Do clinical nurse specialists in palliative care de-skill or empower general ward nurses?

Abstract

This article reports on a small-scale exploratory study looking into the relationships between specialist nurses and general nurses in acute palliative care, to establish mutual role expectations and conditions under which generalists exhibit empowered or de-skilled behaviour. The main aims were to investigate understandings of role expectation and to establish the conditions under which generalists exhibited empowered or de-skilled behaviour. Semi-structured interviews, based on a patient vignette, were conducted with eight general nurses and two specialist nurses in one UK NHS trust. It was found that generalists valued specialists' clinical knowledge and skills, especially their communication skills. However, generalists demonstrated little insight into the work methods or full job remit, particularly the educational role, of specialists. There was a common understanding of the generalist's role by both generalists and specialists. Generalists shared anxieties about palliative care. De-skilling was not reported, but generalists acknowledge 'handing over' care and a disinclination to develop challenging clinical skills. Empowerment was not found to be associated with clinical grade, but with motivation to learn about palliative care. Further research is required to verify these preliminary findings.