Advancing the status of nursing: reconstructing professional nursing identity through patient safety work

Abstract

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.

Serial Multiple Mediation of Professional Identity, and Psychological Capital in the Relationship Between Work-Related Stress and Work-Related Well-Being of ICU Nurses in China: A Cross-Sectional Questionnaire Survey

“…Professional identity is a form of social identity and includes deep insight into professional performance, which also includes the establishment of professional values and goals that are widely accepted by staff ( Chai, 2012 ). The professional identity of a nurse primarily entails the recognition of his/her goals and social values; factors in the nursing profession, including personal experience and dignity; and other factors in his/her self-image as a nurse ( Hao et al, 2014 ; Pardanjani et al, 2014 ; Heldal et al, 2019 ). Positive professional experience in the workplace is very important for accomplishing multiple tasks, becoming more productive, experiencing job satisfaction, and improving retention in the profession ( Lakanmaa et al, 2012 ; Mousazadeh et al, 2018 ).…”

Effects of Nursing Education Using Films on Perception of Nursing, Satisfaction With Major, and Professional Nursing Values

“…Nursing students who are not satisfied with their major may neglect their studies, hold a negative perception of nursing ( Admi et al, 2018 ; Feng et al, 2016 ), and fail to establish a proper professional nursing identity, which may negatively affect their development of professional competencies ( Mazhindu et al, 2016 ). Having a proper professional nursing identity enables nurses to examine and judge clinical situations comprehensively ( Heldal et al, 2019 ). Thus, nursing students must be provided with a nursing education that promotes the development of a proper professional nursing identity.…”

The construction of contemporary nursing identity from narrative accounts of practice and professional life

“…We can consider that professional identity is related to history, with the experiences lived within the practice, with the concept of oneself as a person and as a professional, with personal and family history, with self-esteem, with education, with beliefs and with respect for the legitimacy of the discipline [ 1 ]. Thus, we can argue that the concept of nursing as a profession has become increasingly important, including responsibility, specificity and precision of tasks, decision-making power and autonomy, the level of knowledge and the contribution to maintaining and promoting a healthy society [ 2 , 3 , 4 , 5 ].…”