title: 'Doing the writing' and 'working in parallel': how 'distal nursing' affects delegation and supervision in the emerging role of the newly qualified nurse.
abstract: BACKGROUND
  The role of the acute hospital nurse has moved away from the direct delivery of patient care and more towards the management of the delivery of bedside care by healthcare assistants. How newly qualified nurses delegate to and supervise healthcare assistants is important as failures can lead to care being missed, duplicated and/or incorrectly performed.
  
  
  OBJECTIVE
  The data described here form part of a wider study which explored how newly qualified nurses recontextualise knowledge into practice, and develop and apply effective delegation and supervision skills. This article analyses team working between newly qualified nurses and healthcare assistants, and nurses' balancing of administrative tasks with bedside care.
  
  
  METHODS
  Ethnographic case studies were undertaken in three hospital sites in England, using a mixed methods approach involving: participant observations; interviews with 33 newly qualified nurses, 10 healthcare assistants and 12 ward managers. Data were analysed using thematic analysis, aided by the qualitative software NVivo.
  
  
  RESULTS
  Multiple demands upon the newly qualified nurses' time, particularly the pressures to maintain records, can influence how effectively they delegate to, and supervise, healthcare assistants. While some nurses and healthcare assistants work successfully together, others work 'in parallel' rather than as an efficient team.
  
  
  CONCLUSIONS
  While some ward cultures and individual working styles promote effective team working, others lead to less efficient collaboration between newly qualified nurses and healthcare assistants. In particular the need for qualified nurses to maintain records can create a gap between them, and between nurses and patients. Newly qualified nurses require more assistance in managing their own time and developing successful working relationships with healthcare assistants.
authors.affiliation: University of Salford, UK. Electronic address: m.johnson2@salford.ac.uk.
authors.forename: Martin
authors.initials: M
authors.lastname: Johnson
authors.affiliation: University of Surrey, UK.
authors.forename: Carin
authors.initials: C
authors.lastname: Magnusson
authors.affiliation: University of Middlesex, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Allan
authors.affiliation: University of London, UK.
authors.forename: Karen
authors.initials: K
authors.lastname: Evans
authors.affiliation: University of Salford, UK.
authors.forename: Elaine
authors.initials: E
authors.lastname: Ball
authors.affiliation: University of Surrey, UK.
authors.forename: Khim
authors.initials: K
authors.lastname: Horton
authors.affiliation: University of Surrey, UK.
authors.forename: Kathy
authors.initials: K
authors.lastname: Curtis
authors.affiliation: University of Surrey, UK.
authors.forename: Sue
authors.initials: S
authors.lastname: Westwood
mesh_terms: D000488:Allied Health Personnel; D000884:Anthropology, Cultural; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D004282:Documentation; D004508:Education, Nursing, Baccalaureate; D004739:England; D006801:Humans; D007400:Interprofessional Relations; D009745:Nursing, Supervisory / Q000592:standards*
keywords: Aark project; Delegation; Health care support workers; Multi-disciplinary working; Newly qualified nurses; Record keeping; Supervision