title: Health care managers' perspectives on new nursing and midwifery roles: perceived impact on patient care and cost effectiveness.
abstract: OBJECTIVE
  The aim of this study was to explore new nursing and midwifery roles and associated levels of practice from the health care providers' perspective. This paper will present findings relating to the perceived cost effectiveness of these roles and their impact on patient care.
  
  
  BACKGROUND
  Profound changes in the way the health care systems are organized, managed and financed have resulted in the proliferation of new nursing and midwifery roles. However, the evidence base for these workforce developments is limited, especially with regard to health care providers' perspectives on cost effectiveness and patient outcomes.
  
  
  METHODS
  Qualitative interviews were carried out with all Directors of Nursing in the 18 Health and Social Services (HSS) Trusts and the Chief Nurses and Directors of Primary Care in the four HSS Boards in Northern Ireland.
  
  
  RESULTS
  Key findings were as follows: there was widespread support for the development of these roles, they are perceived to have a positive impact on patient care; however, the need for support was recognized to ensure the continuation of such roles. Securing funding was problematic and this was influential on the kind of new roles that were developed.
  
  
  CONCLUSIONS
  Issues relating to effective implementation and the need for further research into the efficacy and effectives of such initiatives is required.
authors: University of Ulster, Cromore Road, Coleraine, Co. Londonderry BT52 1SA, UK. hp.mckenna@ulster.ac.uk
authors: Hugh
authors: H
authors: McKenna
authors: Sinead
authors: S
authors: Keeney
authors: Felicity
authors: F
authors: Hasson
mesh_terms: D001291:Attitude of Health Personnel; D003362:Cost-Benefit Analysis; D055317:Evidence-Based Practice; D018166:Health Care Reform / Q000458:organization & administration; D006301:Health Services Needs and Demand; D006801:Humans; D009660:Northern Ireland; D009718:Nurse Administrators / Q000523:psychology*; D009720:Nurse Clinicians / Q000193:education / Q000458:organization & administration*; D009721:Nurse Midwives / Q000193:education / Q000458:organization & administration*; D024802:Nurse's Role; D015403:Nursing Evaluation Research; D015404:Nursing Methodology Research; D011320:Primary Health Care / Q000458:organization & administration; D036301:Qualitative Research; D011787:Quality of Health Care / Q000458:organization & administration*; D012944:Social Support; D013222:State Medicine / Q000458:organization & administration; D017749:Total Quality Management / Q000458:organization & administration