Difficulties and solutions related to the experience of developing a new project by Japanese municipal public health nurses according to their seniority

OBJECTIVES: Public health nurses (PHNs) have to regularly develop new projects that actively solve community health problems. The purpose of this study was to clarify the difficulties encountered by PHNs while developing a new project and their solutions for them. We also aimed to examine the effect of experience of Japanese PHNs in developing new projects, according to their seniority. METHODS: Using random sampling, we chose 374 of 1871 municipalities that could not be consolidated with neighbouring municipalities in 2005, and 305 municipalities responded to questionnaires. The self-administered questionnaires were mailed to 2306 Japanese PHNs working within the municipalities. The questionnaire included items on the following: (1) PHN-related variables; (2) whether the PHN had experience in project development; (3) open-ended description of the difficulties and solutions related to the development of new projects by the PHN; (4) the reasons why the PHN could not create new services. We used content analysis to categorize the descriptions based on commonalities. We divided PHNs into 4 groups according to their seniority: Novice, Lower middle-level, Upper middle-level, and Expert. We performed the chi2 test (Fisher's exact test) to examine the relationship between experience and parameters such as "the difficulties" and "the solutions" in each group. RESULTS: Among the 1270 respondents, 340 PHNs were in the Novice group, 347 in the Lower middle-level group, 329 in the Upper middle-level group, and 254 in the Expert group. The chi2 test (Fisher's exact test) revealed that there was a significant difference between difficulties and having experience in all 4 groups: 'Facing a busy schedule.' In these 4 groups, the following 7 solutions were statistically related with experience: 'Deepening the understanding of the PHNs' work of supervisors and colleagues,' 'Explaining the need for creating a new system with evidence,' 'Sharing information for creating a new service on a daily basis, 'Organizing the evidence to demonstrate the need for developing a new project,' 'Making a practical project plan,' 'Cooperating with persons concerned and facilitating consensus-building among them,' 'Coping with the cost of a new program. CONCLUSION: In order to overcome difficulties encountered by PNHs while developing new projects, our findings suggest that the work done by PHNs' should be better understood by supervisors and colleagues. Further, evidence should be used to explain the need for creating a new system, and a consensus should be built at carefully. Moreover, the budget of the new program should be carefully managed.