Ten years ago, I took a step back from senior nursing leadership for consultant level practice. My return to a clinically orientated post was fuelled my enduring commitment to, (an infatuation if you will), for Ophthalmology. I had succumbed to the lure of this specialty early on in my career and the longevity of clinical practice and knowledge coupled with twenty plus years in leadership and management, has led me to this point.

Mike Rice, writing for the Kings Fund back in 2015, suggested that many aspiring CD’s didn’t at the time of appointment, understand the role. I would argue this is true of any role; you don’t know what to expect until you are in post. My biggest fear was that the period spent away from management would be a disadvantage, but this turned out not to be the case. The support and shared senses of purpose of the Directorate Triumvirate (myself, Directorate Manager and Matron) brings a differing perspective to the task and an interesting and sometimes challenging debate. Along with our clinical lead, we achieve an agreement for the strategic direction of the service. 

And of course there is the very real issue about time management. After years of experience, you might think you have mastered that particular skill, but the requirement to remain informed and responsive to unpredictable and often urgent matters whilst still trying to juggle a clinical workload, may suggest otherwise. It certainly does for me. In the average week the CD role, usually 12 hours of allocated time, will most certainly spill over into my protected clinical and down time and therefore my ability is to deliver is enormously reliant on the tolerance and support of my immediate clinical colleagues and my family. I have had to make peace with this because the alternative risks self-imposed stress and my ability to deliver.  I worry less about maintaining clinical expertise and credibility as I do deadlines. Partly this is because I have long since accepted that is ok not to know everything, believing instead that it is more important to ask the right questions, being comfortable in doing so and bringing those with the absolute expertise to the table.

There are two broad aspects of the CD role that I have found the most challenging. The first being the need to oscillate between local and corporate demands and the tension this place’s on professional accountability. There is no rule book to support the CD particularly when Trust and Directorate objectives are seemingly at odds with each other. Quite often this turn out to not be the case. Discussion, negotiation and a ruthless approach to justifying your position with patient need, data and national policy forming the core elements of my approach. The second is about leadership and the management of difficult conversations with clinical peers, who may have formerly held positions of seniority through their clinical and management status. My tactic is to be honest, factual and fair, with the backing of Trust policy and enormous support from the Human Resources Consultant. This really is the hard bit.

The CD role is mostly strategic, a bit pastoral with a need for a smattering of the operational. Then there are the endless rounds of job planning, (which for the uninitiated, can be difficult to grasp at first) and business case development. There is also the need to keep everyone and everything safe, so you have no option but to rely heavily on your governance leads and practitioners. The role is seemingly inestimable.

It may sound altruistic and slightly naive to say that my motivation was and is, to make a positive difference to the organisation and the patient. Secretly, I am driven by change management, the principles of which are integral to the role of the CD. Endurance and emotional resilience are necessary re-requisites along with a mutual respect of clinical peers. A steadfast commitment to the service and a very healthy approach to communication is essential. There is an advantage to having established relationships and a network within the field is not to be underestimated.

And as for being a nurse, eight months in, I have a rare moment when I feel being a nurse may put me at disadvantage, but this is more than outweighed by an enormous sense of achievement and enjoyment of being part of a well-functioning team.

Reference

Mike Rice (2015) To be, or not to be, a clinical director...but is that the question? Kings Fund.