Practice development ‘without walls’ and the quandary of corporate practice

Abstract

Aim. The context of this study is a group of clinical nurse specialists from across a Trust seeking accreditation as a practice development unit. The university was asked to facilitate the accreditation process via 11 2‐hour learning sessions (including a one‐hour focus group). During initial discussions between the university and practice development unit, the overarching research question for this study was set as: ‘what are the main roles and responsibilities of clinical nurse specialists?’ Background. Although there is no known study of a practice development unit based beyond a ward or speciality, the central tenet of the practice development unit literature is that units must demonstrate their worth if they are to survive and harness senior management support in doing so. Design and methods. Data gleaned from the transcribed audio tape‐recordings of the learning sessions were studied at least three times to ensure transcription accuracy and produce detailed charts. Ethical approval was granted by the appropriate Local Research Ethics Committee and written informed consent obtained from clinical nurse specialists. The study lasted 30 months and ended in October 2004. Results. The four crucial statements that give meaning to specialist practice are: quality care giver; expert; information giver and initiator of change. Further analysis reveals the area of corporate and political practice as being missing from this and other lists of clinical nurse specialist attributes found in the literature. Clinical nurse specialists characterize their relationship with the Trust in terms of dichotomy – differing agendas and perceptions of value. Conclusions. The specialist role requires professional development in the areas of corporate and political acumen and professional business management. Relevance to clinical practice. While the findings of this study relate to one Trust and a group of 16 clinical nurse specialists, with careful application they may be transferable to other settings and groups of senior nurses.

Reflections on a ‘virtual’ practice development unit: changing practice through identity development

“…Ethical approval was granted by the appropriate Local Research Ethics Committee and written informed consent was obtained from the CNSs. Previous findings from this study have been published in this journal (Graham et al. 2006).…”

“…Ethical approval was granted by the appropriate Local Research Ethics Committee and written informed consent was obtained from the CNSs. Previous findings from this study have been published in this journal (Graham et al 2006). However, what follows are the critical reflections of the PDU leaders (CF and DR) and the professor of nursing development (IG) on the above process, in addition to written reflections from 10 of the 32 PDU members on whether the PDU process had assisted in personal and group development.…”

“…Instead, we are made up of a group of nurses and their extended multiprofessional teams who have a strong association and relationship through shared roles and a mutual aim – to provide quality, evidence‐informed care to people who use services and their carers. As others have put it, we are ‘without walls’ (Graham et al. 2006).…”

“…The first part of the model that Roberts cites is an examined acceptance; which encompasses acceptance of the roles of nurses, their questions of belief in the power structure, their belief that physicians and administration should control the system, and their internalized negative view of nursing. In the reflective work we did together during several learning sets and discussion groups (Graham et al. 2006) prior to accreditation, IG would argue that this group of CNSs began to understand the nature of the work that they did and the importance of their work in achieving patient care: how they needed to develop partnerships and alliances, build an agenda, understand on a macro level how health policy was being implemented, and understand how that translated on a micro level so that they could put forward their views from a rational and logical perspective.…”

“…The group had become increasingly aware (awareness building) that they needed to negotiate within these partnerships and alliances to gain the resources needed to fulfil their strategy. These negotiations were of a political nature (political action) (Graham et al. 2006).…”