'Nursing Hours' or 'nursing' hours - a discourse analysis

Abstract

This thesis is about the business of nursing; the making and remaking of nurses’ work in the context of private healthcare. Nurses in Australia, as in other countries around the world, have experienced considerable workplace changes over the past 15 years due to governments and public and private healthcare organisations seeking to reform healthcare service delivery. These reforms have significantly changed not only how private hospitals manage care, but the nursing role in practice. This ethnographic study explores the impact of these reforms on nurses’ work in one Australian acute care private hospital. It critically examines nurses’ organising practices in light of the workload measurement method used to staff the hospital, unit and ward with minimum staffing. Using Foucault’s (1972) archaeological approach and drawing upon governmentality theory as the analytical framework, I will argue that within the political rationality of neo-liberalism, ‘care’ in nursing is a technology of governance. As such, nurses’ ‘care’ transforms contemporary healthcare policy, in particular policy pertaining to private healthcare, from a macro to the micro level of everyday practice. Care is the means of producing a ‘business savvy’ nurse; someone who is not only an expert clinician with transferable skills but who knows the private health market and is able to work within a competitive business environment. Analysis reveals the contradictions and tensions that exist for nurses between the clinical and economic foci, and the economics and business of health as the nursing role is played out within the organisational imperatives of their work. This study illustrates the shifting boundaries of nurses’ work in relation to the ascendancy of business concerns in healthcare delivery. While methods of workload measurement may well represent what counts as the nursing hours in healthcare organisations, the nurses in this study spoke at length of the strategies they used to make the nursing hours ‘work’. Findings indicate that nurses employ specific discursive strategies when talking about ‘nursing hours’. When addressing their workloads, their discourses centred on the business of care delivery, of nurse-to-patient ‘allocations’ and ‘handover’, or the many instances of ‘handing over’ their work. The study challenges nurses’ professional discourses about what nursing is, what nurses actually do and the sophistication with which this is accomplished at work. Conceiving of nurses’ work in terms of ‘nursing’ hours rather than patients in the business of health service delivery provides a different way of thinking about nursing workforce issues at a time when healthcare organisations and systems worldwide grapple with the question of how many nurses and what kind of nurses they need.