News Release

SISTERS UNDER STRESS

Stress in the NHS is now a significant problem. A new report published today by the independent Policy Studies Institute, Stress among Ward Sisters and Charge Nurses by Isobel Allen, examines the stresses identified by this key group of NHS staff and draws comparisons with previous research on stress among hospital consultants. The study was commissioned by the NHS Executive London to provide them with reliable information upon which they could plan action to tackle these problems as part of their modernisation drive.

The new study found many similarities between ward sisters and consultants who play such a pivotal role in the delivery of health care in hospitals. Professor Isobel Allen, author of the report, says:

'Much of the stress is caused by organisational and managerial factors which they feel to be beyond their control. They have big problems related to the infrastructure of the organisation - unreliable support services, old and poorly maintained equipment, and inadequate IT and administrative support.

'Both groups of staff say their roles have become increasingly complex, with additional responsibilities heaped upon them. They feel that management imperatives and targets are imposed on them with insufficient consultation or consideration of how they are to be implemented. Ward sisters and charge nurses in particular find it very difficult to get their voices heard.'

Among the key findings of the new report:

• The major source of stress among ward sisters and charge nurses was their anxiety about whether, how and by whom their wards or units were to be staffed each day.

• They had serious concerns about the level of competence of unknown agency nursing staff.

• They deplored the pressure they put on their own staff and themselves to work extra hours to make certain their wards and units were safe.

• Recruitment and retention problems took a heavy toll on them and they found it difficult to build up a good team spirit or sense of common purpose when nursing staff were constantly changing.

• They were particularly concerned about poor cleaning and domestic support services and emphasised that qualified nursing staff should not be expected to make up for the inadequacies of the system.

• They rarely complained of a heavy workload as such but found it difficult to prioritise the multiplicity of functions expected of them and to manage their time effectively.

• Most ward sisters and charge nurses were concerned about patients who were in the wrong place at the wrong time. They gave graphic examples of the stress this caused by creating pressure from further up or further down the line for beds to be vacated for more patients. It was identified as an organisational bed management problem beyond their control.

• Like the consultants, ward sisters felt themselves increasingly disenfranchised within their workplace. They gave evidence of being admonished or even reprimanded for drawing attention to organisational deficiencies which they felt should have been dealt with by management.

• The key relationship between consultants and ward sisters had been eroded by the move away from consultant-based wards and increased split-site working. Some ward sisters reported dealing with up to 18 consultants on one ward, who all wanted to liaise with the sister.

• They reported stress from supervising junior medical staff who were said to be lacking in experience, sometimes unmotivated, and often insufficiently supported by senior medical staff.

• There was evidence of a lack of teamworking among medical, nursing and other health care staff, resulting in increased stress.

• Ward sisters and charge nurses appeared to be rather detached professionally, both in management and educational terms, and found few opportunities for peer-group support or continuing professional education.

The report makes 22 detailed recommendations. It concludes that there is an urgent need for the medical, nursing and management hierarchies within trusts to establish a common purpose and clear lines of communication and discussion between the key players. The report argues that if organisations do not offer support to staff in achieving change, the challenges laid down by government will not be taken up and change will not take place. If the modernisation agenda of the NHS Plan is to be implemented, it is time to tackle the underlying organisational, inter-professional and professional causes of stress among key members of NHS staff.

Professor Charles Easmon, Director of Workforce Development at the NHS Executive, London, which commissioned the research, says: 'What we wanted was a realistic view of the levels and causes of stress. What we have got not only confirms that stress levels are high in another group central to the delivery of health care, but also gives a critique of some of the personal and organisational issues which are responsible for this… This is not easy or palatable reading, but we hope it will provide the basis for work at all levels to address a largely hidden problem which does have an impact on recruitment and retention and on clinical governance and staff performance.'

Contact details

• Policy Studies Institute Publications Department 020 7468 0468

• The author can be contacted on 020 7468 2250 or 07774 756921

Notes for editors

• Stress among Ward Sisters and Charge Nurses by Isobel Allen is published by Policy Studies Institute (PSI) and is available from Publications Department, PSI, 100 Park Village East, London NW1 3SR. Telephone: 020 7468 0468. FAX: 020 7468 2211. Price £12.50 plus £2.50 p&p (ISBN 0 85374 786 5).

• The research was commissioned and funded by the NHS Executive London and is a follow-up study to Stress among Consultants in North Thames by Isobel Allen and colleagues, published in 1999 and available from Dean Director, London Department of Postgraduate Medical and Dental Education, 20 Guilford Street, London WC1N 1DZ

• Isobel Allen is Professor of Health and Social Policy at Policy Studies Institute/University of Westminster

• PSI is a registered educational charity (no 313819) and has no association with any political party, pressure group or commercial interest.