Between a rock and a hard place: managing professional practice alongside organisational directives in child and family health nursing

Child and family health nurses (CaFHNs) hold strong views around their belief in social justice and their capacity to deliver preventative health care within a primary health care agenda. While this belief is sound professionally, it was difficult for CaFHNs to enact this care within current organisational frameworks for practice. This paper describes and discusses the challenge of enacting care in child and family health nursing, drawing from findings from an ethnographic study into intercultural communication in child and family health nursing.

The study was undertaken in three stages. Data included participant observation, video recording of intercultural child health consultations and reflective viewing of consultations with participant CaFHNs.

The nurses’ sense of discomfort operated at two levels. The first structural level related to professional goals of child and family health practice that seemed to conflict with changes made to the structure and delivery of child and family health services.

Secondly, on an individual level, participants experienced organisational changes as leading to a reduced capacity to care. This was manifest in increased level of writing and assessment tasks that limited their scope to engage with parents in meaningful ways, such as building relationships and following through with clinical management.