Ward leaders key to safety as new roles introduced, says chief nurse

In an in-depth interview, Ruth May said trusts had responsibility for ensuring new roles such as nursing associates and physician assistants were deployed safely.

Promoted to become CNO at the beginning of the year, Ms May is now the most senior nurse in England. She acknowledged the introduction of new roles meant care could increasingly be fragmented into a series of separate tasks, something research has shown can damage outcomes and safety.

Ms May said: “Yes, there is a risk. Alison Leary’s and Jane Ball’s work show evidence of the [registered nurse] role, the responsibility and the need for the graduate nurse. That’s important.”

She pointed out there had always been non-registered support staff working on wards, but that as the new roles were introduced, ward level team leaders needed to “safely deploy” their teams.

Trusts should ensure these ward leaders, typically senior nurses, had the necessary skills for this and were supported, she said. She added that NHS Improvement – her main employer – would be providing training and guidance in coming weeks.

She said: “It’s not just me that will make sure patients are safe. It is people working at all levels in the NHS. This is why we need to support and develop our ward leaders because they’re the ones who have the role to make sure they lead and support their team.”

Her comments come ahead of changes to the NHS standard contract from 1 April aimed at protecting safety as new staff groups are introduced, including an expectation to follow NHSI workforce safeguard guidance, carry out quality impact assessments before making staffing changes, and have procedures for dealing with day to day shortages.

Ms May told HSJ the contract changes were an “important step”, adding: “I am very clear I want to do everything possible to support directors of nursing to ensure they have safe staffing for their patients and care settings.

“All this does is say how we are asking trusts to safely deploy staff and consider how they do their staffing day in day out as well as on an annual basis. Our responsibility is to make sure we support trusts but with that support comes constructive challenge.”

NHSI has never taken regulatory action at a trust over safe staffing, but Ms May indicated it could be more interventionist if necessary, saying it had “lots of boots on the ground” in trusts.

The new chief nurse’s role sits across NHS England and NHS Improvement – on their new joint national executive team – as well as serving as an adviser to ministers.

She said one of her top priorities was to highlight the “contemporary” role of nursing as a high-skilled profession.

She said: “I passionately believe we need to lead nursing with our head and our heart. We absolutely should have kindness without any doubt as any professional working in healthcare needs to have. But we need recognition of the contemporary role nurses have. Some of those really specialist nurses and the skills they have.”

She said attracting men to nursing was important, as was appealing to school leavers.