Shifting the balance of care? A qualitative study of policy implementation in community nursing

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This qualitative study examined the interaction between policy implementation and service organisation and delivery for community nursing services.


Leadership in nursing is at the fore front of the policy agenda for shifting the balance of care from hospitals to the community setting and for improving the quality of healthcare services. Yet, little is known about the implementation of policy within the community setting.


A qualitative, interpretive analysis including semi-structured interviews with nurse leaders (n = 12) and community nurses (n = 27) and three focus groups (n = 13) with community nurses (Total N = 39) in three Health Boards in Scotland.


Policy implementation is not adequately integrated between primary and secondary care service at the point of care delivery. The ‘top down approach’ to policy implementation for shifting the balance of care is currently at odds with the grass roots service organisation and delivery in the community setting.


The aspirations of integrated, collaborative health and social care require more clinicians working at the frontline in both primary and secondary care to value more the work of colleagues in the different sectors.

Implication for Nursing Management

The current ‘top down approach’ to policy implementation encourages resistance in the frontline community nurses rather than commitment. A more ‘bottom up’ integrated approach to policy implementation is therefore required.

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