Perceptions and Experiences of Practice Nurses and Health Care Assistants Following the Introduction of the Hca Role Into General Practice: a Longitudinal Study Using Constructivist Grounded Theory

With increasing demands being placed upon services in General Practice, Practice Nurses‟ (PNs) roles have expanded to alleviate pressure upon GPs time and Health Care Assistants (HCAs) have been introduced to assist in care provision in Scotland. This development was also encouraged in the Review of Nursing in General Practice (SE 2004). A small initial research project following introductory training for the HCAs (Burns 2006; Burns and Blair 2007) raised further questions about the HCA role and its development: What are the on-going perceptions and experiences of HCAs and supervising PNs? How has the HCA role developed overtime? What factors aid and hinder HCA role development?
A longitudinal constructivist grounded theory study was undertaken in Scotland with the aim of exploring the on-going perceptions and experiences of HCAs and PNs within General Practice following the introduction of the HCA role (Charmaz 2006). Data collection and constant comparative analysis took place within two contrasting regions in Scotland over a 2 year period for each participant with annual personal in-depth interviews of HCAs (n=14) and supervising PNs (n=13) and a 3 monthly postal follow up of all participants. The total period of data collection and analysis was 3 years 2008-2010, each year relating to Phases 1, 2 and 3 respectively in the findings.
On-going data analysis and comparative review of the literature facilitated the emergence and identification of 3 major categories relating to Phases 1 to 3 of data collection and analysis; getting going and proving worth, building confidence and respect and shifting and shaping roles. Within the 3 major categories were 7 categories and 28 codes in total. Team relationships were very important to the HCAs and their role has grown and developed over time. Responding to the GP Contract is of central importance to the HCA role. The PN status and influence within the practices appears pivotal to the HCA role development as the PNs provided support and mentorship. This emergent theory of HCA role growth and identity was identified: „The HCA role in General Practice is incremental and is predicated on a search for belonging and occupational identity. It is developed and influenced according to the organisational dynamics and support for learning from within the specific small business environments of individual General Practices.’ The HCA role in General Practice in Scotland has proved unique and separate from other HCA roles in hospital and community. Further research investigating the HCA/Health Care Support Worker (HCSW) role in health care would be advantageous.