who really runs a hospital ward?

There, the question is posed. Who is in charge of a hospital ward? In a local community hospital where I previously worked there were a number of candidates, some think they are in charge, some are in charge (but don't know it), and some are just clueless.

The main protagonists in this scenario are:

Consultant
Charge Nurse
Hospital manager
GP

On a day to day basis the charge nurse is 'seen' to be in charge. If the hospital manager is feeling pressured, then will often remind the charge nurse "you have 24 hour responsibility, sort it out". This tends to happen when things are going a bit hairy.

However, when wanting to reduce staffing levels or change skill mix then the hospital manager feels they are really in charge and will make decisions directly related to the work on the ward, so, maybe they are in charge?

But of course our medical colleagues always believe they are ultimately in charge of everything. They tend not to be involved in decisions around mediocre stuff like finances and staffing, but are definitely (in their eyes) the final voice when it comes to admitting, discharging and planning treatment for patients.

Quick quiz: Can you guess who deals with each scenario below?

1. Irate patient, is very angry and upset about treatment and demands to speak to person in charge.

2. Local politician recently treated and about to be discharged. Gives a brief press conference to thank the hospital. Who is standing beside him receiving the praise?

3. Mother of a local dignitary feeling a bit unwell. Does not fit the criteria for admission, but decision is made to admit to the ward?

The above is a very simplified look at what in reality is a huge problem for charge nurses. Charge nurses are constantly reminded from staff on the ward and their managers that they are responsible and accountable for patient care and safety on the ward (as well as a million other things). However, even on a day to day basis, managers, medics etc can all make important decisions which directly affect the running of a hospital ward without recourse to the charge nurse.

Who said it was going to be easy?