Is the ward sister role still relevant to the quality of patient care? A critical examination of the ward sister role past and present

Aims and objectives.  To examine the UK ward sister role in contemporary and historical context. Background.  The ward sister role once key to nursing is now confused. Design.  A critical examination of the changing role of the ward sister. Sources consulted: nursing textbooks 1877–1971, nursing and medical periodicals 1912–2010, official government reports 1947–2010, research studies on nursing 1960–2010, secondary works on nursing history. Method.  An historiographical analysis of archival sources which interrogates primary and secondary evidence to make transparent interconnection, coherence, consistency and reliability. Results.  As a consequence of professional, educational and managerial changes, the traditional authority of the ward sister for nursing standards, ward services and ward facilities is diminished. Ward sisters are primarily motivated by nursing rather than managerial values. Hence, there is disparity in the title ‘ward sister’ espoused by ward sisters and the public and the title ‘ward manager’ espoused by non‐nursing managers. This is not just terminology, but concerns the kind of values enshrined by the term and entrusted to the role. Conclusions.  Until the late 1970s, the ward sister was key to maintaining standards of care. She was the trustee of a tradition and transmitted its values. Subsequent organisational and professional changes have diminished the authority of the role. History may suggest the need to examine and strengthen the ward sister role in the light of its original orientation. Relevance to clinical practice.  The ward sister role could have a fundamental effect on the quality of patient care if it were to regain its former scope and authority.