title: Street-level bureaucracy and policy implementation in community public health nursing: a qualitative study of the experiences of student and novice health visitors.
abstract: Aim To explore the experiences of student and novice health visitors in implementing health visiting policy reform pre- and post-qualification.
  
  
  
  In England, public health nursing has been subject to major policy reform. The Health Visitor Implementation Plan (2011) set out a plan to recruit increasing numbers of nurses and midwives to the profession to deliver an expanded and refocussed health visiting service. Exploring this policy change from the viewpoint of those new to health visiting offers a unique perspective into how a specific policy vision is translated into nursing practice.
  
  
  
  A descriptive qualitative study in which participants were enrolled on a one-year post-graduate health visiting course at a University in South West of England. Qualitative data were collected pre- and post-qualification. A total of 16 interviews and a focus group were conducted with nine participants between September 2012 and March 2013. Findings Descriptive data were interpreted using Lipsky's theoretical framework of street-level bureaucracy. Three themes emerged which relate to this 'bottom-up' perspective on policy implementation; readiness to operationalise policy, challenges in delivering the service vision; and using discretion in delivering the vision. Community public health nurses operate as street-level bureaucrats in negotiating the demands of policy and practice, and by this means, attempt to reconcile professional values with institutional constraints. Barriers to policy implementation at a local level mediate the effects of policy reform, ultimately impacting upon outcomes for children and families.
authors.affiliation: 1Senior Lecturer,Department of Nursing and Midwifery,University of the West of England,Bristol,UK.
authors.forename: Alison
authors.initials: A
authors.lastname: Hughes
authors.affiliation: 2Associate Professor,College of Human and Health Sciences,Swansea University,Swansea,UK.
authors.forename: Louise
authors.initials: L
authors.lastname: Condon
mesh_terms: D003152:Community Health Nursing / Q000331:legislation & jurisprudence* / Q000458:organization & administration*; D004739:England; D006291:Health Policy / Q000331:legislation & jurisprudence*; D006801:Humans; D011057:Politics; D011637:Public Health Nursing / Q000331:legislation & jurisprudence* / Q000458:organization & administration*; D036301:Qualitative Research; D013222:State Medicine / Q000331:legislation & jurisprudence* / Q000458:organization & administration*
keywords: Lipsky’s theoretical framework; community public health nursing; health visitor implementation plan; health visitors; qualitative research; street-level bureaucracy