‘Nurses whisper.’ Identities in nurses’ patient safety narratives of nurse‐trainee doctors’ interactions

Abstract

Context Nurses are integral to patient safety, but little is known about their narrative constructions of identity in relation to their dyadic interactions with trainee doctors about patient safety and competence during the trajectory of a medical career. Aim We sought to examine how identities are constructed by experienced nurses in their narratives of patient safety encounters with trainee doctors. Methods Our qualitative study gathered narrative data through semi‐structured interviews with nurses of different professional standing (n = 20). Purposive sampling was used to recruit the first eight participants, with the remainder recruited through theoretical sampling. Audio recordings were transcribed verbatim and analysed inductively through a social constructionist framework and deductively using a competence framework. Results We classified seven identities that participants constructed in their narratives of dyadic interactions with trainee doctors in relation to patient safety: nurses as teacher, guardian of patient wellbeing, provider of emotional support, provider of general support, expert advisor, navigator and team player. These identities related to the two key roles of nurses as educators and as practitioners. As they narrated these dyadic interactions, participants constructed identities that positioned trainee doctors in character tropes, suggesting gaps in professional competence: nurses as provider of general support was commonly narrated in the context of perceived deficits of personal or functional capabilities and nurses as team player was mainly associated with concerns (or reassurances) around ethical capabilities. Discussion and Conclusion Our findings are consistent with, and extend the wider literature on the development of professional competence, interprofessional collaboration in health care, and the nature and organisation of nursing work. Nurses' work in ensuring patient safety and support trainee doctors’ professional development merits greater formal recognition and legitimation.

Specialty Grand Challenge: Diversity Matters in Healthcare Professions Education Research

“…With professional roles and occupational boundaries being flexible and malleable, when working across these boundaries, cooperation can occur. Cooperation comes in many forms, including doctors deferring to nurses' experience and expertise, resulting in productive interprofessional relationships and enhanced patient outcomes ( 2 , 5 ). Thus, research has shown how newly qualified doctors learn from nurses who have an important role in junior doctors' procedural skill development, alongside their professional socialization, as they navigate the complexities of hospital cultures and practices ( 6 ).…”

“…Rather, subjectivity of what is real centers around discursive processes, including who is talking, to whom they are conversing, for what purpose , and so on. To know something is to attend to what is being said and how it is conveyed ( 5 , 36 ). Here there are no causal links between constructs, no regular patterns or universal laws.…”

Nurses’ Contributions in Rural Family Medicine Education: A Mixed-Method Approach

“…Previous studies have shown that nurses can act as practitioners of patient safety and educators of medical residents [ 15 , 16 ]. Their observations and feedback to medical residents and senior doctors can make patients safer and lead to more effective patient care [ 15 , 17 , 18 , 19 ].…”

“…Previous studies have shown that nurses can act as practitioners of patient safety and educators of medical residents [ 15 , 16 ]. Their observations and feedback to medical residents and senior doctors can make patients safer and lead to more effective patient care [ 15 , 17 , 18 , 19 ]. The level of nurses’ contributions to physicians’ education can differ depending on clinical situations, such as medical resources, the number of senior doctors, and the specialty of education.…”

“…Currently, there is a lack of evidence regarding nurses’ contributions to rural family medicine education [ 15 ]. In addition, nurses’ difficulties in rural family medicine education have not been clarified.…”