Time for change in community nursing? A critique of the implementation of the Review of Nursing in the Community across NHS Scotland

AIM: Current literature underpinning change is examined and a critique offered of the implementation of the role of the generic Community Health Nurse in Scotland, from a leadership and cultural perspective. BACKGROUND: In November 2006, Government strategy outlined a new service model for community nursing to be implemented in four demonstration sites across Scotland. Almost two-thirds of community nurses were not supportive of the model. There was belief this generic role would not meet the health needs of patients and carers. EVALUATION: Evidence supporting the model is presented and the implementation process evaluated from leadership and cultural perspectives. The literature is examined to offer explanations as to why implementation was unsuccessful. CONCLUSIONS: Transformational and transactional leadership at all levels of the organization are required to make change happen. Evidence supporting change provides an impetus for change. The culture of an organization should be recognized and harnessed during the change process. Effective facilitation will empower staff to make change happen. IMPLICATIONS FOR NURSING MANAGEMENT: Engagement with staff is vital, at the beginning of the change process. The concept of 'nearby' leadership offers an enabling style of leadership at an individual and group level which will enable effective change.