Health secretary Alan Milburn wants ward sisters to manage their own budgets, typically worth hundreds of thousands of pounds, so that they can make decisions about how money is spent on the front line. I was appointed to my current post as a G grade sister four years ago. Of all the areas of responsibility in my job description - clinical standards, professional development of staff, effective skill mix, daily organisation and management of clinics across specialities - it was the words 'will be responsible for managing the outpatient budget' that made me wince.