NURSES PARTICIPATION IN AUDIT - A REGIONAL STUDY

Objectives-To find out to what extent nurses were perceived to be part icipating in audit, to identify factors thought to impede their involv ement, and to assess progress towards multidisciplinary audit. Researc h design-qualitative. Methods-Focus groups and interviews. Participant s-Chairs of audit groups and audit support staff in hospital, communit y and primary health care and audit leads in health authorities in the North West Region. Results-In total 99 audit leads/support staff in t he region participated representing 89% of the primary health care aud it groups, 80% of acute hospitals, 73% of community health services, a nd 59% of purchasers. Many audit groups remain medically dominated des pite recent changes to their structure and organisation. The quality o f interprofessional relations, the leadership style of the audit chair , and nurses' level of seniority, audit knowledge, and experience infl uenced whether groups reflected a multidisciplinary, rather than a doc tor centred approach. Nurses were perceived to be enthusiastic support ers of audit, although their active participation in the process was c onsidered substantially less than for doctors in acute and community h ealth services. Practice nurses were increasingly being seen as the lo cal audit enthusiasts in primary health care. Reported obstacles to nu rses' participation in audit included hierarchical nurse and doctor re lationships, lack of commitment from senior doctors and managers, poor organisational links between departments of quality and audit, work l oad pressures and lack of protected time, availability of practical su pport, and lack of knowledge and skills. Progress towards multidiscipl inary audit was highly variable. The unidisciplinary approach to audit was still common, particularly in acute services. Multidisciplinary a udit was more successfully established in areas already predisposed to wards teamworking or where nurses had high involvement in decision mak ing. Audit support staff were viewed as having a key role in helping t eams to adopt a collaborative approach to audit.Conclusion-Although nu rses were undertaking audit, and some were leading developments in the ir settings, a range of structural and organisational, interprofession al and intraprofessional factors was still impeding progress. If the u ltimate goal of audit is to improve patient care, the obstacles that m ake it difficult for nurses to contribute actively to the process must be acknowledged and considered.