Service changes’ impact on outpatient nurses and health care assistants

This study investigated the impact of service changes on nurses and healthcare assistants’ job motivation and wellbeing, in outpatient services within a large London acute healthcare organisation. While previous studies have focused on nurse staffing in inpatient settings, outpatient nurses are under-researched (Adynski et al., 2022). Three research questions were explored to seek answers to the research problem which included: How would the outpatient nurses and healthcare assistants be supported and motivated during and after service changes?

Based on a relativist ontological stance, a qualitative descriptive methodology grounded the choice of phenomenological approach for this study. Purposive sampling was used for the recruitment of outpatient nursing staff working within three main sites of the reseracher’s organisation. Eighteen participants took part in virtual audio-transcribed semi-structured interviews, which occurred during the surge period of COVID-19 pandemic. Data were initially analysed using NVIVO12 database tool followed by Colaizzi's (1978) phenomenological method. The qualitative data was triangulated with the NHS Staff Survey (2021-2022).

Four main themes were generated from the qualitative data as follows: (1) New ways of working with increased nurse-led autonomous activities; (2) lack of staff training and development with perceived limited career progression opportunities; (3) Staff experience during redeployment COVID-19 redeployment; (4) Staff perceived lack of management and leadership support.

The findings suggest that two out of the eighteen participants had access to learning and development, which enhanced their job motivation and wellbeing. However, sixteen participants reported lack of access to training and development opportunities due to lack of Training Needs Analysis (TNA). TNA is an essential mechanism for staff to engage in their Continuous Professional Development (CPD) (Dening et al., 2019). Despite the frequent service changes and the outpatient nurses' indelible roles, there was little or no distinct career pathway leading to; lack of job motivation and professional mobility.