What do nurses do?
: a mixed-methods study of nursing work and adaptation in complex adaptive systems

Student thesis: Doctoral ThesisDoctor of Philosophy


Introduction to TopicNursing is a ubiquitous and important profession that makes a crucial contribution to high quality healthcare, as the largest (and costliest) healthcare profession in the UK. Many policy initiatives have re-organised healthcare delivery, impacting the work of nurses. However, there is concern among nurses that many of these policy initiatives do not adequately recognise the complexity of nursing work.
Research Aim
This thesis had the dual aims of developing a new model of nursing work, based on the insights of resilient healthcare theory, and extending resilient healthcare theory by examining its applicability to nursing work.
MethodsThe study had three phases. The first phase consisted of two reviews: a meta-narrative review of nursing work, and a scoping review of the resilient healthcare concepts of work-as-imagined and work-as-done. Phase 1 mapped literature and identified relevant aspects of theory. Phase 2 saw the creation of a serious video game, Resilience Challenge, which translated resilient healthcare concepts to clinicians through an engaging digital experience. This phase was evaluated using a cross-sectional survey at the end of the game, which assessed the feasibility and acceptability of the game as an elicitation tool.
Phase 3 of the study consisted of interviews with nurses about their work, using Resilience Challenge as an elicitation tool. These interviews were conducted and analysed by drawing on methods from interpretive description.
FindingsResilience Challenge is an effective and feasible way to elicit reflections on work in healthcare. The findings of all phases of this thesis reinforce the complexity and challenge of nursing work. Nurse researchers have studied nursing work as different domains of labour (emotional, cognitive, organisational, and physical labour). However, nurses themselves understand their work as a role, either clinical work (patient facing), managing work (supporting a given ward/jurisdiction), or enabling work (research, education). Adaptation is a constant, hidden feature of nursing work.
DiscussionOther researchers have examined the role of resilient healthcare in safety science, and this theory applies to nurses’ work in a variety of settings. This thesis adds new models of nurses’ labour and nurses’ roles, which build upon previous research by creating comprehensive pictures of what nurses do.
ConclusionOverall, this thesis demonstrated that technology is an effective way of eliciting ideas from participants. Resilient healthcare theory resonates with clinicians, and provides a useful lens for interpreting nursing work. Nurses adapt their work constantly, and these adaptations require judgement and experience, as well as a supportive environment. New models of nurses’ work may support the education and work of the profession.
Date of Award16 Nov 2020
Original languageEnglish
Awarding Institution
  • King's College London
SupervisorJanet Anderson (Supervisor) & Jill Maben (Supervisor)

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