The UK government recently called for better nurse leadership and ward management1—for example, by calling for nurses to undertake hourly rounds—after increasing concern about the quality of patient care in the NHS. In response, the Royal College of Nursing commented that ward sisters are experienced nurses who can provide expert leadership to the team, and that they need to be able to call the shots and supervise and develop the wider workforce.2 The college’s response signals recognition that ensuring safe care is less about pronouncements from Whitehall and more to do with local ownership of local problems, underpinned by committed and effective leadership at all levels of the organisation.

The prime minister’s call to improve nursing quality through “intentional rounding”—a formal process of patient checks conducted by responsible nursing staff every one to two hours—implies that nurses would improve care merely by focusing on patients rather than on tasks. Ironically, “back rounds”—a series of nurse led actions focused on specific care needs—were cast into the wilderness by leaders in the mid-1980s, …