Of the 1.3 million people now employed within the NHS, over 400,000 are nurses. Nurses are literally everywhere, spread right across primary, community and secondary care. Not only do nurses deliver hospital care, they are seen in many other fields such as health visitors, school nurses, midwives and GP practice nurses. (Medical sales.co.uk) (20.11.05)
Nursing through the years has improved dramatically, and most remember the 19th Century pioneer Florence Nightingale as the woman who changed nursing practice and opinions based around the nursing profession. This, perhaps then coupled with the advancement of medical science and knowledge can be credited for the nursing practice we have come to depend on today, which has in fact grown from strength to strength with societies acceptance of the need to train, educate and co-operate. (www.agnescott) (29.11.05)
Nursing is a high paced occupation with pressures of time, resources and of dealing with pain, discomfort and the distress of others being dominant factors. Balliere’s nurse dictionary defines a registered general nurse as:
“A person who is qualified in the art of science and nursing and meets certain prescribed standards of education and clinical competence. The nurse’s duties include providing services that are essential or helpful in the promotion, maintenance and restoration of health and well-being”
(www.isbn.bookfellas.co.uk) (no date available)
With this in mind it is essential to establish what exactly the expectations of a modern registered nurse are, and whether or not these expectations are met with opposition.
In August 2004 Beverly Malone the General Secretary of The Royal College of Nursing published the NHS plan for nurses which encompassed ten key roles:
* Ordering diagnostic investigations such as pathology test and x-rays.
* Making and receiving referrals direct, for example to a clinical psychologist, therapist or a pain consultant.
* Admitting and discharging patients for specified conditions with agreed protocols.
* Managing patient caseloads, for example those suffering with diabetes or clinical depression.
* Running clinics, for example for ophthalmology or child development.
* Prescribing medicines and treatments.
* Carrying out a wide range of resuscitation procedures, including defibrillation.
* Performing minor surgery and outpatient procedures.
* Triaging patients, using the latest IT, to the appropriate health professional.
* Taking the lead in the way local health services are organised and in the way they are run.
These key roles urge nurses to become more entrepreneurial and this extra responsibility is not seen as merely increasing workloads but providing faster more efficient patient care combined with the opportunity for a wider career scope for the nurse.
Many nurses wishing to broaden their horizons were once edged onto managerial positions which took away much of the fundamental nurse-patient care, replacing it with clinical based practice. With the emergence of consultant nurse posts or nurse practitioners as they are better known this provides scope for upward mobility in occupation, yet still carrying with it the prestige of managerial jobs. (www.Nursing-standard.co.uk) (no date available)
Despite the multi tasks that a modern nurse can be involved in there is still a clear disparity between nurse and physician. The nurse’s main task remains to be caring for the patient and the physician’s task is to diagnose and treat the ill and injured. However one key driver for the appearance of all these new roles is the shortfall in the number of both GP’s and hospital doctors. This will inevitably mean that the nurses must pick up more work.
One of the major areas of development when examining expanding nurse roles is that of nurse prescribing. For the last ten years community nurses i.e. district nurses, health visitors, and a small number of practice nurses have been able to prescribe from a limited list of medicines known as “The Nurse Prescribers Formulary”.
More recently however, all registered nurses have been eligible to be trained as prescribers with a wider range of items listed in “The Nurse Prescribers Extended Formularly” (www.pionline.com) (15.11.05). Nurse prescribing is an area of development that is changing constantly, and it is believed by many that it carries with it benefits to the medical, nursing and associated healthcare staff, but also to the patients. As nurse prescribing grows it will affect all nurses at all levels with a need for increased educational requirements in life sciences, pharmacology, anatomy and physiology. There is some scepticism as to whether or not this is a step too far and indeed although the Department of Health believes these measures will provide patients with quicker more efficient access to medicine the fact still remains that the nurses undertaking these measures need to be confident, willing, prescribers in order for them to successfully fulfil their role requirements.
Some nurses are hesitant to move forward in this area and worry about the balance between providing patient care and influencing the planning of care. Perhaps it is right to be sceptical, and some argue that if they had felt the need for such supremacy they would have taken the necessary steps and trained as doctors. This belief is challenged by Beverly Malone who states: “It is not about nurses becoming mini-doctors but about them
becoming maxi-nurses” (www.replondon.ac.uk) (26.10.05).
The aim of this research is to establish whether or not these evolutionary changes and job role expansions are welcomed by the nurse profession or whether they feel coerced into conforming through fears of being pigeonholed. Pressure is a dominant feature in most medical professions but if these added pressures are administered through compulsion there runs the risk of inefficient conduct and also the loss of valuable employees.
In the undertaking of this research project, the researcher firstly needed to ascertain what would be the most appropriate method of collating and recording information.
The two most commonly used methods of researching are quantitative and qualitative. Quantitative research relates to statistically reliable and generalisable results. Sample amounts of information can be collected and generalised to a larger population in order to justify findings, in say a survey/questionnaire form. Qualitative research however takes on a more observant role and is quite a complex analysis of often an individual, this research can adopt the form of an interview.
The researcher in this case has chosen to adopt the quantitative form of research, as it is felt more appropriate given the nature of this topic. In order to obtain a proper insight into the nursing profession it would only be appropriate that any investigations should be targeted specifically at nurses and at more than one nurse, in order to obtain a truly analytical conclusion.
Quantitative researchers are often known as positivists (www.educationforum.co.uk/) (no date available) as they adopt a more scientific approach to researching. They feel that with systematic investigations and data analysis they can present a more substantial understanding of a subject and therefore a more reliable result.
Quantitative researchers refute qualitative methods believing that being overly subjective undermines their view and that they take too much account of prejudices that cloud human perspectives. Quantitative researchers also doubt the validity and reliability of data collected by qualitative researchers, as conditions, events and situations can never be successfully replicated and that the mere presence of the researcher and lack of anonymity will have a profound effect on the participant’s responses to questions.
Qualitative researchers, often known as interpretevists (www.analytictech.com/) (no date available) attempt to analyse and understand people and their social and cultural differences and views in much complexity. Qualitative researchers make great emphasis on ‘human beings’ and feel that they should be treated as such and individuals thoughts and feelings should be analysed in an in depth manner in order to mirror an accurate result. Quantitative researchers however, argue that human judgement and bias can be dominant factors and may affect the outcome of results.
The question of subjectivity arises again, and it is felt that it can become a problematic task remaining objective when situations are staged on such a personal level. A danger when using qualitative research is that question responses can be unknowingly provoked by the nature of the interview technique and the interviewer has the arduous task of trying to remain impartial at all times.
The researcher of this particular topic has, as previously mentioned used the positivist quantitative research method as it will appropriately tackle this particular study. When trying to comprehend the thoughts and feelings centred around nurse roles it would have been inappropriate to undertake a qualitative method and interview only one nurse, as this would give a misguided interpretation of nurses on a whole.
Nurse professions vary greatly as they work in many different fields, so in order to establish a collection of objective results, a collective sample of investigable findings must be collated and systematically examined. This quantitative approach generates large quantities of information and it is believed that with this systematic investigation and analysis of data a clear and precise set of results can be recorded. Qualitative researchers argue however, that this method ignores the crucial human element involved and that this process is somewhat obscure and vague in its enactment.
Although personal bias may creep into qualitative research it is also felt that bias maybe collected from the participants of a quantitative study, as persons involved may be somewhat indolent with information. This can be indicative with the questionnaire form of researching, whilst a plus of this research is the quantity of opinion gained, it can also be challenged for its accuracy with regards to light-hearted dishonesty, and certain groups proffering desirable answers as opposed to accurate or honest opinions.
In order to justify the results of a quantitative method, careful consideration must be given to the participants involved and a definite positive factor with this approach is its enablement to be repeated. This in itself enables the researcher over a period of time to provide a continuous record of results, therefore to some extent disproving inaccuracy theories.
The appropriateness of quantitative research with reference to this project becomes apparent when we consider that a qualitative study involves quite a lengthy, time-consuming process.
Subjects must be studied in great detail and over a long period of time in order for accurate conclusions to be drawn.
The research method for this particular project was chosen with much consideration and has a definite element of control, which enables the researcher to identify key issues regarding the thesis. Control is necessary in order to provide unambiguous answers to questions. Definition is another key element when undertaking research tasks, and this method aims to provide defined steps to information findings thus eliminating any confusion that may arise with regards to communication. (Bryman) (pg 282).
Whatever method of data collection is used during a research topic, it should be critically examined to assess to what extent it is reliable and valid. Reliability relates to the extent to which a procedure produces similar results on repeatable occasions. As discussed previously this quantitative method is repeatable therefore is high in reliability as opposed to the qualitative form.
Validity is an altogether more complex concept, and is the process of measuring or describing an item and assessing whether or not this process has been successful. Measuring the extent of validity can become extremely involved and it was not appropriate in this instance to delve deeply into complex validity testing. However every effort has been made to ensure sufficient validity exists. (Bell) (pg104)
The researcher, having decided upon the quantitative research method must now establish the actually ‘quantity’ of recipients to undergo the study. An appropriate sample of subjects is key to obtaining a typical representation of a larger group. If time and money were no object it would have been highly advantageous to the researcher to distribute questionnaires to the whole of the nursing population, however as this was not an option a sample of 50 nurses was chosen.
There are many different types of sampling that would justify a quantitative research project however, random, opportunity, cluster and stratified are samples that would not appropriately justify this research. The main reasons for the non-use of these is that they would not accurately target the specific need in this research i.e. nurses.
The sampling technique chosen was quota sampling, this enables the researcher to target a specific group as opposed to randomly selected members of the public whose knowledge on nursing would be opinionated and not fact.
The researcher established the technique of distribution in order to collect information, this keeps costs to a minimum and proves less time-consuming. This method of data collection is considerably advantageous as it protects the anonymity of participants, which reduces the risk of bias.
Meticulous design and development of the questionnaire has been tackled with the utmost precision. The size and font of the questionnaire was chosen for its basic structure and appears to be comprehendible to all. The questions are set out in a language that is elementary and should provide readers with an early comprehension. A three choice answer was chosen enabling the respondents to be inconclusive if necessary to avoid the possibility of non-completion. The researcher concluded that the questionnaire stimulated respondent interest, with a clear-cut yet precise manner and justified all the criteria needed for this research. A pilot of 5 copies was then distributed to test this theory, and the feedback mirrored the researchers conclusions therefore compilation was complete.
As with any research it is imperative that participants rights and feelings are respected at all times. Confidentiality and anonymity are key. Research ethics, relates to the clearness and nature of the agreement entered into. (Bell) (pg 39). When undertaking this research, all participants gave informed consent. Respondents were re-assured that only the researcher, tutor and internal verifier would see the data and that participants would remain anonymous. Ethics are centred around right and wrong, fair and unfair and what is acceptable practice. What remained in the forefront of the researchers mind is that participants were helping the researcher to gain merit and every precaution was taken to ensure that no physical, mental or psychological harm was inflicted upon them throughout.
Bias, as previously mentioned is extremely difficult to avoid. A key difference between qualitative and quantitative research is that quantitative attempts to eliminate bias, whereas qualitative carries with it unavoidable bias. Unavoidable bias often creeps into research and is as noted ‘unavoidable’. Examples of this could be geographical area, income, occupation, race or age and although all steps have been taken to avoid bias in this research, it was carried out in one particular hospital. The only way around this element would have been to carry out a nationwide census, but again this was unachievable.
As can be seen throughout this methodology, meticulous detail, careful consideration and subtlety of choice have all been major factors in its compilation. The researcher has done everything possible to ensure this research is appropriate, ethical and free from personal opinion.