Establishing new nursing roles : A case study of the English community matron initiative
Aim and objective : To examine the factors affecting the extent to which English policy on the introduction of community matrons for people with chronic conditions was implemented. Background : Improving health services for people with chronic diseases (long-term conditions) is an international priority. In England, the new post of community matron, a case management role, was introduced. A target was set for 3000 community matrons to be in post by 2008, but this was not achieved. Design : A realist, pragmatic evaluation of the introduction of community matron posts. Method : The study used mixed methods at multiple levels: an analysis of national and local strategy and planning documents, a national survey and a stakeholder analysis using semi-structured interviews in three primary care organisation case study sites. Results : National policy established targets for the introduction of community matron posts, but there was local variation in implementation. Pragmatic decisions reflected the history of local service configurations, available finance, opportunities or challenges created by other service redesigns and scepticism about the value of the community matron role. There was resistance to 'bolt on' nursing roles in primary care. Conclusions : The implementation of the community matron role is an example of how a policy imperative that valued the clinical skills and expertise of nurses was reinterpreted to fit with local patterns of service delivery. Before new nursing roles are introduced through national policies, a more nuanced understanding is required of the local factors that resist or support such changes. Relevance to clinical practice. There is a need for consultation and understanding of local conditions before the implementation of workforce initiatives. For clinicians, it is important to understand how the context of care shapes priorities and definitions of new nursing roles and how their expertise is recognised and used.