Organisational interventions in nursing care: A scoping review and descriptive system to support comparison.

BACKGROUND: The nursing profession across developed countries faces significant pressures, particularly due to nursing shortages, highlighting the need for effective organisational interventions of nursing care at hospital level, e.g. new nursing roles, experimenting with different types of nurses and differentiated practices of nursing, and the expansion of the nursing profession within the hospital. However, it is difficult to learn from those experiences, partly because of the absence of a standardised description of these interventions. We benefited from a window of opportunity that occurred after failed reorganisation attempts at national level in the Netherlands, leading to a wide range of local initiatives to experiment and organise nursing care differently.

OBJECTIVE: To develop a comprehensive descriptive system to systematically describe the diversity of interventions to reorganise nursing care in different hospital settings.

METHODS: A scoping review of Dutch grey literature on these initiatives was conducted to identify interventions to (re)organise nursing care in Dutch hospitals between 2015 and 2021. The results were analysed thematically and synthesised into a descriptive system, consisting of a checklist and a matrix, embedded in international literature to capture the diversity in the (re)organisation of hospital nursing care. We applied the descriptive system on two cases of interventions of (re)organising nursing care in Dutch hospitals.

RESULTS: Initially, 1102 records were identified, of which 27 were included in the review. Three main themes were determined: the organisation of different types of nurses, the organisation of different types of nursing work, and the organisation based on terms of employment. The three themes formed the basis for the descriptive system, each outlined with three dimensions describing each theme in more detail. Nine dimensions were identified within these three themes: (1) educational degree, competences, and subjective professional requirements, (2) patient care, indirect operational patient tasks, and quality and research, and (3) positions and embedding, quantity and ratios, and valuation. Additionally, the context was added to the descriptive system in order to take into account contextual factors not captured by the dimensions. All themes and dimensions proved valuable when applying the descriptive system to the two existing interventions.

CONCLUSIONS: We propose a system of interventions of (re)organising nursing care to enable a systematic and comprehensive description of such interventions as the basis for evaluation.