Sub-ordinate theme: University contextual influences

All the eight participants had worked within the NHS for several years, some for thirty years in community settings and acute secondary care services or both. Janet was the only participant who had recent experience in working for a local authority, which had its own systems of work. All participants were well established in the NHS culture. Transition to a different, unfamiliar organisation, which had different systems and processes and its own culture, was identified as a threat and evoked stress for most participants.

Lorna was quite anxious regarding working in a different organisation that did not resemble the NHS with which she has been familiar, identifying the negative aspects:

No idea really. …quite difficult, quite challenging really to get to know the processes and the different structures and systems. (Lorna)

Brenda’s account demonstrated the distress she felt – a sense of loss at leaving the NHS, using words such as ‘fears’ and ‘all I’ve known’. Her perceptions of the need for information and support emphasised how she felt as she struggled to manage and comprehend the new information. She used the idiom ‘get your head around’ to illustrate how complicated she felt the system and processes were. Brenda also showed that she felt neglected and unsupported through these challenges as the following quote illustrated:

…biggest fears… leaving the NHS… all I’ve known… Processes and systems [in HEI] … difficult to get your head around…. not informed… expected to learn it yourself. It’s very complex information. (Brenda)

Tracey’s account captured participants’ challenges in relation to the pace of change at the university, in comparison to the NHS. Tracey expressed her frustrations relating to her previous role in a critical care unit, in which decisions had to be made

immediately. She uses the words ‘quite a big culture shock’, indicating the magnitude of the change for her:

The pace of change particularly [coming from] critical care… was quite a big culture shock. NHS better at change management… here it takes like a year! … it’s like four months… get it signed off. (Tracey)

All participants highlighted the need for information and support that would enable them to understand their role and the new systems and processes. Brenda felt pressured – that it was expected she should know – which made her unsure of how to approach this, causing her to doubt her ability to do the job:

…It’s almost like you’re expected to just absorb how to do things, [but] you don’t know what you don’t know. (Brenda)

Hannah expressed how she had felt awkward repeatedly approaching the same member of staff for information and taking their time up. Hannah perceived that the experienced colleague was overwhelmed with her own duties and supporting her, and was anxious and concerned that she was wasting her colleague’s valuable time. However, Hannah also identified that when she had sought information from other members of staff, the information provided had often been inconsistent and incorrect:

I try not to ask the same people all the time so they just feel mithered. But I certainly have got sent down the wrong direction a couple of times by asking the wrong people. (Hannah)

For Lorna, her perception was that she did not feel confident in her new role, using the word “need”. It was indicated that she had to have clear structures, procedures and plans of work, and missed such structures that she had been used to

previously:

You, kind of need… an A to Z guide… of what needs doing when you start… you first may feel like… that these are the things that you should be

reading… ground rules when you’re teaching. (Lorna)

Tracey expressed similar feelings as Lorna: a need for information in developing her role and confidence. She was concerned that the information should be at a level that she could understand, indicating that she had not always understood new information and how it related to her role. However, when she referred to a ‘secret manual’ the perception was that she had not been involved in understanding the tacit knowledge of experienced staff:

When I first started, I felt like there should have been like a handbook… like all those idiot questions… you feel… have to ask… felt… secret manual people were hiding from me. (Tracey)

In summary: in this sub-ordinate theme of university contextual influences, participants identified that they were well established in the NHS culture, having worked in it for several years and more. Some participants expressed their loss and fears on leaving the NHS. As previously identified, participants referred to

experiencing a culture shock in adapting to new systems and new challenges, and that this had evoked stress. Some participants acknowledged that they had felt neglected and unsupported, and that there was an expectation that they had to learn these new systems for themselves. Participants found the pace of change in the university was slower than that of the NHS, which they found frustrating. Participants also identified the need for a handbook supplying additional information to support new lecturers who struggled to understand procedures and roles within the

university.