Nurses are advised against behaviour that could be deemed patronising
Senior nurses who manage hospital wards are being too overburdened with paperwork and patients to do their jobs properly, unions say.
The Royal College of Nursing ran a series of focus groups with 90 ward sisters in England about their jobs.
The nurses, who oversee nursing care on wards, said their roles needed to be more strictly defined to help improve the quality of care being provided.
The Department of Health acknowledged there were challenges to overcome.
Ward sisters are among the most experienced and best paid nurses in the NHS workforce.
Most will have been working as a nurse for at least 10 years before being appointed to the position.
The RCN, which also used past surveys and research to compile the report, said part of the problem was that their roles have never been clarified, meaning different approaches are taken across the country.
This had led to a situation where the nurses were being asked to do tasks, particularly paperwork, that were taking them away from overseeing nursing care on wards, the union added.
One example given was of a ward sister being asked to write up a job advert when the HR unit should have done it.
Other nurses reported having to buy batteries for equipment because they did not have the authority to order them through the hospital system.
The RCN also said they were being allocated individual patients, when it argued the role should be a predominantly supervisory one to oversee care and maintain standards.
The union called on hospital chiefs to review what they were asking of ward sisters - sometimes referred to as charge nurses or ward managers.
It said where ward sisters were given time to do their jobs properly there were higher levels of public satisfaction and lower rates of staff sickness and medication errors.
Peter Carter, general secretary of the Royal College of Nursing, said the situation the nurses find themselves in would not be tolerated in other industries.
"Talented nurses should be free to lead and to nurse."
But the report did highlight several hospitals for the good work they were doing to support ward sisters.
At University College London Hospital, a training programme has been created for those looking to become ward sisters.
Since 2005, all those who have been promoted have been through the twice-yearly programme.
Participants said it had meant there was a clear mandate for the role and the training left them fully-prepared for the work.
Louise Boden, the hospital's chief nurse, said ward sisters were "key to delivering the best possible care".
"We know that when a patient comes into hospital, they need to know who is in charge."
A Department of Health spokesman said the government would be studying the findings "very seriously."
"The report highlights the challenges that need to be overcome in order to ensure that this committed and dedicated group of staff are free to focus on improving the quality of care which patients receive."