The integrated nursing team in primary care: views and experience of participants exploring ownership, objectives and a team orientation

Abstract

The development of integrated nursing teams consisting of district nurses, health visitors and practice nurses based in general practice is a widespread recent change in primary care. This development has been justified by promising to meet the need for a more cost-effective service, through a reduction of duplication in nursing work, improvements in the consistency of advice to patients and the provision of accessible and responsive patient care. This paper reports on topic-led qualitative interview data which were collected as part of a multimethod evaluation of various models of evolving integrated nursing teams. The overall aim of the evaluation was to explore progress towards integration by assessing nurse workload, team effectiveness and staff perception of change. The assessment of workload and team effectiveness is reported elsewhere. Staff perception of change was measured by analysis of interview data collected from 12 teams, 9 months after the implementation of nurse integration in two London health authorities in 1998. A total of 33 interviews explored nurses' interpretation of integrated nursing, their expectations relating to their changing roles and activities and their perceptions of key activities and outcomes relating to the implementation of integrated working. Although achievements were identified, including some changes in clinical practice, in general participants reported a partial and variable understanding of the concept of integrated teamwork, and there was uncertainty reported over changes in professional boundaries. A lack of ownership of the process of change and a dearth of team objectives were reported. Developments towards teambuilding were more common than strategic planning to reorganize the workload of the team collectively according to a local population-based agenda. To implement an integrated approach to primary care nursing, we suggest that there is a need for increased ownership and support for teambuilding strategies and skill development. If integrated nursing is to contribute to health improvements, it is necessary that participants agree on patient-focused objectives that orient towards a collective and locally targeted delivery of care.

People and Teams Matter in Organizational Change: Professionals' and Managers' Experiences of Changing Governance and Incentives in Primary Care

“…Although the effect of strongly negative emotions on staff in the delivery of care within organizations has been recognized for many years (Obholzer and Zagier Roberts ; Stokes ; Taylor ; Smith and Cowie ), particularly in public sector organizations where staff face continuing organizational change (Cardona ; Obholzer ), this does not seem to be recognized by policy leaders in current service change in health and social care. Pescosolido () has argued for the emergence of leaders to manage group emotions particularly in times of ambiguity, for example, during the process of strategic change in nursing organizations (Furne, Rink, and Ross ) and to reconcile the expectations of different groups of staff trying to meet government directives (Smith and Bryan ; Smith et al. ).…”

Interdisciplinary teamwork in the community rehabilitation of older adults: an example of flexible working in primary care

“…This is a recurring theme in the literature (e.g. Booth and Hewison, 2002;Furne et al, 2001;Molyneux, 2001), and was a considerable problem at the beginning of the project. Health care professionals are becoming increasingly used to unqualified -but nonetheless 'skilled'colleagues taking on aspects of their work if adequately supervised.…”

“…Recognizing the abilities of colleagues, potential or realized, and matching the skills of staff to the needs of the client/patient group is essential to teamwork in primary health care (West, 1994). It is arguably rarely achieved, with a few emerging exceptions such as integrated community nursing teams, some of which have managed to address the skills of team members and to break down traditional role boundaries (Black and Hagel, 1996;Furne et al, 2001;Gerrish, 1999). If individuals from the same profession find it difficult to work this flexibly then it is perhaps not surprising that those from different professions will find it challenging.…”

“…The issue of pooling skills and knowledge is of particular interest as it is arguably something that is only slowly being recognized by practitioners, perhaps because they feel threatened by genericism (Booth and Hewison, 2002;Drennan and Williams, 2001;Furne et al, 2001;Goodman, 2000). Working across professional boundaries in order to pool knowledge and skills is an issue that is explored later in this paper.…”