Dispensing emotions: Norwegian community nurses' handling of diversity in a changing organizational context

Abstract

Since the mid-1990s, public sector health care services in Norway have been restructured, in line with New Public Management ideas. This restructuring has coincided with demographic changes that have led to a more culturally diverse patient population. Both developments have created new challenges for community nurses in managing their work. This qualitative study applies the concept of "emotional labor" to examine nurses' experiences in working with ethnic minority patients in the context of pressures arising from organizational reforms. The analysis sheds light on the nurses' attempts to comply with system-induced efficiency considerations, while catering to the special situation of patients with language barriers and unfamiliar cultural traditions. The article demonstrates how efficiency requirements and time constraints either aggravate the nurses' insecurity in dealing with minority patients or, in some cases, compel them to assume more work responsibilities so as to mitigate the effects of such constraints.

Health‐care professionals’ experiences of patient participation among older patients in intermediate care—At the intersection between profession, market and bureaucracy

“…29 If the emotional work is not perceived to be sufficiently recognized in the service, and the execution of technical tasks is prioritized, this might be an important reason for the challenges the IC-staff experience. 24 Based on our finding, health-care professionals should be involved in the continuous work of quality improvement. In addition to the establishment of a collaboration model between IC and the districts, a patient experience measurement (PREM) specifically designed for IC services could also be developed and implemented to evaluate the service and patient participation.…”

“…Hasenfeld argues that it is the institution that defines acceptable emotions . If the emotional work is not perceived to be sufficiently recognized in the service, and the execution of technical tasks is prioritized, this might be an important reason for the challenges the IC‐staff experience . Based on our finding, health‐care professionals should be involved in the continuous work of quality improvement.…”

“…They are nevertheless held responsible for meeting the patient's needs and for documenting their work progressively. Thus, in situations with limited professional discretion, bureaucratic standardization might be prioritized over individualized rehabilitation …”

“…Thus, in situations with limited professional discretion, bureaucratic standardization might be prioritized over individualized rehabilitation. 24 According to Lipsky, standardization of health-care services can be seen as a strategy in order to survive balancing work between regulatory constraints, limited resources and patients' needs. 30 In addition, as a patient in the standardized pathway, you have to fit the system based on predominantly physical criteria, often at the expense of mental and social aspects.…”

“…Successful patient participation within IC services is associated with satisfaction with health-care services, [33][34][35] a lower number of readmissions, 16,36,37 better treatment outcome 24,25,38 and has the potential to prevent the need for nursing home placement. 39 Further, patient participation is shaped by organizational structures, 40 the patients' condition, 41 resources, 11 staff attitudes 42,43 and support from relatives.…”