Nurses’ engagement with power, voice and politics amidst restructuring efforts

Abstract

Change is inevitable, and increasingly rapid and continuous in healthcare as organizations strive to adapt, improve and innovate. Organizational change challenges healthcare providers because it restructures how and when patient care delivery is provided, changing ways in which nurses must carry out their work. The aim of this doctoral study was to explore frontline nurses’ experiences of living with rapid and continuous organizational change. A critical hermeneutic approach was utilized. Participants described feeling voiceless, powerless and apolitical amidst rapid and continuous organizational changes which fuelled apathy, cynicism and disengagement from the organization. However, critical analysis of the data showed that nurses actively engaged with power, voice and politics through resistant and transgressive behaviours in micro‐ethical moments of practice. There is a need to reconceptualize the concepts of voice, power and politics in nursing as there is dissonance between nurses’ beliefs about these concepts and what they are enacting in practice. Recognizing their enactment of power, voice and political agency at the micro‐level may empower nurses. Empowerment would mitigate the high levels of reports of powerlessness experienced in practice during organizational changes.

‘The office of disaster management’ nurse managers' experiences during COVID‐19: A qualitative interview study using thematic analysis

“…Nurse managers in our study had to coordinate and plan a response to COVID‐19, while navigating a volatile political climate. While nurses often have to navigate politics in their work (McMillan & Perron, 2020 ), nurses are generally unprepared to manage during disaster conditions (Labrague et al, 2018 ). For nurse managers, chronic stress is known to impact decision making during challenging situations (Shirey et al, 2013 ), which has implications for an organizational response to a pandemic.…”

Change fatigue in nurses: A qualitative study

“…The intensification of nursing work has been shown to have a negative impact on quality of patient care delivery, resulting in patient safety events (Willis et al, 2018), often resulting in missed care for patients (Willis et al, 2015). Based on additional findings from this doctoral research reported elsewhere (McMillan & Perron, 2020), the authors suggest that the negative impacts on patients (such as missed care) also contribute to nurses' experiences of moral distress in the context of rapid and continuous change implementation, which has troubling implications for the nursing profession.…”

La dénonciation infirmière en contexte de pandémie de COVID-19: une analyse de contenu de la plate-forme « Je dénonce »

“…Bien que certains problèmes dénoncés soient clairement liés au contexte pandémique (ex : disponibilité des équipements de protection individuelle, suivi des directives des autorités de santé publique), il convient de souligner que bon nombre d'entre eux faisaient déjà l'objet d'analyses et de critiques depuis plusieurs années, tant au Québec qu'ailleurs. C'est le cas par exemple de processus organisationnels réifi ant et invalidant le soin et ceux qui le prodiguent, de pratiques de gestion abusives, de l'aggravation des conditions du travail soignant, et de processus visant à museler le personnel infi rmier[voir par exemple [25][26][27][28][29][30]. À la lumière des témoignages analysés, il semble que le contexte de pandémie ait non seulement perpétué, mais même amplifi é ces problèmes.…”