Registered Nurses’ experiences of working within professional and contractual boundaries: A Grounded Theory study

Abstract

Aligned to the Nursing and Midwifery Council’s (NMC) The Code (2018a) and other supporting regulatory documents, Registered Nurses (RNs) are accountable to the healthcare organisation through an employment contract and must work within the remit of professional standards and organisational policies. Falling below explicit professional and organisational standards has the potential for repercussions for the RN, the public and the organisation. This research explores RNs’ experiences of meeting the needs of the patient whilst fulfilling the requirements of The Code (NMC, 2018a) in conjunction with operational policies in a small District General Hospital within the British Isles. As far as can be ascertained, this study is the first to focus on the topic of interest. To explore this subject area and to have generated a substantive theory of Professional Liminality, a qualitative constructivist grounded theory approach situated in the interpretive research paradigm was espoused. Participants were purposefully and theoretically sampled to take part in this study. 12 face-to-face individual semi-structured interviews were conducted with experienced RNs. The interview guide evolved and lengthened over the data collection process in keeping with a grounded theory approach pertaining to emerging theoretical interests from the participants’ answers. The grounded theory principles of data collection techniques, constant comparative method of analysis to code data, construction of categories and the development of theoretical themes were adopted to produce a theory explaining the relationships between the emerging themes. Analysis of the findings uncovered three themes: Governance, Professional discrepancies, and Professional disquiet. These themes highlighted a dichotomy between professional and organisational expectations, significantly affecting RNs’ daily clinical practice, and are contextualised in the theoretical framework of professional liminality, representing the complexity of the findings. A new model, Rules versus Roles (RvR), is proposed as an approach to address and resolve the precarious professional liminal positions in which RNs find themselves. Whilst The Code (NMC, 2018a) and operational policy are both vital; they coexist paradoxically. This research indicates that they would benefit from complementing each other to affect an evolving and dynamic contemporary healthcare organisation.