Nurse middle managers contributions to patient-centred care: A 'managerial work' analysis.
Nurse middle managers are in an ideal position to facilitate patient-centred care. However, their contribution is underexposed in literature due to difficulties to articulate this in practice. This paper explores how nurse middle managers contribute to patient-centred care in hospitals. A combination of time-use analysis and ethnographic work was used to disclose their contribution to patient-centred care at a micro level. Sixteen nurse managers were shadowed for over 560 hours in four hospitals. Some nurse middle managers seldom contribute to patient-centred care. Others are involved in direct patient care, but this does not result in patient-centred practices. At one hospital, the nurse middle managers did contribute to patient-centred care. Here balancing between "organizing work" and "caring work" is seen as a precondition for their patient-centeredness. Other important themes are feedback mechanisms; place matters; with whom to talk and how to frame the issues at stake; and behavioral style. Both "hands-on" and "heads-on" caring work of nurse middle managers enhances their patient-centeredness. This study is the first of its kind to obtain insight in the often difficult to articulate "doings" of nurse middle managers with regard to patient-centred care through combining time-use analysis with ethnographic work.
HU University of Applied Sciences Utrecht, Utrecht, The Netherlands.
Pcb
0000-0003-4520-8756
P
Lalleman
Sioo; Interuniversity Center for Organization Studies and Change Managment, Utrecht, The Netherlands.|Open University of the Netherlands, Heerlen, The Netherlands.
Gac
G
Smid
HU University of Applied Sciences Utrecht, Utrecht, The Netherlands.
J
J
Dikken
Western Michigan University, Kalamazoo, Michigan, United States.
M D
MD
Lagerwey
HU University of Applied Sciences Utrecht, Utrecht, The Netherlands.|Utrecht University, Utrecht, The Netherlands.
M J
MJ
Schuurmans
D000884:Anthropology, Cultural; D006801:Humans; D007857:Leadership; D009718:Nurse Administrators / Q000523:psychology*; D009741:Nursing Staff, Hospital / Q000523:psychology; D018802:Patient-Centered Care
ethnography; leadership; management; patient-centred care; work organization