Nursing power : an ethnography

Abstract

Nurses are portrayed in the literature as working according to the institutional conditions that are determined by the medical and managerial professions. Thus, the aim of this study was to explore the institutional possibilities that existed for local nurses to exercise their own power in a Maltese medical ward setting. A practitioner's ethnography that collected data by participant observation and ethnographic interviewing was adopted for this inquiry. Nine staff nurses and two nursing officers working in a medical ward participated in this study. Interviews with the three departmental nursing managers and the two directors of nursing overseeing this ward were also carried out. Furthermore, Six medical firms consented for the observation of ward rounds, and interviews with one consultant and four house officers were also done. Two themes emerged from this study; 'Nursing roles and structure', and 'Nursing relationships in the context of institutional change'. The role of clinical floor nurses' was determined by their own perceptions of nursing and the expectations of others within the hospital. These nurses considered their relationship with patients as leverage in resisting management and medical firms from imposing changes on their practice. The multidisciplinary approach to care was dysfunctional, due to inter-professional conflicts among managers, doctors and clinical floor nurses in this ward. Clinical nursing staff felt that managerial instrumental rationality and decreased subsidiarity discouraged clinical staff from cooperating with nursing management. This study thus suggests that a managerial culture that does not work towards the devolution of managerial authority and responsibility disempowers nurses in the ward. Policies, multidisciplinary meetings and educational initiatives, are recommended to help mitigate issues of conflict among professional groups.