This thesis examines the government's tripartite approach to workforce policy and planning in British nursing from 1939 until 1960. Emerging histories have placed emphasis on the ministries and their effect upon the development of nursing. However, there remains no examination of their distinctive and interrelated roles in managing nursing workforce policy and planning, This thesis examines the contribution of three of these ministries from initial workforce involvement in the early 1940s, through to the 1950s and the advent of the Committee on Senior Nursing Staff Structure (the Salmon Report). It concludes that three distinct roles emerged from each of the ministries. The Ministry of Labour and National Service (MLNS) dealt with nurse recruitment, the Ministry of Health addressed retention through conditions of service, while the Colonial Office represented replenishment. Such division of ministerial roles and any limited collaboration, however, did not appear to be a part of any conscious workforce policy. The thesis argues that although the Ministry of Health and the MLNS viewed nursing as less prestigious than a traditional profession, strategies appealing to nurses' aspirations were used to promote a sense of professional value in an occupation of many countervailing tensions. Nursing appeared to occupy its own unique space between professions and industrial labour. i The post-war management of the nursing workforce emerges as a highly reactive policy, focusing upon diverse groups for recruitment. It covered the use of part-time nurses to fit into the social expectations of post-war women, the recruitment of male nurses and a manipulation of colonial legislation to the clear benefit of British nursing. Nurse shortages are explored against government unease in the immediate post-war period with the effects of increasing colonial immigration of black workers, which was uncontrolled due to their status as British subjects. The ultimate inadequacy of workforce policies in nursing to deal with the recruitment of black nurses remains a current and controversial workforce issue.

Since the late 1990s there has been an increasing focus on parenting ability, support and education which is reflected in policy, practice and research in the UK. This research analyses how nurses might intervene to provide this support, specifically in relation to crying baby and the role of nurses at NHS direct. It involves collection and analysis of data from NHS Direct call data in 2002, and solo focus group data in 2006. Within the wider tradition of grounded theory, the methodology includes use of discourse and thematic analytical approaches. The research analyses the means by which NHS Direct nurses make different use of the algorithms and organisational protocols to make decisions and give advice to parents with crying babies, how their clinical knowledge and experience influences these decisions, and how nurses explore parents’ ability to cope. This is seen within the organisational context of NHS Direct, a 24 hour government funded telephone service described as both a triage service and an advice/helpline service. Findings from the study indicate a degree of tension between the essentially humanistic nursing culture and the highly scripted, protocol driven rules based system that underpins NHS Direct. Despite this tension, nurses will sometimes combine their knowledge with that of the algorithm where the call is involved with eliminating emergencies. The same synthesis of knowledge is not apparent with the knowledge contained in the algorithm regarding non-medical, nonemergency, value-sensitive issues relating to parental coping with excessive infant crying. Findings suggest that NHS Direct nurses use the ‘crying baby’ algorithm differently and this variance is influenced by experience and familiarity with the algorithm. Adherence to the algorithm is perceived by nurses as safe in relation to the medical questions which exclude emergencies. The non-medical elements of the algorithm, which include prompting the nurse to ask about parent coping ability and the possibility of shaking their child, are treated differently and it is considered safe to not ask, or ask around the question and to not offer the advice prompted by the decision aid software. The algorithm prompt to assess parental coping ability is rarely successful in encouraging the nurse to do so overtly. From these findings, consideration might be given to enhancing nurses’ knowledge, skills and confidence, supported with appropriate supervision, to provide effective intervention in relation to value sensitive, non-medical issues such as parental coping ability and in handling the uncertainty such issues may yield. Allied to this would be establishing clarity and recognition of the inherently different, but not opposing functions of providing a triage service and an advice/ helpline service.