Background
Recent decades have seen increased attention to patient safety in health care. This is often in the form of programmes aiming to change professional behaviours. Health professionals in hospitals have traditionally resented such initiatives because patient safety programmes often take a managerialist form that may be interpreted as a challenge to professional identity. Research, however, has mostly paid attention to the role of physicians. This study aims to highlight how such programmes may affect professional nursing identity.
Methods
We qualitatively investigated the implementation of a patient safety programme in Norway, paying attention to changes in nurses’ practices and values. Based on purposive sampling, two group interviews, four individual interviews and five hours of observational studies were conducted in a hospital department, involving ten nurses and three informants from the hospital management. Interviews were conducted in offices at the hospital, and observations were performed in situ. All the interviews lasted from one to one and a half hours, and were recorded and transcribed ad verbatim. Data was analysed according to ad-hoc meaning generation.
Results
The following analytical categories were developed: reconstructing trust, reconstructing work, reconstructing values and reconstructing professional status. The patient safety programme involved a shift in patient safety-related decisions, from being based on professional judgement to being more system based. Some of the patient safety work that previously had been invisible and tacit became more visible. The patient safety programme involved activities that were more in accordance with the ‘cure’ discourse than traditional ‘care’ work within nursing. As a result, this implied a heightened perceived professional status among the nurses. The safety programme was – contrary to the ‘normal’ resistance against audit systems – well received because of the raised perceived professional status among the nurses.
Conclusions
Reconstructing trust, work, values and status, and even the profession itself, is being reconstructed through the work involved in implementing the procedures from the safety programme. Professional knowledge and identity are being challenged and changed, and what counts as good, professional nursing of high quality is being reconstructed.
Electronic supplementary material
The online version of this article (10.1186/s12913-019-4222-y) contains supplementary material, which is available to authorized users.
Safety management regulation is an important supplement to market forces to establish a sufficient safety level in high-risk industries. The accident statistics in Norwegian maritime passenger transportation display a paradox: personal injuries have decreased while ship accidents have increased in the period during which safety management has been regulated (the International Safety Management Code was effectuated in the late 1990s). We interview regulators, shipping company management, and crewmembers about their practices and opinions regarding safety management regulation and use these data to explore how this regulation influences safety management practices to prevent different types of accidents. This study underlines earlier research showing that regulation serves to 'raise the bar' by heightening the industry levels of safety investments and organizational safety awareness. In addition, our results suggest that safety management regulation in maritime transportation is mostly effective for preventing personal injuries in cases in which the personal have sufficient time and resources available, and the procedures are consistent with seafarers' professional values. For ship accidents, such as groundings, other causal factors come into play. We find that the negative consequences of regulation (proceduralization) in particular influence the performance of safety-critical tasks, such as navigation. This may explain why personal injuries have decreased while ship accident frequencies have continued to increase in spite of the regulations aimed at improving safety.
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