Accidental, unprepared, and unsupported: clinical nurses becoming managers

To what extent have hospitals developed their skilled clinicians to perform the administrative and human resources (HR) manager role of the ward manager? We consider this research question through an analysis of an acute hospital called ‘The Hospital’ where the executive team is aiming to adopt a form of high-performance work system (HPWS). We focus primarily on explanations in terms of conditions, rather than the personalities of individual managers, which are most powerful in shaping their behaviour. There has long been a failure of hospitals (and other employing organisations) to develop fully the skills required by employees before they become line managers. Line managers are a critical link in the high-performance chain and this study illustrates that, despite their rhetoric, hospitals may still have much potential for implementing schemes to develop nurses further to prepare them for line-manager positions and to support them after they move into such roles. We infer from this study that such hospitals may not yet have completed the journey to having HPWS. Hence, there is still much scope for such hospitals to progress and enjoy the benefits that proponents claim for HPWS.