UBC Theses and Dissertations

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UBC Theses and Dissertations

Nurse managers and certified practice in British Columbia Stevenson, Janine Marie


The new Health Professions Act (HPA) is umbrella legislation that represents a change in health policy. Some activities that nurses historically performed under medical delegation like diagnosis and treatment of sexually transmitted infections (STI) are no longer allowed unless additional training and certification occurs. As a result of their role in the system, nurse managers were given the responsibility for implementing certified practice. The purpose of this study was to explore the experience of nurse managers in leading the implementation of certified practice in order to gain some understanding of the process of change management in our health care system. I chose complexity theory as a lens to understand change in the healthcare system because it emphasizes connection and inter-relationship. I undertook an interpretative descriptive study to analyze the events and contextual factors that have impacted the nurse manager’s experience of implementing certified practice. I conducted nine semistructured interviews in one-on-on and group formats with a total of sixteen nurse managers. Thematic analysis of the data revealed two overarching and inter-related themes, namely (a) consistency with nursing values; and (b) structural constraints. The first theme comprised three sub-categories: autonomy, recognition and role clarity. The second theme, structural constraints, had three sub-categories: multiple models of practice; training and education barriers; and competing system changes. Certified nursing practice is consistent with the goals of the nursing profession of being a regulated and recognized profession; however multiple and competing challenges constrained attainment of these benefits. This study aligned with the existing research on change management in the healthcare system in that it identified what is required for successful implementation of a new health policy. The barriers that were identified also aligned with the literature. The theme of multiple models of practice has not previously been reported. This research highlights the difficulties of a complex system that is comprised of different parts that may operate independently when in truth they are highly inter-related. When this is not taken into consideration, miscommunication and competing system demands can interfere in the implementation of new health policy such as STI certified practice.

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