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The interplay between management and key staff on a ward becomes extremely important when the number of staff exceeds 30. Both the ward sister and key staff need extra clarity regarding frameworks and tasks. At the same time, agreements on, and communication of, expectations of the role played by key staff in the general management task is exceptionally important when it comes to managing large units and wards. This is revealed by a survey of management on large wards with the primary focus on the conditions of the ward sister. The Training Department at Århus County Council, now HR, Organisation and Management, Mid-Jutland Region, carried out the survey in 2006 in collaboration with Skejby Hospital. The survey is based on interviews and workshops. It documents that a ward sister's management of a hospital ward changes significantly when the number of staff increases. A ward sister with more than 30 staff cannot maintain close, professional and personal contact with each individual. As a result, the ward sister no longer manages via her relationship with her staff but manages instead through a functional support system of key staff. The survey concludes that ward sisters on large wards must for one thing be very clear about their own needs if they are to manage via their support system of key individuals and for another, provide their support system with legitimacy in the form of unambiguous expectations and task descriptions. Similarly, it is vital for the key staff to be coached and involved in strategic and organisational decisions which they are involved in implementing.

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