My own experiences of disjuncture sparked questions related to how practical nursing education is situated within the larger nursing disciplinary landscape. On acute care nursing units, work relationships are changing between RNs and LPNs as new collaborative care models are introduced, creating ambiguity and confusion with increasingly overlapping scopes of practice. Gaps remain in knowing how RNs and LPNs experience changes in these intra-professional team contexts, and how patient care, nursing work, and nursing education may be influenced by these new collaborative models. This has been the foundation for the journey towards graduate study and this dissertation work. In this dissertation I address the overarching research question: How are registered and practical nurses’ experiences of learning to work together being organized by educational and work contexts? This question consists of two sub-questions: 1) What are the experiences of pre-licensure health professional students and educators learning to work in intra-professional teams? and, 2) How are institutional texts organizing post-licensure nurses’ experiences of learning to practice on intra-professional teams? The first sub-question is addressed using the Joanna Briggs Institute (JBI) qualitative systematic review methodology to reveal what is currently known about how pre-licensure health professional students learn to work on intra-professional teams. The second question is approached using an institutional ethnographic analytic lens to explore how post-licensure nurses’ (RNs and LPNs) work is socially organized via educational, union, health authority, and regulatory texts and how this social organization impacts intra-professional relationships. Taking a plural approach to knowledge construction allows for a multi-perspectival view of RNs and LPNs experiences and the role of educational and work contexts in shaping how they learn to work together. Incorporating methodologies as diverse as a JBI systematic review and institutional ethnography raises methodological tensions. Each has its own philosophical assumptions, reflecting particular strengths and limitations in the production of knowledge. The challenges of employing a plural approach are explored alongside new knowledge and possibilities for exploring and understanding how best to care for patients and educate students within complex, collaborative environments. / Graduate / 2018-08-29

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By the year 2025, the nursing workforce shortage will exceed 500,000 registered nurses (RN). Hospitals will primarily experience this loss. The retention of RNs is a critical issue for hospitals, and studies about RNs leaving jobs in hospital nursing are essential to addressing the workforce shortage. Limited data exists about why RNs leave hospital nursing, other than job dissatisfaction. There is limited current data on whether horizontal violence, bullying, and intraprofessional conflict between RNs influence such decisions. This qualitative phenomenological study explored RNs’ experiences of horizontal violence, bullying, and intraprofessional conflict in hospital nursing. Findings suggest behaviors such as alienation, intimidation, sabotage, lack of intellectual respect, and failed professionalism contribute to horizontal violence and intraprofessional conflict among RNs in the hospital workplace. These findings may help develop strategies to educate healthcare teams and hospital administrative staff, and lobby for universal anti-horizontal violence and anti-bullying policies in hospitals. The findings highlight the need for conflict management training for RNs and healthcare workers, to facilitate intraprofessional communication and collaboration, and the need for further research.

While holistic care is fundamental to occupational therapy (OT) practice, organizational and systemic factors often push for compartmentalized and specialist practice. Because services in many practice areas are compartmentalized, occupational therapy practitioners’ (OTPs) continuing professional development (CPD) efforts typically focus on one clinical specialty, and many often do not learn skills across different clinical areas. It is imperative that OTPs continue to learn and integrate knowledge across specialty areas so as to provide comprehensive and holistic care to all individuals who seek OT services. In addition to this, there is a known knowledge-to-practice gap that limits the implementation of research into practice. Numerous research studies (Summers et al. 2015; Stewart et al. 2020; Jones et al. 2015; Thomas et al. 2020) support the need for active engagement in CPD, implementing the most recent research into practice, and maintaining a holistic and integrated approach to healthcare. However, many clinicians experience barriers to the implementation of that knowledge, such as time, cost, staffing, and organizational influence. Healthcare organizations, on the other hand, must function in a competitive healthcare industry, by optimizing client outcomes while maintaining qualified and engaged staff. Occupational Therapists Fostering Unified Expertise and Learning (OT F.U.E.L.) was designed with these barriers in mind, and addresses them by creating a cost-effective, timely, and engaging platform for knowledge exchange across the profession of occupational therapy. OT F.U.E.L. is designed as an online community of practice, focusing on intra-professional social learning and knowledge implementation for OTPs working in the various siloed specialties of OT, including pediatrics, orthopedics/hand therapy, inpatient/outpatient rehabilitation, and mental health. The objective is to reconnect with the common roots and approaches of occupational therapy, and enhance practice skills and expertise — integrating clinical knowledge and skills from various clinical specialties across the profession. Overall group size will be limited to 16 participants, with subspecialty groups of approximately four members to ensure diversity of experience. The groups will be moderated by a “knowledge broker” who can facilitate interconnections between the specialty areas. There will be three phases to the piloting of this program. In the initial pilot (Phase 1), participants will be OTPs who are also fieldwork educators (FWEs), recruited using established affiliations with an entry-level Master of Occupational Therapy program. For the pilot, FWEs will be recruited through their employer in order to get organizational buy-in for their engagement in the program, as well as encouragement from management to participate. A secondary objective for this approach is to demonstrate the value of organizational support of professional development during established work hours. Phase 2 of piloting will involve running the program through other Universities in a variety of regions within the United States. Phase 3 will be potential dissemination through the American Occupational Therapy Association (AOTA). Ultimately, OT F.U.E.L is expected to result in several intermediate and long-term outcomes, including OTPs increased the confidence and competence with integrating skills and concepts across specialty areas in their practice. By reducing the barriers and facilitating the implementation of new knowledge, the clients will benefit, and likely demonstrate improved outcomes.

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