A decade of reflections as chief nurse before retirement
After almost a decade as our Chief Nurse, Caroline Alexander is retiring. She shares her thoughts about leaving her Barts Health family later this year.
The nurse was making up a bed when a senior manager dropped in to check up on the ward and started asking detailed questions. She retorted: “If you’re going to stay, at least help me finish this bed first.” The surprised manager complied, and the nurse learned a lesson she put into practice when she herself became a senior leader.
That young nurse was Caroline Alexander, and she mentioned this episode from her early career while noting how much life at Barts Health had changed since she first arrived as Chief Nurse and started going round the hospitals.
“I was nervous enough, but nurses on the wards were terrified, they would wonder what on earth you were up to, this random person turning up unexpectedly, she said.
“People didn’t feel supported, so couldn’t imagine anyone would come round. There was a palpable anxiety in the air. The trust was in special measures, memories of the merger were raw, and the impact of cost-cutting was evident on people.”
She added: “When I came to Barts Health it felt massive and uncontrollable. We didn’t have effective structures and processes in place to make it manageable and it was hard to know what was going on, yet we had the external regulators all over us telling us what to do.”
What Caroline did – as part of a new leadership team - was help bring a measure of calm, managing the expectations of regulators while supporting staff to change the culture, structure, and governance of the organisation on the long improvement journey to being the effective group we are now.
To this day she continues to be one of our most visible and popular leaders, regularly visiting the wards, talking to staff, making a point of dropping in on the front line even when on call at weekends.
“My job is to listen, to see what’s happening, and think about what we can do to solve any problems. You can never know everything, but you can take the temperature and feel the pulse of a place by having a good old chat.
“I love doing it, especially when you drop in on a Sunday morning and find people proudly talking about the improvements they are making. Seeing the joy on their faces at being recognised and thanked is so special.”
Despite the challenges of the time, there were triumphs too. Having funded a pioneering leadership programme for women and BME staff at Barts Health when still in her regional job, she found herself accompanying the team that set it up to the Nursing Times awards, the first time an all-BME team had taken the podium and won Team of the Year. “An evening that brought a tear to my eye,” said Caroline
Unlike other Chief Nurses, Caroline doesn’t wear the uniform. She believes, in her role, it acts as a barrier between her and staff, and has only donned it once in recent times, at the Westminster Abbey memorial service for Florence Nightingale during the pandemic.
Talking of which, Caroline recalls: “Professionally this was the hardest of times. The pandemic forced us to be adaptable and flexible in the face of the unknown. We had to push at the boundaries of safety and our leadership skills were tested to their limit. I have never been prouder of the resilience and the compassion of our staff, though this is being put to the test again with our current operational challenges.”
Caroline is confident in the strengths of our group model. She cites our response to the cyberattack of 2017 as a critical turning point in fostering closer collaboration between hospitals. The experience of Covid only reinforced this.
“Since then, I have spent a lot of time with my team and the directors of nursing on continually refining the way we work to adapt to changing circumstances. We bring people together, have creative conversations, design things once and then implement them locally.
“By achieving a level of consistency across the group that also reflects local circumstances we can ensure the safety and quality of care for our patients.
“It has been a total privilege being Chief Nurse and to have been a part of the most incredible improvement journey has been the pinnacle of my career – I have big expectations for #TeamBartsHealth and will watch it evolve with great interest.”
Caroline says she’s lucky to have had an incredible career. She took a degree in nursing at Edinburgh University before it was the norm and worked in the city before moving to Guy’s Hospital in 1990. “I was probably a good nurse but not the greatest. I loved rehab, enabling and empowering people. It was most rewarding being a ward sister, helping other people to deliver better care. That is still what gets me out of bed in the morning.”
This approach eventually took her to becoming Chief Nurse for London, via a spell working in the PCT in Tower Hamlets. In both roles she worked closely with Alwen Williams who then enticed her to join her new leadership team at Barts Health.
Caroline will not be stopping working as such, but her husband is already retired, and she has reluctantly decided she cannot sustain a work-life balance by commuting weekly from home outside London.
“I am not finished,” she insisted. “I am making a conscious but hard decision to step down from an all-consuming job away from home. I want to use my experience as a senior leader to help people in a different way – I don’t know exactly what, but I want to be useful, but awkward too!
We are great at saying “Life is short” so I want to have more time with my husband doing different things particularly on our recently bought canal boat exploring the waterways of England.”
Caroline will formally step down at the end of August, allowing time to recruit a successor with minimum disruption.