Leadership on the wards

12 November 2012

Dear Editor,

We were pleased to see the issue of nurse leadership emphasised in the editorial on nurse leadership and patient safety (BMJ 2012;345:e4589).

Leadership and professionalism are essential to improve patient safety. However, there was no reference to team working and the role of other professionals in ensuring patient safety through distributed leadership, in particular nurses working with consultants on the ward.

There is currently a lack of communication between ward nurses and consultants on the wards – in a recent survey by the RCN and RCP, it was reported that consultants and nurses failed to both be present on 70% of wards rounds [1]. The clinical review of patients is therefore inherently disjointed and ineffectively coordinated. This situation must change. Medical staff and nursing staff must both take ownership of the holistic safe care of patients. Our recent publication on ward rounds gave examples of and guidance on good practice where communication has been enhanced [2] [3].

Some teams have introduced safety checklists on ward rounds to ensure that issues of hydration, pressure areas, falls and continence amongst others are regularly reviewed, whilst empowering active nurse participation and leadership in the ward round setting. The Royal College of Physicians has also called for a named consultant to be designated to work with the ward manager to keep patient safety and the holistic care of patients under review.

It is only by working better together, beyond the traditional professional barriers, that we can ensure patients receive high quality joined-up care.

References:

[1] Royal College of Physicians, Royal College of Nursing. Survey of nurse participation on ward rounds. London: RCP, 2011.

[2] Royal College of Physicians, Royal College of Nursing. Ward rounds in medicine: principles for best practice. London:
RCP, 2012.

[3] Editorial. Ward rounds: what goes around comes around. The Lancet 2012 380: p1281.

Competing interests: Both authors were lead authors on a recent report from the RCP and RCN entitled 'Ward rounds in medicine: principles for best practice'.

Linda Patterson, Clinical Vice President

Varo Kirthi

Royal College of Physicians, 11 St Andrews Place, Regent's Park, NW1 4LE

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