Abstract:This case study presents a critical reflective account of a change to working practices in one NHS Trust. To promote quality care and effective clinical decision making, a 'grand round' was introduced in the orthopaedic department. Implementation presented frustrations and challenges for members of the multidisciplinary team. These are explored using transformative learning and critical reflection, enabling connections to be made between micro-level interactions of clinical care and macro-level structures that… Show more
“…Traditionally, a physician generally leads medical rounds where nursing staff and allied healthcare professionals are present (Bradfield, 2010). Throughout the years, many initiatives have attempted to change the traditional bedside round through alternative concepts such as consultations when needed, family‐centred medical rounds, consulting rooms and conferences (Chaponda et al, 2009; Cooper & Mercer, 2017). Regardless of the construction of the round, it can be considered as a power structure, by which newly employed nurses get to know their place in the social game that is implicit at the clinic.…”
Section: Discussionmentioning
confidence: 99%
“…This raises questions about what nurses do other than being the extended arm of doctors in the oncological clinic, and what nurses and nurse managers can do to maintain and develop the desired and ideological area of nursing competences and knowledge in clinical practice. By extension, in nursing, Cooper and Mercer (2017) problematise that medical and administrative demands take focus from patients because of the given power structure, hierarchy of knowledge and order of the clinic. Due to those issues, it may be important in determining which nurses apply for employment at the clinic and which will be retained after the introduction process.…”
Aim and objectives
To explore newly employed nurses’ socialisation in the process of introduction into an oncological clinic from the perspectives of unit managers and newly employed nurses.
Background
There are managerial challenges in retaining nurses at workplaces. The way in which nurses are socialised into their work is important for their job satisfaction and retainment.
Method
Qualitative, semi‐structured interviews with seven nurses and two unit managers, and written introductory material. Thematic analyses were made, inspired by Goffman's concepts of social interaction, back stage, front stage and roles. SRQR checklist was used.
Results
Unit managers created the framework for socialising newly employed nurses through written introductory guidelines and assignments of supervisors as mainstream role models. Newly employed nurses were socialised gradually through mirroring their supervisors in their role as nurse. Front stage, patients often functioned as objects for newly employed nurses’ training. Back stage, patients often functioned as communication objects for all professionals. Newly employed nurses, who also demand roles such as transformer, boss, coordinator, prompter and friend, were socialised into the role of assistant to the doctor. Medical rounds functioned as a socialisator in this process.
Conclusion
The allocated supervisors were role models in socialising newly employed nurses into an oncological clinic and its culture. Nurses were socialised into an understanding of care as a biomedical orientation, in which medicine had a higher value than care in the existing knowledge hierarchy at the oncological clinic. This might have implications for who applies for and stays in the job.
Relevance to clinical practice
Increased awareness of the importance of socialisation of nurses into the clinic during the introduction process. Re‐thinking nurses’ independent functions and patient perspectives in introduction of newly employed nurses to maintain and develop nursing as an independent profession.
“…Traditionally, a physician generally leads medical rounds where nursing staff and allied healthcare professionals are present (Bradfield, 2010). Throughout the years, many initiatives have attempted to change the traditional bedside round through alternative concepts such as consultations when needed, family‐centred medical rounds, consulting rooms and conferences (Chaponda et al, 2009; Cooper & Mercer, 2017). Regardless of the construction of the round, it can be considered as a power structure, by which newly employed nurses get to know their place in the social game that is implicit at the clinic.…”
Section: Discussionmentioning
confidence: 99%
“…This raises questions about what nurses do other than being the extended arm of doctors in the oncological clinic, and what nurses and nurse managers can do to maintain and develop the desired and ideological area of nursing competences and knowledge in clinical practice. By extension, in nursing, Cooper and Mercer (2017) problematise that medical and administrative demands take focus from patients because of the given power structure, hierarchy of knowledge and order of the clinic. Due to those issues, it may be important in determining which nurses apply for employment at the clinic and which will be retained after the introduction process.…”
Aim and objectives
To explore newly employed nurses’ socialisation in the process of introduction into an oncological clinic from the perspectives of unit managers and newly employed nurses.
Background
There are managerial challenges in retaining nurses at workplaces. The way in which nurses are socialised into their work is important for their job satisfaction and retainment.
Method
Qualitative, semi‐structured interviews with seven nurses and two unit managers, and written introductory material. Thematic analyses were made, inspired by Goffman's concepts of social interaction, back stage, front stage and roles. SRQR checklist was used.
Results
Unit managers created the framework for socialising newly employed nurses through written introductory guidelines and assignments of supervisors as mainstream role models. Newly employed nurses were socialised gradually through mirroring their supervisors in their role as nurse. Front stage, patients often functioned as objects for newly employed nurses’ training. Back stage, patients often functioned as communication objects for all professionals. Newly employed nurses, who also demand roles such as transformer, boss, coordinator, prompter and friend, were socialised into the role of assistant to the doctor. Medical rounds functioned as a socialisator in this process.
Conclusion
The allocated supervisors were role models in socialising newly employed nurses into an oncological clinic and its culture. Nurses were socialised into an understanding of care as a biomedical orientation, in which medicine had a higher value than care in the existing knowledge hierarchy at the oncological clinic. This might have implications for who applies for and stays in the job.
Relevance to clinical practice
Increased awareness of the importance of socialisation of nurses into the clinic during the introduction process. Re‐thinking nurses’ independent functions and patient perspectives in introduction of newly employed nurses to maintain and develop nursing as an independent profession.
“…Nonetheless, considerable lucidity is demanded of those operating in the academy, and the epithets ‘scholarship’ and ‘research’ require or involve demonstrations of significant communicative exactness. What then are we to make of the following statements (Cooper & Mercer, , p. 927; McAllister, Brien, & Piatti‐Farnell, , p. 315)?[T]he neoliberal nature of healthcare organisation … represents an assault on the foundational values of the [UK] NHS, a reduction of the welfare state … and austerity measures … (Cooper & Mercer, 2017, p. 927)Regards the UK Mid‐Staffordshire NHS inquiry and subsequent Francis Report: “nurses are rarely in charge of the neo‐liberal policies that underpinned this scandal”. (McAllister, Brien & Piatti‐Farnell, 2018, p. 315)…”
The terms neoliberalism and neoliberal play a variety of roles ranging from major to trivial in the papers they appear in. Both phrases carry pejorative connotations in nurse writing. Yet irrespective of the role assumed in argument, readers are rarely provided with enough information to determine what the descriptors mean in a substantive or concrete sense. It is proposed that scholars who use these terms in their work should consider expressing themselves more carefully than often occurs at present. Virtue signalling in academic writing should, absent critical argument, be discouraged.
“…Several studies that have analyzed the impact of NPM on nursing practices point to transformations in the hospital setting. However, none of the studies identified in the scientific literature analyzed this impact in the PHC field in either Brazil or France [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27].…”
The literature in the field of health management mentions a concept called new public management (NPM), introduced in Brazil and France at the end of the 20th century. The objective of the study was to analyze the repercussions of the work of nurses in primary health care in Brazil and France under the influence of NPM. This is an excerpt of a double-titled thesis, which is a research intervention with nurses from two Brazilian states and five French departments. Data were produced between February 2019 and July 2021. The public policy Health on the Hour acted as an institutional transducer, provoking a reduction in access and producing effects on professional practices. In both countries, NPM amplified the predominance of technical and quantifiable acts, the focus on individual care, and the loss of autonomy. Nurses reported insurmountable situations, using the metaphor “Sophie’s choice”. The results showed that making dilemmatic decisions has been the daily routine of nurses, which has not resulted in debureaucratization and higher quality of care.
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