Annex A > Chapter 14 - Care in the Operating Theatre and the `Learning Curve' > Care in the operating theatre > Management of the theatre nurses
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Management of the theatre nurses
27 Mrs Armstrong [33] was Staff Nurse in the cardiac theatre at the BRI from October 1984, being promoted to Sister in 1986. The Cardiac Theatre Sisters [34] managed the day-to-day running of the theatres and were responsible to the Theatre Nursing Officer, who in turn was responsible to the Director of Nursing Services. [35]
28 In 1984, the Director of Nursing Services was Miss Janet Gerrish and the Theatre Nursing Officer was Miss L MacKenzie. Mrs Armstrong explained that in the following years leading up to 1995 the management structure changed frequently and often with little warning, and that the cardiac theatre had six different managers over this period. [36] After Miss Gerrish left in October 1991, Mrs Armstrong said that the nursing staff felt that there was no one at management level specifically designated to take account of and be responsible for nurses' interests. Miss Gerrish's role was subsumed into a general management post and the post of Director of Nursing Services came to an end. [37]
29 She explained further in her oral evidence:
`When Julia Thomas first took over the cardiac unit as Nurse Manager, she actually did not have theatre under her at that point, so for some time, we had Lesley Salmon. First we had Gill Kelly and then Lesley Salmon, then Julia was made responsible for us as well. So in that time I had to answer to all of those people.' [38]
`On a daily basis, we would be answerable to the Nurse Manager. If there were any issues which we were not happy with or she was not happy with, that would be dealt with by the General Manager.' [39]
30 In 1991, Lesley Salmon as Associate General Manager for Cardiac Surgery delegated the job of managing the cardiac theatres to one of the ICU Sisters. Mrs Armstrong stated that it was very difficult to run theatres at that time and to be managed by someone who did not understand how theatres worked. She gave the example that they were being asked to work shift patterns that were unworkable. [40] This had an effect on the staffing levels and on recruitment to theatres. [41]
31 Mrs Armstrong said that as a Sister it was essentially her responsibility to run the cardiac theatres. This included staffing, both recruitment and training; daily organisation of the running of the theatre lists; maintenance and ordering of equipment and stores; health and safety, by, for example, providing a safe environment for the patients and everyone working in theatres. [42]
32 The budget was managed by the Nursing Manager and was not the responsibility of the Theatre Sisters. [43]
33 After the Directorate of Cardiac Services was set up in 1993, the structure of line-management became Clinical Director to Cardiac Services Manager to Cardiac Theatre Manager. The Cardiac Theatre Sisters still had no control over their theatre budget or staffing numbers. [44]
34 The co-ordination of the staff team was the responsibility of the Sister in charge for that day. On rare occasions, if there was no Sister on duty, this responsibility fell to the most senior member of staff on duty, who would liaise with the Theatre Manager if there were any issues with which they felt unable to deal. [45]
35 Mrs Armstrong stated that the nature of work in the theatre makes it essential to work well as a team. She said that this was often made difficult, however, by poor communication from members of the surgical staff. She gave as an example that:
`... it was a regular occurrence to be told at the start of the day that we would be cancelling a case due to the lack of an ICU bed yet carry on and operate on that patient later in the day. This would cause confusion particularly if staff had been relocated to other duties'. [46]
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Footnotes
[33] Cardiac Theatre Sister at the BRHSC October 1984-1988
[34] There were three G grade Cardiac Theatre Sisters
[35] WIT 0132 0003 Mrs Armstrong
[36] Mrs Armstrong listed these managers in order as Alison Whiting, Gill Kelly, Lesley Salmon, Julia Thomas, Fiona Thomas and Rachel Ferris
[37] WIT 0132 0004 Mrs Armstrong
[40] The shift patterns would involve theatre continuing past the scheduled finishing time of 5.00 pm often until 7.00 or 8.00 pm
[41] WIT 0132 0004 Mrs Armstrong
[42] WIT 0132 0005 Mrs Armstrong
[43] WIT 0132 0005 Mrs Armstrong
[44] WIT 0132 0009 Mrs Armstrong
[45] WIT 0132 0011 Mrs Armstrong
[46] WIT 0132 0014 Mrs Armstrong