Nursing development units: between a rock and a hard place

Abstract

Professional development is fundamental to the advancement of nursing and to the provision of a high standard of care for patients. Practice is the heart of nursing. All else in nursing, whether it is education, research or management exists to support and nurture practice. Practice development, situated at the nurse-patient interface, is a crucial aspect of professional development as a whole. The Nursing Development Unit (NDU) is one model of structured clinical practice development. NDUs have their origins in a desire to provide the best possible care for patients through the support and development of autonomous therapeutic nurses. All possible sources of NDU-related literature from 1983-1999 were reviewed to determine the effectiveness of the NDU model. The purpose of this research was to establish the role of the parent organisation in supporting the ongoing viability of NDUs; to describe the key processes and activities of NDUs that are instrumental in the development of nursing practice; to clarify the role of the NDU in contributing to improved patient outcomes, and finally to identify the critical indicators of successful NDUs for their application in the New Zealand context. The premise that the nursing literature as a whole is a reflection of nursing's epistemology was a guiding principle in the decision to review both research-based literature and opinion-based literature. The data was abstracted from the literature through a series of questions grouped under 'structure, process and outcome'. The study found that British nursing journals have played a large part in promoting the NDU model. The pioneering units were given positive coverage and this has by and large continued. Accreditation systems have been important in maintaining standards and providing units with a generic framework for implementation. The trend is now towards internal funding from the parent organisation. The review identified a number of key features for the successful establishment of NDUs. These include organisational support, a strategic plan with clear objectives and an evaluation strategy, strong clinical leadership, good marketing and public relations strategies, and above all the commitment of the nurses, and the understanding of the multidisciplinary team. NDU activities are numerous and include many initiatives aimed at improving patient self-determination and advancing the skills and knowledge base of nurses. NDUs have been very conscious of the need to develop expertise in research and evaluation. The nursing staff have often lacked the skills and knowledge for collecting evaluation data. However, they have been successful in developing expertise in peer appraisal, clinical supervision and reflective practice and in a range of dissemination activities. NDUs appear to have under emphasised the development of socio-political acumen in the nursing staff. However, the NDU does offer a model for the development of confident, assertive, autonomous professionals. The NDU model values nursing as professional practice. The NDU model has stood the test of time, and demonstrated the ability to be at the vanguard of contemporary practice development. The model is flexible and its potential is maximised when it is tailored to meet the needs of the parent organisation. The model has been successfully established in Australia, and has the potential to be adapted and refined for the New Zealand context.