Kingston University and St, George's University of London, UK.
BMC Health Serv Res. 2011 Aug 20;11:200. doi: 10.1186/1472-6963-11-200.
Recruiting, retaining and meeting increasing demand for experienced, qualified nurses is an issue of concern for all health care systems. The UK has been creating clinical career structures for nurses that include innovative posts known as nurse consultants. While the numbers overall appear to have grown over the last eleven years, there is evidence that in some specialities and regions the numbers are decreasing. This paper considers the factors that sustain or curtail workforce innovations through the case example of a cohort of nurse consultants established in one community health service in England.
A mixed method case study evaluation was undertaken over three years, using interviews, observations, documentary analysis and questionnaires. The final element of data collection was obtained three years later. Data was anonymised, analysed using a framework method and then integrated using a narrative synthesis.
Ten nurse consultant posts were created over a period of two years (2002-2004). Within two years only five posts remained and within five years (2009) only two part time posts, with the original appointees, remained. When the nurse consultants left their posts, these were not replaced. In exploring the interaction between the innovation (the nurse consultant posts), the adoptees (the senior staff in the organisation) and the context (the immediate service colleagues, the service organisation and commissioners as well as the broader NHS policy context) three key factors were identified as influential in the demise of the posts. These were: a) the extent to which there was support for individual nurses rather than the post, b) the extent to which there was an unambiguous and uncontested clinical service requirement for a nurse consultant and c) the extent to which finances for the post were judged as being used to best effect in a service setting.
This case study example demonstrates how tantalisingly close the nurse consultant initiative came to achieving a clinical career pathway for nurses in community services but more work was required to normalise clinician and managers' beliefs in the relevance and need for the role. Those looking to embed these types of nursing workforce innovations should pay due regard to these issues.
招聘、留住并满足对经验丰富、合格护士日益增长的需求是所有医疗保健系统都关注的问题。英国一直在为护士创建临床职业结构，其中包括被称为顾问护士的创新职位。尽管在过去的十一年中，这些职位的数量总体上似乎有所增加，但有证据表明，在某些专业和地区，这些职位的数量正在减少。本文通过在英格兰一个社区卫生服务机构设立的顾问护士队列的案例研究，考虑了维持或限制劳动力创新的因素。
在三年的时间里，采用混合方法案例研究评估，使用访谈、观察、文件分析和问卷调查。最后一次数据收集是在三年后进行的。数据经过匿名处理，使用框架方法进行分析，然后使用叙述性综合进行整合。
在两年（2002-2004 年）期间设立了 10 个顾问护士职位。两年内只剩下 5 个职位，五年内（2009 年）只剩下 2 个兼职职位，最初的任命者仍然保留。当顾问护士离开他们的职位时，这些职位并没有被取代。在探索创新（顾问护士职位）、采用者（组织中的高级员工）和背景（直接服务同事、服务组织和委托方以及更广泛的 NHS 政策背景）之间的相互作用时，确定了三个关键因素对职位的消亡有影响。这些因素是：a）对个人护士而不是职位的支持程度，b）对顾问护士有明确和无争议的临床服务需求的程度，以及 c）对职位的财务投入在服务环境中被认为是最有效的程度。
本案例研究示例展示了顾问护士倡议如何接近实现社区服务中护士的临床职业途径，但需要做更多的工作来使临床医生和管理人员相信该角色的相关性和必要性。那些希望将这些类型的护理劳动力创新嵌入的人应该适当关注这些问题。
