October 13, 2008

Matron’s Back to Bring NHS Up to Scratch

By Kate Foster

THEY once ruled the wards in their starched uniforms and white frilly caps, their bossiness epitomised by actress Hattie Jacques in the Carry On films.

Now the first matron is to appear in a Scottish hospital for almost 30 years.

A new training scheme has just been completed and the first batch of Senior Charge Nurses, dubbed 'modern matrons', have begun to patrol wards in the Scottish Government's latest move in fighting superbugs and improving patient care.

Some aspects of the new matrons' jobs, such as strict discipline and attention to detail, are similar to those of their formidable predecessors.

But others, such as patient care action plans, assessing nutrition and health risks, and the job description "guardians of quality", are far more 21st century.

One of the new batch is Lesley Lawson, a 50-year-old mother of two teenagers who recently returned to nursing after a long career break, and who is more interested in getting to know her patients and their families than instilling fear in her junior colleagues.

Lawson, a Senior Charge Nurse managing a 21-bed assessment ward for the elderly at Woodend Hospital, Aberdeen, is more informal and friendly than the traditional matrons may have been

Yesterday she admitted that as a trainee in the 1980s she was in awe of her own hospital matron.

But she insisted that, despite her plans to pay attention to "every detail" on her own ward, she did not expect her management style to change with the new role.

Lawson said: "When I did my nursing training there was a matron in charge of the nursing staff. She was very strict and didn't suffer fools gladly. We were all in awe of her, but respected her. But I don't see my attitude changing in how I relate to staff or anyone else I come into contact with.

"I think this is a really exciting opportunity to empower nurses to make changes for our patients, and the whole point is that it's patient focused. We are hoping to improve Scotland's health."

Lawson, from Banchory, Aberdeenshire, added: "I know each of the patients on my ward individually, as well as their families and carers, as far as you can.

"This new role frees up my time to allow me to do things that are more important in terms of clinical leadership and improving care."

Lawson's responsibilities, which will be taken up by other Senior Charge Nurses on most wards throughout Scotland over the next two years, include auditing patient care and making action plans for improvement, such as assessing risk of falls, food and nutrition, monitoring and observations.

Although modern matrons will have less of an authoritative role than traditional matrons, with responsibility for wards, rather than overall charge of the hospital, much of their job description is the same.

The new Senior Charge Nurses will also make sure their wards are safe and clean by monitoring the work of the cleaning team and being on the look out for dirty sheets, trip hazards and anyone failing to wash their hands regularly.

Lawson added: "I have been able to identify where staff have training issues and I can give training or allow them to leave the ward to go on courses and keep up to date. Because I have been released from having a clinical caseload I have had more time to do these things."

The role of the matron was phased out from the 1970s as part of a reorganisation of the NHS, with the trend in nursing shifting to a less hierarchical approach. But there have been growing calls for a reintroduction of the role amid falling standards of hygiene, infection control and patient care in the health service.

The hospital superbug Clostridium difficile was linked to almost 600 fatalities in Scotland in 2007 - up more than 40 per cent on the previous year.

The new matrons, who will earn up to GBP 38,352, have been relieved of the responsibility of individual patient cases in view of their new role.

By 2010 there will be one on each ward in Scotland in charge of about 10 to 40 patients, nursing staff and cleaners.

The move has been warmly welcomed by patients' groups who have long campaigned for a return to traditional NHS values.

Margaret Watt, chairwoman of the Scotland Patients' Association, last night described the move as "fantastic". She said: "When I was in hospital as a child, when Matron came into the room, everyone stood to attention. Slackness should not happen. This will give patients back their confidence about going into hospital."

Theresa Fyffe, director of the Royal College of Nursing in Scotland, said: "If the role is fully implemented over the next two years and supported appropriately by all health boards, Senior Charge Nurses have the potential to make a huge difference to the patient experience."

Oooh Maatron! Memorable quotes from Carry On films

Sister: It's Matron's round. Percy Hickson: Mine's a pint !- Carry On Nurse, 1959

Matron: This hospital is getting too small for us Doctor! Dr James Kilmore: Well you're not all that big Matron. - Carry On Doctor, 1967

Matron: [handing Sir Bernard envelopes] By the way - your mail. Sir Bernard Cutting: Yes, I am! And I can prove it, d'you hear! Prove it! - Carry On Matron, 1972

Matron: I'm a simple woman with simple tastes, and I want to be wooed! Sir Bernard Cutting: Ooh, you can be as 'wude' as you like with me! -Carry On Matron

Matron: That's the third one this week. Dr James Kilmore: Well Matron you can still use it on people who are a bit round the bend. [After Dr Kilmore has collided with her in the hall, matron takes thermometer out of her pocket now shaped like a boomerang] - Carry on Doctor

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