Matron: What does the title mean to nurses today? – Nursing Times

The role of matron is one steeped in nursing history and the publics perception. With a new matrons handbook being published, Nursing Times has looked at the role today and what it means to those with the title.

More than 60 years on from the release of the film Carry On Nurse and the image of the bossy matron immortalised by Hattie Jacques still looms large. The phrase ooh matron is still very much bandied about, notes Queens Nurse and community matron Paula Boyer.

People do react differently they automatically respect your opinions and your authority

Joanne Beniston

Neither did it help that when modern matrons were introduced to the NHS in 2001, the government announced it with the cry: Were putting matron back in charge.

This is the view of Peter Carter, former Royal College of Nursing chief executive and now an independent healthcare consultant, who believes the way the role was sold was unhelpful, reviving the stereotype of a stern matriarch obsessed with following rules.

Nevertheless, he told Nursing Times that the creation of a swathe of new matron roles did have a positive impact.

The concept of the modern matron was informed by a public consultation that identified the need for strong clinical leaders with the authority to address shortcoming in basic care.

Those holding the title would be accountable for a group of wards and be easily identifiable to patients, highly visible, accessible and authoritative figures, stated guidance at the time.

But evaluation of the scheme a few years down the line revealed significant variation in the way trusts interpreted the concept, according to nursing lecturer Mick Ashman, who was involved in the research.

The most successful organisations were those that saw it as an opportunity to inject leadership and that was really down to selecting the right people, he said. In other places, it was just another managerial post and the leadership element was rather limited.

I dont think anything gave us as much kudos as community matron

Paula Boyer

The best matrons had attributes in line with models of transformational leadership, he noted.

They had charisma, were inspiring, very approachable and had a good ability to engage and have a rapport with their staff, he said. The ones who were less successful were those who were aloof and distant.

However, much has changed since modern matrons were introduced not least the advent of austerity.

After 2010, it was a very different climate with lots of trusts getting rid of these posts or not re-appointing when people left, said Mr Ashman. Shrinking workforces also saw matrons given additional responsibilities.

Today, there continues to be variation in the way matrons are deployed, according to Wendy Preston, RCN head of nursing practice.

In some areas, matrons are over-stretched and may be working across six to 10 wards. I have also seen the other end of the spectrum, where each ward has a matron, she said. Ms Preston highlighted the need for a happy medium.

The way I have seen it work best is where there is a matron over a particular speciality or a suite of areas that work well together.

As nursing has become more complex, the value of the matron is they can give a bespoke focus

Peter Carter

Mr Carter, now an independent healthcare consultant, agreed, saying: As nursing has become more complex, the value of the matron is they can give a bespoke focus for example, a nurse who has worked in cardiothoracic surgery and is now matron for cardiac services and has a very high degree of specialist knowledge.

Karen Stow is paediatric matron at West Hertfordshire Hospitals NHS Trust. Before that she was a paediatric ward manager.

Stepping up to the role of matron has meant taking a step back from direct patient care and a change in mindset.

Instead of looking after individual children, I see it as looking after all children and young people to ensure they have as positive experience as possible, she said.

Her remit extends across a wide range of areas, including accident and emergency, outpatients, day surgery and assessment.

She highlighted that a key part of her role was supporting band 7 nurses to maintain quality and safety standards, while another focus was recruitment with a national shortage of childrens nurses.

A district nurse is band 6 while a matron is band 7 even though they dont manage anybody

Crystal Oldman

Ms Stow said the role could be isolating but it also offered independence and the freedom to innovate. It needs to be autonomous, so you need people who can work in that way, she said.

Since being appointed a year ago, she felt she had been able to develop the role, for example, extending it to cover 16-17-year-olds who do not come under paediatrics.

Context was everything when it came to fulfilling potential, according to Tom Wilkins, matron for medicine and gynaecology at University Hospitals Birmingham NHS Foundation Trust.

In a previous trust I worked in, all you did was firefight staffing and bed challenges every day and that didnt give you much time to do other things or focus on quality improvements, he said.

Another trust I worked at was quite financially constrained so getting permission to try new things was sometimes difficult.

His current organisation takes a triumvirate approach that means each division has an operational manager, clinical service lead who is a doctor, and a nursing lead who is a matron.

Modern matrons in Nursing Times

All three work together on absolutely everything and this was really effective, noted Mr Wilkins.

The quality of patient care is a top priority for him as is supporting staff. That is one of the best parts of the job building the team, seeing them flourish and helping them through their ups and downs, he said.

However, there continues to be debate about the title matron and whether it is suitable for the 21st century.

Some trusts use other titles instead but for many nurses, matron has a certain status that patients, fellow clinicians and other staff understand.

Joanne Beniston

When Joanne Beniston recently became a matron having previously been a district nursing team manager she noticed a positive difference in the way people responded to her.

People do react differently they automatically respect your opinions and your authority. I am getting so much more done.

Like other job titles in nursing and midwifery, such as sister and midwife, the word matron is a gendered term.

Mr Wilkins said patients were sometimes surprised when they met a male matron but he was not that bothered by the title and was not sure there was a credible alternative.

In other organisations I have worked in, matrons are called senior clinical nurse managers, which I think sounds awful, he said.

Mr Wilkins, who was 29 when he got his first matron post, believed age may be more of a factor than gender in discouraging people applying for matron jobs.

You perhaps worry about going for matron jobs because you think theyre expecting this older matriarchal figure, he noted.

In hospitals, matrons have traditionally been part of the management hierarchy, but community matrons are very different, stressed Crystal Oldman, chief executive of the Queens Nursing Institute.

Crystal Oldman

They do not line-manage staff and instead work as expert practitioners in a specific area of clinical practice such as frailty, tissue viability or diabetes usually with their own caseload with a focus on enabling patients to avoid hospital and continue to live at home.

New community roles were created as part of the modern matron rollout but it had unintended consequences, sparking resentment among district nurses who felt they were already doing that kind of work, recalled Ms Oldman.

Concerns about differences in terms and conditions continued to this day, she said.

In many areas, a district nurse leading and managing a team of maybe 10 staff with a massive caseload is paid at band 6 while a matron is at band 7 even though they dont manage anybody and have a smaller caseload.

However, she stressed that areas with community matrons had seen huge benefits with those in the role increasingly providing vital expertise across community, primary care and hospital services.

Paula Boyer is a community matron for the Rotherham NHS Foundation Trust. She covers seven GP practices with a caseload of around 50 patients with complex health needs. The community matron role was priceless, she said, adding: We literally know our patients inside out.

But, as with hospital matrons, the role varies between different areas and organisations. Were very lucky because were band 8a but community matrons in many neighbouring areas are not, she said.

In her area, there was talk of changing the title to help people understand the difference between hospital and community matrons but the idea did not take off.

They were looking at things like advanced nurse practitioner for long-term conditions but I dont think anything gave us as much kudos as community matron, she said.

Paula Boyer

Her trust also tried to incorporate the management of district nursing teams within the role but it didnt work as well because being pulled into the politics of managing the team took us away from patients, noted Ms Boyer.

According to Paul Reeves, head of nursing for education and new roles at NHS England and NHS Improvement, matrons were almost certainly an under-utilised resource.

This is one of the reasons chief nursing officer for England Ruth May is launching a new matrons handbook, designed to help us to ensure that the scope of what matrons do, can do and will do is fully recognised and appreciated.

There is no doubt the role has evolved since the publication of the matrons 10 key responsibilities in 2003 and the Matrons Charter in 2004, as has the context in which matrons work, said Mr Reeves.

Some aspects of the role remain the same, he noted, including the idea matrons were responsible for promoting high standards of clinical care with a focus on patient safety and experience, infection prevention and control, and monitoring cleanliness.

But it had expanded to include workforce management, finance and budgeting, education and development, patient flow, performance management, technology and research as reflected in the handbook.

Previous coverage of the matron role by Nursing Times:

Matrons are often powerful, energised and insightful and need to be seen as such, said Mr Reeves.

So how might the matron role evolve in the future? Ms Preston would like see more flexibility and a move away from the idea that, at some point in their career, nurses had to choose between management and advanced clinical practice.

In the future that will probably change, as you get blended roles, she said and was particularly pleased to see an emphasis on collaborative working in the new matrons handbook.

For Mr Carter, the potential is endless and the matron role is an essential ingredient in order to really address some of the ongoing difficulties and challenges.

He saw a role for matrons in developing the scope of practice nurses and allied health professionals in primary care. Similarly, in acute hospitals were going to need more nursing associates, he said.

They need to be properly trained, developed and supervised and I see a key role for the modern matron.

Peter Carter

Ms Beniston has just begun in a new post as modern matron for the Tavistock neighbourhood at Livewell Southwest, covering the community hospital as well as community-based services.

My role has broken out of the four walls of the hospital but it is still along the same lines, she said.

Her goal is to ensure patients receive the same high standard of care from practice nurses, district nurses treating them in residential care or at home, nursing home and hospital nurses and to enable seamless transitions between services.

For her, the key to success is empowering fellow nurses and other health professionals in the same way she has been empowered to lead by her own managers.

The Matrons Charter is not about the matron making sure the hospital is spick and span it is about bringing along the team so everyone strives for those high standards together, she said.

Focus on matrons

This article forms one of a series that appear in the February 2020 issue ofNursing Times, all of which are on the theme of matrons

See the rest here:
Matron: What does the title mean to nurses today? - Nursing Times