Policy in the hearts, minds and hands of nurses

Introduction: Hospital Policies are mandated to meet governance and accreditation requirements that aim to support the safe provision of patient care. System reviews and investigations consistently link contributing factors related to policy adherence failures as key causes of adverse events and incidents causing patient harm.

Purpose: This research study was undertaken to explore and gain greater understanding of the everyday experiences of nurses and how they made sense of the relationship between hospital policy and nursing practice. The aims of the study were to become aware of the issues around policy, to gain greater understanding of the problem and to discern a way forward.

Methods: A bi-phased qualitative research methodology was undertaken in this study: a hermeneutic phenomenological approach with ten semi-structured in-depth interviews exploring nurse experience of policy, and an ethnographic approach to observing six nurses working eight-hour shifts in medical wards in three private hospitals. This field work supported observation of how they actually experienced hospital policy in their everyday work, and was followed by a reflective practice session with the researcher to better understand these experiences.

Results: Results facilitated awareness of understanding nurses’ experience and everyday work through thematic analysis and validated that there was a problem with the relationship between policy and nursing practice. This then enabled the researcher to observe how nurses actually practiced in their daily work in relation to policy and undertake further thematic analysis.

Conclusions: Nurses did more than act out policies and procedures in their everyday work, they used their knowledge, experience, skills and their community of nursing practice to show resilience in resolving uncertainty and ambiguity in the workplace and patient care needs – policy existed in the hearts, minds and hands of nurses. Vignettes emphasised the impact of complexity on nurses’ everyday work, and described their responses to this challenge.