The research confirms that there are multi-factorial situational stressors that significantly impact on a nurse’s performance and conduct.
The participants highlighted their experience of the employer investigating and learning from incidents and errors in practice to ensure a rigorous and fair process is followed. The participants’ explain the early career nurse’s behaviour and conduct, mental
health, insight and mitigation can affect a nurse’s ability to function as a safe nurse. The participants expressed the importance of protecting the public, upholding the
reputation of the profession, at times, whilst in the best interest of the nurse.
The participants describe cases of nurses who lack emotional “resilience” which can result in periods of “sickness and absence and lateness”.
The research highlights that some early career nurses are “vulnerable to disciplinary action”.
The research confirms the importance of a culture of support and sharing experiences and reasonable adjustments can be made to accommodate an individual’s circumstances to relieve stress.
It is evident that in some cases, a nurse whose fitness to practice is in question may have little or no evidence of mitigating circumstances to compensate for their actions.
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Chapter 8 Core Category: A Decision to Refer
8.1 Introduction
A decision to refer emerged as the core category in this adapted constructivist grounded theory research. This chapter explains the contributing factors of why employers make a decision to refer an early career nurse to the professional regulator. The development of the core category discusses the three central themes the participants are grappling with and their perceptions of the situation: the employer’s responsibility of public safety; which is underpinned by the values and expectations of the nurse; this is often exposes the early careers nurse’s professional vulnerability to a referral to the professional regulator, displayed in diagram 33.
These central themes have emerged from the four categories which are the outcome of the study’s aim and objectives and how this have generated into new knowledge and a deeper understanding of the phenomena, illustrated in diagram 34. This chapter also demonstrates how the formation of the four categories consolidated into the development of a form of constructivist grounded theory, by intertwining the fragmented concepts into hypotheses that work together to form the core category – a decision to refer, presented in diagram 41. The study represents the key experiences, beliefs, perceptions, and opinions of the 20 participants. The theoretical codes emerged from the process of constantly comparing the data in the transcripts, field notes, and memos leading to the four categories which formed into core themes. Glaser, Strauss, Corbin and Charmaz debate the procedural matters of a core category and point out the benefits of one method versus another. In this study it is important that the grounded theory is not only emergent in terms of the theories developed but also in relation to the methods are transparent, credible and dependable. Thereby, reiterating the importance of staying close to the data.
Charmaz, (1994) outlines that a constructivist approach does not construct a core category in the studied phenomenon and this is an unconventional way compared to a true constructivist grounded theory approach. This study utilises Glaser and Strauss (1967: 40) approach that “during the research the emergent categories began to form patterns and interrelations which formed into the core of the emerging theory”. Certainly, Glaser (1978) reinforces the importance of a core category because the requirement for the generation of theory occurs around a core category. He argues that without a core category the grounded theory study will drift away from relevancy and workability (Glaser, 1978).
Throughout this study it is clear how the core category emerged with “public safety” (P7) being the priority for healthcare employers, underpinned by the employer’s fundamental
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responsibility to protect the public. The participants experience highlighted how nurse’s “vulnerability” and the employers values and expectations of a nurse whose fitness to practise is in question.
The core category illustrates fitness to practise decisions are based on a combination of factors: The public safety issues related to the situation and the response of the nurse, which can be influenced by the employer’s values and expectations; the employer’s perceptions of the employee and the employer’s relationship with the nurse, which can lead to the nurse being vulnerable, this is based on the four categories:
Alarm bells which signal that patient safety has been compromised either by a single or series of related events;
The characteristics and values of a nurse that employers expect and appear to value following a concern about their fitness to practise;
Employers’ expectations of a nurse’s reaction once an error has occurred; Contributory multi-factorial stressors and health issues of the nurse.
Diagram 33 The Central Themes of Public Safety, Values and Expectations and Vulnerability
Public safety
'"Monitoring
patterns of
behaviour"
'"A fair
employer"
System &
process issues
Values and
Expectations
"Privileged
position"
Professional
responsibility
and insight
Vulnerability
"Breakdown of
relationships"
'"Vulnerable to
disciplinary
action'"
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