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