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Nurses in the lead: a qualitative study on the development of distinct nursing roles in daily nursing practice

BACKGROUND: Transitions in healthcare delivery, such as the rapidly growing numbers of older people and increasing social and healthcare needs, combined with nursing shortages has sparked renewed interest in differentiations in nursing staff and skill mix. Policy attempts to implement new competency...

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Autores principales: van Schothorst–van Roekel, Jannine, Weggelaar-Jansen, Anne Marie J.W.M., Hilders, Carina C.G.J.M., De Bont, Antoinette A., Wallenburg, Iris
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8201810/
https://www.ncbi.nlm.nih.gov/pubmed/34120594
http://dx.doi.org/10.1186/s12912-021-00613-3
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author van Schothorst–van Roekel, Jannine
Weggelaar-Jansen, Anne Marie J.W.M.
Hilders, Carina C.G.J.M.
De Bont, Antoinette A.
Wallenburg, Iris
author_facet van Schothorst–van Roekel, Jannine
Weggelaar-Jansen, Anne Marie J.W.M.
Hilders, Carina C.G.J.M.
De Bont, Antoinette A.
Wallenburg, Iris
author_sort van Schothorst–van Roekel, Jannine
collection PubMed
description BACKGROUND: Transitions in healthcare delivery, such as the rapidly growing numbers of older people and increasing social and healthcare needs, combined with nursing shortages has sparked renewed interest in differentiations in nursing staff and skill mix. Policy attempts to implement new competency frameworks and job profiles often fails for not serving existing nursing practices. This study is aimed to understand how licensed vocational nurses (VNs) and nurses with a Bachelor of Science degree (BNs) shape distinct nursing roles in daily practice. METHODS: A qualitative study was conducted in four wards (neurology, oncology, pneumatology and surgery) of a Dutch teaching hospital. Various ethnographic methods were used: shadowing nurses in daily practice (65h), observations and participation in relevant meetings (n=56), informal conversations (up to 15 h), 22 semi-structured interviews and member-checking with four focus groups (19 nurses in total). Data was analyzed using thematic analysis. RESULTS: Hospital nurses developed new role distinctions in a series of small-change experiments, based on action and appraisal. Our findings show that: (1) this developmental approach incorporated the nurses’ invisible work; (2) nurses’ roles evolved through the accumulation of small changes that included embedding the new routines in organizational structures; (3) the experimental approach supported the professionalization of nurses, enabling them to translate national legislation into hospital policies and supporting the nurses’ (bottom-up) evolution of practices. The new roles required the special knowledge and skills of Bachelor-trained nurses to support healthcare quality improvement and connect the patients’ needs to organizational capacity. CONCLUSIONS: Conducting small-change experiments, anchored by action and appraisal rather than by design, clarified the distinctions between vocational and Bachelor-trained nurses. The process stimulated personal leadership and boosted the responsibility nurses feel for their own development and the nursing profession in general. This study indicates that experimental nursing role development provides opportunities for nursing professionalization and gives nurses, managers and policymakers the opportunity of a ‘two-way-window’ in nursing role development, aligning policy initiatives with daily nursing practices. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12912-021-00613-3.
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spelling pubmed-82018102021-06-16 Nurses in the lead: a qualitative study on the development of distinct nursing roles in daily nursing practice van Schothorst–van Roekel, Jannine Weggelaar-Jansen, Anne Marie J.W.M. Hilders, Carina C.G.J.M. De Bont, Antoinette A. Wallenburg, Iris BMC Nurs Research Article BACKGROUND: Transitions in healthcare delivery, such as the rapidly growing numbers of older people and increasing social and healthcare needs, combined with nursing shortages has sparked renewed interest in differentiations in nursing staff and skill mix. Policy attempts to implement new competency frameworks and job profiles often fails for not serving existing nursing practices. This study is aimed to understand how licensed vocational nurses (VNs) and nurses with a Bachelor of Science degree (BNs) shape distinct nursing roles in daily practice. METHODS: A qualitative study was conducted in four wards (neurology, oncology, pneumatology and surgery) of a Dutch teaching hospital. Various ethnographic methods were used: shadowing nurses in daily practice (65h), observations and participation in relevant meetings (n=56), informal conversations (up to 15 h), 22 semi-structured interviews and member-checking with four focus groups (19 nurses in total). Data was analyzed using thematic analysis. RESULTS: Hospital nurses developed new role distinctions in a series of small-change experiments, based on action and appraisal. Our findings show that: (1) this developmental approach incorporated the nurses’ invisible work; (2) nurses’ roles evolved through the accumulation of small changes that included embedding the new routines in organizational structures; (3) the experimental approach supported the professionalization of nurses, enabling them to translate national legislation into hospital policies and supporting the nurses’ (bottom-up) evolution of practices. The new roles required the special knowledge and skills of Bachelor-trained nurses to support healthcare quality improvement and connect the patients’ needs to organizational capacity. CONCLUSIONS: Conducting small-change experiments, anchored by action and appraisal rather than by design, clarified the distinctions between vocational and Bachelor-trained nurses. The process stimulated personal leadership and boosted the responsibility nurses feel for their own development and the nursing profession in general. This study indicates that experimental nursing role development provides opportunities for nursing professionalization and gives nurses, managers and policymakers the opportunity of a ‘two-way-window’ in nursing role development, aligning policy initiatives with daily nursing practices. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12912-021-00613-3. BioMed Central 2021-06-14 /pmc/articles/PMC8201810/ /pubmed/34120594 http://dx.doi.org/10.1186/s12912-021-00613-3 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
van Schothorst–van Roekel, Jannine
Weggelaar-Jansen, Anne Marie J.W.M.
Hilders, Carina C.G.J.M.
De Bont, Antoinette A.
Wallenburg, Iris
Nurses in the lead: a qualitative study on the development of distinct nursing roles in daily nursing practice
title Nurses in the lead: a qualitative study on the development of distinct nursing roles in daily nursing practice
title_full Nurses in the lead: a qualitative study on the development of distinct nursing roles in daily nursing practice
title_fullStr Nurses in the lead: a qualitative study on the development of distinct nursing roles in daily nursing practice
title_full_unstemmed Nurses in the lead: a qualitative study on the development of distinct nursing roles in daily nursing practice
title_short Nurses in the lead: a qualitative study on the development of distinct nursing roles in daily nursing practice
title_sort nurses in the lead: a qualitative study on the development of distinct nursing roles in daily nursing practice
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8201810/
https://www.ncbi.nlm.nih.gov/pubmed/34120594
http://dx.doi.org/10.1186/s12912-021-00613-3
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