Barbara Davey

Integrating health and social care: implications for joint working and community care outcomes for older people.

In England, the theme of promoting collaborative working between social and primary health care remains high on the policy agenda. The underlying assumption, largely untested, is that a greater degree of structural integration benefits service users. This paper reports the findings from a feasibility study comparing two models of joint working and examining the relative impact of personal characteristics, service use and co-location on the likelihood of older people remaining in the community. Baseline standardised interviews with 79 older people aged 75 + with complex needs in two social services departments were carried out following referral, covering social circumstances, physical and mental health and services received, with follow-up interviews after six months. Contacts between social workers and primary care were tracked. The findings suggest that co-location does not necessarily lead to substantially closer interprofessional working in terms of greater contact between social workers and GPs or social workers and community nurses. Factors affecting outcome were degree of cognitive impairment, intensity of home care received and whether the older person lived alone. Whatever the model of collaborative working, its effects on remaining in the community must be assessed in the wider context of the characteristics and services received by older people.

Returning to work after maternity leave UK nurses’ motivations and preferences

In the UK, the implementation of flexible working is seen as a key strategy in retention of nurses in the National Health Service (NHS) once they have children. However, Preference Theory argues that the majority of women returners are driven by motivations other than career or work, and that part-time workers are not as committed as full-timers, a perception held by some managers in the NHS. This article examines the motivations of 112 nurse returners after their first child, the differences between nurses returning part time or full time and between nurses preferring to work full time, part time or not at all.The findings suggest that neither hours worked nor preferred hours are good indicators of whether nurses are committed to work or a career, except for respondents who prefer not to work. The main differences are between nurses who would prefer not to work and all others.The findings that nurses returning part time at their preferred hours are motivated by their work and career challenge the view that they are not committed.The policy implications point to the importance of NHS organizations providing both flexible working and flexible career and training opportunities to retain returners’ commitment to nursing.

The policy–practice divide Who has clinical supervision in nursing?

The role of the NHS in supporting qualified nurses is important for the development and retention of staff. Although there is a general perception that clinical supervision is beneficial and leads to better outcomes of patient care, most literature focuses on the main functions of the supervisory role, the interactions between supervisee and supervisor, or the supervisory process. There is limited large-scale empirical evidence on nurses’ receipt of clinical supervision or their perceived need of its various dimensions. This paper reports findings from a large-scale nationally representative sample of diplomate nurses who qualified between 1997 and 1998. Using Proctor’s model, it discusses the experiences of clinical supervision of 1,918 nurses in early career, 18 months after qualification, from the adult, child, learning disability and mental health branches. The findings show that the receipt of clinical supervision varied among the branches. Just over half of learning disability and mental health diplomates were receiving supervision, compared with approximately one-third of diplomates graduating from the adult and child branches. Sizeable proportions of nurses had never had a clinical supervisor in their current job. It is generally agreed that clinical supervision should enable the development of new skills through reflection on practice. However, many supervisees identified that they were not given the opportunity to do this in their supervision sessions. There was a perceived need for more supervision in these and other aspects. These findings are particularly important given the increased expectation of organisational support for staff development under Agenda for Change, a new pay and grading system introduced in 2004 throughout the NHS.

Taking a degree after qualifying as a registered general nurse: constraints and effects

In recent years, there has been a growing emphasis on nurses obtaining degrees with many arguing for an all graduate profession. Traditionally trained nurses may feel increased pressure to obtain degrees to compete with their diploma and degree trained successors. This paper presents findings from the sixth questionnaire in a Department of Health-funded, longitudinal study into the careers of traditionally trained nurses who qualified in 1990/91. It discusses the experiences of a cohort of 620 nurses eight years after qualification, in terms of the proportion who had taken/were taking a degree, the support offered by employers and the perceived effects of a nursing/healthcare degree on their work. The findings showed that almost half did not plan to take a degree and that a main constraint was the difficulty of combining paid work with studying, especially for women with childcare responsibilities. However, for the minority who had taken/were taking a degree, the perceived effects included increased self-confidence, with the majority reporting enhancement of clinical skills and better career prospects. The findings point to a need for employers to address issues of flexible working, study leave and funding in order that nurses are given every opportunity for career development.

Family friendly policies: general nurses' preferences and experiences

While European Union policy emphasises that one of the aims of family-friendly working arrangements is to increasing gender equality, in the UK the focus has been primarily on workforce retention. Drawing on a study of Registered General Nurses who returned to work after breaks for maternity leave, this paper considers their preferences and experiences in light of current UK family-friendly policies and the implications of the findings for increasing gender equality. Questionnaires were completed by respondents in three regional health authorities and focused on the four to eight year period after qualification. The following topics were investigated: views about length of maternity break and reasons for returning to work sooner than preferred; hours sought after a return and hours obtained; the availability of preferred patterns of work and of flexible hours; retention of grade on return; the availability and use of workplace crèches, and childcare arrangements when children were unwell.

Joint Working Between Social and Health Services in the Care of Older People in the Community: A Cost Study

There have been few economic evaluations of joint working between social and health care. This paper focuses on collaboration between professionals providing care for people aged 75 and over, and examines the economic costs of contacts made by social workers with community nurses, GPs and older people or their carers. Two areas were studied, one where social care and primary care services were co‐located, and the other with social work teams located separately from local health services. The two forms of social care location had an impact on contacts and costs but overall it was fairly small. Contact costs made up only a small amount of the overall costs of care These findings suggest that altering the organisational arrangements for care delivery may improve the process of care delivery, but result in only minor changes to the proportion of overall resources directed to older service users.

Commitment expressions of nurses aged 45 and over: organisational, professional and personal factors.

Abstract The aims of the study were to explore personal, professional and organisational factors that would affect future participation in the workforce of nurses aged 45 and over. The research was proposed against a background of concerns about a shortage of a skilled nursing workforce in London and ever increasing numbers of older nurses taking retirement. Data were collected with 37 mainly senior F grade nurses and health care assistants using a semi-structured interview schedule and biographical methods. There can be multiple expressions of commitment, which may differ at different levels of the organisation. Personal commitment (i.e., to family and children) was also very important. Expressions of commitment were not expressed in isolation, this means commitment is negotiated, contested and sustained across and within multiple situations.