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Barriers contributing to policy deviation: a mixed methods study of policymakers and frontline nurses


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Newans, j and Siddiqui, N ORCID: 0000-0002-1841-3095 2021 , 'Barriers contributing to policy deviation: a mixed methods study of policymakers and frontline nurses' , American Journal of Nursing Research, vol. 9, no. 5 , pp. 164-170 , doi: 10.12691/ajnr-9-5-2.

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Deviation from the policy at the point of care is frequently studied as a balancing act of health professionals, resulting in a lesser focus on barriers leading to such deviation. This study investigated practices of policy application or deviation with two aims. One, to assess if the frontline nursing staff is applying or deviating from the policy. Two, to understand the barriers that lead to policy deviation from the perspectives of policymakers and frontline staff. An explanatory sequential mixed methods design was applied, with a quantitative survey first (n = 50) and then two qualitative focus group discussions. Data was collected in 2018 within a Local Health District (LHD) in New South Wales, Australia. Most respondents (96%) rated policy application to be the usual practice at work. Despite that, survey respondents (54%) agreed to have discretionally acted against policy requirements. Frontline nurses deviated from policy when they perceived a lack of functional merit. Examples of barriers that contributed to deviation from policy are unstructured policy review, inadequate support for policy writing and communication challenges during policy implementation. These barriers were jeopardizing appropriate policy development and implementation and often negatively influenced the functional merit of policy. A few known strategies, such as appointing policy champions and promoting policy messages through a combination of channels, should be considered to mitigate the identified barriers. Future studies can explore effective ways to manage policy deviation rather than relying on street-level bureaucracy.

Item Type: Article
Authors/Creators:Newans, j and Siddiqui, N
Keywords: policy deviation, policymakers, frontline nursing staff, practice policy at point of care, barriers
Journal or Publication Title: American Journal of Nursing Research
Publisher: Science and Education Publishing Co. Ltd.
ISSN: 2378-5594
DOI / ID Number: 10.12691/ajnr-9-5-2
Copyright Information:

Copyright 2021 the authors. Licensed under Creative Commons Attribution 4.0 International (CC BY 4.0)

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