Vision, permission and action: a bottom up perspective on the management of public health nursing.

Abstract

To explore the opportunities and obstacles that impinge on attempts to advance public health nursing, paying particular attention to the role of, and implications for, nursing management. Nurses are to have a central role in the government's drive to re-invigorate the United Kingdom public health agenda. This paper explores the perceptions and support needs of the primary and community nurses, health visitors and midwives charged with meeting that goal. Focus group interviews were conducted separately with health visitors, school nurses, district nurses, community midwives and practice nurses from the a single health authority area in Yorkshire. Eight group interviews were conducted involving 31 practitioners in total. All interviews were audio recorded and transcribed in full. Data were analysed using the framework approach. Workload, resource and time pressures limit the ability of community and primary care nurses to deliver public health work. Furthermore, nurses feel that the leadership required to guide service delivery and optimize deployment of under utilized public health skills at local level is missing, and that public health activity lacks legitimacy. If the new public health agenda is to be delivered, nursing managers will have to be clear about what is meant by public health work and decide whether it is to remain a peripheral concern or core activity. Having made that decision they must communicate it to practitioners on the ground through word and deed--that is, by identifying capacity, restructuring workloads and re-prioritizing activity.