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Aim: To discuss nurses' use of networks to address nursing recruitment and retention in London, UK., Design: Qualitative evaluation of the Capital Nurse programme reporting on 30 narrative interviews with executive, clinical and student nurses in 2019., Results: Executive nurses within the Capital Nurse programme recognized the importance of sociomaterial contexts in the health and social care system in London and worked strategically across these contexts to achieve change. Supported through the Capital Nurse programme, executive nurses from health organizations across London initiated collaborative working to improve recruitment and retention. Primarily by designing and delivering sociomaterial products (organizational and educational) to support nurses to build a career in London. Drawing on ideas from actor network theory, in particular sociomaterial contexts, nurses' actions at all levels to develop and sustain networks to address nursing recruitment and retention across the NHS in London are described., Conclusions: Capital Nurse supported collaborative working both within single organizations and across organizations in London. There is evidence of change in how nurses across the capital work together to improve patient care, improve recruitment and retention. Findings may resonate with nurses in other settings who seek to address the problem of recruitment and retention. They show how nurses coming together in networks to effect changes in practice can work successfully., Impact: Nurses' use of networks led to novel models of communication and action to address the problems of recruitment and retention in London. We argue that sociomateriality should be considered outside the clinical practice setting, as part of nurses' professional development and organizational practice, that is how they plan their career, how they address recruitment and retention, how they communicate across organizations about nursing issues., No Patient or Public Contribution: This was an evaluation of a staff development project in London, which sought to elicit nurses' experiences of participation in Capital Nurse., (© 2023 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Introduction: Preconception care promotes better maternal outcomes, may assist in preventing birth defects and improves fertility awareness among healthy childbearing couples. Yet, the significance of preconception care for infertile couples is undeveloped area of practice in Europe., Aims and Objectives: To discuss the importance of nurses and midwives in providing preconception care to infertile couples in the United Kingdom and Spain., Design: Discursive paper., Method: A comparison of different midwifery and nursing approaches to preconception care for infertile couples in two European countries., Findings: At present, infertile couples' needs for preconception care are not routinely identified or understood. There is an opportunity for these needs to be considered and identified by nurses at the time of investigation for infertility or when planning pregnancy with assisted conception., Conclusions: We argue that, by providing preconception care, nurses and midwives have an opportunity to deliver important advice to infertile couples in both primary care and specialist infertility services., (© 2018 John Wiley & Sons Ltd.)

Aim: To explore how adult, child and mental health nursing and midwifery students, selected using multiple mini interviews, describe their 'values journey' following exposure to the clinical practice environment., Background: Values based recruitment (VBR) incorporates assessment of healthcare students' personal values using approaches like multiple mini interviews. Students' experience of adjustment to their values during their programme is conceptualized as a 'values journey'. The impact of VBR in alleviating erosion of personal values remains unclear., Design: A cross-professional longitudinal cohort study was commenced at one university in England in 2016 with data collection points at the end of years one, two and three. Non-probability consecutive sampling resulted in 42 healthcare students (8 adult, 8 child and 9 mental health nursing and 17 midwifery students) taking part., Methods: Six semi-structured focus groups were conducted at the end of participants' Year One (DC1). Data analysis incorporated inductive and deductive approaches in a hybrid synthesis., Findings: Participants described a 'values journey' where their values, particularly communication, courage and wanting to make a difference, were both challenged and retained. Participants personal journeys also acknowledged the: 'courage it takes to use values'; 'reality of values in practice' and 'need for self-reflection on values'., Conclusion: A 'values journey' may begin early in a healthcare student's education programme. This is important to recognize so that appropriate interventions designed to support students in higher education and clinical practice can be implemented. The values incorporated in VBR should be continually evaluated for fitness for purpose., (© 2017 John Wiley & Sons Ltd.)

Aims: This paper reports the findings from a 2015 survey of the Commissioning Nurse Leaders' Network. Our aim was to understand how governing body nurses perceive their influence and leadership on clinical commissioning groups., Methods: An online survey method was used with a census sample of 238 governing body nurses and nurses working in Commissioning Support Units, who were members of the Commissioning Nurse Leaders' Network. The response rate was 40.7% (n = 97)., Results: While most governing body nurses felt confident in their leadership role, this was less so for non-executive governing body nurses. Nurses in Commissioning Support Units were much less positive than governing body nurses about their influence on clinical commissioning groups., Conclusion: Governing body nurses were satisfied with their impact on clinical commissioning groups and so could be said to be leading a nursing agenda but this evidence is limited to their own perceptions and more objective or diverse measures of impact are needed. The purpose of such roles to 'represent nursing, and ensure the patient voice is heard' may be a flawed aspiration, conflating nursing leadership and patient voice., Implications for Nursing Management: This is the first study to explore explicitly the differences between executive and non-executive governing body nurses and nurses working in commissioning support units. Achieving clinical commissioning groups' goals, including developing and embedding nursing leadership roles in clinical commissioning groups, may be threatened if the contributions of governing body nurses, and other nurses supporting clinical commissioning groups, go unrecognised within the profession, or if general practitioners or other clinical commissioning group executive members dominate decision-making on clinical commissioning groups., (© 2018 John Wiley & Sons Ltd.)

Aim and Objective: To understand how nurses and midwives manage informal complaints at ward level., Background: The provision of high quality, compassionate clinical nursing and midwifery is a global priority. Complaints management systems have been established within the National Health Service in the UK to improve patient experience yet little is known about effective responses to informal complaints in clinical practice by nurses and midwives., Design: Collaborative action research., Methods: Four phases of data collection and analysis relating to primarily one National Health Service trust during 2011-2014 including: scoping of complaints data, interviews with five service users and six key stakeholders and eight reflective discussion groups with six midwives over a period of nine months, two sessions of communications training with separate groups of midwives and one focus group with four nurses in the collaborating trust., Results: Three key themes emerged from these data: multiple and domino complaints; ward staff need support; and unclear complaints systems., Conclusions: Current research does not capture the complexities of complaints and the nursing and midwifery response to informal complaints., Relevance to Clinical Practice: Robust systems are required to support clinical staff to improve their response to informal complaints and thereby improve the patient experience., (© 2015 John Wiley & Sons Ltd.)

Aims and Objectives: To evaluate the training needs and awareness of childhood sexual abuse amongst clinical staff taking cervical screening samples in one inner city primary care trust., Background: Studies exploring sexual abuse and nonparticipation in cervical screening have demonstrated that women can experience re-traumatisation if care during examinations is insensitive to their particular needs., Design: This was a mixed methods, service evaluation in three phases., Methods: A literature review, a questionnaire to cervical screening staff in an inner city primary care trust and a focus group of four staff drawn from questionnaire respondents to explore themes raised in the questionnaire data., Results: Data analysis of both quantitative and qualitative data showed that clinical staff underestimated the frequency of childhood sexual abuse although they were aware of the difficulties and reluctance some women experience undergoing gynaecological examinations. When women did disclose childhood sexual abuse or when staff suspected a history of childhood sexual abuse, staff reported feeling unsure of how they should proceed. There was no support or clinical supervision, and unmet training needs were identified., Conclusions: Nurses expressed anxiety around the potential of the screening test to cause more harm than good and at their inability to provide more help than listening. Staff wanted support and further training after completing their cervical screening training course to assist in their provision of sensitive care to patients who have experienced childhood sexual abuse., Relevance to Clinical Practice: Whilst our results cannot be generalised to a wider population, they may be meaningful for the community of cervical screening takers. We argue that screening staff require further training and professional support (clinical supervision) to increase their confidence when providing safe and sensitive practice for childhood sexual abuse survivors. If staff feel more confident and competent when responding to disclosure of childhood sexual abuse in screening situations, women who have experienced childhood sexual abuse might participate in the screening programme more readily., (© 2013 John Wiley & Sons Ltd.)

Aims and Objectives: To explore how peacetime employment of military nurses in the UK National Health Service Medical Defence Hospital Units prepares them to be competent to practise in their role on deployment., Background: Military secondary care nurses are employed within UK National Health Service Trusts to gain clinical experience that will be relevant to their military nursing role., Design: A two-stage grounded theory study using mixed methods: postal questionnaire survey and in-depth interviews., Methods: In stage one a postal questionnaire was distributed to all serving military nurses. Stage two involved 12 semi-structured interviews. The data from both parts of the study were analysed using grounded theory., Results: Four categories and one core category were identified, which suggested that participants did not feel fully prepared for deployment. Their feelings of preparedness increased with deployment experience and decreased when the nature of injuries seen on deployment changed. Respondents argued that even when unprepared, they did not feel incompetent. The findings suggest that the peacetime clinical experience gained in the National Health Service did not always develop the necessary competencies to carry out roles as military nurses on deployment. This study highlights the unique role of military nurses. We discuss these findings in the light of the literature on competency and expertise., Conclusion: The military nurses in this study did not feel fully prepared for deployed operations. We propose a new model for how military nurses could gain relevant experience from their National Health Service placements., Relevance to Clinical Practice: National Health Service clinical placements need to be reassessed regularly to ensure that they are meeting military nurses' clinical requirements. Experiences of nurses returning from deployment could be shared and used as a basis for reflection and learning within National Health Service Trusts and also inform decisions regarding the appropriateness of clinical placements for qualified military nurses., (© 2012 Blackwell Publishing Ltd.)

Aims and Objectives: This paper aims to increase our understanding about how student nurses' experiences of supernumerary status are embedded in the hidden curriculum in clinical practice and contribute to the theory-practice gap in nursing., Background: Current literature suggests that the hidden curriculum exists in many professional curricula and that it functions to socialise students into professional behaviours and practice. However, in nursing, there is a gap in our understanding of how these socialisation processes have been influenced by supernumerary status and what forms the hidden curriculum might take currently in clinical practice., Design: An ethnographic case study design., Method: Data were collected in four sites using fieldwork in clinical practice as well as interviews with students, mentors and key stakeholders, an online survey of student bodies and curriculum analysis in four universities. The findings in this paper are drawn from the qualitative fieldwork and interviews and were analysed thematically., Results: The findings suggest that supernumerary status is an important aspect of the hidden curriculum in clinical learning for nursing students; that students are expected by trained staff to work while they learn and that on registration, they are expected to be competent to work immediately as registered nurses. These expectations are at odds with those of academic nurses and contribute to a theory-practice gap for student nurses. These expectations form part of the hidden curriculum that shapes the clinical context, and students have to learn to negotiate their status as supernumerary students in practice to meet these expectations., Conclusion: Consequently, students have to learn in a disintegrated learning context where opposing values of learning exist., Relevance to Clinical Practice: To reintegrate student nurses' learning, educators in universities and clinical practice have to understand how the hidden curriculum and expectations around supernumerary status among trained staff affect learning for students., (© 2011 Blackwell Publishing Ltd.)

Aim: We present three case studies of discrimination to illustrate how racist bullying as discriminatory practices operates in the workplace., Background: Workplace bullying in the British health care sector is reported along with evidence of discrimination towards overseas-trained nurses recruited to work in the United Kingdom (UK)., Methods: The three interviews, which form the basis of the discussion in this paper, were selected purposively from a national study of overseas nurses because they present strong examples of the phenomenon of workplace bullying. The data on which this paper draws were collected through semi-structured, audio-recorded interviews and thematically re-analysed using nvivo V2., Results: The national study showed how racism is entrenched in health workplaces. Our findings in this paper suggest that racism can be understood by the concept of racist bullying. There are four key findings which illustrate racist bullying in the workplace: abusive power relationships, communication difficulties, emotional reactions to racist bullying and responses to bullying., Conclusions: We argue that the literature on workplace bullying adds a layer of analysis of discrimination at the individual and organizational levels which enables us to further delineate racist bullying. We conclude that racist bullying can be specifically identified as a form of bullying. IMPLICATIONS FOR NURSING MANAGERS: Our data may assist managers to challenge current workplace working practices and support bullied employees. The three interviews show different responses to racist bullying which allow us to explore some implications for management practice.

Aim: To report a literature study of leadership for learning in clinical practice in the United Kingdom. Background Previous research in the United Kingdom showed that the ward sister was central to creating a positive learning environment for student nurses. Since the 1990s, the ward mentor has emerged as the key to student nurses' learning in the United Kingdom., Methods: A literature study of new leadership roles and their influence on student nurse learning (restricted to the United Kingdom) which includes an analysis of ten qualitative interviews with stakeholders in higher education in the United Kingdom undertaken as part of the literature study., Results: Learning in clinical placements is led by practice teaching roles such as mentors, clinical practice facilitators and practice educators rather than new leadership roles. However, workforce changes in clinical placements has restricted the opportunities for trained nurses to role model caring activities for student nurses and university based lecturers are increasingly distant from clinical practice., Conclusions and Implications for Practice: Leadership for learning in clinical practice poses three unresolved questions for nurse managers, practitioners and educators - what is nursing, what should student nurses learn and from whom?, Implications for Nursing Management: Leadership for student nurse learning has passed to new learning and teaching roles with Trusts and away from nursing managers. This has implications for workforce planning and role modelling within the profession.

Aim: To explore the meaning of caring in a fertility unit and to present the findings and discuss their implications for practice., Background: Little research has been published internationally on the nature of nursing care in the fertility field. This study was intended to stimulate debate over the nature of care in fertility work., Methodology: An ethnographic approach, which included part-time participant observation and in-depth focused interviews with staff and patients. Data were also collected using a field and a research diary. Data were analysed using a modified thematic analysis., Findings: The data suggest that caring is strongly linked with nurses and that patients' expectations of nurses may be more practically than emotionally focused. I argue that the organization of nursing work, which I call 'nursing the clinic and the doctor', facilitated this practical approach to caring. I discuss two features of nursing the clinic and the doctor: hovering and being there., Conclusions: While there may be other factors that influence the practice of this form of non-intimate caring, nursing in this way may be what patients desire and may be congruent with managing emotions. The findings have implications for the discourse on intimacy and caring within fertility nursing as well as in different outpatient settings.