Editorial: The invisible work of nurses

Although nursing work has always had an organising component, in recent history this has tended to be regarded as the dirty work of the profession and a distraction from nurses’ “real work” with patients.

(Allen, 2015: 148)

I have had the privilege of reading an advanced copy of the new book by Davina Allen – ‘The Invisible Work of Nurses (Allen, 2015). The book is based on an ethnographic study of nurses working in adult healthcare services in the UK. The study is a fascinating account of the work of nurses. In particular, Allen exposes and makes visible, something that we have known about nursing for a long time, but for which we have not had a discourse, that is that much of the significant work of nursing is invisible! Through her ethnographic study of the everyday work of nurses, Allen demonstrates the significant role that nurses play in what she calls ‘organising work’ – ‘. . . unremarkable as it first appears, nurses’ organising work contributes in important ways to the quality, safety and efficiency of healthcare and that recognising its content, form and function and the knowledge, skills and logic that underpin it has important implications for our efforts to improve the service’ (page 148). Whilst Allen’s research is not specifically focused on gerontological nursing, many of the practices she describes in detail in her research do relate to nurses meeting the needs of older people in an acute care context. This research really struck a cord with me and resonated with me greatly as a

© 2014 John Wiley & Sons Ltd

gerontological nurse. The invisibility of the knowledge, skills and expertise of gerontological nurses has been documented in the nursing literature for many years (Nolan, 1997; Heath et al., 1996). The invisibility of this expertise has resulted in an erosion of the Registered Nurse workforce in gerontological settings as the undertaking of ‘the tasks’ in delivering care to older people gets labelled as ‘simple work’ that needs minimal knowledge, skill or expertise. A number of researchers have vociferously argued for the expertise of gerontological nurses to be recognised, as the so-called ‘simple tasks of gerontological nursing’ are actually highly complex but made to look simple, because of the expertise of nurses! In 2004, the Royal College of Nursing (UK) identified 4 key roles of the gerontological nurse and these roles (Ford et al., 2004) resonate with the research undertaken by Allen, particularly that of coordination. Gerontological nurses have always needed to have expertise in coordinating care with older people and their families. Further, the fact that in older people care settings (unlike acute care settings), the skill-mix is so low that it is impossible for the Registered Nurse to provide direct care to all older people. Instead, registered gerontological nurses have to develop expert skills in coordinating a range of care workers and other health and social care professionals in developing care programmes and ensuring that complex care needs are met. This work has rarely been valued in the nursing literature or indeed understood and gerontological nurses have been

subjected to a range of criticisms for not providing more ‘direct care’. Allen’s work helps to counteract those criticisms, as she clearly demonstrates the importance of this work and even highlights how significant it is to the provision of safe and effective care. Coordination work is as Allen suggests a form of ‘translational mobilisation’ (Allen, 2015: 136), that is coordination of complex systems and processes to ensure the translation of knowledge, people, processes and material resources into meaningful and person-centred care trajectories. If ever an explanation of gerontological nursing was apt, then this is it! Expert gerontological nurses work ‘between the lines’ and between formal systems to ensure that the best packages of care and the most personcentred care plans are developed and implemented. To do this requires a high level of skill and expertise (Phelan & McCormack, 2013). The International Journal of Older People Nursing has as an essential purpose, that of articulating the contribution of the Registered Nurse to the lives of older people. Davina Allen’s work, whilst not specifically about gerontological nursing, resonates with and in many ways gives clear voice to a debate that has been around for a long time. Her work enables us to clearly argue for the role of the Registered Nurse in coordinating care and to not be defensive about the fact that this is as important as providing direct care. Allen takes the argument further of course when she questions if it is possible for Registered Nurses to combine

247

Editorial

these roles of direct care giver and care coordinator, but that’s another issue for debate! Brendan McCormack DPhil(Oxon.), BSc(Hons.) Nursing, PGCEA, RGN, RMN, FEANS, FRCN IJOPN, Professor and Head of Nursing, Queen Margaret University, Edinburgh, Scotland E- mail: [email protected]

References

Ford P., Heath H., McCormack B. & Phair L. (2004) What a Difference a Nurse Makes: An RCN Report on the Benefits of Expert Nursing to the Clinical Outcomes in the Continuing Care of Older People. Royal College of Nursing, London. Heath H., McCormack B., Phair L. & Ford P. (1996) Developing outcome indicators in continuing care: part 1. Nursing Standard 10, 41–45. Nolan M. (1997) Gerontological nursing: professional priority or eternal cinderella? Ageing and Society 17, 447–460.

Phelan A. & McCormack B. (2013) Exploring nursing expertise in residential care for older people in Ireland. All-Ireland Gerontological Nurses Association. Available at: http://www.nhi.ie/zuploads/page_docs/nhi %20aigna%20research%20exploring% 20nursing%20expertise.pdf (accessed 14 November 2014).

Allen D. (2015) The Invisible Work of Nurses: Hospitals, Organisations and Healthcare. Routledge, London.

248

© 2014 John Wiley & Sons Ltd

The invisible work of nurses.

The invisible work of nurses. - PDF Download Free
36KB Sizes 4 Downloads 78 Views