Rationing nurses: Realities, practicalities, and nursing leadership theories

Abstract

In this paper, we examine the practicalities of nurse managers' work. We expose how managers' commitments to transformational leadership are undermined by the rationing practices and informatics of hospital reform underpinned by the ideas of new public management. Using institutional ethnography, we gathered data in a Canadian hospital. We began by interviewing and observing frontline leaders, nurse managers, and expanded our inquiry to include interviews with other nurses, staffing clerks, and administrators whose work intersected with that of nurse managers. We learned how nurse managers' responsibility for staffing is accomplished within tightening budgets and a burgeoning suite of technologies that direct decisions about whether or not there are enough nurses. Our inquiry explicates how technologies organize nurse managers to put aside their professional knowledge. We describe professionally committed nurse leaders attempting to activate transformational leadership and show how their intentions are subsumed within information systems. Seen in light of our analysis, transformational leadership is an idealized concept within which managers' responsibilities are shaped to conform to institutional purposes.

Psychometric properties of Authentic Leadership Self‐Assessment Questionnaire in a population‐based sample of Polish nurses

“…For instance, the statement I admit my mistakes to others (item_16), which was originally a part of the relational transparency, was qualified into the moral processing subscale. The above‐mentioned observations support the thesis about the need to develop a model of authentic leadership dedicated to nursing, which would consider rationing nursing care (Fast & Rankin, ) and patient safety (Agnew et al., ; Dirik & Seren Intepeler, ; Perry, ; Stewart & Usher, ). Such a model can be important for in improving the curricula of pre‐ and postgraduate courses.…”

Nurses’ views on workload, care rationing and work environments

“…For nurse managers, the challenge is to align service targets with looking after the safety of the nurse and the patient. Fast and Rankin (2018) showed that ‘nurse managers’ consciousness is being bifurcated—what they know from experience, from being there, is overruled by authoritative institutional information’ (p. 8). Supporting this view, Hegney et al.…”

Being conductor of the orchestra: an exploration of district nursing leadership

“…Although several participants claimed to draw upon a transformational leadership approach their descriptions of leadership failed readily to match up with key theoretical constructs of transformational theory. Moreover, it is also argued that the day-to-day demands of community nursing and the systems within which these operate, effectively subsume even the best leadership intentions of those working in the field, precluding the successful operation of a model such as that of transformational leadership (Fast & Rankin, 2018). For such reasons Hutchinson and Jackson (2013) argue that, in contrast to the critical examination of leadership found elsewhere, within nursing there has been too much reliance on theories that do not readily reflect nursing in practice: what is needed is a different understanding of nursing leadership that is 'cognisant of the complexities and challenges of the healthcare environment'.…”

“…This relational approach has positive impacts on positive outcomes for patients and staff (Asif et al 2019;Boamah, et al 2018). However, the challenges encountered in District Nursing Leadership settings where the day-to-day demands of service provision are not readily compatible with principles of transformational leadership make such leadership very difficult to achieve (Fast & Rankin, 2018). It is for such reasons that previous writers have argued for a model of nursing leadership that takes greater account of the challenges that nurses do face in everyday provision of care (Hutchinson & Jackson, 2013).…”