Is anybody listening? A qualitative study of nurses' reflections on practice.

摘要

AIM AND OBJECTIVES: To explore nurses' perceptions of the reality of practice based on data from the Nurses and Midwives e-cohort Study which examined the workforce characteristics, work-life balance and health of nurses. BACKGROUND: Recruitment and retention of the nursing workforce is of international concern as demands increase due to demographic changes, political pressure and community expectations, in a climate of economic constraint. DESIGN: Qualitative analysis of data from a cohort of Australian, New Zealand and UK nurses. METHOD: Of the 7604 participants in the electronic cohort, 1909 provided qualitative comments of which 162 related to nursing practice; thematic analysis resulted in four high order themes. The analytical discussion is structured around 'care' as the organising construct. RESULTS: Four themes emerged: 'embodied care' which discusses the impact of work on the nurse's physical and emotional health; 'quantity/quality care' which addresses increasing pressures of work and ability to provide quality care; 'organisational (non)care' raising the seeming lack of support from management; and '(un)collegial/self care' where bullying and professional relationships were raised. CONCLUSIONS: Issues raised by participants have been discussed in the nursing literature for several years yet nurses still experience these negative aspects of nursing. It appears there is a significant gap between what is known about the practice environment, recommendations for change and change occurring: the management equivalent of the theory-practice gap, resulting in nurses intending to leave the profession. RELEVANCE TO CLINICAL PRACTICE: Research demonstrates that a well-qualified, stable nursing workforce improves quality of health care and health outcomes. Changing the work environment and fostering a positive workplace culture seems fundamental to supporting the retention of nurses, that this is not occurring in some areas in the current climate is a concern for the profession and those responsible for the provision of care.