Creating an organizational infrastructure to develop and support new nursing roles - A framework for debate

Aim: This paper offers for debate a framework that will promote an effective organizational infrastructure when developing and supporting new nursing roles. The framework identifies key systems that need to work effectively in isolation but also clearly integrate to ensure a joined up approach to organizational thinking and working. A working example of how the infrastructure could be initiated in practice utilizing the concept of developing an Advanced Practitioner role is offered. Background: The National Health Service has set out a modernization agenda to deliver consistent and high quality care to patients. However, often underpinning government vision and philosophy is the need for trust strategies to make real and operationalize recommendations made. It is against this background of government targets and change in the National Health Service that new nursing roles are created, which require an effective organizational infrastructure if they are to survive, let alone succeed. The government seems to be recognizing that lessons could be learned when developing new roles in the National Health Service by acknowledging the key themes identified from the earlier literature on the development and impact of new roles in nursing. Key issues: In reality, each of the key systems identified as part of the framework is very complex, particularly in large organizations. However, the framework proposed offers a simplified and user-friendly approach to this complex subject. There is no suggestion that organizations do not have the systems in place but what is often missing is the underpinning communications to link the systems together. Although, this paper relates to nursing roles the framework is transferable to all health care practitioners and organizations. Conclusion: Whilst supporting new roles, the framework presented offers a wider dimension for enhancing organizational thinking and working practices. It is open to debate, which would be welcomed by the authors, yet provides a challenge to health care organizations in assessing how integrated their systems are in meeting its business, aspirations and new targets.