The role of the ward sister in the context of supervisory status and the impact that the role has on quality of care

The aim of this study, is to explore factors that influence the supervisory status of ward sisters in an acute hospital Trust and examine the impact that the role has on the quality of care both perceived and actual. Specifically, the study explores the lived experiences of ward sisters who move from non-supervisory to supervisory status, and the impact this has on the quality of patient care. Using case study methodology, ward sisters from five different wards participated in a 12-month study during which they underwent a role change from non-supervisory to supervisory status. Managerial interventions created structural changes, first to their role and working environment via a professional development programme, and secondly, through the design of the new supervisory role. The supervisory role facilitates enabling of time, access to resources and to lines of support. Using semi structured interview techniques and a hermeneutic approach to interpretation, the lived experiences of ward sisters were captured first in their non-supervisory states (their roles formed part of the clinical care team), and later, in their new supervisory role. In addition, to establish the impact of the role change on patient outcomes, nursing quality indicators were observed over the course of the study period. The findings of the research provide empirical support for propositions derived from Kanter’s theory of work empowerment. Whilst fluctuating clinical staffing challenges did not always enable the participants to manage with 100% supervisory status, when empowerment was operationalised in the organisational setting, ward sisters perceived increased levels of control, authority and support, as well as feelings that patient outcomes had improved. Quantitative data analysis of the nursing quality indicators showed no significant relationship with the role change; however closer inspection of the indicators revealed organisational inaccuracy of data capture. The research makes a unique contribution to practice by providing guidance to enhance ward sisters’ contributions to the quality of patient care and draws our attention to the way in which we measure this.