Rise and demise of the hospital: Managing hospital inpatient care

doi:10.1136/bmj.332.7532.52-d

BMJ 2006;332:52 (7 January), doi:10.1136/bmj.332.7532.52-d

Letter

Rise and demise of the hospital

Managing hospital inpatient care

The first 150 words of the full text of this article appear below.

Editor—Black calls for nurses to transform our hospitals.¹This will not happen without a major change in the clinicalculture that pervades hospital practice.

Observational studies show inadequate communication betweendoctors and other clinical staff.² Attempts to foster collaborationare undermined by differential power and status, lack of interprofessionalsocialisation, and inadequate attention to team building. Theproblem is intensified by the pressure on senior nurses to enhancetheir managerial roles. Time spent on management too often leavesthem with inadequate time in which to provide the leadershipnecessary to maintain standards of clinical care.³ This sapsmorale and may play an important part in the high turnover ofnurses in most of our hospitals. Meanwhile senior nurses seekcareer progression through management or by becoming nurse specialistsrather than continuing as ward sisters, a role that was onceregarded as the apex of the nursing profession.