In a programme that pre-empted the Productive Ward initiative by a year, Ipswich Hospital trust improved its nursing services by changing the ward sister role

In 2005 - when the Productive Ward programme was just a twinkle in the eye of the NHS Institute for Innovation and Improvement - Ipswich Hospital trust was quietly busy.

Based on evidence that ward sisters were struggling to find a balance between being educators, clinicians, managers and leaders, the hospital set out to make changes that would support their role.

The Ward Sister programme aimed to improve patients' experiences and provide visible leadership and supervision of clinical standards.

Shaking things up

Put simply, nursing needed to get its house in order and visibly improve the care given to patients.

A phased investment in ward establishments partly released ward sisters from making up the numbers necessary to deliver basic care. This change in working brought with it a new level of responsibility and, although daunting at first, they felt empowered and focused.

After seeing the results and positive outcomes, no-one wishes to turn back the clock.

When the drive began to implement the Productive Ward programme, Ipswich Hospital could put a case to East of England strategic health authority that it was already meeting most, if not all, of the requirements through its Ward Sister programme. Since 2005, the trust has had 12 key performance measures for every ward:

  • environment;
  • hand washing;
  • infection control screening;
  • nutrition and pressure ulcer screening;
  • weekly review of clinical incidents;
  • delays in transfer of care;
  • nurse co-ordinated care;
  • discharge planning;
  • key performance indicators;
  • rosters;
  • financial management;
  • sickness monitoring.

The programme worked on the basis that you cannot aim to change things until you know where the problems are, and so the hospital started a weekly auditing system of the performance measures, which was more detailed than that used by any other trust at the time.

As time progressed and standards improved, audits were conducted monthly, reverting to weekly if standards dropped.

Cost savings

In the first year of implementation, the programme saved£1.3m by allowing ward sisters to mange their budget for temporary staffing in a controlled manner.

Gwen Collins, director of nursing and quality and director of infection prevention and control, said: "In 2005, we looked back and saw there had been many changes in the structure of nursing, with a growing complexity of roles and responsibilities. The role of the ward sister/charge nurse was classic to this change and much had been written debating the expectation and value of the position.

"Without exception, all literature acknowledged the ward sister role was complex and demanding. It was multifaceted, requiring them to be clinically credible, visible to patients, carers and families, a source of expert knowledge, a leader and developer of their team, have managerial and budgetary skills and have 24-hour responsibility for their ward areas.

"The role was challenged, suggesting that ward sisters should step back from the clinical arena to that of managerial activities, or in some cases the expectation of achieving both."

Three years on, the Ward Sister programme has been completely rolled out in Ipswich. It has been discussed at a National Patient Safety Agency event and other trusts in the East of England have visited Ipswich to see the new way of working.