Nurses’involvement in the development of a municipal acute ward

Concurrently building individual capacity and developing the service


Background: The Norwegian government has implemented a Coordination Reform with devolution of healthcare services from specialist health services to municipal health services. Further, the municipalities should provide a 24-hour acute ward (MAW), as an alternative to hospitalization. Consequently, the municipality’s health services have increased patient flow and are responsible for patients with more acute and critical conditions than before.

Goal: In this article, we explore nurses’ involvement in the implementation of a MAW in a rural municipality, and by this, we contribute to a broader understanding of nursing work and their role in service development.

Methods: The study applies an ethnographic approach to the data collection by combining observations and interviews with nurses in the emergency health service. The fieldwork was conducted while the acute ward was being implemented. In our analysis, we draw on a sociological perspective on healthcare work that considers nursingas practiced between the boundaries of clinical patient work, organizational structures, managerial, and professional requirements.

Conclusions: With the new service, the nurses were given a variety of responsibilities in caring for patients. Patients with acute illness, aggravation of chronic diseases, and other critical conditions should no longer be directly transferred to the hospital but should be observed, treated, and stabilized by the nurses at the emergency health service, with GPs on call. The nurses operated the emergency health service, provided care for the patients that needed observation, and at the same time, developed capacity and routines to handle the new service and their added responsibilities. In developing the new service, the nurses drew on their knowledge about work arrangements and routines at the emergency health service, knowledge about high-quality nursing for emergency care patients, including local infrastructure. This new need-based capacity was of importance for how the nurses involved themselves in the development process. In fact, and generally speaking, the nurses’ organizing work is invaluable in developing new services, yet little emphasized


Helle Krone-Hjertstrøm