Organisational culture and consultant nurse outcomes: part 2 consultant nurse outcomes

This action research project was the formal stage of a much longer developmental journey. It involved a consultant nurse and staff working in a general intensive care unit that had become a Nursing Development Unit (NDU). Our mission was to continue to improve the care provided to our patients and their families through developing nurses and nursing. The journey began in 1989, three years before the formal project period of 1992-1995. In 1989, all staff were committed to sharing early experiences about the journey on which they had embarked and this was reflected in a series of early publications (Clayton and McCabe 1991, Jenkins 1991, Manley 1990, Warfield and Manley 1990). Brown argues that an organisational culture can only be understood as the product of historical process (Brown 1998), because culture changes and evolves with time. To recognise the significance of this cultural journey it is, therefore, important to understand the early context and how it compares today. In 1989, the unit had just regained permission to run its English National Board (ENB) postregistration clinical course in ITU nursing. This had previously been withdrawn because of difficulties with staff recruitment and retention (Hansard 1986), and thus the maintenance of an adequate learning experience. Only the six G grade sisters/charge nurses of the 35 staff establishment possessed a specialist qualification. The rest of the staff possessed only their initial nursing qualifications. The consultant nurse worked in post for four days a week for the threeyear formal project phase. This phase was funded by the King’s Fund’s Nursing Development Programme. The fifth day was spent as course director to a masters course in nursing. At the end of the formal project phase, the trust took over the funding from the King’s Fund and since that time there have been two postholders. The same approaches have continued to be used, in conjunction with the unit’s clinical leader and staff, to sustain the culture established over preceding years, underpinned by the same values and beliefs previously articulated by staff. In 1999, four years after the formal project period, the characteristic culture has continued. Study background Kim Manley MN, BA, RGN, Dip N (Lond), RCNT, PGCEA, is Acting Head of Practice Development, RCN Institute. Organisational culture and consultant nurse outcomes: part 2 nurse outcomes