Expertise in action: Insights into the dynamic nature of expertise in community-based nursing

Aims and objectives: To gain insight into community nurses' experiences and how they make sense of the expertise they offer in their role.

Background: Globally, the spotlight is currently on community nursing expertise because of the movement of hospital-based to community-based care. Caring for people at home is no longer solely concerned with prevention, but delivering complex care to patients who are acutely unwell or at the end of their life. Little is known about the distinct expertise of community nurses, or their contribution to patient outcomes. There is a need to examine expertise in this group in order to inform current and future care provision within community settings.

Design: A hermeneutic, phenomenological study.

Method: Semistructured interviews were conducted with eight community nurses in Scotland, UK, who hold an additional postregistration, professional qualification. Participants also kept audio-journals. Data were analysed using interpretive phenomenological analysis.

Findings: Participants described their expertise in three themes: negotiating a "way in" to care, managing complexity and "thinking on your feet." They did not refer to themselves as specialist practitioners, nor did they perceive that they were viewed as specialist by colleagues or management. They appeared to dismiss their range of expertise which included forming trusting relationships, anticipating care needs and problem-solving, enabling them to undertake complex care management.

Conclusions: Expertise of community nurses in this study is dynamic, contextualised and action-oriented enabling them to be creative problem-solvers. It reflects engagement with patients and families and all aspects of the setting where care is provided, rather than being solely an identifiable set of specialist skills.

Relevance to clinical practice: It is vital to recognise community-based expertise internationally, especially if current WHO aims for community-based health care are to be achieved. Highlighting this expertise contributes to current discourse and may be considered in education and practice reviews.