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

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journal contribution
posted on 2023-05-21, 02:17 authored by Newans, J, Nazlee SiddiquiNazlee Siddiqui
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.


Publication title

American Journal of Nursing Research










College Office - College of Business and Economics


Science and Education Publishing Co. Ltd.

Place of publication

United States

Rights statement

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

Repository Status

  • Open

Socio-economic Objectives

Provision of health and support services not elsewhere classified; Expanding knowledge in human society