Modern Matrons in an Acute Setting: a Qualitative Case Study

Abstract

The arrival of the modern matron into the NHS acute setting in 2001 was in response to increased public and political concern regarding standards of nursing care and the quality of patient care. As a politically motivated initiative, the modern matron role and its relationship with the concept of the traditional matron has been extensively debated. The aims of this study were to explore:

1. How far the modern matron represents continuity between the traditional matrons of the mid 20th century and the present day. 2. What socio-political forces led to the development and establishment of the modern matron? 3. From the perspective of health professionals, what impact has the modern matron had on the quality of patient care?

Adopting a case study design underpinned by realistic evaluation, the study involved interviewing patients and a carer, a focus group and interviews with staff and national policy leads. Documentary analysis was undertaken on a set of traditional matron archives.

A number of key themes emerged from the research, including: the importance of uniform and visibility, patient expectations, the impact of policy processes and the political rationale for national policy change. Conflict between ensuring nursing quality and operational demands, which acts as a barrier to the modern matron role, was also found. Long-held assumptions about the functions and the positioning of the traditional matron are explored, with continuity and divergence between the traditional and modern matron roles revealed.

Using a realistic evaluation approach, the findings were framed whilst considering the structural and generative elements, which resulted in social interplay or visible phenomena and provided an explanation for the predicament of the modern matron.

The key conclusions were that national policy decisions appeared to be diluted once locally implemented. Modern matrons in part did positively impact on care quality. The introduction of modern matrons and the quality agenda may have been the start of a national discussion about how to continually improve patient care in an arena where intermittent care quality challenges which give concern. The effect of previous national policies that impacted on senior nurses may have diverted them away from their core purpose – patient care. The modern matron guidance may have been limited before publication by the inference within it about limiting the authority of the new post-holders. There was limited evidence of the modern matrons’ visibility to patients and this was reflected by the traditional matron’s accounts. The expectation of modern matrons’ physical presence may have been drawn from assumptions embedded in nostalgia and media portrayal of the traditional matron. The thesis concludes with implications for strategic nurse leaders and national policy leads to consider how the organisational arrangements for secondary care can best support and secure the ultimate aim of consistent provision of good quality nursing care.