would be
, the co-ordinator. Some unit directorscould report direct to the divisionaldirector.The area director (nursing) with
clinical responsibility would have tohave daily clinical sessions or undertakeresearch at district level.I have given the title "Director of
Nursing" to the district nursing officer.It is a more appropriate title. Thedirector's staff, apart from divisionaldirectors in charge of service, would be .other divisional, area, unit directors andsenior sisters. These posts couldincorporate planning, personnel,research, child health and so on.The system I have proposed would
allow nurses to continue in clinicalnursing up to Scale 20. Exceptionally, adistrict health authority might promotea clinical nurse to divisional director(nursing) (Scale 18-25) if it could provea need for such a post, particularly in aclinical research situation. Theattraction to the clinical nurse would bethat Scale 20 is two-thirds to the top ofthe system (66 per cent), while mostclinical posts now stop at n.; ..sing officerlevel, which is only about 39 per cent ofan area nursing officer's salary.Nul-sing management, on the other
hand, 'would be a good choice for thosewho enjoy managing people andsystems. .The professional may well reject this
system, but if this is rejected, what willwe put in its place? 0
Nursing Mirror, August 21 198012
