A qualitative study to nurse role differentiation in Dutch hospitals: an invitation for experimentation

Abstract

Background: Nurse role differentiation is associated with reduced patient mortality and complications. However, nurse role differentiation in the Netherlands has been discussed for decades and in 2017 it still has not been implemented. An announced law amendment and proposed healthcare reform to catalyse the implementation provoked nationwide resistance among nurses and resulted in an abolishment of this law. In the light of these developments a follow-up on earlier research is warranted to further investigate the current state-of-affairs concerning nurse role differentiation. Aim: Gain insight into the reasons and motives of the chosen strategies to further develop and implement nurse role differentiation, according to project leaders responsible for the reform towards nurse role differentiation, in hospitals in the Netherlands. Method: A generic qualitative study including ten semi-structured interviews with thirteen participants was conducted in February and March 2020. Interviews were voice recorded, transcribed, and thematically analysed according to Braun and Clarke. Results: Four themes emerged: A change was seen from extrinsic reasons to intrinsic motives to further develop nurse role differentiation. The used strategy is known as experimenting and developing. Leadership and management played an important role in further developing nurse role differentiation, as well as listening to the voices of nurses. Conclusion: The strategy of experimenting and developing seemed suitable for further developing nurse role differentiation wherein the unit manager’s role was essential. Through this strategy, nurses were able to raise their voices and influence the development of differentiation. Recommendations: Hospitals should consider the crucial role of the unit manager during the reform. Nurse role differentiation for specialised wards is underexposed. Further research is needed to explore how nurse role differentiation can improve nursing care on these wards.