Keywords:

framework for debate;

new nursing roles;

organizational structure

Abstract

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Abstract

Introduction

Introduction to an organizational framework when developing and supporting new

roles

Business planning

Human resources

Training and development

Organizational culture

Clinical governance

Conclusion

References

Aim This paper offers for debate a framework that will promote an effective
organizational infrastructure when developing and supporting new nursing roles.
The framework identifies key systems that need to work effectively in isolation but
also clearly integrate to ensure a joined up approach to organizational thinking and
working. A working example of how the infrastructure could be initiated in practice
utilizing the concept of developing an Advanced Practitioner role is offered.

Background  The National Health Service has set out a modernization agenda to
deliver consistent and high quality care to patients. However, often underpinning
government vision and philosophy is the need for trust strategies to make real and
operationalize recommendations made. It is against this background of government
targets and change in the National Health Service that new nursing roles are
created, which require an effective organizational infrastructure if they are to
survive, let alone succeed. The government seems to be recognizing that lessons
could be learned when developing new roles in the National Health Service by
acknowledging the key themes identified from the earlier literature on the
development and impact of new roles in nursing.

Key issues In reality, each of the key systems identified as part of the framework is
very complex, particularly in large organizations. However, the framework proposed
offers a simplified and user-friendly approach to this complex subject. There is no
suggestion that organizations do not have the systems in place but what is often
missing is the underpinning communications to link the systems together. Although,
this paper relates to nursing roles the framework is transferable to all health care
practitioners and organizations.

Conclusion Whilst supporting new roles, the framework presented offers a wider

dimension for enhancing organizational thinking and working practices. It is open to
debate, which would be welcomed by the authors, yet provides a challenge to
health care organizations in assessing how integrated their systems are in meeting
its business, aspirations and new targets.

Introduction

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Abstract

Introduction

Introduction to an organizational framework when developing and supporting new

roles

Business planning

Human resources

Training and development

Organizational culture

Clinical governance

Conclusion

References

Key government papers identify that trusts are required to deliver consistent and
high quality care to patients (Department of Health (DoH) 1997, 1998, 1999,
2000a). To achieve this requirement Trusts need to maintain a workforce and
service that can meet the changing needs of health care. This may account for the
extensive developments within the nursing profession in the United Kingdom in
recent years.

Professional forces in nursing, increasing crisis in medical manpower and extension

of primary health care have combined to also create new roles for nurses (Cameron
& Masterson 2000). Lorentzon et al. (1994), for example, provided overwhelming
evidence that general practitioners wanted more nurses in their teams both acting
in traditional roles and ‘extended roles’. Indeed, a research study commissioned by
the DoH entitled Exploring New Roles in Practice (ENRiP 2001) has brought to light
both the range and breadth of new roles and the complex manner in which they
have been developed. Castledine, Chair of the Higher Level Practice Steering Group
(United Kingdom Central Council (UKCC) 2002) acknowledges that the nature of the
work undertaken by nurses, midwives and health visitors has and will continue to
develop in response to the needs of patients. He recognizes that in all health and
social care settings, traditional boundaries between professional groups are being
constantly rethought and redrawn in response to these developments, ultimately
offering new challenges and opportunities for all practitioners.

The government seems to be recognizing that lessons could be learned when

developing new roles in the National Health Service (NHS) by acknowledging the
key themes identified from the earlier literature on the development and impact of
new roles in nursing. The key themes include lack of evaluation of the roles (Wade
& Moyer 1989, Donaghy 1995, Hobbs & Murray 1999), lack of support (Humphris&
Soar 1994, Bousefield 1997, Read 1999), career choice and preparation for the role
(Cameron & Masterson 2000, Mills et al. 2000) and role ambiguity (Colerick et al.
1980, Loudermilk 1990, Ormond-Walshe&Newham 2001). Many of these themes are
mirrored in research findings by Leigh et al. (2002) exploring the role of the lecturer
practitioner. Key themes that emerged from the above earlier literature appear to
be the focus of current government vision and philosophy. For example, Agenda for
Change (DoH 2003a) although focusing on modernizing pay and conditions in the
NHS also addresses the need for clearly defined new career progression pathways
linked to continuing professional development and lifelong learning. Another
example is the Balance of Power (DoH 2000b). One of the main themes in this
document being greater authority and decision-making power to patients and
frontline staff. A final example can be found in the document Developing Key Roles
for Nurses (DoH 2003b), which recognizes the crucial role that nurses play in
achieving a patient centered future.

However, often underpinning government vision and philosophy is the need for trust
strategies to make real and operationalize recommendations made. Indeed, a key
recommendation in the document Shifting the Balance of Power (DoH 2000b) leaves
the practical arrangements to be organized locally. With this in mind, trusts need to
develop an organizational infrastructure to operationally government philosophy
and thinking.

The purpose of this paper is to offer for debate a framework that will promote an
effective organizational infrastructure when developing and supporting new nursing
roles. The framework identifies key systems that need to work effectively in
isolation but also clearly integrate to ensure a joined up approach to organizational
thinking and working. This would ensure transparency to everybody. There is no
suggestion that organizations do not have the systems in place but what is often
missing is the underpinning communications to link the systems together. Indeed,
recent Commission for Health Improvement reports reinforce this position (CHI
2003). The framework offered attempts to integrate the systems together;
recognizing that if one or more of the systems are missing this can be detrimental
to the patient. Although this paper relates to nursing roles the framework offered is
transferable to all health care practitioners and organizations.

Introduction to an organizational framework when developing and supporting new

roles

Jump to…

Top of page

Abstract

Introduction

Introduction to an organizational framework when developing and supporting new

roles

Business planning

Human resources

Training and development

Organizational culture

Clinical governance

Conclusion

References

Organizations need to develop an infrastructure to meet both the needs of patients

and the government's agenda. To achieve this, there are a number of key
dimensions or systems that are required to ensure adequate communications in
meeting the changing needs of patients (see Figure 1). The systems below form the
basis of a framework to achieve a robust organizational infrastructure:

Figure 1.Overview framework when promoting an effective organizational structure.

• 

Business planning.

• 

Human resources.

• 

Training and development.

• 

Organizational culture.

• 

Clinical governance.

Each system will be discussed in turn and will be related to the development and
support of new nursing roles. It is important to highlight that the elements
underpinning the systems, as identified in Figure 1 are not exhaustive and are
constantly changing in response to patient needs and the development of the
organization. A live exemplar using the development of Advanced Practitioners will
illustrate the key concepts involved in developing this role. Advanced Practitioners
are currently being introduced in response to the reduction in junior doctors’ hours
(DoH, The National Assembly for Wales and the British Medical Association 2002)
and the European Working Time Directives (2000). These roles are either being
funded locally by the trusts or pump primed monies by the strategic health
authorities or workforce development confederations.

Business planning

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Top of page

Abstract

Introduction

Introduction to an organizational framework when developing and supporting new

roles

Business planning

Human resources

Training and development

Organizational culture

Clinical governance

Conclusion

References

The first system identified is the business plan. Elphick and Dillarstone (1990)
suggest that business planning is a process by which organizations put their mission
and aims into quantified plans to be achieved, often over several years. Historically,
business planning in the NHS was seen to be the remit of general managers and
accountants; however Young (1996), identifies that professionals now see it as
being unacceptable that managers and accountants should have such a major
influence on what they deem to be clinical decisions. It is important that the
business plan is developed by key strategic staff, including nurses with its content
encompassing the change in philosophy from competition to collaboration between
primary and secondary care. Its philosophy should also clearly identify how an
organization will meet the needs of its local population whilst at the same time
addressing government agendas. It is also important that the business plan is
owned by people within the organization who feel they can contribute to its success
and in its evaluation. There is also the need for the business plan to inform people
working within the organization of the direction they need to move within their
clinical areas and of financial implications of all decisions made.

The NHS in recent years has seen the implementation of new nursing roles, which
encompass elements of business planning, for example, modern matron and nurse
consultant. Such role developments demonstrate the government's commitment in
recognizing the pivotal role that nurse leaders play in service development and
ultimately their vital contribution to the business-planning process. Nurse leaders
when functioning in the role often utilize those qualities of transformational leaders
that Broome (1998) identifies as empowerment, inspiring vision and have a long-
term focus on developments in service and practice.
When developing and supporting new roles as part of the business-planning
process, an organization needs to address the key themes identified from the
earlier literature. For example, formulation of a job description that clearly defines
the role, developing a role that has some form of career progression for the person
in post and the identification of clear lines of authority can help to alleviate
problems associated with role ambiguity, lack of support and career progression
(Colerick et al. 1980, Loudermilk 1990, Ormond-Walshe&Newham 2001, Leigh et al.
2002). Furthermore, as all organizations are different in structure and purpose, local
measures are required to integrate the other four systems, with the direction
articulated through its business plan.

Table 1 provides an example of the key concepts involved in developing Advanced

Practitioners. The Table 1 explores each system, whose responsibility is, some of
the key questions which need to be addressed and the activities which may help to
answer them.

Table 1. An example of the key concepts involved in developing Advanced

Practitioners
System Responsibility Key questions to address Activity
Stage 1 – Developing of an Advanced Practitioner role
Trust Board to 1. How we respond to the
Set up a working group to
develop/ new European Directives
answer these questions
communicate re: DRS hours
2. What are the changing
Include a Trust Board,
B. Plan patient needs for the local
acting as a Chair
community re:
Nurse
Include representative
Managers to Access
from:
address
B. Plan
(strategic Finance
direction) Manager to
Treatment and care Human resources
identify
funding
Discharge Training and development
3. How can the workforce
Clinical governance
be utilized more effectively
4. Could the Advanced
Practitioner role meet
service needs?
Stage 2 – Setting up a practitioner role
Table 1. An example of the key concepts involved in developing Advanced
Practitioners
System Responsibility Key questions to address Activity
1. How would the
Human
practitioner role add to the Human Resource to
Resource
existing workforce to meet coordinate
Directorate
local needs?
2. What would their role Include nurse managers,
consist of and the hours medics, legal
they would work? representatives
3. How many do we
Representative from
need/where, now and in the
modernization department
future
4. Where would the
Human Advanced Practitioner be
resource recruited from, taking into
management Directorate account equal
Manager opportunities?
(medical,
surgery) 5. Who needs to be
involved in drawing up the
job description and
specification
6. Who should be involved
in the selection of
Advanced Practitioner's
7. Who would manage the
performance of the
Advanced Practitioner?
Training and Human 1. What are the current
Human Resource to lead,
Development Resources and future learning needs
include Training and
of Advanced Practitioner's
Development Manager,
to meet our workforce
Service Managers
requirements?
2. Are these learning needs
best met by:
(a) An in-house training
programme
(b) A placement
Table 1. An example of the key concepts involved in developing Advanced
Practitioners
System Responsibility Key questions to address Activity
(c) A work-based academic
programme
3. What support
infrastructure is needed
such as:
(a) C. Supervision
(b) Mentorship associated
with clinical decision
making
(c) Legal and professional
support
(d) Peer support
4. What systems need to
be in place to keep
Advanced Practitioner's up
to date to enable job
effectiveness
1. Have the right people Human Resource to
Human
been involved in designing coordinate and develop
Resource
this role communication systems
2. How do we communicate
to the workforce about the
O. Culture
role of the Advanced
Service Practitioner
Managers
3. How can the
organizational culture
embrace this new role?
C. Human Resource to
Governance What quality assurance coordinate working group
Human
systems need to be in place to include ‘C.’ Governance
Resource
to make this role work Department and Service
Manager
C Governance How will the role fit within
department the quality assurance
systems within the
Table 1. An example of the key concepts involved in developing Advanced
Practitioners
System Responsibility Key questions to address Activity
organization?
Who will be responsible for
evaluating the role (i.e.
Service their impact)
Managers Does this role meet the
local community care
needs?
In respect of business planning the trust board must develop and communicate this
to all staff if the organization is to respond to meeting the needs of the local
community. With fewer doctors and a reduction in medical cover likely as the
impact of the European Directives kick in the trust must make contingency
arrangements in its business planning activities to maintain and enhance service
provision.

Each organization differs on how a business plan is developed. Some use a ‘bottom-
up’ approach so that all staff within the organization is involved whilst a ‘top-down’
process is evident in other structures. Either way nurse managers need to know
about the business plan as they will have a major role to play in the development,
promotion and acceptance of Advanced Practitioners to the existing workforce.

A number of key questions arise from the introduction of ‘Advanced Practitioners’ as

a business plan development. These should focus on how:

• 

they will fit and become an integral part of the workforce;

• 

the workforce can be deployed more effectively, capitalizing upon their range of
expertise and capabilities;

• 

Advanced Practitioners will contribute to meeting the changing patient, needs for
access to health care provision, treatment and ongoing care, e.g. out of hour's
service provision and discharge arrangements.

The answers to these questions may often be overlooked due to a lack of planning
in the initial thinking and a range of activities are proposed for each system in the
framework. In respect of business planning as the first stage of the system a
working group with key representatives from the trust board, human resources,
clinical governance and nursing management teams would help to tease out the
key elements.

The inclusion of a trust board representative promotes the link between strategic
visioning and operational implementation adding credibility to the promotion of the
role across the organization.

A representative from human resources helps to blend the organizational visioning

into reality adhering to role development, promotion of equal opportunities and
other legislative requirements around employment and performance management
issues.

A training and development representative is necessary in identifying what may be

needed from the practitioner now and in the future. Resources needed on the job
and external developmental activities are the contributing areas, which this
representative can bring to the group discussions.

By including a clinical governance representative, the link to organizational

effectiveness can be made. The role and its contribution to the quality of service
delivery need evaluatory systems built-in from the beginning.

Last but not least, nurse managers can contribute to the group on how the
Advanced Practitioner role will fit and become an accepted part of the workforce.
They can along with the other group members provide the leadership to changing
the culture of the workforce in valuing the Advanced Practitioners. Furthermore,
nurse managers can play a vital function in planning job descriptions and
specifications with clear lines of accountability to complement existing work roles.

Without the inception of a working group to inform and implement the business plan
on Advanced Practitioners the development may fail.

Human resources

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Abstract

Introduction

Introduction to an organizational framework when developing and supporting new

roles

Business planning

Human resources
Training and development

Organizational culture

Clinical governance

Conclusion

References

Storey (1995) describes human resource management as…

‘A distinctive approach to employment management which seeks to achieve

competitive advantage through the strategic deployment of a highly committed and
capable workforce using an integrated array of cultural, structural and personnel
techniques (P2)’.

Health care organizations will seek to develop a workforce that can meet the
changing health agenda as well as changes in local health needs as identified
through its business plan. For this to occur there needs to be effective
communication systems that merge workforce planning, workforce development
and the business activities of the organization. This will be underpinned by robust
human resource strategies and policies, including equal opportunities, recruitment
and retention, performance management and personal development planning.
Human resource strategies are therefore essential to an organization's overall
effectiveness.

There are clear links between business planning, robust human resource systems
and workforce planning. The following clearly demonstrates the potential impact of
developing nursing roles if these systems do not integrate. Whilst achieving
improved patient outcomes for specific patient groups, and achieving targets set
out in government documents, for example, National Service Frameworks (DoH
1998), there is the potential of ‘creaming off’ the most expert nurses who will be
utilized to strategically develop the service, which in some cases may mean they
are not involved in direct patient care. There is the danger that the nursing staffs
that are left are less experienced and have a lower level grasp of the specialty in
which they are working. The nurses who are left to staff the wards and community
settings may also feel disadvantaged or overlooked, as they are not perceived to
have expert knowledge or skills. In turn, with the emergence of consultant nurse
roles, specialist nurses and nurse practitioners themselves may feel overlooked and
disadvantaged because of their position within the organizational structure. This
may have implications for patient care, staff morale and on the recruitment and
retention of staff unless there are effective systems in place to ensure succession
planning, career development and empowerment of the remaining nursing
workforce.
In relation to the example of Advanced Practitioner development, each organization
will probably have a human resource directorate/department that would play a
major part in workforce development as part of the business plan of the
organization. A number of key questions would need to be addressed by human
resources in association with service managers (nurses, medics and allied health
professionals), representatives from the modernization department and the
organization's legal team.

These should focus on how:

• 

Could the Advanced Practitioner role add and become integrated into the existing
workforce.

• 

Many posts are needed, in what fields of practice and where will they be recruited
from.

• 

Will the recruitment and selection procedures be managed?

• 

Will these practitioners be performance managed?

Training and development

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Abstract

Introduction

Introduction to an organizational framework when developing and supporting new

roles

Business planning

Human resources

Training and development

Organizational culture
Clinical governance

Conclusion

References

Pedder (1998) defines training strategy as an umbrella term to describe the

processes that underpin education and training in the workplace. She believes a
training strategy should be driven by or planned around information and issues
arising from an organization's business cycle. This is reiterated in part by Benton
(1998) who believes that unless service development and delivery is underpinned
by a training strategy, an organization will not change.

An organizations training strategy will also need to reflect government initiatives

and agendas aimed at modernizing the NHS. An example being following the
publication of a consultation document by the DoH entitled A Health Service of all
the Talents: Developing the NHS Workforce (DoH 2001a), organizations are
encouraged to maximize the contribution of all staff to patient care by doing away
with barriers which say only particular staff can provide particular types of care.
This will require the modernization of training and education to ensure that staff are
equipped with the skills they need to work in the complex and changing NHS. This
also integrates with the government's vision that learning and development are key
to delivering its vision of patient centred care in the NHS (DoH 2001b). The
development of its lifelong learning framework sets out a vision and comprehensive
strategy for lifelong learning, recognizing that lifelong learning is one of the central
elements in developing a workforce that is fit for the future.

The NHS Plan (DoH 2000a) again demonstrates the government's commitment to
invest an extra £140 million by 2003/04 to ensure that all professional staff are
supported in keeping their skills up to date by ensuring more help with personal
development and training. Indeed Agenda for Change (DoH 2003a) see personal
development planning as a critical element of modernizing the NHS pay structure
whilst at the same time developing the knowledge and skills of the workforce. There
is also the need to link personal development planning to support systems such as
mentorship, preceptorship and clinical supervision. Here, the personal development
planning process can be monitored and evaluated.

Most organizations have a training strategy in place but it does not always translate
to the organizations activities as identified in the business plan, to government
agendas, or to individuals personal, professional and academic needs. Often what is
missing in organizations is the communication or link between the business plan,
government agendas and training strategy.

An integral part of the training strategy is the need for training needs analysis.
Pedder (1998) suggests training needs analysis occurs when training or learning
objectives are established, knowledge is mapped, gaps are identified and
appropriate action is taken. Therefore, it is essential that the business plan and
training needs analysis are made visible to everyone through the training strategy.

Built into the training strategy specifically relating to the development of new roles
is the need to identify the knowledge and skills required of the person working
within the role. These are often identified initially in the job description. A further
integral component of the training strategy and training needs analysis is the
identification of key people required to support and enable staff to gain the skills to
ultimately meet the business plan and their own personal, professional and
academic develop needs. This again can help address the key themes identified
from the earlier literature on the development and impact of new roles in nursing
such as preparation for the role and support in the role once appointed (Humphris&
Soar 1994, Bousefield 1997, Read 1999, Cameron & Masterson 2000, Mills et al.
2000, Leigh et al. 2002). Ultimately, an organization that can demonstrate
commitment to continuing professional development and lifelong learning, which is
made visible through the training strategy, can assist in the recruitment and
retention of staff, as support for training, education and development is a real
employment incentive.

The development of Advanced Practitioner roles is consistent with the government's

agenda in breaking down role boundaries, putting the patient first and having the
most appropriate health care practitioner meeting their needs. In introducing
Advanced Practitioner roles, the human resource directorate/department must take
into account the training and development requirements in association with
significant others, for example, the training and development manager and service
managers. These should focus on the following areas:

• 

What are the learning needs of Advanced Practitioners?

• 

How will they be identified building on existing capabilities?

• 

Which delivery method would be most appropriate to develop these Advanced

Practitioners?

• 

What support infrastructure may be needed to provide personal, professional

clinical, managerial and legal advice?

• 
What continuous developmental processes are required to maintain and further
enhance role competence?

Organizational culture

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Abstract

Introduction

Introduction to an organizational framework when developing and supporting new

roles

Business planning

Human resources

Training and development

Organizational culture

Clinical governance

Conclusion

References

Moorhead and Griffin (1998) define organizational culture as the way people
customarily behave towards each other. They believe a culture cannot be precisely
defined for it is something that is perceived and felt. However, the effectiveness
and style of leadership directly influences the culture of an organization. The
organizational structure also directly influences the culture particularly in relation to
the empowerment of staff. Mullins (1993) suggests the purpose of an organizational
structure is the division of work among members of the organization and the
coordination of their activities so they are directed towards achieving the goals and
objectives of the organization.

An organization's effectiveness is often reliant on a culture that values its staff and
the contribution that they make to the achievement of the business plan. An
organization's value system is one that is about working together and learning
together and staff empowerment. Rodwell (1996) defines empowerment as an
enabling process or a product arising from mutual sharing of resources and
opportunities which enhances decision making to achieve change.
Organizational culture in relation to the development of new roles is crucial. Staff,
for example, to be effective in their new role require education, training and support
and need to clearly articulate the need for the role which should be explicit within
the business plan. This can ultimately assist an organization to recruit and retain
staff as it demonstrates vision, forward thinking and a commitment to continuing
professional development and lifelong learning of its employees. Similarly an
organization that invests in the evaluation of the impact of new roles can clearly
demonstrate to both the individual and organization how the role is effective, thus
contributing towards meeting the clinical governance agenda.

In respective to the development of advance practitioner roles it is essential the

process is designed and coordinated rigorously by the human resource
directorate/department. This process may involve medics, nurse managers or other
health care professionals, depending on the nature of the role. Clear lines of
responsibility, accountability, role expectation and performance management will
create an acceptance and in time value the new role members within the
organization.

Clinical governance

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Abstract

Introduction

Introduction to an organizational framework when developing and supporting new

roles

Business planning

Human resources

Training and development

Organizational culture

Clinical governance

Conclusion

References

All health care organizations are required to have clinical governance arrangements
in place for…
‘Continuously improving the quality of their services and safeguarding high
standards of care by creating an environment in which excellence in clinical care
will flourish (DoH 1998, p. 32)’.

Clinical governance provides a framework for reviewing the vision and values of the
organization manifested through its business plan; agreeing and obtaining
ownership for planning and implementing the business objectives; making it happen
by monitoring achievements in addition to analysing where improvements could be
made; evaluating if differences have been made and that these benefits will
continue.

Although organizations are required to have clinical governance strategies in place

what is often missing are the robust communications or links between this system
to the four other identified systems. Recent Commission for Health Improvement
reports (CHI 2003) indicate that CHI are looking for evidence that clearly
demonstrates that health care organizations have in place robust communication
systems linking clinical audit, clinical benchmarking or research and development
activities to the business plan. Similarly, they are looking for links between
continuing professional development activities to what is needed locally in terms of
individual career aspirations, personal, professional and academic development.
Ultimately they want to see that there are human resource policies in place and the
evidence to demonstrate their effectiveness.

The application of new roles to clinical governance is quite apparent. New clinical
roles are espoused through the leadership and vision of the organization in order to
meet patient needs. Their planning and implementation required ownership,
commitment and teamwork to structure the new roles in a manner in which the post
holders feel valued, supported and work to agreed business objectives. Post holders
will draw upon other organizational processes such as clinical audit, risk
management, evidence-based systems, patient experiences and resource
effectiveness to function effectively but like clinical governance are dependent upon
an organizational culture of continuous learning and development (Hallett 2002).
Regular monitoring and evaluating the roles will enhance their output, evidenced
through the achievement of the business objectives and the quality of patient care
provided. In addition, these feedback mechanisms also provide information to
inform the future planning of new clinical posts within the organization.

In designing Advanced Practitioner roles the human resource

directorates/department may have to set up a working group with service manager
representative and key personnel from the clinical governance team. The working
group should focus on:

• 

What quality assurance systems needs to be place to make this role work?
• 

How will the role contribute to the quality assurance systems in the organization?

• 

Who will be responsible for evaluating the role?

Conclusion

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Top of page

Abstract

Introduction

Introduction to an organizational framework when developing and supporting new

roles

Business planning

Human resources

Training and development

Organizational culture

Clinical governance

Conclusion

References

In conclusion, health care organizations must have a robust infrastructure to meet

the needs of its local population and to achieve government targets. Its
effectiveness will be tested further by other constant changing forces such as
increasing patient expectations, role diversification, European Working Time
Directives and the reduction in workforce numbers. It is against this background of
change that new nursing roles are created such as Advanced Practitioners, which
require an effective organizational infrastructure if they are to survive, let alone
succeed. A systems framework has been suggested in this paper to enable this
process. Whilst supporting new roles, the framework offers a wider dimension for
enhancing organizational thinking and working practices. It is open to debate, which
would be welcomed by the authors, yet provides a challenge to health care
organizations in assessing how integrated their systems are in meeting its business,
aspirations and new targets.
References

Jump to…

Top of page

Abstract

Introduction

Introduction to an organizational framework when developing and supporting new

roles

Business planning

Human resources

Training and development

Organizational culture

Clinical governance

Conclusion

References

Benton D. (1998) Workforce planning. Nursing Management 4 (9), 12–13.

Bousefield C. (1997) A phenomenological investigation into the role of the clinical

nurse specialist. Journal of Advanced Nursing 25, 245–256.

Direct Link:

Abstract

PDF(192K)

References

Broome A. (1998) Managing Change.Macmillian, London.

Cameron A. & Masterson A. (2000) Managing the unmanageable?Nurse Executives

Directors and new role developments in nursing. Journal of Advanced Nursing 31
(5), 1081–1088.

Direct Link:

Abstract
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PDF(76K)

References

CHI (2003) Available at: http://www.chi.nhs.uk/eng/organisations, (accessed on 24

July 2003).

Colerick E., Bastnagel P. &Proulx J. (1980) Evaluation of the clinical nurse specialist
role development and implementation of a dual purpose framework. Nursing
Leadership 3 (3), 26–34.

PubMed,

ChemPort

Department of Health (DoH) (1997) The New NHS: Modern and Dependable. The
Stationery Office, London.

Department of Health (DoH) (1998) A First Class Service: Quality in the New NHS.
The Stationery Office, London.

Department of Health (DoH) (1999) Making a Difference: Strengthening the Nursing,

Midwifery and Health Visiting Contribution to Health and Healthcare. The Stationary
Office, London.

Department of Health (DoH) (2000a) The NHS Plan: A Plan for Investment. A Plan for
Reform. The Stationery Office, London.

Department of Health (DoH) (2000b) Shifting the Balance of Power. The Stationery
Office, London.

Department of Health (DoH) (2001a) A Health Service of All the Talents: Developing
the NHS Workforce. The Stationary Office, London.

Department of Health (DoH) (2001b) Working Together-Learning Together: A

Framework for Lifelong Learning. The Stationary Office, London.

Department of Health (DoH) (2003a) Agenda for Change. The Stationery Office,
London.

Department of Health (DoH) (2003b) Developing Key Roles for Nurse and Midwives:
A Guide for Managers. The Stationery Office, London.

Department of Health (DoH), The National Assembly for Wales and the British
Medical Association (2002) Guidance on Working Patterns for Junior Doctors. The
Stationary Office, London.
Donaghy D. (1995) The asthma specialist and patient education. Professional Nurse
11, 160–162.

PubMed,

ChemPort

Elphick C. &Dillarstone P. (1990) Order out of chaos.The Health Service Journal. 8

February.

PubMed

ENRiP (2001) Exploring New Roles in Practice: Final Report, School for Policy
Studies, University of Bristol, School of Health-related Research, University of
Sheffield, Kings Fund Nursing Development Programme. Available at
http://www.shef.ac.uk/snm/research/enrip/index.html. (accessed on 4 October
2003).

European Parliament and Council (2000) Organisation of Working Time (basic

directive) 2003/34/EC. Available at:
http://europa.eu.int/scadplus/leg/en/cha/C10405.htm (accessed on 24 July 2003).

Hallett L. (2002) Clinical Governance – A Teaching Resource Pack.Emap Healthcare,

London.

Hobbs R. & Murray E.T. (1999) Specialist liaison nurses. British Medical Journal 318,
683–684. Available at: http://www.chi.nhs.uk/eng/organisations (accessed on 24 July
2003).

PubMed,

ChemPort,

Web of Science®

Humphris D. & Soar C. (1994) Educator telling or selling. In The Clinical Nurse
Specialist Issues in Practice (D.Humphris ed.), pp. 47–60. MacMillan Press, London.

Leigh J., Monk J., Rutherford J., Windle J. & Neville L. (2002) What is the future of the
Lecturer Practitioner role: a decade on? Nurse Education in Practice 2, 208–215.

CrossRef,

PubMed

Lorentzon M., Jarman B. &Bajekal M. (1994) Inner City Task Force Report for the
Royal College of General Practitioners, Occasional Paper 66. RCGP, London.
Loudermilk L. (1990) Role ambiguity and the clinical nurse specialist. Nursing
Connections 3 (1), 3–12.

PubMed,

ChemPort

Mills N., Campbell R. & Bachmann M. (2000) Professional and organizational

obstacles to establishing a new specialist service in primary care: case study of an
epilepsy specialist nurse. Journal of Advanced Nursing 37 (1), 43–51.

Direct Link:

Abstract

Full Article (HTML)

PDF(80K)

References

Moorhead G. & Griffin R. (1998) Organizational Behaviour Managing People and

Organizationals. Houghton Mifflin Company, New York.

Mullins L. (1993) Management and OrganisationalBehaviour. Pitman, London.

Ormond-Walshe S. &Newham R. (2001) Comparing and contrasting the clinical

nurse specialist and the advanced nurse practitioner roles. Journal of Nursing
Management 9, 205–207.

Direct Link:

Abstract

Full Article (HTML)

PDF(52K)

References

Pedder L. (1998) Training needs analysis. Nursing Standard 13 (6), 50–56.

PubMed,

ChemPort

Read S.M. (1999) Nurse-led care: the importance of management support 21.
Nursing Times Research 4 (6), 408.
Rodwell C.M. (1996) An analysis of the concept of empowerment. Journal of
Advanced Nursing 23, 305–313.

Direct Link:

Abstract

PDF(910K)

References

Storey J. (1995) Human Resource Management: A Critical Text.Routledge, London.

United Kingdom Central Council (UKCC) (2002) Report of the Higher Level of
Practice Pilot and Project. UKCC, London.

Wade B. & Moyer A. (1989) An evaluation of clinical nurse specialists: implications

for education and the organization of care. Senior Nurse 9, 11–16.

Young A.P. (1996) Who sets the business agenda? Journal of Nursing Management
4, 347–352.

PubMed,

ChemPort

Main ref
Journal of Nursing Management

Volume 13, Issue 2, pages 97–105, March 2005