'Meticulous in details on which the life of a patient depends' 'In general, matrons are over-conscientious and not good at delegating. They have not been trained in management and their training as nurses - meticulous in details on which the life of a patient depends - leads in a contrary direction. Because they can do things better than their subordinates, they may retain duties which ought to be delegated.
'The title of matron can be traced back to the 16th century. In the voluntary hospitals she was normally a married woman, a widow of respectable background. Her duties were those of a housekeeper; they did not extend to teaching and hardly to supervision of the nurses. '
'Under the Nightingale pattern, matron's functions could be arranged in three groups - head of nurse training, head of the nursing service and housekeeper. '
'Confusion arises from the indiscriminate and imprecise use of the title 'matron'It is applied equally to the nursing head of large hospitals of over 1,000 beds and of small hospitals of as few as 10. '
Report of The Committee on Senior Nursing Staff Structure, chaired by Brian Salmon,1966 'The public consultation provoked a strong call for a 'modern matron'figure - a strong clinical leader with clear authority at ward level - and we will do it. The ward sister or charge nurse will be given authority to resolve clinical issues, such as discharge delays and environmental problems such as poor cleanliness.
'By April 2002 every hospital will have senior sisters and charge nurses who are easily identifiable to patients and who will be accountable for a group of wards. They will be in control of the necessary resources to sort out the fundamentals of care, backed up by appropriate administrative support. In this way, patients'demand for a 'modern matron'will be met. '
'Senior sisters - 'modern matrons'- will have the authority to make sure wards are kept clean and that the basics of care are right for the patient. '
'The consultation with the public supported the return of 'matron'- with authority on the ward, in charge of getting the basics right, without getting bogged down in bureaucracy. '
NHS plan, July 2000 'I always tell people I am a qualified nurse' Maureen Fraser-Gamble, appointed matron at Hammersmith Hospital, London, in 1960 I am not one for looking back with rose-coloured spectacles, but in my day matron had real clout and authority. I held the nursing budget and said how it should be spent and nobody could veto what I said except the chair of the board of governors. You were in charge, though, of course, you were hauled over the coals if you overspent.
I remember I once went over budget by£3,000 and the chairman of the finance committee was very severe with me. I had to give an undertaking that it wouldn't happen again.
As matron you oversaw the domestic staff, but then cleaning became a non-nursing duty and the responsibility was taken away from us.
Following the Salmon report they dropped the title of matron and they took her out of uniform. At my hospital it happened overnight. As matron I would always felt that although I didn't need to wear a uniform all the time, when I went on ward rounds I thought it was a good thing to be seen in. As for the title change, that was unnecessary. What it meant for the staff was that a senior figure seemed to disappear overnight - they felt bereft. Then in the 1980s Roy Griffiths brought in general management and muddied the waters still further. What happened was they took the senior nursing roles too far from the patient and put too many layers in between.
Of course the medical staff didn't cherish matron when she was there, but they missed her when she was gone because she used to ensure their patients were being cared for properly.
Although I am broadly in favour of this new idea, I do have some concerns. I've recently been in hospital and though the nurses were very good they were so busy they barely had time to say hello. So the idea of giving the ward sister responsibility for non-nursing duties is rather worrying. It is all very well to say bring back matron, but everything's changed now. The nurses at the junior end of the spectrum are just too busy and those at the top would clash with the chief executive.
'I was asked to bring mother to interview' Baroness Audrey Emerton, former trust chair and now chief officer of St John Ambulance When I was a student nurse I had a job interview with Muriel Powell who was matron at St George's Hospital in London. I recall I was asked to bring my mother along, which I did, and we sat in matron's office at a round table.
Dame Muriel told me later that she always had a round table so no-one was at the head. That made an impression on me and I've always used a round office table since.
Dame Muriel was a real role model for us and I wouldn't have gone on to enjoy the success I did if it were not for her. I would describe her as one of nursing's real visionaries.
She was a modern matron - very young when she was appointed and she served on a number of national committees. She helped compile the report on the inpatient day which said it was wrong to wake patients up at the crack of dawn. Dame Muriel used to do an early ward round to make sure the night staff didn't wash the patients before 7am.
Although most nurses have not joined in with the 'bring back matron'call, they do accept you need someone in charge who can make sure the ward is clean, the patients are eating their meals and so on.
When I was a trust chair I would visit wards and if I found a dirty bathroom or sluice I would go to the chief executive and say, 'Come along, this needs sorting out. 'He would then take the matter up with the facilities manager.
As Florence Nightingale pointed out, the nurse should control the ward environment so I look forward to the introduction of modern matrons. However, I think the idea needs careful thought, especially the lines of accountability and communication. It is important not to put more non-nursing tasks on nurses, but It is right to give them the authority to ensure the people who are meant to be doing the job are actually doing it.
' David Weeks thinks back
The position of matron has always had a high degree of psychological appeal. When I first started working in the NHS more than 25 years ago, matrons were held in awe and affection, or rather they commanded such responses.
The image was that of the benevolent disciplinarian. They were highly visible and to some intimidating with a distinctive uniform and peculiarly-shaped starched headwear.
But the values the best of these senior nurses represented cannot be a bad thing for the NHS of the 21st century.
This is not all based on a rose-tinted nostalgia. A ward or unit under matron's control would be run correctly both in terms of hygiene and the patients'physical and emotional well-being. The matron had complete and unchallenged authority, not only over her nursing staff, but also the many helpful domestics. The return of hygienic standards, the first commandment in hospital environments, will represent a significant step forward.
Importantly, the matron also acted both as team leader and patient advocate. No doubt there are now very many clinically experienced and responsible charge nurses possessing equivalent commitment. And research suggests that two-thirds of charge nurses favour further developments in their role. But the matron seemed to embody, from the patient's point of view, another dimension of excellence - the ideal provider of quality nursing care.
For the patient, excellence in care is characterised by clinical knowledge, seamless continuity of care, attentiveness, co-ordination of staff, and empathic rapport. Busy clinicians sometimes forget that for many people, simply becoming a patient in hospital is stressful. They hope for the best, but fear the worst. Under such anxieties they may become more sensitive to their immediate environment and how the ward is run and maintained.
If all other things are equal, patients respond exceedingly well to the projection of prestige, especially that of hard-earned experience. Leadership is indispensable to a sense of well-being. Matron will be well placed to project calm and the trustworthiness that comes with much experience. This, in turn, will engage the commitment of her staff.
Nurses in general have always enjoyed the community's esteem, and as an experienced nurse the matron was at the apex of her profession. Her work was her life and all she did professionally stemmed from this vocation. This strengthened junior colleagues'sense of responsibility. As [German-American political scientist] Hannah Arendt has observed: 'Since authority always demands obedience, it is commonly mistaken for some form of power. Yet authority precludes the use of external means of coercion; when any compulsion is used, authority itself has failed. '
The new matrons will surely re-establish themselves, actively and reassuringly, as the hospital wards'inspirational centre of gravity. Their return may not be a panacea for all the problems of the NHS but their personal presence will help to restore public confidence at a time of phenomenal therapeutic innovation.
'The mighty atom': history in the making
One of the earliest matrons was Rose Fisher, whose name appears in Bart's Hospital archives from 1547 to 1559. A charter granted by Henry VIII had ordered that there should be 'one Matron and 12 women under her to make the beds and wash and attend upon'the patients.
In the 19th and early 20th century Bart's attracted some notable women to the post of matron. These included Ethel Gordon Manson (who became Mrs Bedford Fenwick) who was matron from 1881-87, campaigned for state registration and was the first name on the nursing register.
She clashed with the matron at the London Hospital, Miss Eva Luckes, who was a friend and correspondent of Florence Nightingale. Other famous matrons included Alicia LloydStill at St Thomas'Hospital in London and Dame Sarah Swift at Guy's, who was known as 'the mighty atom'.