Background: A trial scheme to improving night-time nursing in residential care homes for dependent older people in the Ile de France region of France involved appointing degree-qualified nursing staff to circulate between three or four care homes. In most old age care homes, the absence of a qualified nurse to carry out health procedures during the night leads to night-duty care teams having to deal with urgent medical complications. This study aims to identify the factors which may impede the building of cooperative relationships between night staff and mobile nurses working in a number of medical settings.
Design: An inductive approach was used, based on analysis of in-depth interviews, observations and informal conversations to elicit the key themes. The field study was carried out over a four-month period from February to May 2015 in a number of selected residential care homes.
Methods: 35 semi-structured interviews were conducted with health professionals representing a range of paramedical categories, and 7 night-time participant observation sessions, in which the researcher accompanied mobile nurses during their night-duty work. 22 care homes were visited in total. The participant observation sessions included informal conversations to complete the data collection process.
Results: The findings demonstrate the importance of shared understandings of the organization of work among health professionals of different categories. Representations concerning mobile nurses by health care teams and their managers may have counter-productive effects and give rise to status tensions in relationships between care home staff. For their part, nurses who are not permanently present within care establishments have to employ strategies to maintain the cohesion with colleagues that their professional actions require, especially for managing emergency situations.
Clément Picot-Ngo, Dominique Bonnet-Zamponi, Florence Tubach and Maria Teixeira