‘We’re all Florence Nightingales’: Managers and nurses colluding in decoupling through contingent roles

Abstract

The present study develops our understanding of the micro-level dynamics of decoupling by addressing how and why various occupational groups, that is, managers and professionals, are involved in decoupling in response to institutional complexity. Our conceptualization of occupational groups' involvement in decoupling emerges from an in-depth qualitative study * This chapter is based on:

Professional Values and Managerialist Practices: Values work by nurses in the emergency department

“…In our empirical case, doctors and nurses – and not hospital management – designed the managerialist practices that comprised Enzyme, while Enzyme’s implementation in the emergency department increased organizational efficiency and improved patient outcomes. In contrast to prior research that suggests professionals will resist managerialist practices that undermine values (Dent, 2003; Hallett, 2010; Suddaby & Viale, 2011; Thomas & Davies, 2005; van Wieringen et al, 2017) or take on hybrid roles to protect them (Bévort & Suddaby, 2016; Blomgren & Waks, 2015; Farrell & Morris, 2003; Llewellyn, 2001; Spyridonidis & Currie, 2016), our model illuminates how values work within managerialist practices operates as a normal frontline alternative to professional resistance and hybridization. This theorizing builds on and extends Noordegraaf’s (2015, p. 202) view that contemporary organizing trends mean ‘acting professionally in an organized way becomes normal work .…”

“…Resistance may be active, such as when academics oppose performance-based management in public universities (Chatelain-Ponroy et al, 2018) or when medical professionals defend professional values from economic rationality (Dent, 2003). Other forms of resistance are covert, such as when nurses comply symbolically with a managerialist practice but decouple it from their everyday practice of caregiving (van Wieringen et al, 2017). Professionals can also resist by attempting to ‘wriggle out’ of elements of managerialist practices that seek to control their work in ways that undermine professional values and identity (Thomas & Davies, 2005, p. 700).…”

“…Thus, the Enzyme model, as enacted by emergency nurses, offers a compelling case study for investigating our research question. Prior research highlights the key role that nurses play in frontline patient care delivery (Bolton, 2004; Carvalho, 2014; Currie & Spyridonidis, 2015; van Wieringen et al, 2017) and their commitment to the profession’s values (Goodrick & Reay, 2010; Schmidt & McArthur, 2018). Core values that anchor the training and work practices of the nursing profession globally include altruism, autonomy, competence, human dignity, integrity, honesty and social justice (Fahrenwald et al, 2005; Martin, Yarbrough, & Alfred, 2004; Schmidt & McArthur, 2018).…”

“…Second, research often implies an either/or outcome (Currie, Burgess, & Tuck, 2016). Either an organization’s goals are attained at the expense of the values of a profession (Bolton, 2004; Chatelain-Ponroy et al, 2018; Kraatz et al, 2010) or professionals act autonomously and potentially undermine organizational goals (Doolin, 2002; Martin, Currie, Weaver, Finn, & McDonald, 2017; van Wieringen, Groenewegen, & Broese van Groenou, 2017).…”

‘Nurses are seen as general cargo, not the smart TVs you ship carefully’: the politics of nurse staffing in England, Spain, Sweden, and the Netherlands

“…Kuhlmann et al , 2015), and discussions on professionalisation that is targeted in literatures on professions and organisations (eg. van Wieringen et al , 2017; Ernst, 2020), to healthcare politics. We apply Laswell's (1936) classic political question ‘who gets what, when, and how’ to the nursing workforce, examining how and to what extent nurses play a role in healthcare systems in England, Spain, Sweden, and the Netherlands.…”