A community of practice: the nurses’ role on a medical assessment unit

Abstract

To explore the nurses' role on a medical assessment unit. Medical assessment units facilitate the acceptance of medical emergencies to one dedicated clinical space and are a response to politically driven strategies to enhance the provision of acute medical care in the UK. Despite the essential contribution that nurses make, there is a paucity of research-based literature that has investigated the nurses' role in these units. An ethnographic study of a medical assessment unit in Wales, UK. Data were collected over a three-year period from 2003-2006 by participant observation (200 hours) with the researcher, a registered nurse and university lecturer, working alongside the nurses as a contributor to care delivery, semi-structured interviews with nurses, doctors, paramedics and patients (n = 19) and the collection of documentary and artefact evidence. Three main themes were identified: 'making beds': organising the clinical space; 'knowing your stuff': having professional knowledge; and 'loving the buzz': having the ability to work under pressure. A distinctive community of practice had developed to satisfy the workplace demands that the nurses faced in a culture that valued autonomous practice and provided a positive working environment. However, a cautionary note must be raised in that new approaches to care delivery, such as medical assessment units, whilst being operationally efficient, may not reflect a nursing ethos of holistic and individualised care delivery. The concept of community of practice aids the exploration of the interplay of the goals of practice and the attendant social relations developed in nursing teams. Findings from this study have identified aspects of the role of the nurse in a medical assessment unit setting and so can help inform educational programmes. Further research is required to enable the development of this distinctive nursing role.