The development of the scope of practice in rehabilitation care: a learning history study

Abstract

Background: The number of people per year in the Netherlands requiring geriatric rehabilitation care is increasing. Despite the recognition of rehabilitation care as a nursing specialisation, there remains a lack of clarity regarding the scope of practice of rehabilitation nurses. Nurses’ scope of practice is influenced by education, experience, field of work and personnel availability. Care organisations face a major challenge to organise care, with a focus on staff autonomy. Self-organising teams are used in this case study as an implementation of more autonomy and positive work environment. How this is experienced by different stakeholders in a long-term care setting is unclear. Research question: How did the scope of practice in short-term rehabilitation care developed over time and how does this relate to nurse autonomy in a self-organising team in a long-term facility? Method: A qualitative descriptive method called learning history was used to investigate the research question. Results: Increased complexity of care and nurse autonomy have deepened the scope of practice. New tasks for the nurses through the introduction of self-organising teams have broadened the scope of practice. Nevertheless, varying degrees of autonomy, one-sided communication and lack of a supportive manager put pressure on the introduction of self-organising teams. Conclusion: The scope of practice has become broader and deeper due to the increased complexity of care and development of the nurse autonomy. However, the introduction of self-organising teams is under pressure due to challenging change process regarding the autonomy of nurses. Recommendations: A positive work environment consisting of autonomy, teamwork and a positive manager are the basis for self-organising teams. This basis is needed to provide a proper fulfilment of the changing nursing scope of practice.