Contextual factors that enable or disable nurses' professional practice.
This study explored the complex world of nursing at a time of humungous change in the
delivery of health care services. The initial focus of the research was registered nurses' use
of knowledge in professional practice; however this was largely displaced by contextual
issues, which emerged from the data. Eraut's (1992,1994) concepts of professional
knowledge informed the data generation and the analysis.
A broadly qualitative approach drawing on grounded theory and constructivism provided
the methodological framework and the research methods involved observation and
interview. The sample comprised registered nurses undertaking a four-year part-time
degree in nursing studies. Twenty-seven were observed in a variety of clinical settings:
sixteen of this group were subsequently interviewed. Six of their managers were then
Data analysis followed a pattern of literal, interpretive and reflective coding and revealed a
number of key issues for registered nurses working in the United Kingdom at the time of
the research. The nurses fell into three categories, the survivors, the battle weary and the
battle hardened; the largest group being the battle weary. The key causes of the weariness
originated from organizational constraints such as low staffing levels, poor teamwork and
an inability to give appropriate care to their patients. The effects of battle weariness
included low morale, which affected their motivation, tearfulness and a general fatigue.
The 'survivors' (a minority) were characterized by a sense of purpose and a fulfillment
from their work.
The contexts in which the battle weary worked were likened to a war zone with a clearly
Significant changes to the traditional role of the ward sister/charge nurse have left the
majority of nurses in this study feeling unsupported and with a lack of clinical leadership.
The nurses, often only working at 'D' or 'E' grade, frequently found themselves trying to
cope with conflicts in practice with nursing colleagues, with patients and with doctors.Professional knowledge used in practice included communication and interpersonal skills,
teamwork, delivering 'hands on' care to patients and coping with the ever changing
demands on the nursing time.
A number of recommendations are made and include an 'enabling curriculum' for
educating nurses at initial and post registration level, a return of the clinical leadership role
for ward sisters and charge nurses and a renewal of the focus of nursing practice.