Commentary on Nancarrow S (2007) The impact of intermediate care services on job satisfaction, skills and career development opportunities. Journal of Clinical Nursing 16, 1222–1229

Abstract

There have been few initiatives in primary care as thoroughly researched as intermediate care in England (e.g. see Godfrey et al. 2005, Cornes et al. 2007). This is explicable for a number of reasons. Firstly, the service is new; secondly, central insistence and target setting have encouraged it; and thirdly, it arrived at a time when finding out ‘what works’ was in theory central to health service policy making and management. Finally, the unique localism of intermediate care, where each model is different and continually evolving, means that this has made national generalizations difficult and of limited applicability. Many of these elements are evident in Nancarrow’s article (2007). She identifies, for example, that the two case study sites chosen for this research had intermediate care services that are very different in scale, approach, location and goals. In this study, she focuses on staff and their work, drawing on a wider discussion elsewhere that would provide useful contextual data (Nancarrow 2004) for readers who are seeking further opportunities to reflect on the implications of role redesign. At one level, the lessons from this research are highly confirmatory of the process of change. The data show that staff find intermediate care work highly satisfying. This is not simply good for them, but likely to benefit service users. The work enabled them to exercise their skills, to gain a sense of control over their tasks (even if this could be stressful) and made clinical and managerial responsibilities and leadership relevant to patient care. Not surprisingly, nurses when interviewed were encouraged by this new type of work and the scope it provided for personal and professional fulfillment. However, intermediate care is a joint endeavour and reflects many elements of ‘modernized’ health care. This means that, while the job satisfaction of nurses may clearly be an important consideration, their work has an impact on close colleagues who are often not professionally trained and may not be part of the health service. This is why I would be more cautious about depicting intermediate care teams as non-hierarchical. While nurses may share some tasks with social-care colleagues and work collegially in their company, there is a hierarchy of power, pay and professionalism. This may be seen in the reflections of some of the nurses in this study that care work was not for them.