A theoretical case study in Scotland of professional boundary work in the face of change to generalist working in community nursing: a 'jack of all trades, master of none'?

Critical approaches to change management theories challenge assumptions that change in organisations is a linear and progressive process. Changes within community nursing in the UK have been subject to debate in recent years in the UK. Sociological insights about ‘boundary work’ in professional disciplines are informative for understandings about proposed new roles in community nursing. National government initiatives within Scotland recently proposed radical changes to the role of the community nurse from specialist disciplines to a generalist single discipline community health nurse model. The model was originally tested in four pilot sites across Scotland within NHS Lothian, NHS Tayside, NHS Borders and NHS Highlands. Within NHS Lothian, two development sites were further established to test the model which was centred in two pioneer cohort sites. The present study was a theoretical exploration of the perceptions of community staff and managers about the change process and the new community nurse role in NHS Lothian. Focus group discussions were held with community nursing staff (n=27) and semi-structured interviews with managers (n=3). Initial thematic analysis was used to highlight key themes from the data and later to focus on the rhetorical strategies used by participants. Findings indicated how the generalist community health nurse model was undermined through the ‘jack of all trades’ metaphor; how the boundary work of specialist working was negotiated in order to emphasise professional job choice and autonomy, demarcate the specialist role and make recourse to local and practice issues and, finally, how the status quo was constituted as a validation of existing specialist roles. The theoretical case study explored here, informed by critical change management notions and the sociology of professional ‘boundary work’ in community nursing, has further implications for discussions about future role change debates within community nursing.