NEWS FEATURE

NEWS FEATURE

Leading from the front

Although public sector managers experience more stress than their private sector counterparts, many appear to be prioritising leadership among staff
Kin Ly
Assistant editor

Public sector managers work within a very demanding environment, and recent research has confirmed that workload and pressure to perform are key contributing factors to stress. This is certainly reflected in the NHS, particularly within middle management, where many are having to contend with the demands of senior executives to deliver audit reviews and meet targets as well as the addressing the needs of their staff. However, among all other workplace priorities, there appears to be a keen commitment to develop frontline leadership roles.

Commission reviews and target setting. Having priorities is good, but the demand on us needs to be realistic. Very often, we are asked to produce pieces of work statistics, data, reports and all at very short notice.

More public sector managers experience stress than managers in the private sector
She adds: Middle managers are the meat in the middle of a sandwich they are pressured by senior managers, and complaints are brought to their door by frontline staff. Often, targets or projects will be delegated from a senior executive to a member of management, and the work may well involve setting targets for frontline staff. Staff will often accuse middle management of placing unrealistic targets on them, and senior executives will come down on the manager for not delivering on what was initially set out. Lack of clarity over job roles was also identified in the report as one of the top ten major stressors. Of 900 survey respondents, 33% in the public sector said that job roles were unclear, compared with 23% in the private sector. This may be a prominent problem among community nursing, and particularly of concern for

frontline staff working in a skill-mix team. Senior school nurse Amanda Corr states: The requirements of staff nurses and community nursery nurses differ from one primary care trust (PCT) to another. For example, in one PCT, some community nurses may hold child protection cases and in another trust they may not. There are so many different types of community nurses and if skill mix is not used appropriately, then this can sometimes lead to confusion as to what the specific job requirements for that nurse are.

A demanding environment Roffey Park is a charitable trust that produces an annual management agenda report on workplace trends in the UK. According to this years report, more public sector managers experience stress than managers in the private sector nearly eight in 10 compared with seven in 10 respectively and workload and pressure to perform were the top precursors of stress. NHS Leicester City education and development lead Christine Wint co-ordinates and commissions leadership and management training for band-5 to band-8 nurses and is a middle-tiered manager. She states: We do work in a very stressful environment and a lot of this is to do with the persistent change and competing priorities the constant audits, reports, Care Quality

Enhancing leadership roles Despite the high level of workplace demands, developing leadership appears to be a priority for managers. The management agenda report suggested that 62% of public sector managers were looking at leadership development as a future strategy a reflection of the aims of NHS managers. Christine states: We are certainly looking to develop more leadership roles within NHS Leicester City and hoping to develop a local programme that provides training for this. The outcomes for practitioners will include increased confidence, and they will acquire leadership qualities and skills that will enable personal growth. Practitioners would then feel empowered to lead for change rather than having change imposed on them.
April 2010 Volume 83 Number 4

She adds: We are hoping to establish a local pathway that examines aspects of the band-6 and band-7 roles, look at what clinical leadership is and the qualities and skills needed at that level, and then link it to a local work-based programme. Then we will look at leadership as a whole, explore what is happening nationally and again relate this to a local level. Elsewhere, other solutions are being implemented to increase leadership opportunities. Unite/CPHVA School Nurse Forum member and team leader Judi Greenbank says: Leadership development is being addressed by some trusts with a plan to introduce more staff in bands 2, 3, 5 and 6. Historically, school nurses have been lone workers and had no-one to delegate any work to. More recently, school nursing teams have been created, which means the band-6 school nurse is expected to lead teams by delegating appropriate work to the mix of staff that they work with. Hopefully this will enhance the service they are able to offer school-aged children and young people.

visitors to lead this programme. Christine emphasises the role of inservice training in improving leadership skills. She states: It would be more pertinent to develop local clinical leadership programmes, because we would have

Senior managers have been supportive of leadership opportunities, particularly in preparation for the HCP
more influence over the curriculum and outcomes for staff. We can link training to work-based projects, which is an effective way of practising leadership skills. On the publication of the 2010 management agenda, Roffey Park director of research Jo Hennessy stated: Given that more public than private sector managers complain of poor communication, bureaucracy, lack of clarity over their role and lack of control or support at work, it seems sensible that the public sector is looking to developing their leaders as their number one strategy this year. In doing so, they will have to support this with wider organisational changes to ensure lasting transfer of learning into the workplace. However, as the need for more NHS leaders grows, there is also a fear that some PCTs are purchasing inappropriate training from private companies. Unite/CPHVA Health Visitor Forum chair Maggie Fisher states: Leadership is certainly an area that needs to be invested in. However, some trusts are investing large amounts of money in commercial leadership and management training. Often, this type of training is focused on performance management rather than on developing the required leadership skills.

Access to training Although there may be managerial support, there appear to be limitations affecting the number of practitioners accessing such training pathways. Christine states: You can only release one or two nurses from their usual area of work to undertake such training. Ideally, we want to be able to release larger numbers of practitioners in order to have a definite and immediate impact but this is a capacity issue. She added: At the moment, only a handful of practitioners are approaching their managers to be enrolled onto these courses. One of the main reasons is a lack of confidence, and many do not feel empowered within their current environment to be deemed leaders. Excellence in leadership NHS managers generally seem to be appreciated, despite the stressful environment. Amanda states: Although our manager is not a school nurse by background, she has proactively taken steps to understand the school nursing role and the problems that we face my manager is very supportive and positive. Christine adds: I have seen excellence in leadership from my line manager I have been supported in terms of my development, and there is a real sense of collaborative team work, particularly around sharing of information. Strengths and achievements need to be acknowledged among staff at all levels of the NHS, who may all work in very demanding and stressful environments. The work done by NHS managers to promote leadership capacity and roles could provide real opportunities to improve services and working lives.
COMMUNITY PRACTITIONER

Nurturing leadership Demand for community nurse leaders is increasing, with recent national initiatives providing additional leadership responsibilities for specialist community public health nurses. The Department of Health has stated that the Healthy Child programme (HCP) from birth to five will be led by a qualified health visitor, and states that there is likely to be a significant leadership role for school nurses as part of the HCP for five- to 19-year-olds. Amanda Corr states: Senior managers have been supportive of leadership opportunities, particularly in preparation for the HCP. There has been a reshuffle of teams in order to allow school nurses and health
April 2010 Volume 83 Number 4

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COMMUNITY PRACTITIONER

PHOTOLIBRARY

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