Are modern matrons needed in mental health?

Why are modern matrons needed in mental health?

Okay, so we’ve already looked at The ugly truth about mental health nurses here and The curse of ward managers here. Now let’s take a look at Modern Matrons needed in mental health. And do we actually need them? Like me, perhaps you’ve thought there must be alternatives to the way we work? And have you ever been frustrated or concerned that patient care is not as good as it should be? I know I was.

While I was working for the NHS on an acute inpatient mental health ward, we had 6-7 modern matrons (MM’s). Each one oversaw two wards. You read that right, two wards and two only managers to oversee! Upwards of 60k in London — that’s a dream role; one where you could literally sleep on the job.

The job spec for Modern Matrons might look something like this:

1. must have skills in leadership, clinical competence, and the mentoring and development of nursing staff.
2. implement and maintain standards
3. be able to identify needs and opportunities to further develop clinical practice according to the needs of patients.
4. combine strong clinical credibility with the ability to inspire and influence change.
5. will have direct operational and clinical responsibilities for two acute admission wards.
6. will have overall responsibility for the management of resources within the area of responsibility.
7. The Matron’s role is crucial in improving the quality of patient care. To do this through visible inclusive leadership and engagement with patients and families, frontline staff and senior management teams.

Now lets think about some of the above in more detail and see how it all works in practice:

Leadership, mentoring and developing nursing staff in mental health

Most of our MM’s either clean forgot or misunderstood the importance of these tasks. They never went further than the ward manager’s office and rarely spoke to nursing staff. Nor did they offer any input into communicating with, mentoring or developing any staff, other than their ward managers. But even then, as a ward manager, my MM didn’t have supervision with me, let alone mentoring or anything else in her job description.

What I did as ward manager initially was to check that all staff statutory and mandatory training was up to date. If not, staff were sent reminder to attend. Once everyone had updated this training, we identified what skills staff lacked and what skills were needed on the ward so we could organise relevant training courses to suit both ours and patient needs.

We organised a clinical supervision tree to ensure that each member of staff had a supervisor and would have supervision each month. Clinical supervision underpins the very essence of good care, and without it clinicians cannot develop their knowledge, skills and abilities, Nursing in Practice, 2013.

We also made a chart to show which specific skills staff had, and where they could use them to take the lead on various aspects of nursing care i.e. Fire Officer. This made it easier to identify areas that needed improvement or change and also gave staff the sense of responsibility and belonging.

Modern Matrons need to identify needs and opportunities to further develop clinical practice (for patients)

Because they didn’t engage with patients or nursing staff, our MM’s wouldn’t have known how to identify our patient needs, and were therefore unable to develop our clinical practice. Furthermore, they clearly lacked any skills and confidence to try different approaches to improving patient care. Seemingly, as long as they saw smiling patients on the wards, they were happy and their job was done.

What we did was to ensure the weekly team meeting actually happened and that all available staff attended. Staff were encouraged to speak out by asking questions of them i.e. “How do you feel about the new strategy to reduce our team from 2 to 1.5 on night shifts?” And, “What are the risks?” or “How can we implement the latest directives from the Audit Team?” Key points from discussions that followed would be documented in the minutes. These would then be copied to all ward staff, our manager, MM’s and Clinical Nurse Director (CND).

When the discussion around the risk of working with 1.5 nurses at night was raised, there were many hands in the air. So, we invited our MM, the Clinical Nurse Director (you might have read elsewhere on my blog, that we certainly weren’t bff’s). Staff asked had many questions but the last questions was “How long will this go on?” MM and CND shrugged their shoulders, “Who knows,” mumbled our CND. You can read about the near-death outcome of this action here.

We also held a patient and staff meeting 2-3 mornings a week, where everyone got a chance to discuss any concerns or say what was good about the ward. Again, this was minuted and sent to the same powers that be.

Possess clinical credibility with the ability to inspire and influence change

Clinical credibility, ha! Influence change; ha ha, rolling on the floor laughing. Our MM’s whole disposition was about control, knowing your place, keep smiling and don’t rock her boat. The only time we’d see her trying to influence change was if someone from PALS mentioned a patient’s dissatisfaction with the broken toilets.

She’d pull out some dog-eared policy on health and safety, trying to find a clause to suit her dilemma. After which, she’d draw up another useless appendix on who ought to report the broken toilets and how quickly they should be fixed. This was duly filed away for staff to read, well — never.

She’d obviously forgotten her time as a nurse, where you report the problem and wait for anything up to 7 days for the outsourced plumber to arrive. He’d take one look and shake his head, “Oooh, these cisterns are out of date now. I’m not sure what I can do.” And, pen behind his ear, off he shuffled back to his workshop for a nice cuppa.

What we did was ensure our patients knew about PALS; a place to discuss things like concerns about the ward, their care or leave status. We also had someone from PALS hold a morning clinic on the ward so even patients without leave could attend. Of course, (you getting the gist here?) this was all documented and minuted, to be shared in team meetings, where the minutes would be cc’d to our masters.

Modern Matrons need visible leadership in mental health

Just for the record, all you current modern matrons, I don’t think that sitting in your office with the door shut makes you visible to anyone. And sitting at your computer looking at used cars and campervans is certainly not included in the job spec. Trust me, my modern matron, whose office I could see into through the one way mirror in my office, stared at her screen most days.

To my boss (MM): “Didn’t you realise I could see you? All that time, you always kept two screens up so you could shut one down if anyone came into your office. Me and our charge nurse often giggled, gobsmacked as you read The Sun online. Could you feel my envy whenever you surfed stunning holiday sites, knowing you could afford such luxuries on an NHS salary? And were you aware that I drooled over your ridiculously high heel, red soled, Louboutins plonked carelessly on your desk?”

Ooops, I digress, “Could you not sense my fatigue as you fell asleep rested in your big ergonomically designed office chair? Didn’t you think that I, or our nurses might need a break or a cuppa? Why did you just pop your head out of your door when there was an altercation on the ward? We could have done with another body helping at times, when we were restraining a patient. Perhaps your Whistles suit was too posh to adorn the grubby floor we all rolled around on?

What I did as a ward manager, was keep an open door policy, which meant anyone could drop in if they needed help or support. Moreover, I was able to see what was happening on our ward, pre-empt any patient disagreements and de-escalate potential risk.

Fortunately for me, I was a Human Resources Manager prior to nursing, so it didn’t take long to get through admin and paperwork side of my job. This left quality time to spend with staff and patients, where I could anticipate and address specific problems. These were always my favourite times, chatting socially with patients and engaging with their families outside of those pesky wardrounds.

Change and improvement

That change needs to come from our MM’s, who would normally have the skills, knowledge, tools and confidence to lead and effect change. Our MM’s ought to understand the need for and how trying different approaches can make practical improvements for patients and ward staff.

However, that change and improvement doesn’t always have to come from the top down. It also needs to come from the shop floor, up, where patients and frontline staff know exactly what’s required to improve care, and can take the necessary action, however small.

Improvement and change is all about continually working together; nursing staff and multi-disciplinary teams together with patients and their families. Talking, questioning and sharing ideas is the best way to make changes and improve the health and social care we offer to patients.

What we also did was to ensure all ideas and concerns were documented. Minutes of all meetings were delivered to all ward staff, the manager, MM and the CND. That way, nobody had any excuse whatsoever to say, “I didn’t know,” or “I wasn’t aware staff felt they were at risk,” and “Are you sure you told me?”

As a team, I think we always went over and above what was expected of us. And where someone; patient, carer or staff, was able to effect change, they got the credit for it, which was as always, documented. No sneaky manager or MM got to steal that well-deserved credit.

Over to you

Do you think we need modern matrons in mental health? Did tales of our MM’s remind you of your bosses in some way? Of course my lovely readers, you might have other ideas of what we could have done differently? So, as always I look forward to your comments and any questions.

Related: Measuring the impact of modern matrons in the ward setting (1)