The balancing act of organizing professionals and managers: An ethnographic account of nursing role development and unfolding nurse-manager relationships

Scholars describe organizing professionalism as ‘the intertwinement of professional and organizational logics in one professional role’. Organizing professionalism bridges the gap between the often-described conflicting relationship between professionals and managers. However, the ways in which professionals shape this organizing role in daily practice, and how it impacts on their relationship with managers has gained little attention. This ethnographic study reveals how nurses shape and differentiate themselves in organizing roles. We show that developing a new nurse organizing role is a balancing act as it involves resolving various tensions concerning professional authority, task prioritization, alignment of both intra- and interprofessional interests, and internal versus external requirements. Managers play an important yet ambiguous role in this development process as they both cooperate with nurses in aligning organizational and nursing professional aims, and sometimes hamper the development of an independent organizing nursing role due to conflicting organizational concerns

Walking the tightrope

Purpose – The purpose of this paper is to empirically explore and conceptualize how healthcare professionals and managers give shape to the increasing call for compassionate care as an alternative for system-based quality management systems. The research demonstrates how quality rebels craft deviant practices of good care and how they account for them. Design/methodology/approach – Ethnographic research was conducted in three Dutch hospitals, studying clinical groups that were identified as deviant: a nursing ward for infectious diseases, a mother–child department and a dialysis department. The research includes over 120 h of observation, 41 semi-structured interviews and 2 focus groups. Findings – The research shows that rebels’ quality practices are an emerging set of collaborative activities to improving healthcare and meeting (individual) patient needs. They conduct “contexting work” to achieve their quality aims by expanding their normative work to outside domains. As rebels deviate from hospital policies, they are sometimes forced to act “under the radar” causing the risk of groupthink and may undermine the aim of public accounting. Practical implications – The research shows that in order to come to more compassionate forms of care, organizations should allow for more heterogeneity accompanied with ongoing dialogue(s) on what good care yields as this may differ between specific fields or locations. Originality/value – This is the first study introducing quality rebels as a concept to understanding social deviance in the everyday practices of doing compassionate and good care

Optimal length of antiviral therapy in patients with hepatitis C virus genotypes 2 and 3: a meta-analysis.

Contains fulltext : 81551.pdf (publisher's version ) (Closed access)BACKGROUND: Current guidelines recommend a duration of 24 weeks of treatment with pegylated interferon and ribavirin for patients infected with chronic hepatitis C virus (HCV) genotypes 2 and 3. Several trials investigated whether shorter treatment duration is equally effective in achieving sustained virological response (SVR). Our aim was to determine the optimal length of treatment in patients with HCV genotypes 2 and 3. METHODS: Systematic literature identified eight randomized controlled trials (RCTs). Meta-analyses were carried out on SVR data from three studies randomized at baseline and five studies randomized at rapid virological response (RVR) to either 12-16 weeks or a 24-week course. RESULTS: Pooled SVR data were higher in standard treatment in RCTs that randomized at baseline, with a relative risk (RR) of 0.88 (95% confidence interval [CI] 0.76-1.01). The pooled proportion of SVR rates of RCTs that randomized at RVR were similar in the short treatment group (82%) as in the standard treatment (83%), with the pooled effect given by a RR of 1.00 (95% CI 0.92-1.09). CONCLUSIONS: A shorter course (12-16 weeks) of combination therapy does not impair efficacy compared with a 24-week course in HCV genotypes 2 and 3 patients who achieve an RVR. HCV patients without RVR should consider 24 weeks of treatment

Rebels with a cause : How positive deviance works for quality of care

__Research Aim:__ How do healthcare rebels do ‘quality work’, design alternative forms of care delivery and account for their practices? __Methods:__ Selection of rebel-groups based on interviews. Ethnographic observational study of three rebel-groups in three Dutch hospitals with different institutional backgrounds (academic, large ‘top clinical’ teaching and general). __Conclusion:__ Rebels build their own micro systems of providing and organizing care. They have a strong focus on quality of care and quality of life, and adjust their care accordingly. Rebels walk the tight rope by coloring outside the lines while safeguarding legitimacy and organizational trust

Role of Dutch internal policy advisors in a hospital quality improvement programme and their influence on nurses' role development

Objective Nurses are vital in providing and improving quality of care. To enhance the quality improvement (QI) competencies of nurses, hospitals in the Netherlands run developmental programmes generally led by internal policy advisors (IPAs). In this study, we identify the roles IPAs play during these programmes to enhance the development of nurses' QI competencies and studied how these roles influenced nurses and management. Design An exploratory ethnographical study comprising observations, informal conversations, semistructured interviews, focus groups and a strategy evaluation meeting. Setting A teaching hospital in an urban region in the Netherlands. Participants IPAs (n=7) in collaboration with four teams of nurses (n=131), team managers (n=4), senior managers (n=4) and the hospital director (n=1). Results We identified five distinct advisory roles that IPAs perform in the hospital programme: gatekeeper, connector, converter, reflector and implementer. In describing these roles, we provide insights into how IPAs help nurses to develop QI competencies. The IPA's professional background was a driving force for nurses' QI role development. However, QI development was threatened if IPAs lost sight of different stakeholders' interests and consequently lost their credibility. QI role development among nurses was also threatened if the IPA took on all responsibility instead of delegating it timely to managers and nurses. Conclusions We have shown how IPAs' professional background and advisory knowledge connect organisational, managerial and professional aims and interests to enhance professionalisation of nurses.</p