The current context of nursing is complex. The Health and Social Care Act (2012), Deficit Reduction targets (‘Austerity’), Brexit, the NHS funding gap and Trust deficits, lack of integration of health and social care, ‘safe’ staffing levels, skill mix, post Francis fall out, and for the NQN: preceptorship and managerial support, competence worries and occupational socialization. The NQN also has to consider ‘patient opinion’, the 6Cs, revalidation and the new nursing framework. These latter three may be passing fads, but it is too early to say.
Philip Darbyshire (2017) writes on the perennial issues faced in health care delivery that is also the context for the NQN: http://onlinelibrary.wiley.com/doi/10.1002/nop2.80/epdf
- Staff working under constant pressure (notwithstanding substantial increases in the number of clinical staff in recent years) in the face of growing demand from an ageing population with complex needs
- Difficulties for hospital staff in communicating with GPs about patients who are admitted to hospital, including knowing who patients’ GPs are
- Problems in communication within the hospital between acute medical staff and A&E staff, as well as between different specialist teams
- Difficulties in communicating with staff in other hospitals when patients are transferred
- Delays in ordering and receiving the results of diagnostic tests, which in turn lead to delays in treatment and increase in the time patients spend in hospital
- Challenges in teamworking, for example, on ward rounds when consultants are sometimes not accompanied by trainees and nurses
- Information systems that do not link data about patients held in primary and secondary care, and that are often slow in use
- Patients having to repeat their histories (where they are able to) at different stages in their treatment
- Care being delivered inefficiently and often ineffectively because of the amount of re-work required by the above
- Old buildings and cramped layouts that do not allow privacy and sometimes dignity for patients, or space for staff to work without interruption
- Poorly organized paperwork and documents
- Inefficient organization of supplies and workflows on hospital wards
Linking these together is the NQNs ability to exercise personal agency within these structures.
A small part of the literature on the experiences of NQNs:
Horsburgh and Ross (2013) stated that we know that inadequate staffing levels, eclectic support and concerns over competence provide the challenging context for NQNs.
In their study the NQNs stated:
“…flung in at the deep end”
“…sink or swim”
Colleagues were perceived as “ingrained in the woodwork” and resistant to change, even of a minor nature. That there was:
They suggest undergraduate nursing programmes should prepare students for the reality of delivering care despite competing commitments.
Whitehead et al (2013) undertook a systematic review of support for newly qualified nurses in the UK. This was done in 2011. Three themes were identified:
- Managerial Support Framework.
- Recruitment and Retention.
- Reflection and critical thinking in action.
They conclude that there is strong evidence that NQNs benefit from supported and structured preceptorship which then improves retention. This could have been hypothesized beforehand. The three themes indicate contextual issues.
Is the emphasis on ‘personal responsibility/resilience’ placing undue burdens on new nursing staff who have to exercise responsibility without full control?
Horsburgh D and Ross J (2013) Care and Compassion. The experience of newly qualified staff nurses. Journal of Clinical Nursing. 22(7-8):1124-1132
Whitehead B, Owen P, Holmes D, Beddingham E, Simmons M, Henshaw L, Barton M and Walker C. (2013) Supporting newly qualified nurses in the K: A systematic literature review. Nurse Education Today. 33(4):370-377