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Schalkwijk H, Felder M, Lalleman P, Parry MS, Schoonhoven L, Wallenburg I. Five pathways into one profession: Fifty years of debate on differentiated nursing practice. Nurs Inq 2024:e12631. [PMID: 38470567 DOI: 10.1111/nin.12631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 03/14/2024]
Abstract
The persistence of multiple educational pathways into the nursing profession continues to occupy scholars internationally. In the Netherlands, various groups within the Dutch healthcare sector have tried to differentiate nursing practice on the basis of educational backgrounds for over 50 years. Proponents argue that such reforms are needed to retain bachelor-trained nurses, improve quality of care and strengthen nurses' position in the sector. Opponents have actively resisted reforms because they would mainly benefit bachelor-trained nurses and neglect practical experience and technical skills. This historical case study aims to provide insight in this apparent stalemate. Our analysis of this debate is informed by literature on institutional work and current debates within the historiography of nursing. This study contributes to a better understanding of this contemporary debate by examining a broader timeframe than is usually studied, and by highlighting nurses' roles in complex processes of change. We argue that, rather than being stuck in their professional development, different groups of nurses have forged their own path forward in their professional development, albeit via different strategies.
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Affiliation(s)
- Hugo Schalkwijk
- Research Group of Person-Centredness in an Ageing Society, Fontys University of Applied Sciences, Eindhoven, The Netherlands
- Department of History, University of Amsterdam, Amsterdam, The Netherlands
| | - Martijn Felder
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
| | - Pieterbas Lalleman
- Research Group of Person-Centredness in an Ageing Society, Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Manon S Parry
- Department of History, University of Amsterdam, Amsterdam, The Netherlands
- Department of Art & Culture, History and Antiquity, VU, Amsterdam, The Netherlands
| | - Lisette Schoonhoven
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Iris Wallenburg
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
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Harrison M, Smith AKJ, Adams S. Matters of time in health and illness. HEALTH SOCIOLOGY REVIEW : THE JOURNAL OF THE HEALTH SECTION OF THE AUSTRALIAN SOCIOLOGICAL ASSOCIATION 2024; 33:1-9. [PMID: 38506657 DOI: 10.1080/14461242.2024.2319943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Affiliation(s)
- Mia Harrison
- Centre for Social Research in Health, University of New South Wales, Kensington, Australia
| | - Anthony K J Smith
- Centre for Social Research in Health, University of New South Wales, Kensington, Australia
| | - Sophie Adams
- Alfred Deakin Institute of Citizenship and Globalisation, Deakin University, Burwood, Australia
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van Pijkeren N, Schuurmans J, Wallenburg I, Bal R. 'The night is for sleeping': how nurses care for conflicting temporal orders in older person care. HEALTH SOCIOLOGY REVIEW : THE JOURNAL OF THE HEALTH SECTION OF THE AUSTRALIAN SOCIOLOGICAL ASSOCIATION 2024; 33:10-23. [PMID: 38557328 DOI: 10.1080/14461242.2024.2316737] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 02/06/2024] [Indexed: 04/04/2024]
Abstract
This paper examines the conflicting temporal orders of the regional nurse, a role which has been introduced to deal with the increasing demands of aged care and workforce shortages in regional settings. We build on ethnographic research in the Netherlands, in which we examine regional district nurses as a new professional role that attends to (sub)acute care needs, connecting and coordinating different places of care during out of office hours. We use the concept of 'temporal regional order' to reflect on the different ways caring practices are temporally structured by management and care practitioners, in close interaction with patients and informal care givers. In the results three types of disruptions of the regional temporal order are distinguished: interfering bodily rhythms and needs; (un)expected workings of technologies; and disrupting acts of patient and relatives. It was region nurses' prime responsibility to stabilise these interferences and prevent or soften a disruption of the regional order. In accomplishing this, we show how nurses craft their professional role in between various care settings, without getting involved too much in patient care, to be mobile as 'temporal caregivers'.
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Affiliation(s)
- Nienke van Pijkeren
- Erasmus School of Health, Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Jitse Schuurmans
- Erasmus School of Health, Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Iris Wallenburg
- Erasmus School of Health, Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Roland Bal
- Erasmus School of Health, Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
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Kuijper S, Felder M, Clegg S, Bal R, Wallenburg I. "We don't experiment with our patients!" An ethnographic account of the epistemic politics of (re)designing nursing work. Soc Sci Med 2024; 340:116482. [PMID: 38064819 DOI: 10.1016/j.socscimed.2023.116482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 11/17/2023] [Accepted: 11/27/2023] [Indexed: 01/23/2024]
Abstract
This article draws on ethnographic research investigating experimental reform projects in local nursing practices. These are aimed at strengthening nursing work and fostering nurses' position within healthcare through bottom-up nurse-driven innovations. Based on literature on epistemic politics and critical nursing studies, the study examines and conceptualizes how these nurses promote professional and organizational change. The research draws on data from two pilot projects to show how epistemic politics frame the production and use of knowledge within reform efforts. The study finds that knowledge produced through such experimenting is often not considered valid within the contexts of broader organizational transitions. The nurse-driven innovations fail to meet established legitimate criteria for informing change, both among stakeholders in the nurses' socio-political environment, as well as within the nursing community. The research reveals that the processes inadvertently reinforce normative knowledge hierarchies, perpetuating forms of epistemic injustice, limiting both nurses' ability to function as change agents and healthcare organizations' capacity to learn.
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Affiliation(s)
- Syb Kuijper
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3062, PA, Rotterdam, the Netherlands.
| | - Martijn Felder
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3062, PA, Rotterdam, the Netherlands.
| | - Stewart Clegg
- School of Project Management, The University of Sydney, 21 Ross St, Forest Lodge, NSW, 2037, Australia.
| | - Roland Bal
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3062, PA, Rotterdam, the Netherlands.
| | - Iris Wallenburg
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3062, PA, Rotterdam, the Netherlands.
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Felder M, Schuurmans J, van Pijkeren N, Kuijper S, Bal R, Wallenburg I. Bedside Politics and Precarious Care: New Directions of Inquiry in Critical Nursing Studies. ANS Adv Nurs Sci 2023:00012272-990000000-00084. [PMID: 37983116 DOI: 10.1097/ans.0000000000000518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
Health care systems are facing soaring workforce shortages, challenging their ability to secure timely access to good-quality care. In this context, nurses make difficult decisions about which patients to deliver care to, transfer to other providers, or strategically ignore. Yet, we still know little about how nurses engage in situated practices of bedside rationing. Building on the work of Giorgio Agamben and Judith Butler, we have developed a research agenda that homes in on a politics of bedside rationing. We argue that this agenda is essential to better understand the implications of scarcity for nursing and to explore new ways to cope with challenges faced.
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Affiliation(s)
- Martijn Felder
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
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Wallenburg I, Friebel R, Winblad U, Maynou Pujolras L, Bal R. '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. HEALTH ECONOMICS, POLICY, AND LAW 2023; 18:411-425. [PMID: 37702051 DOI: 10.1017/s1744133123000178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
Nurse workforce shortages put healthcare systems under pressure, moving the nursing profession into the core of healthcare policymaking. In this paper, we shift the focus from workforce policy to workforce politics and highlight the political role of nurses in healthcare systems in England, Spain, Sweden, and the Netherlands. Using a comparative discursive institutionalist approach, we study how nurses are organised and represented in these four countries. We show how nurse politics plays out at the levels of representation, working conditions, career building, and by breaking with the public healthcare system. Although there are differences between the countries - with nurses in England and Spain under more pressure than in the Netherlands and Sweden - nurses are often not represented in policy discourses; not just because of institutional ignorance but also because of fragmentation of the profession itself. This institutional ignorance and lack of collective representation, we argue, requires attention to foster the role and position of nurses in contemporary healthcare systems.
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Affiliation(s)
- Iris Wallenburg
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Rocco Friebel
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Ulrika Winblad
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Laia Maynou Pujolras
- Department of Econometrics, Statistics and Applied Economics (Public Policies), Universitat de Barcelona, Barcelona, Spain
- London School of Economics and Political Science, London, UK
- Center for Research in Health and Economics, Universitat Pompeu Fabra, Barcelona, Spain
| | - Roland Bal
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
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Harrison M, Lancaster K, Rhodes T. The fluid hospital: On the making of care environments in COVID-19. Health Place 2023; 83:103107. [PMID: 37683402 DOI: 10.1016/j.healthplace.2023.103107] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023]
Abstract
This paper explores the boundary-making practices enacted by the hospital. Taking a hospital in Sydney, Australia, as our case, we investigate how the hospital holds together as a care environment through the coordinating movements of many materials, spaces, bodies, technologies, and affects. Drawing on interviews with hospital healthcare workers involved in care, research, and management related to COVID-19, we examine the multiplying effects of these movements to trace the ways in which the hospital is (re)made in relation with pandemic assemblages. We accentuate the material affordances of care environments and how care is adapted through the reshaping of the spaces and flows of the hospital. Through this, we highlight how care providers can work with the fluidity of the hospital, including through reorganizing routines and spaces of care, engaging with communication technologies to enact care at many scales, and remaking mundane materials as medical objects in the evolving care environment.
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Affiliation(s)
- Mia Harrison
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia.
| | - Kari Lancaster
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - Tim Rhodes
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia; London School of Hygiene & Tropical Medicine, London, UK
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Overton C, Emerson T, A Evans R, Armstrong N. Responsive and resilient healthcare? 'Moments of Resilience' in post-hospitalisation services for COVID-19. BMC Health Serv Res 2023; 23:720. [PMID: 37400780 DOI: 10.1186/s12913-023-09645-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 06/04/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND COVID-19 caused disruption to healthcare services globally, resulting in high numbers of hospital admissions and with those discharged often requiring ongoing support. Within the UK, post-discharge services typically developed organically and were shaped over time by local need, funding, and government guidance. Drawing on the Moments of Resilience framework, we explore the development of follow-up services for hospitalised patients by considering the links between resilience at different system levels over time. This study contributes to the resilient healthcare literature by providing empirical evidence of how diverse stakeholders developed and adapted services for patients following hospitalisation with COVID-19 and how action taken at one system level influenced another. METHODS Qualitative research comprising comparative case studies based on interviews. Across three purposively selected case studies (two in England, one in Wales) a total of 33 semi-structured interviews were conducted with clinical staff, managers and commissioners who had been involved in developing and/or implementing post-hospitalisation follow-up services. The interviews were audio-recorded and professionally transcribed. Analysis was conducted with the aid of NVivo 12. RESULTS Case studies demonstrated three distinct examples of how healthcare organisations developed and adapted their post-discharge care provision for patients, post-hospitalisation with COVID-19. Initially, the moral distress of witnessing the impact of COVID-19 on patients who were being discharged coupled with local demand gave clinical staff the impetus to take action. Clinical staff and managers worked closely to plan and deliver organisations' responses. Funding availability and other contextual factors influenced situated and immediate responses and structural adaptations to the post-hospitalisation services. As the pandemic evolved, NHS England and the Welsh government provided funding and guidance for systemic adaptations to post-COVID assessment clinics. Over time, adaptations made at the situated, structural, and systemic levels influenced the resilience and sustainability of services. CONCLUSIONS This paper addresses understudied, yet inherently important, aspects of resilience in healthcare by exploring when and where resilience occurs across the healthcare system and how action taken at one system level influenced another. Comparison across the case studies showed that organisations responded in similar and different ways and on varying timescales to a disruption and national level strategies.
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Affiliation(s)
- Charlotte Overton
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Tristan Emerson
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Rachael A Evans
- Leicester NIHR Biomedical Research Centre - Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Natalie Armstrong
- Department of Population Health Sciences, University of Leicester, Leicester, UK.
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