Developing New Roles for Nursing Work

1
Developing New Roles for Nursing Work

• Dr Ann Humphreys
• School of Nursing Acute Care
• Faculty of Health Social Work

2
Named Nurse Standard

• .you should have a named, qualified nurse,
  midwife or health visitor who will be responsible
  for your nursing or midwifery care
• Department of Health 1991

3
Research Questions

• Do areas where there is a Named Nurse system
  function any differently to those areas where
  there is no identified Named Nurse system?
• What are the implications of the Named Nurse
  Standard for the organisation of nursing work?

4
Case Study Design

• An in-depth investigation of a single
  subject/unit (Yin 1994)
• Enabled comparison of wards with high and low
  adherence to criteria associated with the Named
  Nurse Standard

5
Multiple Sources of Evidence

• Methods of organising work (Thomas Bond 1990)
• Audit of nursing notes
• Nurses perception of the Named Nurse Standard
• Patient experience of the Named Nurse role
  (Thomas et al 1996)
• Quality of nursing care (Qualpacs - Wandelt
  Ager 1974, Carr-Hill et al 1992)

6
Sample

• Surgical wards in two NHS trusts
• A high a low adherence ward from each
• Non-participant observation of eight patients
• Interviewed 12 qualified nurses
• Seventy respondents to Newcastle Satisfaction
  with Nursing Scales
• 84 sets of nursing notes audited
• Eight patients observed using Qualpacs

7
Results

• The Named Nurse Standard was not fully
  implemented on any of the wards
• No significant difference in the organisation of
  nursing work between wards identified as high
  adherence and those in the low adherence
  category

8
Organisational Constraints

• Increasing demand for hospital beds
• Rapid throughput of patients
• Number and working patterns of staff

9
Professional Constraints

• Rapid introduction
• Lack of preparation for the role
• Enhanced accountability

10
Conclusions

• An initiative that was implemented rapidly
• Management of change process was not structured
  to facilitate implementation
• Perceived as imposed by management with a
  hidden agenda