The curse of ward managers in mental health

What do ward managers do on mental health wards

Ah, here’s the rub

Coloured image of female asleep at her desk
Ward Manager asleep at her desk —
Image from

Each ward had a manager who worked 9-5 and was expected to split their role 50% managerial and 50% clinical. What p’d me was the fact that most managers sat in their office 99% of their day. Tho’ they did pop their smug faces around the nursing office on their way out to get coffee or lunch.

Crikey, like most nurses, I’d forgotten what a lunch break was.

And heaven forbid, Managers might get their hands dirty. Or their neatly pressed shiny trousers, if they dared to sit with patients at mealtimes. Managers should have been out there on the floor, supporting nursing staff to do their jobs effectively.

What could managers do?

Coloured image of elderly lady walking with walking stick
Elderly patient had walking stick
snapped in two — Wolfgang
Eckhert from

They might have noticed the patient with false teeth who was choking on a large chunk of beef and nearly died. Or that a nurse really did break an elderly patient’s walking stick over her knee then hid it behind the filing cabinet. Why believe the lady with psychosis, eh?

A manager on the floor might have spotted (when a nurse didn’t) an elderly patient sneaking out with the lunch trolley. They’d be contacted at home later to be told that this poor man died. The next day it would be all about filling in paperwork for the impending investigation. Never mind the poor patient or his family.

Oh, and the manager would be looking for someone to blame. Why did nobody notice? What were all the staff doing? Where was everyone? Who opened the door and let Archie out? He actually snuck out. The video footage from security didn’t detect him behind the lunch trolley either.

Perhaps they could’ve stopped the gullible junior doctor unlocking a side door to let a patient out. She was yelling through the door that she was a visitor and had got locked in. He didn’t think to check. And he didn’t notice her slippers as she shuffled out? She was found, safe but causing pandemonium in the local market, throwing wet fish from a stall at anyone who went near her. The not too friendly police stank of rotten prawns when they returned her to the ward.

How Managers could sit on their fat lardy arses in their back office with the door shut was beyond me.

What managers should do

The following is a shortened version from my previous Job Specification for Ward Manager. In it, it states that a Ward manager must:

Coloured image of black man with wild hair painting
The provision of Art therapy —Image by andrea Piacquadio from Pexels
  • promote a therapeutic environment that is conducive to recovery and the development of independence.
  • lead and be responsible for the clinical management of a ward, where patients may present with complex behaviour that challenges services.
  • allocate and support individuals with delegated work
  • coordinate and monitor the delivery of evidence-based person-centred healthcare.
  • be accountable for the provision of appropriate physical care to support the general health needs of service users.
  • be responsible for ensuring that services are responsive to individual customs and beliefs, age ………. and that service users and staff are supported to fulfil these.
  • be responsible for the provision of and access to a range of therapeutic activities, emotional support and stability to clients to ensure effective engagement.
  • support and supervise staff to ensure the maintenance of professional boundaries.
  • create, develop and maintain professional supportive relationships with all members of staff to enhance service delivery and recovery.
  • ensure that all documentation is robust and that audit is undertaken to evidence this.

Job spec doesn’t apply to management

Image white shredded paper with Job specification no longer needed

That all seems clear enough to me. However, I get the feeling that once managers have the job, the job spec’s shredded, never to be referred to again. I think all managers should have this framed, or at least laminated, and displayed in their office. And just for good measure, they could add a great big arrow pointing to this “Please let me know how I’m doing.” and stick it their office door. That way nurses, patients and family or carers can pull them up when they’re not doing their job.

Love your enemies

While perhaps I didn’t call my managers out directly, I would let them know when I was unhappy with their suggestion or directives that went against Trust policies. As a Band 6 Charge Nurse (assistant manager), my manager would tell me to have staff plan the dates for their entire year’s annual leave, including me.

Er Errr, the policy says no. Staff didn’t have to do this and many couldn’t or didn’t want to. Mostly, as our rotas were distributed each month, I would plan my holidays prior to the following month’s rota.

When I relayed this back to my manager, he whined: “I’m going to have to tell Miranda (our local nursing director).”

“Ooh, scary. Tell Miranda,” I’d grin.

Nope, he wasn’t best pleased, “Oh come on. Don’t make me do this. Miranda won’t be happy.”

“Tell Miranda to speak to me then. I’m not pushing staff to do this.” And he did tell her. She came up to his office, arms folded and grimacing, “What’s all this nonsense about? Who the hell do you think you are?” without letting me answer she raged on, “I’m your boss and I’m telling you………”

Colour picture of an NHS lanyard
NHS Staff identification holder

With my hand up, “Let me stop you there Miranda. If we take our badges off, we’re just the same, me and you. We’re both human and I’d appreciate it if you treated me so.” As I watched her eyes bulging and the fumes flaming from her nose I continued, “The Trust Policy states that staff can plan their holidays whenever they like, so I’m not going to do as you ask. I can’t plan for a year so I don’t expect twenty-eight other staff to be able to either.”

“Do you know what. Just bloody leave it,” she snapped, “Mark will do it,” nodding at him before storming off the ward. She absolutely hated me. She’d ignore me in corridors or in meetings, even though I’d always smile at her and say “good morning Miranda.”

“Love your enemies, it will drive them crazy.”


I won’t even start on about our Modern Matrons, I’ll leave that for another post.

You might be interested in the following articles:

Over to you

Have you ever worked with ineffective and impossible managers? Would you have called your manager out? I’m interested in your thoughts and I look forward to any comments or questions.

This is a true account from my perspective and all names have been changed to protect the lardy arsed, ineffective and impossible managers — and save them from any embarrassment.


Mum to two amazing sons. Following recovery from a lengthy psychotic episode, depression, anxiety and anorexia, I decided to train as a Mental Health Nurse and worked successfully in various settings before becoming a Ward Manager. I am a Mental Health First Aid Instructor and a Mental Health Awareness Trainer, Mental Health First Aid Youth and Mental Health Armed Forces Instructor. Just started my mental health from the other side blog.

18 thoughts on “The curse of ward managers in mental health”

  1. Hiya Caz, I hope all is well with you.
    Surely (a) being able to plan the rota, and (b) not leaving the ward short-staffed, are the only two drivers here? Why did they want everything sorted a year in advance?
    I often found that there was a problem with managers fitting in. They were there to fulfil a specific role in a team, just as the rest of us were, basically that of co-ordination. Many would come in assume that they were king of the castle, and pretty soon you’d have a pissed off team. Over the years I worked with people at director level and I found them very switched-on – but obviously these people had got where they were by being good managers – where most people would fall by the wayside.

    1. Hi P, you’re right and they wanted to ensure everyone took their holidays and not try to carry them over to the following year. But, I think you can just keep an eye on what leave people are taking and encourage them to use it all by end of year! Hey, what do I know 🙂

      Oh Crikey – no Kings in our castle lol. Unacceptable! Unfortunately, most managers were trained to be nurses – not managers! At least I had HR management experience I could use when I became a manager. They could have ensured that Managers were trained in admin, management etc.

  2. When I was working inpatient, my manager was gossipy, manipulative, and back-stabbing. She spent most of the time in her office or in meetings.

  3. Ha, I love that, “Love your enemies, it will drive them crazy.” 😂

    I have a hard time respecting any manager who does not spend some time “down in the trenches” or at least having serious conversations with those who are. It’s too easy to get out of touch if you don’t observe the action directly.

  4. I recognize everything you wrote including planning your hours or holidays. The law says (here) that we needed to fill in our requests 10 days before the new month. Except all the schedules were ready waaaaay before that deadline and no change was possible. It was difficult for me to plan that much ahead and keep some social life outside work.
    I didn’t complain that much about it but was stunted nobody else noticed or mentioned it. People can be sheeple sometimes!

    1. Lol. When I was ward manager, people always wanted to make changes to the rota and one months I counted 128 changes to a rota one particular month. We discussed it in a team meeting and someone suggested ‘people makes changes in emergencies!’ Like I asked “128 emergencies? From 32 staff?” Ha, I don’t think so! Like I told them, there isn’t another company in the world that would allow you to keep changing your work pattern!

      1. Oh now I need to admit that I’ve made maybe the most changes on my team. They were always looking at my hours to adapt them 🙂
        When I got a great idea to do the next day, I just changed my hours so I could manage what I’ve thought about!
        That was maybe not so kind of me, looking back …. 😮

  5. I was a mental health nurse for 32 years and ended up as a patient .some of the staff I worked with were great others were definitely psychopaths.i still have flashbacks about bullying and bad practice. I regret ever joining the profession and wish I could turn back the clock and save myself from a life of misery.

    1. Hi John, sorry for the delay in responding. I haven’t been too well. Nice to meet you and congrats on your long career in mental health.

      But I am so sorry to hear of your experience with bullying and bad practice. And it still goes on doesn’t it? And Senior staff allow it to go on because they’re unable to deal with it effectively themselves!

      That’s such a shame you regret joining the profession 🙁 I loved my job and fortunately moved up quite quickly so I was able to stop some of the bullying and change working practices. Unfortunately, I got sick about 10 years ago and had to be medically retired. I’d obviously have to hope to move even further up the ladder so that more changes could be made. Even our HR department was useless too – they were too afraid of the unions!

      Nice to meet you on here John and hope to catch up some more. Do you have a blog?


  6. I’m a manager and I’m working as an RMN and a manager, basically doing the jobs of two or more people at the same time as we just don’t have the staff anymore. I don’t get overtime just toil but can never take this and work over and above my hours to protect patients and support staff and it’s never enough. I don’t know anyone that’s smug. I know a lot of intensely stressed but kind people doing the best they can in impossible circumstances. It feels like it’s just getting worse and everyone expects you to do everything and you’re always criticised.

    1. Anna, I’m so sorry, I’ve just seen yur comment. I’ve been unwell both physically and mentally for a while now. Thank you for commenting and I get where you’re coming from; not having breaks, working in dreadful situations, lots of toil but being unable to use it etc. Leep yp the good work 🙂

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