Structure

Well after MMW's suggestion I'm writing a post on the structure of nursing. This is based on the heirachy where I work now, though I think it will be fairly similar all over - it certainly was similar where I trained.

So, there are three types of nurse you'll come across on the ward.
Staff Nurse, someone employed permanently by the hospital - that's me.
Bank Nurse, someone who has signed up to the hospitals internal nursing agency - that can also be me - usually someone who already works in the hospital and wants extra shifts.
Agency Nurse, someone who works for an external nursing agency. Sometimes they're good, often not too bad but slightly more a hinderance than a help, and occasionally absolutely awful.

Why would someone want to work for an agency? Agency nurses get paid higher rates than Staff or Bank nurses, (Bank nurses earn slightly more than Staff Nurses) - the ward waits as late as possible before "putting the shift out to agency" in the hope someone cheaper will agree to do it.
Less responsibility.
Agency nursing is flexible; you can work which shifts you choose.
However the downsides to Agency nursing:
Shifts may not always be available when you want them
Depending on where you work you will be unappreciated and looked down upon, you also run the risk of being given the difficult patients or those no one else wants to look after - I don't believe this is true of where I work now, I think we treat our agency nures fairly well, that's why we have some regulars who keep coming back to us.

On the ward I work on we have 20 beds, this closes to 15 over the weekend. On week days we (hopefully) have 6 staff, on week nights 4 staff, and on weekend days 4 staff and weekend nights 3 staff. At night you can expect to care for 5 patients, if fully staffed. On days 3-4, if fully staffed.

Some of the patients we have require a lot of nursing intervention, 1:3 may not sound like a lot but depending on the patient the workload can be very heavy, and day shifts are always busier than nights. That being said, nursing 5 patients overnight can also keep you very busy. We have a lot of jobs that are supposed to happen on the hour, an example of the hourly jobs you may have to do for 5 patients overnight could be: 3 pump readings, 3 sets of observations, 1 set of inhalers (on some hours rising to 2), giving a feed hourly or two hourly, plus on various hours on top of that IV antibiotics (which I'm not yet trained to do), observations for other patients, medications. I often find that I'll have just finished my hourly jobs just in time to start the next hour.

However, I have trailed off the topic for this post. Sorry for that rather boring interlude! Back to structure.

Band 5 - This is a Staff Nurse, generally speaking, in their first 5 years of nursing, after this point to progress through the pay scale you would have to move up a Band. You have lower and upper Band 5's, which represent the old D and E grades, basically those with more or less experience. These lettered grades were removed with Agenda For Change, but we still refer to them.

Band 6 - This is a Senior Staff Nurse, in some places they may be called a Junior Sister or Charge Nurse. They have more responsibility than us lowly Band 5's, which is one reason why some nurses choose not to move onto Band 6 despite reaching a cap in their pay. Where I work we currently have 5 Band 6's, two of which are very part time (2-4 shifts a month).

Band 7 - This would be the ward Sister, or where I work Ward Manager. The Ward Manager is similar in role to Sister but as far as I can work out is less clinical and more office based. We have one Ward Manager.

We have recently had a Modern Matron come into post, in the last few weeks, this is a very new position for us and I'm guessing it is a Band 8 position. He previous was a Ward Manager, and now manages the whole of children's unit with Ward Manager's in each ward.

Now, that is our basic structure for ward Staff Nurses and Managers, but there are a couple more "important" roles. During the day we have a Paeditric Bed Manager, and you've guessed is he manages the Paeditric Beds. He keeps tabs on all the beds and cubicles available across the unit and the demand for them in A&E. Any child admitted during the day needs to go through him, and he makes the decision about where to allocate them. At night this role is filled by the Site Manager, who has the unenviable job of being Site Manager/Bed Manager for the whole of the hospital. They need to keep track of the admissions, discharged, allocations and transfers as well as any staffing issues that may arise. Our last key person is the Senior Nurse (not to be confused with Senior Staff Nurse). This person carries The Bleep, and their responsibility is staffing; if someone calls in sick they have to speak to the Senior Nurse, they have to be aware of staffing across the unit and make decisions about where to send nurses to cover if we're short staffed. This is usually a Band 6 or above nurse, though some of our more experienced Band 5's will also do it. This is also on top of thier normal patient workload as staff nurse that day or night. Oh, and we have a shift co-ordinator in charge of every shift, this can be almost anybody who's been there at least a few months!

So that's how it all works. Kind of! I know this was probably a bit of a long winded and boring post, but I think understanding what goes on "behind the scenes" will make my blog make more sense!