“Nursing by the long stretch of the arm”: an exploration of community nursing middle managers’ experiences of role enactment within Community Health Partnerships in three regions of Scotland.
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Aim: This thesis aimed to explore community nursing middle manager role enactment in managing change within Community Health Partnerships (CHPs) in three regions of Scotland from 2008-2011. Background: CHPs were established to play a key role in shifting care from the acute to the community setting. Within this context the community nursing workforce has been adapting roles in response to Scottish Government (SG) directives. However literature review demonstrated there has been very little research into the role of Community Nurse Middle Managers (CNMMs) in the midst of this change. This investigation sought to address this deficit in the literature. Design and Methodology: The study was conducted in four distinct phases comprising of the reflexive, foundational, recursive and expansive. A total of 42 semi-structured interviews were conducted over the period of investigation. The investigation was qualitative and phenomenological in character. A hermeneutic approach was adopted, broadly based on Heideggerian philosophy. More specifically this study drew on the Interpretative Phenomenological Analysis (IPA) approach of Jonathan Smith (1996). Main findings: In general CNMMs perceived that their jobs had become more complex, with the pace and intensity of work having increased. They held a wide range of responsibilities managing the challenges of driving change within a hierarchy and professional bureaucracy. Opportunities for education and learning were felt to have reduced. A small but significant proportion had left and some were considering leaving the NHS service. A primary motivation for CNMMs was maintaining an implicit connection with service users. They were proud to be members of the nursing profession and aligned their identity with their career history. This was perceived to influence their management and leadership style. In overcoming some of the personal challenges they faced they identified protective factors or “assets” to counteract stress. The application of a salutogenic perspective emerged as important in supporting this. Conclusion: The study has addressed a knowledge gap in literature. It contributes to understandings of NHS community nursing, middle management, role, change and Community Health Partnership literature. In particular it gives a voice to the perspectives of community nursing middle managers in Scotland. It suggests that much more attention needs to be paid to the needs, constitution and sustenance of middle managers in Scottish community nursing and that this has policy, practice, education and research implications.