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

Abstract

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.

Job crafting as retention strategy: An ethnographic account of the challenges faced in crafting new nursing roles in care practice

“…In fact, many non-supervising nurses also saw such tasks as a fundamental aspect of their nursing profession. 12 Femke, for instance, who took on a leading role in the second data extract, had a vocational training background. And just like Elise, Femke was celebrated by nursing peers for taking charge.…”

“…To move towards a more sustainable nursing workforce, Dutch hospitals have introduced pilot projects in which nurses are provided with time-spaces to learn how to differentiate between vocationally and bachelortrained nurses and to develop new nursing roles 'from the bottom up'. 12 New roles typically involve combining direct patient care with care coordination, evidence-based practice, quality improvement, and participation in healthcare decision-making at different organisational levels. 13 The impact of these new roles on workforce resilience is expected to be high, as they are supposed to lead to improved job satisfaction and retention of higher educated nurses 14 as well as the further professionalisation of nursing and stronger positioning of the nursing workforce more generally.…”

Public Opinion Leadership in Nursing Practice: A Rogerian Concept Analysis

“…In Dutch clinical practice settings, a recent surge of shared or professional governance structures promotes the inclusion of nurses’ knowledge, skills, and expertize in organizational decision making ( Lalleman et al, 2020 ) and implementation of evidence-based practice (EBP) ( van der Goot et al, 2018 ; van Schothorst–van Roekel et al, 2021 ). Other literature would describe such knowledge, skills, and expertize of nurses as local opinion leadership (LOL) ( Flodgren et al, 2019 ).…”

Nursing Practice Combined with Scene Simulation Teaching Mode in Standardized Training and Teaching for Newly Recruited Nurses in Post Anesthesia Care Unit

“…By the competence is meant the required knowledge, professional skills and personal comprehensive quality. Therefore, high-quality nursing service can only be provided by those who are of great competence ( 8 – 11 ). In practice, there are already standardized training modes focusing on competence improvement.…”