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Managing to Nurse

Managing to Nurse: Inside Canada's Health Care Reform

Copyright Date: 2006
Pages: 224
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  • Book Info
    Managing to Nurse
    Book Description:

    AlthoughManaging to Nursemay contradict contemporary beliefs about health care reform, the insiders' account that it provides is undeniable evidence that nurses' caring work is being undermined and patient care is being eroded, sometimes dangerously, by current health care agendas.

    eISBN: 978-1-4426-5713-7
    Subjects: Public Health, Health Sciences

Table of Contents

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  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
  3. List of Figures
    (pp. ix-2)
  4. Introduction
    (pp. 3-22)

    This book problematizes the apparent routineness of nurses’ work. As health care is being transformed in response to a variety of acute challenges, the question arises about how nurses are experiencing that transformation. More and more, a ‘typical’ shift of duty is fraught with changing demands and new complexities (Armstrong et al., 1994, 2000). Not that much attention is paid to what nurses do! The special skills and knowledge that nurses bring to health care are much more likely to be noted in their absence than celebrated in their accomplishment. One common complaint from hospital authorities is about what they...

  5. 1 The Managerial Turn in Nursing
    (pp. 23-44)

    Medicare,¹ Canada’s system of public health insurance, emerged slowly and indirectly out of citizens’ post–Second World War demand for a more equitable distribution of resources. Money has always been at the centre of discussions about health care provision. Until Medicare was instituted, many Canadians couldn’t afford health care. Government-subsidized hospital care was made available in 1957,² and by then some provinces were subsidizing private medical insurance for low-income people. In 1961, a fully subsidized system for insuring medical services was pioneered by the socially conscious government of Saskatchewan. It was taken up more or less completely in the policy...

  6. 2 ‘Three in a Bed’: Nurses and Technologies of Bed Utilization
    (pp. 45-64)

    In acute care hospitals there is an inevitable uncertainty about patient admissions, because illness and accidents are unplanned. Emergency admissions account for 50 to 70 per cent of all hospital admissions (CAEP 2001) and cannot be booked in advance. This uncertainty complicates the job of hospital administrators and their new public management strategies that ‘re-conceiv[e] and, to some extent reorganiz[e], many if not all organizational activities (support and administration as well as production or service) as work processes involving identifiable inputs, outputs and customers’ (McCoy 1999: 9). Managing waiting lists¹ and determining who should be admitted next remain big problems...

  7. 3 Doing the Right Thing at the Right Time: Adjusting the Mindset of Nurses
    (pp. 65-88)

    This vignette holds traces of several restructuring strategies that are entering nurses’ work. Two of them are analysed in this chapter to show that virtual realities generated within and integral to these strategies supplant nurses’ knowledge and eventually displace their judgement. Unlike the admissions, discharge, and transfer (ADT) system discussed in Chapter 2, the restructuring technologies we analyse here target clinical practice. The first is a clinical pathway. Mr Jones was at ‘day seven’ of his clinical pathway, the day scheduled for discharge. Second, the vignette hints at case-typing – a technology that kicks in when a patient such as Mr...

  8. 4 Managing Resistance to Restructuring: The Ruling Work of Nursing Leaders
    (pp. 89-111)

    In previous chapters we have shown managerial technologies working up aspects of hospital activities into cost-relevant information used for, among other things, coordinating nurses’ activities. These technologies do not directly control nurses’ actions but, rather, individual nurses activate managerial technologies ‘knowledgeably’ (thus, the attempts to influence nurses’ ‘mindset’). As nurses adopt the technologies and the concomitant mindset, a managerial perspective emerges as dominant. But the terrain in which this happens is contested. It is true that nurses often recognize the utility of the new technologies for solving problems that they encounter in pressured workplaces. Yet in some situations the organizational...

  9. 5 Patient Satisfaction and the Management of Quality
    (pp. 112-138)

    This chapter considers quality in health care, especially how quality as a management concept differs from quality as nurses might understand good, or good enough, care. Everyone wants the provision of health care to be adequate or better. In this chapter we analyse some current efforts to improve hospital services through managerial technologies. As in the previous chapter, we focus on how things to be managed are known, by whom, and for what purposes. Here we analyse quality management, seeing it as a strategy for quality improvement guided by textual practices of tracking, classification, and evaluation that constitute ‘quality of...

  10. 6 Language and the Reorganization of Nurses’ Consciousness
    (pp. 139-162)

    We have argued that health care reform takes place through text-mediated practices in which nurses are active participants. Various texts ‘instruct’ new nursing practices. Nurses engage in what we call text-reader conversations about what they might do for assigned patients (already constituted within the accounting logic of the new public management of health care reform.) In these text-reader conversations, the contemporary nursing workforce is learning new ways to practice nursing. As subjects in these text-mediated conversations, nurses act within their professionally approved and sanctioned capacities and become participants in a discourse that happens in sequences of social action (Smith 1999:...

  11. Conclusion
    (pp. 163-184)

    Across Canada nurses report for duty in health care institutions where, around the clock, their work coordinates and maintains the always contingent and unpredictable environment in which care takes place. Their knowledge and skills have long been relied upon to ensure that, not just nursing, but all the care of hospitalized patients unfolds safely, properly (and efficiently). Patients, families, physicians, and many allied health care workers trust nurses to know what is required, what to do, what must be done first, and what must be left out or done differently. In particular, nurses see to it that patients are prepared...

  12. Notes
    (pp. 185-198)
  13. References
    (pp. 199-210)
  14. Index
    (pp. 211-222)