The invisible work of the district nursing team: methodological problems associated with exploring skills

Abstract

This paper begins by identifying the context and extent of grade-mix changes in the district nursing service, drawing attention to significant dilution in grade mix at a time of considerable organizational change. The paper goes on to argue that there is no easy formula for providing sound evidence on which policy and management decisions about grade mix can be based. It suggests that the focus on tasks in much of the research on district nursing does not offer a sufficient basis for making grade-mix decisions, because nursing skills are not made explicit. The paper then makes reference to one ethnographic research study in order to illustrate and explore some of the methodological difficulties associated with trying to provide evidence of the use of district nursing skills, focusing in particular on the invisible work undertaken by team members. The paper concludes that if differences in the use of skills by different grades of nurse can be identified, then further increases in grade dilution will have consequences for patient care and must therefore address issues of quality in order to comply with the principles of clinical governance.