T his month, I attended the awards ceremony of eleven senior nurses who had all successfully completed their Aspiring Nurse Director

development programme at London South Bank University with NHS Improvement (NHSi). The programme aims to talent spot and equip aspiring nurse leaders into chief nurse posts. It was a great afternoon, full of personal reflections from those who had undertaken the course. These were people with ambition and there was a drive to progress into board-level nursing posts from many, but not all of the scholars. During the open debate that afternoon, the scholars reflected that undertaking the programme had enabled them to consider ‘the right chief nurse job for them, rather than the next one advertised’ as key in their future decision making, with some individuals reflecting that the programme had enabled them to conclude that they did not wish to progress onto a board-level post.

Concerns have been reported recently in the nursing press surrounding the high turnover levels of nurse directors. Jones-Berry (2016) reported an analysis of 230 English NHS trusts, 14 Scottish and 7 Welsh Health Boards and revealed that 132 (53%) of chief nurses had only been in post since 2014. Of this figure, 33 chief nurses had only taken up post in the last year.

Following the awards ceremony, Professor Kelly, Chair of Nursing Research and Director of Research and Innovation at the Royal College of Nursing shared his research findings (Kelly et al, 2015). Semi-structured telephone interviews with chief nurses were conducted. The aim of these interviews was to explore

Promoting resilience in nursing Sam Foster, Chief Nurse at Heart of England NHS Foundation Trust, considers recent research into role stressors and coping strategies for executive nurse directors

role stressors experienced by executive nurse directors and the strategies that they used to maintain resilience.

The drivers behind the study were multifaceted and included:

■ The recent financial pressures on the NHS. Dame Professor Donna Kinnair recognised that organisational failures are all too often blamed on the chief nurse, despite having no budgetary responsibility for improving care, making the role even more difficult (Jones-Berry, 2016)

■ A number of well-publicised care quality scandals in the UK. This was well debated in Allan et al (2016): with headlines depicting how under fire nursing has become in recent times: ‘too posh to wash’, ‘too clever to care’, ‘complicit in cruelty’ and the list goes on

■ The short length of tenure and the high number of vacancies for chief nurse posts. The researchers raised questions about not

only the demands of the role, but also the support mechanisms in place.

Professor Kelly presented us with three key theoretical positions to consider in the context of the issues facing board-level nurses:

■ Failures of foresight—disasters preceded by long incubation periods typified by signals of potential danger being ignored or misinterpreted (Weick, 1998)

■ Normalisation of deviance—incremental process involving a gradual erosion of normal procedure and standards that would never be tolerated if proposed in one single abrupt leap (Vaughan, 1997)

■ Deaf effect—when a decision maker doesn’t hear, ignores or overrules a report of bad news to continue a failing course of actions (Jones and Kelly 2014) The results of the study found both chronic

and acute stressors. Chronic stressors included overall workload, a feeling of a lack of shared corporate responsibility for quality, and tensions between financial solvency and care quality that engendered a feeling of personal vulnerability. Acute stressors included dealing with the immediate such as complaints and incidents.

The resilience strategies that were reported by the chief nurses included the support of fellow board members, peers, family and mentors, along with a degree of self-discipline regarding work–life balance, good preparation for the post and ongoing coaching.

Kelly et al (2016) found that the current fiscal austerity and recent care scandals have increased pressure on chief nurses and this, coupled with larger organisations to lead, limited resources devoted to quality, and repetitive demands for data by oversight organisations, could be detracting from more important quality assurance strategies. Clear strategies are required to maintain resilience in the face of these major stressors. As a chief nurse, the study resonated with me. I was pleased to hear Ruth May, executive director of nursing at NHSi, speak at the event, detailing the strategies in place to support those thinking about becoming a chief nurse or those already in post. These include the development programme for aspiring nurse directors, a programme to support new nurse directors to help plan for the first 100 days, and a buddy programme for people new in post and those in difficult circumstances.

While I have largely focused on the struggles of the role, I would like to add that, for me, the chief nurse role is a privilege. It is a role that has opportunities for huge personal and professional pride in leading an amazing profession, as well as daily opportunities to make a significant difference for our patients. BJN

Allan H, Traynor M, Kelly D, Smith P (2016) Exploring Sociology in Nursing. Sage Publications, London

Jones A, Kelly D (2014) Deafening silence? Time to reconsider whether organisations are silent or deaf when things go wrong. BMJ Quality & Safety 23(9): 709–13

Jones-Berry S (2016) Trusts are struggling to retain chief nurses. Nurs Standard 31(4): 12-3

Kelly D, Lankshear A, Jones A (2016) Stress and resilience in a post-Francis world—a qualitative study of executive nurse directors. J Adv Nurs 3. doi: 10.1111/ jan.13086 [Epub ahead of print]

Vaughan D (1997) The Challenger launch decision: risky technology, culture, and deviance at NASA. University of Chicago Press,Chicago

Weick KE (1998) Foresights in failure-an appreciation of Barry Turner. Journal of Contigencies and Crisis Management 6(2): 72-5


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