What do nurses do?

HomeNursing WorkWhat do nurses do?

On my nursing labour page, we see how other nurse researchers have studied nursing work. In my PhD, I found out that nurses understand their work differently. Nurses explain their work by its role in the healthcare system, not by the tasks they do. Nurses told me they understood their work by its role or purpose, and what their overall goals were. This was true no matter where a nurse worked.

This frame is important for two reasons: 1) it meant that nurses weren’t defined by their tasks, and 2) a role frame enabled nurses to adapt their work. Nurses told me that they would do whatever they needed to do during their shift, whether it was in the job description or not. They had a spirit of teamwork and weren’t picky about what specific jobs they were ‘supposed’ to do. Nurses also recognized that nursing changes every day, and there is no rigid list of things that they do. Nurse did not define their work by its tasks, so understanding nurses based on the tasks nurses completed didn’t make sense.

Nurses also adapted their work constantly. Thinking of their work as a role helped them do this. If nurses were focused on tasks, they couldn’t adapt. However, they focused on their role, and then they could respond to any needs in their setting.

Nurses described their roles in three ways: clinical work, managing work, and enabling work. These roles aren’t separate. You might do all three in the same job. What was different was the purpose of this work, and which type of work was the most prominent.

Clinical work was perhaps the most obvious type of work- work where nurses work directly with patients, families, and communities. This work involved giving medications, assessments, teaching, and other activities that were directly patient facing.

This isn’t a surprise. The interesting findings were that this is not all that nurses do. Nursing is much more than patient care.

Managing work is a unique contribution that nurses make to healthcare. Nurses’ managing work keeps the healthcare system running. In hospitals, managing work refers to looking after a ward. It can include everything from ordering towels to hiring new staff. Nurses are the ones who do this, because other professions move all over the hospital. Nurses tend to stay in a specific space, so they have developed this role. In community settings, nurses may manage things like equipment for someone’s home, rather than a physical space like a ward.

Managing work can also be for patients, such as arranging discharge, diagnostic tests, or appointments with other professionals. Nurses may think managing takes them away from their ‘real’ work, but my research found managing IS real nursing work. Nurses know who to phone, what to ask for, how to navigate the system, and take for granted the skills and knowledge that are required to keep everything going.

The third kind of nursing work is enabling work. This is work that ensures we have a nursing profession and a healthcare system! These nurses enable others to manage and work clinically. Enabling roles include education, policy, organizational leadership, and research. These roles are the things that make nursing a profession with a distinct body of knowledge. This work does not necessarily connect with patients, but that doesn’t mean that it isn’t essential for our profession.

So what?

The main finding is that nursing work is not all patient care. This is a fundamental change in how we understand what it is that nurses do. Many of our tools to determine staffing are based on patient census and acuity, BUT that means we are only staffing for patient-directed work. My research demonstrated that nurses do a lot of other work, which is not taken into account for staffing models. A change could be to discuss what nurses actually do, and how the breadth of this work can be considered when making staffing decisions. This could mean nurses are asked to do an appropriate amount of work per shift, so that patients get better care, there is less burnout, and fewer injuries etc.

Some nurses might think this is obvious, but the profession has not been great at explaining what we do, and how we add value to healthcare systems. Hopefully this research can provide nurses with language that explains their work, regardless of setting or patient population.

It can also help to enrich the conversation within nursing itself. There can be ideas that, if you don’t work with patients, you’re ‘not a real nurse anymore’. This study has proven, this isn’t true. We need all of these roles, or we won’t be a profession. Nurses can consider how to explain their work, and how roles work together, to ensure nursing work is recognized, paid appropriately, and supported. As a result, patients will get better care.

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