BACKGROUND: The introduction of new healthcare roles internationally has had mixed results with some evidence that variations can be accounted for by the manner of their introduction rather than role content. Explanation may be found partly in the ways in which new roles establish a workplace jurisdiction; that is, recognition in the workplace of a role's legitimate rights to undertake a particular scope of practice. OBJECTIVE: To explore the factors that influence the development of workplace jurisdiction of new nursing roles. DESIGN AND SETTING: Critical realist multiple case study design within two NHS Acute Hospital Trusts in England and two new nursing roles as embedded units of analysis in each case (n=4 roles). In Phase 1, data were collected through semi-structured interviews (n=21), non-participant observation of committees (n=11), partial participant observation and shadowing of the role holders' working day (n=9), together with analysis of organisational documents (n=33). In Phase 2, follow up interviews with role-holders (n=4) were conducted. Participants Staff in new nursing roles (n=4) were selected purposively as embedded units according to the theoretical framework and other informants (n=17) were selected according to the study propositions. RESULTS: Qualitative analysis demonstrated that different role drivers produced two different role types, each of whom faced different challenges in negotiating the implementation of the role in the workplace. Negotiation of workplace jurisdiction was shown to be dependent on sharing social identities with co-workers. Four major workplace identities were found: professional, speciality, organisational and relational. CONCLUSION: The current focus on setting legal and public jurisdictions for new nursing roles through national standards and statutory registration needs to be complemented by a better understanding of how workplace jurisdiction is achieved. This study suggests that social identity is a significant determinant.
BACKGROUND: The introduction of new healthcare roles internationally has had mixed results with some evidence that variations can be accounted for by the manner of their introduction rather than role content. Explanation may be found partly in the ways in which new roles establish a workplace jurisdiction; that is, recognition in the workplace of a role's legitimate rights to undertake a particular scope of practice. OBJECTIVE: To explore the factors that influence the development of workplace jurisdiction of new nursing roles. DESIGN AND SETTING: Critical realist multiple case study design within two NHS Acute Hospital Trusts in England and two new nursing roles as embedded units of analysis in each case (n=4 roles). In Phase 1, data were collected through semi-structured interviews (n=21), non-participant observation of committees (n=11), partial participant observation and shadowing of the role holders' working day (n=9), together with analysis of organisational documents (n=33). In Phase 2, follow up interviews with role-holders (n=4) were conducted. Participants Staff in new nursing roles (n=4) were selected purposively as embedded units according to the theoretical framework and other informants (n=17) were selected according to the study propositions. RESULTS: Qualitative analysis demonstrated that different role drivers produced two different role types, each of whom faced different challenges in negotiating the implementation of the role in the workplace. Negotiation of workplace jurisdiction was shown to be dependent on sharing social identities with co-workers. Four major workplace identities were found: professional, speciality, organisational and relational. CONCLUSION: The current focus on setting legal and public jurisdictions for new nursing roles through national standards and statutory registration needs to be complemented by a better understanding of how workplace jurisdiction is achieved. This study suggests that social identity is a significant determinant.